Flat Feet and Plantar Fasciitis: How VA Rates Foot Conditions

If you spent years humping a ruck, pounding pavement in boots, or standing watch on steel decks, odds are your feet took a beating. For a lot of veterans, that shows up later as flat feet (pes planus), plantar fasciitis, or both — and when it's time to file for VA disability, the ratings can feel all over the map. One veteran gets 30% for the same symptoms another vet gets 10% for. Why?

The short answer: foot conditions are rated under some older, somewhat vague parts of the Rating Schedule, which gives examiners a lot of room to interpret what they see. That cuts both ways. A well-documented claim with the right evidence can land where it should. A thin claim with a rushed C&P exam often doesn't. Let's walk through how VA actually rates these conditions, where veterans tend to get lowballed, and what you can do about it.

How VA Rates Flat Feet (Pes Planus)

Flat feet are rated under Diagnostic Code 5276, part of the musculoskeletal rating schedule in 38 CFR § 4.71a. The ratings run from 0% to 50%, and VA breaks them into unilateral (one foot) and bilateral (both feet) categories.

Here's the general structure:

• 0% — Mild symptoms relieved by built-up shoes or arch supports.
• 10% — Moderate; weight-bearing line over or medial to the great toe, inward bowing of the Achilles tendon, pain on manipulation and use of the feet (bilateral or unilateral).
• 20% (unilateral) / 30% (bilateral) — Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.
• 30% (unilateral) / 50% (bilateral) — Pronounced; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation, not improved by orthopedic shoes or appliances.

Notice something? The language — "moderate," "severe," "pronounced" — leaves a lot of room for examiner judgment. That's where cases get won or lost.

What Examiners Actually Look For

A C&P examiner evaluating pes planus is checking for a specific set of findings: weight-bearing line relative to the great toe, Achilles alignment, pain on manipulation, calluses from abnormal gait, deformity, and whether orthotics actually help. If any of those don't make it into the exam report, your rating is going to be based on an incomplete picture.

This is one of the biggest reasons flat feet claims get underrated. The examiner spends ten minutes with you, doesn't document the swelling you get after a shift, doesn't ask about flare-ups, and writes "mild" because that's what they saw in the exam room. Then VA rates you at 10% — or denies compensable at 0% — and you're left wondering what happened.

How VA Rates Plantar Fasciitis

Plantar fasciitis got its own diagnostic code in 2021 — DC 5269 — which was a big deal because before that, VA was analogizing it to other foot conditions and the results were inconsistent. Now there's a cleaner framework:

• 10% — Unilateral or bilateral plantar fasciitis that doesn't meet the 20% or 30% criteria.
• 20% — Unilateral, with no relief from both non-surgical and surgical treatment.
• 30% — Bilateral, with no relief from both non-surgical and surgical treatment.

The surgical-treatment language matters. If neither non-surgical treatment nor surgery (such as a plantar fascia release) has given you relief, you're in the 20% or 30% tier. If a doctor has recommended surgery but you're not a surgical candidate, VA rates you under those same 20% or 30% criteria, and actual loss of use of the foot rates 40%. Otherwise — orthotics, injections and physical therapy alone — it's 10%, however bad the pain.

That's a frustrating structure for a lot of veterans — the pain can be genuinely disabling at 10%, but the schedule keeps you there unless surgery failed to help or you were recommended for surgery and aren't a candidate. It's worth knowing going in so you're not surprised by the ceiling.

Painful Motion and the § 4.59 Floor

Here's a rule that helps a lot of foot-condition claimants: under 38 CFR § 4.59, actually painful joints get at least the minimum compensable rating for that joint. Translated — if your foot condition causes documented painful motion and the diagnostic code's lowest compensable level is 10%, you should be at 10% minimum, even if the other criteria aren't fully met.

The catch: the pain has to be in the record. Under Petitti v. McDonald, it doesn't have to be proven by objective findings alone — your own credible description of painful motion counts as evidence. Still, what the examiner observes (guarding, grimacing, an antalgic gait, tenderness) carries real weight, so describe your pain plainly at the exam and back it up with a written statement.

If your C&P exam didn't document the pain you were showing, that's an exam-adequacy problem — § 4.59 directs examiners to test for pain — and it's a legitimate basis for challenging the rating.

Flare-Ups and Pain on Use

Foot conditions are classic flare-up conditions. You feel okay in the morning, then after eight hours on your feet you can barely walk. The problem is that a C&P exam is one short appointment on one day, and it often misses the flare picture entirely.

For joints rated on range of motion, § 4.40 and § 4.45 call for VA to consider what are commonly called the DeLuca factors: weakness, fatigability, incoordination, additional limitation on repetitive use, and flare-ups. The flat-feet and plantar fasciitis codes aren't based on range of motion, so those factors work differently there — but how your feet hold up with use still matters. The examiner should be asking you about repetitive use, estimating additional functional loss during flares, and documenting it. If the exam report says "flare-ups: not addressed" or just leaves that section blank, that's a gap worth raising — the flat-feet criteria themselves turn on pain and swelling "on use," which an exam-room snapshot can miss.

At Augustus Miles, our VA-accredited attorneys often see foot-condition decisions built on exam reports that never ask how your feet are after a day of use. That's one of the first things to look at when a rating comes back lower than it should be.

Secondary Conditions: Where Foot Claims Really Add Up

Foot pain doesn't stay in the feet. When you change how you walk to avoid plantar pain, you throw off your knees, hips, and back. This is where § 3.310 secondary service connection comes in — a condition caused OR aggravated by an already service-connected condition qualifies for its own separate rating.

Common secondaries from foot conditions include:

• Knees — altered gait causing meniscal wear or patellofemoral pain
• Hips — compensatory loading from asymmetric stride
• Lower back — chronic strain from gait changes
• The other foot — overuse from favoring the painful side (if it's the same condition, VA rates both feet together under one code, which may or may not raise the rating)
• Mental health — chronic pain contributing to depression or anxiety

Each of these needs a medical nexus opinion linking it back to the service-connected foot condition. For aggravation claims (where the secondary condition existed but got worse because of the foot problem), you also need baseline evidence — medical records from before the worsening began, or the earliest records after it began, showing how bad the knee or back was. VA compensates only the worsening beyond that baseline.

This is where a lot of veterans leave money on the table. They get 10% for flat feet and stop there, not realizing the back pain, knee pain, and hip pain they've developed over the last five years are all potentially secondary. A combined rating built out through secondaries can be substantially higher than any single foot rating.

The Bilateral Factor

One more piece that matters for foot claims: § 4.26, the bilateral factor. When you have a compensable service-connected disability in each leg — foot, ankle, knee or elsewhere in the leg — VA first combines the right- and left-side ratings, then adds 10 percent of that combined value (two 10% ratings combine to 19, and the factor adds 1.9) before combining the result with your other ratings under § 4.25. It's not a huge boost, but it's real.

A single rating that covers both feet (bilateral flat feet under DC 5276, or plantar fasciitis under DC 5269) doesn't get the bilateral factor on its own; VA's rating manual applies it only when you also have a separately rated condition in one of your legs (a knee, say) or in both arms. If that's you and your decision letter doesn't mention the bilateral factor, that's worth a second look.

Why Foot Ratings Get Lowballed

A few patterns we often see:

Rushed C&P exams. The examiner doesn't document pain, doesn't test weight-bearing adequately, skips the flare-up section. You end up with a report that doesn't reflect your actual condition.

Wrong diagnostic code. The code shapes the rating: flat feet belong under DC 5276 and plantar fasciitis under DC 5269. If you have both and one or both came from an actual foot injury, VA's rating manual lets raters rate them together under the foot-injury code (DC 5284) when that pays more, so a decision that misses a better-paying code is worth a second look.

No secondaries filed. The veteran has knee and back pain from altered gait but never files secondary claims, so the related conditions never get rated.

Pyramiding. VA's rating manual says flat feet and plantar fasciitis should be rated together, under whichever diagnostic code gives the higher rating for the combined symptoms, rather than separately. When a decision rates only one condition's symptoms or picks the lower-paying code, that's worth challenging.

Mild rating when flares are severe. The decision relies on how your feet looked on exam day and ignores evidence of what happens after a day on your feet — swelling and accentuated pain — which the flat-feet criteria specifically ask about.

What To Do About a Lowball Decision

If VA rated your foot condition and the number doesn't match what you're actually dealing with, you've got options. The three AMA review lanes each do something different:

• Higher-Level Review (HLR) — a senior reviewer re-examines the existing record. Good when you think VA misapplied the rating criteria to the evidence already in your file. No new evidence allowed.
• Supplemental Claim — you submit new and relevant evidence (updated exam, nexus opinion, buddy statements documenting flares). Good when the original record was thin.
• Board appeal — takes it to a Veterans Law Judge. Three sub-lanes with different evidence and hearing options.

Filing within one year of the decision also preserves your original effective date under § 3.2500(h) — important if any back pay is on the table.

Augustus Miles can help. Our VA-accredited attorneys look at the C&P exam, the rating criteria, and the actual evidence, and figure out whether the number VA assigned actually matches what the record supports. When it doesn't — and it often doesn't on foot claims — that's a problem worth fixing.

Rating criteria shown reflect VA's rating schedule as of 2026; check va.gov for the latest.

The Bottom Line

Flat feet and plantar fasciitis are two of the most common foot conditions veterans deal with, and they're also two of the most inconsistently rated. The rating schedule leaves room for interpretation, the C&P exams are often incomplete, and secondaries often get missed. If your decision came back lower than you expected, that's not necessarily the final word — it's often the start of a conversation.

Augustus Miles Can Help

If VA's decision on your foot condition doesn't line up with what your records and symptoms show, Augustus Miles' VA-accredited attorneys can take a hard look at the appeal, the HLR, or the rating-increase route. You pay nothing upfront — our attorneys work on a contingency basis. Our support team is made up of veterans, many of whom are former clients.

Frequently Asked Questions

Can I get service-connected for flat feet if I had them before I enlisted?

Possibly, yes. The presumption of soundness under 38 CFR § 3.304(b) protects veterans whose entrance exam didn't note a condition — VA needs clear and unmistakable evidence of BOTH preexistence AND non-aggravation by service to rebut it. Even if flat feet were noted at entry, you can still get compensation under an aggravation theory if service made them worse.

Can I be rated for both flat feet and plantar fasciitis at the same time?

Usually not as two separate ratings. VA's rating manual treats both codes as compensating the same thing — foot pain — so it tells raters to evaluate the two conditions together under whichever diagnostic code gives the higher rating; separate ratings would be pyramiding under § 4.14. On appeal, separate ratings can still be argued under Esteban v. Brown if medical evidence shows the symptoms truly don't overlap, but expect VA to push back. If one or both conditions came from an actual foot injury, VA's rating manual also allows rating them together under the foot-injury code (DC 5284) when that pays more. Either way, make sure the rating reflects the symptoms of both conditions.

Why did I only get 10% when the pain is severe?

Plantar fasciitis stays at 10% under DC 5269 unless neither non-surgical treatment nor surgery gave you relief, or a doctor recommended surgery and you're not a surgical candidate (actual loss of use of the foot rates 40%). For flat feet under DC 5276, higher ratings require specific findings — for the severe level, marked deformity, accentuated pain on manipulation and use, swelling on use and characteristic calluses; for the pronounced level, marked pronation, extreme plantar tenderness and Achilles spasm not helped by orthopedic shoes — and those findings need to be in the record. If the exam report doesn't capture what you were showing, the rating gets built on an incomplete picture. That's often fixable on review.

What secondary conditions should I think about filing for?

Common ones: knee pain from altered gait, hip pain from asymmetric loading, lower back strain, and overuse injury to the opposite foot. Each needs a medical nexus opinion linking it to the service-connected foot condition under § 3.310. If a non-service-connected condition existed before but got worse because of the foot problem, that's an aggravation claim — and you'll want baseline evidence showing the condition's severity before it started worsening.

The VA decision came back lower than I expected. What should I do?

Pull the C&P exam report and compare it to the rating criteria in DC 5276 (flat feet) or DC 5269 (plantar fasciitis). Look for missing items: pain documentation, flare-up analysis, weight-bearing testing, and bilateral factor application if it applies to you. If any of that is missing or the rating doesn't match the evidence, you've got grounds for a Higher-Level Review, Supplemental Claim, or Board appeal. Filing within a year of the decision preserves your effective date. Augustus Miles can take a look if you want a second set of eyes.