Citation Nr: 21008469 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 17-51 404 DATE: February 17, 2021 REMANDED A rating in excess of 50 percent for headaches with vision problems. Service connection for an eye disorder due to myasthenia gravis (MG). Service connection for rhinitis. Service connection for Grave's Disease. REASONS FOR REMAND In December 2020, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In January 2020, the Veteran submitted correspondence withdrawing her claim of entitlement to a total disability rating based on individual unemployability (TDIU). She confirmed her desire to withdraw this issue at her December 2020 Board hearing. Thus, the claim is deemed withdrawn and the Board has limited its consideration accordingly. The Veteran has been in receipt of the maximum schedular assignment of 50 percent for headaches with vision problems since 2000. At the December 2020 hearing, she suggested that her symptoms were indicative of an extraordinary disability picture and that an extraschedular rating was warranted. As such, the claim is referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran’s disability picture requires the assignment of an extraschedular rating. Next, the Veteran has asserted that her eye disorder, to include her diagnosis for MG, began in service with the development of several symptoms that were not properly diagnosed until 2015. She has also asserted that the eye disorder could be aggravated by her service-connected headaches. In this regard, the vision problems have been connected to her service-connected headache disorder and is therefore inextricably intertwined with the remanded issue. Additionally, no medical opinion was obtained as to whether the Veteran’s eye disorder, to include her diagnosed MG, was aggravated beyond its natural progression by her service-connected headaches with vision problems. She has submitted a private letter which suggest that her symptoms may have begun with her in-service symptomatology. Also, in January 2016, the Veteran’s private treating physician submitted a letter suggesting that her eye movements, and dissociated vertical deviation, which is connected to her service-connected headaches, could make her condition more troublesome. Thus, an aggravation opinion should be obtained. Finally, at the December 2020 hearing, the Veteran noted that she received private treatment at Laken Health. Upon review of the record, those treatment records have not been obtained and it is not clear that any such attempt has made. Thus, an attempt should be made to obtain those records. With regard to her claims of service connection for Grave’s Disease and rhinitis, VA and private treatment notes suggest, and the Veteran has testified that these disorders are all interconnected. Thus, they are inextricably intertwined and must likewise be remanded. The matters are REMANDED for the following actions: 1. Identify and obtain any outstanding, pertinent, VA and private treatment records and associate them with the claims file. This is to specifically include an attempt to obtain the treatment records referred to by the Veteran at the December 2020 Hearing for which she sought treatment at Laken Health. 2. Refer the Veteran’s file to the Under Secretary for Benefit or the Director of the Compensation and Pension service to determine whether the Veteran’s disability picture supports the assignment of an extraschedular rating. 3. Obtain an addendum opinion as to whether it is at least as likely as not (50% probability or greater) that the Veteran’s MG, or any eye disorder, was permanently worsened, or aggravated beyond its natural progression by, a service-connected headache disorder with vision problems. The entire claims file should be made available to, and reviewed by, the clinician. An examination need not be scheduled unless deemed necessary by the clinician. The clinician is asked to specifically consider, and address, the Veteran’s contentions, as well as the January 2016 and January 2018 letters from the Veteran’s treating providers.   A thorough rationale is requested for any opinion rendered. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yacoub, 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.