Gout VA Rating

Gout sits in an odd spot in the rating schedule. It's a metabolic disease that attacks joints, but VA doesn't rate it on its own terms. Under 38 CFR § 4.71a (opens in a new tab), gout carries diagnostic code 5017, and since February 7, 2021, the schedule directs that DC 5017 be evaluated as degenerative arthritis, based on limitation of motion of the affected parts. So the rating analysis for a gout claim runs through the general arthritis rules at DC 5003 and the motion codes for each joint. That borrowing is the first thing to understand, because it controls everything that follows.

It is also a change that much of the gout guidance still in circulation does not reflect. Before February 7, 2021, gout was rated under DC 5002, which offered two methods that did not add together: an active-process method based on incapacitating flares, weight loss, anemia, and impairment of health, and a chronic-residuals method based on limitation of motion or ankylosis, with the higher of the two assigned. The 2021 musculoskeletal rewrite retitled DC 5002 so that it expressly excludes gout. Today the rating turns on measured motion in each joint gout has damaged, with painful motion, swelling, and flare-up losses factored in. Guidance written for the old two-method rule can mislead a claim built today, unless that claim was already pending when the rule changed.

This page walks through DC 5017 and the DC 5003 rules it now borrows, what happened to the old DC 5002 method, why flare documentation still matters under 38 CFR § 4.40 (opens in a new tab) and § 4.45 (opens in a new tab), the C&P exam, the secondary chains through diuretics and kidney disease, and why VA denies gout claims. Remand is the most common Board outcome on these cases, at more than half of decided rulings, so the documentation problem is the story.

TL;DR

• Gout is rated under 38 CFR § 4.71a at DC 5017. Since February 7, 2021, DC 5017 is evaluated as degenerative arthritis, based on limitation of motion of the affected joints.
• DC 5002 now expressly excludes gout. Its active-process method (incapacitating exacerbations, weight loss, anemia, impairment of health) still governs periods before February 7, 2021, and, for a claim pending on that date, later periods when it is more favorable.
• Each affected joint is rated on its own limitation-of-motion code. When the loss of motion is noncompensable but objectively confirmed by swelling, muscle spasm, or painful motion, DC 5003 allows 10% for each major joint or group of minor joints, combined rather than added.
• The X-ray-only 10% and 20% ratings in DC 5003 are not available for gout. A note to DC 5003 bars them for DCs 5013 through 5024, and gout is DC 5017.
• Flares still matter. Under §§ 4.40 and 4.45, DeLuca v. Brown, and Sharp v. Shulkin, the rating has to account for added functional loss during flare-ups, and the examiner has to estimate the added loss of motion during a flare or explain why that is not feasible.
• A gout rating already in effect under the old DC 5002 method on February 7, 2021, cannot be reduced because of the schedule change alone unless the disability actually improved (38 CFR § 3.951(a)).
• Secondary chains under 38 CFR § 3.310: gout is associated with chronic kidney disease, and thiazide and loop diuretics raise uric acid, so a diuretic taken for a service-connected condition can support a secondary claim.
• A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 2,013 decided Board rulings on gout from 2021 to 2026, 17.7% were granted, 26.8% denied and 55.4% remanded. Remand is the most common outcome, and gout's grant rate sits 7 points below the Board-wide 24.7%.

Gout VA rating criteria (DC 5017)

DC 5017 has no rating criteria of its own. The schedule lists gout among DCs 5013 through 5024, and one note covers the whole group.

Note to DCs 5013 through 5024: Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.

So each affected joint is rated on its limitation of motion or, in severe cases, ankylosis, under the code for that joint: a gouty ankle under the ankle codes, a knee under the knee codes. For the big toe, the Board has looked to the foot codes. In a January 2025 decision, it rated gouty arthritis of a veteran's great toe at 30 percent under DC 5284 because the functional loss was equivalent to a severe foot injury (Citation A25002836).

When the motion loss isn't compensable under a joint's own code, DC 5003 provides a floor.

When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 pct is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.

38 CFR § 4.59 (opens in a new tab) points the same way: with any form of arthritis, painful motion is an important factor of disability, and the schedule intends to recognize painful motion with joint or periarticular pathology as productive of disability. Under § 4.45, the shoulder, elbow, wrist, hip, knee and ankle are major joints, and multiple involvements of the small joints of the foot (interphalangeal, metatarsal and tarsal) count as a group of minor joints.

One DC 5003 route is closed to gout. DC 5003 also has X-ray-based ratings of 10% and 20% for involvement of two or more major joints or minor joint groups when there is no limitation of motion, but Note (2) to DC 5003 says those X-ray ratings are not used for DCs 5013 through 5024. For gout, the rating has to come from motion findings, painful motion, or the objective findings that confirm them.

Gout most often attacks the joint at the base of the big toe (PMID 25591183). In a study done to update the gout classification criteria, the big toe joint was the most common pattern, and tender joints elsewhere in the foot or ankle and an attack that settles within two weeks were among the features that marked gout (PMID 25777045). A limitation-of-motion rating is measured on one exam day, and a joint measured between attacks can look close to normal. That mismatch is why the flare-up estimate carries so much weight. Long-standing gout that has damaged several joints usually rates on the permanent motion loss in each of them.

The rule was different before February 7, 2021. The old note to DCs 5013 through 5024, as the Board has quoted it, said those diseases "will be rated on limitation of motion of affected parts, as arthritis, degenerative, except gout which will be rated under diagnostic code 5002" (Citation A25011113). The 2021 rewrite (85 FR 76453, November 30, 2020) retitled DC 5002 as multi-joint arthritis "except post-traumatic and gout," which took gout out of that code.

The old DC 5002 method and claims pending in 2021

Before February 7, 2021, gout was rated under DC 5002 as an active process. The tiers below are the current DC 5002 text, which now covers rheumatoid arthritis and similar disease; Board decisions describe the same tiers for gout before the change (Citation A25002836).

100 percent: With constitutional manifestations associated with active joint involvement, totally incapacitating

60 percent: Less than criteria for 100% but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods

40 percent: Symptom combinations productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year

20 percent: One or two exacerbations a year in a well-established diagnosis

DC 5002 never defined an incapacitating exacerbation, so the Board borrows the definition used elsewhere in the schedule: acute signs and symptoms that require bed rest prescribed by a physician and treatment by a physician (Citations 25002437 and A25002836). A flare you rode out at home without a doctor's order for bed rest is hard to count toward the 40% or 60% tiers. The old method also allowed chronic residuals to be rated on limitation of motion instead, with the higher of the two evaluations assigned.

Which rules apply depends on when your claim was filed.

• Claim filed after the change. If the whole appeal period, including the one-year look-back for an increase, falls after February 7, 2021, only the new rules apply (Citation A25002836).
• Claim or appeal pending on February 7, 2021. VA applies the old criteria to the period before the change. From that date, it considers both the old and the new criteria and uses whichever is more favorable to you (38 U.S.C. § 5110(g); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003)). In one long-running appeal, the Board assigned a 40 percent rating for gout in both ankles from March 1, 2021, under the old tiers, for incapacitating episodes three or more times a year (Citation 25002437).
• Rating already in effect. Under 38 CFR § 3.951(a), a readjustment to the rating schedule is not grounds for reducing a rating in effect on that date unless medical evidence establishes that the disability actually improved. In the 2025 decision above, VA had kept a 20 percent gout rating from the old criteria as a protected evaluation (Citation A25002836).

Rating several joints: pyramiding and the old higher-of-two rule

Under the old DC 5002 method, you did not get an active-process rating plus a chronic-residuals rating. The code told raters to assign whichever was higher, and rating the same gout both ways would have been pyramiding under 38 CFR § 4.14 (opens in a new tab). For a claim period governed by the old criteria, a decision that rated only the joint residuals and never computed the active-process picture, or the reverse, did half the analysis.

Under the current rule the question is different. Each joint gout has damaged is rated on its own, and ratings for separate joints combine under § 4.25. The great toe and the ankle are different joints, and each can carry its own rating. What § 4.14 still bars is evaluating the same disability under various diagnoses: the same joint's loss of motion cannot be counted under two codes. The line between "the same joint, two ways" (barred) and "two separate joints damaged by gout" (allowed) is where these decisions get argued.

Gout flares and your VA rating

Gout is still episodic, and the rating still has to reckon with the attacks. Under 38 CFR §§ 4.40 and 4.45 and DeLuca v. Brown, 8 Vet. App. 202 (1995), a motion-based rating has to account for functional loss from pain, weakness, fatigability, and incoordination, including during flare-ups. Under Sharp v. Shulkin, 29 Vet. App. 26 (2017), when a flare-up cannot be observed at the exam, the examiner has to get the flare history from you and estimate the additional loss of motion during a flare, or explain why an estimate is not feasible. So the single most valuable thing in a gout file is still a dated, specific record of flares.

What a flare looks like in a useful record: the date it started, which joint, how severe the pain and swelling were, how far the joint could move, whether you could bear weight or work, what treatment was needed (a course of colchicine, prednisone or an NSAID, which are standard treatments for an acute attack per PMID 25591183, or an urgent-care or ER visit), and how many days it lasted. A flare that kept you off your feet for four days, with the ankle too swollen to flex, gives an examiner something to estimate from. A flare mentioned in passing as "occasional gout" tells the rater nothing it can use.

The problem is that gout is treated episodically and often at home. A veteran who knows the drill takes their colchicine, stays off the foot for a few days, and never generates a medical note for that attack. Multiply that across a year and a veteran with eight genuinely disabling flares can have a chart that documents one. The rating follows the chart, not the disease, so the undocumented attacks drop out of the picture.

This is where your own documentation does real work. A flare log with dates, the joint, pain level, days unable to work or walk, and the medication taken gives the examiner a record to estimate from. Use a symptom tracker for gout flares to keep the log as attacks happen, because a log written in real time is more credible than a history reconstructed from memory at the exam. For any period still rated under the old DC 5002 criteria, the same log supplies the exacerbation count, and a note showing a doctor ordered bed rest is what makes a flare incapacitating. Pharmacy refill records for colchicine, prednisone, or allopurinol corroborate the frequency.

Lay statements count here because gout flares are observable to a non-expert. You are competent to report that your toe swelled and you couldn't walk, and a spouse is competent to report watching it happen (Layno v. Brown, 6 Vet. App. 465 (1994)). That testimony is probative on the frequency and severity of attacks no clinician witnessed, as long as it's credible and consistent.

The gout C&P exam

The gout C&P exam is harder to get right than a typical orthopedic exam, and the Board data fits that: 55.4% of decided Board rulings on gout ended in a remand, 10.1 points above the Board-wide remand share of 45.3%. An inadequate VA exam or opinion was the most common reason the Board sent gout claims back; the Board section below shows how often each reason came up.

A complete gout exam has to capture both the joints and the flares. The examiner needs goniometer range-of-motion measurements for every joint gout has affected, not only the one that hurts on exam day, with the point where pain begins, repetitive-use testing, and notes on swelling, tophi, deformity, or ankylosis. Because you are usually seen between attacks, the examiner also needs a flare history and, under Sharp, an estimate of the additional motion loss during a flare. If the claim covers a period still governed by the old criteria, the old active-process questions (frequency of incapacitating exacerbations, weight loss, anemia, which means lab work, and impairment of health) also need answers for that period.

The exam fails most often in predictable ways. The examiner sees you on a day with no active flare, records normal or near-normal joints, and writes the condition up as quiescent without ever capturing the flare history or estimating the flare-up losses. Or the examiner documents the joints but never addresses flares at all. Or the exam measures range of motion in a single joint and ignores the others gout has touched. An exam that rates only what's visible on a quiet day is the kind the Board sends back, and a second exam with a real flare history can move the rating.

Give the examiner the flare history out loud and on paper. Use C&P exam prep to organize the frequency, severity, and duration of your attacks, and ask the examiner to measure every affected joint and estimate the added loss of motion during a flare.

Is gout service connected? Direct, presumptive and secondary claims

Direct and presumptive service connection

Direct service connection needs a current diagnosis, an event or onset in service, and a medical link between them. The strongest direct claims have a flare treated in service: a sick-call note for a swollen big toe, a uric acid test, a colchicine prescription. Board decisions treat gout as arthritis, a chronic disease under 38 CFR § 3.309(a) (Citation 25001991), so service connection can be presumed if gout reached 10 percent or more within one year after separation (§ 3.307(a)(3)), or shown by continuous symptoms since service. Gout is not on the herbicide list in § 3.309(e), but the Board has told examiners not to rest a negative opinion on that absence (Citation 25000409).

Gout secondary to diuretics for hypertension

Thiazide and loop diuretics can raise uric acid (PMID 25591183). In 5,789 adults with hypertension, diuretic use raised serum urate and was associated with new gout, an association explained by the rise in urate (PMID 22031222). A UK case-control study that compared 91,530 people newly diagnosed with gout against matched controls found the same for loop, thiazide and thiazide-like diuretics, but not potassium-sparing ones (PMID 24449584). A veteran who takes a diuretic for a service-connected condition, often hypertension or a heart condition, and then develops or worsens gout has a secondary theory under 38 CFR § 3.310 (opens in a new tab), which covers a condition caused or aggravated by a service-connected disability (Allen v. Brown, 7 Vet. App. 439 (1995)). Aggravated means the gout would be less severe but for that treatment. Secondary conditions to hypertension lists the conditions most often claimed secondary to high blood pressure.

Gout and kidney disease

The kidneys excrete roughly 70 percent of the uric acid the body makes each day, so failing kidneys can push urate up (PMID 34502127). A meta-analysis found gout independently associated with chronic kidney disease and kidney stones, and about one in four people with gout had stage 3 or worse chronic kidney disease (PMID 25889144). Those are associations, not proof of cause in one veteran. A veteran with service-connected gout who develops kidney disease or kidney stones has a secondary theory, and the kidney rating can be substantial, but the opinion has to describe the mechanism and time course in your records.

Both chains live or die on the medical opinion. A bare statement that "the diuretic caused the gout" isn't probative; an opinion that walks through the uric acid pathway and the chronology carries the case. If the claim is that a service-connected condition made gout worse, the opinion has to answer aggravation directly; one that addresses only causation is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)). The Board section below shows how direct, secondary and presumptive gout claims fared.

Why VA denies gout claims

When the Board denied gout service connection, it most often found no link between the gout and service, and often no event or onset in service; the Board section below shows how often each part of the claim failed and why claims were sent back. Across the gout decisions I review, the same gaps repeat.

No link to service. The gout started years after separation, there is no in-service flare or treatment, and no opinion explains a secondary chain. This is the most common reason a gout service connection claim fails.

No usable flare record. The disease is episodic, and the chart documents a fraction of the attacks because most flares are managed at home. Without dated records of flares, the examiner has little to base a flare-up estimate on, and for any period rated under the old DC 5002 criteria, the rater can't reach the 40% or 60% tiers no matter how bad the disease actually was. Symptom logs, pharmacy refill records, and lay statements are what fill this gap.

The C&P exam catches a quiet interval. Gout looks fine between flares. An exam on a good day records near-normal joints and undercounts the disease, and remand, the outcome the Board uses to get a new exam, is the most common result on gout appeals.

Old and new rules blurred. A claim pending on February 7, 2021, can involve the old DC 5002 method for the earlier period and the better of the two methods afterward. A decision that applies one set of rules to the whole period without saying so, or an argument that relies on the old flare-count tiers for a claim filed after the change, misses how the rules now work.

Missing labs for the old higher tiers. The old 60% tier referenced weight loss and anemia, and anemia is a lab finding. For periods still rated under the old criteria, missing blood work leaves that prong with nothing to stand on.

The kidney and medication secondaries go unclaimed. Veterans with service-connected gout and chronic kidney disease, or with gout that worsened on a diuretic taken for hypertension, often never raise the secondary theory. The conditions sit in the file as unrelated when § 3.310 connects them.

I don't know exactly what share of gout claims have one or more of these gaps. What I can say from Claim Raven's read of 2,013 decided Board rulings on gout is that remands ran at 55.4%, the most common single outcome, denials at 26.8%, and grants at only 17.7%. Appeals over service connection fared worse than appeals over the rating; the Board section below shows results by what the appeal asked for. The Board is sending gout cases back for better exams and flare development more often than it's granting them outright.

When a decision measures only one joint, skips the flare-up estimate, or does not say which criteria it applied to which period, point that out and ask for the missing analysis. Run the secondary conditions tool for the kidney and medication chains, with an evidence checklist that separates the joint-motion proof from the flare proof.

Questions veterans ask about gout

What is the VA rating for gout?

Since February 7, 2021, gout has no percentage of its own. Each affected joint is rated on its limitation of motion under that joint's code, and when motion is painful but not limited enough to be compensable, DC 5003 allows 10 percent for each major joint or group of minor joints.

Is gout a presumptive condition for veterans?

Not under the toxic exposure rules. Board decisions treat gout as arthritis, a chronic disease under 38 CFR § 3.309(a), so service connection can be presumed if gout reached 10 percent or more within one year after separation.

Can gout be secondary to blood pressure medication?

Yes, if a medical opinion ties it to your records. Thiazide and loop diuretics raise uric acid and are associated with new gout, so gout that began or worsened after a diuretic prescribed for service-connected hypertension can be claimed under 38 CFR § 3.310.

Does VA still rate gout under DC 5002?

Only for periods before February 7, 2021, and, for a claim pending on that date, for later periods when the old method is more favorable. Claims filed after the change are rated on joint motion.

Can VA lower my gout rating because of the 2021 change?

Not because of the change alone. Under 38 CFR § 3.951(a), a schedule readjustment is not grounds to reduce a rating in effect on that date unless medical evidence shows the gout actually improved.

How do gout flares count toward a VA rating?

The examiner has to estimate how much more motion you lose during a flare, or explain why that cannot be done. A dated flare log, refill records and statements from people who saw the attacks give the examiner the facts to estimate from.

Bottom Line

Gout ratings turn on a borrowed code. Since February 7, 2021, DC 5017 is evaluated as degenerative arthritis, on the limitation of motion in each joint gout has damaged, with a 10% floor for each major joint or minor joint group when swelling, muscle spasm, or painful motion confirms the limitation, and no X-ray-only rating. The old DC 5002 method, with its flare-count tiers and its higher-of-two-methods rule, governs periods before the change and, for claims pending then, later periods only when it is more favorable; a rating already in effect under it is protected from reduction for the schedule change alone. Flares still matter, because the rating has to account for the added loss of motion during attacks, which is exactly what an episodic disease managed at home tends not to document. The cases I see succeed are the ones with a dated, specific flare record and an exam that takes a real history rather than rating a quiet day. The 55.4% remand share in the Board data points to the same thing: gout is hard to rate from a single snapshot, and the veterans who win are the ones who turn an episodic disease into a documented record before the exam, not after the denial.

Related Conditions

Gout connects to several other pages because the rating mechanics and secondary chains overlap. Before February 7, 2021, gout borrowed the DC 5002 framework that rheumatoid arthritis is rated under directly; since then it runs through the general arthritis rules at DC 5003. The joints gout can attack have their own pages worth reviewing for the limitation-of-motion analysis, including the ankle, the knee, and the foot, where gout can coexist with flat feet. The most important secondary is kidney disease, which is associated with gout through uric acid and can carry a substantial rating of its own.

Methodology and Limitations

• Data source: 38 CFR § 4.71a as of the eCFR text current to October 2, 2026: DC 5017, the note to DCs 5013 through 5024 (effective February 7, 2021, 85 FR 76453), DC 5003 and DC 5002. Functional loss from §§ 4.40, 4.45 and 4.59, pyramiding from § 4.14, preserved ratings from § 3.951(a), chronic-disease presumptions from §§ 3.307 and 3.309(a), secondary service connection from § 3.310. Case law and Board decisions are cited where used; medical statements come from the PubMed abstracts cited by PMID.
• Sample size: Board figures in this post come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings. Of 2,213 Board rulings on gout, 2,013 were decided (granted, denied or remanded); the rest were dismissed, withdrawn or closed another way. Across 2,013 decided Board rulings on gout from 2021 to 2026, 17.7% were granted, 26.8% denied and 55.4% remanded, against a Board-wide grant rate of 24.7% on decided rulings. The Board section on this page breaks these down by denial reason, remand reason, outcome after a remand, appeal type, medical opinion, claim theory and era; those figures are computed from the data, not typed here. The data does not record which version of the criteria each decision applied.
• Limitations:
• Decisions from 2021 to 2026 can still apply the old DC 5002 method to periods before February 7, 2021, and to later periods for claims pending then, so outcome patterns in this data may partly reflect that superseded framework.
• The line between rating "the same joint two ways" (barred as pyramiding) and rating two genuinely distinct damaged joints (allowed) is fact-specific and litigated.
• Board decisions cited as examples are not precedential, and the medical studies describe associations in groups of people, not the cause of any one veteran's gout.
• Selection bias: BVA-level patterns reflect cases that appealed. Most gout claims resolve at the RO level and aren't in any BVA dataset.
• Exam quality varies widely, and application of the flare-up estimate requirement at the RO level is uneven.
• These observations are not predictions of individual outcomes.