Citation Nr: 20022424 Decision Date: 03/31/20 Archive Date: 03/31/20 DOCKET NO. 17-57 574 DATE: March 31, 2020 ORDER Entitlement to service connection for gout, to include as secondary to service-connected right knee condition is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s gout had its onset in service or was proximately caused or aggravated by a service-connected condition. CONCLUSION OF LAW The criteria for establishing service connection for gout including as secondary to right knee condition have not been met. 38 U.S.C. §§ 1101, 1110, 1113, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1989 to October 1989 and December 2003 to March 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a Board hearing before the undersigned Veterans Law Judge in February 2020. A transcript of the hearing is in the Veteran’s file. Entitlement to service connection for gout, to include as secondary to service-connected right knee condition The Veteran contends that his gout is secondary to his service-connected right knee strain with meniscectomy. At a February 2016 VA examination, the VA examiner noted a diagnosis for gout and opined that it is less likely than not connected to of the Veteran's service-connected right knee condition. The examiner noted that the Veteran’s intake of meats is likely contributing to his gout. At the February 2020 Board hearing, the Veteran stated he has changed his diet to include less red meat, but it did not result in any improvement for his gout. He testified that his VA provider said his gout came from scar tissue in the knee. VA treatment records, however, do not contain any such opinion. In fact, November 2017 VA treatment records show his provider explicitly stated that he will only write a letter that shows gout is service connected if STRs show the Veteran had gout while on active duty. The Board finds that the Veteran's claim for entitlement to gout must be denied on a direct basis because there is no evidence of an in-service injury or disease; his service treatment records are silent for any signs or symptoms of gout. The Board also finds that the Veteran's claim must be denied on a secondary basis based on the February 2016 VA opinion and the November 2017 provider’s note mentioned above. The VA examination reports explain that the Veteran's gout is not related to his right knee condition but is instead a due to his diet. Further, his VA provider was also not able to provide a nexus to service. The Veteran believes his right knee gout is related to his service-connected right knee condition, however, in this case, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it concerns internal processes, and the interrelationship between divergent medical conditions. Therefore, it is outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical opinion of record. Accordingly, service connection for gout on a direct and secondary basis is not warranted, as the Veteran's service treatment records are silent for any signs or symptoms of gout and gout was not shown to be proximately due to or aggravated by his service-connected right knee condition. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jaigirdar, Associate 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.