Citation Nr: 0812911 Decision Date: 04/18/08 Archive Date: 05/01/08 DOCKET NO. 06-17 088 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for myasthenia gravis. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD K. Ahlstrom, Associate Counsel INTRODUCTION The veteran served on active duty from March 1944 to February 1946. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The appeal is REMANDED to the RO via the Appeals Management Center (AMC) in Washington, DC. VA will notify the veteran if further action is required. REMAND The veteran contends that his myasthenia gravis is related to his active service, including as a result of his tropical service. In order to establish service connection for the claimed disorder on a direct basis, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The veteran contends that he started experiencing diplopia (double vision) in service and was issued eyeglasses. He veteran further asserts that he sought treatment for his symptoms from a VA medical center in Memphis, Tennessee, in 1946, within one year of his separation from service. The RO attempted to obtain these treatment records; however, these records were destroyed and are not available for review. The veteran reports that he was initially diagnosed with myasthenia gravis in 1954 by a private physician. A private physician, who treated the veteran for his myasthenia gravis from 1980 to 1997, submitted a statement indicating that the veteran had been diagnosed by Dr. W.K. in 1954, after many years of suffering from a "mysterious illness." The statement also indicated that the diagnosing neurologist had long since retired and his records were unavailable. The Board notes that the veteran underwent a VA neurological examination in May 2006. He reported that he was diagnosed with myasthenia gravis in 1954, and had experienced symptoms related to speech and diplopia years before this diagnosis, including during his period of active service. The examiner, a Physician's Assistant, diagnosed myasthenia gravis, reflected that myasthenia gravis was not a tropical disease, and noted that the veteran's claims file did not contain any complaints suggestive of myasthenia gravis. Nonetheless, there is lay evidence of symptomatology related to myasthenia gravis in service (veteran's statements regarding diplopia in service) and he is currently diagnosed with myasthenia gravis. However, the Board is unable to render a decision on this claim due to the lack of a medical nexus opinion. Because the May 2006 VA examination provided no conclusion regarding a medical nexus between his claimed symptoms of slurred speech and double vision in service and current myasthenia gravis, the Board finds that a remand is necessary to obtain such an opinion. Accordingly, the case is REMANDED for the following actions: 1. The RO is asked to direct the claims file to an appropriate specialist for review. The physician should express an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the veteran's myasthenia gravis, which was initially diagnosed in 1954, was incurred in service, keeping in mind that a number of records (such as VA treatment records from 1946 and private treatment records from 1954) are not available for review. 2. Then, readjudicate the claim of service connection for myasthenia gravis. If the determination remains unfavorable to the veteran, issue a Supplemental Statement of the Case and provide him and his representative a reasonable period of time in which to respond before this case is returned to the Board. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ L. HOWELL Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).