Can Nephrolithiasis (kidney stones) be service-connected as secondary to Gout?

Yes. Under 38 CFR § 3.310, a condition that is caused or aggravated by an already service-connected disability can be granted secondary service connection. Excess uric acid. You'll need a current Nephrolithiasis (kidney stones) diagnosis and a medical nexus opinion linking it to your service-connected Gout, the same standard the VA uses for any secondary claim.

What evidence do I need to service-connect Nephrolithiasis (kidney stones) as secondary to Gout?

Strong evidence for the underlying Nephrolithiasis (kidney stones) diagnosis includes: Dated procedure reports for every invasive or non-invasive procedure performed for stones, since the code's exception turns on more than two within a year; Emergency department and clinic records for each attack of colic, stating whether infection was present and whether catheter drainage was required; Imaging confirming stone formation and its recurrence; Laboratory evidence of kidney function where infected attacks have occurred, which the 30 percent hydronephrosis row names. For the secondary link itself, a nexus letter from a treating provider explaining how Gout caused or aggravated Nephrolithiasis (kidney stones) is typically the deciding piece of evidence. If the claim is that a pre-existing Nephrolithiasis (kidney stones) got worse, include records showing how severe it was before it worsened: VA will not concede aggravation unless the baseline is established by medical evidence created before the worsening began, or by the earliest medical evidence after it (38 CFR 3.310(b)).

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Secondary Condition Claim · DC 7508

Nephrolithiasis (kidney stones) Secondary to Gout

A condition caused or aggravated by an already service-connected disability can be granted its own service connection as a secondary condition under 38 CFR § 3.310. Here's how that works for Nephrolithiasis (kidney stones) when it develops after Gout.

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Why is Nephrolithiasis (kidney stones) linked to Gout?

Excess uric acid

Primary condition · VASRD 5017

Gout

Gout is a crystalline arthritis in which uric acid crystals deposit in joints, causing sudden, intensely painful attacks — classically in the big toe — and, over time, joint damage. VA rates it under DC 5017 on limitation of motion of the joints it affects.

Secondary condition · VASRD 7508

Nephrolithiasis (kidney stones)

Formation of stones in the kidney causing pain and urinary problems.

How does secondary service connection work?

When the service-connected condition caused it: 38 CFR § 3.310(a): “Except as provided in § 3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition.”
When it made an existing condition worse: 38 CFR § 3.310(b): “Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected.” VA will not concede aggravation unless medical evidence establishes the baseline severity; it then deducts that baseline, and any natural progress, from the current level.
How strong the evidence for the link has to be: 38 U.S.C. § 5107(b): “When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.” When the positive and negative evidence on the link is in approximate balance, VA gives the benefit of the doubt to the veteran.
What VA means by reasonable doubt: 38 CFR § 3.102: “By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.”
A statute that asks for an “at least as likely as not” medical opinion: 38 U.S.C. § 1168(a)(1)(B): “obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under subparagraph (A)) as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity.” § 1168 covers exams and opinions in toxic-exposure claims. For any claim for VA benefits, § 5107(b) above gives the veteran the benefit of the doubt when the evidence is in approximate balance.

How is Nephrolithiasis (kidney stones) rated as a secondary condition?

If Nephrolithiasis (kidney stones) was caused by the service-connected condition, VA rates it on its own severity under its own diagnostic code, as part of the original condition (38 CFR 3.310(a)). If Nephrolithiasis (kidney stones) existed first and the service-connected condition made it worse, VA compensates only the worsening: it rates the baseline and current severity and deducts the baseline, and any natural progression, from the current level (38 CFR 3.310(b)). Read 38 CFR § 3.310.

Rating	Criteria
100%	Rated as hydronephrosis (DC 7509), severe, which is rated as renal dysfunction: chronic kidney disease with glomerular filtration rate (GFR) less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient.
80%	Rated as hydronephrosis (DC 7509), severe, which is rated as renal dysfunction: chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months.
60%	Rated as hydronephrosis (DC 7509), severe, which is rated as renal dysfunction: chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months.
30%	Recurrent stone formation requiring invasive or non-invasive procedures more than two times per year (DC 7508's own exception to the hydronephrosis cross-reference); or, rated as hydronephrosis, frequent attacks of colic with infection (pyonephrosis) with kidney function impaired; or, rated as severe hydronephrosis under renal dysfunction, chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months.
20%	Rated as hydronephrosis (DC 7509): frequent attacks of colic, requiring catheter drainage.
10%	Rated as hydronephrosis (DC 7509): only an occasional attack of colic, not infected and not requiring catheter drainage.
0%	Rated as hydronephrosis (DC 7509), severe, which is rated as renal dysfunction: GFR from 60 to 89 mL/min/1.73 m2 and either recurrent red blood cell (RBC) casts, white blood cell (WBC) casts, or granular casts for at least 3 consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and structural kidney abnormalities (cystic, obstructive, or glomerular) for at least 3 consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) ≥30 mg/g for at least 3 consecutive months during the past 12 months.

Example combined rating

10% Gout + 30% Nephrolithiasis (kidney stones) = 40% combined

The VA combines ratings with Table I of 38 CFR 4.25, not simple addition: 10% and 30% combine to a Table I value of 37%, which VA converts to a 40% combined rating under 38 CFR 4.25, not 40%. These figures are illustrative; your actual rating for each condition depends on your own evaluation.

What evidence does a secondary Nephrolithiasis (kidney stones) claim need?

•Dated procedure reports for every invasive or non-invasive procedure performed for stones, since the code's exception turns on more than two within a year.
•Emergency department and clinic records for each attack of colic, stating whether infection was present and whether catheter drainage was required.
•Imaging confirming stone formation and its recurrence.
•Laboratory evidence of kidney function where infected attacks have occurred, which the 30 percent hydronephrosis row names.

Common questions about Nephrolithiasis (kidney stones) secondary to Gout

Can Nephrolithiasis (kidney stones) be service-connected as secondary to Gout?: Yes. Under 38 CFR § 3.310, a condition that is caused or aggravated by an already service-connected disability can be granted secondary service connection. Excess uric acid. You'll need a current Nephrolithiasis (kidney stones) diagnosis and a medical nexus opinion linking it to your service-connected Gout, the same standard the VA uses for any secondary claim.
What VA rating can I get for Nephrolithiasis (kidney stones) as a secondary condition?: Nephrolithiasis (kidney stones) is rated under VASRD diagnostic code 7508. Possible VA ratings for Nephrolithiasis (kidney stones) are 100%, 80%, 60%, 30%, 20%, 10%, 0%. If Nephrolithiasis (kidney stones) was caused by the service-connected condition, VA rates it on its own severity under its own diagnostic code, as part of the original condition (38 CFR 3.310(a)). If Nephrolithiasis (kidney stones) existed first and the service-connected condition made it worse, VA compensates only the worsening: it rates the baseline and current severity and deducts the baseline, and any natural progression, from the current level (38 CFR 3.310(b)).
How does a secondary Nephrolithiasis (kidney stones) claim affect my combined VA rating?: The VA doesn't add ratings together. With example figures of 10% for Gout and 30% for Nephrolithiasis (kidney stones): 10% and 30% combine to a Table I value of 37%, which VA converts to a 40% combined rating under 38 CFR 4.25, not 40%. Approving Nephrolithiasis (kidney stones) as secondary still typically raises your overall combined rating and monthly compensation.
What evidence do I need to service-connect Nephrolithiasis (kidney stones) as secondary to Gout?: Strong evidence for the underlying Nephrolithiasis (kidney stones) diagnosis includes: Dated procedure reports for every invasive or non-invasive procedure performed for stones, since the code's exception turns on more than two within a year; Emergency department and clinic records for each attack of colic, stating whether infection was present and whether catheter drainage was required; Imaging confirming stone formation and its recurrence; Laboratory evidence of kidney function where infected attacks have occurred, which the 30 percent hydronephrosis row names. For the secondary link itself, a nexus letter from a treating provider explaining how Gout caused or aggravated Nephrolithiasis (kidney stones) is typically the deciding piece of evidence. If the claim is that a pre-existing Nephrolithiasis (kidney stones) got worse, include records showing how severe it was before it worsened: VA will not concede aggravation unless the baseline is established by medical evidence created before the worsening began, or by the earliest medical evidence after it (38 CFR 3.310(b)).

Primary condition

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Secondary condition

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