Citation Nr: 21063726 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 10-10 314 DATE: October 15, 2021 REMANDED Entitlement to an initial rating in excess of 30 percent for Crohn's disease with rectal sparing, gastroesophageal reflux disease (GERD), and erosive gastritis is remanded. Entitlement to an initial rating in excess of 20 percent prior to May 11, 2017, for reactive arthritis of multiple joints, including the left shoulder and bilateral knees, is remanded. Entitlement to a rating in excess of 20 percent as of May 11, 2017, for symptomatic reactive arthritis of the left glenohumeral joint (rated with resolved left shoulder impingement) is remanded. Entitlement to a rating in excess of 10 percent as of May 10, 2018, for reactive arthritis affecting the left knee is remanded. Entitlement to a rating in excess of 10 percent as of May 10, 2018, for reactive arthritis affecting the right knee is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to March 19, 2015, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2000 to June 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2008 by a Department of Veterans Affairs (VA) Regional Office. In August 2012, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In February 2013, February 2017, and December 2020, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to an initial rating in excess of 30 percent for Crohn's disease with rectal sparing, GERD, and erosive gastritis. In December 2020, the Board, in pertinent part, remanded the Veteran's claim for a higher initial rating for Crohn's disease with rectal sparing, GERD, and erosive gastritis in order to afford him a VA examination so as to assess the current nature and severity of his such disability. Thereafter, at an April 2021 VA examination, he reported symptoms of stomach pain, diarrhea, and gas, and surgery for rectal prolapse in January 2019. In this regard, VA treatment records confirm the performance of a rectopexy for rectal prolapse on January 2, 2019. However, despite documenting such surgery, the VA examiner did not address whether the Veteran's rectal prolapse is a manifestation of his Crohn's disease with rectal sparing, GERD, and erosive gastritis. In this regard, while the Veteran has a separate appeal pending for service connection for anal prolapse, the Board is required to rate all manifestations of his service-connected gastrointestinal disability. Consequently, the Board finds that a remand is necessary in order to obtain an opinion as to whether the Veteran's rectal prolapse is a manifestation of his Crohn's disease with rectal sparing, GERD, and erosive gastritis. 2. Entitlement to an initial rating in excess of 20 percent prior to May 11, 2017, for reactive arthritis of multiple joints, including the left shoulder and bilateral knees. 3. Entitlement to a rating in excess of 20 percent as of May 11, 2017, for symptomatic reactive arthritis of the left glenohumeral joint (rated with resolved left shoulder impingement). 4. Entitlement to a rating in excess of 10 percent as of May 10, 2018, for reactive arthritis affecting the left knee. 5. Entitlement to a rating in excess of 10 percent as of May 10, 2018, for reactive arthritis affecting the right knee. In December 2020, the Board, in pertinent part, remanded the Veteran's claims for higher initial ratings for reactive arthritis of the left shoulder and bilateral knees in order to ensure compliance with previous Remand directives by obtaining addendum opinions addressing range of motion findings for pain on both active and passive motion and on weight-bearing and nonweight-bearing at VA examinations conducted in March 2008 and August 2013. Thereafter, the Veteran underwent VA examinations of his left shoulder and bilateral knees in April 2021 and addendum opinions were obtained in May 2021. In this regard, the examiner indicated that she was unable to provide an opinion regarding the findings for the left shoulder at the March 2008 VA examination. However, she did note such examination, and the August 2013 VA examination, were clinically consistent with the Veteran's statements regarding functional loss with repetitive movement and use, respectively. The examiner then proceeded to repeat the findings from the August 2013 examination report. With respect to the Veteran's bilateral knee disabilities, she noted the VA examinations in March 2008 and August 2013 revealed objective findings of right knee pain and limitation of motion due to service-connected reactive arthritis. She further noted the Veteran's reported symptomatology on examination and the specific range of motion findings related to right and left knee flexion in August 2013. However, as the examiner did not directly address the specific questions posed by the Remand directives, another remand is necessary in order to obtain an addendum opinion addressing such matters. Stegall v. West, 11 Vet. App. 268, 271 (1998). 6. Entitlement to a TDIU prior to March 19, 2015. As noted in prior Remands, the Veteran asserts that several of his service-connected disabilities, to include those on appeal, have prevented him from securing and following a substantially gainful occupation. Again, the Board finds the development of the issues remanded herein could impact the determination as to entitlement a TDIU for the period prior to March 19, 2015. Therefore, the TDIU claim is inextricably intertwined with such claims and, thus, adjudication of the former issue must be deferred pending the outcome of the latter issues. Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Forward the record, to include a copy of this Remand, to the VA examiner who conducted the April 2021 examination, or an appropriate clinician if unavailable, for an addendum opinion addressing the severity of the Veteran's Crohn's disease with rectal sparing, GERD, and erosive gastritis. Following a review of the record, the clinician should indicate whether the Veteran's rectal prolapse, with resulting rectopexy in January 2019, is a manifestation of his service-connected Crohn's disease with rectal sparing, GERD, and erosive gastritis. If so, please describe the nature and severity of such symptomatology, to include whether such is mild with constant slight or occasional moderate leakage; moderate, persistent or frequently recurring; or severe (or complete), persistent in severity. A timeline of the severity of such symptoms would also be useful, if appropriate. A rationale any opinion offered should be provided. 2. Forward the Veteran's record, to include a copy of this Remand, to an appropriate clinician other than the VA examiner who provided the May 2021 opinions, for an addendum opinion concerning the severity of the Veteran's service-connected reactive arthritis, to include the left shoulder and bilateral knees, throughout the pendency of the appeal. The clinician is asked to review the VA examination reports containing range of motion findings pertinent to the Veteran's left shoulder, left knee, and right knee that were conducted in March 2008 and August 2013. With regard to each examination, the clinician is asked to offer an opinion as to the range of motion findings rendered during such examinations for pain on both active and passive motion and on weight-bearing and nonweight-bearing. The clinician is also asked to offer an opinion as to the range of motion findings rendered during the March 2008 examination for flare-ups. Such opinions should be expressed, if possible, in terms of degrees. A rationale for any opinion offered should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she must make clear that s/he has considered all procurable data (i.e., the information regarding frequency, duration, characteristics, severity, and/or functional loss related to such flare-ups elicited from the Veteran), but any member of the medical community at large could not provide such an opinion without resorting to speculation. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. M. Celli, 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.