Flat Feet VA Rating: Pes Planus Criteria Under DC 5276

Detailed breakdown of each DC 5276 rating level

VA rating specialists match the findings recorded on your examination report directly against the clinical language in Diagnostic Code 5276.

0 percent rating: Mild flatfoot

A noncompensable 0% rating applies when a veteran has service-connected acquired flatfoot, but symptoms are mild and relieved by a built-up shoe or arch support. Even though a 0% rating pays no monthly cash benefit, it establishes formal service connection, entitles the veteran to VA podiatry care and replacement custom orthotics at no cost, and preserves the right to file for an increased rating if arch collapse worsens later.

10 percent rating: Moderate flatfoot (unilateral or bilateral)

The 10% evaluation covers moderate acquired flatfoot whether one foot or both feet are affected. Diagnostic Code 5276 specifies three clinical indicators for moderate severity:

1. Weight-bearing line over or medial to the great toe: A normal arch aligns the weight-bearing line down the front of the shin bone (tibia) between the first and second toes. When the arch collapses and the ankle rolls inward, this line shifts inward so that it falls directly over or medial to the big toe.
2. Inward bowing of the tendo achillis: As the heel tilts outward in valgus deformity during arch collapse, the Achilles tendon (tendo achillis) curves inward rather than tracking vertically.
3. Pain on manipulation and use of the feet: Pain occurs both when the examiner physically moves or palpates the foot (manipulation) and when the veteran stands or walks (use).

Because the regulation states “bilateral or unilateral” for the moderate tier, having moderate flat feet in both feet results in a single 10% rating under Diagnostic Code 5276.

20 percent and 30 percent ratings: Severe flatfoot

When acquired flatfoot causes marked structural deformity and tissue changes, the rating schedule assigns 20% for unilateral severe flatfoot and 30% for bilateral severe flatfoot based on four objective clinical signs:

• Objective evidence of marked deformity (pronation, abduction, etc.): Inward rolling of the foot with complete flattening of the longitudinal arch under weight-bearing (pronation) or outward drifting of the forefoot away from the midline (abduction).
• Pain on manipulation and use accentuated: Pain intensifies noticeably during weight-bearing activity and clinical palpation.
• Indication of swelling on use: Localized edema develops along the arch, plantar surface, or ankle after standing or walking.
• Characteristic callosities: Thick, painful calluses form along the inner border of the foot and beneath the metatarsal heads due to abnormal weight-bearing pressure.

30 percent (unilateral) and 50 percent (bilateral) ratings: Pronounced flatfoot

The highest evaluation tier under Diagnostic Code 5276 is “pronounced” flatfoot, rated at 30% when unilateral and 50% when bilateral, requiring four severe clinical findings:

• Marked pronation: Severe collapse of the medial longitudinal arch with pronounced inward tilt of the ankle and heel.
• Extreme tenderness of plantar surfaces of the feet: Severe pain upon palpation of the soles.
• Marked inward displacement and severe spasm of the tendo achillis on manipulation: The Achilles tendon is displaced significantly inward and exhibits severe spasm when the examiner manipulates the foot and ankle.
• Not improved by orthopedic shoes or appliances: Prescribed arch supports, custom orthotics, braces, or orthopedic shoes fail to relieve symptoms.

Direct service connection vs. aggravation of preexisting flat feet

Establishing a flat feet VA rating requires proving either direct service connection under 38 CFR 3.303 or service connection by aggravation under 38 CFR 3.306, depending on your Military Entrance Processing Station (MEPS) physical examination.

Direct service connection (normal arches at enlistment)

Diagnostic Code 5276 evaluates acquired flatfoot rather than asymptomatic congenital flatfoot. If your MEPS entrance physical noted normal arches and you developed fallen arches during or following active service, your claim proceeds as a direct service connection claim under 38 CFR 3.303.

If no foot defect was noted on your entrance exam, you are protected by the presumption of soundness under 38 U.S.C. 1111 and 38 CFR 3.304(b). Common in-service causes include road marches under heavy rucksacks, running on pavement in combat boots, parachute landings, standing on steel ship decks, and lower-extremity trauma.

Service connection by aggravation (flat feet noted at MEPS)

Many service members enter active duty with “pes planus, mild, asymptomatic” recorded at MEPS. A preexisting notation does not bar VA disability compensation. Under 38 CFR 3.306, a preexisting condition is service connected when active service permanently increases its severity beyond natural progression:

1. Baseline severity: Your entrance physical establishes the preservice baseline—typically asymptomatic or mild pes planus (0% baseline).
2. Permanent increase in disability during service: Service treatment records, podiatry consults, profile restrictions, custom orthotic prescriptions, or separation exams must show that your flat feet permanently worsened during service rather than experiencing only a temporary flare-up.
3. Presumption of aggravation: Under 38 CFR 3.306(b), once an in-service increase in severity is shown, aggravation is presumed unless the VA establishes by clear and unmistakable evidence that the worsening resulted solely from natural progression.

How the C&P exam and Foot Conditions DBQ measure flat feet

When you file a claim for flat feet, the VA typically schedules a Compensation and Pension (C&P) examination where the clinician completes the Foot Conditions Including Flatfoot (Pes Planus) Disability Benefits Questionnaire (DBQ), available on the VA Public DBQs directory:

• Weight-bearing vs. non-weight-bearing inspection: Flexible flat feet often show a visible arch when sitting with feet off the floor, but flatten completely when standing. Under 38 CFR 4.59 and DBQ instructions, the examiner must inspect your feet in both weight-bearing and non-weight-bearing positions.
• Alignment and deformity: The examiner checks whether the weight-bearing line falls over or medial to the great toe, whether the Achilles tendon bows or displaces inward, and whether marked pronation or forefoot abduction is present.
• Palpation and manipulation: The clinician palpates the plantar surfaces for extreme tenderness, checks for characteristic callosities and swelling on use, and manipulates the foot and ankle to check for pain and Achilles tendon spasm.
• Orthotic response and functional loss: The DBQ records whether you wear built-up shoes, arch supports, or orthotics, whether they relieve your symptoms, and functional limitations during flare-ups and repeated weight-bearing use under 38 CFR 4.40 and 4.45.

Anti-pyramiding rules and related foot diagnostic codes

Under 38 CFR 4.14, the VA cannot rate the same disability manifestation twice under different diagnostic codes (avoidance of pyramiding). Because flat feet often coexist with other foot disorders in 38 CFR 4.71a, rating specialists compare all diagnosed foot conditions:

• Diagnostic Code 5269 (Plantar fasciitis): Rated at 10% (unilateral or bilateral, responsive to treatment), 20% (unilateral, no relief from both non-surgical and surgical treatment), or 30% (bilateral, no relief from both non-surgical and surgical treatment). Under Note (2), if surgery is recommended but the veteran is not a surgical candidate, the 20% or 30% criteria apply.
• Diagnostic Code 5277 (Weak foot, bilateral): A constitutional condition with muscle atrophy, disturbed circulation, and weakness, rated at a 10% minimum.
• Diagnostic Code 5278 (Claw foot / pes cavus, acquired): Abnormally high arch with dorsiflexed toes and shortened plantar fascia, rated from 0% to 50%.
• Diagnostic Code 5279 (Metatarsalgia, anterior / Morton’s disease): Ball-of-foot pain and nerve irritation, rated at 10% unilateral or bilateral.
• Diagnostic Codes 5280, 5282, 5283, and 5284: Cover unilateral hallux valgus (10%), hammer toes (10% all toes of one foot without claw foot; 0% single toes), tarsal/metatarsal malunion or nonunion (10% to 30%), and other foot injuries (10% to 30%).

When a veteran has both flat feet (DC 5276) and plantar fasciitis (DC 5269) or metatarsalgia (DC 5279), the VA assigns a single evaluation under whichever diagnostic code provides the highest rating if the symptoms overlap, unless distinct functional impairments are documented. Note (1) under DC 5269 and the Notes under DC 5283 and DC 5284 also provide a 40% rating for actual loss of use of the foot.

Secondary conditions linked to service-connected flat feet

Because your feet anchor the lower-extremity kinetic chain, collapsed arches and overpronation rotate the shin bone (tibia) and thigh bone (femur) inward during walking, altering joint loading from the ankles to the lower spine. Under 38 CFR 3.310, a disability proximately caused or permanently aggravated by a service-connected condition may qualify for secondary service connection when supported by a medical nexus opinion:

• Plantar fasciitis (DC 5269) and Achilles tendinitis (DC 5271): Arch collapse stretches the plantar fascia and strains the Achilles tendon. If Achilles tendinitis restricts ankle motion, it may be rated separately if distinct from DC 5276 symptoms.
• Hallux valgus (bunions, DC 5280) and hammer toes (DC 5282): Shifting the weight-bearing line medial to the great toe crowds the forefoot and may cause or aggravate bunions and toe deformities.
• Shin splints (DC 5262): Overpronation increases traction stress along the inner tibia, which may cause medial tibial stress syndrome.
• Knee pain (DC 5260, 5261, 5257): Internal tibial rotation from flat feet alters patellar tracking and medial knee loading, which may cause or aggravate patellofemoral syndrome or knee osteoarthritis.
• Hip arthritis and back pain (DC 5251–5255, DC 5237–5243): Altered gait mechanics and pelvic tilt from severe pronation may cause or aggravate hip osteoarthritis, lumbosacral strain, or lumbar degenerative disc disease.

Combining ratings and the bilateral factor

When you hold multiple service-connected ratings, the VA combines them using the Combined Ratings Table in 38 CFR 4.25 rather than adding percentages directly. You can see how a 10%, 20%, 30%, or 50% flatfoot rating affects your combined score with our VA combined rating calculator.

How the 10% bilateral factor under 38 CFR 4.26 applies depends on your other lower-extremity ratings:

• Standalone bilateral DC 5276 rating: Because Diagnostic Code 5276 builds bilateral involvement into its 10%, 30%, and 50% tiers, the VA assigns a single rating for both feet under DC 5276 without adding a separate 10% bilateral bonus on top of that standalone evaluation.
• Combined with other lower-extremity disabilities: Under 38 CFR 4.26(a)—which explicitly cites pes planus as an example—when a compensable foot disability combines with a separate compensable disability on the opposite lower extremity, the lower-extremity ratings are combined first and increased by 10% of their combined value.

When to get help from a VA-accredited representative

Flat feet claims are often underrated when an examination overlooks weight-bearing alignment, Achilles displacement, callosities, or the failure of orthotics to relieve pain, or when aggravation under 38 CFR 3.306 is misapplied. If you need help with a claim or appeal, work with a VA-accredited representative:

• Veterans Service Organizations (VSOs): Accredited representatives from the DAV, VFW, and American Legion assist with claims and appeals free of charge.
• Accredited Claims Agents and Attorneys: VA-certified professionals who handle complex appeals under federal fee regulations, without ever promising a guaranteed outcome.

You can verify credentials or locate free representation through the official VA Office of General Counsel Accreditation Search.