ACQUIRED FLATFOOT

MICHAEL MARTIN · 2026 · Case ID: A26033969

MIXED

Summary

The veteran, who served in the Army National Guard with periods of active service from 2001 to 2002 and 2003 to 2004, appeals a prior Board decision denying entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus and plantar fasciitis, and denying service connection for residuals of dental problems for compensation purposes. The Board reviewed evidence of record up to the time of the prior decisions, including lay statements, private provider DBQ, VA treatment records, and a March 2021 VA examination. For the foot condition, the Board found that while the veteran experienced pain and functional loss, the evidence did not support a rating higher than 30 percent under Diagnostic Code 5276, as the symptoms did not approximate the most severe cases or loss of use of the foot. The Board noted the recent addition of Diagnostic Code 5269 for plantar fasciitis, which warranted a 30 percent rating for bilateral plantar fasciitis with no relief from non-surgical treatment and the veteran not being a surgical candidate, effective February 7, 2021. For the dental claim, the Board denied service connection for compensation purposes, as there was no evidence of in-service dental trauma or specific compensable dental conditions. However, the Board remanded the dental claim for treatment purposes, requiring the RO to refer the claim to VAMC for eligibility determination under 38 C.F.R. § 17.161.

Rationale

Evidence did not support rating higher than 30% under DC 5276; Symptoms did not approximate most severe cases or loss of use

Service Branch

ARMY NATIONAL GUARD

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210702-170166

Full Decision Text

Citation Nr: A26033969
Decision Date: 04/14/26 Archive Date: 04/14/26

DOCKET NO. 210702-170166
DATE: April 14, 2026

ORDER

Entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus and plantar fasciitis from August 20, 2014, is denied.

Entitlement to a separate 30 percent rating, but no higher, for bilateral plantar fasciitis is granted from February 7, 2021, subject to the laws and regulations governing the payment of monetary benefits, is granted.

Entitlement to service connection for residuals of dental problems for compensation purposes is denied.

REMANDED

Entitlement to service connection for residuals of dental problems for treatment purposes is remanded.

FINDINGS OF FACT

1. From August 20, 2014, the Veteran's service-connected foot disability was manifested by severe bilateral acquired flat foot and bilateral plantar fasciitis.

2. From February 7, 2021, the Veteran's service-connected foot disability was manifested by bilateral plantar fasciitis with no relief from non-surgical treatment and the Veteran was not a surgical candidate for recommended surgical intervention.

3. The Veteran does not have a current dental disorder for which VA disability compensation may be paid.

CONCLUSIONS OF LAW

1. From August 20, 2014, the criteria for entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus and plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5276 (2014-2025).

2. From February 7, 2021, the criteria for entitlement to a separate 30 percent rating, but no higher, for bilateral plantar fasciitis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5269 (2025).

3. The criteria for entitlement to service connection for residuals of dental problems for compensation purposes have not been met. 38 U.S.C. §§ 1110, 1712, 5107 (2012); 38 C.F.R. §§ 3.303, 3.381, 4.150 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran enlisted into service with the Army National Guard (ANG) of Maryland in July 1999. He had periods of active service with ANG mobilized service from October 2001 to September 2002 and from July 2003 to March 2004.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision that granted service connection and assigned a 30 percent rating effective August 20, 2014, for bilateral pes planus and plantar fasciitis.

In January 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a March 2020 decision that denied service connection for dental problems. In January 2021, the Regional Office (RO) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior March 2020 decision.

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2020 and May 2021 decisions on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the RO issued the decisions on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

In a September 2024 decision, the Board, in pertinent part, denied entitlement to service connection for residuals of dental problems as well as entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus and plantar fasciitis. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In August 2025, the Court issued an Order that partially vacated the Board's September 2024 decision and remanded the matters on appeal for adjudication consistent
evidence was submitted after the RO issued the decisions on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

In a September 2024 decision, the Board, in pertinent part, denied entitlement to service connection for residuals of dental problems as well as entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus and plantar fasciitis. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In August 2025, the Court issued an Order that partially vacated the Board's September 2024 decision and remanded the matters on appeal for adjudication consistent with the instructions outlined in a June 2025 Joint Motion for Partial Remand (Joint Motion) by the parties.

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 increased rating and service connection 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.

However, because the Board is remanding the service connection claim for residuals of dental problems for treatment purposes, any evidence the Board could not consider will be considered by the RO in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an initial evaluation in excess of 30 percent for bilateral pes planus and plantar fasciitis from August 20, 2014, is denied.

2. Entitlement to a separate 30 percent rating, but no higher, for bilateral plantar fasciitis is granted from February 7, 2021, subject to the laws and regulations governing the payment of monetary benefits, is granted.

The Veteran seeks a higher rating for his service-connected bilateral pes planus and plantar fasciitis. His service-connected bilateral pes planus and plantar fasciitis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5276, for acquired flatfoot.

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. Prior to February 7, 2021, the Board may only consider the old version of the diagnostic code; however, for the period beginning February 7, 2021, the Board may consider both the old and amended version of the diagnostic code and rate based on whichever is most favorable to the Veteran.

Under both the former and revised Diagnostic Code 5276, 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 pronounced 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. 38 C.F.R. § 4.71a, Diagnostic Code 5276.

With regards to Diagnostic Code 5276, while some of the symptoms listed in the rating criteria are conjunctive - e.g., "pain on manipulation and use accentuated" - the rating criteria themselves are not. In other words, a veteran does not need to demonstrate all of the symptoms under a particular rating to be assigned that evaluation. See Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009) (discussing how some Diagnostic Codes, such as Diagnostic Code 7903 for hypothyroidism, are not conjunctive); c.f. Camacho v. Nicholson, 21 Vet. App. 360, 366-67 (2007) (noting that inclusion of the conjunctive "and" indicates that all criteria must be demonstrated). Where a disability manifests some criteria from a lower evaluation and some criteria for a higher evaluation, the Board should address 38 C.F.R. §§ 4.7 and 4
of the symptoms under a particular rating to be assigned that evaluation. See Tatum v. Shinseki, 23 Vet. App. 152, 156 (2009) (discussing how some Diagnostic Codes, such as Diagnostic Code 7903 for hypothyroidism, are not conjunctive); c.f. Camacho v. Nicholson, 21 Vet. App. 360, 366-67 (2007) (noting that inclusion of the conjunctive "and" indicates that all criteria must be demonstrated). Where a disability manifests some criteria from a lower evaluation and some criteria for a higher evaluation, the Board should address 38 C.F.R. §§ 4.7 and 4.21 and explain which evaluation the disability more nearly approximates.

Historically, plantar fasciitis was rated by analogy, usually under Diagnostic Code 5276 or Diagnostic Code 5284. However, effective February 7, 2021, VA amended the rating schedule by adding Diagnostic Code 5269 for plantar fasciitis. Under the newly added Diagnostic Code 5269, a 10 percent rating is warranted for unilateral or bilateral plantar fasciitis; a 20 percent rating is warranted for unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment; and a 30 percent rating is warranted for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. 38 C.F.R. § 4.71a, Diagnostic Code 5269 (in effect since February 7, 2021). A note to Diagnostic Code 5269 provides that a 40 percent disability rating will be assigned for actual loss of use of the foot. 38 C.F.R. § 4.71a, Diagnostic Code 5269, Note (1) (in effect since February 7, 2021). A second note indicates that if a veteran has been recommended for surgical intervention, but is not a surgical candidate, the plantar fasciitis is to be rated under the 20 percent or 30 percent criteria, whichever is applicable. 38 C.F.R. § 4.71a, Diagnostic Code 5269, Note (2) (in effect since February 7, 2021).

"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. Examples under 38 C.F.R. § 4.63 that constitute loss of use of a foot include extremely unfavorable ankylosis of the knee, complete ankylosis of two major joints of an extremity, shortening of the lower extremity of 3 1/2 inches or more, or complete paralysis of the external popliteal nerve and consequent foot drop.

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis, to include in situations where the disability at issue is not evaluated based on range of motion measurements. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

Descriptive terms such as severe are not defined in the Rating Schedule and the Board must define such subjective terms. See Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018). The Board looks to the contemporary, common meaning of the terms; according to Merriam-Webster, "moderate" means "not violent, severe, or intense". "Moderately" means "to a moderate degree or extent". "Severe" means "very painful or harmful" or "of a great degree." "Marked" means "having a distinctive or emphasized character". "Pronounced" means "strongly marked". "Extreme" means "existing in a very high degree". See www.merriam-webster.com/dictionary/.

The Board finds that the evidence of record, including an April 2015 DBQ from a private provider, VA, SSA, and private treatment records, and a March 2021 VA examination report, persuasively weighs against an initial rating in excess of 30 percent for
"not violent, severe, or intense". "Moderately" means "to a moderate degree or extent". "Severe" means "very painful or harmful" or "of a great degree." "Marked" means "having a distinctive or emphasized character". "Pronounced" means "strongly marked". "Extreme" means "existing in a very high degree". See www.merriam-webster.com/dictionary/.

The Board finds that the evidence of record, including an April 2015 DBQ from a private provider, VA, SSA, and private treatment records, and a March 2021 VA examination report, persuasively weighs against an initial rating in excess of 30 percent for bilateral pes planus and plantar fasciitis under the former and revised Diagnostic Code 5276. The Board acknowledges the Veteran's lay reports of symptoms like pain and burning and that there was functional loss due to pain, fatigability, pain during flare-ups, and pain during repetitive use over time. Additional contributing factors of disability were listed as disturbance of locomotion, interference with standing, pain, fatigue, and lack of endurance. During the appeal period, the Veteran's bilateral pes planus and plantar fasciitis were noted to impede his ability to stand and walk for over 20 minutes, run, do any high-impact activities, or walk barefoot particularly on hard surfaces. He tried arch supports and cortisone injections but was noted to remain symptomatic on both sides.

However, even considering the Veteran's lay reports of symptoms of pain and burning and functional loss, the degree of additional limitation reflected by the statements that weekly, moderate flare-ups with burning/shooting pain after prolonged standing/walking and difficulty standing/walking more than 10 minutes, would not result in symptoms more nearly approximating pronounced bilateral acquired flatfoot. The maximum 50 percent rating for flatfoot contemplates the functional impairment caused by the most severe cases of the condition. While the April 2015 private provider noted bilateral marked pronation and extreme tenderness of plantar surfaces of the feet not improved by orthopedic shoes or appliances, improvements in tenderness were clearly documented in private treatment records after treatment and the March 2021 VA examiner highlighted that there was no swelling on use, characteristic callosities, extreme tenderness of plantar surfaces, marked deformity, marked pronation, marked inward displacement, or severe spasm of the Achilles tendon in either foot. VA treatment records revealed findings of plantar fasciitis with decreased plantar longitudinal arch with pronation noted on weightbearing stance bilaterally. The Veteran was also shown to have plantar calcaneal spurs as well as a bilateral plantar fasciitis diagnosis.

Thus, the Board finds that the Veteran's bilateral foot disability does not more nearly approximate the most severe cases of flatfoot or loss of use of either foot. As such, the Board finds that the maximum 50 percent rating under Diagnostic Code 5276 is not warranted at any point during the appeal period. The Board is aware that the RO has assigned a 50 percent disability rating for the combined effects of the bilateral pes planus and plantar fasciitis effective from April 24, 2025. However, that period of time is later than the appeal period being reviewed in the current decision.

The Board also concludes that, from February 7, 2021, a separate 30 percent rating, but no higher, for bilateral plantar fasciitis is warranted. Evidence of record reflected that the Veteran has a bilateral plantar fasciitis diagnosis with no relief from non-surgical treatment and had been recommended for surgical intervention but was not a surgical candidate. However, the "amputation rule" states that the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were the amputation to be performed. 38 C.F.R. § 4.68. The rating for an amputation of the foot would be 40 percent under 38 C.F.R. § 4.71a, Diagnostic Codes 5166-5167. Thus, although the assignment of a separate rating based on plantar fasciitis is warranted, the Board notes that the Veteran may not necessarily be paid at a higher level.

With the newly assigned 30 percent rating, the Veteran is in receipt of the maximum schedular rating available under Diagnostic Code 5269 for plantar fasciitis for the period from February 7, 2021. Again, evidence of record does not show actual loss of use of either foot under 38 C.F.R. § 4.63 during the appeal period.

The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only
.71a, Diagnostic Codes 5166-5167. Thus, although the assignment of a separate rating based on plantar fasciitis is warranted, the Board notes that the Veteran may not necessarily be paid at a higher level.

The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the Federal Circuit expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott, 920 F.3d 1375 (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id.

Here, the Veteran's disability is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. Additionally, the evidence of record does not reflect that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different Diagnostic Code.

The Board finds that the evidence of record persuasively weighs against an initial rating in excess of 30 percent for the Veteran's service-connected bilateral foot disability. As the evidence of record persuasively weighs against a rating in excess of 30 percent under Diagnostic Code 5276, the benefit-of-the-doubt rule does not apply. With the assignment of a separate 30 percent rating, the Veteran is also now in receipt of the maximum schedular rating available under Diagnostic Code 5269 for plantar fasciitis for the period from February 7, 2021. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for residuals of dental problems for compensation purposes is denied.

Compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. 38 C.F.R. § 4.150 (2025). Compensation is available for loss of teeth if such is due to loss of substance of body of maxilla or mandible, but only if such bone loss is due to trauma or osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, as such loss is not considered disabling. Id. at Note. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service connected solely for the purpose of establishing eligibility for outpatient dental treatment and cannot be considered for compensation purposes. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150.

The Veteran is seeking entitlement to service connection for residuals of dental problems. In written statements of record, the Veteran has asserted that his front tooth was knocked out. However, evidence of record does not indicate that the Veteran suffered any in-service dental trauma. Available service treatment records also do not contain complaints, treatment, or diagnosis for a dental condition. Post-service VA dental treatment records reflected generalized gingivitis, carious lesions, and tooth extraction (not related to any trauma or condition developed during military service) but do not document complaints or treatment for any dental disorder eligible for compensation under 38 C.F.R. § 4.150. In addition, the Board reiterates that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not compensable disabilities and will only be service connected solely for the purpose of determining entitlement to outpatient dental treatment. Further, there is no evidence that the Veteran has tooth loss due to loss of body of the maxilla or mandible caused by in-service trauma or osteomyelitis. The record does not suggest any other basis for awarding service connection for a dental disorder for VA compensation purposes.

Thus, the criteria to award entitlement to service connection for residuals of dental problems for compensation purposes have not been established, either through medical or probative lay evidence. In arriving at the decision to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the weight of the persuasive evidence is against the claim of entitlement to service connection for residuals of dental problems for compensation purposes, that doctrine is not applicable. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Entitlement to service connection for residuals of dental problems for treatment purposes is remanded.

A claim of service connection for a dental disability for compensation purposes is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). This issue has not been adjudicated by the RO or referred to the appropriate VAMC for a formal determination. The regulation relating to service connection of dental conditions for treatment purposes was amended, effective February 29, 2012, in order to clarify existing regulatory provisions and to reflect the respective responsibilities of the Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA) in determinations concerning eligibility for dental treatment. The amended version of 38 C.F.R. § 3.381 clarifies that VBA will adjudicate a claim for service connection of a dental disability for treatment purposes after VHA determines that a veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 and requests that VBA make a determination on relevant questions. 38 C.F.R. § 3.381(a). Accordingly, remand of the Veteran's AMA appeal is necessary to allow the RO to fulfill a statutory or regulatory duty (appropriately adjudicating this matter under 38 C.F.R. § 3.381) which, if corrected, would have a reasonable possibility of aiding in substantiating the issue in the Veteran's AMA appeal. 38 C.F.R. § 20.802(a).

The matter is REMANDED for the following action:

The RO should refer the claim of service connection for residuals of dental problems for treatment purposes to the appropriate VAMC to determine if the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161. If the VAMC determines that the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 and requests a determination from VBA, the claim should be adjudicated.

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. D. Deane, 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.

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