Evidence Checklist: Gout

Uric acid (serum urate) laboratory resultsCritical

Serum uric acid levels documenting hyperuricemia. Note that uric acid may be normal during an acute flare -- serial testing is more informative than a single result.

Nexus opinion linking gout to service or service-connected condition ("at least as likely as not")Critical

A medical opinion connecting gout to military service, or as secondary to a service-connected condition such as chronic kidney disease, hypertension, or medication use (diuretics, low-dose aspirin).

Synovial fluid analysis (joint aspiration with crystal identification)

Laboratory results from joint aspiration showing monosodium urate monohydrate crystals under polarized microscopy -- the gold standard for gout diagnosis.

Imaging studies (X-ray showing tophi or erosions; ultrasound or DECT)

Radiographs showing characteristic gout erosions with overhanging edges, or ultrasound/dual-energy CT showing urate crystal deposition (double contour sign or tophi).

Documentation of acute flare episodes (frequency, affected joints, duration)

Medical records or personal log tracking the frequency, duration, and severity of acute gout attacks, including which joints are affected and how attacks limit function.

Treatment records (urate-lowering therapy, colchicine, NSAIDs)

Records documenting urate-lowering therapy (allopurinol, febuxostat), acute attack management (colchicine, NSAIDs, steroids), and response to treatment.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ Joint ConditionsCritical

Standardized form capturing range of motion, pain, and functional limitations of the primarily affected joint(s).

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.