Citation Nr: 21070275
Decision Date: 11/23/21	Archive Date: 11/23/21

DOCKET NO. 15-18 711A
DATE: November 23, 2021

REMANDED

The claim for service connection for gout is remanded.

REASONS FOR REMAND

The Veteran had active service from August 1991 to September 1994. He is seeking service connection for gout, which he believes started during service and has continued since service. 

The Board has previously remained the matter to the Agency of Original Jurisdiction (AOJ) in July 2018, September 2020 and May 2021 for further development.  In its May 2021 decision, the Board directed the AOJ to obtain an addendum opinion on direct nexus and specifically asked the examiner to address the lay statements from the Veteran, his family members, his colleagues and friends that he suffered from foot pain while in service. 

Subsequently, a VA medical opinion was obtained in June 2021. The examiner opined that it was less likely than not (less than 50 percent probably) that the Veteran's gout occurred during or was otherwise caused by his service.  The examiner provided a rationale which addressed the lay statements as well as other medical evidence.  The Board is satisfied that there has been substantial compliance with the remand directives.

However, the Veteran's representative argued in a written brief dated September 2021 that service treatment records (STRs) dated June 9, 1994 showed that the Veteran had findings of modest obesity, and that researchers discovered that people who had gained a lot weight as adults had a higher risk of developing gout, specifically, people who became obese as adults were 1.65 times more likely to develop gout.  Although no citation was provided for this statistic, this contention was not specifically addressed by the June 2021 VA medical opinion or any other previous medical opinions.  As such, the Board believes that such an argument should be considered by a medical professional.

STRs show that the Veteran weighed 209 pounds at the time of enlistment (see April 1991 enlistment physical), and he weighed 225 pounds at the time of separation (see June 1994 separation physical). His separation physical also noted moderate obesity. 

The matter is REMANDED for the following action:

Obtain a VA addendum opinion (if possible, from the June 2021 examiner). The examiner should answer the following question:

Is it at least as likely as not (50 percent or greater probability) that the Veteran's gout disability began during or is otherwise caused by this active service? Why or why not?

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In doing so, the examiner should address the representative's argument that the Veteran became obese (weighing 209 lbs at the time of enlistment and 225 lbs at the time of separation) during service and that this obesity (a possible risk factor for developing gout) led to his developing gout. (See 9/30/2021 document entitled "Appellate Brief").

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Q. Wang, 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.