VA Disability Benefits for Gout
What is Gout?
Gout is a common and complex form of arthritis that can affect anyone. It is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, often the joint at the base of the big toe. Attacks of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint becomes extremely hot, swollen, and tender. Other signs and symptoms of gout may include the following:
- Intense joint pain. Gout usually affects the large joint of the big toe, but can also affect the ankles, knees, elbows, wrists, and fingers. The pain is usually the most severe within the first 4 to 12 hours after it begins.
- Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks.
- Inflammation and redness. The affected joint(s) become swollen, tender, warm, and red.
- Limited range of motion. As gout progresses, you may not be able to move your joints normally.
You are more likely to develop gout if you have high levels of uric acid (i.e. a natural waste product from the digestion of foods that contain purines) in your body. Factors that may increase uric acid levels include a person’s diet, weight, medications, and family history. However, veterans may also experience gout as a result of their military service. If this is the case, they may be eligible to receive VA disability benefits.
Service Connection for Gout
Veterans can obtain service connection for gout in a number of ways. First, veterans can apply for service connection on a direct basis. To establish direct service connection, the following three elements must be present:
- A current diagnosis of gout
- An in-service event, injury, or illness
- A medical nexus linking the current diagnosis of gout to the in-service event
However, veterans may also be eligible for service connection for gout on a secondary basis. A secondary service-connected condition is one that is caused or aggravated by an already service-connected condition. If you are claiming secondary service connection for gout, providing a nexus opinion will be especially important. Specifically, the nexus must state that your gout is “at least as likely as not” caused or aggravated by your primary service-connected condition.
How Does VA Rate Gout?
VA rates gout according to 38 CFR § 4.71a, Schedule of Ratings – Musculoskeletal System, Diagnostic Code 5002. The rating criteria is as follows:
- 100% – with constitutional manifestations associated with active joint involvement, totally incapacitating
- 60% – less than criteria for 100% but with weight loss and anemia productive of severe impairment or healthy or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods
- 40% – symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring three or more times a year
- 20% – one or two exacerbations a year in a well-established diagnosis
TDIU for Gout
Total disability based on individual unemployability (TDIU) is a disability benefit that allows for veterans to be compensated at VA’s 100 percent disability rate, even if their combined schedular disability rating does not equal 100 percent. TDIU is awarded in circumstances in which veterans are unable to secure or follow substantially gainful employment due to their service-connected conditions. As such, if your gout contributes to your inability to work, you should consider applying for TDIU. You can apply for TDIU on its own or when filing for an increased rating. In both cases, you will need to fill out and submit VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability.
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