Citation Nr: 21025365 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-20 280 DATE: April 27, 2021 REMANDED Entitlement to service connection for Reiter’s syndrome and residuals is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a bilateral ankle disability is remanded. Entitlement to service connection for a bilateral foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1973 to May 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in May 2019. The issues of entitlement to service connection for Reiter’s syndrome and residuals, a low back disability, a bilateral knee disability, a bilateral ankle disability, and a bilateral foot disability, were denied. The Veteran appealed the May 2019 decision to the Court of Appeals for Veterans Claims (CAVC). In an April 2020 Joint Motion for Remand (JMR) decision, CAVC vacated the May 2019 decision and remanded for readjudication consistent with the JMR. The specific directives of the JMR will be discussed below. 1. Entitlement to service connection for Reiter’s syndrome and residuals The JMR states, in part: The Board failed to address the credibility and probative weight of Appellant’s statements that the onset of his Reiter’s symptoms began in December 1975… This was necessary as Appellant may be entitled to presumptive service connection for a chronic disease under 38 C.F.R. § 3.303(b) because, as the Board noted, he had active military service until May 1975… Thus, on remand, the Board must provide an adequate statement of reasons or bases addressing the credibility and probative value of Appellant’s statements about the onset of his symptoms and entitlement to presumptive service connection for a chronic disease under 38 C.F.R. § 3.303(b). Additionally, the JMR noted: The Board also found that the “evidence does not reflect that Dr. Feeman was aware of the Veteran’s November 1975 diagnosis of cystitis[,]” and “even assuming as true the Veteran’s assertion of the possible onset of symptoms in December 1975, this would coincide timewise with his post-service cystitis and not instead his [venereal disease] in service,” However, to the extent that the Board finds the timing of his November 1975 diagnosis of cystitis significant with regard to the etiology of Appellant’s Reiter’s syndrome, the Board failed to support this finding with any competent medical evidence before relying on it to find the private medical opinion of record less probative. See R. at 11; Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board may not “refut[e] the expert medical conclusions in the record with its own unsubstantiated medical conclusions”). Thus, on remand, the Board must support its findings, where appropriate, with competent medical evidence. The Veteran has alleged his Reiter’s syndrome is related to a January 1974 in-service venereal disease diagnosis. In a December 1985 letter, the Veteran’s private doctor, T.F., noted the Veteran’s reports of leg pains beginning 10 years prior. However, it does not appear the doctor was aware of the Veteran’s November 1975 diagnosis of cystitis, as the doctor noted the Veteran is a vague historian. In January 1986, the Veteran was diagnosed with Reiter’s syndrome. The Board finds this evidence warrants an addendum VA opinion because if the Veteran did in fact have symptoms beginning in December 1975 as he has alleged, and there is a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis, the Veteran’s Reiter’s syndrome may be considered chronic and the Veteran may be entitled to presumptive service connection for a chronic disease under 38 C.F.R. § 3.303(b). As such, the Board need a VA addendum opinion to reconcile the Veteran’s November 1975 diagnosis of cystitis, the statement alleging an onset of his Reiter’s symptoms as December 1975, and the etiology of the subsequently diagnosed Reiter’s syndrome. 2. Entitlement to service connection for a low back disability 3. Entitlement to service connection for a bilateral knee disability 4. Entitlement to service connection for a bilateral ankle disability 5. Entitlement to service connection for a bilateral foot disability The JMR states, in part: “the parties agree that the Board must obtain a new VA examination or medical opinion that addresses whether Appellant’s current low back disability is related to his service, including his in-service complaints of back pain and diagnosis of back strain.” The JMR also states, in part: The parties also agree that Appellant’s claims for service connection for a low back disability, a bilateral knee disability, a bilateral ankle disability, and a bilateral foot disability, are inextricably intertwined with his claim for Reiter’s syndrome because Appellant has claimed these disabilities are residuals or complications of his Reiter’s syndrome. In view of the JMR’s findings, the Board finds a new VA examination is warranted for the service connection claim for a low back disability. Notably, because of this decision, the Reiter’s syndrome is remanded. Likewise, the bilateral knee, bilateral ankle, and bilateral foot disability, are remanded as they are inextricably intertwined with his claim for Reiter’s syndrome. The matters are REMANDED for the following action: 1. Obtain any ongoing VA or private treatment records. Should they exist, associate them with the claims file. 2. Provide the Veteran with a VA compensation examination to ascertain the current nature and etiology of a current Reiter’s syndrome disability. The examiner must consider the Veteran’s January 1974 in-service venereal disease diagnosis. Also, the examiner must address the following. a. Whether the November 1975 diagnosis of cystitis is related to the Reiter’s syndrome? b. Whether the Veteran’s reports of the onset of his Reiter’s symptoms in December 1975 are related to the diagnosis of cystitis and/or the January 1986 Reiter’s syndrome diagnosis. After addressing the above questions, the examiner shall provide an opinion as to the following question: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s current Reiter’s syndrome disability is the result of an injury incurred in or as a result of his period of active duty service? A detailed rationale supporting the examiner’s opinions should be provided. The rationale for any opinion expressed must be provided. Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. Note: 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 against it. 3. Provide the Veteran with a VA compensation examination to ascertain the current nature and etiology of a current low back disability. The examiner must consider the Veteran’s reports of back pain and diagnosis of back strain during active service, as noted in the service treatment records. The examiner shall provide an opinion as to the following question: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s current low back disability is the result of an injury incurred in or as a result of his period of active duty service, to include as secondary to Reiter’s syndrome? If the low back disability is not related to service, is it at least as likely as not (a fifty percent probability or greater) proximately due to or aggravated by Reiter’s syndrome? A detailed rationale supporting the examiner’s opinions should be provided. The rationale for any opinion expressed must be provided. Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. Note: 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 against it. 4. As it relates to the bilateral knee, bilateral ankle, and bilateral foot disability, provide the Veteran with a VA compensation examination to ascertain the current nature and etiology of each claimed disability, if and only if, the examiner determines the Reiter’s syndrome is related to service. If a VA examiner determines the Reiter’s syndrome is related to service, the examiner shall provide an opinion as to the following questions: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s current bilateral knee disability is a residual of Reiter’s syndrome and whether it is at least as likely as not proximately due to or aggravated by Reiter’s syndrome? Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s current bilateral ankle disability is a residual of Reiter’s syndrome and whether it is at least as likely as not proximately due to or aggravated by Reiter’s syndrome? Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s current bilateral foot disability was a residual of Reiter’s syndrome and whether it was at least as likely as not proximately due to or aggravated by Reiter’s syndrome? A detailed rationale supporting the examiner’s opinions should be provided. The rationale for any opinion expressed must be provided. Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. Note: 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 against it. 5. Conduct any other development deemed necessary and then readjudicate the Veteran’s claim. The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded for additional development or other appropriate action by the Board or United States Court of Appeals for Veterans Claims must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. JESSICA SEAY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jackman, Associate 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.