BVA9507423 
DOCKET NO.  89-39 703     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Nashville,
Tennessee

THE ISSUE

Entitlement to an increased rating for Reiter's syndrome with
"persistent arthralgia of the left ankle and right knee and
uveitis," currently rated 40 percent disabling.

REPRESENTATION

Appellant represented by: The American Legion

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

Michael E. Kilcoyne, Counsel
INTRODUCTION

The veteran had active military service from November 1970 to
January 1976.

The matter on appeal arises from a March 1989 decision by the
aforementioned regional office (RO), which denied an increased
rating for the disability at issue.  A notice of disagreement was
received in March 1989, and a statement of the case was issued in
April 1989.  A substantive appeal was received in June 1989, and
the veteran testified at a hearing conducted at the RO in August
1989.  To ensure the veteran's appeal has been fully developed,
and that his disability was properly evaluated, the case was
remanded by the Board in July 1990, September 1991, April 1993
and April 1994.

REMAND

Since 1990, the Board has been attempting, without success, to
establish the joints of the veteran's body which are affected by
Reiter's Syndrome, together with the range of motion in degrees
of those joints.  The Board has also been attempting to have the
RO assign a percentage disability evaluation for each of the
chronic residuals of the veteran's Reiter's syndrome.  The
purpose of this has been to comply with the provisions of the
diagnostic code under which the veteran's disability has been
rated, 38 C.F.R. Diagnostic Code 5002.  This requires that when
Reiter's syndrome is an active process, which the RO has
evidently found, a comparison must be conducted between the
rating assigned for the active process of the disability, and the
ratings assigned to the chronic residuals, so that the higher of
the two may be awarded.

In the most recent examination of record, conducted in May 1994,
the examiner stated, the veteran's "main problems are with his
ankles ... He also has had problems in the hips. ...He has
definite problems in both knees at times."  Thereafter, range of
motion in degrees is given with respect to the knees and ankles,
but not with respect to the hips.  What appears to be forward
flexion of the veteran's lumbar spine is provided, but the
particular relevance of this in the context of the examination's
purpose is unclear.  In contrast, on the examination report dated
in May 1993, it was indicated that the areas most affected by
Reiter's syndrome were the lower back, ankles and the right knee.
However, the range of motion of these joints in degrees was not
provided.  This examiner did report the range of internal and
external motion of the hips, but given his apparent conclusion
that hip joints were not affected by the veteran's service
connected disability, the purpose for the inclusion of this
information in the examination report is unclear.  The Board
observes that even if it were to be assumed that both the lower
back and hips were affected by Reiter's syndrome, and the range
of motion for these joints that were reported over the course of
both 1993 and 1994 examinations were used to evaluate the extent
of those disabilities, an accurate evaluation of those joints
would not be possible because the range of motion of those joints
was not reported in all directions of possible movement.  Thus,
the precise joints affected by Reiter's Syndrome, and the range
of motion in degrees of those joints remains unknown.

In addition, the Board observes that the RO has not prepared a
rating action which lists each chronic residual of the veteran's
Reiter's syndrome, and the percentage evaluation assigned for
each such disability under the appropriate diagnostic codes for
those disabilities.  This makes it difficult to determine if a
comparison between the rating assigned for the active process of
Reiter's Syndrome, and the ratings assigned to the chronic
residuals of the disability has been properly conducted.  This is
particularly detrimental to the veteran because it renders him
incapable of making a fully informed argument on appeal.

The VA has a duty to assist the veteran in the development of
facts pertinent to his claim.  38 U.S.C.A. § 5107 (West 1991).
This duty includes the conduct of necessary examinations in order
to determine the effects of disability upon a person's ordinary
activity, and requires that the reports of those examinations be
fully descriptive of the particular disability.   See Schafrath
v. Derwinski, 1 Vet.App. 589 (1991), Green v. Derwinski, 1
Vet.App. 121 (1991), 38 C.F.R. § 4.1 (1994).  Moreover, when an
examination report does not contain sufficient detail, it is
incumbent upon the rating board to return the report as
inadequate for rating purposes.  38 C.F.R. § 4.2.  Because the
extent of the affect that the veteran's Reiter's syndrome has on
his joints cannot be determined from the current record, further
development in this case must be undertaken.  Although additional
delay in this matter is regrettable, this case is Remanded to the
RO for the following which should be accomplished as
expeditiously as possible.

1.  The RO should obtain and associate with
the claims file, copies of any VA outpatient
treatment records relating to the veteran
that are dated subsequent to April 1994.

2.  Next, the veteran should be scheduled
for a VA examination the purpose of which is
to determine the extent of his Reiter's
syndrome.  All indicated tests and studies
should be performed, and the examination
should be conducted in accordance with the
pertinent provisions of the VA Physician's
Guide for Disability Evaluation
Examinations.  The claims file must be made
available to the examiner for review prior
to examination, and the examiner is
requested to include in his or her report, a
summary as to the impairment caused by
Reiter's syndrome, and a complete list of
the specific joints affected by Reiter's
syndrome, together with a precise range of
motion in all directions for each joint so
affected.   The list of the joints affected
by the Reiter's syndrome should not be
limited to a statement as to the joints
which are "most affected" or to the
appellant's "major problems."   Instead, the
list must be a precise and complete list of
the specific joints affected by Reiter's
syndrome, along with a precise statement of
range of motion for each specific joint on
the list.

3.  Upon completion of the above, the RO
should review the evidence obtained, and
ensure that all of the foregoing development
actions have been conducted and completed in
full.  If any development is incomplete,
including if the requested examination does
not include all ranges of motion tests and
summary requested, appropriate corrective
action should be taken.  A rating action
should then be prepared which should include
a listing of all the chronic residuals of
the veteran's Reiter's syndrome and the
percentage evaluation assigned each such
residual.  It should also be determined
whether the veteran's Reiter's syndrome is
active, and if so, the rating warranted on
this basis should be entered and compared
with the ratings assigned to the individual
chronic residuals, so that the higher of the
two may be awarded.  In the event the
disability is not found to be active, the
ratings for the chronic residuals should be
assigned.  If the ultimate decision remains
adverse to the veteran, he and his
representative should be provided a
supplemental statement of the case which
should include the following: a recitation
of the percentage rating for each chronic
residual of the veteran's Reiter's syndrome;
a citation to the appropriate diagnostic
codes for the evaluation of each chronic
residual of the veteran's Reiter's syndrome;
a recitation of the percentage rating
assigned to the veteran's Reiter's syndrome
if it is found to be an active process; a
citation to the appropriate diagnostic code
for the evaluation of active Reiter's
syndrome; a discussion of the applicability
of the cited diagnostic codes to the
veteran's disability.  The veteran and his
representative should then be given an
opportunity to respond, before the case is
returned to the Board for further review.

No action is required of the veteran until he is further
informed.

          G. H. SHUFELT
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. § 20.1100(b) (1994).