Citation Nr: 25005690 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 20-24 671 DATE: April 25, 2025 ORDER Entitlement to service connection for bilateral cataracts, to include as secondary to the Veteran's service-connected diabetes mellitus type 2 (diabetes), is granted. FINDING OF FACT The Veteran's bilateral cataracts have, at least as likely as not, been aggravated by his service-connected diabetes. CONCLUSION OF LAW The criteria for an award of service connection for bilateral cataracts have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1968 to March 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This claim was previously before the Board in October 2023 and November 2024. Entitlement to service connection for bilateral cataracts, to include as secondary to the Veteran's service-connected diabetes, is granted. The law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11?Vet. App.?509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc). The Veteran primarily asserts that his bilateral cataracts are secondary to his service-connected diabetes, while the record only raises the theory of service connection on a direct basis. See October 2018 Notice of Disagreement (NOD); November 2024 Attorney Brief. As service connection can be awarded based on aggravation, which is what the Veteran is requesting, the Board will focus its analysis accordingly. See April 2025 Attorney Brief. The Veteran presented for VA examinations in September 2017 and was diagnosed with bilateral cortical cataracts and bilateral nuclear sclerotic cataracts, while the May 2024 examination confirmed a diagnosis of bilateral cortical cataracts. Significantly, VA has conceded exposure to herbicide agents while on active duty and the Veteran is already service connected for diabetes as a result. Thus, elements one and two are met for both direct and secondary service connection. Therefore, the only remaining element is medical nexus. The Board has previously found the September 2017, May 2024, and October 2024 opinions to be inadequate and remanded the claims. Subsequent VA opinions were obtained in January 2025, including an opinion for aggravation. The examiner opined that the Veteran's cataracts are less likely than not aggravated beyond its natural progression by the Veteran's diabetes; the evidence does not show increased severity from the baseline; and there is no evidence that the cataract causes any impairment. In response to the Veteran's assertions that his cataracts are considered a complication of his diabetes, and that adults are 2-5 times more likely than those without diabetes to develop cataracts, the examiner notes that those statements are typical of a risk factor (diabetes), which is found more commonly with the disorder (cataracts), and that risk factors can be causative, but in the case of diabetes, all of the leading experts agree that the diabetes accelerates, but does not cause age-related cataracts. Although the examiner provided a negative opinion regarding aggravation (as well as for direct service connection and proximate causation and toxic exposure risk activities) the Board is able to extrapolate from the examiner's opinion that the diabetes, did, in fact, aggravate the Veteran's bilateral cataracts, in causing the process of creating cataracts to be accelerated. See Bufkin v. McDonough, 75 F.4th 1368 (Fed. Cir. 2023) citing Jackson v. Virginia, 443 U.S. 307, 319 (1979) (stating it is "the responsibility of the trier of fact fairly to . . . draw reasonable inferences from basic facts to ultimate facts"); Bastien v. Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010) ("The evaluation and weighing of evidence and the drawing of appropriate inferences from it are factual determinations committed to the discretion of the fact finder."). (Continued on the next page) ? In light of the above, and resolving reasonable doubt in the Veteran's favor, the Board finds that the criteria for an award of service connection for bilateral cataracts, as aggravated by his service-connected diabetes, have been met. Accordingly, the appeal is GRANTED. JIMMY L. BARDIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. J. Rogers, 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.