HAMMER TOE

L. B. CRYAN · 2026 · Case ID: A26030393

MIXED

Summary

The Veteran, an Army Veteran who served from June 1975 to June 1979, appeals the denial of service connection for left foot hammer toes and the denial of a compensable rating for this condition. The Veteran also appealed the denial of service connection for right foot hammer toes, claiming it was secondary to his service-connected right foot disability. The Board granted service connection for the right foot hammer toes, finding that the Veteran's current disability was proximately due to or the result of his service-connected right great toe condition, citing favorable evidence from a private podiatrist. The Board found the private opinion probative due to its consideration of the Veteran's history, examination findings, and medical literature on foot biomechanics, concluding the hammertoes were more likely than not related to service or aggravated by his service-connected hallux valgus. However, the Board denied a compensable rating for the left foot hammer toes. While acknowledging the Veteran's complaints of pain and functional impairment, the Board found that the symptoms impacted only three toes, which did not meet the criteria for a compensable rating under Diagnostic Code 5282. The Board also considered other diagnostic codes but found them inapplicable or already accounted for by existing ratings, and noted that the Veteran's left foot disability did not meet the criteria for loss of use of the foot. The Board also determined that a claim for Total Disability based on Individual Unemployability (TDIU) was not raised by the record.

Rationale

Favorable private opinion from board-certified podiatrist; Opinion grounded in medical literature on foot biomechanics; Service treatment records document in-service foot pathology

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210308-146195

Full Decision Text

Citation Nr: A26030393
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 210308-146195
DATE: April 2, 2026

ORDER

Service connection for right foot hammer toe, as secondary to service-connected post-operative bunionectomy/osteotomy right great toe with internal fixation, is granted.

A compensable rating for service-connected left foot hammer toes is denied.

FINDINGS OF FACT

1. The evidence shows that the Veteran's currently diagnosed right foot hammer toe was caused by his service-connected post-operative bunionectomy/osteotomy right great toe with internal fixation/right foot hallux valgus.

2. The Veteran's service-connected left foot hammer toes more nearly approximate symptoms impacting single toes-here, his second, third, and fourth toes.

CONCLUSIONS OF LAW

1. Resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for right foot hammer toe, secondary to service-connected post-operative bunionectomy/osteotomy right great toe with internal fixation/right foot hallux valgus have been met. 38 U.S.C. § §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

2. The criteria for a compensable rating for left foot hammer toes have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Code 5282.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 1975 to June 1979.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2020 higher-level review of a March 2020 rating decision and a November 2020 rating decision issued by a VA Regional Office (RO), which is an agency of original jurisdiction (AOJ).

In the September 2020 rating decision, the RO confirmed and continued the 0 percent rating for the service-connected left foot hammer toes, and issued a Higher-Level Review Return (VA Form 20-0999) to correct a duty to assist error in the March 2020 rating decision with regard to the issue of service connection for right foot hammer toes, and therefore transferred the claim to a Supplemental Claim to correct the duty-to-assist error. Following additional development, the RO issued the November 2020 rating decision, which confirmed and continued the previously denied claim of service connection for right foot hammer toe.

In the March 8, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned Veterans Law Judge (VLJ) on October 30, 2024. A transcript of the hearing is associated with the claims file.

Therefore, with regard to the claim for an initial compensable rating for left foot hammer toes, the Board may only consider the evidence of record at the time of the underlying March 2020 rating decision that was subject to the higher-level review, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

With regard to the claim for service connection for right foot hammer toe, the Board may only consider the evidence of record at the time of the November 2020 rating decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. §20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R.
at the hearing or within 90 days following the hearing. 38 C.F.R. §20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, air or space service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service' the so-called nexus' requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Service connection is also warranted for disability which is proximately due to or "the result of" service-connected disease or injury. 38?C.F.R. § 3.310(a). Secondary service connection under 38 C.F.R. § 3.310(a) is warranted where a non-service-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Spicer?v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and instead holding that a "but for" causation or aggravation is enough to show entitlement to secondary service connection).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary.

It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. §§ 5107;
, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102

Entitlement to service connection for right foot hammer toe, to include as secondary to service-connected right foot post-operative bunionectomy/osteotomy right great toe with internal fixation

The Veteran contends that his right foot hammer toes began during active service as a result of trauma to the right great toe, prolonged use of Army combat boots, and extensive physical training. He reports experiencing right foot pain and related symptoms during service between 1978 and 1979, and believes the hammer toe deformity developed at that time. Alternatively, the Veteran asserts that his right foot hammer toes developed secondary to his service-connected right foot disability, including the post-operative bunionectomy/osteotomy of the right great toe with Morton's neuroma. He reports that after undergoing bunion surgery around 2010, his symptoms worsened and his toes began shifting, leading to increased pain, burning sensations, numbness, swelling, and shooting pain, which sometimes cause limping and difficulty walking long distances. See January 2020 VA Foot Conditions Disability Benefits Questionnaire (DBQ), September 2020 HLR - Informal Conference Worksheet, October 2020 VA Foot Conditions DBQ, October 2024 Board Hearing Transcript, and October 2024 private opinion from Syed N. Ahmed.

Initially, the Veteran's status-post bunionectomy/osteotomy of the right great toe with internal fixation, status-post comminuted fracture, to include a spur and Morton's neuroma (previously right great toe fracture) is already service connected. According to https://pubmed.ncbi.nlm.nih.gov/31971732/ hallux valgus is characterized by a lateral deviation of the proximal phalanx of the great toe and a medial deviation of the first metatarsal head, which further results in the adduction of the first metatarsal, a condition known as metatarsus primus varus. Essentially, the big toe is misaligned, leading to the formation of a bony bump at the base of the big toe, commonly known as a bunion. In other words, bunions are the physical manifestation of the hallux valgus deformity. Thus, both describe the same condition. Accordingly, the Board finds that the Veteran's service-connected right great toe disability encompasses right foot hallux valgus.

The medical evidence of record demonstrates that the Veteran has been diagnosed during the appeal with right foot hammer toes. See September 2015, January 2020, and October 2020 VA Foot Conditions DBQ. In addition, in the November 2020 rating decision on appeal, the AOJ made the favorable finding that the Veteran has been diagnosed with a current disability, specifically, hammer toe, right foot. The AOJ also found that a qualifying event, injury, or disease had its onset in service, as service treatment records show that the Veteran was seen in service for right foot pain. As such, the first and second elements of the service connection claim are met.

As for in-service incurrence, the April 1975 enlistment examination noted no foot abnormalities. Service treatment records later document several complaints involving the right foot and great toe. In March 1977, the Veteran reported right foot pain and was noted to have a blister and unusual prominence of the right great toe, with pain centered at the base of the toe. An X-ray taken at that time was negative. In May 1977, he again complained of trauma to the right great toe, but X-ray findings remained negative. In August 1977, he reported pain along the medial and lateral aspects of the right foot, which he believed was related to wearing military boots, and he indicated that surgery on the right foot had been discussed with referral to a podiatrist. The May 1979 separation examination noted a history of a fractured right great toe in 1977 that healed with bunion formation.

Shortly after separation, a September
foot pain and was noted to have a blister and unusual prominence of the right great toe, with pain centered at the base of the toe. An X-ray taken at that time was negative. In May 1977, he again complained of trauma to the right great toe, but X-ray findings remained negative. In August 1977, he reported pain along the medial and lateral aspects of the right foot, which he believed was related to wearing military boots, and he indicated that surgery on the right foot had been discussed with referral to a podiatrist. The May 1979 separation examination noted a history of a fractured right great toe in 1977 that healed with bunion formation.

Shortly after separation, a September 1979 VA examination documented the Veteran's report of occasional cramping in the right great toe following a fracture sustained in February 1976 when he slipped during a field exercise at Fort Lewis. The examiner diagnosed bilateral hallux valgus and residuals of a fracture of the right great toe.

As noted above, the Veteran primarily contends that his right foot hammer toe disability was caused or aggravated by his service-connected right foot disability. He further asserts that his right foot hammer toes began during service due to trauma and prolonged boot wear.

Accordingly, the remaining question before the Board is whether the Veteran's currently diagnosed right foot hammer toes are related to his active service, or are caused or aggravated by his service-connected right foot disability.

On this question, there is both favorable and unfavorable evidence.

The unfavorable evidence includes a January 2020 VA examination report, in which the examiner opined that the Veteran's right foot hammer toes were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that although the medical records document various bilateral foot problems, including hallux valgus and residuals of a toe fracture, there was no diagnosis or mention of hammer toes in the medical evidence. As such, examiner concluded that the Veteran's diagnosed right foot hammer toes were less likely than not related to his military service.

The Board finds that the January 2020 VA opinion is of limited probative value. In reaching the negative conclusion, the examiner relied primarily on the absence of a specific diagnosis of hammer toes in the service treatment records. However, the lack of a specific diagnosis in service, standing alone, is not a sufficient basis to conclude that a current disability is unrelated to service. Notably, the service treatment records document several complaints of right foot pain, trauma to the right great toe, and the development of a bunion deformity (hallux valgus) during service. These records reflect the presence of right foot pathology during active duty. The examiner did not adequately explain why these documented in-service foot problems could not be related to the later development of hammer toes, nor did the examiner meaningfully address the Veteran's lay statements regarding the onset and progression of his symptoms. Because the opinion appears to rely largely on the absence of documented hammer toes during service, without sufficient consideration of the documented in-service symptoms and the Veteran's competent reports, the Board finds that the January 2020 opinion is of limited probative value.

An October 2020 VA examiner also provided an opinion regarding the Veteran's claimed right foot hammer toes. The examiner acknowledged the Veteran's report that his hammer toes developed secondary to a right bunionectomy performed approximately ten years earlier. However, the examiner noted that the Veteran's VA problem list and primary care treatment records did not document a diagnosis of hammer toes, and there were no civilian medical records showing diagnosis or treatment for the condition. The examiner also observed that there was no medical opinion of record supporting a nexus between the Veteran's reported hammer toes and the 2010 right bunion surgery. Based on the available evidence and medical guidelines regarding causation, the examiner concluded that the evidence did not support a relationship between the Veteran's hammer toe condition and the prior bunion surgery.

The Board affords the October 2020 VA opinion limited probative value. In rendering the nexus opinion, the examiner relied in part on the absence of documentation of hammer toes in the Veteran's VA problem list and primary care records, and indicated that there were no medical records confirming a diagnosis of the condition. However, the record reflects that the Veteran has in fact been diagnosed with bilateral hammer toes, including during VA examination in 2015 and 2020. The September 2015 examiner noted that the diagnosis was made based on July 2015 findings, and the January 2020 examiner specifically identified hammer toes on the second, third, and fourth toes of both feet. Because the examiner's conclusion was based, at least in part, on an inaccurate factual premise regarding the existence of a diagnosis, the opinion is of diminished probative value.

The favorable evidence includes an October
of hammer toes in the Veteran's VA problem list and primary care records, and indicated that there were no medical records confirming a diagnosis of the condition. However, the record reflects that the Veteran has in fact been diagnosed with bilateral hammer toes, including during VA examination in 2015 and 2020. The September 2015 examiner noted that the diagnosis was made based on July 2015 findings, and the January 2020 examiner specifically identified hammer toes on the second, third, and fourth toes of both feet. Because the examiner's conclusion was based, at least in part, on an inaccurate factual premise regarding the existence of a diagnosis, the opinion is of diminished probative value.

The favorable evidence includes an October 2024 private medical opinion from Dr. Syed N. Ahmed, a board-certified podiatrist from Riverside, California, who reported reviewing the Veteran's service and post-service medical records and conducting a telehealth consultation with the Veteran. Dr. Ahmed noted that the Veteran sustained trauma to the right foot during service, which led to the development of a hallux valgus (bunion) deformity of the right foot, a condition for which the Veteran is already service connected following a post-operative bunionectomy/osteotomy with Morton's neuroma. Dr. Ahmed explained that the Veteran's enlistment examination in April 1975 documented no foot abnormalities, and that the hallux valgus deformity developed after the in-service trauma and was aggravated by prolonged use of Army combat boots. Dr. Ahmed further reported that the Veteran has experienced chronic bilateral foot pain since service, including pain related to hallux valgus and hammertoe deformities. Post-service records reviewed by Dr. Ahmed include a 2010 treatment for the right foot and right great toe, as well as medical records and VA examinations documenting diagnoses of pes planus, hallux valgus, and bilateral hammertoes. During the October 2024 telehealth examination, the Veteran reported severe intermittent bilateral toe pain (rated up to 10/10), difficulty wearing shoes, swelling, painful calluses, and pain with walking, with flare-ups occurring every other day. Objective findings observed during the consultation included semi-rigid contractures of toes two through five bilaterally, painful range of motion of the toes, decreased arch height, prominent first metatarsal heads, hyperkeratotic lesions, and an antalgic gait requiring the use of a cane.

Dr. Ahmed explained that it is well documented in the medical literature and known in the foot and ankle community that hallux valgus can cause hammertoes. Specifically, as the big toe deviates to the side, it pushes against the smaller toes, resulting in the smaller toes dorsiflexing/becoming hammertoes. Based on his review of the Veteran's medical history, examination findings, and the known biomechanics of foot deformities, Dr. Ahmed concluded that the Veteran's bilateral hammertoes are more likely than not proximately due to or the result of his activities during service and his service-related hallux valgus deformity, and therefore represent a secondary condition related to his service-connected right foot disability.

The October 2024 private medical opinion is probative. Dr. Ahmed is a board-certified podiatrist, and thus possesses specialized training and expertise in disorders of the foot and ankle. His opinion reflects consideration of the Veteran's relevant medical history, including review of the service treatment records, post-service medical records, and a telehealth consultation with the Veteran. Moreover, the doctor provided a clear, detailed rationale grounded in the medical principles governing foot biomechanics, including the relationship between hallux valgus and the development of hammer toes.

As competent evidence establishes that currently diagnosed right foot hammer toe disability is proximately due to the service-connected right great toe with internal fixation, status-post comminuted fracture, to include a spur and Morton's neuroma /right foot hallux valgus, the criteria for secondary service connection are met. 38 C.F.R. § 3.310. Resolving all reasonable doubt in the Veteran's favor, service connection for right foot hammer toes, secondary to service-connected right great toe with internal fixation, status-post comminuted fracture, to include a spur and Morton's neuroma /right foot hallux valgus is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Increased Ratings

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during active
olving all reasonable doubt in the Veteran's favor, service connection for right foot hammer toes, secondary to service-connected right great toe with internal fixation, status-post comminuted fracture, to include a spur and Morton's neuroma /right foot hallux valgus is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Increased Ratings

The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § § 4.14. However, § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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.

Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Hart v. Mansfield 21 Vet. App. 505 (2007).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary of VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3.

Entitlement to a compensable rating for left foot hammer toes

The Veteran contends that he is entitled to a higher disability evaluation for his left foot hammer toes because he has pain on the ball of the foot. See September 2020 HLR - Informal Conference Worksheet.

As noted above, in a March 2020 rating decision, the RO continued a 0 percent (noncompensable) rating for left foot hammer toes. In May 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the March 2020 decision. In a September 2020 rating decision, the RO continued a 0 percent rating for left foot hammer toes. The current appeal ensued. See March 2021 VA Form 10182, NOD.

The Veteran's left foot hammer toes is rated as 0 percent disabling (noncompensable), under 38 C.F.R. § 4.71a, Diagnostic Code 5282 for hammer toe.

Under Diagnostic Code 5282, for hammer toe, a noncompensable rating is warranted for hammer toes of single toes. A maximum 10 percent rating is warranted for hammer toe of all toes, unilateral, without claw foot.

Other diagnostic codes pertinent to disabilities of the feet include Diagnostic Code 5276 through Diagnostic Code 5281, Diagnostic Code 5283, and Diagnostic Code 5269.

Under Diagnostic Code 5276, for acquired flatfoot, a noncompensable rating is warranted for mild acquired flatfoot; symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the tendo Achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; 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. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; 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.

Diagnostic Code 5277 for bilateral weak foot states that bilateral weak foot is a symptomatic condition secondary to many constitutional conditions, characterized by atrophy to the musculature, disturbed circulation and weakness: rate the underlying condition, minimum rating of 10 percent.

Under Diagnostic Code 5278, for acquired claw foot (pes cavus), a noncompensable rating is warranted for slight acquired claw foot. A 10 percent rating is warranted for unilateral acquired claw foot great toe dorsiflexed, some limitation of dorsiflexion at the ankle, definite tenderness under metatarsal heads. A 10 percent rating is also warranted for bilateral acquired claw foot great toe dorsiflexed, some limitation of dorsiflexion at the ankle, definite tenderness under metatarsal heads. A 20 percent rating is warranted for unilateral acquired claw foot all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. A 30 percent rating is warranted for bilateral acquired claw foot all toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads. A 30 percent rating is also warranted for unilateral acquired claw foot marked contraction of plantar fascia, with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity. A maximum 50 percent rating is warranted for bilateral acquired claw foot marked contraction of plantar fascia, with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity.

Under Diagnostic Code 5279, a maximum 10 percent rating is provided for unilateral or bilateral anterior metatarsalgia (Morton's disease).

Under Diagnostic Code 5280, for unilateral hallux valgus, a maximum 10 percent rating is warranted for unilateral hallux valgus severe, if equivalent to amputation of great toe. A maximum 10 percent rating is also warranted for unilateral hallux valgus operated with resection of metatarsal head.

Under Diagnostic Code 5281, for severe unilateral hallux rigidus, the condition is rated as hallux valgus severe. A note to Diagnostic Code 5281 instructs that hallux rigidus is not to be combined with claw foot ratings.

Under Diagnostic Code 5283, for nonunion or malunion of tarsal or metatarsal bones, a 10 percent rating is warranted for moderate nonunion or malunion of tarsal or metatarsal bones. A 20 percent rating is warranted for moderately severe nonunion or malunion of tarsal or metatarsal bones. A 30 percent rating is warranted for severe nonunion or malunion of tarsal or metatarsal bones. A Note to Diagnostic Code 5283 instructs that with actual loss of use of the foot rate as a maximum 40 percent.

Under Diagnostic Code 5284, for other foot injuries, a 10 percent rating is provided for a moderate condition, 20 percent for a moderately severe condition, and 30 percent for a severe condition. The Note to Diagnostic Code 5284 indicates that a maximum 40 percent rating will be assigned for actual loss of use of the foot.
A 20 percent rating is warranted for moderately severe nonunion or malunion of tarsal or metatarsal bones. A 30 percent rating is warranted for severe nonunion or malunion of tarsal or metatarsal bones. A Note to Diagnostic Code 5283 instructs that with actual loss of use of the foot rate as a maximum 40 percent.

Effective February 7, 2021, During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71A were amended effective February 7, 2021. 83 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. In this case, the revisions to the regulations are not relevant to the instant claim as no changes were made to any diagnostic codes applicable to this claim.

The terms "moderate," "moderately severe," and "severe" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Therefore, the Board finds that it is appropriate to turn to a general purpose dictionary definition of these terms. See Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003) (in the absence of an express definition, words are given their ordinary meaning). "Moderate" means limited in scope or effect. "Severe" is defined as "extremely intense." The term "moderately severe" includes impairment that is considered more than "moderate" but not to the extent as to be considered "severe." Webster's New World Dictionary (2nd ed. 1999), 1012. The term "severe" is used throughout the rating schedule, including in Diagnostic Code 5284, to indicate a very great or intense case of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. Within the context of Diagnostic Code 5284, which establishes a successive, tiered rating structure, it represents the highest or most extreme level.

"Loss of use of a foot" is defined as no effective function remaining other than that which would be equally well served by an amputation stump at the site of election below the knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function of balance, propulsion, etc., which could be accomplished equally well by an amputation stump with prosthesis. 38 C.F.R. § 4.63.

In a July 2015 VA foot conditions examination, the examiner diagnosed the Veteran with left foot Morton's neuroma, hallux valgus, and hammer toes. The Veteran reported constant pain in the foot that ranged from moderate to severe and lasted days at a time. He also complained of flare-ups of left foot pain that prevented him from walking or standing for short periods of time without pain and discomfort. He also reported functional impairment described as stiffness and cramping. The examiner recorded that the second and third toes on the Veteran's left foot were affected by hammer toe. There was also noted pain on weight-bearing and non weight-bearing, and interference with sitting due to the left foot hammer toes.

On VA foot conditions examination in January 2020, the examiner diagnosed the Veteran with left foot flat foot (pes planus), metatarsalgia, hallux valgus, and hammer toes. The Veteran reported sharp pain in the foot, which he treated with shoe inserts, Motrin, and foot soaks. He also complained of mild to severe, daily flare-ups of left foot pain that lasted 1 - 2 hours, precipitated by prolonged walking and alleviated by rest. The examiner noted that hammertoes, hallux valgus, and bunions were causing alteration of the weight-bearing line of both feet. The examiner also reported that the second, third, and fourth toes were now affected by the left foot hammer toe.

After considering the
0, the examiner diagnosed the Veteran with left foot flat foot (pes planus), metatarsalgia, hallux valgus, and hammer toes. The Veteran reported sharp pain in the foot, which he treated with shoe inserts, Motrin, and foot soaks. He also complained of mild to severe, daily flare-ups of left foot pain that lasted 1 - 2 hours, precipitated by prolonged walking and alleviated by rest. The examiner noted that hammertoes, hallux valgus, and bunions were causing alteration of the weight-bearing line of both feet. The examiner also reported that the second, third, and fourth toes were now affected by the left foot hammer toe.

After considering the evidence, the Board finds that a compensable rating is not warranted for the Veteran's left foot disability.

The Veteran's left hammer toe symptomology is best approximated by a noncompensable rating because the evidence of record indicates that his hammer toe symptoms impact single toes, specifically his second, third, and fourth toes. See July 2015 and January 2020 VA Foot Conditions Disability Benefits Questionnaires (DBQs). Although the Veteran's left foot hammer toe disability impacts several of his toes, the next highest rating requires that his symptomology impact "all toes unilaterally without claw foot." 38 C.F.R. § 4.71a, Diagnostic Code 5282.

In sum, although there is no evidence of clawfoot, because the Veteran's left foot hammer toe symptomology involves only three of five toes, he is not eligible for a compensable, 10 percent rating for this disability.

Under certain circumstances additional disability could be awarded under the provisions of 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Those circumstances are not present in this case, as the provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 should only be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996). The rating criteria of Diagnostic Code 5282 are not predicated on limitation of motion. Thus, no further consideration pursuant to the Court's holding in DeLuca is warranted.

The Board has also considered whether other diagnostic codes are applicable to the Veteran's left foot disability. See Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc) (the assignment of a particular diagnostic code is "completely dependent on the facts of a particular case."). However, at no time during the period on appeal was the Veteran diagnosed with weak foot (Diagnostic Code 5277), claw foot (Diagnostic Code 5278), hallus rigidus (Diagnostic Code 5281), or malunion or nonunion of the tarsal or metatarsal bones (Diagnostic Code 5283).

During the appeal period, the Veteran was diagnosed with metatarsalgia (Diagnostic Code 5279). The Veteran currently receives a separate, maximum 10 percent rating under Diagnostic Code 5299 - 5279 for the left foot, for the entire period on appeal. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. Unlisted disabilities requiring rating by analogy will be coded by the numbers of the most closely related body part and "99." 38 C.F.R. § 4.27. The hyphenated diagnostic code in this case indicates that the Veteran's service-connected left foot disability is an unlisted foot disability, under DC 5299, that is rated by analogy under the criteria for metatarsalgia (Morton's disease) (Diagnostic Code 5279).

He was also diagnosed with hallux valgus (Diagnostic Code 5280). However, the evidence does not show that the Veteran has had an operation for left foot his hallux valgus with resection of the metatarsal head, or severe symptoms equivalent to amputation of the great toe. Therefore, the condition does not meet the criteria for a compensable rating under this code. He was also diagnosed with flat foot (pes planus) on VA examination in January 2020, but his condition does not meet the criteria for a compensable rating under this code.

The Board has considered whether a higher rating may be assigned under 38 C.F.R. § 4.71a, Diagnostic Code 5284, which pertains to "other foot injuries." However, the Board's reading
However, the evidence does not show that the Veteran has had an operation for left foot his hallux valgus with resection of the metatarsal head, or severe symptoms equivalent to amputation of the great toe. Therefore, the condition does not meet the criteria for a compensable rating under this code. He was also diagnosed with flat foot (pes planus) on VA examination in January 2020, but his condition does not meet the criteria for a compensable rating under this code.

The Board has considered whether a higher rating may be assigned under 38 C.F.R. § 4.71a, Diagnostic Code 5284, which pertains to "other foot injuries." However, the Board's reading of VA regulations leads it to conclude that a separate rating under Diagnostic Code 5284 is not warranted in this case. In this regard, VA's Schedule for Rating Disabilities sets forth a specific diagnostic code applicable to hammer toe (i.e., Diagnostic Code 5282). It is significant in the Board's view that hammer toe is expressly addressed by a specific diagnostic code. The Veteran's symptoms are specifically noted in the rating criteria for Diagnostic Code 5282. Where a condition is specifically listed in the rating schedule, it may not be rated by analogy under Diagnostic Code 5284. See Copeland v. McDonald, 27 Vet. App. 333, 336-37 (2015) ("the Court reiterates that when a condition is specifically listed in the Schedule, it may not be rated by analogy"). Because there is a specific diagnostic code for hammer toe, it is not appropriate to rate the Veteran's disability under another diagnostic code. As noted, the Veteran has also been granted service connection for Morton's neuroma of the left foot, which is specifically contemplated under Diagnostic Code 5279. Because the Veteran's foot disabilities are expressly listed in the rating schedule, Diagnostic Code 5284 is not for application. See Copeland, 27 Vet. App. at 338.

Moreover, rating the Veteran's left foot disability under Diagnostic Code 5284 would risk compensating overlapping symptomatology, such as pain with weight-bearing, difficulty with prolonged standing and walking, and functional impairment of the foot, which is already contemplated by the separately assigned ratings for left foot hammer toe and Morton's neuroma, in violation of the rule against pyramiding. See 38 C.F.R. § 4.14. In this regard, Morton's neuroma is a painful neuropathy resulting from a benign enlargement of the common plantar digital nerve that occurs commonly in the third webspace and, less often, in the second webspace of the foot. https://pmc.ncbi.nlm.nih.gov/articles/PMC10853972/ Those are the symptoms contemplated by his current rating(s). See September 2020 HLR - Informal Conference Worksheet.

The evidence also persuasively weighs against finding that the Veteran has had actual loss of use of the left foot at any time during the period on appeal. Accordingly, assignment of a separate rating under Diagnostic Code 5284 is not warranted.

In reaching this determination, the Board also acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130 (2025). Here, the Veteran reported treating his left foot disability with shoe inserts, foot soaking, and Motrin on examination in January 2020. The examiner considered the Veteran's lay description of functional impairment due to pain in all worse case-scenarios. There is no indication that the examiner considered the ameliorative effects of medication and indeed, factored in the Veteran's description of when his pain is at its worse, i.e., discounted such effects. The Board, too, in rendering this decision, resolved all reasonable doubt in the Veteran's favor. As such there is no indication that the examiner considered the ameliorative effects of medication in rendering the findings in the report. Therefore, the examination report is adequate to base a decision.

Finally, the Board has considered whether the evidence of record raises the issue of a total disability rating based on individual unemployability due to service-connected disability (TDIU). See Rice v. Shinseki, 22 Vet. App. 447 (2009) (holding that a claim for a total rating based on unemployability due to service- connected disability; either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating). In this case, a TDIU claim is neither explicitly nor implicitly raised by the record. The record reflects that the Veteran experiences some functional impairment due to his service-connected disabilities, for
Finally, the Board has considered whether the evidence of record raises the issue of a total disability rating based on individual unemployability due to service-connected disability (TDIU). See Rice v. Shinseki, 22 Vet. App. 447 (2009) (holding that a claim for a total rating based on unemployability due to service- connected disability; either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating). In this case, a TDIU claim is neither explicitly nor implicitly raised by the record. The record reflects that the Veteran experiences some functional impairment due to his service-connected disabilities, for which he is already compensated. However, the Veteran has not asserted that he is unable to secure or follow substantially gainful employment due to his service-connected disabilities. The evidence shows that the Veteran retired after working for approximately 36 years as a manager with the United States Postal Service, and he has not contended that he retired because he was unable to continue working due to his service-connected conditions. The record likewise does not otherwise suggest that his retirement was related to such disabilities. Moreover, the evidence reflects that the Veteran was approved for participation in the VA vocational rehabilitation program in June 2024, which further indicates an ability to pursue employment or training. Accordingly, the issue of entitlement to a TDIU has not been raised as part of the Veteran's increased rating claim.

(Continued on the next page)

In denying the claim, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence persuasively weighs against the claim, that doctrine is not applicable. 38 U.S.C. § 5107; see Lynch, 21 F.4th at 781; 38 C.F.R. § 3.102.

L. B. CRYAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board F. Yankey, 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