Military service can lead to many types of bone and ligament damage. Significant injuries from training or combat are a common source of chronic disability for veterans. Even without significant injuries, the strain of physical work puts pressure on the body, which leads to a risk of repetitive motion injuries. Sometimes the effects of that kind of damage won't be apparent until years later.
Veterans are often at risk for problems with their feet, knees, and ankles. Flat feet, sometimes called pens planus, is a common, if misunderstood, condition. Flat feet aren't just about how high the foot's arch is. The fallen arch of a flat foot is evidence of physical damage that changes the anatomy of the foot. The condition can be painful, leading to loss of mobility.
Veterans who have flat feet due to military service may be entitled to monthly disability payments from the VA.
Symptoms of Flat Feet
For many veterans, flat feet start as mild pain in the feet and ankles. Without proper treatment, the condition can progress and lead to increased pain and mobility issues. Symptoms of flat feet include:
- Leg cramps
- Muscle pain in the foot or leg
- Pain in the arch, ankle, heel, or outside of the foot
- Pain when walking
- Gait changes
- The front part of the foot and toes point outward
- Swelling on the inside of the ankle due to inflammation of the tibial tendon
- Pain that increases after high-intensity activities, such as running
- Difficulty walking or standing for long periods
- Painful, bony bumps called bone spurs on the top and inside of the foot
- Numbness and tingling along the top of the foot and into the toes as a result of bone spurs pinching nerves
Flat feet put veterans at risk for knee, hip, and or back pain. People unconsciously compensate for foot instability by changing the way they walk and stand. This can put undue pressure on other joints and lead to increased pain and a higher risk for injuries.
Causes of Flat Feet
Some people are born with low or flat arches in their feet. Others develop fallen or flat arches as the result of injury. Veterans are at an increased risk of acquired flat feet due to the physical demands of military service. If a veteran had arch issues before joining the military, service may have aggravated the problems and caused disability later in life.
One of the most common injuries that causes flat feet is Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon connects the calf muscles to the bones of the foot and supports the arch. If the tendon is injured, it can't hold the arch up, and the foot slowly collapses. PTTD can be a result of acute trauma or repetitive motion injuries. Injuries to the tendon can cause chronic weakness, leading to flat feet symptoms.
Foot injuries are also a cause of flat feet, particularly injuries to the midsection of the foot. Any damage to the bones or ligaments of the foot can reduce the strength and flexibility of the foot. Injuries that don't heal properly may leave deformities in the bones and ligaments that can worsen over time. Even injuries that got the proper care and healed well result in weak spots in bones and ligaments, which can be vulnerable to re-injury later.
Veterans with chronic conditions like rheumatoid arthritis or diabetes may develop flat feet as a complication. If a veteran had prior injuries to the feet or leg, he or she could be at higher risk for diabetes- or RA-related flat feet.
VA Ratings for Flat Feet
The pain and mobility problems from flat feet can limit activities for veterans. If a veteran cannot walk or stand for long periods, he or she may not be able to work. If flat feet have led to additional joint issues such as knee, hips, or back problems, a veteran may need mobility aids such as a walker or wheelchair. Even moderate cases of flat feet can require complex treatments such as custom orthotics, physical therapy, and periods of rest. In some cases, surgery may be required.
The VA assigns benefit levels for flat feet based on a defined formula. The benefit formula is based on the severity of the disability and how well it responds to treatment.
Pronounced flat foot:
Feet have marked pronation (collapsing inward), extreme pain on the bottom of the foot even when the foot is not in use, the Achilles tendon is displaced and tight or spasmed, and orthopedic shoes or appliances do not improve symptoms.
Both feet: 50%
One foot: 30%
Severe flat foot:
Obvious deformities include pronation (foot collapsing inward) or abduction (foot collapsing outward), pain when the foot is touched during an examination, pain from using the foot, swelling after use of the foot, and callouses.
Both feet: 30%
One foot: 20%
Moderate flat foot:
When standing, weight is distributed more to the inside of the foot, mild bowing of the Achilles tendon, pain when the foot is touched during the examination, and pain from the use of the foot.
One or both feet: 10%
Mild flat foot:
Symptoms are alleviated by corrective footwear
One or both feet: 0
If you have a secondary condition such as diabetes or rheumatoid arthritis that aggravates the symptoms of flat feet and causes a more severe disability, you may be eligible for higher compensation.
Applying for VA Benefits for Flat Feet
Veterans who have developed flat feet due to active duty service may be eligible for VA disability benefits. Veterans may also be eligible to make a VA claim if military service has aggravated a preexisting condition. If a veteran had flat feet before service, he or she might be able to apply for benefits if military service made the condition worse.
To qualify for VA disability benefits, veterans need to establish a link between military service and current health conditions. To demonstrate the service connection, a veteran must satisfy three basic criteria. The first is medical evidence of a current disability. Veterans will need to show that the condition impacts their well-being and ability to work.
The second step requires medical evidence of the disabling condition. Veterans must show records of their diagnosis and treatment of flat feet. Veterans will need copies of medical records detailing symptoms, treatment, and results. Any test results or medical imaging records will be important, as well.
Finally, veterans need to show a connection between in-service injury or disease and the present disability. Veterans must have evidence establishing that a disabling disease or injury was "incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein." In in-service treatment records, relevant injuries that occurred during active duty should be documented. If flat foot symptoms started after service, a doctor should document show service-related activities contributed to the veteran's current disability. This is known as establishing the causation, and veterans will need a doctor to write a letter stating that their disability is the result of their time in service.