Citation Nr: 20021358 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 19-28 761 DATE: March 25, 2020 ORDER Entitlement to service connection for gout of the left foot is granted. Entitlement to service connection for gout of the right foot is granted. FINDINGS OF FACT 1. The most probative evidence of record shows that the Veteran’s left foot gout at least as likely as not developed during service. 2. The most probative evidence of record shows that the Veteran’s right foot gout at least as likely as not developed during service. CONCLUSIONS OF LAW 1. The criteria for service connection for gout of the left foot is met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 2. The criteria for service connection for gout of the right foot is met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1999 to March 2017. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In response to the rating decision, the Veteran filed a Notice of Disagreement (NOD), in October 2017, as to the issues of a depressive disorder, gout of the bilateral feet, chronic fatigue syndrome, and a left ankle disorder. In July 2019, a Statement of the Case (SOC) was issued. In a September 2019 VA Form 9, the Veteran stated that he wished to appeal the issue of gout of the bilateral feet. As the Veteran did not file a VA Form 9 perfecting his appeal as to the issues of a depressive disorder, left ankle disorder, or chronic fatigue syndrome, these issues will not be addressed. 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 military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 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 in service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303 (b), service connection will be presumed where there are either chronic symptoms shown in service or continuity of symptomatology since service for diseases identified as “chronic” in 38 C.F.R. § 3.309 (a). Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Gout (arthritis) is a “chronic disease” listed under 38 C.F.R. § 3.309 (a). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. 1. Entitlement to service connection for gout of the left foot is granted. 2. Entitlement to service connection for gout of the right foot is granted. The Veteran contends that his left foot and right foot gout is related to his military service. He reported that during service, he had increased levels of uric acid levels and averaged at least one attack per month. The Veteran also reported that he was diagnosed during his period of service, has a current diagnosis of gout, and takes prescription medication to reduce exacerbations of his condition. A September 2009 VA treatment record shows that the Veteran presented with complaints of left foot pain which had lasted two weeks. It was also noted that there was a concern whether the Veteran had a “stress fracture vs. gout.” Laboratory testing revealed an elevated level of uric acid. A November 2012 emergency physician record reveals that the Veteran presented with complaints of right foot pain, described as dull in nature, without injury. The clinician noted that the etiology was unknown, but that the Veteran had a possible stress fracture. A VA treatment record, dated in April 2015, notes that the Veteran had elevated levels of uric acid when flare resolved and that the Veteran was started on prescription medication. The Veteran was assessed with gout. A May 2016 private treatment record shows that the Veteran had a diagnosis of gout. A July 2016 private treatment record also shows that the Veteran was diagnosed with gout. The Board also notes that the Veteran had elevated uric acid levels on several occasions. See VA treatment records dated September 2009, December 2014, April 2015, September 2015, and January 2016. The Veteran was afforded a VA examination in March 2017, at which time the examiner noted that the Veteran did not have a current diagnosis of gout because there was no pathology to render a diagnosis. At the time of the examination, the Veteran reported that the date of onset was in 2008 and that, at such time, he noticed severe pain and had high uric acid levels. The Veteran also reported that his condition has worsened. In a March 2017 Separation Health Assessment, it was noted that the Veteran had, in relevant part, a diagnosis of gout of the bilateral feet. A September 2019 VA medical record reveals that the Veteran has a confirmed diagnosis of gouty arthritis with period flare-ups. The clinician also noted that the diagnosis was evidence since 2009 by clinical presentation and laboratory. It was further noted that the Veteran was taking prescription medication. In a September 2019 VA Form 9, the Veteran noted that his gout attacks began in 2009 and that, at such time, he sought treatment for the severe pain and discomfort in both feet. As the attacks became more frequent and severe, the Veteran continued to seek treatment and the Veteran noted that he was diagnosed with gout in 2015. The Veteran stated that his in-service attacks were so severe that he would be removed from flight status for weeks at a time. The Veteran additionally reported that he was taking prescription medication to reduce his exacerbations. He further expressed his disagreement with the March 2017 VA examination in which the examiner determined that the Veteran did not have a diagnosis of gout; in this regard, the Veteran stated that the examiner did not perform a uric acid blood tests to determine the levels of uric acid and creatinine in his blood and there was no joint fluid test conducted. The Veteran also stated that the examiner failed to account for the fact that the Veteran had been prescribed high dosages of medication to control the uric acid that leads to attacks. Here, the Board recognizes that the March 2017 VA examiner determined that the Veteran did not have a diagnosis of gout. However, the Board finds this unfavorable opinion to be of little probative value as there is other information in the Veteran’s claims file supporting the fact that he has a diagnosis of gout. Further, the Board notes that the Veteran was diagnosed with gout during service; the Veteran has asserted that he had left and right foot pain in service continuing to the present; and a VA physician has also stated that the Veteran had gouty arthritis with periodic flare-ups since 2009, as noted by clinical presentation and laboratory testing. As such, the Board finds that the Veteran’s condition onset during service and, thus, entitlement to service connection for gout of the left and right feet is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.