ANKLE IMPAIRMENT OF

EMILY TAMLYN · 2026 · Case ID: 26003894

MIXED

Summary

The veteran, who served from September 1996 to September 2002, appeals the denial of increased ratings for bilateral pes planus and bilateral plantar fasciitis, and the grant of service connection for ankle disability and left foot posttraumatic arthritis as secondary to his service-connected foot conditions. The Board reviewed the evidence, including multiple VA examinations and medical opinions from October, November, and December 2025. The Board found the October 2025 opinion more probative, concluding that the veteran's ankle disability would be less severe were it not for his service-connected pes planus and plantar fasciitis, thus granting service connection for ankle disability secondary to these conditions. A separate medical opinion from December 2022 also supported granting service connection for left foot posttraumatic arthritis secondary to pes planus. Regarding the increased rating for pes planus, the Board denied an evaluation higher than 40 percent, finding that while the veteran's condition met the criteria for the maximum 50 percent rating, the pre-existing 10 percent rating for pes planus was subtracted, leaving the maximum schedular rating at 40 percent. The Board also denied an increased rating for plantar fasciitis, as the veteran had not undergone surgical treatment and the evidence did not show actual loss of use of the foot, thus not meeting the criteria for a rating higher than 10 percent.

Rationale

October 2025 VA examination reflects ankylosis of left ankle, degenerative arthritis of left ankle, and bilateral ankle strain.; October 2025 medical opinion provided positive nexus stating ankle disability would be less severe and result in less functional impairment if service-connected pes planus or plantar fasciitis were absent.; November 2025 VA examination and opinion were found insufficient.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

16-43 060

Full Decision Text

Citation Nr: 26003894
Decision Date: 03/27/26 Archive Date: 03/27/26

DOCKET NO. 16-43 060
DATE: March 27, 2026

ORDER

Entitlement to service connection for an ankle disability as secondary to service-connected bilateral pes planus and plantar fasciitis is granted.

Entitlement to service connection for left foot posttraumatic arthritis as secondary to service-connected bilateral pes planus, is granted.

Entitlement to an evaluation in excess of 40 percent for bilateral pes planus is denied.

Entitlement to an initial evaluation in excess of 10 percent for bilateral plantar fasciitis is denied.

FINDINGS OF FACT

1. The probative evidence is for finding that the Veteran's bilateral ankle disability would be less severe were it not for the service-connected foot disability.

2. The probative evidence is for finding that the Veteran's left foot posttraumatic arthritis is caused by the service-connected pes planus.

3. The Veteran's bilateral pes planus is productive of symptoms and functional impairment comparable in severity, frequency, and duration to those described under the criteria for the maximum 50 percent rating and his pre-existing bilateral pes planus has been assigned 10 percent evaluation.

4. The evidence of record indicates that he has never had surgical treatment and fails to show the actual loss of use of the foot.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral ankle disability as secondary to bilateral pes planus and plantar fasciitis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for service connection for left foot traumatic arthritis as secondary to pes planus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for an evaluation in excess of 40 percent for bilateral pes planus are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.71a, Diagnostic Code (DC) 5276.

4. The criteria for a disability rating in excess of 10 percent for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a. DC 5269.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1996 to September 2002.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from Department of Veterans Affairs (VA) Regional Office (RO)'s rating decision issued in December 2012. The Veteran testified before the undersigned Veterans Law Judge during an April 2022 Board hearing; a transcript is of record.

The Board previously remanded the issues for further development in July 2025. In accordance with the remand directives, the AOJ scheduled VA examinations and medical opinions. The case has now been returned to the Board for appellate review.

Service Connection

1. Entitlement to service connection for an ankle disability is granted.

In the July 2025 remand, the Board found that the medical evidence of record raises a possibility that his pes planus and subsequent corrective surgery might be impacting his use of the ankles.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303 (d).

As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in-service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

A November 2025 VA examination reflects a diagnosis of ankylosis of left ankle, subtalar or tarsal joint, degenerative arthritis of the left ankle, and bilateral ankle strain.

An October 2025 medical opinion provides a positive nexus stating that the Veteran's ankle disability would be less severe and result in less functional impairment if service-connected pes planus or plantar fasciitis were absent. The examiner explained that excessive pronation and flattening of the longitudinal arch increase internal rotation and eversion at the subtalar and ankle joints, leading to progressive fatigue, weakness, and pain with weight-bearing and that pain localized to the plantar fascia limits push-off and promotes compensatory inversion moments, producing cumulative strain at the ankle during gait cycles. The examiner provided references in support of her opinions.

In November 2025, an examiner different from the October 2025 examiner provided another medical opinion. He stated that he did not see evidence that the ankle disability would result in less functional impairment but for the foot and/or foot scar disabilities. An addendum opinion to this November 2025 opinion was obtained in December 2025, in which the November 2025 examiner stated that the ankle disability is independent of the service-connected foot or foot scar conditions and that there is no objective evidence demonstrating that the foot disabilities or scars have altered gait mechanics, contributed to biomechanical stress on the ankle, or exacerbated the severity of the ankle pathology. The examiner further stated that general medical principles support the assessment that an ankle disability develops based on its own structural integrity, trauma history, degenerative changes, and functional load-bearing capacity.

The Board affords more probative weight to the October 2025 medical opinion. On the one hand, the August 2025 VA foot examination notes that chronic foot pain from plantar fasciitis and pes planus contributes to gait alteration and compensatory stress on the left foot, resulting in secondary arthritis and the October 2025 medical opinion is consistent with medical evidence of record and based on medical principles supported by medical literature. On the other hand, the November 2025 examiner conducted a separate VA examination, which only evaluated pain and it does not even note diagnoses for the foot disabilities. As such, the November 2025 VA examination is insufficient and the November 2025 medical opinion based on the insufficient examination is not adequate.

For the foregoing reasons, the Board finds that the probative evidence is for finding that the Veteran's bilateral ankle disability would be less severe were it not for the service-connected foot disability. The claim of service connection for bilateral ankle disability secondary to service-connected bilateral pes planus and plantar fasciitis is granted.

2. Entitlement to service connection for left foot posttraumatic arthritis as secondary to service-connected bilateral pes planus, is granted.

A December 2022 medical examiner provided an opinion that the Veteran's left foot posttraumatic arthritis is a progression of his service-connected pes planus. The rationale was that the medical literature showed pes planus is a risk factor for developing posttraumatic arthritis of the foot because the abnormal foot structures lead to excessive strain over time and change in his gait, which may cause the inflammation to occur. The examiner cited multiple references in support of the opinion.

The Board finds this medical opinion probative because it is based on the facts found in the claim file and well-known medical principles.
granted.

2. Entitlement to service connection for left foot posttraumatic arthritis as secondary to service-connected bilateral pes planus, is granted.

The Board finds this medical opinion probative because it is based on the facts found in the claim file and well-known medical principles. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A review of the claims file indicates no other etiology for the left foot traumatic arthritis. Accordingly, entitlement to service connection for left foot traumatic arthritis is granted.

Increased Rating

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155 ; 38 C.F.R. § Part 4.

When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Such separate disability ratings are known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999) (noting that staged ratings are assigned at the time an initial disability rating is assigned).

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown,7 Vet. App. 55 (1994). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. §4.7.

In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38C.F.R. §§4.1, 4.2, 4.10.

The Court has emphasized that when assigning a disability rating it is necessary to consider limitation of a joint's functional ability due to flare-ups, fatigability, incoordination, and pain on movement, or when it is used repeatedly over a period of time, functional loss due to flare-ups, fatigability, incoordination, and pain on movement. DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). In Mitchell, the Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance (38 C.F.R. § 4.40 ), as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing (38C.F.R. §4.45). Joints should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 38 C.F.R. § 4.59; Correia v. McDonald, 28 Vet. App. 158 (2016).

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id.

Furthermore, 38 C.F.R. § 4.59 recognizes that painful motion is an important factor of disability. Joints that are painful, unstable, or misaligned, due to healed injury, are entitled to at least the minimum compensable rating for the joint. Id. Special note should
Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id.

Furthermore, 38 C.F.R. § 4.59 recognizes that painful motion is an important factor of disability. Joints that are painful, unstable, or misaligned, due to healed injury, are entitled to at least the minimum compensable rating for the joint. Id. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. Id. Pain that does not result in additional functional loss does not warrant a higher rating. Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011).

1. Entitlement to an evaluation in excess of 40 percent for bilateral pes planus is denied.

The Veteran's bilateral pes planus is currently evaluated as 40 percent disabling under DC 5276. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed.

As explained in the September 2023 Board decision that granted the 40 percent evaluation, the AOJ had already found in the January 2003 rating decision that his bilateral pes planus was 10 percent disabling prior to service and the 10 percent was subtracted from the maximum 50 percent evaluation, resulting in the assignment of 40 percent.

Under DC 5276, a 30 percent rating is assigned, where there is severe bilateral acquired flat foot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A maximum 50 percent rating is warranted for pronounced bilateral acquired flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achilles on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276.

A review of the evidence of record reflects that the Veteran's bilateral pes planus is still more nearly approximated by the 50 percent criteria. Most recently, he underwent a VA examination in August 2025. Due to pes planus, the examiner determined that the Veteran had pain on use of the feet bilaterally and the pain was accentuated on use. He had pain on manipulation of the feet. There was no swelling on use nor characteristic calluses. Marked deformity of one or both feet was observed, with extreme tenderness of plantar surfaces on both feet. He had decreased longitudinal arch height of both feet on weight-bearing. There was marked pronation of one foot or both feet, not improved by orthopedic shoes or appliances. For both feet, the weight-bearing line was over or medial to the great toe. There was no lower extremity deformity other than pes planus, causing alteration of the weight-bearing line. He had inward bowing of the Achilles' tendon bilaterally. Accordingly, as of August 2025, the Veteran's bilateral pes planus is productive of symptoms and functional impairment comparable in severity, frequency, and duration to those described under the criteria for the maximum 50 percent rating.

Thus, the rating in excess of 40 percent (50 percent adjusted with the 10 percent severity for pre-existing pes planus), is not warranted.

The Veteran raises an argument for an extraschedular consideration because his pes planus causes pain, stiffness, tenderness, swelling, limited movement, cramping, spasms, popping, clicking of the ankles, abnormal gait, sleep impairment, his ability to run, lift, bend, climb stairs or ladders, walk, and stand. See June 2024 Appellant's Brief.

Referral for an extraschedular rating requires evidence reflecting that a veteran's disability picture is not sufficiently contemplated by the rating schedule. See Thun v. Peake, 22 Vet. App. 111, 115-16 (2008).

In Thun, the Court explained that "the determination of whether a claimant is entitled to an extraschedular rating under 38 C.F.R. § 3.321(b) is a three-step inquiry... The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service
climb stairs or ladders, walk, and stand. See June 2024 Appellant's Brief.

In Thun, the Court explained that "the determination of whether a claimant is entitled to an extraschedular rating under 38 C.F.R. § 3.321(b) is a three-step inquiry... The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate." Thun v. Peake, 22 Vet. App. 111, 115 (2008).

"Initially, there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability...[I]f the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required." See id.

In the present case, the scheduling criteria reasonably describe the Veteran's disability level and symptomatology related to musculoskeletal impairment. As for sleep impairment, the evidence of record fails to indicate its impact on his ability to work. Thus, none of the lay or medical evidence of record appears to show the kind of "exceptional" disability picture that justifies referral for consideration of an extraschedular rating. See 38 C.F.R. § 3.321; Thun v. Peake, 22 Vet. App. 111, 115-16 (2008). As the Veteran is already receiving the maximum evaluation under DC 5276, and there is no evidence that the Veteran's pes planus symptoms are not adequately contemplated by the schedular rating criteria, entitlement to an increased rating for pes planus must be denied.

2. Entitlement to an evaluation in excess of 10 percent for bilateral plantar fasciitis is denied.

The Veteran's bilateral plantar fasciitis is currently evaluated as 10 percent disabling under DC 5269, effective February 7, 2021.

The Board notes that in a May 2024 Joint Motion for Partial Remand (JMPR), the parties moved to vacate the part of the September 5, 2023, Board decision that denied, inter alia, entitlement to a rating higher than 40 percent for bilateral pes planus from April 6, 2022, and to remand the matter to the Board. This June 2024 JMPR was granted by the Court (Court of Appeals for Veterans Claims) in June 2024. The current appeal originates from this JMPR. Since in the September 5, 2023, decision, the Board granted a separate evaluation of 10 percent for bilateral plantar fasciitis effective February 7, 2021, noting that prior to February 7, 2021, when the schedular criteria were introduced for plantar fasciitis, this foot disability was evaluated analogously under DC 5276 for pes planus.

The Veteran contends that he is entitled to a 10 percent evaluation for bilateral plantar fasciitis prior to February 7, 2021, because he had the disability before that date. See June 2024 Appellant's Brief. No other argument was raised.

In the present case, as explained in the September 2023 Board decision that granted a separate evaluation for plantar fasciitis under the new code DC 5269, the disability of plantar fasciitis had been evaluated under DC 5276. This means that a separate evaluation for plantar fasciitis prior to February 7, 2021, under DC 5276 would be pyramiding prohibited in 38 C.F.R. § 4.14. Therefore, the Board considers whether his bilateral plantar fasciitis warrants an evaluation in excess of 10 percent under DC 5279, effective February 7, 2021.

DC 5269 provides for a 10 percent rating for a diagnosis of plantar fasciitis, a 20 percent rating for unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment and a 30 percent rating for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. Note (1) also provides a 40 percent rating with the actual loss of use of the foot.

(Continued on the next page)

Most recently, in August 2025, the Veteran underwent a VA
, the Board considers whether his bilateral plantar fasciitis warrants an evaluation in excess of 10 percent under DC 5279, effective February 7, 2021.

(Continued on the next page)

Most recently, in August 2025, the Veteran underwent a VA examination, which reflects a diagnosis of bilateral plantar fasciitis. The examiner determined that the Veteran had undergone non-surgical treatment and did not relieve the symptoms. He had not undergone surgical treatment for plantar fasciitis, and he was not recommended for surgical intervention. The functional loss due to plantar fasciitis were chronic pain and stillness in both feet that limited prolonged walking, standing, and running. Pain increased with weight-bearing and was only minimally improved by orthotics. During the flareups, the Veteran must rest, elevate the feet, or limit activity, resulting in functional impairment for occupational and daily tasks requiring mobility.

Therefore, the evidence of record indicates that he has never had surgical treatment. The 20 percent rating and higher require both non-surgical and surgical treatment, and additionally, the evidence fails to show the actual loss of use of the foot. Therefore, an evaluation in excess of 10 percent for bilateral plantar fasciitis is not warranted. The claim is denied.

Emily Tamlyn

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Y. Taylor, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

Analyze in VA Law Explorer