Citation Nr: 21069991 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 18-42 583 DATE: November 22, 2021 ORDER Entitlement to service connection for myasthenia gravis is granted. FINDING OF FACT Resolving all doubt in the Veteran's favor, his currently diagnosed myasthenia gravis is related to his military service. CONCLUSION OF LAW The criteria for service connection for myasthenia gravis have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from October 1965 to July 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Philadelphia, Pennsylvania, Department of Veterans Affairs (VA) Regional Office (RO). In November 2021 Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. Entitlement to service connection for myasthenia gravis. The Veteran is claiming service connection for myasthenia gravis, asserting his symptoms originated in service. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131 ; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent, credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Myasthenia gravis is an enumerated condition under 38 C.F.R. § 3.309 (a). The Veteran has consistently maintained his myasthenia gravis began in-service, and that his symptoms originated during service. Service treatment records (STRs) contain reports of weakness and insomnia, as well as complaints of not seeing clearly. There was no diagnosis of myasthenia gravis during active duty. The question before the Board is whether the medical evidence of record supports a determination that the Veteran's myasthenia gravis is related to his period of active duty. The Board finds that it does. In a July 2017 statement, the Veteran reported experiencing loss of strength during service that would come and go. He reported in 1974 experiencing a right drooping eyelid and double vision. He reported undergoing a thymectomy in 1977. The Veteran underwent an examination in May 2018. The Veteran was diagnosed with bilateral upper eyelid ptosis in 1974. The Veteran was diagnosed with myasthenia gravis in 1977 and had been treated previously with prednisone and a thymectomy. Symptoms included weakness in the left ankle, triceps, and finger flexors for several years. He was able to walk two blocks on level ground and stand for 25 minutes. He was unable to pick up small coins from the table, or play sports, or type easily. The examiner concluded the Veteran's myasthenia gravis was not incurred in or otherwise proximately aggravated by exposure to herbicides and chemicals during service. There is an August 2018 opinion from a private provider, Dr. W. F., concluding that the Veteran's myasthenia gravis is related to exposure to herbicides. Dr. F. indicated the Veteran had been treated since 2009. In a July 2020 statement, the Veteran reported symptoms of myasthenia gravis as being right eyelid and general paralysis and muscle atrophy throughout his body. He reported that shortly before his tour of duty was over in Vietnam, a medic noticed the right side of his face was drooping and he examined him but found no known cause. He also reported during service having symptoms of swollen lumps under armpits and groin, as well as eye discomfort, and shoulder pain. At a February 2021 VAMC visit, the examiner noted the Veteran had a long history of myasthenia gravis, having been diagnosed in 1974. The Veteran was noted as having symptoms of myasthenia gravis for several years prior to his diagnosis. The Veteran testified at his November 2021 hearing. The Veteran provided a detailed history of his symptoms, explaining that he began having a drooping face during service, and continued to have progressive symptoms ever since. The Board concludes the competent and probative evidence warrants a finding of service connection under the chronic disease presumption. Although he was discharged in 1967, he was treated and diagnosed with early symptoms of myasthenia gravis shortly thereafter, in 1974. During service he was seen with complaints of weakness, insomnia, and difficulty seeing. The Veteran has been diagnosed with myasthenia gravis and has continuously and credibly relayed his symptoms originated during service and have continued ever since. The Veteran has also presented consistent and credible testimony, supported by medical records. The Board finds that myasthenia gravis was both incurred in-service and presumptive service connection is warranted. Based on the foregoing, the Board resolves all doubt in the Veteran's favor and finds that his currently diagnosed myasthenia gravis is related to his military service. Therefore, service connection for such disorder is warranted. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Skiouris, Elena 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.