Citation Nr: 18152953
Decision Date: 11/26/18	Archive Date: 11/26/18

DOCKET NO. 10-32 004
DATE:	November 26, 2018
REMANDED
Entitlement to service connection for myasthenia gravis (MG) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from April 1968 to November 1969, including service in the Republic of Vietnam.   
This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. 
The Veteran and his wife testified at a hearing before the Board in December 2012.  The Veteran additionally testified at a hearing before an RO Decision Review Officer (DRO) in November 2011.  Transcripts of the Veteran’s hearings are of record.
In October 2014, the Board remanded the claim on appeal for further evidentiary development to the RO and returned the matter to the Board. 
The Board denied service connection for myasthenia gravis in August 2017. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In May 2018, the Court granted a joint motion for remand (Joint Motion), vacating the Board decision and remanding the appeal to the Board for further proceedings consistent with the Joint Motion. 
Pursuant to the Joint Motion, the parties agree that the Board relied on an inadequate medical opinion in denying his claim for myasthenia gravis. Specifically, the January 2016 VA opinion concluded that the disability is not related to service because the condition is not entitled to presumptive service connection, without clearly considering direct service connection. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, on remand, a new opinion that addresses whether the Veteran’s MG was at least as likely as not due to in-service herbicide exposure based on a theory of direct service connection is necessary. See id. 
The matter is REMANDED for the following action:
Request an opinion from an appropriate VA physician addressing the below. A full VA examination should not be scheduled unless it is deemed necessary by the evaluator or otherwise required by the evidence. The evaluator should review the records contained in the electronic claims file.  
Based on a review of the record, the physician should opine whether it is as least as likely as not (50 percent or greater probability) that the current MG had its onset during service or within one year of separation, or was otherwise causally or etiologically related to service, to include any symptoms manifested during service or presumed exposure to Agent Orange (i.e., herbicide agent) during service. 
In answering this question, the physician should not use as a basis for his/her opinion the fact that MG is not on the list of diseases presumed service connected in veterans exposed to Agent Orange.
The physician is advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account in formulating the requested opinions.
A complete rationale should accompany any opinion provided.

 
JAMES L. MARCH
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Sarah Campbell