Two wrong assumptions do most of the damage in flat feet claims. The first is that a mild pes planus note on the entrance exam kills the claim; aggravation theory exists for exactly that file. The second is that the bilateral factor stacks on top; DC 5276 already builds the both-feet percentages into its own criteria, so 50 percent for pronounced bilateral flat feet stands on its own.
Two wrong assumptions sink most flat feet claims. The first is that a mild pes planus note on the entrance exam kills the claim. Aggravation theory exists for exactly that file. The second is that the bilateral factor stacks on top of a DC 5276 rating. It does not. DC 5276 already builds the both-feet percentages into its own criteria, so 50 percent for pronounced bilateral flat feet stands on its own.
How VA rates flat feet
Flat feet (pes planus) are rated under diagnostic code 5276 in 38 CFR 4.71a. Unlike most joint codes, 5276 does not use range of motion. It rates the deformity and the symptoms, and it has separate, higher percentages built in for when both feet are affected:
- Mild: symptoms relieved by orthopedic accommodation such as a built-up shoe, arch support, or similar supportive device or insert. 0 percent.
- Moderate: the weight-bearing line is over or medial to the great toe, inward bowing of the achilles tendon, pain on manipulation and use. 10 percent (one foot or both).
- Severe: marked deformity (pronation, abduction), pain on manipulation and use that is accentuated, swelling on use, and callus formation. 20 percent one foot, 30 percent both feet.
- Pronounced: marked pronation, extreme tenderness of the plantar surfaces, marked inward displacement and severe spasm of the achilles tendon on manipulation, not improved by orthopedic shoes or appliances. 30 percent one foot, 50 percent both feet.
The bilateral percentages are already in the code
This is the point veterans most often miss. Because 5276 already lists higher percentages for bilateral flat feet (30 percent and 50 percent), the standard bilateral factor under 38 CFR 4.26 does not stack on top of a 5276 rating. The code already accounts for both feet. Pronounced bilateral pes planus is 50 percent, full stop.
Aggravation: the most common path
Many veterans had mild flat feet noted at their entrance exam. That does not end the claim. If a condition is noted at entry, you can still be service connected on an aggravation theory: service made it permanently worse beyond its natural progression. VA establishes a baseline from the entrance exam and compensates the increase. Foot-pounding training, marching, and load-bearing are common aggravators worth documenting.
Functional loss still matters
Even though 5276 is symptom-based, the examiner should account for pain on use and after activity under 38 CFR 4.40 and 4.45 (the DeLuca principle). Describe what your feet feel like at the end of a long day on them, not just at rest.
Common rating mistakes to avoid
- Bilateral is built into the code, so do not expect the separate bilateral factor on top of a 5276 rating.
- Flat feet noted at entry can still be service connected through aggravation. The entrance note sets a baseline; it does not bar the claim.
- Orthopedic shoes, orthotics, or other appliances that do not help point to the pronounced level, which is exactly what the 50 percent criteria call out. Document everything you have tried and that it did not provide relief.
- Plantar fasciitis and a foot deformity are different conditions, rated under their own codes, and can be claimed alongside flat feet.
- Describe end-of-day pain, because the rating turns on pain on manipulation and use, not on a calm exam-room foot.