Citation Nr: 21032623 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-30 482 DATE: May 27, 2021 ORDER Entitlement to service connection for pseudophakia and cataracts of the left eye is denied. FINDING OF FACT The preponderance of the evidence is against finding that pseudophakia and cataracts of the left eye began during active service, or are otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for pseudophakia and cataracts of the left eye are not met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army on active duty from April 1969 to October 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision. The Veteran's claim was previously remanded for additional development in August 2019 and September 2020. That development has since been completed and the matter returns for further adjudication. 1. Entitlement to service connection for pseudophakia and cataracts of the left eye is denied. The Veteran underwent cataract surgery of both eyes in March 2013, and he asserts his left eye vision has worsened in severity since that time. In particular, he contends that his left eye cataract disability was caused or aggravated by his service-connected diabetes mellitus. In the alternative, he contends that such disability is directly related to in-service exposure to herbicide agents. See April 2019 Board Hearing Transcript. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (2004). A veteran who served in Vietnam during the Vietnam Era is presumed to have been exposed to herbicides during that service. 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to an herbicide agent during active service, certain diseases are deemed service-connected. The Board notes that the Veteran did serve in Vietnam during the presumptive period of January 9, 1962 to May 1975 and is therefore presumed to have been exposed to an herbicide agent during his service. 38 U.S.C. § 1116; 38 C.F.R. § 3.307. That stated, pseudophakia and cataracts are not on the list of diseases enumerated under 38 C.F.R. § 3.309(e) for which presumptive service connection is warranted based on herbicide exposure. This does not, however, preclude the Veteran from establishing service connection for the claimed disorders on a direct basis, to include as due to exposure to herbicides. See Combee v. Brown, 34 F.3d 1039 (1994). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, to include exposure to herbicide agents. The Veteran's service treatment records show complaints of an "eye strain" in July 1969. This finding was noted upon the Veteran's C&P examination in March 2014 by the VA examiner, who reported that this finding is not related to any eye condition that the Veteran currently has. The examiner also reported that he saw no evidence of active eye disease, but did note that the Veteran has had cataract surgery in the left eye within the last several years. Following surgical removal, the Veteran's vision improved to at least 20/40. The examiner noted that cataracts are a common result of aging and, in the Veteran's case, are less likely than not (less than 50 percent probability) related to service. When the Veteran was examined again in January 2020, the examiner noted that the Veteran's condition was less likely than not (less than 50 percent probability) incurred in or caused by service, as the Veteran no longer had cataracts of the left eye and no longer had a visual deficit of the left eye. In taking a history of the Veteran's condition, the examiner noted that the Veteran had been diagnosed with pseudophakia in 2015, but that his cataracts had since been removed. He noted that the course since onset has been stable with no changes and good visual acuity, with no symptoms at this time. At the time of examination, the Veteran's uncorrected distance vision in his left eye was measured as 20/50, with his corrected distance vision being 20/20 or better. The Veteran's uncorrected near (reading) vision in his left eye was 15/200, with his corrected near vision being 20/20 or better. The examiner noted that the Veteran did not have a difference equal to two or more lines on the Snellen test type chart or its equivalent between distance and near corrected vision, with the near vision being worse. He noted that the Veteran's pupils were round and reactive to light and that an afferent pupillary deficit was not present. The examiner noted that the Veteran did not have anatomical loss, light perception only, extremely poor vision or blindness of either eye. The examiner noted that the Veteran did not have an asigmatism or diplopia. Tonometry revealed left eye pressure of 20. The slit lamp test was abnormal, with the external exam of the eyelids and eyelashes, conjunctiva/sclera, cornea, anterior chamber, and iris being normal, but the lens examination being abnormal in the Veteran's left eye due to well-centered PCIOL (posterior chamber intraocular lenses). The Veteran's internal eye (fundus, optic disc, macula, vessels, vitreous, and periphery) exam was normal. The Veteran did not have a documented visual field deficit. His lens condition was listed as postoperative (cataract has been removed). The examiner noted that the Veteran did not have any scarring or disfigurement attributable to an eye condition and had no incapacitating episodes in the past twelve months attributable to an eye condition. The examiner identified no other pertinent findings. The Veteran's records were reviewed in March 2021 by a VA contract examiner. The examiner commented on the evidence, noting that in March 2014, the Veteran's vision was at least 20/40 in both eyes at distance and near, with normal intraocular pressure, and visual field. She also noted that the Veteran had pseudophakia in the left eye in his anterior segment, but had a normal posterior segment. She also noted that the Veteran has had cataract surgery in the left eye within the last several years but has at least 20/40 vision following removal. The examiner noted that cataracts are a common result of aging and in this case are less likely than not related to service. The examiner again noted the July 1969 "eye strain" complaint in the Veteran's service treatment records. She noted that, at this point in time, an eye examination revealed mild myopia in the left eye for which glasses were prescribed, and that the Veteran's vision was 20/20 upon correction with eyeglasses. The examiner noted that the Veteran's January 2020 examination report showed corrected vision of 20/20 in the Veteran's left eye. The March 2021 examiner clarified that the Veteran had a prior history of cataracts OS (oculus sinister; left eye), which required cataract surgery and were corrected in the left eye, with a current diagnosis of pseudophakia. The examiner considered the Veteran's contention that his vision had deteriorated in spite of his 2013 cataract surgery, as well as his contention that his left eye conditions were related to in-service exposure to herbicide agents while serving in Vietnam, and determined that it was not at least as likely as not (50 percent or greater probability) that such disability had onset in, or is otherwise related to his period of active duty service. In contrast, the examiner, indicated that the Veteran's cataract and pseudophakia conditions were most likely related to normal aging progression as opposed to in-service exposure to herbicide agents. The examiner also considered whether the Veteran's conditions were caused or aggravated beyond the natural progression by his service-connected diabetes mellitus. The examiner determined that, per record review, the Veteran's cataract/pseudophakia was not at least as likely as not (50 percent or greater probability) caused or aggravated beyond the natural progression by diabetes mellitus, because the Veteran's eye conditions were consistent with the normal aging progression. As directed in the Board's prior remand instructions, the examiner addressed the Merck Manual's explanation of various cataract etiologies, which had specifically identified systemic disease (e.g., diabetes). She indicated that she had reviewed the Merck Manual's explanation of various cataract etiologies and determined that the Veteran's conditions were most likely due to the normal aging progression because the Veteran's specific subtype of cataracts was nuclear cataracts, and nuclear cataracts are most likely due to the normal aging progression. Taken together, the examiners' combined opinions are probative, because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). (Continued on Next Page) Based on the foregoing, the Board finds that the weight of the evidence is against the Veteran's claim. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Hennessy, 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.