Degenerative Arthritis Secondary to Flatfoot Claim Guide
Degenerative Arthritis (VA diagnostic code 5003) 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 degenerative arthritis (DC 5003) claimed as secondary to flatfoot (DC 5276) is a small but documented claim pool that wins more often than not once it reaches a merits decision.
How those 239 issues came out
Symptoms Recorded in Granted Arthritis Decisions
We analyzed 10,863 granted Board decisions involving arthritis 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.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
ICD-10 Diagnosis Codes for Degenerative Arthritis
The ICD-10 diagnosis codes most commonly used for DC 5003, Degenerative Arthritis (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 degenerative arthritis (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 degenerative arthritis 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 degenerative arthritis 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).
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 degenerative arthritis (§ 3.310(a)), or it aggravated an existing degenerative arthritis (§ 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: 82% of them found the flatfoot caused the degenerative arthritis, 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 30 denied claims the Board looked at this pairing and found no link, meaning it decided the flatfoot neither caused nor worsened the degenerative arthritis. 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
The record VA actually reviews centers on a small set of documents. 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 degenerative arthritis to your service-connected flatfoot and naming the mechanism.
- Range of motion measured in degrees
- X-ray confirmation of arthritis
- Objective painful motion findings
- Flare-ups and additional functional loss addressed
- Repetitive-use testing performed
The diagnostic code involved: DC 5003 (Degenerative Arthritis). 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 Degenerative Arthritis Secondary Claims
What veterans who win this pairing actually put in the file, and why each piece moves the claim.
- Current diagnosis of degenerative or post-traumatic arthritis: get a doctor, podiatrist, or orthopedic surgeon to put the diagnosis in your chart with a date. VA needs it documented, not just something you mention at an appointment.
- X-rays, MRI, or CT scans of the affected joint: VA's own rating rule for arthritis (Diagnostic Code 5003) requires imaging that shows the joint damage. Pain and stiffness alone will not rate the claim. If you have not had imaging, ask your doctor to order it now and submit the results.
- Proof your flatfoot is already service connected: secondary claims only work if the first condition is already rated. Include a copy of your VA rating decision letter for flatfoot.
- Gait or biomechanical evaluation: a podiatrist or physical therapist note describing your arch collapse, inward foot roll (overpronation), and abnormal walking pattern builds the bridge between your feet and your joint damage. Ask for measurements of foot angle or arch height if they can be done.
- Medical records showing the arthritis developed or got worse over time: a file that shows joint pain and swelling starting or worsening after your flatfoot was service connected helps prove the wear happened because of the foot problem, not by coincidence.
- A nexus letter from a podiatrist or orthopedic surgeon: this is the single most important piece of evidence. It must say the arthritis is "at least as likely as not" caused by, or made worse by, your flatfoot. Words like "could be" or "possibly" will not hold up. If your joint is a knee or hip, the letter should also explain the chain: collapsed arch, abnormal foot roll, extra force on the knee or hip, and faster joint wear. A private specialist opinion carries more weight than a VA exam note that skips this reasoning.
- Watch for the causation vs. aggravation trap: your claim can win either way, arthritis caused by the flatfoot, or an existing arthritis made worse by it, but the letter has to say which one and use that exact legal language. A vague statement that just links the two conditions without picking causation or aggravation gives VA room to deny.
- A private nexus opinion in hand before your VA exam: VA doctors often will not write a service-connection opinion, and if the VA examiner writes a negative opinion first, it becomes part of your file and works against you. Get your private opinion and gait documentation lined up ahead of time and bring them to the exam.
Evidence Cited in Published Arthritis Decisions
We analyzed 135,274 published Board decisions involving arthritis 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 56.9%, 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.
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.
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
These cases show veterans winning service connection for degenerative arthritis in a knee, hip, ankle, or other joint by tying the arthritis to their already service-connected flatfoot condition. In each case, the Board looked at whether a doctor's opinion linking the joint problem to the flatfoot was better supported than the VA examiner's opinion against it. Board decisions like these are not binding on other cases, but they show the kind of evidence that has worked.
Private nurse practitioner's opinion with medical literature beat a VA opinion with no rationale Citation A25087590 (October 2025), Hearing docket
The record: The veteran had degenerative osteoarthritis in both knees and was service-connected for bilateral pes planus. A private opinion from M.M., a nurse practitioner (NP), explained that the veteran had a tarsal osteotomy for his feet, developed an antalgic gait, and later developed bilateral knee osteoarthritis. She cited medical literature on the "knee hip spine syndrome" showing how foot problems change posture and load on the knees. A VA examiner in April 2023 gave a negative opinion but did not explain her reasoning or cite any medical literature.
Why it won: The Board gave the NP's opinion more weight because it was "detailed and well-reasoned" and used medical literature and specific facts from the veteran's history. The VA opinion got "reduced probative value" because it had no supporting rationale. With the evidence in equipoise, the Board resolved doubt in the veteran's favor.
Family doctor's opinion tied to gait stress helped win knee, hip, and spine claims Citation A25076897 (September 2025), Evidence Submission docket
The record: The veteran's family doctor, Dr. S.F.W., opined that "excess stress placed on his joints caused by the acquired pes planus caused and contributed to the premature degenerative disease of his spine, right hip, and right knee." A VA examiner disagreed, but her own rationale cited orthopedic literature confirming that flat feet can cause back, hip, and knee pain, then concluded against the claim mainly because more than 20 years had passed since the pes planus diagnosis.
Why it won: The Board found neither opinion more probative than the other. The VA examiner's own literature review supported the private doctor's theory, and the examiner never explained why the passage of time mattered for a degenerative condition. With the nexus evidence in equipoise, the Board resolved reasonable doubt for the veteran.
VA's own examiner supplied the winning opinion on a left knee claim Citation A25072527 (August 2025), Evidence Submission docket
The record: A February 2023 VA opinion found it at least as likely as not that the veteran's left knee osteoarthritis was linked to her service-connected pes planus. The examiner noted x-ray evidence of "minimal degenerative changes of bilateral knees" and explained that foot conditions causing abnormal posture, like pes planus, can lead to "abnormal knee rotation which can lead to knee arthritis," citing medical literature.
Why it won: The Board called this VA opinion "highly probative" because the examiner used her own expertise plus lay evidence, medical history, and literature. There was no competing negative nexus opinion on this specific joint, so the Board resolved doubt in the veteran's favor.
Two private opinions outweighed two VA opinions on ankle arthritis Citation A25054470 (June 2025), Evidence Submission docket
The record: The veteran had left ankle impingement syndrome, synovitis, and degenerative arthritis, along with right ankle tendinitis. A private physician, Dr. SD, explained in March 2020 that pes planus disrupts the normal balance of biomechanical forces and can lead to progressive osteoarthritis in the feet and ankles. A second private doctor, Dr. MS, added in October 2022 that the pes planus weakened the veteran's ankles and caused chronic instability. The VA obtained two opinions, in June 2021 and September 2021, both against the claim. The September 2021 VA examiner argued that one joint's disease does not "spread" to another and cited an orthopedic textbook.
Why it won: The Board found the VA opinion adequate but only "somewhat probative" because it did not address the March 2020 private opinion or explain how pes planus affects weight bearing and gait. The Board found the private opinions probative because they were based on a "thorough review of the medical evidence" with sound reasoning. The evidence was in approximate balance, so the Board resolved doubt for the veteran.
What the Board Said in Recent Grants
These are the Board's own words, quoted from the findings in 5 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 evidence is in equipoise as to whether the Veteran's osteoarthritis of the right and left knees was caused by his service-connected bilateral pes planus.”
“The Veteran's degenerative disc disease of the thoracolumbar spine and lumbosacral strain, right hip osteoarthritis, and right knee osteoarthritis are due to his service-connected acquired flat feet.”
“The osteoarthritis of the left knee is due to service-connected pes planus”
“The probative evidence of record is approximately balanced as to whether the Veteran's impingement syndrome, synovitis, and degenerative arthritis of the left ankle (claimed as extreme pain and swelling in the left ankle) is as likely as not due to his service-connected bilateral pes planus.”
“The evidence is at least in relative equipoise as to whether the Veteran's right knee tendonitis/tendonosis with degenerative arthritis has been aggravated by his service-connected pes planus and left ankle disability”
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 |
|---|---|
| No VA or private medical opinion in the file actually addressed whether the foot arthritis was caused or aggravated by the now service-connected pes planus. | The Board said it could not fill this gap itself. Under the modernized appeals system, the Board can only remand for a new exam if there was a duty-to-assist error, and there was none here because pes planus was not yet service-connected when the earlier decision was made. Without any nexus evidence, the claim was denied (A25003719). |
| The veteran's degenerative arthritis was claimed as secondary to bilateral pes planus, but the pes planus itself was found not to be aggravated by service. | The Board explained that a secondary claim cannot succeed if the underlying condition is not service-connected. Because the pes planus claim failed on its own facts, the arthritis claim failed too, as the two issues were "intertwined" (A24077523). |
| The VA examiner found no evidence of an abnormal gait that would favor one leg over the other and speed up joint damage in the hip. | The Board found the examiner's rationale persuasive and noted that private opinions on the same issue offered no supporting rationale at all, so they carried no probative value. The hip arthritis claim was denied (A24025170). |
| No current diagnosis of the claimed degenerative arthritis appeared anywhere in the service records or the treatment records submitted. | The Board reiterated that a current disability is "the cornerstone of any claim for service connection." Without any diagnosis, there was no duty to even schedule an exam, and the claim was denied on that basis alone (23052503). |
If Granted: How Degenerative Arthritis 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 5003, Degenerative Arthritis |
|---|---|
| 20% | You qualify for this rating if X-rays show your degenerative arthritis affects at least two major joints (like shoulders, elbows, hips, or knees) or at least two groups of smaller joints (like fingers, toes, or wrist bones). You must also experience occasional flare-ups that are severe enough to temporarily disable you or significantly limit your daily activities. |
| 10% | You qualify for this rating if X-rays show that your degenerative arthritis (wear-and-tear joint damage that gets worse over time) affects at least 2 major joints like your shoulders, elbows, hips, or knees, OR affects at least 2 groups of smaller joints like those in your hands, feet, or spine. The arthritis must be visible on X-ray imaging, but you don't need to have severe pain or major limitations in movement to meet this criteria. |
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 written opinion that explains, step by step, how flatfoot changes your gait or posture and how that led to arthritis in the joint you are claiming.
- Ask your doctor to cite medical literature or textbooks that support the foot-to-joint connection, the way the winning opinions in these cases did.
- Make sure your doctor addresses specific facts in your file, like x-ray findings, surgery dates, or a documented abnormal gait.
- Point out if a VA examiner's negative opinion actually contains language that supports your claim, such as literature admitting flat feet can cause joint pain elsewhere.
- Submit evidence during your appeal window. In several of these cases, evidence submitted after a hearing or within 90 days of the Notice of Disagreement was what the Board relied on.
- Don't rely only on a private opinion that states a conclusion without any explanation. The Board gave no weight to opinions with no rationale.
- Don't assume a claim for arthritis will succeed just because your flatfoot is service-connected. If the flatfoot claim itself is denied, the arthritis claim tied to it fails too.
- Don't skip getting a diagnosis on record. Several claims were denied simply because there was no evidence of a current diagnosis at all.
- Don't ignore a VA examiner's reasoning about the passage of time or lack of gait abnormality. If that reasoning goes unanswered, it can support a denial.
- Don't expect the Board to order a new exam to fix a missing opinion. Under the current appeals system, the Board can only do that if there was a specific duty-to-assist error.
Quick Checklist Before You File
- Service connection already in place for Flatfoot, and a current medical diagnosis of degenerative arthritis.
- Diagnostic testing, imaging, or clinical records documenting the degenerative arthritis, whatever your provider used to diagnose and track it.
- A nexus opinion, whenever possible from a doctor familiar with degenerative arthritis, 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 degenerative arthritis 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 degenerative arthritis 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 degenerative arthritis 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 degenerative arthritis worsens, see the Rating Increase Guide.
Frequently Asked Questions
Does Flatfoot have to be highly rated to support a degenerative arthritis secondary claim?
No. 38 CFR 3.310 looks at whether the service-connected Flatfoot caused or aggravated the degenerative arthritis, 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 239 published Board decisions on this exact pairing: 40% granted, 31% denied, 27% 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.