Citation Nr: 21007277 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 17-05 860A DATE: February 9, 2021 ORDER Service connection for diabetic retinopathy as secondary to service-connected diabetes mellitus, type 2 is granted. REMANDED Service connection for anterior cortical cataract, right eye with NLP as secondary to service-connected type 2 diabetes mellitus is remanded. FINDING OF FACT The Veteran has a current diagnosis of diabetic retinopathy and he is service-connected for diabetic mellitus, type 2. CONCLUSION OF LAW The criteria for service connection for diabetic retinopathy as secondary to service-connected diabetes mellitus, type 2 have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1966 to February 1968. This matter comes before the Board of Veterans’ Appeals (Board) from an May 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the appeal in May 2020 for further development. This appeal has been advanced on the docket pursuant to 38 C.F.R. §20.900 (c). 1. Service connection for diabetic retinopathy as secondary to service-connected diabetes mellitus, type 2 is granted. Secondary service connection may be granted for a disability that is proximately due to or aggravated by a service-connected condition. 38 C.F.R. § 3.310. For the reasons that follow, service connection for diabetic retinopathy secondary to service-connected diabetes mellitus is warranted. The Veteran is service-connected for diabetes mellitus, type 2. Thus, the question for the Board is whether the Veteran has a currently diagnosed eye disability that is proximately due to or aggravated by his diabetes mellitus, type 2. VA treatment records show conflicting findings regarding whether the Veteran has diabetic retinopathy. However, treatment records dated as recent as March 2019 show a diagnosis of diabetic retinopathy in both eyes based on digital retinal imaging during a diabetic surveillance assessment. An October 2020 VA examination report reflects an examiner’s finding that the Veteran was noted to have diabetic retinopathy beginning in 2015. The examiner also noted that a diabetic surveillance assessment in August 2012 also revealed bilateral retinal images of mild, nonproliferative diabetic retinopathy. Although there is no specific opinion stating whether the Veteran’s diabetic retinopathy is caused or aggravated by his service-connected diabetic mellitus, the medical evidence reasonably suggests a causal connection between the two. As the evidence is in relative equipoise as to whether the Veteran’s current diabetic retinopathy is etiologically related to his service-connected diabetes mellitus, the Board resolves all reasonable doubt in favor of the Veteran. Service connection for diabetic retinopathy is warranted secondary to service-connected diabetes mellitus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 3.310. REASONS FOR REMAND 2. Service connection for anterior cortical cataract, right eye with NLP as secondary to service-connected type 2 diabetes mellitus is remanded. Unfortunately, further development is necessary prior to adjudication. In May 2020, the Board remanded this issue for an addendum opinion regarding the nature and etiology of the Veteran’s right eye condition. In compliance with the Board’s remand directives, a VA examination and opinion was obtained in October 2020. In addition to diabetic retinopathy, the October 2020 VA examiner diagnosed right eye cataract and optic nerve atrophy. In providing a negative secondary opinion, the examiner noted that the Veteran’s central artery occlusion is a vascular condition caused by carotid artery atherosclerosis, which is the reason for the Veteran’s NLP in the right eye. The October 2020 VA examiner also found that the Veteran’s cataract is less likely than not due to his hypertension as the literature does not support it. However, in finding that the Veteran’s NLP is due to his carotid artery atherosclerosis, the Board notes that the VA examiner did not address whether the Veteran’s right eye condition is, thus, secondary to his service-connected coronary artery disease. Moreover, the October 2020 VA examiner’s finding that medical literature does not support a relationship between the Veteran’s right eye condition and hypertension is in conflict with the February 2016 VA examination, which indicates that the Veteran’s right eye condition is due to his 30-year history of smoking, hypertension, and high cholesterol. Accordingly, on remand, an addendum opinion should be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran’s anterior cortical cataract, right eye with NLP. A copy of the Remand should be provided to and reviewed by the examiner. The examiner is also to review the claims file. The examiner must provide an opinion as to whether the anterior cortical cataract, right eye with NLP at least as likely as not is: EITHER proximately due to his service-connected disabilities, including diabetes, hypertension, and/or coronary artery disease; OR aggravated beyond its natural progression by these service-connected conditions. The examiner must provide a complete rationale for all proffered opinions. The examiner should review the February 2016 VA examination finding that the Veteran’s right eye condition is, in part, due to having hypertension and the October 2020 examiner’s comment that the central artery occlusion is a vascular condition caused by carotid artery atherosclerosis. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.Aoughsten, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.