What Pes Planus Is
Pes planus (flatfoot) is collapse or loss of the medial longitudinal arch of the foot, producing a flat foot posture when standing. There are two principal subtypes: flexible flatfoot, in which the arch is preserved when non-weight-bearing and collapses with weight-bearing, and rigid flatfoot, in which the arch is absent in both positions and is associated with structural changes such as tarsal coalition.
Adult-acquired flatfoot most commonly results from posterior tibial tendon dysfunction, in which progressive failure of the posterior tibial tendon causes the arch to collapse, the heel to evert into a valgus position, and the forefoot to abduct. Trauma, prolonged weight-bearing under load (as in military service), genetic predisposition, and connective tissue disorders all contribute.
How the VA Rates Pes Planus (DC 5276)
Pes planus is rated under 38 CFR 4.71a, Diagnostic Code 5276, with criteria that distinguish unilateral from bilateral involvement and grade severity by symptoms and anatomic findings.
0 Percent
Mild pes planus - symptoms relieved by built-up shoe or arch support.
10 Percent (Unilateral or Bilateral)
Moderate pes planus - weight-bearing line over or medial to the great toe, inward bowing of the tendo Achillis, pain on manipulation and use of the feet, with or without symptoms with manipulation and use.
20 Percent (Unilateral)
Severe unilateral - objective evidence of marked deformity (pronation, abduction), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities.
30 Percent (Bilateral)
Severe bilateral - same criteria as severe unilateral, applied to both feet.
30 Percent (Unilateral)
Pronounced unilateral - 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.
50 Percent (Bilateral)
Pronounced bilateral - same criteria as pronounced unilateral, applied to both feet.
The Bilateral Factor (38 CFR 4.26)
When disabilities affect both arms, both legs, or paired skeletal muscles, the bilateral factor at 38 CFR 4.26 adds 10 percent of the combined value of the bilateral disabilities to the running total before further combining with other (non-bilateral) ratings.
How It Works
Example: A veteran with severe bilateral pes planus rated at 30 percent does not need additional bilateral factor calculation because the diagnostic code itself already accounts for bilateral involvement. However, when bilateral pes planus is combined with other bilateral lower extremity conditions (such as bilateral plantar fasciitis or bilateral knee conditions), the bilateral factor applies to the combined evaluation of those bilateral conditions.
Stacking Bilateral Conditions
Veterans with multiple bilateral lower extremity conditions can see substantial rating elevation through the bilateral factor. The combined value of bilateral pes planus, bilateral plantar fasciitis, and bilateral knee conditions, after applying the bilateral factor, often exceeds what a simple combined rating calculation would produce.
Diagnostic Workup
A defensible pes planus claim is anchored in objective documentation.
Clinical Examination
Examination by a podiatrist, orthopedist, or foot and ankle specialist documenting the foot posture in weight-bearing and non-weight-bearing positions, the hindfoot alignment (valgus, neutral, varus), the position of the weight-bearing line, tendo Achillis bowing, callosities, response to manual reduction, and functional findings such as the single-leg heel rise.
Weight-Bearing X-rays
Standing AP and lateral foot X-rays demonstrate the arch collapse. The Meary angle, calcaneal pitch, and talonavicular coverage angle are quantitative measures of arch loss.
Posterior Tibial Tendon Imaging
MRI or ultrasound of the posterior tibial tendon documents the underlying tendinopathy or tear that produces adult-acquired flatfoot.
Functional Documentation
Treatment history with orthotics, physical therapy, anti-inflammatory medication, immobilization, or surgery. Documentation of impact on prolonged standing, walking distance, and activities of daily living.
Service Connection Pathways
Pes planus claims involve several distinct pathways.
Direct Service Connection from In-Service Onset
Veterans whose pes planus was first identified or first became symptomatic during active service can establish direct service connection with service treatment records documenting the condition, a current diagnosis, and a medical nexus when continuity of symptomatology is established.
Aggravation of Pre-Existing Pes Planus
Many veterans enter service with mild pes planus identified at enlistment. When the condition worsened during service due to prolonged weight-bearing, marching, or trauma, the aggravation theory applies. The opinion characterizes the baseline severity (typically documented at enlistment) and the current severity attributable to service.
Secondary Service Connection
Pes planus can be claimed secondary to other service-connected conditions affecting gait or lower extremity biomechanics (knee, hip, or ankle conditions producing altered weight-bearing patterns).
Combat or Trauma-Related Onset
Acute foot trauma during service producing posterior tibial tendon injury can result in adult-acquired flatfoot. Service treatment records documenting the injury and post-service imaging documenting the tendon pathology support direct service connection.
Evidence That Strengthens the Claim
Strong bilateral pes planus claims include the following.
Specialist Diagnosis
Diagnosis from a podiatrist, orthopedist, or foot and ankle specialist using current diagnostic criteria with documentation of the specific findings required by DC 5276.
Weight-Bearing Imaging
Standing X-rays documenting arch collapse with quantitative measurements (Meary angle, calcaneal pitch, talonavicular coverage angle) and any associated degenerative changes.
Tendon Imaging
MRI or ultrasound of the posterior tibial tendon when adult-acquired flatfoot is the clinical picture.
Treatment Records
Records of orthotic prescription and use, physical therapy, casting or boot immobilization, corticosteroid injections, and any surgical management.
Functional Impact
Documentation of pain on prolonged standing, walking limitations, callosities, swelling, and the impact on work and routine activity. Statements from family, coworkers, or employers supporting functional impairment.
Nexus Opinion
For direct or secondary service connection where the link is not obvious, a medical opinion that it is at least as likely as not (50 percent probability or greater) that the bilateral pes planus is related to service or to a service-connected condition. For aggravation claims, the opinion characterizes baseline and current severity.
Common Rating Issues
Several recurring issues affect bilateral pes planus claims.
Examination Documentation Gaps
The DC 5276 criteria require specific findings - pronation, abduction, weight-bearing line position, tendo Achillis bowing, callosities, response to orthotics. C&P examinations that do not document each criterion may underestimate severity.
Confusion with Plantar Fasciitis
Plantar fasciitis is rated separately under DC 5269 and frequently coexists with pes planus. Both conditions can be rated when each produces distinct manifestations and the rating does not pyramid.
Aggravation vs Direct Service Connection
Veterans whose pes planus was noted at entrance must analyze whether the in-service course aggravated the condition beyond natural progression. The aggravation analysis requires baseline-to-current comparison.
Pronounced vs Severe Distinction
The distinction between severe (30 percent bilateral) and pronounced (50 percent bilateral) often hinges on the response to orthopedic shoes or appliances. Pronounced disease is characterized as not improved by orthotics, with marked pronation and extreme plantar tenderness.
Related Ratable Conditions
Pes planus frequently co-exists with other ratable foot and lower extremity conditions.
Plantar Fasciitis
Plantar fasciitis is rated under DC 5269 and frequently coexists with pes planus due to altered plantar mechanics.
Posterior Tibial Tendon Dysfunction
The tendinopathy underlying adult-acquired flatfoot can be a ratable musculoskeletal injury under the relevant tendon codes.
Ankle Conditions
Pes planus alters ankle biomechanics and can contribute to ankle sprains, instability, and degenerative changes. Ankle conditions are rated under DC 5270-5274.
Knee Conditions
Altered foot mechanics affect knee loading and can contribute to or aggravate knee conditions. Knee conditions are rated under DC 5256-5263.
Frequently Asked Questions
Bilateral pes planus is rated under 38 CFR 4.71a, Diagnostic Code 5276, at 0 percent (mild, symptoms relieved by built-up shoe or arch support), 10 percent (moderate, with weight-bearing line over or medial to the great toe, inward bowing of the tendo Achillis, and pain on use), 30 percent bilateral (severe, with marked deformity, accentuated pain on use, swelling on use, and characteristic callosities), or 50 percent bilateral (pronounced, with marked pronation, extreme plantar tenderness, marked inward displacement and severe spasm of the tendo Achillis, not improved by orthotics).
The bilateral factor at 38 CFR 4.26 adds 10 percent of the combined value of bilateral disabilities to the running total before further combining with other ratings. DC 5276 itself has explicit bilateral rating tiers (30 percent severe bilateral, 50 percent pronounced bilateral), so the bilateral factor is generally not added on top of the pes planus rating. However, when bilateral pes planus is combined with other bilateral lower extremity conditions (such as bilateral plantar fasciitis or bilateral knee conditions), the bilateral factor applies to the combined value of those bilateral conditions.
Yes, through the aggravation theory. When pre-existing pes planus was aggravated during service beyond natural progression, service connection on an aggravation basis under 38 CFR 3.306 can apply. The medical opinion must characterize the baseline severity at entrance and the current severity, identifying the increase attributable to service.
Strong evidence includes a current diagnosis from a podiatrist, orthopedist, or foot and ankle specialist documenting the specific DC 5276 findings (pronation, abduction, weight-bearing line position, tendo Achillis bowing, callosities, response to orthotics); standing weight-bearing X-rays with quantitative measurements; posterior tibial tendon imaging when adult-acquired flatfoot is the clinical picture; treatment records; functional impact documentation; and a medical nexus opinion when service connection is not already established.
Need a Nexus Letter for Bilateral Pes Planus?
Semper Solutus provides MD-authored medical opinions and nexus letters tying bilateral pes planus to in-service onset, in-service aggravation of pre-existing flatfoot, or service-connected biomechanical conditions. Schedule a free consultation to discuss your claim.
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