Acquired Flatfoot
Foot structure and intensive training/overuse driving pes planus and related lower-extremity overuse injury in recruits and service members.
38 CFR diagnostic code 5276
Peer-reviewed evidence (5)
The verified studies behind an Acquired Flatfoot claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.
- Finnern M Jr, Ryan P, Anderson C. Occupational Outcomes of Reconstructive Surgery for Adult Acquired Flatfoot Deformity. Mil Med. 2017;182(11):e2066-e2068. PMID:29087883. doi:10.7205/MILMED-D-17-00201.
- Parviainen M, Pihlajamäki H, Kautiainen H, Kiviranta I. Incidence and Risk Factors of Foot and Ankle Disorders in Male Finnish Conscripts. Mil Med. 2019;184(5-6):e352-e358. PMID:30423135. doi:10.1093/milmed/usy297.
- Kaufman KR, Brodine SK, Shaffer RA, Johnson CW, Cullison TR. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999;27(5):585-93. PMID:10496574. doi:10.1177/03635465990270050701.
- Song J, Choe K, Neary M, Zifchock RA, Cameron KL, Trepa M, Hannan MT, Hillstrom H. Comprehensive biomechanical characterization of feet in USMA cadets: Comparison across race, gender, arch flexibility, and foot types. Gait Posture. 2018;60:175-180. PMID:29247970. doi:10.1016/j.gaitpost.2017.12.001.
- Wang X, Wang PS, Zhou W. Risk factors of military training-related injuries in recruits of Chinese People's Armed Police Forces. Chin J Traumatol. 2003;6(1):12-7. PMID:12542958.
Controlling law
The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.
Direct (§ 3.303)
Regulation
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
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