GOUT

Summary

The veteran, who served in the Army from October 1978 to January 1979, appeals the denial of service connection for left hip and left shoulder conditions and the grant of service connection for gout affecting the left elbow, left hand, and left knee. The Board granted service connection for gout in the left elbow, left hand, and left knee, finding that the veteran had a confirmed diagnosis of gout during service and that the current diagnosis was reasonably related to the in-service condition. The Board noted the veteran's competent and credible testimony regarding the onset of gout during active duty and the existence of a confirmed diagnosis in service. For the left hip and shoulder conditions, the Board denied service connection due to insufficient evidence. The veteran described occasional shooting pain in the hip but provided no specific details or treatment records. Similarly, for the shoulder, the veteran claimed arthritis treated by multiple surgeries but offered no evidence of in-service onset, continuity of symptoms, or a nexus to service. The Board advised the veteran that he could submit a supplemental claim with more detailed statements or treatment records for these conditions.

Rationale

Confirmed diagnosis of gout in service; Reasonably related to in-service diagnosis; Competent and credible testimony of in-service onset

Full Decision Text

Citation Nr: A26037796
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 210621-167629
DATE: April 22, 2026

ORDER

Service connection for left elbow condition to include diagnosis of gout is granted.

Service connection for left hand condition to include diagnosis of gout is granted.

Service connection for left knee condition to include diagnosis of gout is granted.

Service connection for left hip condition to include chronic pain (also claimed as rheumatoid arthritis in the left hip) is denied.

Service connection for left shoulder condition to include chronic pain to include multiple surgeries is denied.

FINDINGS OF FACT

1. The Veteran's left elbow condition gout is related to service.

2. The Veteran's left hand condition to include a diagnosis of gout is related to service.

3. The Veteran's left knee condition to include a diagnosis of gout is granted.

4. A left hip disability is not currently manifested and did not manifest at any point during the appeal period.

5. A left shoulder disability is not currently manifested and did not manifest at any point during the appeal period.

CONCLUSIONS OF LAW

1. The criteria for service connection for gout of the left elbow have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

2. The criteria for service connection for gout of the left hand have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

3. The criteria for service connection for gout of the left knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

4. The criteria for service connection for gout of the left hip have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

5. The criteria for service connection for gout of the left shoulder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had service in the Army from October 1978 to January 1979.

These matters come before the Board of Veterans' Appeals (Board) on appeal of a March 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In a May 2021 VA Form 10182, the Veteran requested Board review of the rating decisions under the Hearing Review docket.  A hearing was held with the undersigned Veterans Law Judge on December 6, 2024 and a transcript has been associated with the record.  

Accordingly, the Board may consider the evidence of record as of the date of the prior rating decision on appeal, in addition to evidence submitted within 90 days following the date of the hearing, December 6, 2024.

1. Service connection for left elbow condition to include diagnosis of gout is granted.

2. Service connection for left hand condition to include diagnosis of gout is granted.

3. Service connection for left knee condition to include diagnosis of gout is granted.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

The Veteran generally contends that he should be entitled to service connection for gout
 be granted for any disease 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). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

The Veteran generally contends that he should be entitled to service connection for gout of the left elbow, hand and knee. See October 2020 VA 21-526EZ, Fully Developed Claim (Compensation).

The Veteran generally claims that gout initially manifested during active duty.

In the instant case a diagnosis of gout has been confirmed in the Veteran's elbow, hand and knee. See January 2025 opinion by Dr. W.D. Thus, the first element of service connection has been satisfied.\

Turning to the second element of service connection, evidence of in-service incurrence or aggravation of a disease or injury, the Veteran's service treatment records note a diagnosis of gout in 1979 during the Veteran's active duty service.

Further, the Veteran has competently and credibly reported acquiring gout while on active duty. See December 2024 Hearing Transcript. Thus, the second element of service connection has been satisfied.

As such, the primary question to be resolved with regard to the appealed issues enumerated above is whether the most probative evidence reflects that gout was caused by service.

The Board notes that the Veteran submitted a private opinion in January 2025, in which Dr. W.D. stated that the Veteran was being treated for gout and that he has been treated for such for the past 20 years.  The Board notes that as the RO has previously conceded that the Veteran had a diagnosis of gout in service, this current diagnosis of gout is reasonably related to the in service diagnosis.  

Since the evidence is persuasively in favor of a nexus between the Veteran's service and his gout, service connection for gout of the elbow, hand and knee is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Service connection for left hip condition to include chronic pain (also claimed as rheumatoid arthritis in the left hip) is denied.

The Veteran contends that he has a left hip condition related to service.  At the outset, the Board notes the Veteran has never been diagnosed with a left hip injury or disease. See December 2024 Hearing Transcript. 

The existence of a current disability is the cornerstone of a claim for VA disability benefits.  See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997).  Therefore, in the absence of current disability, there can be no valid claim.  See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).  

However, for VA purposes, a "disability" is not a physical or mental pathology per se, but rather the effect such a condition is having on a veteran's ability to function in a civilian job. 38 C.F.R. §§ 3.321(a), 4.1, 4.2, 4.10. See also, Clemons v. Shinseki, 23 Vet. App. 1, 4 (2009) (holding "the appellant did not file a claim to receive benefits only for a particular diagnosis, but for the affliction his [] condition, whatever that is, causes him."); Saunders v. Wilkie, 886 F.3d 1356, 1362 (Fed. Cir. 2018) (holding under 38 U.S.C. § 1110, "disability" refers to functional impairment of earning capacity, not the underlying injury or disease causing that impairment). 

The Federal Circuit has explicitly held that requiring a formal diagnosis before finding a disability is "the wrong legal standard" because in Saunders, the Court "articulated a definition of 'disability'...distinct from and not coextensive with disabilities listed on the rating schedule." Larson v. McDonough, 10 F.4th 1325, 1329 (Fed. Cir. 2021).

In short, under the provisions of 38 U.S.C. §§ 1110 and 1131, evidence of a functional impairment may establish a disability even if the underlying pathology causing it remains unidentified.  

The Veteran described occasional "shooting pain" on movement, but did not
 not the underlying injury or disease causing that impairment). 

The Federal Circuit has explicitly held that requiring a formal diagnosis before finding a disability is "the wrong legal standard" because in Saunders, the Court "articulated a definition of 'disability'...distinct from and not coextensive with disabilities listed on the rating schedule." Larson v. McDonough, 10 F.4th 1325, 1329 (Fed. Cir. 2021).

In short, under the provisions of 38 U.S.C. §§ 1110 and 1131, evidence of a functional impairment may establish a disability even if the underlying pathology causing it remains unidentified.  

The Veteran described occasional "shooting pain" on movement, but did not provide sufficient detail to support a finding of a functional disability. Notably, the Veteran mentioned during his hearing testimony that he had been treated for hip problems, but he could not recall the name of the practice, and no treatment records are in the record at this juncture.  

If, in the future, the Veteran is able to provide medical treatment records, or, in the alternative, he can provide a more detailed and specific statement as to the precise limitations imposed by his hip and shoulder conditions, he may submit a supplemental claim for service connection. See 38 U.S.C. § 5104C(a)(2)(A) and (B) (while a veteran may not pursue both a Board appeal and a supplemental claim simultaneously, there is no prohibition on doing so in succession); 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 3.2501 (the AOJ will readjudicate a claim if new and relevant evidence is submitted with a supplemental claim).

Additionally, the Board observes if the Veteran submits a supplemental claim within one year of this decision, that claim will constitute "continuous pursuit" of the issue, and therefore the date of his original claim, not the new supplemental claim, will apply for purposes of determining the effective date of any award of benefits based on the readjudication. 38 U.S.C. § 5110(a)(2); 38 C.F.R. § 3.2500(h)(1) (under the AMA, the date of the initial claim applies so long as the Veteran "continuously pursues" the benefit in question by timely and properly filing an appeal or other administrative review option after a VA decision on the initial claim); Calhoun v. McDonough, 37 Vet. App. 96, 103 (2024) (the concept of continuous pursuit applies to supplemental claims submitted after Board decisions as well as to those submitted after AOJ decisions).

At this point, however, the evidence is insufficient to establish the existence of a left hip or left shoulder disability, even in light of the benefit-of-the-doubt doctrine, and therefore, as to this issue, this appeal must be denied.

5. Service connection for left shoulder condition to include chronic pain to include multiple surgeries is denied.

The Veteran contends he has arthritis of the left shoulder, which has been treated via multiple surgeries. See December 2024 Hearing Transcript. 

While the limitations on the admissibility of hearsay evidence applicable in many other forums do not prevent the Board from accepting the Veteran's statement as a true and accurate diagnosis, without any additional information as to the extent, nature, or origin of his left shoulder condition, the Board cannot find service connection.

If the Veteran provides additional information concerning in-service onset of arthritis, an in-service disease or injury that was the incurrence of his current arthritis, he may establish direct service connection for this disability. 38 C.F.R. § 3.303(a) and (d). 

Additionally, if his condition is indeed arthritis, and he provides evidence that he had shoulder-related symptoms that were "noted" (meaning simply that they were noticed as opposed to that they were documented) during service and the persistence of those symptoms after service, he may establish service connection by continuity and chronicity even without medical evidence of a nexus.  38 C.F.R. § 3.303(b). See the preceding section for more information concerning the benefits of a supplemental claim.

At this point, however, the evidence is insufficient to establish any connection to service between left shoulder arthritis and service, even in light of the benefit-of-the-doubt doctrine.  Therefore, as to this issue, this appeal must be denied.  

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Nadia Kamal, 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.