I would have the biopsy done since the dog will already be under anesthesia. Your vet sounds knowledgeable. I have a dog now 12 with MVD and well managing her for the last 7 years has paid off. My early vet wasn't knowledgable and neither was I. If I were in your shoes I would not wait - conditions don't just disappear and are best managed early. I would consult with an ACVIM specialist as my first step though.
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