These guides are AI-generated educational summaries — not legal or medical advice.
C&P Exam Prep: Malunion or Nonunion - Tarsal or Metatarsal Bones
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 of malunion or nonunion of tarsal or metatarsal bones for disability rating purposes under 38 CFR 4.71a DC 5283, capturing functional loss, pain, deformity, range of motion, and impact on daily activities.
What the examiner evaluates:
- Confirmed diagnosis of malunion or nonunion of tarsal or metatarsal bones and which specific bones are affected
- Which foot is affected (right, left, or bilateral)
- Presence, location, and severity of bony deformity visible or palpable on examination
- Range of motion of the ankle and foot under weight-bearing and non-weight-bearing conditions
- Tenderness on palpation over the affected tarsal or metatarsal bones
- Functional loss attributable to the condition including gait disturbance, instability, and inability to bear weight
- DeLuca factors: pain with motion, fatigue, weakness, incoordination, and functional loss after repetitive use or during flare-ups
- Presence of associated findings such as callosities, hammer toes, or plantar fascia involvement
- History of surgical procedures including tarsal osteotomy, metatarsal head resection, or other foot surgeries
- Use of assistive devices (cane, brace, crutches, walker, wheelchair) and their frequency
- Impact on ability to stand, walk, sit, and perform occupational and daily activities
- Whether the condition constitutes actual loss of use of the foot (threshold for 40% rating under DC 5283 Note)
- Review of imaging studies including X-rays confirming malunion or nonunion
The examiner will conduct both an interview and a physical examination. Bring all relevant imaging (X-rays, CT scans, MRI reports). The examiner will observe your gait when you enter and walk during the exam. Weight-bearing and non-weight-bearing ROM measurements will both be taken per Correia requirements. The exam will typically be conducted in person; if conducted via telehealth, the examiner must note how the examination was conducted.
Typical duration: 30-45 minutes
Ankle Dorsiflexion (Active and Passive, Weight-Bearing and Non-Weight-Bearing)
Upward movement of the foot toward the shin; normal is 0-20 degrees dorsiflexion from neutral.
What to expect:
The examiner will ask you to flex your foot upward while seated (non-weight-bearing active), then passively move it, then while standing (weight-bearing). A goniometer may be used. Measurements may differ significantly between positions, which is important for your claim.
Key thresholds:
- Limited to right angle (0 degrees) or worse — Supports severe or moderately severe rating; aligns with limitation of dorsiflexion at ankle to right angle criterion
- Some limitation present but motion preserved — Supports moderate rating
Tips:
- Perform the movement actively to your true comfortable maximum, do not push through severe pain
- Clearly state when pain stops your motion before the full anatomical limit
- Ask the examiner to also document passive range of motion and non-weight-bearing ROM separately
- If weight-bearing is more painful, say so explicitly during measurement
Pain considerations: Pain that limits motion before the anatomical end range is a DeLuca factor. Clearly state 'pain stops me at this point' when dorsiflexion is limited by pain. The examiner should note the point at which pain begins and the point at which motion stops.
Ankle Plantarflexion (Active and Passive, Weight-Bearing and Non-Weight-Bearing)
Downward movement of the foot; normal is approximately 0-45 degrees from neutral.
What to expect:
The examiner will observe and measure how far you can point your foot downward in various positions. Both active effort and passive examiner-assisted motion will be tested.
Key thresholds:
- Significantly reduced plantarflexion — Contributes to overall functional limitation assessment
- Normal plantarflexion with pain — Pain on motion is a DeLuca factor even if ROM appears preserved
Tips:
- Report any pain, catching, or grinding sensation during the movement
- Note if pushing off when walking causes pain or instability
- Describe whether footwear changes (wider shoes, orthotics) are required to perform this movement
Pain considerations: Report pain at initiation of movement, during movement, and at end range. Pain that is present even at rest or after prolonged standing is highly relevant.
Subtalar/Hindfoot Inversion and Eversion
Side-to-side rocking motion of the heel; normal inversion is approximately 0-30 degrees, eversion 0-20 degrees.
What to expect:
The examiner may hold your heel and move it side to side, or ask you to perform the motion actively. This tests tarsal bone mobility and detects restricted or painful motion from malunion deformity.
Key thresholds:
- Marked restriction of subtalar motion — Supports moderately severe to severe rating depending on associated symptoms
- Painful but preserved subtalar motion — Pain on motion supports higher functional loss documentation
Tips:
- Report any clicking, grinding, or sharp pain during this test
- Note if the motion causes referred pain into the arch or forefoot
- This test is particularly relevant when tarsal bones (calcaneus, talus, navicular, cuboid, cuneiforms) are involved
Pain considerations: Subtalar motion is often the most restricted and painful movement in tarsal malunion. Do not brace against the examiner's movement; let the examiner feel the true endpoint while you verbalize your pain level (0-10 scale is helpful).
Midfoot and Forefoot Mobility (Tarsometatarsal and Metatarsal Joints)
Mobility and tenderness at the tarsometatarsal joints and individual metatarsal shafts; assesses for abnormal motion, crepitus, or bony deformity from malunion/nonunion.
What to expect:
The examiner will palpate along the dorsal and plantar surfaces of the midfoot and forefoot, applying pressure to individual metatarsal shafts and heads. Abnormal mobility (hypermobility from nonunion) or rigid deformity (from malunion) will be noted.
Key thresholds:
- Abnormal mobility at fracture site (nonunion with loose motion) — Key finding supporting nonunion diagnosis; may support severe rating or loss-of-use consideration
- Fixed bony deformity with restricted motion (malunion) — Supports moderate to severe rating depending on functional impact
Tips:
- Point directly to where you feel tenderness when the examiner palpates
- Tell the examiner which activities (walking on uneven surfaces, prolonged standing, barefoot walking) aggravate this area most
- If a specific metatarsal is involved, try to identify it by number (1st through 5th)
Pain considerations: Tenderness under metatarsal heads (metatarsalgia) is a separate ratable finding. Report both the direct tenderness at the malunion/nonunion site and any secondary forefoot pain from altered gait mechanics.
Weight-Bearing Assessment and Gait Analysis
How the malunion or nonunion affects your ability to walk, bear weight, and maintain normal gait patterns.
What to expect:
The examiner will observe you walking into the exam room and possibly ask you to walk a short distance. They will note antalgic gait (limping), toe-out or toe-in posturing, inability to heel-strike or toe-off, and use of assistive devices.
Key thresholds:
- Inability to bear weight on affected foot / requires assistive device — Supports severe rating; persistent non-weight-bearing supports loss-of-use consideration at 40%
- Antalgic gait with weight-bearing — Supports moderate to moderately severe rating; documents functional loss
Tips:
- Do not walk differently for the exam than you do in daily life; walk as you normally do
- If you use a cane, brace, or orthotic, bring it and wear it as you normally would
- Tell the examiner how far you can walk before pain forces you to stop or rest
- Describe any calluses, pressure sores, or skin changes from abnormal weight distribution
Pain considerations: Pain with weight-bearing, including pain at rest after prolonged standing, should be clearly stated. Pain that wakes you at night or prevents you from standing for your job duties is highly relevant to functional loss.
Repetitive Use Testing (DeLuca Factors)
Whether symptoms worsen after repeated movement, as they would during a normal workday; captures fatigue, weakness, and increased pain with use.
What to expect:
The examiner may ask you to perform a movement multiple times and then re-measure. Under DeLuca v. Brown (8 Vet.App. 202, 1995), the examiner must consider the effects of pain, fatigue, weakness, and incoordination after repetitive use.
Key thresholds:
- Significant functional loss after repetitive use compared to initial measurement — Higher effective disability rating based on worst functional state rather than resting measurement
- Flare-ups that worsen ROM or function beyond baseline — Flare-up severity and frequency directly support higher rating levels
Tips:
- Before the exam, think through how your symptoms change after a full day of activity versus first thing in the morning
- Describe your worst day symptoms, not your average or best day
- Quantify flare-ups: how often (weekly, daily), how long they last (hours, days), what triggers them (prolonged walking, cold weather, specific footwear), and what your function is like during a flare-up
- Report any increased instability, stumbling, or falls associated with fatigue
Pain considerations: Under M21-1 guidance, the examiner should document the veteran's own description of functional loss during flare-ups even if no flare-up is present at the time of the exam. Be specific and detailed about flare-up symptoms.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 40% | Actual loss of use of the foot due to malunion or nonunion of tarsal or metatarsal bones. The foot is so severely impaired that it has no more practical utility than if it had been amputated at or below the ankle. This is a special rating under the Note to DC 5283. |
CFR: DC 5283 Note: With actual loss of use of the foot, rate 40 percent. This requires a finding functionally equivalent to amputation below the ankle - the foot provides no practical use for ambulation or daily function. This is analogous to the standard under 38 CFR 4.68 and DC 5167 for hand loss of use. |
| 30% | Severe malunion or nonunion of tarsal or metatarsal bones. Severe pain, marked deformity, and profound functional loss that significantly limits or prevents sustained ambulation and weight-bearing. Function of the foot is severely compromised but actual loss of use has not been established. |
CFR: DC 5283: Severe - 30 percent. Severe functional loss and marked deformity. The foot is substantially non-functional for practical purposes of ambulation and weight-bearing but falls short of actual loss of use. This is the highest rating under DC 5283 absent loss-of-use finding. |
| 20% | Moderately severe malunion or nonunion of tarsal or metatarsal bones. Significant pain and functional limitation affecting the ability to walk, stand, or perform work duties for sustained periods. Visible or radiographically confirmed deformity with notable restriction of motion. |
CFR: DC 5283: Moderately Severe - 20 percent. Functional limitation is substantial, with significant pain and deformity that impairs sustained weight-bearing, walking, and standing. Motion is clearly restricted and the deformity produces ongoing functional disability. |
| 10% | Moderate malunion or nonunion of tarsal or metatarsal bones. Some functional limitation, pain with activity, and mild bony deformity or tenderness on examination. Condition does not significantly restrict daily activities or employment. |
CFR: DC 5283: Moderate - 10 percent. The condition causes functional impairment but does not rise to the level of moderately severe disability. Pain and tenderness are present but the foot retains substantial function. |
40% Actual loss of use of the foot due to malunion or nonunion o ...
Actual loss of use of the foot due to malunion or nonunion of tarsal or metatarsal bones. The foot is so severely impaired that it has no more practical utility than if it had been amputated at or below the ankle. This is a special rating under the Note to DC 5283.
Key Symptoms
- Inability to bear any weight on the affected foot
- Constant severe pain preventing any ambulation on the foot
- Complete dependence on wheelchair or non-weight-bearing ambulatory aids
- Marked deformity with complete functional incapacity
- Severe muscle atrophy and trophic changes
- No practical use of the foot for any ambulatory purpose
- Function of foot equivalent to below-ankle amputation
CFR: DC 5283 Note: With actual loss of use of the foot, rate 40 percent. This requires a finding functionally equivalent to amputation below the ankle - the foot provides no practical use for ambulation or daily function. This is analogous to the standard under 38 CFR 4.68 and DC 5167 for hand loss of use.
30% Severe malunion or nonunion of tarsal or metatarsal bones. S ...
Severe malunion or nonunion of tarsal or metatarsal bones. Severe pain, marked deformity, and profound functional loss that significantly limits or prevents sustained ambulation and weight-bearing. Function of the foot is severely compromised but actual loss of use has not been established.
Key Symptoms
- Severe pain with any weight-bearing or at rest
- Marked bony deformity with significant alteration of foot alignment
- Marked limitation or near-complete loss of functional range of motion
- Inability to stand or walk for more than brief periods
- Requires significant assistive devices (cane, crutches, brace, or walker)
- Marked tenderness on palpation throughout the affected area
- Severe gait disturbance or inability to walk normally
- Severe instability with frequent falls or near-falls
- Severe atrophy of disuse of foot and lower leg musculature
- Constant or near-constant pain including rest pain and night pain
- Significant flare-ups causing bed rest or inability to ambulate
- Function severely impaired but not at the level of amputation equivalent
CFR: DC 5283: Severe - 30 percent. Severe functional loss and marked deformity. The foot is substantially non-functional for practical purposes of ambulation and weight-bearing but falls short of actual loss of use. This is the highest rating under DC 5283 absent loss-of-use finding.
20% Moderately severe malunion or nonunion of tarsal or metatars ...
Moderately severe malunion or nonunion of tarsal or metatarsal bones. Significant pain and functional limitation affecting the ability to walk, stand, or perform work duties for sustained periods. Visible or radiographically confirmed deformity with notable restriction of motion.
Key Symptoms
- Moderate to severe pain with weight-bearing and ambulation
- Significant limitation of ankle or foot range of motion
- Marked tenderness under metatarsal heads or over tarsal bones
- Visible bony deformity altering foot alignment
- Disturbed gait (antalgic gait, altered weight distribution)
- Requires arch supports, orthotics, or built-up footwear
- Interference with standing and prolonged walking
- Flare-ups causing temporary inability to bear weight
- Fatigue and weakness with repetitive use
- Some limitation of occupational activities
CFR: DC 5283: Moderately Severe - 20 percent. Functional limitation is substantial, with significant pain and deformity that impairs sustained weight-bearing, walking, and standing. Motion is clearly restricted and the deformity produces ongoing functional disability.
10% Moderate malunion or nonunion of tarsal or metatarsal bones. ...
Moderate malunion or nonunion of tarsal or metatarsal bones. Some functional limitation, pain with activity, and mild bony deformity or tenderness on examination. Condition does not significantly restrict daily activities or employment.
Key Symptoms
- Mild to moderate pain with prolonged walking or standing
- Some limitation of foot motion (less than normal)
- Tenderness on palpation over the affected bone(s)
- Mild bony deformity palpable or visible
- Occasional need for supportive footwear or orthotics
- Mild gait disturbance with extended activity
CFR: DC 5283: Moderate - 10 percent. The condition causes functional impairment but does not rise to the level of moderately severe disability. Pain and tenderness are present but the foot retains substantial function.
How to Describe Your Symptoms
Pain - Baseline and Activity-Related
How to describe:
Describe your pain using location (specific bone area), character (sharp, aching, burning, throbbing), severity (0-10 scale), onset (immediately on weight-bearing, after 10 minutes of walking), duration (lasts hours after activity), and what makes it worse or better. Distinguish between pain at rest, pain with activity, and pain during flare-ups.
Worst-day example:
“On my worst days, I have a sharp, stabbing pain over the outside of my midfoot that starts the moment I stand up in the morning. It's a 9 out of 10. I can't walk to the bathroom without stopping to grip the wall. After I've been on my feet for even 5 minutes, the pain becomes a constant throbbing that radiates into my ankle and doesn't go away for the rest of the day even when I sit down.”
What the examiner listens for:
Specific anatomical location of pain correlating with the malunion/nonunion site; pain that limits function below what examination findings alone would suggest; rest pain or night pain indicating severe involvement; pain that worsens with repetitive use per DeLuca factors.
Understatements to avoid:
Saying 'it hurts sometimes' or 'I manage.' Be specific. Saying 'I take pain medication daily' without describing what the pain is like when unmedicated. Not mentioning that you rated pain lower because you took medication before the exam.
Flare-Ups - Frequency, Duration, and Functional Impact
How to describe:
Describe how often flare-ups occur (daily, several times per week), what triggers them (prolonged walking, standing on hard surfaces, carrying weight, cold weather, certain footwear), how long they last (hours, days), and what your function is like during a flare-up compared to your baseline.
Worst-day example:
“I have bad flare-ups about twice a week. They are usually triggered by walking more than two or three blocks or standing in line for more than 10 minutes. During a flare-up, the pain goes up to a 10 out of 10, my foot swells visibly, I can't put any weight on it, and I have to stay off it completely for at least 24 to 48 hours. My neighbor has had to bring me groceries during these periods.”
What the examiner listens for:
The examiner is required under DeLuca and M21-1 guidance to document the veteran's description of functional loss during flare-ups even when no flare-up is present at the time of the exam. The examiner should document this in the flare-up narrative fields on the DBQ.
Understatements to avoid:
Saying 'I don't really have flare-ups' when you experience periodic episodes of significantly worsened pain and inability to walk. Any period where your symptoms are distinctly worse than your baseline is a flare-up.
Functional Loss - Ambulation and Daily Activities
How to describe:
Quantify how far you can walk before pain forces you to stop or slow down. Describe specific activities you cannot do or have had to modify: grocery shopping, climbing stairs, prolonged standing at work, hiking, walking on uneven ground, barefoot walking, driving long distances.
Worst-day example:
“On a bad day I cannot walk to my mailbox at the end of my driveway - that's about 30 feet - without stopping due to pain. I can't stand in the shower for more than two minutes. I've had to transfer to a desk job because I could no longer stand for my previous work. My spouse does all grocery shopping because I can't walk through a store.”
What the examiner listens for:
Specific functional limitations that demonstrate the foot is not capable of normal use; evidence that the functional limitation exceeds what the objective findings alone suggest; occupational impact; dependence on others for activities requiring ambulation.
Understatements to avoid:
Answering 'I can walk okay' when asked generally. Be precise: 'I can walk approximately one block on flat pavement before pain forces me to stop.' Do not minimize how your foot has changed your life routines.
Deformity and Structural Changes
How to describe:
Describe any visible changes in the shape of your foot since the original injury: bumps, prominences, foot turning inward or outward, dropped arch or abnormally high arch, shortened foot, abnormal toe positioning. Describe whether custom or specialized footwear is required.
Worst-day example:
“Since the fracture healed improperly, I have a visible bump on the top of my foot where the bone didn't line up. My foot turns outward when I walk and I have a callus under the second metatarsal head that becomes extremely painful. I can only wear wide extra-depth shoes with a custom orthotic; I cannot wear regular shoes or any footwear without significant padding.”
What the examiner listens for:
Bony prominence or deformity correlating with the location of malunion; secondary effects of deformity such as callosities, hammer toes, or abnormal gait; the functional consequence of the structural change rather than just the aesthetic finding.
Understatements to avoid:
Not mentioning footwear modifications you've had to make. Not describing callosities or secondary foot problems that resulted from the abnormal bone position.
Weakness, Fatigue, and Incoordination (DeLuca Factors)
How to describe:
Describe whether your foot feels weak when pushing off, whether it gives out or feels unstable, whether you tire quickly, and whether your movements feel uncoordinated or unpredictable. Report how many repetitions or how much time before these symptoms appear.
Worst-day example:
“After walking about half a block, my foot starts feeling like it's dragging. By the end of a full grocery run, I'm stumbling because my foot won't push off properly anymore. I've tripped and nearly fallen multiple times when my foot just gives way without warning, especially on stairs or uneven ground. This has gotten worse since my injury.”
What the examiner listens for:
Weakness and lack of endurance that reduce effective range of motion with repeated use compared to the initial measurement; incoordination that creates fall risk; fatigue that forces rest breaks and limits occupational performance.
Understatements to avoid:
Saying 'I'm just out of shape' to explain why your foot fatigues quickly. The foot fatigue and weakness that occurred after your injury is a direct result of the malunion/nonunion and should be clearly attributed to the bone condition.
Assistive Devices and Adaptations
How to describe:
List every device or adaptation you use: orthotics (custom or over-the-counter), AFO brace, ankle brace, cane, walking stick, crutches during flare-ups, wheelchair for longer distances. Note how often you use each device and whether you would be significantly more limited without it.
Worst-day example:
“I wear a custom orthotic every day without exception. During bad flare-ups, which happen about once a week, I use a forearm crutch to keep weight off my foot. For anything involving more than a few hundred feet of walking, such as airports, large stores, or family events, I use a wheelchair because I cannot sustain that distance without the foot giving out.”
What the examiner listens for:
The frequency of assistive device use is a key DBQ field. Use of devices is documented for cane, brace, crutches, walker, and wheelchair with frequency options. The examiner should document not just whether devices are used but how often.
Understatements to avoid:
Forgetting to mention over-the-counter orthotics, heel cups, or supportive insoles as assistive devices. Not mentioning that you rely on a shopping cart for support or hold walls and railings as compensatory strategies.
Common Mistakes to Avoid
Reporting only how you feel on a good day or average day at the exam
Examiners often see veterans at a single point in time, and the rating is intended to reflect the full disability picture including worst-day function. Understating symptoms at the exam directly leads to lower ratings.
Instead: Explicitly tell the examiner: 'Today is a relatively average day for me. On my worst days, which happen [frequency], my symptoms are [describe worst-day symptoms].' Reference M21-1 guidance that worst-day symptoms must be considered.
Impact: Can incorrectly place a veteran at 10% when they qualify for 20% or 30%
Not volunteering information about flare-ups because none is occurring at the time of the exam
The examiner may not ask specifically about flare-ups. If you don't raise it, it won't be documented. Under DeLuca and M21-1, the examiner must document the veteran's own reported functional loss during flare-ups.
Instead: Proactively say: 'I also experience flare-ups. Can I describe what happens during those?' Then give specific details about frequency, duration, triggers, and functional loss during flare-ups.
Impact: Can mean the difference between 10% and 20-30%, as flare-ups often represent the true severity of the condition
Failing to describe the DeLuca factors (fatigue, weakness, incoordination after repetitive use)
A single ROM measurement at rest may not capture the full functional loss. Veterans who can perform a movement once but cannot sustain it have a greater disability than a single measurement suggests.
Instead: Tell the examiner: 'When I first try that movement, I can do it to about that degree, but after I've been active for 20-30 minutes, my range of motion decreases and I experience much more pain and weakness.' Request that the examiner document this specifically.
Impact: Critical for distinguishing moderate (10%) from moderately severe (20%) and severe (30%)
Not bringing documentation of the specific bones involved and the imaging confirming malunion or nonunion
The examiner needs to confirm the diagnosis with imaging evidence. Without X-ray confirmation of the malunion or nonunion, the examiner may not be able to make a definitive diagnosis on DBQ.
Instead: Bring copies of all relevant X-rays, CT scans, or radiology reports confirming malunion or nonunion of specific tarsal or metatarsal bones. Highlight the radiologist's specific language about the fracture union status and bone position.
Impact: Could result in an inadequate exam requiring remand or incorrect diagnosis under a different DC
Not mentioning secondary problems caused by the deformity (callosities, hammer toes, plantar fascia changes)
Secondary findings like painful callosities under abnormally positioned metatarsal heads, hammer toes from altered mechanics, and plantar fascia involvement are all documented on the DBQ and can support higher severity ratings.
Instead: Describe all downstream consequences of the abnormal bone position: calluses, skin breakdown, toe deformities, secondary pain patterns, and how these compound the primary disability.
Impact: Supporting findings can push a borderline moderate case to moderately severe
Not disclosing the full extent of required footwear modifications and assistive device use
Footwear modifications (custom orthotics, special shoes, built-up soles) and assistive devices directly demonstrate functional limitation. The DBQ has specific fields for these that affect the documented severity level.
Instead: Bring your orthotics, brace, or assistive device to the exam. Show the examiner what you use and explain how often. Describe what happens to your function without the device.
Impact: Documents functional limitation that supports moderate to severe ratings
Minimizing symptoms because you don't want to appear to be exaggerating or complaining
Veterans frequently underreport symptoms due to military culture. This is the single most common reason for underrated conditions. Accurate and complete symptom reporting is not exaggeration - it is your right and responsibility.
Instead: Prepare a written symptom summary before the exam. Practice describing your worst-day symptoms out loud. Remember that you are not complaining - you are providing the medical record with accurate information about how this injury affects your life.
Impact: Affects all rating levels; most commonly causes 30% conditions to be rated at 10%
Not asking about or requesting documentation of the functional impact on employment
The DBQ includes fields for functional loss including interference with standing, sitting, and occupational activities. Occupational impact is a key factor in determining severity and can also support TDIU claims.
Instead: Specifically tell the examiner how the foot condition affects your current or most recent job: 'I cannot stand for more than X minutes, which prevents me from doing [specific job duty].' Request that this be documented.
Impact: Important for distinguishing severe from moderately severe, and for TDIU eligibility
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, in-person C&P examination conducted by a qualified healthcare provider who reviews your entire claims file before the exam.
- You have the right to have your claims file reviewed by the examiner prior to the examination, including all service treatment records and prior medical evidence (Sharp v. Shulkin, 29 Vet.App. 26, 2017).
- You have the right to have range of motion measured under both weight-bearing and non-weight-bearing conditions, and to have both active and passive ROM documented separately.
- You have the right to have functional loss due to pain, fatigue, weakness, and incoordination during repetitive use and flare-ups documented in your examination, even when these symptoms are not directly observable at the time of the exam (DeLuca v. Brown, 8 Vet.App. 202, 1995).
- You have the right to have your worst-day symptoms, not just your symptoms on the day of the exam, considered in the rating determination per M21-1 adjudication guidance.
- You have the right to request a copy of the completed DBQ examination report and to review it for accuracy and completeness.
- You have the right to request a new C&P examination if the original exam is found to be inadequate, incomplete, or based on an inaccurate or incomplete claims file review.
- You have the right to record your C&P examination in states where recording is permitted. Verify your state's law in advance and provide advance notice to the examination facility.
- You have the right to submit additional evidence including buddy statements, private medical opinions, and personal statements after the exam to supplement the examination record.
- You have the right to appeal a rating decision you believe does not accurately reflect the severity of your condition, and to request a Higher Level Review, Supplemental Claim, or Board of Veterans Appeals hearing.
- You have the right to representation by an accredited Veterans Service Officer, attorney, or claims agent at no charge through VSO services.
- You have the right to be treated with dignity and respect during your examination. If the examiner is dismissive, cuts you off, or refuses to document symptoms you report, note this and inform your VSO.
- Under 38 CFR 3.103(b)(1), you have the right to present evidence and argument at any point in the claims process, including after a C&P examination is completed.
Related Conditions
- Os Calcis or Astragalus, Malunion of DC 5273 specifically covers malunion of the os calcis (calcaneus) or astragalus (talus) the two major hindfoot bones. If your malunion involves these specific bones, the rater may evaluate under DC 5273 (20% for marked deformity, 10% for moderate) rather than DC 5283. Understand which bones are documented in your imaging and confirm which DC is being applied.
- Other Foot Injuries (DC 5284) DC 5284 covers foot injuries not specifically addressed by DCs 5276 5283 and 5269. Per M21 1, conditions listed under specific DCs like 5283 must be rated under those DCs and cannot be rated by analogy under 5284. However, if your foot condition involves multiple injuries, understand that 5284 is the catch all for injuries not covered by specific codes.
- Flatfoot (Pes Planus) A malunion of tarsal bones can cause acquired flatfoot deformity by altering the arch supporting structures. If flat foot exists as a secondary or concurrent condition, it may be separately ratable under DC 5276. Discuss with your VSO whether secondary flat foot deformity should be claimed separately.
- Post-Traumatic Arthritis of the Foot Malunion of tarsal or metatarsal bones commonly leads to post traumatic arthritis in the affected joints over time due to altered biomechanics and abnormal joint loading. Post traumatic arthritis can be separately claimed under DC 5010 (arthritis due to trauma) and may be ratable in addition to the malunion/nonunion rating if the joints involved are separately documented.
- Metatarsalgia Pain under the metatarsal heads (metatarsalgia) is a common secondary consequence of metatarsal malunion due to altered weight distribution. Metatarsalgia is evaluated under DC 5279 at 10% regardless of laterality. If you have documented metatarsal head tenderness as a separate condition from your malunion, discuss whether a separate claim is appropriate.
- Ankle Instability or Limitation of Motion Tarsal bone malunion frequently causes secondary ankle joint dysfunction, including limitation of dorsiflexion and plantarflexion. If ankle ROM limitation exists beyond what is explained by the tarsal malunion alone, an additional rating under DC 5271 (ankle, limited motion) or DC 5270 (ankle, ankylosis) may be appropriate.
- Plantar Fasciitis Altered foot mechanics from metatarsal or tarsal malunion can cause or worsen plantar fasciitis. If plantar fasciitis exists as a secondary condition resulting from the changed biomechanics of the malunited foot, it may be separately ratable. Document the temporal relationship between the malunion diagnosis and the onset of plantar fasciitis symptoms.
- TDIU (Total Disability Individual Unemployability) If your malunion or nonunion of tarsal or metatarsal bones, alone or in combination with other service connected conditions, prevents you from maintaining substantially gainful employment, you may be eligible for TDIU under 38 CFR 4.16. The functional limitations of foot disability (inability to stand, walk, or ambulate) are directly relevant to TDIU claims in many occupations.
Get Personalized C&P Exam Preparation
Upload your medical records for AI-powered prep that maps YOUR symptoms to the exact DBQ fields your examiner will evaluate.
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.