Citation Nr: 22007635 Decision Date: 02/10/22 Archive Date: 02/10/22 DOCKET NO. 19-18 203 DATE: February 10, 2022 ORDER Service connection for post-surgical cataracts is granted. FINDING OF FACT The Veteran's post-surgical cataracts were caused or aggravated by service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for service connection for post-surgical cataracts are met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from May 1964 to August 1978, including foreign service. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal. He offered testimony during a July 2021 virtual hearing before the undersigned Veterans Law Judge. This appeal was then remanded by the Board in August 2021 for additional development which has since been completedspecifically, a VA examination which was obtained in September 2021. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Also in August 2021, the Board remanded an appeal seeking service connection for ischemic heart disease (IHD) for a clarifying VA opinion. Said opinion was obtained in September 2021, wherein the examiner offered a current diagnosis other than IHD. Upon this examination, service connection for hypertensive heart disease was awarded in an October 2021 rating decision. The Board finds that this constitutes a complete grant of the appeal seeking service connection for a heart disorder, and the Veteran has not subsequently argued otherwise. Accordingly, this matter is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). Briefly, the September 2021 rating decision also implemented multiple grants issued by the Board in August 2021, including service connection for diabetes, kidney, and psychiatric disabilities. The Veteran submitted a responsive VA Form 20-0996 as to the initial ratings assigned in December 2021, which activated an appeal stream under the modernized appeal system, known as the AMA. 38 C.F.R. § 19.2. This appeal stream remains active and is not before the Board, in any capacity, at this time. Service Connection The Veteran remains in pursuit of service connection for a vision blur on both direct and secondary bases. The Board will limit its analysis to that theory of entitlement upon which the appeal is granted herein. Thus, service connection may be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As to the first element, the record establishes that the Veteran underwent surgery for bilateral cataracts in 2020; at the time of September 2021 VA examination, he presented with bilateral intraocular lenses (i.e., artificial lenses). The Veteran has also offered competent and credible testimony regarding his history of blurred vision during the period on appeal, and during the July 2021 hearing, spoke of ongoing symptoms despite his surgical treatment. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Miller v. Wilkie, 32 Vet. App. 249 (2020). Thus, the first element of secondary service connection is met. The Veteran has offered multiple theories of entitlement in this case, including that his current disability is secondarily related to his service-connected diabetes mellitus (which was granted by the Board in August 2021 and implemented in a September 2021 rating decision). Thus, the second element of secondary service connection is also met. There is conflicting evidence as to the existence of a nexus in this case. Notably, December 2016 and September 2019 VA examiners denied any vision-related complications of the Veteran's diabetes. However, a September 2021 VA examiner concluded that the Veteran's cataracts were at least as likely as not aggravated beyond their natural progression by his service-connected disability. In doing so, the September 2021 examiner offered that the Veteran's vision blur was due to cataracts, which is an age-related condition and was resolved by the 2020 surgery. No specific rationale was offered with respect to the asserted secondary nexus. However, VA treatment records indicate that the Veteran was previously counseled on methods to prevent vision loss due to diabetic eye disease. See also, e.g., September 2020 VA treatment record (reporting post-operative status of cataracts with Veteran's history of diabetes). At this time, the Board finds that the preponderance of the evidence weighs in favor of finding a secondary nexus in this case. Although the December 2016 and September 2019 VA examiners denied any vision problems related to the Veteran's diabetes, their assessments were seemingly limited to only direct symptoms of the Veteran's condition without consideration as to any secondary impact on comorbid disorders. In contrast, the September 2021 opinion is far more definitive, utilizes the appropriate standard for aggravation in accordance with VA regulations, and is supported by a contemporaneous evaluation of both the Veteran and his medical records. Accompanying treatment records are also suggestive of a secondary link in this case. Importantly, there is no competent evidence of record which directly contradicts a finding that the Veteran's diabetes and post-surgical cataracts are secondarily related. Thus, the Board declines to remand for potentially negative evidence at this time. Rather, a secondary nexus is found between the Veteran's post-surgical cataracts and service-connected diabetes mellitus. Therefore, the evidence is at the least in approximate balance, and secondary service connection for post-surgical cataracts is hereby granted. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.