Back or Neck Strain Secondary to Flatfoot Claim Guide
Back or Neck Strain (VA diagnostic code 5237) is sometimes claimed as secondary to service-connected Flatfoot (code 5276) under 38 CFR 3.310. We analyzed published Board of Veterans' Appeals decisions on that pairing; here is what they show. It is an encyclopedic reference, not a forecast.
The Numbers, from 1.9M Appeals
We analyzed the Board's published decisions and found back or neck strain (DC 5237) claimed as secondary to flatfoot (DC 5276) is a real, mid-sized claim pool that is an uphill claim once it reaches a merits decision.
How those 817 issues came out
Start with the essentials
- 01Service Connection
The ways a secondary connection can be established for this pairing.
- 02Diagnosis and Evidence
Common symptoms and the evidence cited in published Board appeals.
- 03Your History
What you experienced, what others observed, and what treatment changed.
Understand the claim
ICD-10 Diagnosis Codes for Back or Neck Strain
The ICD-10 diagnosis codes most commonly used for DC 5237, Back or Neck Strain (the kind on your medical records, decision letter, or C&P exam report). VA rates the disability and its residuals, not the diagnosis itself, so coding can vary.
What a secondary claim on this pairing needs
Under 38 CFR 3.310 a secondary claim turns on three elements:
- A current diagnosis: a medical diagnosis of back or neck strain (the secondary).
- A service-connected primary: Flatfoot, already service-connected (the primary). A 0% primary still counts.
- A medical nexus: a medical opinion linking the back or neck strain to the flatfoot, showing the primary caused or aggravated it.
See the Secondary Claim guide for the caused-versus-aggravated split, and the Nexus Letter guide for what makes the medical opinion strong.
Why back or neck strain is claimed secondary to flatfoot
Whether that medical link exists in any one case is a medical question decided on that case's own evidence (the nexus).
Pairing research and evidence
Symptoms Recorded in Granted Back and neck (spine) Decisions
We analyzed 19,539 granted Board decisions involving back and neck (spine) for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.
Bar length shows decisions. Percentages remain context.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Caused By vs Aggravated By: What the Board Found
The outcome split above counts whole issues. This section goes one layer deeper. Under 38 CFR § 3.310 a secondary claim can be won two ways: the flatfoot caused the back or neck strain (§ 3.310(a)), or it aggravated an existing back or neck strain (§ 3.310(b)). Every grant rests on one or the other, so the numbers below divide up the granted claims only.
Direct causation is the route that carries most grants here: 78% of them found the flatfoot caused the back or neck strain, the rest found aggravation. A practical consequence for the nexus opinion: it should address both routes, because a medical opinion that only argues causation leaves the aggravation theory, a separate legal basis, on the table. See the caused-vs-aggravated guide for how the two theories differ.
On the other side: in 79 denied claims the Board looked at this pairing and found no link, meaning it decided the flatfoot neither caused nor worsened the back or neck strain. That is a separate group from the grants above, counted here so the picture is not one-sided.
We analyzed published Board decisions on this pairing to build this split. The grant split covers granted claims only; denied, remanded, and dismissed claims are not in it. Descriptive of the published record, not a prediction.
What VA Looks For: Tests, Records, and Diagnostic Codes
We analyzed published Board decisions on these claims and ranked the records that appeared most often:
- A medical nexus opinion: the one record VA weighs most on a secondary claim, a doctor's statement linking your back or neck strain to your service-connected flatfoot and naming the mechanism.
- In-service back or neck injury documented
- Range of motion measured in degrees
- Flare-ups and additional functional loss addressed
- Radiculopathy or EMG/nerve-conduction findings
- MRI or imaging of the spine
- Physician-prescribed bed rest
The diagnostic code involved: DC 5237 (Back or Neck Strain). The rating levels for this code are in the rating section below.
Records ranked by how often published Board decisions cited them. The exam that captures most of this is covered in the C&P Exam section below. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
The Evidence That Wins Back or Neck Strain Secondary Claims
What veterans who win this pairing actually put in the file, and why each piece moves the claim.
- A diagnosed back condition: Every grant had a named diagnosis, such as lumbosacral strain. A neck claim failed because no neck condition was ever diagnosed.
- Proof the flatfoot is service connected: Every grant started from service-connected pes planus. In the neck denial, the foot condition was not service connected.
- A nexus opinion that explains how: The winning opinions described foot pain leading to a limp or altered gait, which stressed the low back over time.
- An answer on aggravation: The Board discounted VA opinions that addressed only cause. One grant rested on the flatfoot making the back strain worse.
- A review of your full record: The Board credited opinions whose writers reviewed the claims file and lay statements. It called one private opinion generic because it was based on a minimal review.
- Medical literature tied to your facts: Two grants cited studies on gait and back strain, applied to the veteran's own history.
- Records showing a limp or abnormal gait: VA examiners pointed to a normal gait or no documented gait disturbance when they gave negative opinions.
Evidence Cited in Published Back and neck (spine) Decisions
We analyzed 305,501 published Board decisions involving back and neck (spine) for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 43.4%, combining every diagnostic code below. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.
Bar length shows decisions citing the evidence.
By diagnostic code
These codes are grouped together above. They do not perform the same, so find your own code here rather than reading the combined figure. A code retired in the schedule rewrites appears without a link, because its decisions were judged under criteria that no longer apply.
Bar length shows published decisions reviewed.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Board Grants on This Pairing, Dissected
The five Board decisions below granted a back condition as secondary to service-connected flatfoot (pes planus). In four of them, a private opinion explained how foot pain changed the way the veteran walked and how that put stress on the low back. In the fifth, the private doctor relied on the medical record and medical literature. In every grant the Board gave the private opinion more weight than the VA opinions. Often the VA opinion skipped the gait argument, skipped aggravation, or looked only at service records. Three of the grants rest on flatfoot together with other service-connected leg conditions. Published Board decisions are not binding precedent. Each one decides only that veteran's appeal.
A podiatrist tied the limp to the low back Citation A25096102 (November 5, 2025), Hearing docket
The record: A private podiatrist examined the veteran's feet and diagnosed lumbosacral strain on a Foot Disability Benefits Questionnaire. The podiatrist wrote that pain from pes planus and hallux valgus led to a limp and added stress on the lower back, and that the strain had been exacerbated by biomechanical imbalances and gait changes caused by the pes planus. The veteran's attorney sent this opinion in within the 90 days after the Board hearing. A November 2020 VA examiner said the strain was less likely than not related to the foot conditions, noting no back treatment records, a normal gait, and no cane, crutch, or walker.
Why it won: The Board found the VA examiner "did not address the Veteran's contention that his service connected foot conditions, notably his bilateral pes planus, had caused biomechanical gait changes". That gave the VA opinion reduced weight. With the evidence in equipoise, the Board found the strain was aggravated by the flatfoot and granted service connection under 38 CFR 3.310.
One opinion looked at all the leg conditions together Citation A25089040 (October 16, 2025), Evidence Submission docket
The record: A VA examination diagnosed lumbosacral strain. A private questionnaire from K.R., an advanced practice registered nurse (APRN-C), listed lumbosacral strain, lumbago, and sciatica. In a series of October 2023 opinions, a VA examiner said the back was not caused or aggravated by the pes planus, plantar fasciitis, heel spurs, or either knee strain. The examiner called the back a separate entity and cited a literature review. The examiner did not give an opinion on the service-connected shin splints. K.R. wrote that the veteran's foot, knee, and shin conditions caused postural compensation and an abnormal gait, which put repetitive stress on the back.
Why it won: The Board found the VA opinions looked at each condition in isolation and repeated the same rationale for each. K.R. considered the combined effect of the conditions on the veteran's gait. The Board gave K.R.'s opinion more weight and granted the low back as caused by the service-connected lower extremity conditions, including the bilateral pes planus, under 38 CFR 3.310.
VA opinions that only asked about service lost to a gait explanation Citation A25064855 (July 30, 2025), Evidence Submission docket
The record: The regional office had already found a current diagnosis of lumbosacral strain with degenerative arthritis and that the pes planus was service connected, and the Board was bound by those findings. An April 2021 VA examiner gave a negative opinion. The only reason given was an in-service attack in the veteran's bunk, and the examiner gave no reason why the flatfoot had not worsened the back. An August 2021 VA examiner gave a negative opinion based only on the lack of back treatment in service. A private opinion from Dr. C.J. said the service-connected flatfoot, hip, knee, and left leg conditions altered the veteran's gait. The altered gait compromised muscle strength and normal motion, and over time increased stress on the spine.
Why it won: The Board found both VA opinions inadequate on the secondary theory. One lacked a complete rationale and said nothing about aggravation. The other rested only on the absence of in-service records. Dr. C.J.'s opinion was supported by a rationale. Resolving reasonable doubt in the veteran's favor, the Board granted the lumbar spine as secondary to the flatfoot and the other leg conditions.
Six opinions, and the only adequate one won Citation A25019132 (March 3, 2025), Direct Review docket
The record: The veteran had lumbosacral strain with degenerative disc disease and spinal stenosis, and service-connected pes planus and knee chondromalacia. Five VA opinions were negative. Three rested on the lack of back records in service. A January 2022 opinion called the back a separate entity and said literature showed no causal link. A June 2023 opinion said no gait disturbance or leg length difference was documented, and that one joint rarely causes problems in another without a major shift in the body's center of gravity or more than five centimeters of leg shortening. A December 2022 private opinion from M.B., a physician's assistant, said the flatfoot and knee pain caused a limp and a compensatory abnormal gait that strained the low back, and cited medical studies on limping and gait.
Why it won: The Board gave the VA opinions little, if any, weight. The service-based ones relied only on missing records. The January 2022 and June 2023 opinions did not address aggravation, and the Board said an opinion with only data and conclusions gets no weight. M.B. reviewed the claims file, including lay statements, and gave a thorough rationale. The Board called it the only probative opinion and granted the back as secondary under 38 CFR 3.310.
A detailed private rebuttal outweighed two VA exams Citation A24015742 (April 2, 2024), Evidence Submission docket
The record: VA and private records showed a low back disability diagnosed as early as February 2012. A March 2020 VA examiner said the back was not secondary to the pes planus because medical literature did not support a link. A June 2020 VA examiner reached the same view, but answered an aggravation question about a different condition rather than secondary service connection. Dr. S.P. reviewed the service and medical records and wrote that the back worsened over time as a direct result of the flatfoot. Dr. S.P. cited medical literature and directly answered the VA examiners.
Why it won: The Board found Dr. S.P.'s opinion gave a more detailed, medically sound rationale, with far more medical literature behind it. The evidence was at least in approximate balance, so the Board gave the veteran the benefit of the doubt and granted the back as caused by the service-connected pes planus.
What the Board Said in Recent Grants
These are the Board's own words, quoted from the findings in 2 recent granted decisions on this pairing. Each sentence is the finding the grant rested on, not a summary of it. Click a citation to read the full decision.
“The probative evidence of record is at least in approximate balance that the Veteran's lumbar strain condition is proximately due to or aggravated by the Veteran's service-connected pes planus.”
“The Veteran's lumbar strain with discogenic disc disease is proximately due to his service-connected pes planus”
Quoted from published Board decisions on this pairing, most recent first. Descriptive of the published record, not a prediction about any individual claim. Search the full decisions in BVA Decision Search.
Why VA Denies, and How the Board Answered
The rationales below are the ones VA examiners actually used against this pairing in the published record, each paired with the Board's response.
- Read the left column first: if a VA opinion in your file uses one of these arguments, that is the reasoning your own evidence has to meet.
- The right column is the counter: it shows how the Board actually answered that argument, with the decision cited.
- A rationale appearing here is not a verdict: the same argument won some cases and lost others, on different records.
| VA examiner's rationale | How the Board answered it |
|---|---|
| The back is a separate entity from the foot conditions, and a review of medical literature shows no causal link. | The Board rejected this when it was repeated for each condition in isolation (A25089040), when it gave only data and conclusions and skipped aggravation (A25019132), and when a private doctor gave a more detailed rationale backed by more literature (A24015742). |
| The veteran had a normal gait, used no cane, and had no documented gait disturbance or leg length difference. | The Board gave reduced weight to an opinion that never addressed the claim that the flatfoot changed the veteran's gait (A25096102). It gave little, if any, weight to an opinion that did not address aggravation (A25019132). |
| There are no back complaints or treatment in the service records. | That answers direct service connection, not the secondary claim. The Board found such opinions inadequate on the secondary theory (A25064855, A25019132). |
| The veteran has an abnormal gait, but not of a kind that would change how the lumbar spine works. The accepted pathway is a leg length difference and pelvic tilt, which a person with flatfoot on both sides did not show. | The Board accepted this opinion. It followed a thorough exam of the back and feet with a clinical explanation. The only favorable note was a treating doctor's impression with no explanation (9915616). |
| The back condition came from physical jobs (security, forklift driver, corrections officer) and excess weight, not the flatfoot. | The Board accepted the combined VA opinions because they gave clear conclusions and a reasoned explanation. No favorable medical opinion was in the record, and the veteran's own view on cause was not competent on this complex question (A26001608). |
| The weight gain came from calories taken in, not from being unable to exercise because of flatfoot. | The Board accepted this on the obesity theory. It called the private opinion generic and based on a minimal review of the facts, and found the treatment records weighed against the claim (A24068316). |
If granted: rating and daily function
If Granted: How Back or Neck Strain Is Rated
The VA assigns one of these percentages based on what your medical record documents. Plain-language summary of the rating criteria at 38 CFR; the controlling text is the regulation itself.
| Rating | What the record has to show for DC 5237, Back or Neck Strain |
|---|---|
| 100% | Your entire spine has fused together in a bad position that severely limits your ability to move your back and neck (unfavorable ankylosis means the bones have grown together abnormally). This complete fusion makes it extremely difficult or impossible to bend, twist, or turn your spine in any direction, significantly impacting your daily activities and quality of life. |
| 50% | Your entire middle and lower back spine has fused together in a way that severely limits your movement and function. Unfavorable ankylosis means the vertebrae (spine bones) have grown together abnormally, creating a rigid, inflexible spine that significantly restricts your ability to bend, twist, or move your back normally. |
| 40% | You qualify for this rating if your entire neck is fused or locked in place in a bad position (unfavorable ankylosis), or if you can only bend forward 30 degrees or less in your mid to lower back, or if your entire mid to lower back is fused in a good functional position (favorable ankylosis). Ankylosis means your spine joints have become stiff and immobile, either naturally from your condition or surgically fused together. |
| 30% | You qualify for this rating if your neck can only bend forward 15 degrees or less (normal is 45 degrees), or if your entire neck spine has fused together in a good position (favorable ankylosis means the bones have grown together but in a way that doesn't cause major problems). This represents severe limitation in neck movement that significantly restricts your ability to look down or bend your head forward. |
| 20% | You qualify for this rating if your back or neck injury limits how far you can bend forward - either bending your back forward between 30-60 degrees or bending your neck forward between 15-30 degrees. You also qualify if your overall spine movement is significantly restricted (back movements totaling 120 degrees or less, neck movements totaling 170 degrees or less), or if you have severe muscle spasms that cause you to walk abnormally or develop visible spine curvature like a hunched back, loss of natural back curve, or sideways spine curvature. |
| 10% | You qualify for this rating with any one of these: forward bending of the lower (thoracolumbar) spine of more than 60 but not more than 85 degrees; forward bending of the neck of more than 30 but not more than 40 degrees; combined range of motion of the lower spine of more than 120 but not more than 235 degrees, or of the neck of more than 170 but not more than 335 degrees; muscle spasm, guarding or localized tenderness that does not change your gait or the spine's curves; or a vertebral body fracture with loss of 50 percent or more of its height. The combined range adds the six measured movements together (38 CFR 4.71a, Plate V). |
Do's and Don'ts
Every item below comes from a pattern in the decisions on this pairing, not from general claim advice.
- Get a medical opinion that explains how flatfoot changed your walk and how that strained your back. Four of the five grants turned on that explanation.
- Ask the opinion writer to address aggravation (made worse) as well as cause. The Board discounted VA opinions that skipped aggravation.
- If you have other service-connected leg or foot conditions, ask for an opinion on their combined effect on your gait.
- Point out a VA opinion that ignored your gait argument or only discussed your service records. The Board gave those opinions little weight.
- Make sure your flatfoot is service connected and your back has a diagnosis before you rely on a secondary claim.
- Don't rely on your own statement that your feet caused your back problem. The Board treated that link as a medical question.
- Don't submit a one-line note with no explanation. A treating doctor's unexplained impression lost to a reasoned VA exam.
- Don't treat back pain alone as the diagnosis. In one denial the Board said pain is a symptom, not a disability.
- Don't lean on a weight-gain theory without records that back it up. A generic opinion on obesity lost.
- Don't send key evidence outside your docket's evidence window. The Board can consider only evidence filed in that window.
Prepare and take the next step
Prepare: your own working pages
Optional. These are your own notes, in your own words. They are not a VA form, they are not sent to the VA, and nothing here is a medical finding or a prediction about your claim.
Three reminders while you prepare
- Keep the two conditions separate
Record the history, diagnosis, symptoms, and treatment for Flatfoot and Back or Neck Strain separately before describing the possible relationship. Go to this part
- Ask about causing and worsening separately
A clinician may need to address whether Flatfoot caused Back or Neck Strain, whether it worsened it, and what other explanations the record shows. Go to this part
- Build the timeline from records you have
Mark missing or unverified records honestly. Research from published Board decisions describes the record reviewed; it does not predict an individual claim. Go to this part
Sign in or create an account to save your answers and come back to them later. You can fill these in and print them without an account.
Two-condition timeline
Back or Neck Strain: symptoms and daily function
Provider questions about the relationship
Records and unanswered questions
Decision-letter reading sheet
Quick Checklist Before You File
- Service connection already in place for Flatfoot, and a current medical diagnosis of back or neck strain.
- Diagnostic testing, imaging, or clinical records documenting the back or neck strain, whatever your provider used to diagnose and track it.
- A nexus opinion, whenever possible from a doctor familiar with back or neck strain, stating it is at least as likely as not caused or aggravated by the flatfoot, and naming the mechanism rather than just the conclusion.
- Lay statements: spouse, family, friends, or battle buddies describing what they've witnessed or noticed.
- Your STRs and any VA opinions already in the file on either condition. If a VA opinion already went against you, your submitted opinion or statement should address its specific reasoning.
For the mechanics of filing itself, see the Standard Claim Guide and the Fully Developed Claim Guide.
The Claims Process, Step by Step
A secondary claim moves through the same pipeline as any other. Understanding who does what helps you know who to contact and what to expect.
- You file the claim, naming Flatfoot as the service-connected primary and back or neck strain as secondary. Directly with VA, through VA.gov, or with an accredited representative's help.
- VA assigns a Veteran Service Representative (VSR) to develop the claim: gather your service treatment records, VA and private medical records, and order a C&P exam if needed.
- The C&P exam is conducted, usually with the examiner asked to address the specific secondary theory (causation and aggravation both).
- The file goes to a Rating Veteran Service Representative (RVSR), the "rater," who weighs the medical evidence and decides service connection and, if granted, the rating percentage.
- VA issues the decision letter stating the outcome and the reasoning.
- If denied or under-rated, you choose an appeal lane, Supplemental Claim, Higher-Level Review, or a Board appeal, covered below.
Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner
Your VSO
An accredited representative, agent, or attorney. Not a VA employee. Helps prepare and file, and can represent you on appeal. Has no authority to decide your claim.
VSR
VA staff who develops the claim: gathers records and schedules the exam. Does not decide the rating.
Rater (RVSR)
VA staff who reviews the complete file and makes the actual decision on service connection and percentage.
C&P Examiner
Conducts the exam and, where asked, gives a nexus opinion. Does not decide the claim, but the opinion's reasoning and legal framing carry real weight.
For the full walkthrough, see Inside Your Claim and Claim Stages.
DBQs and Your C&P Exam
A Disability Benefits Questionnaire (DBQ) is the standardized form the examiner completes for your condition. See the DBQ Guide for how these forms work and whether a private DBQ from your own doctor can be submitted instead of relying solely on a VA exam. For what to expect and how to prepare, see the C&P Exam Prep Guide, and be specific about how your back or neck strain symptoms relate to your flatfoot timeline, treatment, and any aggravation, that is the detail a nexus opinion relies on.
Reading Your Decision Letter, and What to Do If Denied
Your decision letter has a narrative "reasons and bases" section and a codesheet with the rating and effective date. See the Reading Your Decision Letter Guide or use the Letter Interpreter tool to decode your own letter. If denied, you have three main lanes:
- Supplemental Claim: refile with new and relevant evidence, such as a nexus opinion that addresses the mechanism and the specific VA rationale you're rebutting. See Supplemental Claim Guide.
- Higher-Level Review (HLR): a senior reviewer looks at the same evidence again, useful if the denial rested on a legal error. See HLR Guide.
- Board Appeal: your case goes to a Veterans Law Judge, with a direct review, evidence, or hearing docket. See Board Appeal Guide.
Not sure which lane fits? See the Appeals decision guide for a side-by-side comparison.
After You Win: Maintaining Your Rating
Keep documentation of ongoing treatment, follow-up evaluations, and any updated diagnostic testing for your back or neck strain on file, this protects you if VA schedules a future reexamination. See Protect Your Rating for when a rating becomes protected and Future Reexaminations for what triggers one. If your back or neck strain worsens, see the Rating Increase Guide.
References and related resources
Frequently Asked Questions
Does Flatfoot have to be highly rated to support a back or neck strain secondary claim?
No. 38 CFR 3.310 looks at whether the service-connected Flatfoot caused or aggravated the back or neck strain, not at how severe the Flatfoot rating is. Even a 0% service-connected primary can anchor a secondary claim.
What do the percentages on this page mean?
They are the historical outcomes of 817 published Board decisions on this exact pairing: 11% granted, 26% denied, 62% remanded. They describe decided appeals already on record. They do not predict what would happen in any individual case.
RateMyVSO. Educational resource. Not affiliated with the U.S. Department of Veterans Affairs. Not legal advice. All RateMyVSO tools are free. Find a VSO representative for personalized guidance.