Flat Feet (Pes Planus): VA Rating Criteria

Plain-language guide

What this rating actually turns on

Flat feet come down to a single code, DC 5276, flatfoot (acquired), in 38 CFR 4.71a. It is one of the few places in the schedule where having the problem in both feet outranks having it in one, and it is graded by severity:

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

The line between the top tier and everything below it is orthotic response. “Not improved by orthopedic shoes or appliances” is what separates pronounced from severe, and “relieved by a built-up shoe or arch support” is what holds a case at 0 percent. The tiers also turn on documented objective signs (spasm of the tendo achillis, callosities, marked pronation, the weight-bearing line), not on pain alone, though 38 CFR 4.59 and the functional-loss rules mean pain on manipulation and use, which is written into the criteria, does count. This is a single code covering both feet, so you do not get a separate rating for each foot; the bilateral versus unilateral distinction is already built into the schedule.

A worked example

Take a veteran with flat feet in both feet who shows up for C&P. The examiner documents marked pronation on both sides, the weight-bearing line falling medial to the great toe, pain on manipulation and on use that is clearly accentuated, swelling after a shift on his feet, and thick callosities under both arches. He has worn custom orthotics for two years; they take the edge off but do not resolve any of it. Because the deformity is objective and bilateral and the pain-on-use signs are all present, this clears the severe tier, and severe bilateral rates 30 percent. It does not reach pronounced (bilateral 50 percent): that top tier requires extreme plantar tenderness and severe spasm of the tendo achillis that is not improved by orthopedic shoes or appliances, and here the inserts help. The orthotic response is the whole difference between 30 and 50 percent. See the pay table on this page for what 30 percent pays.

What the C&P exam measures

The examiner completes the Foot Conditions, Including Flatfoot (Pes Planus) DBQ. It checks pronation, whether the weight-bearing line falls over or medial to the great toe, inward bowing and spasm of the Achilles tendon (tendo achillis) on manipulation, tenderness of the plantar surfaces, swelling on use, and characteristic callosities, and it records whether your symptoms are relieved by arch supports, built-up or orthopedic shoes, or other appliances. Weight-bearing or plain x-rays are not required to diagnose flatfoot, but degenerative or post-traumatic arthritis must be confirmed by imaging.

What to have in your file

Per VA’s evidence requirements: service treatment records (the entrance examination matters for whether the flat feet were noted at entry), podiatry and orthopedic notes, prescriptions for orthotics or corrective shoes together with your documented response to them, and clinical notes or photos of callosities, swelling, and deformity. Lay statements (VA Form 21-10210) describing pain on use and what wearing supports does or does not fix feed the exam questions directly.

Common mistakes

• Reporting pain and nothing else. The higher tiers turn on objective signs (marked pronation, spasm of the tendo achillis, callosities, the weight-bearing line), so those have to be examined and recorded.
• Not documenting that orthotics failed. “Not improved by orthopedic shoes or appliances” is the gate to the 50/30 percent pronounced tier; if an insert helps, you are capped below it.
• Expecting two ratings for two flat feet. It is one diagnostic code; bilateral is a level within it, not a second rating.
• Assuming congenital flat feet can never be service-connected. A pre-existing or congenital pes planus noted at entry can still be service-connected if service aggravated it beyond its natural progression.

Worth knowing

Whether the flat feet are congenital or acquired drives service connection: the presumption of soundness and the aggravation standard, not the rating percentage, are usually the fight. A bilateral pes planus rating is a lower-extremity disability, so when it combines with a separate leg or ankle rating the bilateral factor (38 CFR 4.26) applies to the combination and adds 10 percent of the combined value; the calculator on this site handles that.

If your rating came back lower than this

A decision that ignores the criteria above is a frequent reason veterans are underpaid. Line your decision up against the levels on this page. If the evidence supports a higher level than VA assigned, you have three ways to challenge it, and the right one depends on why it went wrong:

• Something was missing from the record (an exam finding, a prescription, a flare-up statement, a nexus letter): add it with a Supplemental Claim.
• The evidence was already there and VA misread it: ask for a Higher-Level Review by a more senior rater, with no new evidence needed.
• A legal or judgment error: take it to the Board of Veterans' Appeals.

Before you file, recombine this rating with your others (VA math does not add ratings), check how long each lane is taking right now, and remember a VA-accredited representative or VSO will help you for free. You can also browse every other condition's criteria to make sure you are claiming everything you are owed.