Citation Nr: 18152204 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-45 007 DATE: November 21, 2018 ORDER Entitlement to service connection for gout is granted. REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right elbow disability is remanded. Entitlement to service connection for a groin strain disability is remanded. FINDING OF FACT Gout first began in active service and has been recurrent since service separation, and the Veteran’s current gout is as likely as not related to active service. CONCLUSION OF LAW By extending the benefit of the doubt to the Veteran, the criteria for service connection for gout have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1997 to November 2000. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated in August 2014 of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for gout is granted. Service connection will be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection requires competent evidence showing, (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Where a veteran served ninety days or more of active service, and certain chronic diseases, to include arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such 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; 38 C.F.R. §§ 3.307, 3.309(a). 38 C.F.R. § 3.303 (b) applies to the “chronic diseases” under 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.102, 4.3. The Veteran contends that he incurred gout in active service. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for service connection for gout have been met. Service treatment records show that gout was diagnosed in active service. Service treatment records dated in February 2000 show a diagnosis of gouty arthritis. The Veteran was on medication to treat this disorder. See also the service treatment records dated in March 2000. The Veteran’s separation examination was not located. The Veteran separated from active service in November 2000. The Veteran submitted private medical records showing treatment for gout in January 2005, February 2009, and March 2009. The March 2009 private medical record shows a diagnosis of gout arthritis. The Board finds that the evidence supports a grant of service connection for gout. There is competent and credible evidence of a diagnosis of gout in active service and after service separation. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for service connection for gout have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim of service connection for gout is granted. REASONS FOR REMAND 1. The claims for service connection for back, right elbow, left ankle and groin strain disabilities are remanded. VA’s duty to assist a claimant includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A (d)(1) (2012). The Board finds that a VA examination is necessary to obtain medical evidence as to whether the Veteran’s back, right elbow, left ankle, and groin strain disabilities are related to active service to include the symptoms and injuries in active service. A July 2000 service treatment record indicates that the Veteran sought medical treatment for a back issue and he was placed on light duty for 3 days. The assessment was muscular strain. A July 2000 service treatment record indicates that the Veteran had a history of right elbow surgery at age 11 and he had persistent right elbow pain for a month. He was evaluated for possible impingement syndrome. The examiner noted that scarring or arthritis from the previous surgery may be contributing to the current condition. Service records show that the Veteran sought treatment for left ankle pain when running; he had the pain for 3 months. The assessment was mild ankle sprain and he was placed on light duty for 3 days. Service treatment records show that the Veteran was treated for a groin strain on multiple occasions. He strained the groin in March 1998 and June 1999. Subsequent treatment records note a recurring groin strain for 2 years. It was noted that he injured the muscle on an obstacle course and he reinjured it 7 or 8 times. The assessment was chronic left adductor tear. The Veteran did not undergo exam for these issues because the exam notice was sent to an incorrect address. Thus, the Board finds that a VA examination is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine nature and likely etiology of the claimed back, right elbow, left ankle, and groin strain disabilities. The VA examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that any current back, right elbow, left ankle, and groin strain disabilities either began during active service or are related to injury, disease, or other event in active service. The VA examiner should opine as to whether it is at least as likely as not that the Veteran’s right elbow disability pre-existed the period of active service and if so, whether the right elbow disability was aggravated beyond natural progression during this period of service. The rationale for all opinions offered should be provided. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.L. Krasinski, Counsel