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Hispanic female veteran in her mid-30s sitting on the edge of a couch grimacing while placing her bare foot on the hardwood floor during morning first-step heel pain
Foot Conditions — all conditions
DC 5269 · #45147

Plantar Fasciitis

Your plantar fasciitis rating under DC 5269 depends on whether the condition is unilateral (one foot) or bilateral (both feet), and whether you have found relief from treatment — both non-surgical and surgical. A baseline 10% applies for either unilateral or bilateral plantar fasciitis. If you have tried both non-surgical and surgical treatment without relief, the rating rises to 20% for one foot and 30% for both. If the condition causes actual loss of use of the foot, the schedule awards 40%.

Plantar fasciitis — Diagnostic Code 5269 — is one of the most commonly claimed foot conditions in the VA disability system. Under 38 CFR §4.71a, plantar fasciitis received its own dedicated diagnostic code effective February 4, 2021, replacing the prior practice of rating it by analogy under DC 5276 (acquired flatfoot). The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot from the heel bone (calcaneus) to the base of the toes. When this band becomes inflamed or degenerates — often from the repetitive impact of military service (rucking, running, standing on hard surfaces) — the result is stabbing heel pain, especially with the first steps of the morning. The key to maximizing a plantar fasciitis claim is demonstrating that both non-surgical and surgical treatment have failed to provide relief. If you have documented failure of conservative treatments (orthotics, physical therapy, steroid injections, night splints) AND surgical intervention has not resolved the pain — or you have been recommended for surgery but are not a surgical candidate — you qualify for the higher rating tier.

The Diagnostic Codes

Conditions Rated In Foot Conditions

These are the codes the VA will actually stamp on a decision in this group. The code you are granted under decides which formula is used — and that decides your percentage. Plantar Fasciitis (DC 5269) is highlighted below.

Before Anything Gets Rated

What The VA Is Actually Looking For — And What Service Connection Really Means

Before the VA ever opens the rating schedule, it asks one question: is this disability the government’s responsibility? That is what “service connection” means. It is not a diagnosis, it is not sympathy, and it is not a reward for having served. It is a legal finding that a current, diagnosed disability is linked to something that happened to you in uniform. Percentages come later. If service connection is not established, there is nothing to rate and the claim is denied — no matter how bad the plantar fasciitis (dc 5269) is.

A veteran reviewing a VA decision letter at his desk, hands gripping the document

The three elements the VA must find. All three. Every time.

These come out of Caluza v. Brown and Shedden v. Principi, and they are the checklist a rating officer works through on your file. Miss one and the claim fails on that element alone.

1

A current, diagnosed disability

A doctor has to have written a diagnosis in a medical record — plantar fasciitis (dc 5269). Symptoms by themselves are not a disability the VA can rate. Saunders v. Wilkie held that pain causing functional impairment can be a disability, but you still need a clinician to document it as diagnosed and impairing. The diagnosis must exist now, during the claim period — not only years ago.

2

An in-service event, injury, illness or aggravation

Something in service had to have happened — an injury, an exposure, a documented sick call, or steady wear over a career. It does not have to be one dramatic moment and it does not have to be spelled out in your service treatment records: buddy statements, unit records, performance evaluations and your own competent lay testimony can establish it.

3

A medical nexus linking the two

A qualified medical opinion that says the current diagnosis is at least as likely as not related to the in-service event. That phrase matters: at least as likely as not means 50 percent or better. Under 38 C.F.R. §3.102, when the evidence is evenly balanced, the benefit of the doubt goes to you and the claim must be granted.

The five ways service connection is established

Most veterans only know the first one. The other routes are lower-effort paths to the same grant — and the secondary route is the one most often left on the table.

Direct — 38 C.F.R. §3.303(a)

The injury or disease began in service and never went away. The classic route: three elements, one nexus opinion.

Chronicity and continuity — §3.303(b)

A chronic condition shown in service, plus continuity of the same symptoms from separation to now, can establish the link without a formal nexus opinion. Your own testimony about symptoms you can observe is competent evidence.

Presumptive — §3.307 and §3.309

Certain chronic diseases are presumed service connected if they manifest to a compensable degree within a set window after separation. You do not have to prove causation at all.

Secondary — §3.310(a) and (b)

A disability proximately due to, or aggravated by, an already service-connected condition is itself service connected. This is how the downstream conditions plantar fasciitis (dc 5269) sets off get on the rating sheet.

Aggravation of a pre-service condition — §3.306

If you entered service with a condition and service made it permanently worse, the increase is compensable. The VA must rebut the presumption of soundness by clear and unmistakable evidence — a bar it frequently fails to meet.

VA medical care — 38 U.S.C. §1151

An additional disability caused by VA treatment, surgery, or a failure to diagnose is compensated as if it were service connected.

The bottom line — there is no way around this

No diagnosis, no rating. It has to be chronic. It has to cause impairment.

Without a diagnosis, the VA will not rate your claim.

The rating schedule is a list of diagnosed conditions and the codes attached to them. If no clinician has put a name on your condition in a medical record, there is no code to assign. Symptoms reported to a claims examiner are not a diagnosis. Get in front of a doctor and get it written down.

The condition must be chronic.

Chronic means persistent and ongoing — not something that resolved decades ago. The VA compensates a disability you carry today, which is why a documented, continuing treatment history matters more than the single worst day you ever had.

It must cause actual impairment.

Under 38 C.F.R. §4.1 and §4.10, VA compensation exists to pay for reduction in earning capacity. A diagnosis that costs you nothing gets a zero percent rating. The function you have lost is what converts a diagnosis into a percentage.

What this means for you before you file: get the diagnosis in writing, get the treatment history documented so the chronicity is undeniable, and describe the impairment in functional terms — what you can no longer do, and what it costs you at work and at home. Everything on the rest of this page is built on top of those three things.

The Percentages

Rating Schedule — Plantar Fasciitis, Diagnostic Code 5269

Effective February 4, 2021, plantar fasciitis received its own diagnostic code (DC 5269). Claims pending before that date may be rated under the old criteria (DC 5276 by analogy) if those criteria are more favorable. The VA must apply whichever version benefits the veteran.

White male clinician examining a Hispanic female veteran patient foot arch and heel in a well-lit medical examination room

40%

Plantar fasciitis — loss of use of the foot.

30%

Plantar fasciitis, bilateral — no relief from both non-surgical and surgical treatment (or recommended for surgery but not a surgical candidate).

20%

Plantar fasciitis, unilateral — no relief from both non-surgical and surgical treatment (or recommended for surgery but not a surgical candidate).

10%

Plantar fasciitis, unilateral or bilateral.

Service Connection

Advice from the Advocate

3D anatomical illustration showing the inflamed plantar fascia band stretching from the calcaneus to metatarsal heads with red inflammation highlighting on a black background
The plantar fascia is a thick fibrous band that supports the arch and absorbs shock during every step. Military service places extraordinary demands on this structure — prolonged marches, running on hard surfaces, standing in formation, and wearing boots with inadequate arch support all create repetitive microtrauma. Over months and years, microscopic tears accumulate at the fascial attachment on the heel bone. The body attempts repair through inflammation, but ongoing stress prevents full healing — the tissue degenerates rather than regenerates. This chronic degeneration, sometimes called plantar fasciosis, produces the characteristic morning heel pain and progressive disability that persists long after service ends.

The advocate's notes on causation — Plantar Fasciitis (DC 5269)

The separate arguments that decide this code: where the VA will attack, the regulation that answers it, and the evidence that closes the gap.

Professional portrait of an East Asian woman in dark attire serving as a veterans benefits advocate
  1. 1Direct service connection — §3.303(a)

    A current diagnosis of plantar fasciitis linked to documented in-service foot complaints, profiles, or physical therapy referrals. Service treatment records showing heel pain, arch pain, or limited-duty orders for foot conditions anchor the direct connection. The nexus opinion ties the current fascial degeneration to the repetitive impact absorbed during military service.

  2. 2Continuity of symptomatology — §3.303(b)

    If foot pain began during service but a formal plantar fasciitis diagnosis was not made until after discharge, 38 CFR §3.303(b) bridges the gap — the morning heel pain, standing limitations, and arch tenderness that started during service and continued without interruption to the present.

  3. 3Secondary to altered gait — §3.310(a)

    Plantar fasciitis can be secondarily service-connected when caused by an altered gait from a service-connected knee, hip, ankle, or back condition. Compensating for pain in one joint changes foot mechanics — shifting weight, altering heel strike, loading the arch abnormally — and the plantar fascia absorbs the cost.

  4. 4Aggravation by service-connected weight gain — §3.310(b)

    If service-connected conditions (PTSD medication, limited mobility from musculoskeletal injuries) caused weight gain that worsened pre-existing plantar fasciitis, the aggravation is itself service-connectable. Every additional pound increases the load on the plantar fascia during every step.

  5. 5Downstream secondary conditions — §3.310(a)

    Once plantar fasciitis is service-connected, the conditions it causes become claimable: ankle limitation of motion from compensatory gait, knee pain from altered mechanics, hip and back pain from limping, obesity from exercise inability, and depression or anxiety from chronic pain and mobility loss.

Exposure & Aggravation

How Plantar Fasciitis (DC 5269) Happens In Service — And How It Gets Worse

How veterans pick this up in uniform — Plantar Fasciitis (DC 5269)

Plantar Fasciitis (DC 5269) rarely announces itself with one dramatic moment. It is built by what service asked of your body over months and years — and once it is service-connected, it is compensated for how it keeps getting worse, not for how it started. Below is how veterans pick this up in uniform, and who is most prone to it.

  • Prolonged foot marches carrying heavy rucksack loads over varied terrain — the single greatest risk factor for plantar fascia degeneration
  • Running on hard surfaces during physical training — daily PT runs on concrete and asphalt compound microtrauma
  • Standing at attention for extended formation periods — static loading on the plantar fascia without relief
  • Wearing military boots with inadequate arch support — standard-issue boots prioritize ankle stability over arch protection
  • Airborne operations with repeated hard landings — parachute landing falls transmit enormous force through the heel
  • Shipboard duty on hard steel decks — months of standing watches on unyielding surfaces
  • Obstacle course training and combatives on hard-packed ground
  • Cold-weather operations that impair blood flow to the plantar fascia and slow tissue repair

Who is most prone to it

Infantry, airborne, and special operations soldiers who accumulate thousands of miles of rucking and running on hard surfaces; any veteran who spent years in boots with poor arch support; veterans whose post-service weight gain from other service-connected conditions has increased the mechanical load on the plantar fascia; veterans with service-connected knee, hip, or back conditions that alter gait and transfer abnormal stress to the foot.

The Symptoms

What Plantar Fasciitis (DC 5269) Actually Feels Like

  • Sharp, stabbing pain in the heel with the first steps of the morning — the hallmark symptom of plantar fasciitis
  • Heel pain that returns after prolonged standing or when rising from a seated position
  • Pain that worsens with barefoot walking, prolonged weight-bearing, or climbing stairs
  • Tenderness and swelling along the arch and heel of the affected foot
  • Pain that builds throughout the day with activity and limits walking distance
  • Tightness in the Achilles tendon and calf muscles contributing to increased fascial tension
  • Difficulty standing on hard surfaces for more than short periods
  • Pain that may radiate from the heel into the arch or midfoot area

How this one is rated

Plantar fasciitis is rated under 38 CFR §4.71a, Diagnostic Code 5269 on a tiered scale: 10% for unilateral or bilateral plantar fasciitis; 20% for unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment; 30% for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment; and 40% if there is actual loss of use of the foot. The regulation also provides that if a veteran has been recommended for surgery but is not a surgical candidate, the condition is evaluated under the 20% (unilateral) or 30% (bilateral) criteria. Pain on use, functional limitations, and the impact of flare-ups under §§4.40, 4.45, and 4.59 must be considered.

What you are measured against

The examiner documents the location and severity of plantar pain, response to palpation of the medial calcaneal tuberosity and plantar fascia, weight-bearing tolerance, and treatment history. The critical factor is whether the veteran has exhausted both non-surgical AND surgical options without relief. Non-surgical treatments include orthotics, corticosteroid injections, physical therapy, night splints, and extracorporeal shockwave therapy. Surgical treatment refers to plantar fasciotomy or related procedures. The examiner must also assess for functional loss during flare-ups and after repetitive use.

Each One On Its Own Page

Secondary Conditions — Aggravated or Caused by a Current Service-Connected Condition

Under 38 CFR §3.310(a), a disability that is proximately due to a service-connected condition is service-connected in its own right — and under §3.310(b), so is any additional disability caused when a service-connected condition aggravates a problem you already had. Each condition below is a separate evaluation with its own diagnostic code and its own percentage. They do not fold into the plantar fasciitis (dc 5269) rating — they stack on top of it. A veteran who claims only the primary condition leaves these ratings on the table.

White male veteran gripping a staircase railing showing hesitation and anticipatory pain due to foot condition

Altered gait damages the kinetic chain

Walking on the outside of the foot or avoiding heel-strike to protect the plantar fascia creates an abnormal gait pattern that overloads the ankle, knee, hip, and lower back. These compensatory injuries are legitimate secondary service-connection claims under §3.310. Document any new joint pain that began after the plantar fasciitis onset.

Black woman veteran seated on a stool in a warehouse rubbing her foot through her shoe, unable to continue standing work

Occupational capacity destroyed

Any occupation requiring standing or walking is directly impacted. Retail, nursing, construction, teaching, law enforcement, food service — all require prolonged weight-bearing that plantar fasciitis makes impossible. Document every job limitation, accommodation request, missed work day, and position you have had to abandon.

Hispanic male veteran sitting on a park bench holding his bare foot, unable to continue exercising due to plantar fasciitis pain

Weight gain and deconditioning spiral

Inability to walk, run, or exercise leads to weight gain, which increases the mechanical load on the plantar fascia, which worsens the pain, which further limits activity — a vicious cycle. The resulting obesity can aggravate sleep apnea, diabetes, hypertension, and knee conditions, each of which may warrant a secondary claim.

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Foot Conditions, In Detail

Foot Conditions — Service Connection In Depth

Here is each claimable condition in this group on its own terms — what it is, what service did to it, and what the VA requires before it will connect it.

Hispanic female veteran in her mid-30s sitting on the edge of a couch grimacing while placing her bare foot on the hardwood floor during morning first-step heel pain
DC 5269

Plantar Fasciitis

Plantar fasciitis — Diagnostic Code 5269 — is one of the most commonly claimed foot conditions in the VA disability system. Under 38 CFR §4.71a, plantar fasciitis received its own dedicated diagnostic code effective February 4, 2021, replacing the prior practice of rating it by analogy under DC 5276 (acquired flatfoot). The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot from the heel bone (calcaneus) to the base of the toes. When this band becomes inflamed or degenerates — often from the repetitive impact of military service (rucking, running, standing on hard surfaces) — the result is stabbing heel pain, especially with the first steps of the morning. The key to maximizing a plantar fasciitis claim is demonstrating that both non-surgical and surgical treatment have failed to provide relief. If you have documented failure of conservative treatments (orthotics, physical therapy, steroid injections, night splints) AND surgical intervention has not resolved the pain — or you have been recommended for surgery but are not a surgical candidate — you qualify for the higher rating tier.

You are reading this page now

White male veteran in his 40s standing barefoot in a home garage with visibly collapsed arches, one hand on his lower back grimacing from flatfoot pain
DC 5276

Pes Planus (Flatfoot)

Pes planus — acquired flatfoot, Diagnostic Code 5276 — is one of the oldest and most frequently claimed foot conditions in the VA schedule. Under 38 CFR §4.71a, the arch of the foot is a shock-absorbing structure supported by the posterior tibial tendon, the plantar fascia, and the small ligaments of the midfoot. When these structures stretch or fail — often from the cumulative load of military service — the arch collapses, the heel rolls outward (pronation), and the whole foot flattens against the ground. Unlike most musculoskeletal codes, DC 5276 uses a single diagnostic code to rate both feet together, which means the bilateral factor of §4.26 does not add on. The rating turns entirely on severity: mild, moderate, severe, or pronounced. The most important thing to understand about a flatfoot claim is that the words in the rating criteria — *marked deformity, accentuated pain on manipulation, swelling on use, characteristic callosities, marked pronation, extreme tenderness, severe Achilles spasm, not improved by orthopedic shoes* — are the exact findings the examiner must document. If your C&P report does not contain those words, the rater cannot award the matching percentage no matter how bad your feet actually are.

Read the full Pes Planus / Flatfoot (DC 5276) page

The C&P Exam

What To Expect At The Plantar Fasciitis (DC 5269) Exam

This is the encounter your rating is built on. The examiner has a checklist and a limited window — what follows is exactly what happens in that room, so none of it surprises you.

Clinical Section — What To Expect at the Exam

What to Expect at Your Plantar Fasciitis C&P Examination

Diagnostic Code 5269 — this exam focuses on treatment history and functional impact

A plantar fasciitis C&P exam under DC 5269 is different from a pure range-of-motion exam. The examiner is required to document **your full treatment history** — every non-surgical treatment you have tried and whether it provided relief, and whether surgical intervention has been attempted or recommended. The critical threshold for the higher rating is demonstrating that **both non-surgical AND surgical treatment have failed**. Your job is to come armed with complete documentation of every treatment you have tried, every provider who has treated you, and the outcome of each treatment. If surgery has been recommended but you are not a candidate, bring the surgical consultation note.

Condition

Plantar Fasciitis (DC 5269) — DC 5269

Governing questionnaire

VA Form 21-0960M-2, Foot Conditions Including Flatfoot (Pes Planus) DBQ

Click the form number to open the official questionnaire on VA.gov.

01In The Room

What happens during the exam

The tests and maneuvers for this condition

  • Palpation of the medial calcaneal tuberosity and along the plantar fascia for point tenderness
  • Windlass test — dorsiflexion of the great toe to reproduce plantar pain
  • Weight-bearing assessment — standing and walking observation
  • Gait analysis — heel strike pattern, stride length, compensatory movements
  • Bilateral comparison — both feet examined even if only one is claimed
  • Review of treatment history — non-surgical and surgical interventions documented
  • Imaging review — weight-bearing X-ray for heel spur, MRI for fascial thickening or tears

What gets measured, and to what number

Plantar fascia tenderness on palpation

The examiner documents the location and severity of pain when pressing on the medial calcaneal tuberosity and along the plantar fascia. The degree of tenderness is a key clinical finding.

Weight-bearing tolerance

How long the veteran can stand and walk before pain forces them to stop. This is measured in minutes or distance and directly reflects functional impairment.

Treatment response timeline

A complete history of every treatment attempted (orthotics, PT, injections, shockwave, surgery) and whether each provided relief. This is the core data for determining the rating tier.

Windlass test result

Positive or negative reproduction of heel pain when the great toe is dorsiflexed. A positive Windlass test confirms the diagnosis and supports the claim.

Gait pattern analysis

Whether the veteran walks with a normal heel-strike pattern or has adopted compensatory movements (toe-walking, lateral foot loading) to avoid heel pain.

02Orientation

What to expect during this exam

What makes this exam different from every other C&P exam

1Treatment failure is the rating threshold

Under DC 5269, the jump from 10% to 20% (unilateral) or 30% (bilateral) depends entirely on whether both non-surgical and surgical treatment have failed to provide relief. Come prepared with a documented treatment timeline showing every intervention you have tried.

2Unilateral vs. bilateral matters

If both feet are affected, the rating ceiling is 30% instead of 20% for treatment failure. Make sure the examiner evaluates and documents BOTH feet separately — do not let them examine only the worse side.

3Surgical candidacy is an alternative path

If a surgeon has recommended plantar fasciotomy but you are not a surgical candidate (due to age, other conditions, or surgical risk), you qualify for the higher rating even without having had the surgery. Bring the surgical consultation note documenting the recommendation.

See it before you sit in the room

03Preparation

Know your symptoms and secondary factors

What the report must actually say about plantar fasciitis (dc 5269) — dc 5269

  • "I have tried everything and nothing works — orthotics, physical therapy, steroid injections, night splints — and the pain is just as bad as the day it started" — treatment failure is the key.
  • "My doctor recommended surgery but said I am not a good candidate because of [specific reason]" — surgical candidacy path to higher rating.
  • "The first steps of every single morning feel like stepping on a nail — for the past [X] years" — chronicity.
  • "I cannot stand at work for more than 15 minutes before the heel pain forces me to sit down" — occupational impact.
  • "Both feet are affected — the left started first and the right followed within a year" — bilateral claim.
  • "I have gained 30 pounds because I cannot exercise — running, walking, even standing hurts too much" — secondary consequences.

Pain level, frequency, lost work and functional loss — how to say them

Black male veteran in his 40s sitting on the edge of a bed wincing in pain as his bare feet touch the floor during morning first-step heel pain

Describe the morning first-step agony

First-step morning pain is the diagnostic hallmark of plantar fasciitis — it is the symptom that separates this condition from generic heel pain. If the examiner hears you describe this pattern vividly, it anchors the diagnosis and makes it harder for the rater to question the condition's severity.

Describe the exact number of steps before it improves, how long the improvement lasts, and whether it returns after sitting.

"Every single morning when I put my foot on the floor, it feels like I am stepping on a nail. The first 15 to 20 steps are agony. It eases up after about 10 minutes of walking, but if I sit for 30 minutes and stand again, it comes right back just as bad."

White female veteran in her 30s leaning against a kitchen counter grimacing showing heel pain after prolonged standing

Detail every failed treatment

The examiner needs to document treatment failure to justify the higher rating. Do not assume they will ask about every treatment — volunteer the information. Name each treatment, the provider, the duration, and the result.

If you have receipts, EOBs, or pharmacy records showing the treatments, bring them.

"I have tried custom orthotics for two years, 12 weeks of physical therapy, three cortisone injections, a night splint for eight months, and six sessions of shockwave therapy. None of them gave me lasting relief — the pain always comes back within a week of stopping treatment."

Asian male veteran in his 50s stopped mid-walk on a sidewalk leaning on a bench for support with visible foot discomfort

Quantify your standing and walking limits

Functional limitation in minutes and distance is the language the rater uses to assess severity. Vague statements like "it hurts to stand" are not as powerful as "I can stand for exactly 12 minutes before the pain forces me to sit." Precise numbers make the record.

If you have measured your walking tolerance with a pedometer or phone app, bring the data.

"I can walk about a quarter mile before the pain stops me. Standing in a checkout line for more than five minutes is torture. I cannot walk a grocery store — I have to use the motorized cart."

Middle-Eastern woman in her 40s sitting in a chair pressing her heel and arch area showing plantar tenderness and pain

Report the barefoot impossibility

If you cannot walk barefoot at all — if you keep shoes with arch support by the bed, if you wear them in the house, if stepping barefoot on tile or hardwood sends shooting pain through your heel — that level of sensitivity documents severe fascial pathology.

Describe the surfaces that are worst: tile, hardwood, concrete, gravel.

"I cannot go barefoot at all — not even to the bathroom at night. I keep slip-on shoes by the bed because stepping on the hardwood floor barefoot makes me cry out. I wear supportive shoes from the moment I wake up until I go to bed."

Secondary conditions to raise in the same appointment

White male veteran gripping a staircase railing showing hesitation and anticipatory pain due to foot condition

Altered gait damages the kinetic chain

Walking on the outside of the foot or avoiding heel-strike to protect the plantar fascia creates an abnormal gait pattern that overloads the ankle, knee, hip, and lower back. These compensatory injuries are legitimate secondary service-connection claims under §3.310. Document any new joint pain that began after the plantar fasciitis onset.

Black woman veteran seated on a stool in a warehouse rubbing her foot through her shoe, unable to continue standing work

Occupational capacity destroyed

Any occupation requiring standing or walking is directly impacted. Retail, nursing, construction, teaching, law enforcement, food service — all require prolonged weight-bearing that plantar fasciitis makes impossible. Document every job limitation, accommodation request, missed work day, and position you have had to abandon.

Hispanic male veteran sitting on a park bench holding his bare foot, unable to continue exercising due to plantar fasciitis pain

Weight gain and deconditioning spiral

Inability to walk, run, or exercise leads to weight gain, which increases the mechanical load on the plantar fascia, which worsens the pain, which further limits activity — a vicious cycle. The resulting obesity can aggravate sleep apnea, diabetes, hypertension, and knee conditions, each of which may warrant a secondary claim.

How to prepare for this specific exam

  • Compile a complete treatment timeline: every provider, every treatment, dates, and outcomes — this is the most important document you bring.
  • Bring the surgical consultation note if surgery was discussed, recommended, or declined.
  • Do not take pain medication or use your night splint the night before — arrive with the full morning pain.
  • Track your walking tolerance for 30 days: how far can you walk before stopping, and how long can you stand before sitting.
  • Photograph any visible swelling in the heel/arch area, especially after a long day on your feet.
  • Bring a lay statement from your spouse or coworker describing how the foot pain limits your daily activities and work.

04The Protocol

What procedures are required during the exam

These are not courtesies. Each comes out of the regulation or out of binding case law. Take this list in with you and tick them off as they happen.

Close-up of clinician hands pressing on the plantar surface of a patient foot near the heel during diagnostic palpation
Fig. 01Medial calcaneal tuberosity palpation

01Medial calcaneal tuberosity palpation

Clinical diagnosis standard — Diagnostic Code 5269

The examiner presses firmly on the inside of the heel bone where the plantar fascia attaches. Reproducible point tenderness at this specific location is the most specific clinical finding for plantar fasciitis. The examiner should document the veteran's pain response and grade the tenderness severity.

This is the hallmark physical finding — without it, the diagnosis is weakened. If the examiner skips it or records it as negative when you clearly have pain, the exam is inadequate.

Close-up of clinician hands performing the Windlass test by dorsiflexing the patient big toe while palpating the plantar fascia
Fig. 02Windlass test for plantar fascia tension

02Windlass test for plantar fascia tension

Clinical examination standard

The examiner dorsiflexes (bends upward) the great toe while palpating the plantar fascia along its length. A positive test reproduces the veteran's characteristic heel pain by placing the fascia under maximum tension. This is a specific provocative test for plantar fasciitis that should be performed and documented.

The Windlass test is the gold standard clinical test for plantar fasciitis — a positive result directly supports the diagnosis and counters any suggestion that the pain is non-specific.

Clinician observing a veteran patient standing barefoot in a clinical exam room examining foot posture during weight-bearing assessment
Fig. 03Weight-bearing gait assessment

03Weight-bearing gait assessment

38 C.F.R. §§4.40, 4.45

The examiner observes the veteran standing and walking, documenting gait pattern, heel-strike avoidance, compensatory foot positioning, and any assistive device use. An antalgic gait with modified heel-strike is objective evidence of functional impairment that supports the severity of the condition beyond subjective pain reports.

Gait analysis captures the real-world functional impact — how the condition actually changes the way you move through the world. A normal standing exam with an obviously abnormal gait means the static assessment is not capturing the full disability.

Foot X-ray on a dark medical monitor showing a calcaneal heel spur glowing against the dark background
Fig. 04Diagnostic imaging — X-ray and MRI review

04Diagnostic imaging — X-ray and MRI review

38 C.F.R. §4.71a

Weight-bearing foot X-rays may reveal a calcaneal heel spur — a bony growth at the plantar fascia insertion — which provides objective evidence of chronic fascial tension. MRI may show fascial thickening (>4mm), perifascial edema, or partial tears. All imaging should be obtained and reviewed to document the structural basis of the condition.

Imaging converts a subjective complaint of heel pain into an objective, documentable diagnosis. A heel spur on X-ray plus fascial thickening on MRI is powerful evidence that this is a chronic, structural condition — not transient foot soreness.

South Asian female counselor at an office desk across from a white male veteran discussing the functional impact of plantar fasciitis
Fig. 05Functional and occupational impact assessment

05Functional and occupational impact assessment

38 C.F.R. §§4.10, 4.40, 4.45

The examiner documents the overall impact on employment, daily activities, and quality of life. Standing tolerance, walking distance, stair capability, exercise capacity, and effect on employment are all recorded. This assessment feeds directly into any future TDIU claim and should capture the full functional cost of the condition.

The functional assessment captures what point tenderness cannot — the real-world cost of plantar fasciitis on the veteran's life. A veteran who cannot stand at work, cannot exercise, and has gained 40 pounds because of the foot pain has a more severe disability than a tenderness grade alone suggests.

05The Standard

What makes an exam adequate

Read your exam report against these. An exam that fails the standard is legally inadequate, and an inadequate exam is something you challenge rather than accept.

01

The range of motion has to be MEASURED, not estimated

38 CFR §4.46 states that the use of a goniometer in the measurement of limitation of motion is indispensable in examinations conducted within the Department of Veterans Affairs. An examiner who eyeballs your bend and writes a number has not complied with the regulation. This is the most common defect in a spine exam and it is the easiest one to spot from the chair.

02

Joints must be tested in every required condition

Under Correia v. McDonald, a joint examination for pain must, wherever possible, record active motion, passive motion, motion in weight-bearing and motion in non-weight-bearing — and where relevant, the range of the opposite undamaged joint. An exam that records one set of numbers and stops is incomplete on its face, and that incompleteness is grounds to challenge it.

03

Flare-ups have to be addressed, not dodged

Under Sharp v. Shulkin, when a veteran describes flare-ups, the examiner is obligated to estimate the additional loss of motion during a flare based on all the available evidence — including your own account of it. "I cannot opine without resorting to mere speculation" is not automatically acceptable; the examiner has to have actually sought the information first and explained why an estimate is impossible.

04

Repetitive use and functional loss must be factored in

Sections 4.40 and 4.45, and the DeLuca line of cases, require that pain, weakness, fatigability, incoordination and lack of endurance after repeated use be considered — and expressed in additional degrees of lost motion where that is feasible. Your rating is supposed to reflect what you can do on the fifth repetition and on a bad day, not just the first careful bend of the morning.

05

Neurological findings must be separately documented

Note (1) to the General Rating Formula requires that any associated objective neurologic abnormality be evaluated separately under an appropriate diagnostic code. If your leg symptoms were mentioned in the narrative but never tested and never assigned, the exam did not do what the schedule requires of it.

06

The examiner must review the record when the question requires it

Where a medical opinion on cause, aggravation or a secondary relationship was requested, the examiner is expected to review the relevant evidence and give a reasoned explanation. A bare conclusion — "less likely than not related to service" with no reasoning attached — carries little weight, and an opinion with no rationale is challengeable.

07

The examiner has to be qualified for the body system

The VA may use its own clinicians or a contract vendor. Either way, the examiner is expected to have the competence to evaluate the system being examined. If a spinal exam with a neurological component was performed by someone who never tested a reflex, that is a problem worth raising.

08

The exam has to be CURRENT

A rating is supposed to reflect your condition now. An exam performed before a documented worsening, or years before the decision, may not support the current evaluation — and you can request a new one on that basis.

06Afterward

What happens after your exam is complete

The examiner writes the report and submits it, it is reviewed for completeness, and only then does the claim move toward a rating decision. Here is what actually controls the clock.

Examiner at a desk completing and submitting the exam questionnaire
01

The examiner writes and submits the report

Days 1–5 after the exam

The examiner compiles the history, the physical findings, the measurements and any testing into the questionnaire, adds any requested medical opinion, and submits it. Contract vendors typically have a turnaround requirement measured in days, not weeks.

Nothing about your claim moves while this is happening, and nothing you do speeds it up. What matters is that the report is written from notes taken in the room — which is exactly why what you said, and how the examiner recorded it, is already locked in by the time you get to your car. Request your copy now rather than later.

Reviewer flagging an incomplete field and sending the exam report back to the examiner
02

Quality review — and the request for clarification

Days 3–30

The report is reviewed for completeness. If it is internally inconsistent, missing a required field or missing the opinion the VA asked for, it goes back for correction or a second opinion. This is the single most common cause of a claim appearing to stall after the exam.

Understand what a finished exam actually means: it means the appointment happened, not that your claim is ready for a decision. If the reviewer finds a blank range-of-motion field, an opinion that does not answer the question that was asked, or findings that contradict each other, the file goes back out for more information. That is a normal quality control step, not a rejection of your claim, and it is not a sign that you did something wrong — but it does add weeks, and it is the reason so much of what you read online sounds like the system is broken.

Claim status tracker on a screen showing the progress bar jumped backward from a late step to an early step
03

Your status tracker moves backward — and it is usually not bad news

Any time after the exam

The online tracker shows eight steps. Veterans watch it reach step 7 or 8, then find it back at step 3 or 4 a week later. That regression almost always means one thing: the file went back for additional information, most often a returned or clarified exam.

This is the number one thing veterans panic about, and it is misread constantly. The tracker is not a countdown — it is a location marker. When the VA decides it needs one more piece of evidence, a corrected exam, a clarifying medical opinion or an outstanding record, the claim is routed back to the evidence gathering step and the bar redraws itself where the file physically is. It does not mean a denial. It does not mean your case was thrown out or restarted. It does not erase anything already in the file, and it does not change your effective date. What it does mean is that something in the record was not good enough to decide on yet — which is worth knowing, because if the weak link is the exam, this is the window where a corrective statement or a private opinion from your own doctor does the most good.

Medical records folders being handed across a counter as the evidence gathering window closes
04

Evidence gathering closes

Varies

Before anyone rates your claim, the file has to be built. This is the stretch where the Regional Office pulls together everything the decision will rest on: your service treatment records, your VA medical records, any federal records, the C&P exam report, and any private records it has requested on your behalf. The claim sits here until the VA is satisfied the record is complete enough to decide — which is exactly why a status tracker can appear to stall or slide backward at this step. You are not powerless while it sits here. Anything you put into the file yourself lands the day you send it, and every relevant record you add now is one less thing the rater can later say was missing.

A VA request to a private provider is a letter that may or may not be answered, and the VA will wait on it for weeks before moving on — sometimes without ever getting a response. A record you walk in yourself, or upload through your claim, is in the file the day you send it. So do not sit and wait to be asked. If you know a treatment record, an imaging report, a surgical note or a buddy statement exists and it matters, send it now, with a VA Form 21-4138 statement that explains in plain words what the document is and what it shows. This is also the window where a corrective statement or a private medical opinion from your own doctor does the most good — before the rater has locked in a decision, not after. Once the evidence gathering step closes, the file goes to a rating specialist, and your chance to shape the record cheaply and quickly closes with it.

Rating specialist applying the rating schedule to a file and producing the decision letter
05

Rating decision and promulgation

Typically several weeks after the last piece of evidence lands

This is the stage where your evidence finally becomes a number. A rating specialist — not the examiner, and not a doctor — takes everything in the file and applies the rating schedule to it: the exam findings, your range-of-motion measurements, your lay statements, your private records and any medical opinions. They assign a diagnostic code to each condition, pull a percentage from the schedule, set your effective date, and either grant, deny or defer each issue. The decision is then reviewed and authorized — promulgation is simply the VA’s word for making it official — and the decision letter and code sheet are generated and mailed. Where an award is made, payment follows the effective date rules, and back pay is calculated to that date.

Read the code sheet, not just the percentage. It names the diagnostic code used, the exact measurements relied on and the effective date assigned — and that is where most mistakes live. This is a human being reading a file under a production quota, and the two things that go wrong most often are a rater using the pre-repetition range-of-motion numbers instead of the worst-case figures §4.59 and §4.40 require, and a claimed condition being decided on a thin record or quietly left out. Check whether painful motion was accounted for, whether your radiculopathy was rated separately under Note (1) or folded into the spine rating, and whether every condition you claimed was actually addressed. A decision you do not read is a decision you cannot challenge — and the deadline to challenge it starts the day the letter is dated, not the day you understand it.

Opened rating decision letter with a magnifying glass over the reasons for decision section
06

C&P examination is the decision letter

The day it lands in your mailbox

The envelope holds two different documents: the narrative decision letter, and the code sheet. Together they are the single most important piece of paper in your claim, because every deadline, every appeal option and every dollar of back pay is set by what is printed on them — not by what you were told at the exam.

Most veterans read one thing on that letter: the percentage. Then they either celebrate it or get angry at it, and file it in a drawer. That is the mistake. The percentage is the conclusion; the reasons section is the reasoning, and the reasoning is what you attack. It tells you which diagnostic code the rater used, which range-of-motion figures they relied on and which they ignored, whether painful motion under §4.59 was accounted for, whether your neurological findings were rated separately under Note (1) or folded into the spine rating, which conditions were decided, which were deferred, and which were never addressed at all. It also assigns your effective date, which controls back pay. A rating that looks low is very often not a disagreement about how bad your neck is — it is a rater who used the pre-repetition numbers, or missed the radiculopathy, or rated one side and not both. You cannot see any of that from the percentage. Do not go by the percentage alone, and do not decode it by yourself if you are not sure what you are looking at — have someone who reads these for a living read it with you before the clock runs out. You have one year from the date on that letter to file a Higher-Level Review (VA Form 20-0996), a Supplemental Claim (VA Form 20-0995) or a Board appeal, and the deadline runs from the date printed on the letter, not the date you opened it. Bring it to this office and we will go through it line by line, at no cost, and tell you plainly whether it is right.

What normal looks like: 30 to 60 days for a simple claim, longer for a complex one

After your exam you should expect some kind of notification from the VA — a decision, a request for more information, or a notice that another exam has been scheduled. For a straightforward, single-issue claim that often lands within 30 to 60 days. But 30 to 60 days is a rough guide, not a rule, and it is not a ceiling. A claim with several conditions, a toxic-exposure or presumptive question, a returned exam, or missing records routinely takes 90 days or more, and that alone does not mean anything is wrong — the more moving parts your case has, the longer the VA takes to work it. Inside the window that is normal for a case like yours, silence is expected and there is nothing to fix, and a tracker that jumps backward is normal too.

What matters is not a fixed number of days — it is whether the claim is still moving and whether you can get a straight answer about where it is. Once you are well past what is normal for a case like yours and the VA either goes silent or cannot tell you what the claim is waiting on, stop waiting. That is usually where the real trouble hides — an exam that came back twice, a records request that was never answered, a claimed condition that got dropped, or a file sitting in the wrong queue. Call the VA at 800-827-1000, ask specifically what the claim is waiting on and who it is assigned to, and write down the answer. If you cannot get a straight answer, or the answer tells you the exam is the problem, that is the moment to bring it to this office rather than sitting on it for another three months. Problems raised early get fixed inside the claim. Problems discovered in a denial letter get fixed on appeal, and that costs you a year.

Other things that control the clock

Six things decide how long you wait, and none of them are visible from the tracker alone.

VA claim status page on a monitor showing an average days to complete figure with a trend line that changes month to month
01

The average is a moving number

Check it at the source, not second-hand

The VA publishes an average days-to-complete figure for disability claims that moves month to month; check the current number on the VA’s own claim status page rather than relying on any second-hand figure. In practice, most veterans see a decision somewhere between roughly three and eight months from the date the claim was filed, with the exam usually falling in the middle of that window.

Process pipeline showing the exam marked complete at the start followed by evidence gathering, rating decision and authorization still ahead
02

The exam is not the last step

Three stages still sit in front of you

The exam is not the last step. The clock does not start at the exam and it does not stop there either — the claim still has to clear evidence gathering, the rating decision and authorization.

Exam report stamped returned for clarification beside a claim tracker whose progress bar is moving backward
03

A returned exam is the invisible delay

The reason a tracker slides backward

A returned or clarified exam is the most common invisible delay, and it is why a tracker can slide backward. Expect some contact from the VA within 30 to 60 days of the exam. Past 60 days with nothing at all, call and ask specifically what the claim is waiting on.

Calendar with days 30 through 60 shaded as the normal window and everything past day 60 shaded red beside the VA benefits phone number
04

30 to 60 days is a guide, not a deadline

A complex case can take 90 days or more

Thirty to sixty days is a rough average for a simple, single-issue claim — not a hard rule and not a ceiling. A claim with several conditions, a presumptive or toxic-exposure question, a returned exam, or missing records can easily take 90 days or more, and that alone does not mean anything is wrong. Watch whether the claim is still moving, not the calendar. Only when it stalls well past what is normal for a case like yours, and no one can tell you what it is waiting on, should you stop waiting — call 800-827-1000 and ask what the claim is waiting on and who it is assigned to.

Three ways to track a claim shown side by side: the VA.gov claim status page, the VA Health and Benefits mobile app, and the benefits telephone line
05

Watch your status yourself — in one of three places

Weekly, not daily

Check your own status in one of three places: your VA.gov claim status page, the VA Health and Benefits mobile app, or by calling 800-827-1000. Check it weekly, not daily. And understand exactly what a status check can tell you: if a decision is posted in your account, it is live; if it is not posted, it is not ready. That is the whole rule. This is not something your representative or your attorney can speed up — we see the same thing you see, at the same time, and calling us to ask does not move it. Calling the VA to ask for an update does not move it either. Watch it yourself, weekly, and the moment a decision posts, bring it to us.

Flat infographic of a VA rating decision letter held beside a calendar stamped ONE YEAR TO APPEAL, with the three appeal lanes — Higher-Level Review, Supplemental Claim and Board Appeal — labeled below
06

Your decision letter arrives — read it, then start the appeal clock

What to do the day it lands in your mailbox

The decision letter is the finish line of the claim and the starting line of the appeal — and the moment it arrives, a one-year clock starts running. Read it the same day. Find the combined rating, the percentage assigned to each condition, and the effective date, because the effective date controls how far back your back pay reaches. Then request a copy of your C&P exam report so you can see whether the rater used your real range-of-motion numbers or ignored the radiculopathy. If any part of the decision is wrong — a low rating, a denied condition, or a bad effective date — you have three appeal lanes, and you must choose one within one year of the date printed on the letter: a **Higher-Level Review (VA Form 20-0996)**, where a senior reviewer re-decides on the same evidence; a **Supplemental Claim (VA Form 20-0995)**, when you have new and relevant evidence such as a private DBQ or your own range-of-motion exam; or a **Board Appeal (VA Form 10182)** to a Veterans Law Judge. Miss that one-year deadline and the decision becomes final. You can still file again later, but you lose the original effective date — and that lost time is lost back pay you never get back. Bring the letter to this office before the year runs out and we will read it with you, line by line, at no cost.

07Remedy

How to report a bad exam

Where this exam goes wrong

The biggest trap with a plantar fasciitis exam is the examiner documenting only current pain levels without capturing the full treatment history. If the report says "veteran reports heel pain, tenderness on palpation" but never documents which treatments have been tried and failed, you are stuck at 10% because the higher rating requires documented treatment failure. Make sure the examiner goes through every treatment in your timeline and records the outcome of each one.

Flat infographic of a hand writing exam notes on a notepad inside a car with a clock recording the time
01

Write it down the moment you get to your car

Date, start time, end time, the examiner’s name and credentials, the vendor, every test that was performed, and every test that was not. A contemporaneous note written the same day is evidence. A memory reconstructed four months later is not.

Flat infographic of a C&P exam report and a DBQ questionnaire being requested through VA.gov and by phone
02

Get the exam report and the questionnaire

Request a copy through VA.gov, through a written request to the Regional Office, or by calling 800-827-1000. You cannot challenge what you have not read. Compare it line by line against what actually happened in the room.

Flat infographic of a magnifying glass over a document with a defect circled in red and a regulation citation tag
03

Name the defect specifically, with the citation

Never write "the exam was unfair." Write "no goniometer was used, contrary to 38 CFR §4.46" or "flare-ups were reported and not addressed, contrary to Sharp v. Shulkin" or "repetitive use testing was not performed, contrary to 38 CFR §4.40 and DeLuca." A specific, citable defect is what forces action.

Flat infographic of VA Form 21-4138 Statement in Support of Claim being submitted with an upload arrow
04

Submit a statement asking for a new examination

VA Form 21-4138, Statement in Support of Claim, filed through VA.gov or mailed to the Evidence Intake Center. State the defect, cite the authority, and request a new or supplemental examination. Do this BEFORE the decision if the claim is still open — it is far easier than undoing a decision afterward.

Flat infographic of two separate tracks, one labeled Patient Advocate for conduct and one labeled Exam Adequacy
05

Report examiner conduct separately

If the problem is behavior rather than methodology — you were rushed out, dismissed, never touched, or treated with hostility — file a complaint with the VA facility’s Patient Advocate, or with the vendor directly for a contract exam, and copy the Regional Office. Conduct complaints and adequacy challenges are two different tracks and you can run both.

Flat infographic of a signpost forking between Higher-Level Review 20-0996 and Supplemental Claim 20-0995
06

If a decision has already issued, pick the right lane

A Higher-Level Review (VA Form 20-0996) argues the VA erred on the evidence it had — the right vehicle when the exam was inadequate on its face. A Supplemental Claim (VA Form 20-0995) is the vehicle when you are adding new and relevant evidence, such as your own private range-of-motion examination or a completed DBQ from your treating provider.

Flat infographic of a goniometer measuring a joint angle beside a completed DBQ showing range-of-motion degrees
07

Put your own measurements on the table

A private examination with full goniometric measurements, or a DBQ completed by your own provider, creates a conflict in the evidence that the VA has to resolve — and under 38 CFR §3.102 reasonable doubt is resolved in your favor.

End of clinical section

Plantar Fasciitis (DC 5269) — DC 5269

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Straight answers to the questions that decide plantar fasciitis (dc 5269) claims — the ratings, the separate evaluations, and the exam mistakes that cost veterans money.

Plantar Fasciitis (DC 5269) is evaluated under DC 5269. The scale runs across 4 rating levels, and the highest is 40%, which the VA assigns for: plantar fasciitis — loss of use of the foot. Where your evaluation actually lands depends on how your exam and records document those criteria — not on how bad the condition feels on an average day.

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Three Ways to Put an Accredited Agent on Your Case

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