Citation Nr: 21008347 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 17-10 902 DATE: February 16, 2021 ORDER Service connection for myasthenia gravis is granted. FINDING OF FACT The Veteran’s myasthenia gravis is related to his service-connected cervical spine disability. CONCLUSION OF LAW The criteria to establish service connection for myasthenia gravis have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.310(a) (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1962 to July 1966. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2016 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in July 2019. In December 2020, the Board advised the Veteran that the recording of his hearing was inaudible due to audio malfunctions in the Board’s digital audio recording system. He was offered the opportunity to testify at an additional hearing. He was instructed that if he did not respond within 30 days, the Board would assume that he did not desire an additional hearing and would proceed accordingly. The Veteran did not respond. To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). This includes any increase in disability (aggravation) that is proximately due to or the result of a service-connected disease or injury. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused or aggravated by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Service treatment records reflect that the Veteran was involved in a motor vehicle accident in July 1964, when he was thrown from a motorcycle after colliding with an automobile. This accident resulted in open fracture of the left tibia and fibula, which was surgically repaired, requiring skin graft. He was discharged from the hospital in August 1965. In February 1966, the Veteran was involved in another motor vehicle accident, sustaining an unstable marked compression fracture at C5. Cervical spine fusion was carried out. Among the Veteran’s currently service-connected disabilities are ankylosis of the cervical spine, bilateral upper extremity radiculopathy associated with the cervical spine disability, residuals of fractured left tibia and fibula, foot disabilities secondary to the left tibia and fibula disability, and post-operative scars. In January 2017, the Veteran maintained that stress from his service-connected disabilities contributed to his myasthenia gravis symptoms. In February 2017, the Veteran’s VA ophthalmologist indicated that the Veteran was diagnosed with ocular myasthenia gravis. He noted that there was evidence that physical and mental stress could incite auto-immune disorders. He pointed out that the Veteran had sustained a neck injury during service that resulted in surgery due to fracture. He also noted that the Veteran sustained a broken tibia and fibula during service. He indicated that auto-immune disorders were complicated, but essentially resulted from the immune system being overactive and attacking their host. He stated that the Veteran’s years of inflammation from his neck injury might have made him more susceptible to auto-immune disorders such as myasthenia gravis. Having reviewed the record with respect to this issue, the Board concludes that service connection for myasthenia gravis is warranted. In this regard, the medical evidence shows a diagnosis of myasthenia gravis, and an opinion indicating that this auto-immune disease is related to inflammation caused by the Veteran’s service-connected cervical spine disability. This statement was made by a medical professional who diagnosed myasthenia gravis in the Veteran and treated him for that disease. The Board notes that this provider carefully considered the Veteran’s history and provided a discussion of the medical principles supporting his conclusion. (Continued on the next page)   As there is an informed medical opinion indicating that the Veteran’s myasthenia gravis is related to his service-connected cervical spine disability, the Board concludes that service connection is in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Barone, 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.