Transcription
Your first steps in the morning feel like you're walking on broken glass. You swing your legs out of bed. Your feet hit the floor and that stabbing pain shoots through your heel like someone's jamming a knife into the bottom of your foot. After a few minutes of walking, it starts to loosen up. You think, "Okay, I'm fine." But then you sit down for an hour. You stand back up and that pain is back. That same stabbing pain every single time. That, my friend, is plantar fasciitis. And if you've been living with it, you already know exactly what I'm talking about.
Here's what the VA won't tell you. Your military service probably caused it. Years of ruck marching, running on hard surfaces, standing in formations, wearing boots that were never designed for your feet. But here's the part that could be worth money in your pocket right now. If you're already rated for flat feet, plantar fasciitis can be a separate rating. Different condition, different symptoms, different compensation. Most veterans don't know this. They think flat feet and plantar fasciitis are the same thing, but they are not. The VA can rate them separately if you file for it and clearly articulate the difference in symptoms. And flat feet isn't the only connection. Plantar fasciitis can be secondary to knee conditions, hip conditions, back conditions, literally anything that changes the way you walk. And today I'm going to show you exactly what plantar fasciitis is, how to know if you have it, every way it connects to military service, and how to file for the rating most veterans are missing.
I am Dr. Marshall Bar, an actual doctor, an army ranger, a former CMP examiner, and I have seen too many veterans limping through life without the rating they deserve. So, let's get on top of that and fix it.
So, let's start with what plantar fasciitis actually is because understanding it first helps you describe it to the VA. So, on the bottom of your foot, there is a thick band of tissue that runs from your heel to your toes. It's called the plantar fascia. Think of it like a bow string that supports the arch of your foot. When that tissue gets irritated, inflamed or develops tiny tears, that's plantar fasciitis. That "itis," that word "itis" is just meaning inflammation.
Here's why it hurts so much in the morning. When you sleep, your foot relaxes. That inflamed tissue tightens up overnight. Then you put weight on it first thing in the morning before it's had a chance to stretch out and it feels like someone is stabbing your heel. So here's the classic symptom. Stabbing heel pain with your first steps in the morning. This is the signature symptom. If you have this, you probably have plantar fasciitis. If you have pain after sitting for a while, say you sit at your desk for an hour, stand up, and that first step hurts, that's probably plantar fasciitis. If you have pain after, not during, but pain after exercise, your heel might feel okay while you're walking, but then flare up afterward. If you have pain on the bottom of your heel, not the back of your heel, but the bottom, right where you put the weight. Pain that gets worse over time. Plantar fasciitis usually doesn't go away on its own. It tends to get worse if you don't address it. So, if you're nodding your head right now, if you're thinking that's exactly what is happening to me, you probably have plantar fasciitis. And here is the thing. This condition is extremely common in veterans. All those years of abuse on your feet that they took, this is one of the results. So, let me show you exactly how military service causes this.
So, quick thing here. If your first steps in the morning are killing you and you've never connected to your service, I want you to hit subscribe because I will show you how to claim the conditions nobody tells you about.
So, let's talk about how military service absolutely can destroy your feet. So, there are two ways to connect plantar fasciitis to your service. Either direct service connection and secondary service connection. So, let's start with direct.
So, cause number one for direct cause would be repetitive impact on hard surfaces. Running, rucking, marching, PT 5 days a week on concrete and asphalt, field exercises, deployments. Every time your foot hits the ground, it sends force through that plantar fascia. Do it enough times, thousands and thousands of times over years of service, and that tissue starts to break down. Think about it. A four-year enlistment running three miles three times a week. That's over 600 runs. Add in ruck marches, formations, field problems, deployments. Your feet absorbed literally millions of impacts and military boots. They weren't necessarily designed to cushion any of them.
Cause number two is carrying heavy loads. The plantar fascia supports your arch. When you add weight like a ruck, a weapon, body armor, you're putting more stress on that tissue. A 12-mile ruck march with 75 lbs on your back puts massive strain on your feet. Do that repeatedly over a career, your plantar fascia pays the price.
Cause number three, military boots. Military boots are designed for durability and protection, not foot health. They often have minimal arch support, poor cushioning, and rigid construction. Wearing those boots 12 plus hours a day, every day for years, that is a recipe for plantar fasciitis.
Cause number four is standing for extended periods of time. Guard duty, formations, waiting, standing post for hours on end. Prolonged standing fatigues the muscles that support your arch. When those muscles get tired, more stress transfers to the plantar fascia.
Now, certain MOS's and jobs are at higher risk. Things like infantry 11 Bravo, 0311s, you do running, rucking, marching constantly. If you were airborne status, jump-qualified personnel, hard landings and PLFs, they cause impact stress. If you were a combat engineer, you've got heavy loads, physical labor, foot-intensive work. Military police, you're standing, patrolling on your feet constantly. Literally any combat arms job, the physical demands destroy your feet. But honestly, almost any military job involves enough running, standing, and marching to cause this condition. So, if you served, your feet likely took some form of abuse.
Now, let's transition and now talk about secondary service connection because this is where most veterans are leaving money on the table. So, the big one is secondary to flat feet. This is huge. If you're already service-connected for flat feet, pes planus, listen carefully. Flat feet cause your arch to collapse. When your arch collapses, it puts extra strain on your plantar fascia. Over time, that strain causes plantar fasciitis. Flat feet causes plantar fasciitis. Medical literature supports this. It is a well-established connection.
So, here's what most veterans don't realize. Flat feet and plantar fasciitis can be rated separately, not necessarily getting lumped together for pyramiding. Flat feet is rated under diagnostic code 5276 and plantar fasciitis can be rated under a different code or as a foot injury. The symptoms are different. Flat feet symptoms you get arch pain, pain on prolonged standing, swelling in your feet. On the other hand, plantar fasciitis symptoms is heel pain, especially with first steps, and you had a stabbing quality pain.
Now, let's talk about pyramiding for a second because it is an important legal principle. So, pyramiding is rating the same symptoms twice. It is not allowed, but rating different symptoms from different conditions that is allowed and that's encouraged. If you have flat feet and you also have that stabbing heel pain in the morning, file for plantar fasciitis as secondary to your flat feet. You could get a separate rating.
But flat feet isn't the only connection. Plantar fasciitis can be secondary to any condition that changes the way you walk. When you have a knee injury, a hip injury, a back injury, or even an ankle injury, you will change the way you walk. You will compensate. You put weight differently on the way you walk. You limp. And that altered gait, the way you walk, puts abnormal stress on your feet. And over time, it can cause plantar fasciitis.
Conditions that can cause secondary plantar fasciitis are things like knee conditions like meniscus tears, arthritis, instabilities. You favor one leg and the other foot takes more stress. From hip conditions, from arthritis, bursitis, limited range of motion, you change your gait and your feet compensate. From back conditions because lumbar problems affect your posture and gait. Your feet absorb the impact of altered walking mechanics. From ankle conditions like sprains, arthritis, instability, direct connection to how your foot functions. From Achilles tendinitis, it changes how you load your foot and stresses the plantar fasciitis. And obesity secondary to other conditions. Listen, extra weight from limited mobility plus more stress on plantar fascia. If you have a service-connected condition that affects how you walk and you have plantar fasciitis, there is a potential secondary connection for you.
Now, the evidence needed to establish secondary connection. You're going to need a current diagnosis of plantar fasciitis, just get it documented by a medical provider. An existing service-connected condition that affects your gait or adds stress to your feet. A nexus opinion or nexus letter stating that your plantar fasciitis is at least as likely as not caused by your service-connected condition. Now, that nexus opinion can be key to a lot of cases and at Extera Health, I and we write nexus letters that explain exactly how your primary condition led and caused your plantar fasciitis. The biomechanics, the medical literature, the logical connection.
Now, let's talk about how to actually file this claim. So, if you're filing as direct service connection, you're essentially arguing that the military service itself caused your plantar fasciitis. Things from running, rucking, boots, all of it. So, you need a current diagnosis. So, get plantar fasciitis documented in your medical records. You need evidence of an in-service cause like your MOS, your military job, your deployment history, physical demands of your job. You need personal statements that you can describe the activities that stress your feet. You're likely going to need a nexus opinion or letter, a medical statement connecting your current plantar fasciitis to your military service.
Now, for your personal statements, you need to make sure you describe the physical demands of your job like running, rucking, standing, whatever it may be. Specific events or activities that you believe damaged your feet, when you first noticed heel pain, and how the symptoms have progressed since your military service.
Now, option two, if you're filing a secondary service connection, you're literally arguing that your you have an already service-connected condition that is then causing your claim plantar fasciitis. So, you need a current diagnosis of plantar fasciitis. So, just get it in your records. You need existing and existing at least one service-connected condition that affects the way you walk, your gait, or adds foot stress. You're likely going to need a nexus opinion explaining how the primary service-connected condition caused the plantar fasciitis. And then you're going to need a very strong written personal statement that describes how your current service-connected condition caused your plantar fasciitis.
Now, let's transition and talk about the CMP exam. Because at your CMP exam, you need to be able to describe your symptoms clearly. Like, my worst symptom is the stabbing pain in my heel with my first steps in the morning. I also get heel pain after sitting for any length of time. Or the pain is on the bottom of my heel right where I put my weight. Or I've had to change how I walk because of my knee, my ankle, my back, and I believe that's what's caused my feet pain. If you're claiming secondary to flat feet, just make sure to distinguish the symptoms. So you would say, my flat feet cause arch pain and foot swelling, but the plantar fasciitis is different. It's that stabbing heel pain, especially in the morning. They are separate problems and feel completely different.
Now let's transition and quickly cover how plantar fasciitis gets rated. So, plantar fasciitis is usually rated under diagnostic code 5276 flat foot if rated with flat feet, and then it would get rated under diagnostic code 5284 if it's a foot injury or an other rating. So, under diagnostic code 5284, that moderate is going to be 10%, moderately severe is 20%, severe is 30%. The rating depends on how much the condition affects your ability to function, your pain levels, impact on walking, need for orthotics or assisted devices.
Now, at your CMP exam, you need to remember to describe your worst days. How far can you walk before the pain stops you? How long can you stand? What activities have you had to give up? And remember, if you have both flat feet and plantar fasciitis with different symptoms affecting different parts of your foot, argue for separate ratings.
Now, mistake time. I'm going to hit the common mistakes I see all the time. Mistake one is not claiming plantar fasciitis at all. If you have that stabbing morning heel pain, then claim it. Don't assume it's just part of getting older. It's a ratable condition.
Mistake two is not claiming it secondary to flat feet out of fear of pyramiding. If you're rated for flat feet and you have plantar fasciitis symptoms, file for plantar fasciitis as secondary. It can be a separate condition. Worst case scenario is they lump it together and say pyramiding, but you'll never know if you never try.
Mistake three, confusing pyramiding with separate ratings. Remember, pyramiding is using the same symptoms for two ratings. If your flat feet cause arch pain and your plantar fasciitis causes heel pain, those are two different symptoms and you can get rated for both separately.
Mistake number four, not describing symptoms correctly at your CMP exam. You need to be specific, like stabbing heel pain with first steps in the morning, not just "my feet hurt." The examiner needs to document the classic plantar fasciitis symptoms.
Now, if you have plantar fasciitis and you're not sure how to connect it to your service, or you're already rated for flat feet and you want to know if you can get a separate rating, that is exactly what I do and we help with every day at Extera Health. We offer Nexus letters where we write medical opinions connecting your plantar fasciitis to your military service or to your existing service-connected conditions. We explain the biomechanics, we cite the literature, and we make the connection clear. We also offer claims roadmap services where we review your current ratings and identify secondary conditions you might be missing. Plantar fasciitis is one of the most commonly missed conditions. We also offer CMP exam prep where we teach you exactly how to describe your foot symptoms so you get rated correctly. If you're interested in any of these, the link for these options are in the description below. We'll look at your case and give you honest guidance.
Now look, your feet carried you through some of the hardest things you've ever done. Ruck marches, deployments, years of abuse and boots that were really never designed for comfort. And now your feet hurt. Every morning when you get out of bed, you're reminded of what your service cost you. That is not just aging. That's not just part of life. That's a service-connected condition that deserves compensation. If you're already rated for flat feet, claim plantar fasciitis separately. Different condition, different symptoms, potentially different rating. If you have any condition that affects the way you walk, claim plantar fasciitis as a secondary. Don't leave this rating on the table. Your feet took the abuse. Now, make sure the VA knows about it. The VA isn't going to look at your file and say, "Hey, hey, hey, you've got flat feet. We should check if you also have plantar fasciitis." That's your job. That's on you. And now you know how to.
Now, speaking of ratings you might have missed, what if an old VA decision from years ago was wrong all these years? There's something called clear and unmistakable error, CUE, that lets you go back in time and challenge decisions from even decades earlier. No time limit on it. If you win, you get back pay for every month since the original decision. We're talking potentially hundreds of thousands of dollars. So, watch my complete guide to CUE claims. The video link description is in the description below.
Now look, I am Dr. Marshall Bar, an Army Ranger, a special operations combat medic, an actual doctor, and a former CMP examiner. If your first steps in the morning feel like broken glass, that is not normal. That is ratable. So go claim it. I'll see you in the next video. And until next time, stay mission.