Citation Nr: 21016212 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 14-26 593 DATE: March 22, 2021 REMANDED Service connection for myasthenia gravis, to include as secondary to service-connected acquired psychiatric condition to include anxiety and posttraumatic stress disorder and/or as due to Agent Orange exposure. REASONS FOR REMAND The Veteran served on active duty from July 1964 to July 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 decisional letter issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. This case was most previously before the Board in December 2019. The Veteran appeared before the undersigned Veterans Law Judge in September 2017 and delivered sworn testimony via video conference hearing in Nashville, Tennessee. Remand is required for an addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). When a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). A July 2019 VA examination report contained a negative nexus opinion, noting that myasthenia gravis is not an Agent Orange presumptive disease. In an August 2019 addendum, the examiner opined that the myasthenia gravis is not related to in-service chemical exposures and is also not an Agent Orange presumptive disorder. In a January 2020 opinion, the examiner noted that at their level of training, that there was no scientific connection between Agent Orange and myasthenia gravis. That examiner stated that if any further opinion was necessary, that a neurologist specialist examiner should provide the opinion. Thus, an addendum opinion is required that addresses Agent Orange exposure, despite that myasthenia gravis is not a presumptive disease, and that addresses secondary service connection. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to determine the etiology of the claimed myasthenia gravis from an examiner with experience or qualifications with neurology. The claims file must be made available to and reviewed by the examiner. An explanation for all opinions expressed must be provided. First, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that myasthenia gravis had its onset in service or within one year of service discharge, or is etiologically related to the Veteran’s active service, specifically to include exposure to herbicides. The examiner is reminded that a disability can be service-connected due to Agent Orange exposure despite the fact that it is not a presumptive disease. Second, the examiner must also provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran has myasthenia gravis that is caused or aggravated by any of his service-connected disabilities, to include the service-connected acquired psychiatric condition. 4. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2020). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Nelson 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.