Flat feet — medically called pes planus — are one of the most commonly underrated conditions in the VA disability system. Veterans who spent years marching, running in boots, and carrying heavy loads often develop painful fallen arches, yet many receive a 0% rating or miss out on additional compensation for secondary conditions. This guide breaks down exactly how VA evaluates flat feet under 38 CFR Part 4, Diagnostic Code 5276, explains the bilateral factor, and shows you how to claim the chain of secondary conditions that flat feet frequently cause.
Ratings governed by 38 CFR § 4.71a — Foot Ratings. See also: DC 5276 — Flatfoot, Acquired.
VA rates flat feet under 38 CFR Part 4, Diagnostic Code 5276 — Flatfoot, Acquired. The regulation assigns ratings based on the severity of structural deformity and the degree of functional impairment. There are five possible rating levels: 0%, 10%, 20%, 30%, and 50%. Here is what each one requires:
Weight-bearing line: The line drawn from the center of the knee straight down through the ankle. In a healthy arch, it passes through the center of the foot. In moderate pes planus, it shifts medially — falling over or past the great toe. A VA examiner checks this during the standing portion of your exam.
Inward bowing of the Achilles tendon: When viewed from behind, a normal Achilles tendon is straight. As the arch collapses, the heel tilts outward (valgus), causing the tendon to bow inward. This is a hallmark of moderate-to-severe pes planus and is documented by the examiner with the veteran standing.
Marked pronation: Excessive rolling inward of the foot during weight-bearing. It is typically measured by calcaneal pitch angle on x-ray — a lower pitch angle signals more severe pronation.
Extreme tenderness of the plantar surfaces: Significant pain to palpation across the bottom of the foot, particularly along the plantar fascia and the medial longitudinal arch. This is assessed by the examiner applying direct pressure during your C&P exam.
Cannot reasonably walk without severe pain (50%): This is the highest threshold under DC 5276. To reach a 50% rating, you must demonstrate through medical evidence, functional statements, and examiner findings that walking is severely limited by pain — not merely uncomfortable, but genuinely disabling.
The 20% and 30% ratings for bilateral flat feet differ by one element: objective imaging evidence. If your VA examiner or treating physician has ordered weight-bearing foot x-rays or an MRI that documents arch collapse, you should be at 30%, not 20%. Always request imaging before your C&P exam.
This distinction matters enormously to your claim — and it catches veterans off guard. Diagnostic Code 5276 covers only acquired flat feet, meaning flat feet that developed or worsened over time due to external forces such as physical stress, injury, or overuse. Congenital flat feet — present from birth due to bone structure — are not ratable under DC 5276.
If a VA examiner or rating officer concludes your flat feet are entirely congenital, your claim will likely be denied. However, many veterans who were born with a mild predisposition to flat arches had their condition significantly worsened by military service. This is where the argument of aggravation beyond natural progression comes in: even if you had some degree of flat feet before service, if military duties demonstrably worsened the condition, VA must rate the additional impairment caused by that aggravation.
Your service records are critical here. Enlistment physical findings, sick call visits for foot pain, physical training records, and any duty assignments involving prolonged marching, standing, or heavy load-bearing all support the argument that service caused or aggravated your flat feet. A well-written nexus letter from a physician explicitly distinguishing acquired aggravation from natural progression can be the difference between a grant and a denial.
When a veteran has a service-connected disability in both extremities — both feet, both knees, both shoulders — VA applies what is called the bilateral factor under 38 CFR § 4.26. For bilateral flat feet, the bilateral factor adds 10% to the combined value of the two separate foot ratings before that sum is folded into your overall combined rating.
Let's say you have 20% for the right foot and 20% for the left foot. Without the bilateral factor, VA would simply combine them using the standard whole-person formula:
With the bilateral factor, VA first adds the two ratings together (20 + 20 = 40), multiplies by 10% (40 × 0.10 = 4), and adds that back (40 + 4 = 44%) before plugging into the combined disability formula. That combined bilateral value of 44% is then used in the whole-person calculation alongside your other service-connected conditions.
In practice, the bilateral factor adds a few percentage points to your combined rating and can push you across a rating threshold — which has a real dollar impact on your monthly compensation.
If you have flat feet in both feet but only claimed one, file to add the second foot immediately. You are leaving bilateral factor compensation on the table every month you wait. Use our Rating Estimator to see how the bilateral factor changes your combined rating.
To establish service connection for acquired flat feet, you need three elements: a current diagnosis, an in-service incurrence or aggravation, and a medical nexus connecting the two. Here is what each looks like in practice.
You need a physician's diagnosis of pes planus — ideally documented on weight-bearing x-rays showing loss of the medial longitudinal arch. The diagnosis should specify whether the condition is unilateral or bilateral and whether it is acquired or congenital.
Pull your service treatment records (STRs) and look for any of the following: sick call visits for foot, ankle, or arch pain; referrals to podiatry or orthopedics; documentation of march fractures or stress reactions in the foot; Physical Training (PT) test exemptions due to foot pain; or profile limitations on foot activity. If your STRs are thin — which is common — your own lay statement describing foot pain during service carries weight under Jandreau v. Nicholson (2007). Describe specific events: the 12-mile ruck march in boot camp, the hours of standing post, the running program that aggravated your arches.
A nexus letter from a physician, physician's assistant, or nurse practitioner must state — at minimum — that it is "at least as likely as not" that your current flat feet are a result of or were permanently aggravated beyond natural progression by your military service. The letter should reference your specific MOS or duties (infantry, logistics, military police), the biomechanical stress those duties place on the arch, and your current clinical findings.
Flat feet don't just hurt your feet. When the arch collapses, the entire kinetic chain from ankle to hip is thrown out of alignment. This altered biomechanics places abnormal stress on joints and soft tissue up the leg and into the lower back — creating a cascade of secondary conditions that are each independently ratable under 38 CFR § 3.310.
Each of the following conditions can be claimed as secondary to your service-connected flat feet — and each receives its own separate disability rating added to your combined total.
Overpronation caused by flat feet forces the tibia to rotate inward during the gait cycle, pulling the kneecap (patella) off its normal tracking groove. This is the direct mechanism for patellofemoral pain syndrome — characterized by dull, aching pain around or behind the kneecap that worsens with stairs, squatting, or prolonged sitting. VA rates knee conditions under DC 5260 (limitation of flexion) and DC 5261 (limitation of extension), among others.
Inward rotation of the femur — again, driven by overpronation — places repetitive friction on the iliotibial band and the greater trochanteric bursa, the fluid-filled sac on the outer hip. Hip bursitis and hip pain from altered gait mechanics are well-documented secondary effects of pes planus and can be rated under DC 5251 (limitation of hip extension) or other relevant hip codes.
Flat feet reduce the shock-absorbing capacity of the foot's arch, transmitting greater impact forces up through the ankle, knee, and hip into the lumbar spine. Over years of service and post-service activity, this contributes to lumbar muscle strain and degenerative disc changes. If you already have a service-connected back condition, the nexus to flat feet strengthens both claims. If your back pain has no current rating, claiming it secondary to flat feet under the DC 5237 (lumbosacral strain) criteria can add significant compensation.
The plantar fascia — the thick band of tissue running along the bottom of the foot from heel to toes — is under constant stress in a flat foot because it must compensate for the absent arch. Plantar fasciitis (heel and arch pain worst in the morning or after rest) is one of the most direct and common sequelae of pes planus. It can be rated separately under DC 5284 (other foot injuries) based on functional impairment.
Overpronation stretches and strains the Achilles tendon with every step. Achilles tendinitis produces pain, stiffness, and swelling along the back of the heel. The condition can be separately rated and, if chronic, may involve evidence of tendinosis on MRI.
Veterans with flat feet often experienced shin splints during service — particularly during basic training — because overpronation overloads the medial edge of the tibia. Chronic shin splints can be documented in STRs and claimed as a secondary condition, particularly if they contributed to stress fractures or ongoing pain.
Editorial Standards: This article was written by Marcus J. Webb, a veterans benefits researcher who has studied 38 CFR Part 4, the VA M21-1 Adjudication Manual, and thousands of BVA decisions. Content is verified against current 38 CFR regulations and VA.gov guidance. Last reviewed: April 2026. Not legal advice — for representation on your specific claim, talk to a VA-accredited attorney.