Citation Nr: 21006957 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 16-28 948 DATE: February 8, 2021 ORDER Service connection for right foot gout is denied. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s right foot gout began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for right foot gout have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1977 to August 1998. The Veteran testified before the undersigned Veterans Law Judge at an August 2019 hearing. A complete transcript is of record. This appeal was previously before the Board in September 2020. The Board remanded the Veteran’s service connection claims for right foot gout and a right foot condition, to include pes planus and plantar fasciitis, for further development. The Board sought an etiology opinion, that took into account his service treatment records (STRs) which show painful right toes and his testimony that he experienced gout symptoms soon after his separation from the military. The Veteran’s service connection claim for pes planus was remanded to clarify the diagnosis because there was an indication that he may have a diagnosis for plantar fasciitis. The Veteran was afforded a VA examination for gout in October 2020. The examiner indicated that they reviewed the Veteran’s medical records. The examiner’s report noted that the Veteran testified at the August 2019 Board hearing that the onset of his gout was right after he separated from the military. After an in-person examination and a review of the Veteran’s claims file, the examiner provided a medical nexus opinion. As such, the Board finds that there has been substantial compliance with the September 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran was afforded VA examinations for pes planus and plantar fasciitis in October 2020. The VA examiner noted that the Veteran was diagnosed with pes planus, plantar fasciitis, and degenerative arthritis of the right foot. A subsequent November 2020 rating decision granted the Veteran service connection for a right foot disability and assigned a 20 percent rating, effective February 23, 2012. That decision is considered a full grant of benefits sought on appeal, and the appeal concerning a right foot condition, to include pes planus and plantar fasciitis is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). Service connection for gout is denied. The Veteran asserts that the gout in his right foot is due to his active duty service. Specifically, the Veteran testified that the first physical ailment he sought medical treatment after his separation from the military, was for gout. He stated he saw a doctor because his toes swelled up. The Board notes that the Veteran has been diagnosed with gout in his right foot. See Private Treatment Record dated April 18, 2016. The Veteran’s STRs show that he complained of pain in his right toes. See STR dated October 19, 1979. However, there was no specific diagnosis for gout. The Veteran testified at the August 2019 Board hearing that the onset of his gout was right after he separated from the military. He stated that it was the first thing he saw a doctor for when he got out because his toes would swell up. The Veteran has submitted medical opinions from February 2016, March 2016, and May 2019, from three different physicians, which all provided positive nexus opinions for the Veteran’s gout. However, they were all conclusory statements and did not provide a rationale for why they believed the Veteran’s gout was related to his active duty service. None of the examiner’s provided a sufficient rationale that discussed or explained why the specific facts of the Veteran’s case warranted a positive nexus opinion. As such, the September 2020 Board decision afforded those nexus opinions very little probative weight and remanded the issue for a new VA examination, to obtain an etiology opinion. The Veteran was afforded a VA examination in October 2020. The examiner reported that the Veteran stated that he was diagnosed with gout in 2005. The Veteran reported that several years ago, his right toe swelled and he was diagnosed with gout. On examination, there were no findings of gout; the examiner noted that the great toe was normal and there were normal levels of uric acid. The Veteran underwent an x-ray in April 2020, which showed no evidence of gout. After an in-person examination and a review of the Veteran’s claims file, to include the August 2019 Board hearing testimony and the September 2020 Board remand directives, the examiner provided a negative nexus opinion. The examiner acknowledged that the Veteran had gout flares, but reported that there were no findings of gout during the examination because there the great toe was normal and his uric acid levels were also normal. The examiner stated that the claimed right foot gout was less likely as not incurred in or caused by the complaints after service or during service. The examiner explained that a review of the in-service and post-service medical records showed no clinical findings of gout during or proximate to active duty service. Further, the examiner noted that the Veteran reported that he was diagnosed with gout in 2005. To the extent that the Veteran believes that his gout is the result of his complaints of swollen toes soon after his separation from the military, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Given that the Veteran testified that the first physical ailment he sought medical treatment for after his separation from the military, was his gout; a VA examination was ordered to address the medical and lay evidence of record and to provide an etiology opinion. Unfortunately, the October 2020 VA examiner provided a negative nexus opinion. The Board notes that although the Veteran has offered several competent medical opinions, none were supported by a sufficient rationale to support service connection and have not undermined the VA examiner’s medical opinion in regard to service connection for gout. Here, there is only one sufficient medical opinion of record, the October 2020 VA examiner’s opinion that the Veteran’s gout is not related to his active duty service. The Board acknowledges the private nexus opinions submitted by the Veteran. The February 2016, March 2016, and May 2019 private physicians are all competent to provide medical nexus opinions. However, as discussed, the Board has afforded the private nexus opinions very little probative weight because their respective opinions were not supported by any meaningful rationale. The Board affords the October 2020 VA examiner’s opinion great probative weight because the examiner thoroughly examined the Veteran’s claims file and provided an explanation for their negative nexus opinion. To rebut the October 2020 VA examiner, the Veteran must provide a medical opinion from a competent medical professional, with a sufficient rationale that supports their opinion. The Board acknowledges the Veteran’s sincere belief that his gout is a result of his active duty service. The Board recognizes his testimony that he sought medical treatment for swollen toes, soon after he separated from the military, in 1998. However, the Board also points out that the Veteran reported at the October 2020 VA examination, that he was diagnosed with gout in 2005. The contemporaneous medical evidence of record, as noted by the October 2020 VA examiner, does not contain any clinical evidence of gout during or proximate to active duty service. The Board is sympathetic to the Veteran’s claim and does not wish to minimize his assertions or beliefs. However, the criteria for service connection have not been met; until a competent positive nexus opinion, with an adequate rationale is associated with the Veteran’s claims file, the Board cannot resolve reasonable doubt in his favor because the weight of the evidence is not in relative equipoise. Accordingly, service connection for right foot gout is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, 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.