Citation Nr: 18141684 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 09-37 193 DATE: October 11, 2018 ORDER Entitlement to service connection for gout, characterized by joint symptomatology of the bilateral feet, is granted. FINDING OF FACT The probative evidence of record shows the Veteran’s gout manifested to a compensable degree within 1 year from his separation of service. CONCLUSION OF LAW The criteria for service connection for gout has been met. 38 U.S.C. §§ 1101, 1110, 1111, 1153, 5103, 5103A, 5107(b); 38 C.F.R §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United Stated Navy from September 1966 to August 1969. In March 2013, the Veteran was afforded a Board hearing, and a transcript of the hearing is of record. In September 2015 correspondence, the Veteran was notified that the Veterans Law Judge who presided over the March 2013 was no longer at the Board and of his right to another hearing. The Veteran notified the Board in September 2015 that he did not wish to have another hearing, and thus, the Board will proceed. In November 2016, the Board denied the Veteran’s claim for service connection. Following the Board’s denial, the Veteran filed a joint motion remand (JMR) to the United States Court of Appeals for Veterans Claims (the Court or CAVC). In June 2017, the Court granted the JMR, and remanded the issue as to service connection for gout back to the Board. In October 2017, the claim was brought before the Board and was remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). In addition to the requirements above, service connection may also be established with certain chronic diseases, including arthritis, based upon a legal presumption by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. Such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Factual Analysis - Gout The Veteran contends that his gout is related to his active duty service. The Veteran’s service treatment records are silent for any complaints of joint pain or diagnosis of gout. However, the medical evidence of record shows the Veteran was treated for gout by his private physician from January 1972 into the early 1990s. During his January 1972 visit, the physician noted the Veteran was complaining of pain and swelling involving his left big toe that extended into the dorsum of the left foot. The Veteran reported that it occurred 2 days prior; however, he also had a similar episode about a year and a half ago where he was told he had gout. VA treatment records show the Veteran began receiving treatment at the VA in late 2000 for his gout. The Veteran was provided a low dose of allopurinol and indomethacin and was instructed to take as needed for acute gout attacks. His VA treatment records further show that he has consistently been prescribed this medication since 2003, which was noted as keeping his gout well-controlled. The Board notes that despite conflicting findings by previous VA examiners, a January 2018 VA examiner opined that the Veteran did have a valid diagnosis of gout during the pendency of the claim. The examiner noted the continued prescriptions for gout medication and notations of gout within his VA treatment records. Upon review of the record, the Board finds that the evidence of record shows the Veteran has continually suffered from gout since his discharge, and thus, service connection based on chronicity or continuity of symptomatology is warranted. See 38 C.F.R. § 3.309 (a). The Board notes that while not specifically noted to be a chronic disease in 38 C.F.R. § 3.309 (a), gout is a type of arthritis in which uric acid crystals are deposited around joints, usually involving acute inflammation of only a single joint at a time. See 68 Fed. Reg. 6,998, 7,008 (Feb. 11, 2003). Due to arthritis being a chronic disease listed in 38 C.F.R. § 3.309 (a), service connection based on chronicity or continuity of symptomatology is also for consideration with regard to gout. Although the medical records available show the first notation of gout as January 1972, the Board acknowledges the notation from the physician that the Veteran reported a similar episode a year and half prior, which would be around June 1970. Considering the Veteran had an episode in June 1970 where he was first diagnosed with gout, this would mean the Veteran’s condition manifested to a compensable degree within 1 year of discharge. Further, in considering the lay statements by the Veteran, his wife, and his father-in-law, which all report seeing the Veteran suffer from gout symptoms starting in December 1969, the Board finds that the probative evidence is at least in equipoise that the Veteran’s condition began within 1 year of discharge from service. Therefore, as the Board has found that the Veteran has had continuing or chronicity of symptoms related to his gout since discharge, and he has been diagnosed with gout, which is a form of arthritis, and arthritis is a disease listed in 38 C.F.R. § 3.309(a), the Board finds that the evidence supports a grant of service connection for gout on a presumptive basis for chronic disease. The benefit of the doubt doctrine has been applied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Negron, Associate Counsel