FLATFOOT BILATERAL ACQUIRED

TIFFANY HANSON · 2026 · Case ID: A26038251

MIXED

Summary

The Veteran, an Army Veteran who served from October 2012 to February 2016, appeals the denial of an increased rating for bilateral flat feet and the denial of an increased rating for lumbosacral strain. The Board found the Veteran's bilateral flat feet, rated at 30 percent disabling, did not meet the criteria for a higher 50 percent rating due to a lack of marked pronation, extreme tenderness, or severe Achilles tendon spasm, despite the presence of pain on manipulation and use. The Board considered the Veteran's lay statements regarding pain and functional loss but found they did not warrant a higher rating than currently assigned. For the lumbosacral strain, rated at 20 percent, the Board found the VA examination inadequate. Specifically, the examiner failed to adequately address the Veteran's range of motion during repetitive use and flare-ups, necessitating a remand for a new examination to include these details. The appeal for bilateral flat feet is denied, while the claim for lumbosacral strain is remanded.

Rationale

VA examination noted pain on manipulation and use, swelling on use.; Evidence did not meet criteria for 50% rating (marked pronation, extreme tenderness, severe spasm).; Veteran's pain and functional limitations considered but did not warrant higher rating.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5276

Docket No.

211103-195393

Full Decision Text

Citation Nr: A26038251
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 211103-195393
DATE: April 23, 2026

ORDER

Entitlement to an increased evaluation in excess of 30 percent for bilateral flat feet is DENIED.

REMAND ORDER

Entitlement to an increased evaluation in excess of 20 percent for lumbosacral strain is REMANDED.

FINDING OF FACT

The Veteran's flat feet have not been manifested by marked pronation, extreme tenderness of plantar surfaces of the feet, or marked inward displacement and severe spasm of the tendo achilles.

CONCLUSION OF LAW

The criteria for an increased evaluation, in excess of 30 percent for bilateral flat feet, has not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 5276.

FACTUAL AND PROCEDURAL HISTORY

The Veteran served on active duty in the United States Army from October 2012 to February 2016.

In February 2020, the Veteran filed a disability claim with the Department of Veterans Affairs (VA) seeking increased rating for his service-connected bilateral flat feet and lumbosacral strain. In June 2021, the RO issued a rating decision granting and increased rating for service-connected bilateral flat feet at 30 percent disabling, and lumbosacral strain at 20 percent disabling.

In July 2020, the Veteran filed a request for higher-level review. In November 2020, the RO issued a rating decision confirming and continuing the service-connected rating for bilateral flat feet and lumbosacral strain.

In November 2021, the Veteran filed an appeal to the Board of Veterans' Appeals (Board). The Veteran elected the hearing docket. In May 2025 notification advised the Veteran that a hearing was scheduled on August 22, 2025. The Veteran did not appear for the scheduled Board hearing.

Therefore, the Board may only consider the evidence of record at the time of the June 2020 rating decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran within 90 days following the date of the scheduled hearing. 38 C.F.R. § 20.302(c). If evidence was submitted either (1) during the period after the RO issued the decision, which was subsequently subject to higher-level review and prior to the date of the scheduled Board hearing, or (2) more than 90 days following the date of the scheduled hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(c), 20.801.

However, because the Board is remanding the claims of lumbosacral strain, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Although the Board has an obligation to provide adequate reasons and bases supporting this Decision, there is no requirement that every piece of evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Gonzales v. West,?218 F.3d 1378, 1380-81?(Fed. Cir. 2000); Timberlake v. Gober,?14 Vet. App. 122, 128-130?(2000).

Increased Rating

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 military service and their residual conditions in civil occupations. 38?U.S.C. §?1155; 38?C.F.R. §§?3.321(a), 4.1.

Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. Esteban v. Brown,?6 Vet. App. 259, 262?(199
.F.R. Part 4.

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.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). 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 importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id.

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

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

When evaluating musculoskeletal disabilities, if the diagnostic code does not reference medication, then the beneficial medication effects must be discounted when assigning an evaluation or when adjudicating entitlement to increased ratings. Ingram v. Collins, 38 Vet. App. 130 (2025).

In other words, if the diagnostic criteria do not explicitly contemplate medication use, the Board must discount any beneficial effects of medication use when adjudicating entitlement to increased ratings. See also McCarroll v. McDonald, 28 Vet. App. 267 (2016).

1. Bilateral Flat Feet

The Veteran's bilateral flat feet are rated at 30 percent disabling. He seeks a higher rating.

Bilateral pes planus is rated pursuant to section 4.71a of Title 38 of the Code of Federal Regulations, DC 5276.

Under DC 5276, a noncompensable (0 percent) rating is assigned for mild flatfoot with symptoms relieved by built-up shoe or arch support.

A 10 percent rating is assigned for moderate bilateral flatfoot with weight-bearing line over or medial to the great toe, inward bowing of the tendo Achilles, pain on manipulations and use of the feet, either bilateral or unilateral.

A 30 percent rating is assigned for severe bilateral flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.

A 50 percent rating is assigned for pronounced bilateral 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 appliance. 38 C.F.R. § 4.71a, DC 5276.

DC 5276 is not expressly written in the conjunctive as there is no "and" in the listed symptoms for moderate, severe, or pronounced flatfeet that clearly signals a bundling of all the listed symptoms. Thus, it is not expected that all cases show all the findings specified. Dyess v. Derwinski, 1 Vet. App. 448, 455-56 (1991) (applying 38 C.F.R. § 4.21 when evaluating pes planus); Camacho v. Nicholson, 21 Vet. App. 360, 366 (2007) (indicating that 38 C.F.R. § 4.21 applies in DCs where the diagnostic criteria are not clearly joined in the conjunctive).

Accordingly, the Board finds that DC 5276 is not successive in nature, as the criteria for each disability rating appear to be variable and not cumulative of the criteria for the lower ratings. Thus, it is unnecessary for a veteran to meet all criteria in a lower rating to warrant an award for the next higher rating. Tatum v. Shinseki, 23 Vet. App. 152, 155-56 (2009); Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018).

Terms such as "severe," "moderate," and "marked" are not defined in the Rating Schedule. In the absence of an express definition, words are given their ordinary meaning. Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citing Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003)).

The ordinary meaning of "moderate" is "average in amount, intensity, quality, or degree." Gallagher v. Wilkie, No. 19-1855, 2020 U.S. App. Claims LEXIS 1889 (2020) (quoting New Oxford American Dictionary 1124 (3d ed. 2010)).

The ordinary meaning of "severe" is "very great; intense," or "of a great degree." Id. (quoting, respectively, the New Oxford American Dictionary 1599 (3d ed. 2010) and Merriam-Webster Dictionary (internal citation omitted)). Accordingly, while there is no specific dictionary definition for "moderately severe," the Board infers that "moderately severe" lies somewhere between "average in amount" and "very great; intense." Id.

The word "marked" as used in the various DCs is also not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. According to Merriam-Webster Dictionary (internal citation omitted), "marked" means having a distinctive or emphasized character.

DC 5276 provides guidance regarding the types of findings that would indicate the specific level of severity. For example, while moderate flatfeet could present with a weight-bearing line over or medial to the great toe, severe flatfeet could present with pronation, swelling on use and calluses. Additionally, flatfeet presenting with marked pronation, extreme tenderness of the plantar surface and other symptomatology not improved by orthopedic shoes or appliances could be indicative or pronounced flatfeet. This notwithstanding, VA evaluates all evidence such that decisions are equitable and just rather than applying a mechanical formula. 38 C.F.R. § 4.6. Likewise, although the use of similar terminology by medical professionals is not dispositive, it is considered along with all other evidence. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6.

Analysis

The Veteran was seen for a VA examination in March 2020, at which time an examiner noted that the Veteran had a diagnosis of bilateral flat foot (Pes Planus). The Veteran reported the "pain is sharp and constant with prolonged standing and walking." See March 2020, C&P Exam. The Veteran did not report that flare
and just rather than applying a mechanical formula. 38 C.F.R. § 4.6. Likewise, although the use of similar terminology by medical professionals is not dispositive, it is considered along with all other evidence. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6.

Analysis

The Veteran reported "sharp pain to bottom of bilateral feet." Id. He reported functional loss of his feet due to "difficulties with tasks that require prolonged standing and walking." Id. The Veteran reported accentuated pain on use for both feet. He reported accentuated pain on manipulation of both feet. He reported swelling on use for both feet.

He did not report characteristic calluses. He did not report the use of arch supports, built up shoes, or orthotics. He did not report extreme tenderness of plantar surfaces on one or both feet.

The examiner found the Veteran did not have decreased longitudinal arch height of one or both feet on weight-bearing. There was no objective evidence of marked deformity of either foot. There was not marked pronation of either foot. Neither foot had a weight-bearing line that fell over or medial to the great toe. There was not a lower extremity deformity other than pes planus, causing alteration of the weight-bearing line. The Veteran did not have "inward" bowing of the Achilles' tendon. The Veteran did not have marked inward displacement and severe spasm of the Achilles' tendon on manipulation of one or both feet.

The Veteran's right and left foot had pain noted during weight-bearing. The Veteran's right and left foot did not have pain during non-weight-bearing or passive motion. The examiner noted the Veteran had pain "only on palpation and not with motion." Id.

The examiner found the Veteran's right and left foot had pain that contributed to functional loss. Additionally, there was pain, weakness, fatigability, or incoordination that significantly limits functional ability during a flare-up or when the foot is used repeatedly over a period of time. The Veteran does not use an assistive device for locomotion. The Veteran's foot condition does not have a functional impairment such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis.

The Board finds the March 2020 examination persuasive and gives it great weight. In this examination, the examiner documented the Veteran's medical history, symptoms, treatment, and lay statements. The examiner provided a thorough analysis and documentation for his medical examination that was consistent with the Veteran's lay statements and examination.

The Board finds the Veteran has severe bilateral pes planus manifested by pain on manipulation and use that caused impairment contemplated by a 30 percent rating under DC 5276.

However, a higher rating of 50 percent is not warranted because the evidence does not show that the Veteran's condition causes marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achilles on manipulation, or not improved by orthopedic shoe or appliance.

The Board has considered any additional functional limitation due to factors such as pain, weakness, incoordination, or fatigability. 38 C.F.R. §§ 4.40, 4.45. In considering additional limitation of function, the Board acknowledges the Veteran's complaints of pain. The Board notes that the Veteran is competent to give evidence about what he experiences. Layno v. Brown, 6 Vet. App. 465 (1994). These complaints are documented and considered in the Veteran's current 30 percent rating. However, even considering the Veteran's pain and limitation of function, there is no persuasive evidence that the Veteran's disability warrants a rating higher than currently assigned. The Board recognizes the limitations that the Veteran has as a result of his service-connected bilateral foot disability. However, these limitations, including the Veteran's pain, have been considered in his currently-assigned 30 percent rating.

The Board has considered the other DCs 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. Esteban v. Brown, 6 Vet. App. 259, 261-62 (199
current 30 percent rating. However, even considering the Veteran's pain and limitation of function, there is no persuasive evidence that the Veteran's disability warrants a rating higher than currently assigned. The Board recognizes the limitations that the Veteran has as a result of his service-connected bilateral foot disability. However, these limitations, including the Veteran's pain, have been considered in his currently-assigned 30 percent rating.

The Board has considered the other DCs 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. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017). Here, the Veteran's disability is specifically listed under the rating schedule and therefore cannot be rated under a different DC. Additionally, the evidence of record does not indicate the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different DC. 38 C.F.R. § 4.14.

For the foregoing reasons, the Board finds weight of persuasive evidence is against a rating in excess of 30 percent. The appeal is denied.

REASONS FOR REMAND

Under the modernized review system, the Board must remand appeals to the RO to correct pre-decision duty-to-assist errors. 38 C.F.R. § 20.802(a). Here, the record reveals duty-to-assist errors that occurred prior to the rating decision; therefore, a remand is required to correct the errors. Id.

2. Lumbosacral Strain

The Veteran's lumbosacral strain is rated at 20 percent disabling. He seeks a higher rating.

The Veteran's lumbosacral strain is evaluated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5237. This diagnostic code directs that the disability be rated under the General Rating Formula for Diseases and Injuries of the Spine ("General Rating Formula").

Under the General Formula for rating diseases and injuries of the spine, effective September 26, 2003, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings will apply.

A 10 percent evaluation will be assigned where forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; the combined range of motion of the thoracolumbar spine is greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height.

A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gain or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine.

Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011).

Nonetheless, even when
culoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011).

Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. Thompson v. McDonald, 815 F. 3d 781, 785 (Fed. Cir. 2016) ("It is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Court has held the provisions of 38 C.F.R. § 4.59 are also not limited to the evaluation of musculoskeletal disabilities under diagnostic codes predicated on range of motion measurements. See Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the Veterans themselves, when a flare-up is not observable at the time of examination.

Analysis

The Veteran was seen for a VA examination in March 2020, at which time the examiner noted a diagnosis of lumbosacral strain. The Veteran reported difficulties with "achy low back pain especially with prolonged standing." See March 2020, C&P Exam. The Veteran further reported that the "pain is constant." Id. The Veteran denied flare-ups. The Veteran reported having functional loss in "difficulties with tasks that require prolonged standing and walking." Id.

The examiner completed initial range of motion (ROM) measurements of the Veteran. The results of ROM testing reflected the Veteran had forward flexion endpoint to 45 degrees, extension endpoint to 15 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 30 degrees.

The examiner found the abnormal ROM contributed to functional loss in "difficulties with tasks require forward bending." Id. Pain was noted on forward flexion and extension.

The examiner found objective evidence of localized tenderness or pain on palpation in the low back that was mild. There was evidence of pain with weight bearing. There was no objective evidence of pain on non-weight bearing.

The examiner found the Veteran was able to perform repetitive-use testing and there was no additional loss of function or ROM. The examiner then found that pain significantly limits the Veteran's functional ability with repeated use over time.

The examiner did not provide ROM during flare ups due to "no flares reported." Id.

The examiner found the Veteran did have muscle spasms resulting in abnormal gait or abnormal spine contour, but he did not have guarding. The examiner did not find radiculopathy, ankylosis, other neurologic abnormalities, or intervertebral disc syndrome.

The Board finds the March 2020 examination inadequate. The VA examiner did not adequately address the Veteran's estimated range of motion during repetitive use over time and flare-ups due to the functional loss caused by pain. Saunders v. Wil
loss of function or ROM. The examiner then found that pain significantly limits the Veteran's functional ability with repeated use over time.

The examiner did not provide ROM during flare ups due to "no flares reported." Id.

Once VA undertakes the effort to provide an examination or opinion when developing a service connection claim, it must provide one that is adequate for the purposes of the determination being made. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).

The Board finds remand is necessary to correct the above pre-decisional duty-to-assist error and fulfill the RO's duty to assist. 38 C.F.R. § 20.802(a).

(CONTINUED ON NEXT PAGE)

The matter is REMANDED for the following action:

Obtain a medical examination from an appropriate VA clinician regarding the nature and severity of symptoms associated with the Veteran's back. The evidentiary record, including a copy of this remand decision, must be made available to, and reviewed by, the clinician. The reviewing clinician must offer information on the following:

Provide ROM, to include an estimate, of ROM for the Veteran's back during repetitive use and flare-ups.

TIFFANY HANSON

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board H.E. Toole, Associate 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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