Citation Nr: 22011190 Decision Date: 02/25/22 Archive Date: 02/25/22 DOCKET NO. 17-00 262 DATE: February 25, 2022 REMANDED Service connection for a right ankle disability is remanded. Service connection for a right hand disability is remanded. Service connection for a left hand disability is remanded. Service connection for a right knee disability is remanded. Service connection for a left knee disability is remanded. Service connection for a thoracolumbar spine disability is remanded. Service connection for a cervical spine disability is remanded. A disability rating in excess of 20 percent for Reiter's syndrome, left ankle, is remanded. REASONS FOR REMAND The Veteran had active service from June 9 to July 6, 1977. These matters come to the Board of Veterans' Appeals from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In a September 2014 rating decision, service connection was denied for disabilities of the hands, knees, cervical spine, and right ankle, and service connection was granted for Reiter's syndrome, left ankle, 10 percent disabling, effective April 25, 2014. In an October 2014 rating decision, service connection was denied for a thoracolumbar spine disability. In April 2015, the Veteran filed a notice of disagreement. In a November 2016 rating decision, a 20 percent disability rating was assigned to Reiter's syndrome, left ankle, effective April 25, 2014. A statement of the case was issued in November 2016 and a substantive appeal was received in December 2016. The Veteran testified at a Board hearing in June 2021; the transcript is of record. Hands, knees, cervical spine & thoracolumbar spine The Veteran asserts that his disabilities of the right ankle, hands, knees, cervical spine and thoracolumbar spine are due to his diagnosed Reiter's syndrome. While service connection is in effect for Reiter's syndrome in the context of the left ankle disability, it does not appear that the rating contemplates Reiter's as systemic disease affecting additional joints. Opinions must be sought as to the nature of the Reiter's diagnosis and whether his disabilities are due to his period of active service. Left ankle In September 2014, the Veteran underwent a C&P examination wherein the examiner diagnosed osteoarthritis of the left ankle and Reiter's syndrome of the left ankle. The RO assigned the 10 percent rating in contemplation of 38 C.F.R. § 4.71A, Diagnostic Code (DC) 5271, moderate limitation of motion. In the November 2016 rating decision, the RO assigned the 20 percent rating in contemplation of 38 C.F.R. § 4.71A, DC 5002, rheumatoid arthritis, specifically a finding of one or two exacerbations a year in a well-established diagnosis. Effective February 7, 2021, during the process of this appeal, DC 5002 was changed from "Arthritis rheumatoid" to "multi-joint arthritis (except post-traumatic and gout), 2 or more joints, as an active process." The rating criteria for the active process as listed in DC 5002 was not changed. However, the criteria pertaining to rating based on chronic residuals was removed from this DC and notes were added to state that examples of conditions rated using this DC include, but are not limited to, rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies (Note 1). For chronic residuals of multi-joint arthritis, disability is now to be rated using DC 5003 (Note 2). Further, the ratings for the active process will not be combined with the residual ratings for limitation of motion or, ankylosis, or DC 5003, and instead, the higher evaluation is to be assigned (Note 3). 38 C.F.R. § 4.71A, DC 5002 (in effect since February 7, 2021). In short, chronic residuals of rheumatoid arthritis were ratable under DC 5002 before February 7, 2021, but are only ratable under DC 5003 for degenerative arthritis after February 7, 2021. The Veteran should be afforded an examination which contemplates all of the diagnostic criteria pertaining to rheumatoid arthritis and the for the individual joints involved, including the ankle, knees, and spine. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination with an examiner with appropriate expertise to determine the etiology of his claimed disabilities of the right ankle, hands, knees, cervical spine, and thoracolumbar spine. The virtual folder should be made available to and be reviewed by the examiner in conjunction with the examination. The examiner is asked to respond to the following: a) Did Reiter's syndrome at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? If so, exactly what joints are deemed to be impacted by this diagnosis? b) Did a right ankle disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? c) Did a left hand disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? d) Did a right hand disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? e) Did a left knee disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? f) Did a right knee disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? g) Did a cervical spine disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? h) Did a thoracolumbar spine disability at least as likely as not (i.e., a likelihood of 50 percent or more) manifest during service or is it otherwise due to active service? Provide a comprehensive rationale for every opinion. All pertinent evidence, including both lay and medical, should be considered. Consideration should be given to the June 22, 2021 VA opinion. See 07/13/2021 Medical Treatment Record-Government Facility at 1-3. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. 2. Schedule the Veteran for an examination with a physician with appropriate expertise to determine the severity of his left ankle disability. It is imperative that the claims file be made available to and reviewed by the examiner in connection with the examination. All clinical and special test findings should be clearly reported, and pertinent orthopedic findings should be reported. Range of motion testing should be accomplished, and the examiner should report, in degrees, the point at which pain is demonstrated, and whether any limitation of motion is moderate or marked. To the extent possible the functional impairment due to incoordination, weakened movement and excess fatigability on use should be assessed in terms of additional degrees of limitation of motion. With regard to range of motion testing, the examiner should report at what point (in degrees) pain is elicited as well as whether there is any other functional loss due to weakened movement, excess fatigability or incoordination. These determinations must be expressed in terms of the additional limitation of motion in approximate degrees due to each functional factor that is present. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight bearing. The examiner should report on whether there is functional loss due to limited strength, speed, coordination or endurance. The examiner should also estimate any additional loss of function during periods of flare-up, expressed in degrees of lost motion. The examiner shoulder comment on whether his Reiter's syndrome, left ankle, is manifested by one or two exacerbations a year; symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring three or more times a year.; constitutional manifestations with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring four or more times a year or a lesser number over prolonged periods; or constitutional manifestations associated with active joint involvement that is totally incapacitating. The examiner should opine whether the Veteran's left ankle disability precludes gainful employment for which his education and occupational experience would otherwise qualify him. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.W. Kreindler, 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.