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C&P Exam Prep: Myasthenia Gravis
DBQ Overview
Interview + Physical- Form Name
- Central_Nervous_System_and_Neuromuscular_Diseases
- Form Code
- Central_Nervous_System_and_Neuromuscular_Diseases
- Page Count
- 13
- Examiner Type
- Physician or Psychologist
- Estimated Duration
- 60-90 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of Myasthenia Gravis (DC 8025) and any neurological residuals, including muscle weakness, fatigability, respiratory impairment, bulbar symptoms, and functional limitations, in order to assign or re-evaluate a VA disability rating under 38 CFR 4.124a. The minimum assignable rating for Myasthenia Gravis with ascertainable residuals is 30%.
What the examiner evaluates:
- Diagnosis confirmation and ICD code (G70.01 or G70.00)
- Current symptoms including ptosis, diplopia, dysphagia, dysphonia, limb weakness, and respiratory compromise
- Fatigability patterns - especially worsening with repetitive activity or later in the day
- Muscle strength testing across all four extremities (grip, pinch, elbow flexion/extension, wrist flexion/extension, knee extension, ankle dorsiflexion/plantar flexion)
- Deep tendon reflexes (biceps, triceps, brachioradialis, knee, ankle)
- Gait assessment including assistive device use
- Speech intelligibility and presence of dysarthria or aphonia
- Presence and severity of dysphagia and associated aspiration risk
- Respiratory function including FVC and FEV1 if indicated
- Presence of thymoma or prior thymectomy
- Current medications (pyridostigmine, immunosuppressants, IVIG, plasma exchange)
- Frequency and severity of myasthenic crises or hospitalizations
- Sleep disturbances including sleep apnea secondary to neuromuscular respiratory weakness
- Bladder, bowel, and sexual dysfunction if neurologically affected
- Muscle atrophy location and measurements
- Functional impact on occupational and daily activities
- Need for assistive devices (cane, walker, wheelchair, brace)
- Presence of comorbid neurological diagnoses that may be secondary to or aggravated by MG
Exam may be conducted in person at a VA facility, VAMC, or contracted examiner office. Telehealth exams are possible but physical examination is strongly preferred for neuromuscular conditions. Schedule exam for mid-morning if your symptoms are typically worse later in the day, or request accommodation if afternoon exacerbations are your pattern. Bring a support person if possible to corroborate functional limitations.
Typical duration: 60-90 minutes
Manual Muscle Testing (MMT) - Upper Extremities
Strength of elbow flexors/extensors, wrist flexors/extensors, grip, and pinch strength bilaterally using the Medical Research Council (MRC) 0-5 scale
What to expect:
The examiner will ask you to resist force applied to your arm, wrist, and hand in various positions. Testing will be done on both sides. For Myasthenia Gravis, fatigability on repetitive testing is as important as initial strength - ask the examiner to retest after sustained effort if your strength declines.
Key thresholds:
- MRC 0-1 (no or trace contraction) — Supports complete paralysis; may support 100% or SMC consideration
- MRC 2-3 (movement without/against gravity only) — Supports severe muscle weakness; anchors higher rating levels
- MRC 4 (reduced but functional strength) — Supports moderate impairment; relevant to 30-60% range
- MRC 5 (normal strength) — Normal finding - ensure fatigability and fluctuation are separately documented
Tips:
- Perform testing at the time of day when your symptoms are worst, if possible
- If strength appears normal at rest, ask the examiner to note whether you fatigue rapidly with repetitive movements (the hallmark of MG)
- Mention any recent doses of pyridostigmine before the exam and whether you timed medication to allow symptom demonstration
- Report hand weakness when writing, typing, or carrying objects even if grip dynamometry appears adequate
Pain considerations: Myasthenia Gravis does not typically cause pain; however, document any associated myalgias, joint pain from compensatory postures, or neck pain from ptosis-related head positioning
Manual Muscle Testing (MMT) - Lower Extremities
Strength of knee extensors, ankle dorsiflexors and plantar flexors bilaterally; deep tendon reflexes at knee and ankle
What to expect:
The examiner will test leg strength with you seated or supine. Reflex testing uses a reflex hammer. In MG, lower extremity weakness is less common than upper but can be significant - document any difficulty climbing stairs, rising from chairs, or walking distances.
Key thresholds:
- Inability to rise from chair without arms — Functional marker of proximal lower extremity weakness; supports moderate-severe rating
- Foot drop or ankle instability requiring bracing — Supports assistive device notation and higher functional impairment rating
Tips:
- Demonstrate difficulty with chair-rise if present
- Mention any falls or near-falls related to leg weakness
- Note whether weakness in legs fluctuates with activity (fatigue-dependent weakness is pathognomonic for MG)
Pain considerations: Document any hip or knee pain resulting from compensatory gait changes due to neuromuscular weakness
Pulmonary Function Testing (PFT) - FVC and FEV1
Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) as markers of neuromuscular respiratory compromise - critical in Myasthenia Gravis due to risk of respiratory failure
What to expect:
You will breathe forcefully into a spirometer. The examiner may have recent PFT results from your treating neurologist. If not, advocate for formal testing, particularly if you have any dyspnea, orthopnea, or history of myasthenic crisis.
Key thresholds:
- FVC < 50% predicted — Significant respiratory impairment; may warrant rating under respiratory analogues in addition to MG DC
- FVC < 25% predicted or requiring ventilatory support — Supports 100% rating and potential SMC consideration
- Normal FVC but symptomatic dyspnea on exertion — Ensure dyspnea is separately documented as a functional limitation
Tips:
- Bring copies of any pulmonary function tests performed by your treating pulmonologist or neurologist
- Report any history of intubation, myasthenic crisis, or ICU admission for respiratory failure - this is strong evidence of severity
- Describe orthopnea (difficulty breathing while lying flat) if present, as this is a red flag for diaphragmatic weakness in MG
- Note if you use BiPAP or CPAP related to neuromuscular-related sleep apnea
Pain considerations: Respiratory muscle fatigue may present as chest tightness or a sensation of heavy breathing - describe this accurately if present
Gait and Station Assessment
Ability to walk normally, stability, coordination, and need for assistive devices
What to expect:
The examiner will observe you walking, possibly on heels and toes, and assess station (standing balance). Note whether ptosis, diplopia, or vestibular effects from MG impact balance.
Key thresholds:
- Requires cane for ambulation — Documents functional mobility limitation
- Requires walker or wheelchair — Supports higher impairment level; relevant to SMC aid and attendance consideration
Tips:
- Walk at your natural pace - do not perform better than your typical functional capacity
- If you use a cane, walker, or wheelchair, bring it and use it
- Mention if gait worsens after walking even a short distance due to muscle fatigue
Pain considerations: Describe any musculoskeletal pain that further limits ambulation, especially if secondary to MG-related weakness and compensatory postures
Speech and Bulbar Function Assessment
Presence of dysarthria (slurred speech), dysphonia (hoarseness), aphonia (no voice), and dysphagia (swallowing difficulty) reflecting bulbar muscle involvement in MG
What to expect:
The examiner will listen to your speech and may ask you to swallow or describe swallowing difficulties. In MG, speech may worsen with sustained talking - a key fatigability marker.
Key thresholds:
- Constant inability to communicate by speech — 100% level consideration
- Speech not intelligible or aphonic — High severity rating anchor
- Dysphagia requiring daily medication or dietary modification — Important functional limitation for rating
- Aspiration documented — Supports serious complication notation on DBQ
Tips:
- If your voice fatigues during extended conversation, describe this and demonstrate if possible
- Report any choking episodes, nasal regurgitation, or need to modify food textures
- Mention any episodes of aspiration pneumonia if they have occurred
- Note if you require a feeding tube (PEG) or have required one
Pain considerations: Throat discomfort or pain with swallowing should be reported accurately
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | A 100% combined or analogous rating for MG is supported by severe generalized weakness, respiratory failure requiring ventilatory support, inability to communicate by speech, documented myasthenic crises requiring hospitalization, severe dysphagia requiring tube feeding, or total occupational and social impairment. Each disabling manifestation must be separately coded and rated, with all codes cited. |
CFR: 38 CFR 4.124a: Acute phase febrile neurological disease = 100%. For chronic MG, 100% is reached through combination of MG minimum (30%) plus additional coded residuals (respiratory failure, paralysis, dysphagia, speech impairment). VA must consider SMC under 38 U.S.C. 1114 for loss of use of extremities or need for aid and attendance. |
| 60% | Ratings above 30% for MG require citation of additional diagnostic codes under 38 CFR 4.124a for specific manifested residuals. A 60% level may be supported by rating MG at 30% combined with additional codes for significant dysphagia (e.g., DC 7203), respiratory impairment, or limb weakness. Significant functional limitation with moderate-severe residuals supports this combined level. |
CFR: Per 38 CFR 4.124a Note: When ratings in excess of minimum are assigned, diagnostic codes utilized as bases of evaluation must be cited in addition to the codes identifying the diagnoses. Combine MG (DC 8025 at 30%) with codes for dysphagia, respiratory impairment, limb paralysis, or other objectively documented manifestations. |
| 30% | Minimum rating assigned when Myasthenia Gravis is confirmed with ascertainable residuals under 38 CFR 4.124a DC 8025. This is the floor - subjective residuals including fatigability, weakness, and ptosis are accepted as consistent with the diagnosis per 38 CFR 4.124a Note. A rating in excess of 30% requires citation of additional diagnostic codes reflecting specific disabling manifestations. |
CFR: 38 CFR 4.124a DC 8025: Minimum rating 30. Subjective residuals (fatigability, dizziness, headaches) are accepted when consistent with MG and not more likely attributable to other disease. |
100% A 100% combined or analogous rating for MG is supported by s ...
A 100% combined or analogous rating for MG is supported by severe generalized weakness, respiratory failure requiring ventilatory support, inability to communicate by speech, documented myasthenic crises requiring hospitalization, severe dysphagia requiring tube feeding, or total occupational and social impairment. Each disabling manifestation must be separately coded and rated, with all codes cited.
Key Symptoms
- Myasthenic crisis with respiratory failure (history of intubation)
- Requiring mechanical ventilation or BiPAP/CPAP for neuromuscular respiratory failure
- Aphonia or speech not intelligible
- Severe dysphagia requiring PEG tube or parenteral nutrition
- Complete or near-complete limb paralysis
- Wheelchair dependent
- Inability to perform activities of daily living without assistance
- Frequent hospitalizations for MG exacerbations
- Severe aspiration with recurrent aspiration pneumonia
CFR: 38 CFR 4.124a: Acute phase febrile neurological disease = 100%. For chronic MG, 100% is reached through combination of MG minimum (30%) plus additional coded residuals (respiratory failure, paralysis, dysphagia, speech impairment). VA must consider SMC under 38 U.S.C. 1114 for loss of use of extremities or need for aid and attendance.
60% Ratings above 30% for MG require citation of additional diag ...
Ratings above 30% for MG require citation of additional diagnostic codes under 38 CFR 4.124a for specific manifested residuals. A 60% level may be supported by rating MG at 30% combined with additional codes for significant dysphagia (e.g., DC 7203), respiratory impairment, or limb weakness. Significant functional limitation with moderate-severe residuals supports this combined level.
Key Symptoms
- Moderate to severe generalized muscle weakness
- Dysphagia requiring daily medication (DC 7203 analog: 30-60%)
- Significant respiratory involvement (FVC reduction)
- Frequent exacerbations requiring medication adjustments
- Dysarthria affecting communication
- Moderate fatigability limiting work capacity
- Requiring assistive devices part of the time
- Bladder or bowel dysfunction secondary to MG
CFR: Per 38 CFR 4.124a Note: When ratings in excess of minimum are assigned, diagnostic codes utilized as bases of evaluation must be cited in addition to the codes identifying the diagnoses. Combine MG (DC 8025 at 30%) with codes for dysphagia, respiratory impairment, limb paralysis, or other objectively documented manifestations.
30% Minimum rating assigned when Myasthenia Gravis is confirmed ...
Minimum rating assigned when Myasthenia Gravis is confirmed with ascertainable residuals under 38 CFR 4.124a DC 8025. This is the floor - subjective residuals including fatigability, weakness, and ptosis are accepted as consistent with the diagnosis per 38 CFR 4.124a Note. A rating in excess of 30% requires citation of additional diagnostic codes reflecting specific disabling manifestations.
Key Symptoms
- Confirmed MG diagnosis with current medication management
- Mild to moderate muscle fatigability with activity
- Ptosis or diplopia, mild to moderate
- Mild dysphagia managed with dietary modification
- Mild dysarthria not affecting communication
- Condition controlled with medications (pyridostigmine, immunosuppressants)
- Infrequent exacerbations not requiring hospitalization
CFR: 38 CFR 4.124a DC 8025: Minimum rating 30. Subjective residuals (fatigability, dizziness, headaches) are accepted when consistent with MG and not more likely attributable to other disease.
How to Describe Your Symptoms
Muscle Fatigability and Weakness
How to describe:
Describe how your strength declines specifically with repeated or sustained activity - not just constant weakness. Explain the pattern: 'I can lift my arm the first few times, but after 4-5 repetitions I cannot raise it above my shoulder.' Quantify activities: how many stairs before weakness stops you, how long you can hold a fork, how many words you can speak before your voice fades.
Worst-day example:
“On my worst days, I cannot lift my arms above my head to wash my hair, I drop objects because my grip gives out without warning, I cannot climb a single flight of stairs without resting, and even sitting upright becomes exhausting by mid-afternoon. My neck muscles are so weak that I have to support my head with my hand.”
What the examiner listens for:
Fluctuating weakness with a clear fatigability component, worsening later in the day or with exertion, improvement after rest - the classic MG pattern. The examiner should note this is distinct from fixed weakness seen in other neuromuscular diseases.
Understatements to avoid:
Do not say 'I'm just a little tired' or 'I manage okay.' Instead say: 'My muscles physically give out with use - this is not ordinary tiredness. I have to plan every activity around my energy because once my muscles fatigue, they do not recover quickly.'
Ptosis and Ocular Symptoms
How to describe:
Describe whether one or both eyelids droop, when it occurs (morning vs. afternoon, after sustained gaze), whether it obstructs your vision, and whether you experience double vision (diplopia) and how it affects your ability to read, drive, or navigate safely.
Worst-day example:
“On my worst days, my left eyelid droops so severely that it covers my pupil and I cannot see out of that eye. I have double vision that makes it impossible to drive or safely navigate stairs. I have to physically hold my eyelid up to function.”
What the examiner listens for:
Ptosis that worsens with sustained upgaze (positive fatigability test), diplopia from extraocular muscle weakness, need to tilt the head to compensate, and functional vision impairment from ocular MG.
Understatements to avoid:
Do not minimize ocular symptoms as 'my eye droops sometimes.' Explain the functional consequences - inability to drive, read for more than a few minutes, or the safety risk of vision loss at unpredictable times.
Dysphagia and Bulbar Symptoms
How to describe:
Describe difficulty chewing or swallowing, especially with sustained chewing (jaw fatigue during meals), nasal regurgitation of liquids, choking episodes, and any dietary modifications you have made (soft foods, thickened liquids, cutting meals short due to jaw fatigue).
Worst-day example:
“On my worst days, I cannot finish a meal because my jaw muscles give out after a few bites. I have choked on thin liquids and had liquid come out of my nose. I have had episodes where food stuck and I could not swallow - I now eat only soft foods and cannot eat in public because I am afraid of choking.”
What the examiner listens for:
Jaw fatigability with meals, nasal regurgitation (palatal weakness), documented aspiration episodes, dietary modifications made for safety, weight loss secondary to dysphagia, and need for daily medications to manage swallowing.
Understatements to avoid:
Do not say 'swallowing is a little hard sometimes.' Specify: 'I have modified my diet out of necessity, I have choked on [specific foods/liquids], and I have had aspiration episodes documented by my doctor.'
Speech and Voice Impairment
How to describe:
Describe how your voice changes with sustained speaking - becoming hoarse, nasal, or inaudible. Quantify: how many sentences or minutes before your voice gives out, whether people ask you to repeat yourself, whether you avoid speaking situations due to dysarthria.
Worst-day example:
“On my worst days, I lose my voice entirely after speaking for two or three sentences. My speech becomes so slurred and nasal that my family cannot understand me on the phone. I have stopped making phone calls and attending social gatherings because I cannot communicate reliably.”
What the examiner listens for:
Progressive dysarthria or dysphonia with sustained speech, nasal quality from palatal weakness, aphonia, and functional communication limitations in work and social settings.
Understatements to avoid:
Do not minimize as 'my voice gets tired.' Describe the functional impact: 'I am unable to hold conversations of normal length, I cannot use the telephone effectively, and my impaired speech has affected my ability to work.'
Respiratory Symptoms
How to describe:
Describe any shortness of breath, difficulty breathing when lying flat (orthopnea), difficulty taking a deep breath, or anxiety about breathing - particularly any history of myasthenic crisis with respiratory failure. Note any BiPAP, CPAP, or supplemental oxygen use.
Worst-day example:
“On my worst days, I cannot lie flat in bed because I feel like I am suffocating - I sleep in a recliner. I become severely short of breath walking from my bedroom to the bathroom. I was hospitalized [number] times and placed on a ventilator because my breathing stopped due to MG.”
What the examiner listens for:
Orthopnea as a marker of diaphragmatic weakness, exertional dyspnea disproportionate to cardiac cause, history of myasthenic crisis, documented respiratory failure, need for ventilatory support, and reduced PFT values.
Understatements to avoid:
Do not omit hospitalization history or intubation events - these are the strongest evidence of severity. Saying 'I get winded sometimes' understates the life-threatening nature of MG respiratory involvement.
Functional Impact on Daily Activities and Employment
How to describe:
Describe specific activities you can no longer perform or can only partially perform: cooking, driving, personal hygiene, dressing, grocery shopping, childcare, employment. Use concrete time and quantity examples. Explain how MG has changed your occupational capacity.
Worst-day example:
“On my worst days, I cannot shower standing up - I use a shower chair. I cannot prepare a meal because holding my arms up to cook causes immediate exhaustion. I cannot work my previous job as [occupation] because I cannot sustain the required physical or vocal demands. I had to leave work entirely/reduce hours because of MG.”
What the examiner listens for:
Loss of gainful employment, inability to perform sedentary work due to fatigue and weakness, dependence on others for ADLs, and social isolation due to physical and communication limitations.
Understatements to avoid:
Do not say 'I get by.' Specify: 'I rely on my spouse/caregiver for [specific tasks] because my MG prevents me from doing them safely or at all.'
Exacerbations, Crises, and Hospitalizations
How to describe:
Provide specific dates, triggers, hospital names, and outcomes for any myasthenic crises or significant exacerbations. Describe what triggered them (infection, medication change, stress, heat), how they were treated (IVIG, plasmapheresis, intubation), and how long recovery took.
Worst-day example:
“I have been hospitalized [number] times for myasthenic crisis. My most recent hospitalization in [month/year] required intubation and mechanical ventilation for [number] days. Recovery took [number] weeks before I returned to my baseline, which itself is significantly impaired.”
What the examiner listens for:
Frequency and severity of crises, need for IVIG or plasmapheresis, ICU admissions, intubation history, and the trajectory of the disease - whether it is stable, improving, or progressive.
Understatements to avoid:
Do not omit any hospitalization, ER visit, or crisis - even if it was years ago. All documented crises establish the severity and volatility of your condition.
Common Mistakes to Avoid
Describing only your best-day symptoms during the exam
Veterans often feel pressure to appear capable in medical settings and unconsciously demonstrate their best function, not their typical or worst-day function. The examiner documents what they observe that day.
Instead: Before the exam, write down your worst-day symptoms and bring the list. When asked how you are doing, say 'Today is a [better/typical/worse] day compared to my average - let me tell you what a typical bad day looks like.' VA rating is based on the full picture of your condition including worst presentations.
Impact: All levels - this mistake most commonly results in an examiner documenting near-normal function that does not reflect the disabling reality of MG
Failing to mention fatigability as distinct from constant weakness
MG is uniquely characterized by fatigability - strength that is normal or near-normal at rest but rapidly declines with activity. If a veteran says 'my strength is okay,' the examiner may document normal motor function and miss the diagnosis hallmark entirely.
Instead: Explicitly state: 'My weakness is fatigability-based. I may test normally at rest, but after repetitive movement my strength drops significantly. Please test me after sustained effort, not just at rest.' This ensures the examiner understands and documents the fatigability component.
Impact: 30% and above - fatigability is the core symptom that distinguishes MG from other conditions and justifies the minimum rating and any additional functional ratings
Not timing medication (pyridostigmine) to show symptoms vs. taking it for optimal function before the exam
If you take pyridostigmine optimally timed before your exam, your symptoms may be minimized and not representative of your underlying functional capacity. Conversely, deliberately withholding medication creates safety risks.
Instead: Discuss medication timing with your neurologist before the exam. Inform the examiner of exactly what medications you took and when. The examiner should document your condition on medication - but also your functional capacity without optimal medication coverage, based on history. Do not put yourself at medical risk to demonstrate symptoms.
Impact: 30-100% - medication-controlled symptoms can still warrant significant ratings if functional impairment persists or if the medication itself has side effects limiting function
Omitting history of myasthenic crises and hospitalizations
Veterans may not think past events are relevant if they are currently stable. However, crisis history is critical evidence of disease severity and volatility.
Instead: Bring a written timeline of all hospitalizations, ER visits, IVIG infusions, plasmapheresis treatments, and any intubations related to MG. Present this list to the examiner and ensure it is documented in the DBQ.
Impact: 60-100% - crisis history is among the strongest evidence supporting ratings well above the 30% minimum
Failing to describe respiratory symptoms or orthopnea
MG-related respiratory compromise is one of the most serious and ratable manifestations. Veterans may attribute dyspnea to age, deconditioning, or other causes and not volunteer it as an MG symptom.
Instead: Explicitly connect your respiratory symptoms to your MG. State: 'My neurologist has told me my breathing problems are related to my MG affecting my respiratory muscles. I sleep elevated because I cannot breathe lying flat. I have been tested for respiratory muscle weakness.' Bring any PFT results from your neurologist.
Impact: 60-100% - respiratory involvement substantially increases combined disability rating and may trigger SMC consideration
Not requesting that the examiner separately code and rate each disabling manifestation
38 CFR 4.124a specifically requires that when ratings above the 30% minimum are assigned, additional diagnostic codes must be cited for each manifested residual. Examiners sometimes only document the primary MG code without separately coding dysphagia, speech impairment, respiratory compromise, or limb weakness.
Instead: You may politely inform the examiner or note in your pre-exam statement: 'I understand that my MG produces multiple distinct disabilities including dysphagia, speech impairment, and respiratory compromise, each of which may be separately ratable. I want to ensure all of these are thoroughly documented.'
Impact: Above 30% - failure to separately code residuals prevents the combined rating from exceeding the 30% floor
Minimizing the impact of ocular symptoms (ptosis and diplopia)
Ptosis and diplopia can significantly impair function - preventing safe driving, reading, working - but veterans may minimize ocular symptoms as 'just my eyelid drooping.'
Instead: Describe the functional impact: 'My ptosis obstructs my vision to the point that I cannot safely drive, read for more than [time], or work at a computer.' If diplopia is present, note its impact on depth perception and safety.
Impact: 30% and above - ocular involvement can be separately rated under DC 6029 (diplopia) if functionally significant, further increasing combined rating
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to a thorough and accurate C&P examination that fully documents all symptoms and functional limitations of your Myasthenia Gravis.
- You have the right to have all claimed disabilities and secondary conditions considered by the examiner.
- You have the right to record your C&P examination in most states - check your state's consent laws and inform the examiner before recording.
- You have the right to bring a support person, family member, or VSO representative to the examination.
- You have the right to submit supplemental evidence, including private medical opinions, after the C&P exam and before or after the rating decision.
- You have the right to request a copy of the completed DBQ form and all C&P exam reports through your VSO or FOIA request.
- You have the right to challenge an inadequate DBQ by submitting a Supplemental Claim with new and relevant evidence under the Appeals Modernization Act.
- You have the right to have subjective symptoms (fatigability, weakness, dizziness) accepted as valid residuals of MG when consistent with the diagnosis, per 38 CFR 4.124a Note.
- You have the right to have each separately disabling manifestation of MG (dysphagia, respiratory impairment, limb weakness, speech impairment) independently coded and rated above the 30% minimum.
- You have the right to the benefit of the doubt under 38 U.S.C. 5107(b) - when evidence is in approximate balance, the VA must decide in your favor.
- You have the right to have your condition evaluated based on your worst-day presentations, not a single exam snapshot, per VA rating policy and M21-1 guidance.
- You have the right to request a different examiner or an addendum to the DBQ if the original examination was inadequate (i.e., did not include all pertinent testing or failed to address all claimed symptoms).
- You have the right to representation by an accredited VSO, claims agent, or attorney at no cost for representation through the BVA level.
Related Conditions
- Thymoma Thymoma is present in approximately 10 15% of MG patients. If a thymoma is diagnosed and service connected, it should be separately rated under the appropriate neoplasm diagnostic code. Thymectomy for thymoma should be documented on the DBQ.
- Sleep Apnea Neuromuscular respiratory weakness from MG can cause or worsen obstructive or central sleep apnea. If sleep apnea requiring CPAP or BiPAP is documented in the context of MG respiratory muscle involvement, a secondary service connection claim should be filed. Document any sleep study (polysomnography) results.
- Dysphagia / Esophageal Stricture Bulbar MG causing significant dysphagia may be separately rated as a digestive system condition (e.g., DC 7203) when it meets ratable threshold beyond the MG minimum. Document esophageal strictures, need for dilation, aspiration events, and dietary modifications.
- Respiratory Failure / Chronic Respiratory Condition MG related respiratory muscle weakness causing chronic respiratory impairment may be separately rated under respiratory diagnostic codes. FVC and FEV1 results are critical. History of myasthenic crisis with intubation documents the most severe manifestation.
- Major Depressive Disorder / Anxiety (Secondary) Depression and anxiety disorders are common secondary to the chronic, progressive, and life threatening nature of MG and its functional limitations. A secondary service connection claim for mental health conditions secondary to MG service connected disability should be filed if a mental health condition exists.
- Diplopia (Double Vision) Ocular MG producing diplopia may be separately rated under DC 6029 (diplopia) when functionally significant. Document the degree of diplopia, its impact on vision, and any compensatory measures (prism glasses, eye patching).
- Myasthenic Syndrome (Lambert-Eaton) Lambert Eaton Myasthenic Syndrome (LEMS) is a related but distinct neuromuscular junction disorder (DC 8093) often associated with small cell lung cancer. If present, it is rated separately. Distinguish from MG by its proximal weakness improving with repetition pattern.
- Neurogenic Bladder Dysfunction While less common than in spinal cord diseases, autonomic dysfunction associated with MG or its treatments can affect bladder function. If bladder dysfunction is present and attributable to MG, it should be separately documented and rated.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.