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VA Rating Assistant

DC 5277 · 38 CFR 4.71a

Weak Foot, Bilateral C&P Exam Prep

To document the current severity of bilateral weak foot (DC 5277), identify the underlying constitutional or systemic condition driving the weakness, establish functional loss, and support accurate disability rating under 38 CFR 4.71a. Because DC 5277 requires rating the underlying condition with a minimum of 10%, the examiner must also identify and evaluate any associated diagnoses such as flat foot, plantar fasciitis, metatarsalgia, or arthritic conditions.

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

  • Bilateral foot muscle atrophy and degree of weakness in intrinsic and extrinsic foot musculature
  • Circulatory disturbances affecting both feet
  • Range of motion of the ankle, subtalar, and toe joints (active and passive, weight-bearing and non-weight-bearing)
  • Presence and severity of pain on motion, at rest, and during flare-ups
  • Toe alignment abnormalities including dorsiflexion tendencies, hammer toes, and hallux deformity
  • Plantar fascia condition: shortening, marked contraction, dropped forefoot
  • Tenderness under metatarsal heads (definite vs. marked)
  • Presence of painful callosities
  • Assistive device use (cane, brace, orthotic inserts, built-up shoes, walker, crutches, wheelchair)
  • Functional impact on ambulation, standing, sitting, and locomotion for both lower extremities
  • DeLuca factors: pain, fatigue, weakness, incoordination, and functional loss with repetitive use and during flare-ups
  • Arch support or built-up shoe effectiveness in relieving symptoms
  • Underlying constitutional condition causing weak foot (e.g., diabetes, peripheral neuropathy, vascular disease, neurological disorder)
  • Surgical history including tarsal osteotomy, metatarsal head resection, or other procedures
  • Imaging and diagnostic test results (X-rays, MRI, EMG/NCS, vascular studies)
  • Presence of lower extremity deformity other than pes planus

Exam will include seated interview, standing assessment, and physical examination of both feet. You will be asked to walk so gait can be observed. Wear shoes and socks that are easy to remove. Bring any orthotics, braces, or assistive devices you routinely use. The examiner will test you both standing (weight-bearing) and sitting or lying down (non-weight-bearing) per Correia requirements. You have the right to request the exam be recorded in most states.

Measurements and tests

Ankle Dorsiflexion (Active and Passive)

What it measures: Ability to bend the foot upward toward the shin; normal is approximately 20 degrees. Limitation affects gait mechanics and is directly relevant to weak foot deformity patterns.

What to expect: Examiner will ask you to flex your foot upward while seated, then will gently assist the motion passively. Will be repeated standing. Goniometer may be used.

Critical thresholds

  • Limitation to right angle or less Supports higher severity rating for acquired pes cavus or weak foot deformity patterns
  • Some limitation of dorsiflexion at ankle Noted as a distinct finding on DBQ supporting functional impairment beyond minimum 10% rating

Tips

  • Move only as far as you can without pushing through pain; do not force the motion
  • Tell the examiner immediately when you feel pain and at what degree
  • Report if this is worse on your worst days than what you are demonstrating today
  • Perform the test as naturally as possible - the examiner needs your true functional range, not a best effort

Pain considerations: Per DeLuca v. Brown, pain that limits motion must be documented. If pain stops your motion before the normal endpoint, state clearly: 'The pain stops me here.' Ask the examiner to note pain on motion in the report.

Ankle Plantarflexion (Active and Passive)

What it measures: Ability to point the foot downward; normal is approximately 45 degrees. Weakness in plantarflexion reflects intrinsic muscle atrophy characteristic of DC 5277.

What to expect: You will be asked to point your toes downward. Examiner will gently assist passively after active motion.

Critical thresholds

  • Reduced active vs. passive ROM Differential between active and passive motion documents true muscular weakness

Tips

  • Note any asymmetry between right and left feet
  • Describe fatigue or weakness that builds during repeated motion - this is a DeLuca factor
  • Report burning, numbness, or cramping that accompanies the motion

Pain considerations: Weakness is distinct from pain-limited motion. Describe weakness as: 'My foot feels like it gives out' or 'I cannot hold the position against resistance.' This supports the muscular atrophy component of DC 5277.

Subtalar / Inversion and Eversion Testing

What it measures: Side-to-side motion of the heel; assesses subtalar joint flexibility and tarsal instability. Normal inversion approximately 30 degrees, eversion approximately 15 degrees.

What to expect: Examiner will rock your heel inward and outward. May test both actively and passively while seated.

Critical thresholds

  • Marked limitation bilaterally Supports functional impairment beyond minimum 10% and may support analog rating under underlying condition DC

Tips

  • Report pain at end range and through range
  • Note if one foot is significantly worse than the other - both must be documented

Pain considerations: If subtalar motion causes radiating pain up the leg or into the arch, describe this precisely to the examiner.

Toe ROM Testing (Great Toe Dorsiflexion and Plantar Flexion; Lesser Toes)

What it measures: Mobility of metatarsophalangeal (MTP) and interphalangeal (IP) joints. The DBQ specifically tracks great toe dorsiflexion status and toe deformity patterns.

What to expect: Examiner will check whether your great toe tends toward dorsiflexion (hallux characteristic of weak foot) and assess all toes for hammer toe or dorsiflexion tendency.

Critical thresholds

  • Great toe dorsiflexed Directly documented on DBQ as a characteristic weak-foot finding supporting higher functional impairment
  • All toes tending to dorsiflexion Hallmark finding of advanced weak foot deformity; supports maximum functional loss documentation
  • All toes - hammer toes Associated deformity that may support additional or higher rating depending on underlying diagnosis

Tips

  • Point out any toes that are persistently curled, raised, or positioned abnormally at rest - do not straighten them for the exam
  • Report pain when the examiner moves individual toes
  • Mention if shoes cause pressure sores or blisters due to toe deformities

Pain considerations: Painful callosities under the metatarsal heads are a separate rated finding - point them out proactively if present.

Muscle Strength and Atrophy Assessment

What it measures: Intrinsic foot muscle bulk and resistance strength. DC 5277 is specifically defined by musculature atrophy and weakness; this is the core physical finding.

What to expect: Examiner will visually inspect and may measure calf or foot circumference bilaterally. May ask you to resist pressure with your foot or toes.

Critical thresholds

  • Visible atrophy of intrinsic foot musculature Directly confirms DC 5277 diagnostic criteria; supports higher severity documentation
  • Measurable circumference reduction vs. normal limb Objective evidence of atrophy of disuse (DBQ field supported)

Tips

  • Do not flex or tense your foot muscles before measurement - allow natural resting state
  • If you have noticed visible thinning of your foot or reduced shoe size due to atrophy, mention this
  • Report any history of EMG/nerve conduction studies documenting weakness or denervation

Pain considerations: Weakness and atrophy are separate from pain. Clearly distinguish: 'My feet are weak and feel unstable' from pain descriptions to ensure both components are captured.

Vascular / Circulatory Assessment

What it measures: DC 5277 explicitly includes disturbed circulation as a diagnostic criterion. Examiner may assess skin color, temperature, hair distribution, capillary refill, and pedal pulses.

What to expect: Examiner will inspect skin appearance, feel temperature of both feet, and may check dorsalis pedis and posterior tibial pulses.

Critical thresholds

  • Absent or diminished pedal pulses Objective confirmation of circulatory disturbance component of DC 5277
  • Skin changes (pallor, cyanosis, hair loss, shiny skin) Supports underlying vascular or neuropathic etiology; may support higher combined rating

Tips

  • Mention any history of cold feet, color changes, numbness or tingling at rest
  • Report any diagnosed peripheral artery disease or peripheral neuropathy as potential underlying conditions for DC 5277
  • Bring documentation of any vascular studies (ABI testing, Doppler ultrasound)

Pain considerations: Burning pain at rest, especially at night, may indicate vascular or neuropathic etiology - describe this specifically.

Gait and Weight-Bearing Observation

What it measures: How weak foot affects your ability to walk, distribute weight, and maintain stability. The examiner will observe weight-bearing patterns per Correia requirements.

What to expect: You will likely be asked to walk a short distance. Examiner will observe heel strike, push-off, balance, antalgic gait, and use of assistive devices.

Critical thresholds

  • Disturbance of locomotion documented DBQ field directly supports functional loss rating beyond minimum 10%
  • Instability of station Supports documentation of DeLuca incoordination factor and instability finding

Tips

  • Walk naturally - do not try to compensate or walk better than you normally do
  • Use your normal assistive devices during observation
  • If you normally avoid certain surfaces or distances, mention this
  • Report any falls related to foot weakness or instability in the past 12 months

Pain considerations: If walking causes pain that limits distance, state the exact distance before pain becomes intolerable on a bad day: 'On a bad day I can only walk half a block before the pain and weakness force me to stop.'

Rating criteria by percentage

10%

Minimum rating for bilateral weak foot under DC 5277. The underlying condition is rated separately; this minimum ensures at least 10% even if the underlying condition would otherwise be rated lower or is not separately compensable. Characterized by atrophy of the musculature, disturbed circulation, and weakness affecting both feet.

Key symptoms

  • Bilateral foot muscle weakness
  • Some atrophy of intrinsic foot musculature
  • Disturbed circulation (cold feet, diminished pulses, color changes)
  • Mild limitation of foot function
  • Mild pain with prolonged standing or walking
  • Mild instability

From 38 CFR: 38 CFR 4.71a DC 5277: 'A symptomatic condition secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation, and weakness: Rate the underlying condition, minimum rating 10.'

Describing your symptoms accurately

Bilateral Foot Weakness

How to describe it: Describe the specific ways weakness manifests: inability to push off the ground normally when walking, feet feeling like they will give out, difficulty rising on tiptoes, dropping objects with your feet, or tripping due to foot drop tendencies. Distinguish weakness from pain - both are separate components of DC 5277.

Example: On my worst days, my feet feel like dead weight. I can barely push off when walking and I have to consciously watch where I place each foot or I stumble. I cannot stand on my tiptoes at all. By mid-afternoon after any walking, both feet feel completely exhausted and I have to sit down immediately.

Examiner listens for: Specific functional limitations tied to weakness, not just pain; inability to perform activities requiring foot strength such as climbing stairs, walking on uneven terrain, or standing for prolonged periods; distinction between the weakness component and pain component.

Avoid: Do not say 'my feet are just a little weak' or 'I manage.' Describe the full functional impact. Do not conflate weakness with pain - state both separately. Do not omit that both feet are affected.

Muscle Atrophy

How to describe it: Describe observable changes: feet look thinner or smaller than they used to, shoes that used to fit now feel loose in certain areas, visible reduction in the muscle bulk on the soles of your feet or along the arch. If a healthcare provider has commented on visible atrophy, mention this.

Example: I've noticed over the past two years that my feet look visibly thinner. My shoes that fit fine before now feel like there's less cushioning from my own foot. My podiatrist pointed out that the intrinsic muscles of my feet have wasted away, which is why I need special orthotics just to walk.

Examiner listens for: Timeline of progressive atrophy, correlation with underlying constitutional condition, impact of atrophy on footwear needs and daily function, any documented measurements or clinical observations of muscle loss.

Avoid: Do not minimize visible changes. If you have noticed atrophy, describe it specifically. Avoid saying 'my feet look normal' if the atrophy is not obviously visible to a layperson but has been documented by a provider.

Circulatory Disturbances

How to describe it: Describe specific circulatory symptoms: feet are constantly cold regardless of ambient temperature, feet turn pale or bluish when elevated, redness or mottled appearance when dependent, skin is shiny or hairless on feet, wounds heal slowly, burning or tingling sensations especially at rest or at night.

Example: Every night my feet are ice cold even under blankets. When I take off my socks you can see the skin is pale and shiny - my doctor said that is a sign of poor circulation. I get burning pain in both feet at rest that wakes me up at night at least three or four times a week.

Examiner listens for: Objective correlates to circulatory complaints, consistency with underlying diagnosed conditions (diabetes, peripheral arterial disease, peripheral neuropathy), impact on sleep and daily activities, any diagnostic workup confirming circulatory abnormality.

Avoid: Do not dismiss circulatory symptoms as 'just the cold.' Describe all relevant symptoms even if you think they are minor. Mention any prior vascular testing or referrals to vascular surgery.

Pain - Bilateral

How to describe it: For DC 5277 specifically, pain should be described in the context of its relationship to the underlying condition driving the weak foot. Describe location (metatarsal heads, arch, heel, entire foot), character (sharp, burning, aching, throbbing), triggers (weight-bearing, activity, repetitive use), and relief measures (rest, elevation, orthotics, medication).

Example: On a bad day - which happens several times a week - I have severe aching pain across the entire ball of both feet. The pain starts after about 10 minutes of walking and forces me to stop. I also have burning pain at rest that is worse at night. I rate the pain a 7 out of 10 on a bad day even with ibuprofen.

Examiner listens for: Pain that limits ROM per DeLuca doctrine, pain that occurs both on motion and at rest, pain that is worse with repetitive use, flare-up frequency and severity, consistency between reported pain and observable antalgic gait or compensatory posturing.

Avoid: Do not report only your best or average pain level. M21-1 guidance supports reporting the worst level. Do not say 'the pain is tolerable' without qualifying what tolerating it costs you functionally.

Flare-Ups and Repetitive Use Functional Loss (DeLuca Factors)

How to describe it: Describe flare-up triggers, frequency, duration, and severity. Explain how function degrades with repeated use over the course of a day or week. Per DeLuca v. Brown, this information is critical for accurate rating and must be communicated clearly to the examiner.

Example: I have flare-ups roughly three times a week triggered by any sustained walking or standing. During a flare-up, both feet swell, become extremely painful, and feel like they will buckle under me. I cannot walk more than 50 feet and must elevate my feet for the rest of the day. The flare-up lasts 24 to 48 hours. Even on days without a full flare-up, my feet deteriorate significantly after 20 minutes of activity - the weakness and pain build until I have to stop and rest.

Examiner listens for: Specific triggers, measurable functional thresholds (distance walked, time standing), recovery time required, impact on work and ADLs, whether current examination conditions represent baseline or a better-than-average day.

Avoid: Do not omit flare-up information. If you are having a relatively good day at the exam, say so explicitly: 'Today is a better day for me. On my worst days, which happen [X] times per week, my symptoms are significantly worse than what I am showing you now.'

Instability and Incoordination

How to describe it: Describe episodes of the foot giving way, stumbling, near-falls, or actual falls. Describe difficulty maintaining balance on uneven terrain, stairs, or when changing direction. Note any compensatory strategies such as holding onto walls, avoiding certain surfaces, or limiting activities due to fear of falling.

Example: My feet give out on me unpredictably. I have fallen twice in the past three months because my foot buckled on a small step. I now hold onto the wall when I walk down the hallway at home and I no longer walk on uneven ground at all. I feel like I cannot trust my feet to support me.

Examiner listens for: Objective evidence of instability on exam (Romberg, tandem gait, single-leg stance), correlation between reported instability and observed gait pattern, history of falls with dates if possible, assistive devices used as a result of instability.

Avoid: Do not omit fall history out of embarrassment. Near-falls are also relevant. Do not say 'I am careful so I don't fall' without explaining what 'being careful' actually means in terms of activity restriction.

Impact on Activities of Daily Living and Work

How to describe it: Describe specific ADLs affected: unable to stand long enough to cook a meal, cannot walk to the mailbox, limited in grocery shopping, cannot perform a job that requires standing or walking, need assistance with activities due to bilateral foot weakness.

Example: I can no longer perform my previous job which required standing on concrete floors for 8 hours. I now need to sit every 15 minutes and elevate my feet. I cannot do yard work, walk my dog, or stand in line at the grocery store. My spouse now does all the shopping because I cannot manage the walking involved.

Examiner listens for: Vocational impact, loss of recreational activities, dependence on others for ADLs, use of adaptive equipment, changes in lifestyle directly attributable to bilateral weak foot condition.

Avoid: Do not underreport functional limitations. The DBQ specifically asks about interference with standing and sitting - address both. Do not say 'I get by' without explaining the compromises you make.

Common mistakes to avoid

Failing to identify and clearly communicate the underlying constitutional condition causing the weak foot

Why: DC 5277 explicitly requires rating the underlying condition; without a clear underlying diagnosis, the examiner cannot properly rate beyond the minimum 10%, and the DBQ may be returned as inadequate.

Do this instead: Before your exam, identify and be prepared to discuss the underlying condition (e.g., diabetes mellitus, peripheral neuropathy, peripheral arterial disease, rheumatoid arthritis, multiple sclerosis) that your treating providers have linked to your bilateral weak foot. Bring relevant medical records documenting this connection.

Impact: All rating levels - determines the underlying DC used for rating above the 10% minimum

Only describing symptoms on an average or good day rather than worst-day presentation

Why: VA rating is based on the full picture of disability including its worst manifestations. Reporting only average or best-day symptoms systematically underrepresents the true severity of the condition.

Do this instead: Explicitly tell the examiner: 'Today is [better/worse/average] than typical for me. On my worst days, which occur [frequency], my symptoms are [describe]. The examiner must document this even if it cannot be directly observed during the exam per M21-1 guidance.',

Impact: Minimum 10% vs. higher combined rating for underlying condition

Not distinguishing between weakness/atrophy and pain as separate symptom components

Why: DC 5277 is specifically defined by three components: atrophy of the musculature, disturbed circulation, and weakness. If you only describe pain, the examiner may not fully document the weakness and atrophy components that define this diagnostic code.

Do this instead: Separately address each component: 'My feet are weak - here is how that weakness affects my function'; 'My feet have visible atrophy - here is what I have noticed'; 'My circulation is disturbed - here are my symptoms.' Do not roll all symptoms into general 'foot pain.'

Impact: Diagnostic code assignment and minimum 10% rating confirmation

Omitting flare-up and repetitive use information during the exam

Why: Per DeLuca v. Brown (8 Vet.App. 202, 1995), the examiner must address functional loss due to pain, fatigue, weakness, and incoordination during flare-ups and with repeated use. If you do not provide this information, the examiner may not know to document it.

Do this instead: Proactively describe: how long you can stand or walk before symptoms force you to stop, how symptoms progress through the day with activity, what happens during flare-ups, and how long recovery takes. If the examiner does not ask, volunteer this information.

Impact: All rating levels - flare-up severity can increase effective rating of the underlying condition

Removing or not bringing assistive devices, orthotics, or supportive footwear to the exam

Why: Use of assistive devices (cane, brace, orthotics, built-up shoes) is directly documented on the DBQ and supports functional impairment rating. The examiner needs to see what you actually use.

Do this instead: Bring all devices you routinely use: orthotics/insoles, ankle braces, arch supports, built-up shoes, cane, walker. Wear the footwear you use daily. Tell the examiner how often you use each device and whether it provides relief.

Impact: Functional loss section of DBQ; assistive device use supports higher impairment documentation

Performing ROM tests to the best of your ability rather than your functional ability

Why: Performing beyond your normal functional capacity gives an inaccurate picture of your disability. The examiner needs to see what you can actually do, not your maximum effort under pressure.

Do this instead: Move only as far as you comfortably can. Stop at the point of pain and say 'this is where the pain stops me.' Do not push through pain to try to cooperate or impress. Accurate results help you; artificially inflated ROM hurts your claim.

Impact: Underlying condition ROM-based rating criteria

Failing to note that both feet are affected bilaterally and describing only the worse foot

Why: DC 5277 is specifically a bilateral code. If the examiner only documents one foot thoroughly, the bilateral nature of the condition may not be fully reflected in the rating.

Do this instead: Explicitly address both feet when describing symptoms. If one foot is worse, say so and describe both: 'My right foot is worse, but my left foot also has [specific symptoms].' Do not assume the examiner will ask about both.

Impact: Bilateral factor applicability and bilateral DC confirmation

Not reporting the impact of arch supports or built-up shoes on symptom relief or lack thereof

Why: The DBQ specifically asks whether arch supports and built-up shoes relieve symptoms on each side. This information affects how the examiner documents symptom management and residual disability.

Do this instead: For each foot, state clearly whether arch supports or orthotics relieve your symptoms and to what degree: 'My orthotics reduce the pain somewhat but do not eliminate it and do not address the weakness.' Or: 'I have tried orthotics but they provide no meaningful relief.'

Impact: Flat foot and weak foot severity assessment; symptom management documentation

Not mentioning sleep disturbance, rest pain, or nocturnal symptoms

Why: Pain at rest and sleep disruption demonstrate severity beyond activity-related symptoms and support documentation of continuous symptomatology. The DBQ includes on-rest/non-movement pain as a separate finding.

Do this instead: If you have pain at rest, especially at night, describe it specifically: frequency, character, severity, impact on sleep, and any treatments used. Note: 'My foot pain wakes me [X] nights per week even when I am completely still.'

Impact: Functional loss at rest documentation; supports higher severity rating for underlying condition

Prep checklist

  • critical

    Identify and document the underlying constitutional condition causing bilateral weak foot

    DC 5277 rates the underlying condition with a 10% minimum. Review your medical records to identify what your providers have linked to the weak foot: diabetes, peripheral neuropathy, peripheral arterial disease, rheumatoid arthritis, multiple sclerosis, or other systemic conditions. Prepare to clearly communicate this to the examiner. Gather all relevant records documenting the underlying diagnosis.

    before exam

  • critical

    Gather all relevant medical records for the past 12-24 months

    Collect treatment records, podiatry notes, neurology or vascular surgery consultations, EMG/nerve conduction studies, X-rays, MRI reports, ABI vascular testing, and any records documenting foot atrophy, weakness, or circulatory changes. Organize by date and bring copies to the exam.

    before exam

  • critical

    Write a detailed symptom journal covering worst-day, average-day, and flare-up experiences

    Document: how far you can walk before pain or weakness forces you to stop (by distance and time), how long you can stand, frequency and duration of flare-ups, what triggers flare-ups, how long recovery takes, activities you have stopped or modified, falls or near-falls in the past year, and impact on work or daily living. Be specific and use concrete examples.

    before exam

  • recommended

    List all medications taken for foot conditions and the underlying cause

    Include prescription and over-the-counter medications, topical treatments, and supplements. Note which medications are for pain, circulation, neuropathy, or the underlying constitutional condition. Bring the actual medications or an up-to-date medication list.

    before exam

  • recommended

    Document and photograph any visible foot changes

    If you have visible muscle atrophy, skin changes from circulatory disturbance (shiny skin, hair loss, color changes), deformities, callosities, or wounds, photograph both feet before the exam. This documentation can be submitted with your claim to support objective findings.

    before exam

  • recommended

    Verify your state's exam recording rights

    Most states permit veterans to record their C&P examination. Check your state's laws and notify the examiner at the start of the appointment if you intend to record. Recording provides an objective record of what was and was not discussed during the exam.

    before exam

  • recommended

    Review the bilateral factor and how DC 5277 interacts with the underlying condition's rating

    Understand that DC 5277 provides a minimum 10% rating but that your actual rating will also include the underlying condition rated separately. Ask your VSO or accredited claims agent how the bilateral factor (38 CFR 4.26) applies to your specific combination of diagnoses.

    before exam

  • critical

    Wear daily-use footwear and bring all assistive devices

    Wear the shoes you normally wear - not dress shoes or athletic shoes you use only occasionally. Bring orthotics/insoles, ankle braces, arch supports, built-up shoes, cane, walker, or wheelchair if you use them. These items are documented on the DBQ and demonstrate your actual level of function.

    day of

  • recommended

    Dress for easy foot and lower extremity access

    Wear loose-fitting pants, athletic pants, or shorts that can be easily rolled up above the knee. Wear socks that are easy to remove. You will need to expose both feet and ankles for examination.

    day of

  • critical

    Do not take extra pain medication before the exam unless it is your normal regimen

    Do not take additional doses to manage pain for the exam. The examiner needs to see your actual functional state. If you routinely take pain medication, take your normal dose as prescribed - do not skip doses, as that would make you appear worse than usual and is not an accurate representation of your daily managed condition.

    day of

  • recommended

    Bring your written symptom notes to reference during the interview

    You may bring written notes and refer to them during the exam. This ensures you do not forget key symptoms, worst-day experiences, or flare-up information under the stress of the examination setting.

    day of

  • recommended

    Arrive with enough time to rest - do not over-exert before the exam

    Do not walk long distances to reach the exam. If arriving by vehicle, park as close as possible. Arriving fatigued or with already-exacerbated foot pain from a long walk to the clinic may affect your presentation but should be noted to the examiner if it occurs: 'I had to walk [X] distance to reach this room and my feet are already more painful than my baseline.'

    day of

  • critical

    State clearly at the beginning whether today represents a typical, better-than-typical, or worse-than-typical day

    Tell the examiner: 'Today is [better/typical/worse] than average for me. On my worst days, which occur [X] times per week or month, my symptoms are [describe specifically].' This ensures worst-day presentation is documented even when the exam happens to fall on a better day.

    during exam

  • critical

    Vocalize pain immediately and precisely during all range of motion testing

    The moment you feel pain during ROM testing, say: 'I feel pain here at [location] at this point in the motion. I would rate this pain [X]/10.' Do not silently push through pain. The examiner cannot document pain they do not know about.

    during exam

  • critical

    Proactively describe all DeLuca factors if not asked

    If the examiner does not ask about flare-ups, fatigue with use, or functional loss with repeated activity, volunteer this information: 'I want to make sure you know about my flare-ups - they happen [X] times per week and during them my function drops to [describe].' DeLuca requires this to be documented even if it cannot be directly observed.

    during exam

  • critical

    Report both the weakness component and the circulatory component separately

    DC 5277 has three defined components. Address each: (1) 'Here is how my weakness manifests in daily function'; (2) 'Here are my circulatory symptoms'; (3) 'Here is the observable atrophy.' Ensure all three are communicated.

    during exam

  • recommended

    Walk naturally when gait is observed - do not compensate

    Walk as you normally walk, using any assistive devices you normally use. Do not try to walk 'better' for the examiner. An accurate gait observation that reflects your true disability is in your interest.

    during exam

  • recommended

    Request Correia-compliant testing if not performed

    Per Correia v. McDonald, testing must include both active and passive ROM and both weight-bearing and non-weight-bearing positions for all involved joints. If the examiner tests only seated (non-weight-bearing) motion, you may politely note: 'I believe the guidelines require testing in both weight-bearing and non-weight-bearing positions - would you be able to test me standing as well?'

    during exam

  • critical

    Confirm both feet are fully documented

    Since DC 5277 is a bilateral code, ensure the examiner examines and documents findings for both feet independently. If the examiner only focuses on one foot, remind them: 'Both feet are affected and should be documented - here are the symptoms in my [left/right] foot specifically.'

    during exam

  • critical

    Write detailed notes about the exam immediately afterward

    Record what questions were asked, what physical tests were performed, what you reported, what the examiner appeared to document, and anything that was not addressed. Note whether both feet were examined, whether weight-bearing testing was performed, and whether flare-ups were discussed. These notes are essential if the exam report is later found to be inadequate.

    after exam

  • critical

    Request a copy of the completed DBQ and exam report

    Once the exam report is completed, you can request a copy through your claims file (VA Form 3288 or through VA.gov). Review it for accuracy: confirm both feet are documented, DeLuca factors are addressed, Correia ROM testing is reflected, and the underlying condition is identified. If findings are missing or inaccurate, bring this to your VSO's attention immediately.

    after exam

  • recommended

    Contact your VSO if the exam appears inadequate

    If the exam report omits required elements (bilateral documentation, DeLuca flare-up discussion, Correia weight-bearing vs. non-weight-bearing testing, underlying condition identification), your VSO can request a new or supplemental examination citing inadequacy under M21-1 and the relevant case law.

    after exam

  • recommended

    Submit a Buddy Statement or Personal Statement if important symptoms were not captured

    If you leave the exam feeling that key symptoms, functional losses, or worst-day experiences were not adequately addressed, submit a personal statement (VA Form 21-4138) or lay evidence describing what the exam did not capture. Ask a family member or caregiver who observes your daily limitations to submit a buddy statement.

    after exam

Your rights during a C&P exam

  • You have the right to have a representative (VSO, accredited claims agent, or attorney) assist you throughout the claims process and exam preparation.
  • You have the right to request the exam be recorded in most states - notify the examiner at the start of the appointment.
  • You have the right to a thorough and adequate examination - if the exam does not address required elements (bilateral assessment, DeLuca factors, Correia ROM testing), you may request a new exam.
  • You have the right to review your claims file (C-file) including the completed DBQ and exam report by requesting your records through VA.gov or VA Form 3288.
  • You have the right to submit additional evidence at any time, including personal statements, buddy statements, private medical opinions, and lay evidence describing your symptoms.
  • You have the right to the benefit of the doubt - when evidence is in approximate balance, VA must resolve the question in your favor (38 CFR 3.102).
  • You have the right to a rating based on the full range of your disability including worst-day presentations, flare-ups, and functional loss per DeLuca v. Brown guidance.
  • You have the right to have your ROM tested per Correia v. McDonald requirements - both active and passive motion, and both weight-bearing and non-weight-bearing positions.
  • You have the right to request a higher-level review or file a supplemental claim if you disagree with the rating assigned following this examination.
  • You have the right to receive an examination by a qualified examiner - if you have concerns about the examiner's qualifications or conduct, you may raise this with your VSO.
  • You have the right to a VA examination at no cost to you as part of your disability compensation claim process.
  • You have the right to have the bilateral factor applied per 38 CFR 4.26 when bilateral conditions are rated.

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.