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Veterans Law

Secondary Conditions to Flat Feet (Pes Planus) for VA Disability

June 1, 2020
flat feet in white shoes standing on yellow lined paved road

What is Flat Feet (Pes Planus)?

Pes planus, often referred to as flat feet, is a common foot deformity in which the arch of the foot is flattened to the point where it touches the ground, or nearly touches the ground.  Ligaments and tendons from the lower leg and the foot form the arches; however, when these tendons do not pull properly, the foot has little or no arch, resulting in flat feet.

Most of the time, those with flat feet do not experience severe symptoms and treatment is not always necessary.  However, those with more severe cases of flat feet may experience symptoms, including:

  • Feet tiring out easily
  • Aches or pains in the areas of the arches or heels
  • Foot swelling
  • Difficulty performing certain foot movements, such as standing on your toes
  • Leg and back pain

If you are experiencing symptoms of flat feet, it is important to seek out medical attention, as having the condition may increase the risk of injury or pain to the musculoskeletal system, particularly the lower limbs and lumbar spine.  Symptoms of flat feet can vary greatly from case to case.

Relationship Between Falt Feet (Pes Planus) and Veterans

Pes planus among veterans can be caused by a variety of factors.  Oftentimes a veteran’s service can cause them to develop flat feet.  On the other hand, some veterans may have flat feet prior to service.  However, their pes planus may become worse as the result of service.  Common causes and risk factors for developing flat feet include the following:

  • A foot abnormality present since birth
  • Torn or stretched tendons
  • Inflammation or damage to the posterior tibial tendon, which runs from the lower leg, down to the ankle, and to the middle of the arch of the foot
  • Dislocated or broken bones in the legs or feet
  • Health conditions (e.g., rheumatoid arthritis)
  • Nerve damage, such as from peripheral neuropathy
  • Obesity
  • Partaking in frequent high-impact physical activity, such as military training

Service Connection for Flat Feet

To establish service connection for pes planus on a direct basis, veterans must establish three elements: (1) a current diagnosis of pes planus; (2) evidence of an in-service event, injury, or illness; and (3) a medical nexus linking the diagnosed pes planus to the in-service occurrence.  Importantly, this is the most common way to establish service connection.  However, if the veteran’s pes planus existed prior to service, as mentioned above, service connection is still possible.  In this case, veterans will have to prove to VA that their pes planus worsened beyond its natural progression as a result of military service.  Here, evidence showing the progression of the condition is very important.

What if My Pes Planus Causes Other Conditions?

If a veteran’s service-connected pes planus causes an additional condition, that new condition may be eligible for VA disability benefits.  Specifically, it may warrant service connection on a secondary basis.  A secondary service-connected condition is one that resulted from a separate condition that is already service-connected.  For example, a veteran is service-connected for a knee condition and later develops arthritis in that knee.  Here, the veteran’s arthritis may warrant secondary service connection if it is the result of their service-connected knee condition.  Pes planus may produce a number of conditions that veterans can then claim for secondary service connection.

As mentioned previously, pes planus can increase the risk of injury or pain to the musculoskeletal system.  Example of common secondary conditions include the following:

  • Degenerative Disc Disease (DDD). This condition occurs in the lower back or neck.  It is often accompanied by varying levels of pain and can also result in numbness and tingling in the upper or lower extremities in some cases.  Pes planus may cause veterans to walk differently, or change their gait, resulting in additional pressure on the spinal discs.  This additional pressure may cause the discs to deteriorate more quickly, thereby causing DDD.
  • Arthritis of the Foot. Arthritis is inflammation of one or more of the body’s joints.  It can cause pain and stiffness in any joint in the body and is common in the small joints of the foot.  Again, changes to a veteran’s gait due to pes planus may cause this inflammation to occur.
  • Anterior Knee Pain and Intermittent Low Back Pain. A study was conducted to examine the association between pes planus and risk of anterior knee pain and intermittent low back pain, respectively.  Results indicated that the prevalence of intermittent low back pain was 5% in mild pes planus groups, while it was 10% in moderate and severe pes planus groups.  The prevalence of anterior knee pain was 4% in mile pes planus groups, while it was 7% in the moderate and severe pes planus groups.
  • Plantar Fasciitis. This condition is one of the most common causes of heel pain and involves inflammation of a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes.  Pes planus can cause more pressure to be put on a veteran’s heel, thus causing or exacerbating plantar fasciitis.
  • Toe Deformities. Flat feet may cause veterans to bear weight in a way that puts undue strain upon the toes, eventually causing deformity.
  • Calluses. A callus is an area of thickened skin that forms as a response to repeated friction, pressure, or other irritation.  Calluses can be caused from abnormal gait resulting from pes planus.

Importantly, the list included above is non-exhaustive, meaning there could be additional secondary conditions that result from pes planus.  If you believe your current condition was caused by your service-connected pes planus, feel free to file a claim with VA.

Filing a Claim for Secondary Service Connection

Filing a claim for secondary service connection involves the same process as filing any claim for service connection.  Specifically, veterans will fill out and submit VA Form 21-526 – an original claim for service connection.  Veterans may do so online using the eBenefits portal, in person at their local Regional Office, or with help from a veterans’ advocate.