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VA Rating Assistant

DC 5282 · 38 CFR 4.71a

Hammer Toe C&P Exam Prep

To document the current severity of hammer toe deformity, identify which toes are affected and on which foot(s), evaluate functional loss due to the deformity, and establish or confirm a diagnosis under DC 5282 to support VA disability rating.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Foot_Conditions_Including_Flatfoot_Pes_Planus (Foot_Conditions_Including_Flatfoot_Pes_Planus)
Examiner:
Physician or Physician Assistant

What the examiner evaluates

  • Which specific toes are affected (great toe, second, third, fourth, little toe) and on which foot
  • Whether all toes of one foot are involved versus single toe involvement
  • Presence and severity of pain, tenderness under metatarsal heads, and painful callosities
  • Range of motion (ROM) of toe joints - active, passive, weight-bearing, and non-weight-bearing
  • Functional loss including pain, fatigue, weakness, incoordination, and instability during use and at rest
  • Presence of additional deformity such as dorsiflexion or varus deformity of toes
  • Effect of hammer toe on plantar fascia and surrounding structures
  • History of any surgical procedures (e.g., resection of metatarsal head, tarsal osteotomy)
  • Use of assistive devices or orthotic supports (arch supports, built-up shoes, cane, brace)
  • Impact on standing, sitting, walking, and overall locomotion
  • Whether symptoms are consistent with severe function equivalent to amputation of toes
  • Any concurrent foot conditions such as metatarsalgia, plantar fasciitis, bursitis, or arthritis

Exam will include both a structured interview about symptoms and history as well as a physical examination of the foot. The examiner will ask you to stand, walk, and move your toes during the physical portion. Wear comfortable footwear that is easily removed. Bring any orthotics, custom shoes, or assistive devices you use regularly. The exam may be conducted in a VA facility, contract clinic, or via telehealth for records-only review in limited circumstances.

Measurements and tests

Toe Joint Range of Motion - Active Motion

What it measures: The degree to which you can voluntarily move the affected toe joints without assistance, reflecting true functional capability.

What to expect: The examiner will ask you to flex and extend your toes on your own. They will visually observe and may measure the arc of motion. Perform this as you would in daily life - do not push through pain beyond your normal limit.

Critical thresholds

  • All toes, unilateral - all five toes affected with hammer toe deformity 10% rating under DC 5282 without claw foot
  • Single toe affected only 0% (noncompensable) under DC 5282; injury-related single-toe painful motion may qualify under DC 5284 at 10%

Tips

  • Move your toes through the full range you are capable of - do not exaggerate limitation but do not overperform either
  • If movement causes pain, tell the examiner immediately and describe the pain location and character
  • Report if your ROM is worse on bad days or after prolonged activity compared to the current exam moment

Pain considerations: Under DeLuca v. Brown, the examiner must document whether pain limits your active ROM beyond what is observed. If you feel pain before reaching your maximum theoretical arc, state that clearly. The examiner should note pain-limited ROM separately from structural limitation.

Toe Joint Range of Motion - Passive Motion

What it measures: How far the examiner can move your toe joints without your muscular effort, isolating structural versus muscular limitation.

What to expect: The examiner will gently move your toes themselves. This is required per Correia v. McDonald (28 Vet.App. 158). Passive range may exceed active range. Report any pain, even if passive motion feels slightly more tolerable.

Critical thresholds

  • Passive ROM greater than active ROM May indicate pain-limited active motion as a functional factor, supporting higher functional loss description

Tips

  • Relax your foot completely during passive testing - do not resist or assist the examiner
  • Report any pain, clicking, or catching sensations
  • Note whether passive motion feels different from your baseline daily experience

Pain considerations: Even if passive motion is near normal, document any pain experienced during the test. Pain during passive motion is relevant to the overall functional loss picture.

Weight-Bearing vs. Non-Weight-Bearing Assessment

What it measures: How the hammer toe deformity and associated pain change when bearing full body weight versus when the foot is unloaded.

What to expect: Per Correia requirements, the examiner should evaluate your foot both standing (weight-bearing) and seated or supine (non-weight-bearing). Weight-bearing often exacerbates hammer toe pain and deformity appearance. The DBQ specifically includes checkboxes for both conditions.

Critical thresholds

  • Symptoms significantly worse with weight-bearing Supports functional loss documentation and may elevate severity description toward the severe end of the spectrum

Tips

  • Before the exam, note how your symptoms differ when you are on your feet versus sitting or lying down
  • Report any change in deformity appearance, pain intensity, or difficulty walking specifically while standing
  • If you use a cane or brace specifically because of weight-bearing pain, mention this during the exam

Pain considerations: Weight-bearing pain in hammer toe often radiates under the metatarsal heads. Describe the location precisely - under the ball of the foot, along the affected toe, or on the dorsum of the toe where it contacts shoe leather.

Callosity and Tenderness Assessment

What it measures: The presence of very painful callosities on the dorsum of the affected toe(s) from shoe friction, and marked tenderness under metatarsal heads, which are rating-relevant findings under DC 5282 and the DBQ.

What to expect: The examiner will visually inspect and palpate the tops of your toes and the ball of your foot. They will press to assess tenderness. The DBQ has specific checkboxes for 'very painful callosities,' 'definite tenderness under metatarsal heads,' and 'marked tenderness under metatarsal heads.'

Critical thresholds

  • Very painful callosities present Directly checked on DBQ Section 9B; supports higher severity classification and functional loss documentation
  • Marked tenderness under metatarsal heads Directly checked on DBQ Section 9B; distinguishes from 'definite tenderness' and supports more severe rating consideration

Tips

  • Point out any callosities before the exam begins so the examiner does not miss them
  • Describe whether the callosities bleed, crack, or become infected
  • Note whether you have had callosity shaving or padding treatment and how often

Pain considerations: If pressing on metatarsal heads or callosity sites causes significant pain, vocalize it clearly. Do not stoically suppress a pain reaction - this is clinically meaningful data.

Functional Loss Assessment - Repetitive Use / Flare-Ups

What it measures: Whether your hammer toe symptoms worsen after prolonged walking, standing, or repetitive use, and whether you experience flare-ups that are more severe than your baseline state at the time of the exam.

What to expect: The examiner will ask about your worst days and your experience after activity. Per DeLuca v. Brown and M21-1 guidance, the examiner must address pain, weakness, fatigue, and incoordination with repetitive use. The DBQ has a dedicated field asking you to describe flare-ups and functional loss during flare-ups.

Critical thresholds

  • Significant functional loss during flare-ups or after repetitive use Must be documented by examiner; failure to address this is a DBQ deficiency. This factor can support additional functional loss beyond what the snapshot exam shows.

Tips

  • Prepare a specific example of your worst flare-up: what caused it, how long it lasted, what you could not do
  • Describe exactly how many minutes or steps you can take before pain forces you to stop
  • Tell the examiner how your condition was yesterday or last week if that was worse than today

Pain considerations: The exam captures a single moment in time. Your worst-day experience is legally relevant. Explicitly tell the examiner: 'Today is not my worst day. On my worst days I experience [describe specific limitation].'

Rating criteria by percentage

10%

All toes of one foot affected by hammer toe deformity, unilateral, without associated claw foot deformity. This is the maximum compensable rating under DC 5282.

Key symptoms

  • All five toes of one foot showing hammer toe deformity
  • Pain with use and weight-bearing
  • Very painful callosities on dorsum of toes
  • Marked tenderness under metatarsal heads
  • Functional limitation of walking, standing, or prolonged activity
  • Great toe dorsiflexed
  • Some or marked limitation of dorsiflexion at ankle as secondary finding
  • Disturbance of locomotion

From 38 CFR: 38 CFR 4.71a DC 5282: 'Hammer toe: All toes, unilateral without claw foot - 10 percent.' This is the only compensable level. Single toe hammer toe is rated at 0% (noncompensable) under this code.

0%

Single toe hammer toe deformity affecting less than all five toes of one foot, in the absence of injury. Rated noncompensable under DC 5282. Note: If the hammer toe is due to injury and causes painful motion, consider evaluation under DC 5284 (foot injuries, other) which carries a minimum 10% rating.

Key symptoms

  • Hammer toe affecting only one or fewer than five toes of one foot
  • No injury as etiology (if injury is etiology, DC 5284 may apply instead)
  • Mild or absent functional impairment
  • No or minimal pain

From 38 CFR: 38 CFR 4.71a DC 5282: 'Single toes - 0 percent.' M21-1 clarifies: 'Assignment of the minimum compensable evaluation for painful motion due to hammertoes evaluated under DC 5282 requires involvement of all five toes unless the hammertoes are due to injury, in which case the painful motion of less than five toes could be alternatively evaluated under DC 5284.'

Describing your symptoms accurately

Pain - Location, Character, and Triggers

How to describe it: Be specific about exactly where the pain is felt (top of toe from shoe contact, ball of foot under metatarsal head, along the length of the toe), the character of pain (sharp, burning, aching, throbbing), and what triggers it (walking, standing, wearing shoes, going up stairs). Quantify using a 0-10 scale and describe how long it takes before pain begins with activity.

Example: On my worst days, the pain on top of my [toe name] starts within 5 minutes of putting on shoes and reaches an 8 out of 10 by the time I walk to my car. I have to stop and take off my shoe, and even then the aching continues for hours afterward.

Examiner listens for: Specific anatomical location of pain, pain with weight-bearing versus at rest, pain that limits walking distance or duration, pain that wakes you from sleep, and pain that is worse at end of day versus morning.

Avoid: Saying 'it bothers me sometimes' without quantifying frequency and severity. Do not say 'I manage it' without explaining what managing costs you in terms of activity modification.

Callosity Pain and Skin Complications

How to describe it: Describe any thickened skin (calluses) on the tops of your bent toes or under the ball of your foot. Explain whether they are painful to touch, whether they crack or bleed, how frequently you have them treated, and whether they affect your ability to wear standard shoes.

Example: The callus on top of my second toe gets so thick and painful that I can feel it with every step even in padded shoes. It bled twice last month from cracking, and I had to wrap it just to walk to the bathroom.

Examiner listens for: The DBQ has specific checkboxes for 'very painful callosities' - the examiner needs to hear that these are painful, not merely present. Distinguish between a painless cosmetic callus and one that functionally limits you.

Avoid: Saying 'I have some calluses' without specifying they are painful. Do not minimize callus pain - it is a specific rating-relevant finding.

Functional Loss - Walking and Standing Limitation

How to describe it: Quantify how far you can walk before symptoms force you to stop or slow significantly. State how long you can stand before pain becomes limiting. Describe any gait changes - limping, favoring the affected foot, altering your stride to reduce pressure on affected toes.

Example: I cannot walk more than one city block without my left foot pain forcing me to stop. I shift my weight to the outer edge of my foot to avoid pressure on the bent toes, which causes me to limp noticeably by the end of any shopping trip.

Examiner listens for: Disturbance of locomotion, interference with standing, changes in gait pattern. The DBQ has checkboxes for each of these. The examiner needs concrete examples, not vague statements.

Avoid: Do not say 'I can walk okay' if you have modified how or how far you walk. Gait compensation is still functional impairment.

Fatigue, Weakness, and Endurance Limitation

How to describe it: Describe foot fatigue that develops with activity - a heaviness or aching tiredness in the affected foot that is distinct from acute pain. Explain if your foot or lower leg feels weak when walking on uneven surfaces or after extended use. Note how this affects your ability to perform your job or daily activities.

Example: After about 20 minutes on my feet, my left foot becomes so fatigued that I have to sit down. Even when the sharp pain subsides, the foot continues to ache with a deep tiredness that makes standing feel impossible.

Examiner listens for: The DeLuca factors include fatigue and lack of endurance as separate functional loss elements. The DBQ has checkboxes specifically for fatigue and lack of endurance. The examiner must address these even if they exceed what is observed on the day of the exam.

Avoid: Do not confuse general tiredness with foot-specific fatigue. Be clear that the fatigue is in the affected foot and toe area, and that it limits a specific activity.

Flare-Up Description

How to describe it: Describe what a flare-up looks like for you - increased swelling, intensified pain, inability to bear weight, need to elevate the foot, duration of the flare. Identify triggers (prolonged walking, certain footwear, weather changes, standing at work) and how frequently flare-ups occur.

Example: At least twice a month, usually after a day where I have to be on my feet for more than two hours, my entire left forefoot becomes swollen and the pain increases to the point where I cannot put on a shoe at all. I have to use open-toed footwear or sandals for one to three days afterward.

Examiner listens for: The DBQ has a dedicated field asking you to describe flare-ups (field 357). The examiner must document whether flare-ups cause functional loss beyond the baseline exam. This is your opportunity to ensure the worst-day reality is captured.

Avoid: Do not wait for the examiner to ask about flare-ups. Proactively volunteer this information if not asked. Failing to mention flare-ups means they may not be documented.

Shoe and Footwear Impact

How to describe it: Explain whether you are able to wear standard military-style boots, dress shoes, or closed-toe shoes. Describe any special footwear requirements - wide toe-box shoes, open-toed sandals, custom orthotics, or modified insoles. Note any work or activity restrictions that have resulted from your inability to wear required footwear.

Example: I cannot wear closed-toe shoes for more than 30 minutes without the top of my bent toes rubbing against the shoe and causing pain severe enough to stop me. I now wear only wide-fit shoes with a high toe box, and I still have to use padding on my toes every day.

Examiner listens for: The DBQ addresses built-up shoes and arch supports specifically. Footwear modification is a functional impact that reflects the severity of the deformity. The examiner may check whether you received relief or not from these measures.

Avoid: Do not say orthotics or special shoes 'help' without clarifying that you still have significant symptoms even with them. Residual symptoms despite treatment are relevant to rating.

Common mistakes to avoid

Assuming any number of hammer toes qualifies for a 10% rating

Why: Under DC 5282, ONLY all five toes of one foot affected by hammer toe deformity (unilateral, without claw foot) qualifies for 10%. A single hammer toe is rated 0% under this code.

Do this instead: If fewer than five toes are affected and the cause is a service-connected injury, ask your VSO or representative whether DC 5284 (other foot injuries) should be applied instead, as it carries a minimum 10% rating for any foot injury with functional loss.

Impact: 10% vs. 0%

Failing to mention all toes are affected if they truly are

Why: The examiner documents which specific toes are involved using checkboxes (great toe, second, third, fourth, little toe). If you do not volunteer that all five toes are affected or direct the examiner's attention to each toe, some may be missed.

Do this instead: Before the exam, identify each affected toe and be prepared to point them out individually. If all five toes are affected, explicitly state: 'All five toes on my [right/left] foot are affected.'

Impact: 10% vs. 0%

Not describing flare-ups or worst-day symptoms

Why: The C&P exam captures a snapshot. If today is a relatively mild day and you do not mention your worst-day experience, the examiner may only document mild symptoms, leading to an underrating.

Do this instead: Explicitly tell the examiner: 'Today is not representative of my worst days. When my condition flares, I experience [specific limitations].' Reference M21-1 guidance that worst-day reporting is appropriate.

Impact: 10%

Omitting callosity pain because it seems minor or cosmetic

Why: Very painful callosities are a specific checkbox on the DBQ that contributes to severity documentation. If not mentioned, it will not be checked, and a key rating-relevant finding will be absent from the record.

Do this instead: Proactively point out any callosities and describe their painfulness in detail, including whether they bleed, interfere with footwear, or require regular treatment.

Impact: 10%

Not addressing the injury etiology for single-toe hammer toe claims

Why: If your hammer toe in fewer than five toes is caused by a specific service-connected injury, you may be eligible for a 10% rating under DC 5284 rather than 0% under DC 5282. Veterans who do not raise the injury etiology may receive a noncompensable rating that could have been compensable.

Do this instead: If your hammer toe resulted from a specific injury (such as a fracture, crush injury, or blast injury), clearly describe that history during the exam and ensure it is documented in the history section of the DBQ.

Impact: 0% vs. 10% under DC 5284

Demonstrating greater ability during the exam than experienced in daily life

Why: Veterans often push through pain during exams out of habit or not wanting to appear weak. The examiner observes what you demonstrate, not what you experience on a typical day.

Do this instead: Move your toes and walk only to the degree you would on a normal day. Stop when it hurts. Verbalize pain reactions. Do not suppress wincing or limping.

Impact: 10%

Failing to disclose all assistive devices and footwear modifications used

Why: Use of orthotics, special shoes, padding, or a cane is evidence of functional limitation. If not disclosed, the examiner cannot check those DBQ fields or use them to support a functional loss description.

Do this instead: Bring your orthotics, custom insoles, or any toe padding devices to the exam. Tell the examiner you use them and how frequently.

Impact: 10%

Prep checklist

  • critical

    Document all affected toes on each foot

    Write down which specific toes are affected (great, second, third, fourth, little) and on which foot. Count them carefully. This is the single most important rating determination under DC 5282 - all five toes versus single toe determines compensable versus noncompensable.

    before exam

  • critical

    Request and review your VA claims file and service treatment records

    Per Sharp v. Shulkin (29 Vet.App. 26, 2017), the examiner is required to review your claims folder. Ensure your service treatment records documenting any foot injuries, sick call visits, or orthopedic referrals are in your file before the exam.

    before exam

  • critical

    Write a detailed description of your worst-day symptoms

    Prepare a written statement describing your worst flare-up in the past year. Include: what caused it, pain level (0-10), how long it lasted, what activities you could not perform, and any treatments needed. Bring this to the exam to ensure nothing is forgotten.

    before exam

  • critical

    Gather records of all foot-related medical treatment

    Collect podiatry notes, orthopedic consultations, physical therapy records, imaging (X-rays or MRIs of the foot), prescription records for pain medication related to the foot, and any surgical operative reports. These support the medical history section of the DBQ.

    before exam

  • critical

    Identify whether your hammer toe has an injury etiology

    If your hammer toe resulted from a specific injury (fracture, crush injury, blast, training accident), document the injury details. This may allow DC 5284 to apply for fewer than five toes, which carries a minimum 10% rating and is more favorable than DC 5282 for single-toe involvement.

    before exam

  • recommended

    Photograph your feet before the exam

    Take clear photographs of the top and bottom of your affected foot showing the hammer toe deformity, any callosities, and any swelling. Date-stamp the photos. These document your current presentation and can be submitted as evidence.

    before exam

  • recommended

    Note your walking distance and standing tolerance

    Track for several days before the exam how far you can walk and how long you can stand before symptoms force you to stop or change behavior. Write down specific numbers (e.g., '2 blocks,' '15 minutes') to present to the examiner.

    before exam

  • recommended

    Check whether your state allows exam recording

    Many states permit veterans to record their C&P exam. Check your state's laws and VA policy. If permitted, inform the examiner at the start of the exam that you will be recording. A recording protects you if the DBQ does not accurately reflect what was discussed.

    before exam

  • recommended

    Contact your VSO about whether DC 5284 may apply

    If fewer than all five toes are affected, discuss with a Veterans Service Officer whether the injury etiology supports rating under DC 5284 (other injuries of the foot) rather than DC 5282. DC 5284 has a minimum compensable rating of 10% and may be more advantageous.

    before exam

  • critical

    Bring all orthotics, special shoes, and toe padding devices

    Bring any custom orthotics, wide-fit shoes, toe pads, splints, or other devices you use for your hammer toe. Show them to the examiner. Their existence is evidence of functional limitation and will allow the examiner to check relevant DBQ fields.

    day of

  • recommended

    Wear footwear that is easy to remove

    The examiner will need to examine your bare feet. Wear shoes without complex laces or straps. Avoid wearing compression socks that obscure the foot unless medically necessary.

    day of

  • critical

    Do not take extra pain medication before the exam

    Take only your prescribed medication as you normally would. Do not take extra doses to 'get through' the exam. The examiner should see your typical daily functional state, not an artificially suppressed pain presentation.

    day of

  • recommended

    Arrive prepared to walk, stand, and demonstrate toe motion

    The physical exam will likely include observation of your gait, standing posture, and toe movement. Be prepared to walk a short distance in the exam room and to sit for manual ROM testing.

    day of

  • critical

    Verbalize pain immediately when it occurs during testing

    Do not silently endure pain during ROM testing or palpation. Say 'that hurts' or 'I feel pain there' immediately. The examiner must document pain during motion. If you do not verbalize it, it may not be recorded.

    during exam

  • critical

    Explicitly state that today may not represent your worst days

    At some point during the interview, tell the examiner: 'Today is not my worst day. On my worst days [describe specific limitations].' This invokes the M21-1 worst-day reporting principle and requires the examiner to document flare-up functional loss.

    during exam

  • critical

    Confirm the examiner documents which specific toes are affected

    You may politely ask the examiner to confirm they are noting all affected toes by name (great, second, third, fourth, little). If all five are affected, state clearly: 'All five toes on my [left/right] foot are bent and cause me problems.'

    during exam

  • recommended

    Describe how the condition affects your daily life and work

    Tell the examiner specifically how hammer toe affects your employment, household tasks, recreational activities, and personal care. The DBQ's functional impact section (field 851) requires this information to properly document occupational and social impairment.

    during exam

  • recommended

    Mention all related foot symptoms, not just the hammer toe deformity

    If you also have metatarsalgia, plantar fasciitis, bursitis, or callosity pain in addition to the structural deformity, mention each separately. The DBQ has checkboxes for concurrent conditions that may support secondary ratings or additional documentation.

    during exam

  • recommended

    Describe any prior surgeries on the affected foot

    If you have had any foot surgeries (resection of metatarsal head, toe surgery, osteotomy) related to the hammer toe, describe the procedure, date, and whether you still have residual symptoms post-surgery. The DBQ has dedicated fields for surgical history.

    during exam

  • critical

    Write down everything you remember from the exam immediately afterward

    As soon as you leave, write notes about what questions were asked, what the examiner observed, what you said, and anything that may not have been fully captured. This creates a contemporaneous record if you need to challenge the DBQ findings.

    after exam

  • critical

    Request a copy of the completed DBQ

    You can request the completed C&P exam report through your VA eFolder (accessible via VA.gov) or by contacting your VSO. Review it for accuracy. If the DBQ omits things you reported or records findings inaccurately, you can file a statement in support of claim or request a supplemental exam.

    after exam

  • recommended

    Contact your VSO if the DBQ appears incomplete or inaccurate

    If the DBQ does not address flare-ups, does not document all affected toes, fails to address pain during ROM (DeLuca), or does not include weight-bearing versus non-weight-bearing comparison (Correia), the exam may be inadequate. A VSO can help you request a supplemental exam.

    after exam

  • optional

    Consider obtaining a private nexus or severity opinion

    If the C&P exam does not fully capture your symptom severity or if you believe the examiner misidentified the number of toes affected, a private medical opinion from a qualified podiatrist or orthopedist can be submitted as additional evidence.

    after exam

Your rights during a C&P exam

  • You have the right to have your claims folder (VA file) reviewed by the examiner before the C&P exam, per Sharp v. Shulkin (29 Vet.App. 26, 2017). If the examiner has not reviewed your records, you may note this concern.
  • You have the right to have the examiner address additional functional limitation during flare-ups and with repeated use over time under DeLuca v. Brown (8 Vet.App. 202, 1995) and Mitchell v. Shinseki (25 Vet.App. 32, 2011). If not asked about flare-ups, raise them yourself.
  • You have the right to have ROM measured under both weight-bearing and non-weight-bearing conditions, both actively and passively, per Correia v. McDonald (28 Vet.App. 158, 2016).
  • You have the right to request a copy of your completed C&P examination report (DBQ) through your VA eFolder at VA.gov or through a Freedom of Information Act request.
  • You have the right to record your C&P examination in most states. Check applicable state law and current VA policy. Inform the examiner at the start of the exam if you plan to record.
  • You have the right to challenge an inadequate or inaccurate C&P exam by filing a Notice of Disagreement, requesting a supplemental examination, or submitting a private medical opinion as additional evidence.
  • You have the right to have the benefit of the doubt applied when evidence is approximately equal for and against a claim, per 38 CFR 3.102 and 38 U.S.C. 5107(b).
  • You have the right to be examined in person. A records-only review without a physical exam may be inadequate for a musculoskeletal condition like hammer toe. If no physical examination was conducted, you may contest the adequacy of the exam.
  • You have the right to representation by a Veterans Service Organization (VSO), attorney, or claims agent at no cost during the claims and appeals process.
  • You have the right to a supplemental claim or higher-level review if your rating decision does not accurately reflect your condition's severity.

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.