Inside the exam room
1. You will be asked about injury, treatment, walking aids, and whether your ankle gives way. Explain trouble walking, standing, or using uneven ground.
2. You will be asked to pull your foot toward your shin and point it downward. Both directions are measured. Tell the examiner when pain starts and where movement stops. They may also move your foot when safe.
3. You may be asked to repeat the movements if safe. Explain what changes after walking or on worse days, how long recovery takes, and whether prescribed support helps.
The examiner measures joint movement with a goniometer (angle-measuring tool).
How VA rates ankle condition
The examiner measures how far your foot moves up toward your shin and down away from it. DC 5271 uses either direction; do not add the two percentages. Pain or giving way alone does not decide this percentage. A joint stuck in one position and other foot problems need separate checks. Source: 38 CFR 4.71a (2025 edition) .
Ankle reference: moving the foot up toward the shin (dorsiflexion) 0-20 degrees and pointing the foot down (plantar flexion) 0-45 degrees, measured from neutral. Neutral means the foot is at a right angle to the lower leg.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| 10% | Moderate limitation: less than 15 degrees moving the foot up toward the shin (dorsiflexion) or less than 30 degrees pointing the foot down (plantar flexion) (DC 5271). |
| 20% | Marked limitation: less than 5 degrees moving the foot up toward the shin (dorsiflexion) or less than 10 degrees pointing the foot down (plantar flexion). The thresholds are strict less-than comparisons. |
Check these details in your records
The examiner uses a condition form called a Disability Benefits Questionnaire (DBQ). Compare these items with your own records and explain what actually happens in daily life.
- A clinician's records show moving the foot up toward the shin (dorsiflexion) less than 15 degrees or pointing the foot down (plantar flexion) less than 30 degrees (moderate DC 5271 rule)10%
- A clinician's records show moving the foot up toward the shin (dorsiflexion) less than 5 degrees or pointing the foot down (plantar flexion) less than 10 degrees (marked DC 5271 rule)20%
What may happen in the exam room
- The examiner may ask you to move the joint, then move it for you. They may check it with and without weight on it when safe. Follow their directions and tell them when something hurts.
- The examiner checks strength, pain, and what changes after doing the movement several times. One result alone does not decide the diagnosis.
What the measurements tell you
- At exactly 5 degrees upward or 10 degrees downward, that movement does not meet the marked rule. That rule says less than those angles, not equal to them.
- A foot held level does not prove the ankle is stuck there. Do not add the upward and downward movement percentages.
Questions the examiner may cover
- How do symptoms affect walking, standing, uneven ground, or stairs?
- Describe repeated-use changes, flare-ups, and any support such as a brace prescribed by your provider.
Questions to expect
How far does the foot move up or down, especially after use?
Explain: Describe stairs, uneven ground, pain onset, movement limits and flare frequency and duration. The examiner measures upward and downward angles.
Rating connection: DC 5271 uses strict less-than thresholds in its rating criteria. Either direction can meet the rule; the percentages are not added.
Does it give way, or is the joint fixed?
Explain: Identify falls, prescribed support, surgery and recorded fixation, rather than guessing a diagnosis.
Rating connection: A fixed ankle is evaluated under ankylosis rules, not the ordinary limited-motion table.
Your answer outline
My [side] ankle feels [actual symptom] during [activity or surface]. After about [distance or time], I [change in activity]. This occurs [frequency]. [Rest, treatment, or prescribed support] has [actual effect].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Describe your actual limitations and their frequency. Avoid choosing a percentage based only on pain intensity.
Common mistakes to avoid
- Describe a usual day and a worse day, including how often symptoms get worse and how long that lasts. Do not make your symptoms sound better or worse than they are.
- Keep taking medicines as prescribed unless your health care provider tells you otherwise. If a movement hurts or feels unsafe, tell the examiner and follow their directions.
Records to get ready before the exam
- Your treatment records, movement measurements already recorded by a health care provider, and medicine list.
- Notes about daily tasks, what changes after repeating them, and worse periods. Send personal records through VA’s official channels.
Preparation notes
- Use the picture to understand the measurement. At the exam, follow the examiner’s directions and do not force unsafe movement.
- Explain where pain starts, where movement stops, and what changes after repeated activity or during worse periods.
- VA reviews your whole record, including whether the condition is linked to service. The highest box you check here does not decide your rating.
Pain, repeated use, and worse periods
Tell the examiner where pain begins and how far you can move. Those may be different points. Pain alone does not set a percentage. Explain what becomes harder after repeating an activity or during worse periods (flare-ups). The examiner uses your records and description to estimate those changes, and explains if there is not enough information to do so.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
Bring records of changes in how you walk or the ankle giving way. A provider must explain any link to a diagnosed knee or hip problem.
Tell your provider about a long-lasting limp. A back diagnosis and an explanation of how the limp affected your back are still needed.
Bring records of the foot diagnosis and changes in how you put weight on the foot. Ask your provider about the connection.
Using the other leg more does not prove it caused a problem. Bring records over time and ask your provider to explain the connection.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.