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C&P Exam Prep: Foot Conditions (Plantar Fasciitis / Flat Feet)
DBQ Overview
Interview + Physical- Form Name
- Foot_Conditions_Including_Flatfoot_Pes_Planus
- Form Code
- Foot_Conditions_Including_Flatfoot_Pes_Planus
- Page Count
- 16
- Examiner Type
- Physician or Physician Assistant
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity, functional impact, and clinical findings of foot conditions including plantar fasciitis and/or acquired flat foot (pes planus) for VA disability rating purposes under 38 CFR 4.71a.
What the examiner evaluates:
- Current diagnosis with ICD code (plantar fasciitis, flat foot/pes planus, or other foot injury)
- Which foot(s) are affected (right, left, or bilateral)
- Severity of flat foot (mild, moderate, severe, or pronounced) including pronation, inward bowing of tendo achillis, and tenderness
- Whether arch supports or built-up shoes relieve symptoms
- Plantar fascia findings: shortened fascia, marked contraction with dropped forefoot, tenderness under metatarsal heads
- Toe deformities: dorsiflexion, hammer toes, hallux valgus, hallux rigidus
- Range of motion of foot and ankle (active and passive, weight-bearing and non-weight-bearing)
- Functional loss: pain, weakness, fatigue, lack of endurance, incoordination, instability, swelling, disturbance of locomotion
- DeLuca factors: pain on use, fatigue after repetitive use, and flare-up frequency/severity
- History of surgical interventions (tarsal osteotomy, resection of metatarsal head, other hallux valgus surgery)
- Assistive devices used (cane, brace, walker, crutches, wheelchair)
- Whether condition causes functional loss equivalent to amputation
- Effect on ability to stand, walk, sit, and perform daily activities
- Any additional diagnoses (bursitis, tendinitis, tenosynovitis, metatarsalgia, Morton's neuroma, arthritis)
Exam may occur at a VA medical center, community-based outpatient clinic, or contracted QTC/LHI facility. Veterans have the right to request recording of the exam in most states. Arrive 15 minutes early wearing your usual footwear so the examiner can observe your gait. Bring any orthotics, arch supports, or braces you use regularly.
Typical duration: 30-45 minutes
Ankle Dorsiflexion / Plantar Flexion Range of Motion
The degree of upward (dorsiflexion) and downward (plantar flexion) movement at the ankle joint, which is critically impaired in pes planus and plantar fasciitis.
What to expect:
The examiner will ask you to move your foot up and down as far as possible (active motion), then may manually move your foot through its range (passive motion). This will be done both seated (non-weight-bearing) and standing (weight-bearing). Normal dorsiflexion is approximately 20 degrees; plantar flexion approximately 45 degrees. Limitation of dorsiflexion to a right angle (90 degrees total) is a specific rating criterion for pes planus.
Key thresholds:
- Limitation of dorsiflexion at ankle to a right angle — Meets one criterion for 'severe' pes planus (DC 5276, 20% unilateral / 30% bilateral)
- Some limitation of dorsiflexion at ankle (above right angle) — Supports finding of moderate-to-severe pes planus impairment
- Normal or minimally limited ROM with pain — Pain on use still supports at least 10% under DC 5276 via 38 CFR 4.59
Tips:
- Perform the ROM test as you normally would - do not push through pain artificially.
- If weight-bearing makes the motion worse, tell the examiner explicitly: 'Standing on my feet makes this significantly more painful and limits how far I can move my ankle.'
- If you cannot perform weight-bearing ROM without severe pain, say so and explain why.
- Report any pain experienced at specific degree increments during the test.
- If your ROM is worse on bad days or after activity, tell the examiner this is not your worst-day presentation.
Pain considerations: Under 38 CFR 4.59 and DeLuca, pain on motion - even without dramatic ROM limitation - can support a compensable rating. Tell the examiner at what point in the range of motion you begin to feel pain and how severe it is on a 0-10 scale. Passive ROM may exceed active ROM; this discrepancy should be noted as it reflects true functional limitation.
Subtalar / Inversion-Eversion Range of Motion
Side-to-side rocking motion of the heel, reflecting the degree of hindfoot deformity and stiffness common in flat foot and plantar fasciitis.
What to expect:
Examiner will assess inversion (turning the sole inward) and eversion (turning the sole outward). This may be assessed weight-bearing and non-weight-bearing. Normal inversion is approximately 20 degrees; eversion approximately 10 degrees.
Key thresholds:
- Marked spasm of tendo achillis on manipulation, not improved by orthopedic shoes/appliances — Supports 'pronounced' pes planus (DC 5276, 30% unilateral / 50% bilateral)
- Pain on manipulation and use accentuated, indication of swelling on use — Supports 'severe' pes planus (DC 5276, 20% unilateral / 30% bilateral)
- Pain on manipulation and use of feet — Supports 'moderate' pes planus (DC 5276, 10%)
Tips:
- Do not grip the exam table or compensate - let the examiner feel the natural resistance.
- Report pain or stiffness felt during inversion and eversion clearly.
- Describe any grinding, catching, or instability you feel.
Pain considerations: Spasm of the Achilles tendon on manipulation is a specific criterion for the highest rating level under DC 5276. If your Achilles feels tight or goes into spasm when your foot is manipulated, point this out to the examiner.
Weight-Bearing Foot Assessment (Arch Height, Pronation, Valgus Deformity)
Structural deformity of the foot including arch collapse, inward rolling (pronation), inward bowing of the tendo achillis (Helbing's sign), and marked varus/valgus deformity.
What to expect:
The examiner will observe your feet both standing and walking. They will look for the weight-bearing line relative to the great toe, heel position (valgus/varus), arch collapse, and skin changes such as callosities. The DBQ specifically requires weight-bearing assessment for pes planus.
Key thresholds:
- Weight-bearing line over or medial to great toe with inward bowing of tendo achillis — Meets 'moderate' pes planus criteria (DC 5276, 10%)
- Marked pronation with extreme tenderness of plantar surfaces — Supports 'pronounced' pes planus (DC 5276, 30-50%)
- Objective evidence of marked deformity (pronation, abduction) with pain on manipulation — Supports 'severe' pes planus (DC 5276, 20-30%)
- Symptoms relieved by built-up shoe or arch support — Only 0% 'mild' under DC 5276 - critical to communicate if relief is INCOMPLETE
Tips:
- Stand naturally - do not try to correct your posture or hide your arch collapse.
- If your arches collapse more significantly with prolonged standing or after activity, tell the examiner this is a static snapshot that understates your typical presentation.
- Point out any callus formations, especially under the metatarsal heads or heel, as these indicate chronic pressure loading.
- If arch supports only partially relieve your pain, make this clear: 'My arch supports reduce pain somewhat but do not eliminate it.'
Pain considerations: Characteristic callosities under metatarsal heads are a criterion for severe pes planus. Extreme tenderness of the plantar surface is a criterion for pronounced pes planus. If either apply, state this clearly when the examiner palpates your foot.
Plantar Fascia Palpation (Plantar Fasciitis Assessment)
Tenderness, shortened fascia, contraction, and heel spur formation at the insertion of the plantar fascia at the calcaneus, as well as along the medial band of the fascia.
What to expect:
The examiner will press on your heel and along the arch, particularly at the medial calcaneal tubercle (where plantar fasciitis most commonly inserts). They will also assess for shortened plantar fascia and marked contraction with dropped forefoot. This may be performed both weight-bearing and non-weight-bearing.
Key thresholds:
- No relief from both non-surgical and surgical treatment, unilateral — DC 5269, 20% (plantar fasciitis)
- No relief from both non-surgical and surgical treatment, bilateral — DC 5269, 30% (plantar fasciitis)
- Plantar fasciitis with some response to treatment, unilateral or bilateral — DC 5269, 10% (plantar fasciitis)
- Marked contraction of plantar fascia with dropped forefoot — Key objective finding supporting higher rating
Tips:
- Tell the examiner exactly which treatments you have tried and whether they provided relief (physical therapy, corticosteroid injections, orthotics, night splints, PRP injections, ESWT, surgery).
- If you have had surgery and still have pain, emphasize: 'I had surgery and still experience significant pain and functional limitation.'
- If you have been recommended for surgery but declined or are not a surgical candidate, this is explicitly addressed in the rating criteria - state it clearly.
- Describe heel pain specifically: stabbing quality, worst in the morning with first steps, pain after sitting, or pain that worsens with prolonged standing or walking.
Pain considerations: The DBQ asks about pain during active motion, passive motion, weight-bearing, non-weight-bearing, and at rest. Describe all four scenarios accurately. Morning stiffness that gradually loosens is classic plantar fasciitis - but if you also have pain at rest or at night, make sure to report this as it indicates a more severe presentation.
Repetitive Use / DeLuca Factors Assessment
How your symptoms change after repetitive use of the feet - specifically pain increase, fatigue, weakness, incoordination, and lack of endurance after repeated weight-bearing activity.
What to expect:
The examiner may ask you to walk briefly or perform repetitive ankle movements and then re-assess ROM or pain. More commonly, they will ask you to describe what happens to your feet after prolonged walking, standing, or activity. Under DeLuca v. Brown, the examiner must address these factors in the DBQ.
Key thresholds:
- Significant pain increase after walking 1 block or standing 10 minutes — Supports functional loss finding that may increase rating level
- Must rest after short periods of weight-bearing due to pain or fatigue — Supports 'severe' or 'moderately severe' functional loss under DC 5284
- Cannot stand or walk for occupational demands due to foot pain — Supports highest rating levels and vocational impairment
Tips:
- Describe your typical day: 'After walking for 15 minutes, my foot pain increases from a 3 to an 8 and I have to sit down and rest for at least 30 minutes.'
- Describe morning first-step pain if applicable: 'Every morning when I take my first steps, I have a stabbing pain in my heel rated 9/10 for the first 10 minutes.'
- Describe fatigue: 'By the end of a work day where I am on my feet, my arches ache and I limp noticeably.'
- If you have flare-ups, describe frequency and duration: 'About twice a month I have a flare-up where I cannot bear weight at all for 1-2 days.'
Pain considerations: Per DeLuca v. Brown and M21-1 guidance, the examiner is required to document functional loss due to pain, fatigue, weakness, and incoordination after repetitive use and during flare-ups. If the examiner does not ask about these factors, proactively volunteer this information. State: 'I also want to make sure you have information about how my symptoms change with activity and during flare-ups.'
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 50% | Pes planus pronounced bilateral (DC 5276): Marked pronation, extreme tenderness of plantar surfaces of BOTH feet, marked inward displacement and severe spasm of tendo achillis on manipulation bilaterally, not improved by orthopedic shoes or appliances. |
CFR: DC 5276: 'Pronounced; 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%.' |
| 40% | Any foot condition (DC 5269, 5276, 5284): With actual loss of use of the foot. This is noted in all three primary diagnostic codes and represents the maximum evaluation for a single foot. |
CFR: DC 5269 Note 1: 'With actual loss of use of the foot, rate 40 percent.' DC 5276 (analogous): Same principle. DC 5284 Note: 'With actual loss of use of the foot, rate 40 percent.' Loss of use means the foot is so disabled that no effective function remains, equivalent to a service-connected amputation. |
| 30% | Plantar fasciitis bilateral (DC 5269): No relief from BOTH non-surgical AND surgical treatment, bilateral. OR Pes planus severe bilateral (DC 5276): Same as unilateral severe criteria but affecting both feet. OR Pes planus pronounced unilateral (DC 5276): Marked pronation, extreme tenderness of plantar surfaces, marked inward displacement and severe spasm of tendo achillis on manipulation, not improved by orthopedic shoes or appliances. OR Foot injury other severe (DC 5284): Severe. |
CFR: DC 5269: 'No relief from both non-surgical and surgical treatment, bilateral - 30%.' DC 5276 Pronounced Unilateral: '30%.' DC 5276 Severe Bilateral: '30%.' DC 5284: 'Severe - 30%.' |
| 20% | Plantar fasciitis unilateral (DC 5269): No relief from BOTH non-surgical AND surgical treatment, unilateral. OR Pes planus severe unilateral (DC 5276): Objective evidence of marked deformity (pronation, abduction), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. OR Foot injury other moderate-severe (DC 5284): Moderately severe. |
CFR: DC 5269: 'No relief from both non-surgical and surgical treatment, unilateral - 20%.' DC 5276: 'Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities - Unilateral 20%.' DC 5284: 'Moderately severe - 20%.' |
| 10% | Plantar fasciitis (DC 5269): Unilateral or bilateral with treatment providing some relief. OR Pes planus moderate (DC 5276): Weight-bearing line over or medial to great toe, inward bowing of tendo achillis, pain on manipulation and use of feet, bilateral or unilateral. OR Foot injury other (DC 5284): Moderate. |
CFR: DC 5269: 'Otherwise, unilateral or bilateral - 10%.' DC 5276: 'Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet - 10%.' DC 5284: 'Moderate - 10%.' |
| 0% | Pes planus (flat foot) - Mild: symptoms relieved by built-up shoe or arch support. No compensable rating assigned under DC 5276. |
CFR: 38 CFR 4.71a, DC 5276: 'Mild; symptoms relieved by built-up shoe or arch support - 0 percent.' Note: Even at 0% under DC 5276, painful motion via 38 CFR 4.59 can still support a 10% rating. |
50% Pes planus pronounced bilateral (DC 5276): Marked pronation, ...
Pes planus pronounced bilateral (DC 5276): Marked pronation, extreme tenderness of plantar surfaces of BOTH feet, marked inward displacement and severe spasm of tendo achillis on manipulation bilaterally, not improved by orthopedic shoes or appliances.
Key Symptoms
- Bilateral severe spasm of Achilles tendon on manipulation
- Extreme tenderness of plantar surfaces of both feet
- Marked pronation bilaterally
- Bilateral marked inward displacement
- Orthopedic shoes and appliances provide no relief bilaterally
- Severe bilateral functional impairment
CFR: DC 5276: 'Pronounced; 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%.'
40% Any foot condition (DC 5269, 5276, 5284): With actual loss o ...
Any foot condition (DC 5269, 5276, 5284): With actual loss of use of the foot. This is noted in all three primary diagnostic codes and represents the maximum evaluation for a single foot.
Key Symptoms
- Functional loss equivalent to amputation of the foot
- Inability to bear any weight on the affected foot
- Complete inability to use foot for locomotion
- Severe pain at rest preventing any use
- Incapacitating condition requiring wheelchair or constant assistive device use
CFR: DC 5269 Note 1: 'With actual loss of use of the foot, rate 40 percent.' DC 5276 (analogous): Same principle. DC 5284 Note: 'With actual loss of use of the foot, rate 40 percent.' Loss of use means the foot is so disabled that no effective function remains, equivalent to a service-connected amputation.
30% Plantar fasciitis bilateral (DC 5269): No relief from BOTH n ...
Plantar fasciitis bilateral (DC 5269): No relief from BOTH non-surgical AND surgical treatment, bilateral. OR Pes planus severe bilateral (DC 5276): Same as unilateral severe criteria but affecting both feet. OR Pes planus pronounced unilateral (DC 5276): Marked pronation, extreme tenderness of plantar surfaces, marked inward displacement and severe spasm of tendo achillis on manipulation, not improved by orthopedic shoes or appliances. OR Foot injury other severe (DC 5284): Severe.
Key Symptoms
- Bilateral plantar fasciitis unresponsive to all treatments including surgery
- Extreme tenderness of plantar surfaces of both feet
- Marked pronation bilaterally
- Severe spasm of Achilles tendon on manipulation
- Condition not improved by orthopedic shoes or appliances (unilateral pronounced)
- Severe functional impairment with significant inability to walk or stand
- Marked deformity with swelling, callosities, pain accentuated on use, bilateral severe
CFR: DC 5269: 'No relief from both non-surgical and surgical treatment, bilateral - 30%.' DC 5276 Pronounced Unilateral: '30%.' DC 5276 Severe Bilateral: '30%.' DC 5284: 'Severe - 30%.'
20% Plantar fasciitis unilateral (DC 5269): No relief from BOTH ...
Plantar fasciitis unilateral (DC 5269): No relief from BOTH non-surgical AND surgical treatment, unilateral. OR Pes planus severe unilateral (DC 5276): Objective evidence of marked deformity (pronation, abduction), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. OR Foot injury other moderate-severe (DC 5284): Moderately severe.
Key Symptoms
- Persistent plantar fasciitis pain despite exhausting both conservative and surgical treatment (unilateral)
- Marked pronation and abduction deformity visible on exam
- Pain on manipulation that is accentuated compared to rest
- Swelling that appears with use/walking
- Characteristic callosities under metatarsal heads
- Limitation of dorsiflexion at ankle to a right angle
- Moderately severe functional impairment interfering with walking, standing, or occupational duties
CFR: DC 5269: 'No relief from both non-surgical and surgical treatment, unilateral - 20%.' DC 5276: 'Severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities - Unilateral 20%.' DC 5284: 'Moderately severe - 20%.'
10% Plantar fasciitis (DC 5269): Unilateral or bilateral with tr ...
Plantar fasciitis (DC 5269): Unilateral or bilateral with treatment providing some relief. OR Pes planus moderate (DC 5276): Weight-bearing line over or medial to great toe, inward bowing of tendo achillis, pain on manipulation and use of feet, bilateral or unilateral. OR Foot injury other (DC 5284): Moderate.
Key Symptoms
- Plantar fasciitis with some response to conservative treatment (orthotics, PT, injections)
- Heel pain present but manageable with treatment
- Flat foot with pain on manipulation and use
- Inward bowing of Achilles tendon on weight-bearing
- Weight-bearing line medial to great toe
- Moderate foot injury with functional limitation
CFR: DC 5269: 'Otherwise, unilateral or bilateral - 10%.' DC 5276: 'Moderate; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet - 10%.' DC 5284: 'Moderate - 10%.'
0% Pes planus (flat foot) - Mild: symptoms relieved by built-up ...
Pes planus (flat foot) - Mild: symptoms relieved by built-up shoe or arch support. No compensable rating assigned under DC 5276.
Key Symptoms
- Flat foot symptoms fully relieved by arch supports or built-up shoes
- No pain on manipulation or use
- No deformity requiring more than standard orthotics
CFR: 38 CFR 4.71a, DC 5276: 'Mild; symptoms relieved by built-up shoe or arch support - 0 percent.' Note: Even at 0% under DC 5276, painful motion via 38 CFR 4.59 can still support a 10% rating.
How to Describe Your Symptoms
Heel and Arch Pain (Plantar Fasciitis)
How to describe:
Describe the pain as sharp, stabbing, or burning, locating it specifically at the heel (medial calcaneal tubercle) and/or along the arch. Describe the 'first-step pain' that is characteristic of plantar fasciitis - pain that is worst immediately upon standing after rest. Rate pain on a 0-10 scale at rest, with first steps, during prolonged standing, and after activity.
Worst-day example:
“On my worst days, my heel pain is a 9/10 when I first stand up in the morning. I have to hobble to the bathroom grabbing the wall for support. After about 20 minutes of moving around it drops to a 6/10, but if I stand for more than 30 minutes it climbs back to an 8/10. I cannot stand at the kitchen counter without shifting all my weight to one foot. Some days I cannot put my heel down at all and have to walk on my toes.”
What the examiner listens for:
Location of pain (heel vs. arch vs. metatarsal heads), quality of pain (sharp/stabbing vs. aching), temporal pattern (morning vs. after activity vs. constant), severity scale, and whether pain has responded to any treatment.
Understatements to avoid:
Do not say 'it's not too bad' or 'I manage.' Do not describe only your best days. If the examiner asks how you are doing today, clarify: 'Today is relatively okay, but I want to make sure you understand what my worst days are like, as they are more representative of my typical experience.'
Treatment Response and Failure (Critical for Plantar Fasciitis Rating)
How to describe:
Provide a complete treatment history: conservative treatments tried (physical therapy, NSAIDs, steroid injections, orthotics, night splints, ice, RICE protocol, ESWT shock wave therapy, PRP injections) and whether each provided relief. If you have had surgery, describe the procedure and whether it improved, worsened, or did not change your symptoms. The distinction between 'some relief' (10%) and 'no relief from both non-surgical AND surgical treatment' (20-30%) is the primary driver of rating level under DC 5269.
Worst-day example:
“I have tried physical therapy for 12 weeks, two cortisone injections, custom orthotics, and a night splint for 6 months. None of these provided lasting relief - the cortisone helped for about 3 weeks but the pain returned. I had a plantar fascia release surgery in [year] and actually had more pain after surgery than before. I still cannot walk more than a half block without significant pain.”
What the examiner listens for:
Whether conservative treatment was attempted, what specific interventions were tried, duration of each treatment, degree of relief (none, partial, complete), surgical history, post-surgical outcome, and current treatment plan.
Understatements to avoid:
Do not omit treatments that failed - every failed treatment strengthens your claim. Do not say 'the injections helped' if they only helped temporarily. Be specific: 'The injection provided about 30% relief for 3 weeks, then symptoms returned to baseline.'
Flat Foot / Arch Deformity (Pes Planus)
How to describe:
Describe the visible and functional aspects of your flat feet: whether your arches have collapsed, whether your ankles roll inward, whether you can see the entire inner side of your foot touching the ground when standing. Describe whether arch supports or built-up shoes relieve your symptoms - and critically, whether they provide only PARTIAL relief.
Worst-day example:
“When I stand for more than 10-15 minutes, my arches ache intensely and my ankles roll inward so badly that I can see my shoe wear unevenly on the inside edge. My arch supports reduce the aching from a 7 to a 4, but do not eliminate the pain. After a day on my feet at work, the bottoms of my feet are burning and I have to sit with my feet elevated for hours.”
What the examiner listens for:
Degree of arch collapse, whether symptoms are weight-bearing dependent, effectiveness of orthotics or built-up shoes, bilateral vs. unilateral involvement, and callosities.
Understatements to avoid:
Do not say 'the arch supports help' without qualifying the extent: 'They help somewhat but do not take away the pain.' The difference between full relief (0%) and incomplete relief (10%+) is critical to your rating.
Functional Loss - Walking, Standing, and Daily Activities
How to describe:
Quantify exactly how far you can walk before pain forces you to stop, how long you can stand, and what daily activities you have modified or given up due to foot pain. Be specific with distances and times.
Worst-day example:
“I can only walk about half a city block - maybe 200 feet - before my foot pain becomes severe enough that I have to stop and rest. I can stand for about 5-10 minutes before I need to sit down. I no longer go grocery shopping without using a cart to lean on, I avoid parking lots, I stopped exercising and have gained weight as a result. I cannot do yard work, cannot attend my children's sporting events, and had to change to a desk job because I could no longer stand at a counter all day.”
What the examiner listens for:
Specific distance and time limitations, activities abandoned due to foot pain, compensation behaviors (leaning, limping, avoiding activity), impact on employment, and impact on daily living.
Understatements to avoid:
Do not say 'I can walk a little.' Give specific numbers. Do not say 'I get by.' If you have made lifestyle changes due to foot pain, these are losses and should be described as such.
Flare-Ups (DeLuca Factor)
How to describe:
Describe how often flare-ups occur, what triggers them, how long they last, and what you are unable to do during a flare-up. The examiner must document this in the DBQ under M21-1 guidance.
Worst-day example:
“I have severe flare-ups about 2-3 times per month, usually triggered by any activity involving more than 10-15 minutes of walking or standing. During a flare-up, my heel swells noticeably, becomes hot to the touch, and I cannot bear full weight. These last 1-3 days. I have had to call in sick to work multiple times because I literally cannot walk during these episodes.”
What the examiner listens for:
Frequency (times per month or year), duration of each flare-up, severity during flare-up (pain scale, functional limitation), triggers, and what you cannot do during a flare-up.
Understatements to avoid:
Do not minimize flare-ups by saying 'sometimes it gets bad.' Give specific frequencies and functional impact. The examiner needs to document this in the DBQ's flare-up section, so give them the information they need.
Sleep Disruption and Rest Pain
How to describe:
Describe whether your foot pain wakes you up at night, prevents you from finding a comfortable sleeping position, or causes pain even when not bearing weight. Rest pain is a marker of more severe disability.
Worst-day example:
“Some nights the burning and aching in my feet wakes me up even though I am not standing. I cannot sleep on my stomach because pointing my toes down causes arch pain. I wake up 2-3 times a week from foot pain.”
What the examiner listens for:
Whether pain is present at rest and at night, sleep disruption frequency, and requirement for pain medication to sleep.
Understatements to avoid:
Do not omit rest pain. Rest pain indicates a more severe condition than pain only with activity and supports higher rating consideration.
Common Mistakes to Avoid
Telling the examiner your symptoms are 'not too bad today' or describing only your average or good days.
The VA rates your condition based on its impact over time, including worst-day presentations. M21-1 guidance and case law support documenting the full range of symptom severity, not just the day of the exam.
Instead: When the examiner asks how you are doing, say: 'Today is a relatively okay day, but I want to make sure you understand my condition on my worst days, which are more typical of my overall experience.' Then describe your worst-day presentation specifically.
Impact: Can cause under-rating at any level, particularly the difference between 10% and 20-30%.
Saying arch supports or orthotics 'help' without clarifying how much.
Under DC 5276, full symptom relief from arch supports = 0% (mild). Partial relief still supports at least 10% under DC 5276 or 38 CFR 4.59. If you say they help without qualification, the examiner may check 'relieved' on the DBQ.
Instead: Always quantify: 'My orthotics reduce my pain from an 8 to a 5, but I still have significant pain and limitation even with them in. They do not eliminate my symptoms.' Or: 'On bad days my orthotics provide little to no relief.'
Impact: Critical - can be the difference between 0% and 10%, or between 10% and 20%+.
Failing to mention all treatments tried for plantar fasciitis, especially failed treatments.
Under DC 5269, the rating of 20% (unilateral) or 30% (bilateral) requires 'no relief from BOTH non-surgical AND surgical treatment.' The examiner cannot document this if you have not described your treatment history completely.
Instead: Bring a written list of all treatments: dates, providers, outcomes. State clearly which treatments failed. If you are not a surgical candidate despite being recommended for surgery, state this explicitly - DC 5269 Note 2 addresses this specifically.
Impact: The difference between 10% and 20-30% under DC 5269.
Not mentioning bilateral involvement when both feet are affected.
Bilateral conditions warrant higher ratings under DC 5276 (pes planus) and DC 5269 (plantar fasciitis). A veteran with bilateral plantar fasciitis unresponsive to treatment gets 30% vs. 20% for unilateral. Bilateral pronounced pes planus is 50% vs. 30% unilateral.
Instead: If both feet are affected, say so clearly at the start of the exam: 'This condition affects both my right and left feet.' Make sure the examiner documents both sides on the DBQ.
Impact: Can be the difference between 20% and 30% (plantar fasciitis) or 30% and 50% (pronounced pes planus).
Failing to describe DeLuca factors (fatigue, weakness, incoordination, and pain after repetitive use).
DeLuca v. Brown requires examiners to address how symptoms change after repetitive use. If you only describe pain at rest or at the moment of the exam, the examiner may not document your full functional loss.
Instead: Proactively describe: how far you can walk before symptoms worsen, how long it takes to recover after activity, whether you limp or alter your gait, and whether symptoms are worse at the end of the day. Say: 'After walking for 10 minutes, my pain increases significantly and my foot becomes fatigued and weak.'
Impact: Can affect all rating levels, particularly the jump from 10% to 20%+ for plantar fasciitis and moderate to severe/moderately severe under DC 5284.
Not mentioning that you were recommended for surgery but are not a surgical candidate (for plantar fasciitis).
DC 5269 Note 2 explicitly states: 'If a veteran has been recommended for surgical intervention, but is not a surgical candidate, evaluate under the 20 percent or 30 percent criteria, whichever is applicable.' Many veterans do not know this provision exists.
Instead: If a doctor has recommended surgery but you cannot have it due to medical contraindications (diabetes, cardiovascular risk, anticoagulation therapy, etc.), bring documentation and state this explicitly to the examiner.
Impact: Can be the difference between 10% and 20-30% under DC 5269.
Performing ROM tests beyond your actual capability in an attempt to cooperate or appear capable.
The DBQ documents ROM at the time of examination. If you push through pain to demonstrate movement, the examiner records that range as your functional range. Pain with motion is itself a compensable factor under 38 CFR 4.59.
Instead: Move through the range of motion at your normal pace and stop when it becomes painful. Tell the examiner: 'I can move it this far but it is painful at this point - a 7/10 pain.' Do not push beyond your comfortable range.
Impact: Affects all rating levels where ROM is a consideration.
Leaving after the physical exam without asking whether the examiner has all the information they need about your functional impact.
Examiners see many patients and may not prompt you for information about employment impact, daily living limitations, or assistive device use. The DBQ has specific fields for these items that can affect your rating.
Instead: Before leaving, ask: 'Is there anything else you need about how this condition affects my work, daily activities, or daily life?' Then briefly summarize: 'My foot pain has prevented me from [specific examples] and I want to make sure that is documented.'
Impact: Can affect functional impairment findings at all levels.
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to a thorough, accurate, and complete C&P examination. An examination that does not address all required DBQ fields or that fails to consider DeLuca factors (pain, fatigue, weakness, incoordination, flare-ups) is legally inadequate and subject to remand.
- You have the right to request a copy of the completed DBQ after your examination. Review it for accuracy and completeness before your rating decision is issued.
- You have the right to record your C&P examination in most states. Check your state's one-party or two-party consent laws. Recording provides documentation if the DBQ is found to be inadequate.
- You have the right to a new or supplemental examination if the original exam was inadequate, failed to address all claimed conditions, or if new and relevant evidence has been submitted since the last exam.
- You have the right to submit a personal statement (VA Form 21-4138 or 21-10210) describing your symptoms, functional limitations, and treatment history. This lay evidence is considered alongside the C&P exam findings.
- Under 38 CFR 4.59, you have the right to have painful motion considered as functional impairment even if range of motion numbers appear relatively normal. Pain on motion can support a minimum 10% rating even when structural findings are mild.
- Under the benefit of the doubt standard (38 CFR 3.102), when there is an approximate balance of positive and negative evidence regarding a material issue, the benefit of the doubt shall be given to the claimant. You do not have to prove your case beyond a reasonable doubt.
- You have the right to representation by an accredited VSO, attorney, or claims agent at no charge (VSO) or with regulated fees (attorney/agent) at no cost to you unless you win and receive back pay.
- If you believe your C&P examiner was biased, incomplete, or dismissive, you may request a new examination. Document specific deficiencies in writing to your VSO or submit a Notice of Disagreement if the rating decision is based on an inadequate exam.
- You have the right to submit buddy statements (VA Form 21-10210) from family members, friends, or coworkers who have observed how your foot condition affects your daily function. Lay testimony is valid evidence in VA claims.
Related Conditions
- Plantar Fasciitis (Standalone Claim) Plantar fasciitis may be claimed separately under DC 5269 rather than DC 5284. Per M21 1 guidance, when both pes planus and plantar fasciitis are service connected, they should be evaluated together under the DC providing the highest rating to avoid pyramiding under 38 CFR 4.14.
- Acquired Flat Foot / Pes Planus Flat foot (pes planus) is rated under DC 5276 with a specific severity scale from mild (0%) to pronounced bilateral (50%). When claimed together with plantar fasciitis, both conditions are evaluated under the DC providing the highest combined rating per M21 1 anti pyramiding guidance.
- Achilles Tendinitis / Tendinopathy Achilles tendinopathy commonly co occurs with plantar fasciitis and flat foot due to shared biomechanical loading. It may be rated separately as a distinct diagnosis (tendinitis, tendinopathy) unless the symptoms are already captured by the foot condition rating. Spasm of the Achilles tendon on manipulation is also a key criterion for severe/pronounced pes planus.
- Hallux Valgus (Bunion) Hallux valgus (bunion deformity) frequently co occurs with flat foot and plantar fasciitis due to the altered biomechanics of foot pronation. It may be rated separately on the foot DBQ. The DBQ includes specific fields for hallux valgus diagnosis, surgical history, and severity.
- Hallux Rigidus Stiffness and arthritis of the great toe joint (hallux rigidus) is a distinct condition that may co occur with plantar fasciitis and flat foot. It is rated separately on the foot DBQ and has its own specific criteria under 38 CFR 4.71a.
- Metatarsalgia / Morton's Neuroma Metatarsalgia (pain under the metatarsal heads) is a common comorbidity with flat foot and plantar fasciitis, often resulting from altered weight distribution. Definite or marked tenderness under metatarsal heads is a specific finding in the foot DBQ and a criterion for higher pes planus ratings. Morton's neuroma may be rated separately.
- Hammer Toes Hammer toe deformities frequently occur secondary to flat foot and altered gait mechanics. The foot DBQ includes specific fields for hammer toe documentation. Toes tending to dorsiflexion or hammer toe deformity are noted as objective findings in the DBQ's physical exam section.
- Knee Conditions (Secondary to Foot Biomechanics) Flat foot and plantar fasciitis can cause secondary conditions in the knee due to altered gait and biomechanical compensation. A veteran may be able to claim knee conditions (patellofemoral syndrome, medial knee arthritis) as secondary to a service connected foot condition under 38 CFR 3.310.
- Lower Back Conditions (Secondary to Foot Biomechanics) Flat foot related gait alterations and limping can cause or aggravate lumbar spine conditions over time. Secondary service connection claims for lower back conditions may be supported by medical evidence linking gait alteration from flat foot or plantar fasciitis to spinal strain.
- Weak Foot, Bilateral DC 5277 (weak foot, bilateral) provides a minimum 10% rating for a symptomatic condition characterized by atrophy of musculature, disturbed circulation, and weakness often secondary to constitutional conditions. The underlying condition should be rated with a minimum 10% for bilateral weak foot per the diagnostic code.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.