Citation Nr: 20013838 Decision Date: 02/21/20 Archive Date: 02/21/20 DOCKET NO. 19-28 180 DATE: February 21, 2020 ORDER Service connection for myasthenia gravis is granted. FINDINGS OF FACT 1. The Veteran is diagnosed with myasthenia gravis. 2. The Veteran was exposed to Agent Orange while serving in Vietnam. 3. The Agent Orange exposure caused the myasthenia gravis. CONCLUSION OF LAW The criteria for service connection for myasthenia gravis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran, who is the appellant, served on active duty from October 1969 to August 1971. The Veteran served in Vietnam from May 1970 to March 1971. The instant case is an appeal from a Department of Veterans’ Affairs (VA) Regional Office (RO) rating decision that denied service connection for myasthenia gravis. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.326 (2018). The Board finds that the duties to notify and assist have been met. Accordingly, no further discussion is required. Service Connection Legal Authority Service connection can be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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 generally requires (1) medical evidence of a current disability; 2) medical or, in certain circumstances, lay evidence of an 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. Service connection for myasthenia gravis The Veteran is diagnosed with myasthenia gravis. Myasthenia gravis is a rare autoimmune neuromuscular condition. See July 13, 2019 opinion by Dr. A. Myasthenia gravis is characterized by varying degrees of weakness of the skeletal muscles of the body. See October 10, 2017 opinion by Dr. A. The Veteran has produced three letters by Dr. A. that provide the diagnosis and etiology and two other letters from physicians Dr. K. and Dr. S. The Veteran served in Vietnam from May 1970 to March 1971. Service in Vietnam during this time period results in a presumption of exposure to an herbicide agent unless there is affirmative evidence to establish the lack of exposure. See 38 C.F.R. § 3.307(6)(iii). Here, there is no affirmative evidence to the contrary. The Veteran received the Vietnam Service Medal, the Vietnam Campaign Medal, and a Navy Commendation Medal. All serve to corroborate the herbicide exposure in Vietnam. What remains is the nexus between the Agent Orange exposure during service in Vietnam and the currently diagnosed myasthenia gravis. The testimony from the private doctors weighs in support of such nexus of current disability to service. In May 4, 2016, Dr. K. wrote that there is a known correlation between exposure to Agent Orange and autoimmune disease. July 2016, Dr. A. wrote a letter that talks about causation for myasthenia gravis and states that there is “a strong relationship between [Agent Orange] exposure and the development of human autoimmune and neurological disorder,” noting that myasthenia gravis is an autoimmune neuromuscular disorder. In April 2017, Dr. S. wrote that there is a known correlation between exposure to [Agent Orange] and autoimmune disease and stated his opinion that prolonged exposure in Vietnam to Agent Orange is the cause of the Veteran’s myasthenia gravis. In July 2019, Dr. A. described the causation of myasthenia gravis, prescribing the scientific mechanism of how an environmental agent transforms normal cellular function into abnormal autoimmune cellular disease like myasthenia gravis. Dr. A stated that it is his professional opinion that the exposure to Agent Orange in Vietnam is more likely than not the direct cause of his diagnosis of myasthenia gravis. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the nexus requirement is met to warrant service connection for myasthenia gravis. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, 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.