Citation Nr: 21064850 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 09-35 952 DATE: October 21, 2021 ISSUE Entitlement to service connection for a rheumatic disability, to include Reiter's syndrome, rheumatoid arthritis, and polyosteoarthritis. REMANDED Entitlement to service connection for a rheumatic disability, to include Reiter's syndrome, rheumatoid arthritis, and polyosteoarthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1968 to April 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a July 2016 Travel Board hearing. A transcript of that hearing has been associated with the claims file. This is a paperless appeal located on the Veterans Benefits Management System (VBMS), Virtual VA paperless claims processing system, and Caseflow Reader. The Board has reviewed the electronic records maintained these systems to ensure consideration of the totality of the evidence. This matter was previously remanded by the Board in February 2014, December 2017, and June 2019. However, as explained further below, the Board finds that another remand is necessary. In characterizing the issue on appeal, the Board recognizes that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Clemons v. Shinseki, 23 Vet. App. 1 (2009). As the last VA examination in July 2021 indicates possible diagnoses of Reiter's syndrome, rheumatoid arthritis, and polyosteoarthritis, the issue of entitlement to service connection for Reiter's syndrome has been expanded as noted on under issues above, consistent with Clemons. Entitlement to service connection for a rheumatic disability, to include Reiter's syndrome, rheumatoid arthritis, and polyosteoarthritis, is remanded. This matter was last remanded in June 2019 with a request for a new VA examination and opinion. Following the June 2019 remand, the Veteran underwent a July 2021 VA examination. The examiner noted the Veteran's assertions of symptoms in service following drinking contaminated water in service in Vietnam and noted the Veteran's ongoing treatment with medications. The examiner reported the Veteran's ongoing joint pains with continuous hip pain. The examiner opined that the claimed condition was less likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner found that it did seem that the Veteran had reactive arthritis while in service, and that such reactive arthritis was "at least as likely as not related to the gastrointestinal infection that he sustained as a result of drinking the contaminated water while in Vietnam[.]" "[H]owever, although the onset was during service, there is no evidence of chronicity or ongoing treatment for this condition. Reactive arthritis is a disease that tends to resolve after several weeks to months of treatment with non-steroidal anti-inflammatory drugs, and it is rare to become a chronic condition." The examiner further noted that while reactive arthritis may have resolved, the patient "certainly has polyosteoarthritis with evidence of joint changes in his DIP joints manifested by Heberden's nodes." The examiner further noted degenerative arthritis in his cervical spine and left shoulder. The examiner stated that he suspects the Veteran suffers from rheumatoid arthritis given the factor in his blood and decreased range of motion of his wrists. In response, the Veteran submitted a September 2021 correspondence, asserting that "[t]here is no doubt that I do suffer from Osteoarthritis, I would argue to say that I suffer from Secondary Osteoarthritis. Secondary Osteoarthritis happens when the cartilage is damaged by another disease or medical condition e.g. Reiter's syndrome. I will never forget the words of Dr. K.K. said to me after the diagnosis of Reiter's in the early 70's. He told me that there has been damage to my joints but was going to try and get me into remission with Prednisone Therapy." He went on to explain that "An analogy of my situation is like 'Rust on a Piece of Metal'. You can sand it off and paint it, but sooner or later it will come back again and again, and every time it comes back it will be worse. This is what Reiter's has done to my joints and body over the last 50+ years." Given the last VA examiner's opinion, along with the Veteran's statements of record, to include the September 2021 correspondence and July 2016 hearing transcript, the Board remands this matter for an addendum opinion. The Board seeks clarification as to what rheumatic disabilities existed during the pendency of the appeal, that is, from October 2006 forward. The examiner is to consider the Veteran's statements and testimony, any private and VA treatment records, and the Veteran's ongoing treatment with medications. Importantly, service connection may be granted for a disability shown and resolved during the appeal period. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that the "current disability" requirement is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim" and reversing Board's denial of service connection where disability resolved itself during pendency of appeal). Therefore, for any rheumatic disability shown (even if even resolved) during the pendency of the appeal, an opinion as to the nexus of that rheumatic disability must be provided. The matters are REMANDED for the following action: 1. Obtain any ongoing and/or outstanding VA and/or private treatment records and associate such with the file. 2. Thereafter, forward the Veteran's claims file to the July 2021 VA examiner, or if unavailable, to a qualified VA rheumatologist for an addendum opinion with supporting rationale. The entire claims file, including a copy of this remand, must be made available to the examiner for review in connection with the addendum opinion. Another examination of the Veteran should only be performed if deemed necessary by the examiner providing the opinion. Provide answer the following: a.) Identify all rheumatic disabilities present at any point during the pendency of the appeal, from October 2006 forward. The examiner is directed to consider the potential diagnoses of polyosteoarthritis, Reiter's syndrome, and rheumatoid arthritis, as discussed in the September 2021 VA examination report, and reconcile any discrepancies as necessary. Attention is invited to the Veteran's statements of symptoms in service, diagnoses, and ongoing treatment with medications. The examiner is to consider the July 2016 hearing transcript and is to address the Veteran's statements regarding secondary osteoarthritis in September 2021 correspondence. The examiner is specifically directed to list all rheumatic disabilities throughout the period on appeal, to include any that resolved but was present during the appeal. Importantly, service connection may be granted for a disability shown and resolved during the appeal period. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that the "current disability" requirement is "satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim" and reversing Board's denial of service connection where disability resolved itself during pendency of appeal). If the Veteran does not have a current diagnosis associated with his reported symptoms, the examiner should state this with a fully reasoned explanation. The examiner should also state whether there is any functional impairment caused by the Veteran's reported pain, to include any functional impairment caused by the Veteran's reported pain during flare-ups. Evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a disability for VA purposes. b.) For each rheumatic disability identified in a.) above, opine as to whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's rheumatic disability had its clinical onset during active service or is otherwise related to any in service disease, event, or injury, to include as due to exposure to herbicides and/or exposure to unsanitary conditions in service. The examiner must address the lay statements from the Veteran, his ex-wife, and fellow service member regarding his claimed disability. In forming the medical opinion, the examiner should presume that the Veteran's lay statements, as well as those of his ex-wife and fellow service member are credible. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. (Continued on next page.) 3. If, after completing the requested actions and all additional development deemed warranted, the benefits sought remain denied, furnish to the Veteran a Supplemental Statement of the Case and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Tunis, 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.