Citation Nr: 18152691 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 16-25 210 DATE: November 23, 2018 REMANDED Entitlement to an initial disability rating in excess of 10 percent for reactive arthritis of the right wrist and hand is remanded. Entitlement to an initial disability rating, in excess of 10 percent for reactive arthritis of the left ankle is remanded. Entitlement to a compensable initial disability rating for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from June 1999 to March 2004. The Veteran is a Gulf War Era Veteran. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. The Board notes that the Veteran requested a Board hearing on his February 2016 VA Form 9. However, the Veteran, via his representative, withdrew his request for a hearing in an October 2018 correspondence. As such, the Veteran has waived his right to a hearing and this case is properly before the Board. See38 C.F.R. § 20.702(e) (2018). The Board notes that after the last statement of the case in January 2016, additional medical records were received in February 2017. The records were submitted by the Veteran’s representative. Although the representative did not specifically waive initial review of this evidence by the Agency of Original Jurisdiction (AOJ), such a waiver is presumed, as the Veteran submitted his substantive appeal after February 2, 2013. 38 U.S.C. § 7105(e)(1) (2012). 1. Entitlement to an initial disability rating in excess of 10 percent for reactive arthritis of the right wrist and hand is remanded. 2. Entitlement to an initial disability rating in excess of 10 percent for reactive arthritis of the left ankle is remanded. 3. Entitlement to a compensable initial disability rating for GERD is remanded. The Board notes that the Veteran was last afforded a VA examination to assess the severity of the reactive arthritis in his right wrist, right hand, and left ankle in July 2014. His last a VA examination to determine the severity of his GERD was also in July 2014. The Board finds that it is appropriate to obtain new VA examinations to determine the current severity of the Veteran’s GERD and reactive arthritis in his right hand, right wrist, and left ankle. See 38 C.F.R. § 3.159(c)(4) (2018). Therefore, the Veteran should be afforded VA examinations for the aforementioned service-connected disabilities on remand. See 38 C.F.R. § 3.159 (2018); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). The matters are REMANDED for the following actions: 1. Appropriate efforts should be made to obtain and associate with this case file any outstanding VA medical records and all outstanding private treatment records, with all necessary assistance from the Veteran. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 2. Schedule the Veteran for VA examination to determine the current severity of his reactive arthritis in the right hand and wrist from an appropriate medical provider. The examiner should opine as to whether a well-established diagnosis of reactive arthritis exists in relation to the Veteran’s symptomatology in his right hand and wrist. The examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to his right hand and wrist reactive arthritis and discuss the effect of the Veteran's disabilities on any occupational functioning and activities of daily living. The examiner should also specifically address how many exacerbations, both incapacitating and non-incapacitating, occur per year due to the Veteran’s reactive arthritis. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Schedule the Veteran for an examination to determine the current severity of his left ankle reactive arthritis from an appropriate medical provider. The examiner should opine as to whether a well-established diagnosis of reactive arthritis exists in relation to the Veteran’s symptomatology in his left ankle. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to his left ankle reactive arthritis and discuss the effect of the Veteran’s disabilities on any occupational functioning and activities of daily living. The examiner should also specifically address how many exacerbations, both incapacitating and non-incapacitating, occur per year due to the Veteran’s reactive arthritis in the left ankle. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected GERD. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to his GERD alone and discuss the effect of such on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. E. Trotter, Associate Counsel