Flat feet VA rating: DC 5276 tiers and the bilateral factor

By BilateralFactor Editorial Team · Published June 9, 2026

The short answer

VA rates acquired flatfoot (pes planus) under DC 5276 in 38 CFR §4.71a. The code has separate tiers for unilateral and bilateral involvement, so the severity and whether one or both feet are affected both drive the rating. Ratings run from 0% (mild, relieved by arch supports) to 50% (pronounced bilateral).

The relationship between DC 5276’s built-in bilateral tiers and the bilateral factor under §4.26 is a nuanced question addressed in detail below.

DC 5276 rating tiers

The following criteria are quoted from 38 CFR §4.71a, verified 2026-06-09.

Pronounced (marked)

“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.”

• Bilateral: 50%
• Unilateral: 30%

Severe

“Objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.”

• Bilateral: 30%
• Unilateral: 20%

Moderate

“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.”

• 10% (same rate whether bilateral or unilateral)

Mild

“Symptoms relieved by built-up shoe or arch support.”

• 0%

What the C&P examiner documents

The examiner looks for physical findings tied to each severity tier. The criteria language makes clear what matters:

• Mild: Are symptoms controlled by arch supports or built-up shoes? If yes, 0%.
• Moderate: Is the weight-bearing line over or medial to the great toe? Is there inward bowing of the tendo achillis? Pain on manipulation and use?
• Severe: Is there marked deformity (pronation, abduction)? Does pain worsen with use? Are there callosities or swelling?
• Pronounced: Is the tendo achillis severely spasmed on manipulation with marked inward displacement? Is the condition unresponsive to orthopedic footwear?

Weight-bearing X-rays, podiatric exam notes, and documentation of orthotic trial history all support the rating. The examiner does not need to apply every criterion in a tier. The standard is whether the overall picture meets the tier’s description.

The bilateral factor question

DC 5276 is structured differently from most peripheral codes. Most extremity conditions are rated per limb, with separate ratings that combine via the bilateral factor. DC 5276 instead contains explicit bilateral-tier ratings: pronounced bilateral is 50%, pronounced unilateral is 30%, and the code prices that difference directly into the schedule.

38 CFR §4.26 states that the bilateral factor applies when both extremities carry a service-connected disability. The regulation does not carve out an exception for codes that already use bilateral tiers.

This creates two plausible readings:

1. The code already accounts for bilaterality. DC 5276’s bilateral tiers reflect the legislated value of both feet being affected. The bilateral factor adds 10% of a combined value, but there is no second separate rating to combine — the single bilateral-tier rating covers both feet. Under this reading, §4.26 has nothing to apply to.

2. Section 4.26 applies regardless. The regulation says the bilateral factor applies when both extremities are affected. A 50% bilateral flat-feet rating still covers both lower extremities. Under this reading, §4.26 could still add its 10% adjustment to that single rating before it enters the combined-rating calculation.

VA rating decisions and M21-1 guidance may handle this differently across field offices. If your rating decision applied (or declined to apply) the bilateral factor to a DC 5276 bilateral-tier rating, review the explanation carefully. If you believe the decision was incorrect, a Higher-Level Review or Board appeal is the appropriate venue. Consult a VSO or accredited claims agent for case-specific guidance — this is not a question this page can definitively resolve.

Use the VA Combined Ratings Calculator to model both scenarios. If the difference crosses a final rating threshold (for example, moving from 40% to 50%), the stakes of getting it right are real. If your decision letter shows a lower rating than either scenario produces, see what to do after a VA decision you disagree with.

Secondary conditions commonly claimed with pes planus

Flat feet alter foot mechanics and gait. Abnormal weight distribution and pronation can place secondary stress on the knees and lumbar spine over time. Veterans with service-connected pes planus sometimes pursue secondary service connection for:

• Knee conditions (patellofemoral syndrome, medial compartment degeneration) arising from overpronation
• Lumbar strain or degenerative disc disease from altered gait patterns

Each secondary condition requires a medical nexus opinion connecting the secondary diagnosis to the flat feet. The flat feet service connection establishes a plausible mechanism, but a clinician must link the specific secondary condition to that mechanism. A private DBQ or a treating podiatrist’s nexus letter are common paths.

See VA rating for back pain for how lumbar spine conditions are rated once service connection is established.

How flat feet combine with other disabilities

Once your DC 5276 rating is established, it enters the §4.25 combined-rating calculation along with any other service-connected conditions. If the bilateral factor applies (whether through the code tiers alone or through an additional §4.26 adjustment), that value enters first.

For example, a 50% pronounced bilateral flat feet rating combined with a 20% knee condition:

Combine 50 and 20: 50 + (20 × 50/100) = 50 + 10 = 60

Final rating: 60 converts to 60%

The VA Combined Ratings Calculator handles multi-condition combinations automatically.

Related topics

• The bilateral factor explained
• VA rating for back pain
• How VA combined ratings work
• VA Combined Ratings Calculator

This page explains schedular rating math only. Individual VA decisions depend on service-connection evidence, exam findings, and claim-specific facts. See our disclaimer for the limits of this information.