Gout is an inflammatory disorder caused by an accumulation of uric acid in the joints. The body needs uric acid to break down purines that are found in certain foods, such as seafood and steak. However, if too much acid accumulates, it will not dissolve in the body properly and will instead form urate crystals in the joints. Gout is famous for affecting the big toe and ankles, but the acid can technically build up in any major weight-bearing joint, including the fingers, wrists, knees, and elbows.
Common symptoms of gout include:
- Intense joint pain
- Swollen and inflamed joints
- High uric acid levels
- Kidney stones
- Limited range of motion
- Burning sensations
It should be noted that gout does not always have noticeable symptoms. While asymptomatic gout may not be painful, it’s important to know if you have too much uric acid in the joints, as this may eventually lead to pain or discomfort in the body.
Related conditions include pseudogout, which looks and feels similar to gout except that it’s caused by a buildup of calcium pyrophosphate dihydrate (CPPD) crystals. Stress fractures, skin or joint infections, and inflammatory arthritis can also present similar symptoms to gout. The VA sees gout as a type of arthritis under its code, though it will differentiate in its records if you suffer from gout.
VA Service Connection for Gout
You might think that gout has everything to do with the diet, but the causes of gout symptoms are more complicated than that. If you’re filing a disability claim, you should know that trauma has been known to cause gout.
Finding a service connection for this condition begins with understanding how disability benefits work, as you’ll need to prove that your gout was caused by something that occurred in the military. For example, if you witnessed a tragic event in the service, you may have a direct connection to your gout attacks.
To start your claim for gout, you’ll need the following paperwork:
- A full description of the events in the service that led to gout
- A letter from your doctor stating that the events in the military directly triggered the gout
- A recent diagnosis of gout from your doctor
Gout can sometimes be difficult to connect to the military, largely because there are a number of potential risk factors. If you’re applying for any kind of benefits, including a Residual Functional Capacity (RFC) form for a Social Security disability, it’s best to explain the situation in as much detail as possible with your doctor to get a better idea of the potential connection.
Secondary Service Connection for Gout
The VA recognizes that service members may develop more than one condition from a service-connected disability. These claims are generally easier to prove for gout, as gout can often be caused by a number of contributing factors. For instance, certain kinds of medication taken for hypertension can lead to uric acid buildup. If you had a direct service connection for high blood pressure, you can potentially file for a secondary for gout.
Another example would be if you developed obesity after experiencing depression after long-term stress in the military. In this case, the depression would be the primary service connection and obesity and gout might be considered the secondary connections. Whether you’re filing with Social Security Administration for social security disability benefits or through the VA, you need to show how your gout affects your ability to work or go about your daily routine.
Service connections do not necessarily have to stem from events where you were technically on active duty. For example, if you were overseas but technically off duty when the event occurred, you are still eligible to file for benefits.
To file a claim for chronic gout, you’ll need a diagnosis from your doctor, a description of the events that caused both the primary and secondary connections, and a confirmation letter from the doctor that states the primary condition caused the secondary condition.
Service Connection by Aggravation | What if you were diagnosed with Gout before the service?
If you had gout before joining the service, especially asymptomatic gout, you can still file for disability benefits if you can show that your condition was made worse while in the service. For instance, if you had a family history of gout, but you found that your gout attacks became more intense after experiencing a traumatic event or severe lifestyle changes in the military. From the SSA to the VA, the right disability attorney from the right law firm can make it easier to show how exactly your body was affected by the demands of the military.
Compensation & Pension (C&P) Exams for Gout
After you’ve submitted your paperwork to the VA Regional Office (RO), the VA will typically request that you schedule a Compensation & Pension (C&P) exam with a VA doctor. The VA doctor will not treat your gout, but they will examine your medical records as well as your joints to determine the severity of the disease. They’ll also ask questions about how the affected joint is related to your time in the service.
After the VA doctor writes up their findings on your medical conditions, they’ll send their opinion to the RO who will use this information to make their decision. If the RO denies your claim, you can still appeal with the help of the Appeals Modernization Act (AMA).
The AMA allows veterans to appeal in three ways:
- Request a higher authority than the RO to review your case
- Request a different reviewer at the RO
- Gather and submit additional medical evidence to the RO
The VA allows veterans the opportunity to argue their case again if they’re denied. In some cases, a veteran may need additional documentation (e.g., blood tests, X-rays, etc.) to prove the severity of their condition. In other cases, they may just need a different person to look over the evidence — preferably a VA official who specializes in joint disorders.
VA Ratings for Gout
Gout is considered a form of arthritis and falls under the VA diagnostic code. The VA will rate your condition depending on the severity of your pain and whether your disabling conditions prevent you from working. Those who are entirely incapacitated by the disorder may receive a rating of 100, resulting in the maximum amount of benefits.
However, others with milder cases may receive a lower rating. The VA will look at how often your major joints are affected per year. If you have one or two flare-ups per year and an established diagnosis, this will likely rate at 20%. If you have three or more exacerbations per year, this may result in a 40% rating. If you have documented weight loss, anemia, and four or more exacerbations per year (but are not entirely incapacitated), this may result in a 60% rating.
This is why it’s so important to talk to your doctor about the pain you’re experiencing and why you believe it’s connected to your time in the service. The SSA will use a Blue Book to determine how your gout will affect your past work. The VA will follow a similar process, but they first need to see the connection. The more documentation you have and the clearer the connection is, the more likely it is that you’ll be rated at the proper percentage.
TDIU for Gout
From SSDI to VA benefits, disability lawyers can be the key to getting the best possible results of your claim. They’ll review the paperwork from your rheumatologist to see if your gout meets the standards for Total Disability based on Individual Unemployability (the backdoor to a 100% rating from the VA). They’ll maintain an attorney-client relationship whether you’re applying for SSI or service-connected benefits.