Ankle

Most ankle claims come down to a single word, and that word isn't defined anywhere in the regulation. DC 5271 rates limited motion of the ankle as either "moderate" at 10 percent or "marked" at 20 percent. The terms appear nowhere else with a definition. There's no degree threshold that separates moderate from marked, no goniometer cutoff written into the code. The examiner's adjective decides the rating, and that's the source of most of the inconsistency I see in ankle decisions.

That matters because the ankle is a low-ceiling joint. The whole limited-motion code tops out at 20 percent. The only way past that on a single ankle is ankylosis (the joint fused so it doesn't move at all) under DC 5270, which can reach 40 percent at a bad fusion angle, or specific bone-deformity codes. So the rating fight on a typical ankle claim is rarely about which of seven codes applies the way it is on the knee. It's about whether the limited motion you have gets called moderate or marked, and whether the examiner accounted for functional loss during flare-ups on top of the static measurement.

This page walks through the five ankle diagnostic codes under 38 CFR § 4.71a, the normal range of motion the examiner is measuring against, why moderate-versus-marked is the whole game on DC 5271, how DeLuca and Sharp v. Shulkin pull flare-up loss into the rating, the secondary chains that run through the ankle in both directions, and the bilateral factor when both ankles are rated.

TL;DR

• Ankle conditions are rated under 38 CFR § 4.71a across five diagnostic codes: 5270 (ankylosis of the ankle), 5271 (limited motion of the ankle), 5272 (ankylosis of subastragalar or tarsal joint), 5273 (malunion of os calcis or astragalus), 5274 (astragalectomy).
• DC 5271 is the workhorse code, and it has only two tiers: moderate limited motion at 10% and marked at 20%. Neither term is defined in the regulation, which is the single biggest source of inconsistency in ankle ratings.
• Normal ankle range of motion under § 4.71, Plate II, is dorsiflexion 0 to 20 degrees and plantar flexion 0 to 45 degrees. The examiner measures against those numbers.
• DC 5270 (ankylosis) is where the higher ratings live: 20%, 30%, or 40% depending on the angle the ankle is fused at. A fused ankle at a bad angle is the highest single-code ankle rating.
• DeLuca v. Brown and Sharp v. Shulkin require the C&P examiner to account for additional functional loss during flare-ups, not just the in-clinic measurement. § 4.59 requires painful motion to be considered in the rating.
• Secondary chains run both ways: an ankle can be secondary to a service-connected knee, hip, back, or flat feet through altered gait, and the ankle can in turn drive knee, hip, and back conditions.
• The bilateral factor under 38 CFR § 4.26 adds 10% to the combined value when both ankles are rated.
• In Claim Raven's analysis of 586 BVA ankle cases, 40.3% were remanded, 35.7% granted, and 24.1% denied. Of the 515 cases with a C&P adequacy determination, 70.3% had the exam flagged as inadequate. The dataset codes overall outcome rather than per-diagnostic-code breakdown, so I can't read the DC 5270 vs DC 5271 split directly from it.

The Five Diagnostic Codes and What Each One Pays

The ankle section of 38 CFR § 4.71a runs from DC 5270 to DC 5274. Unlike the knee, the ankle doesn't have a stack of motion codes that can layer on top of each other. There's one motion code, one whole-ankle ankylosis code, and three codes for fusion or deformity of specific bones and joints below the ankle.

DC 5270, Ankylosis of the ankle. The ankle joint is fused and doesn't move. The rating turns on the angle the joint is fused at.

In plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees or with abduction, adduction, inversion or eversion deformity, 40% In plantar flexion, between 30 and 40 degrees, or in dorsiflexion, between 0 and 10 degrees, 30% In plantar flexion, less than 30 degrees, 20%

The logic is that a worse fusion angle is more functionally disabling, so it rates higher. A foot frozen in a pronounced plantar-flexed or dorsiflexed position, or with a side-to-side deformity, is the 40 percent case. This is the only ankle code that clears 20 percent on a single ankle.

DC 5271, Limited motion of the ankle. Moderate 10%, Marked 20%. This is the code that applies to most ankle claims, and it has only those two tiers. There is no degree threshold attached to either word. "Moderate" and "marked" are the entire rating scale, and the regulation does not define them. That undefined line is where most ankle rating disputes happen.

DC 5272, Ankylosis of subastragalar or tarsal joint. Marked 20%, Moderate 10%. This covers fusion of the joints below the true ankle joint (the subtalar and midfoot joints) rather than the ankle mortise itself.

DC 5273, Malunion of os calcis or astragalus. Marked deformity 20%, Moderate deformity 10%. The os calcis is the heel bone (calcaneus) and the astragalus is the talus. A fracture that heals in a bad position (malunion) rates here.

DC 5274, Astragalectomy, 20%. Surgical removal of the talus. Single tier.

Two things stand out across these codes. First, four of the five tiers in DC 5271, 5272, and 5273 use the same undefined "moderate" and "marked" language, so the same interpretive problem runs through most of the ankle section. Second, only DC 5270 reaches above 20 percent, which means a single ankle that isn't fused is capped at 20 percent no matter how painful or limited it is. That ceiling shapes the whole strategy on an ankle claim.

Arthritis isn't rated under the ankle motion code directly. Degenerative arthritis falls under DC 5003, with the rating tied to limitation of motion of the affected joint or, if motion isn't compensable, to X-ray evidence (10% per major joint group up to 20%).

Moderate vs Marked: The Whole Game on DC 5271

The single biggest swing in an ankle rating, and where most of the inconsistency lives, is whether limited motion under DC 5271 gets called "moderate" (10%) or "marked" (20%). It's a doubling of the rating that hangs on one adjective.

Here's the problem. Normal ankle range of motion under 38 CFR § 4.71, Plate II, is dorsiflexion 0 to 20 degrees and plantar flexion 0 to 45 degrees. The C&P examiner measures your ankle against those numbers with a goniometer. But DC 5271 never says how many lost degrees turns moderate into marked. There's no line like "dorsiflexion limited to 10 degrees, moderate; limited to 5 degrees, marked." The examiner records the degrees, and then somebody has to translate those degrees into one of two words with no rule for doing it.

In practice the result is that two veterans with nearly identical measured motion can land on different ratings depending on who examined them and who rated the file. The Board has acknowledged this is a fact-specific judgment rather than a mechanical one. That cuts both ways. It means a strong record describing significant functional impairment can support "marked" even when the raw degrees look only somewhat reduced, and it means a thin record can get tagged "moderate" when the underlying impairment is worse than the number suggests.

The cases where veterans get to 20 percent on DC 5271 tend to share a feature. The record doesn't just report a degree number. It describes what the limited motion does to weight-bearing, gait, standing tolerance, and the ability to walk distances or work on the feet, plus pain on motion and the point in the arc where pain begins. A measurement alone gives the rater a number with no context for choosing the adjective. A measurement plus a functional narrative gives the rater a reason to call it marked.

This is also why § 4.59 matters more on the ankle than on a joint with a granular degree scale. Section 4.59 directs that painful motion be considered in the rating and that the painful joint be entitled to at least the minimum compensable rating for the joint. On an ankle where motion is painful but the raw degrees look mild, § 4.59 supports a compensable rating where a purely numeric read might not.

The C&P Exam Mechanics: What the Examiner Has to Measure

The ankle C&P exam follows the DBQ for ankle conditions. Range of motion has to be measured with a goniometer against the Plate II norms (dorsiflexion 0 to 20 degrees, plantar flexion 0 to 45 degrees). The examiner records:

• Initial dorsiflexion and plantar flexion (active and passive)
• Repetitive use testing (three repetitions, then re-measure)
• Pain on motion and where in the range pain begins
• Flare-up estimate with quantified functional loss if possible
• Functional limitations after repetition, including effect on weight-bearing and gait
• Stability and any history of recurrent giving-way or sprains
• Strength testing rated 0 to 5

On the ankle specifically, the exam carries an extra burden that a more granular joint doesn't. Because DC 5271 has no degree thresholds, the examiner's narrative is what lets the rater choose between moderate and marked. An exam that records "dorsiflexion to 10 degrees, plantar flexion to 30 degrees" and nothing else leaves the rater to pick an adjective with no functional context. An exam that adds how far the veteran can walk, how long they can stand, whether they use a brace or cane, and what pain does to the motion gives the rater the basis to call it marked.

That gap shows up hard in the data. Of the 515 ankle cases in the Claim Raven dataset with a C&P adequacy determination, 70.3 percent had the exam flagged as inadequate. That's a higher inadequacy share than I see on many other orthopedic joints, and it's consistent with the structure of the problem: an undefined two-word scale puts enormous weight on the exam narrative, and a sparse exam can't carry that weight. When the exam is missing repetition testing, a flare-up estimate, or any functional description, the Board has a ready reason to send the case back for a new one.

DeLuca, Sharp, and Functional Loss During Flare-Ups

The other piece of ankle rating that often gets short-changed is functional loss. The framework comes from DeLuca v. Brown (1995): range-of-motion ratings have to account for additional functional loss due to pain, weakness, fatigability, or incoordination, not just the static measurements from the C&P exam.

Sharp v. Shulkin (2017) tightened this. When a veteran reports flare-ups, the C&P examiner has to estimate the additional functional loss during a flare, or explain why an estimate isn't feasible. The examiner can't write "no flare-up observed today" and stop there.

On the ankle, this interacts with the moderate-versus-marked problem in a specific way. Measured motion on the day of the exam might look only somewhat reduced, which reads as "moderate." But the veteran reports that during flare-ups the ankle swells, gives way, and dorsiflexion drops to almost nothing, so that walking and standing become severely limited. Under DeLuca and Sharp, the rater is supposed to consider that flare-up presentation. A flare-up picture that shows marked functional loss can support the 20 percent tier even when the in-clinic degrees alone would have stopped at 10.

In practice this gets missed the same way it does on other joints. The DBQ asks about flare-ups, but the examiner's note may just say "patient reports occasional flare-ups" without quantifying them. The rater rates off the measured values, the functional-loss layer falls out, and the rating defaults to moderate.

The Board often catches this on appeal. A typical ankle remand reads like this:

"The Board finds the prior VA examination inadequate because the examiner failed to provide an estimate of the additional functional loss during flare-ups despite the Veteran's reports of such flare-ups. On remand, the examiner must address the flare-up question consistent with Sharp v. Shulkin."

When the second exam comes back with proper Sharp findings, the rating can move from moderate to marked. The evidence that supports a Sharp analysis comes from the veteran's own documentation: symptom journals tracking swelling and motion on bad days, logs of how often the ankle gives way in a month, photographs of swelling, brace and cane use, and statements from people who see the limitation.

Secondary Chains: The Ankle Runs Both Ways

The ankle sits in the middle of more secondary chains than most joints because it can be both the downstream victim of altered gait and the upstream cause of it. Under 38 CFR § 3.310, secondary service connection can be granted for a condition caused by a service-connected condition or aggravated by one (Allen v. Brown).

The ankle as a secondary condition

These are the chains where the ankle is the new claim, secondary to something already service-connected.

Knee, hip, or back to ankle. A service-connected knee, hip, or low back condition forces an altered gait or weight shift, and over years that abnormal mechanics stresses the ankle, producing instability, arthritis, or chronic pain. Recognized when a medical opinion connects the gait alteration to the ankle pathology and addresses the time course.

Flat feet to ankle. Service-connected pes planus (flat feet) changes the alignment and load path of the foot and ankle. Collapse of the arch can drive the heel and ankle into abnormal positions over time, contributing to ankle arthritis and instability. This is a well-recognized chain when the foot pathology is documented and the opinion explains the mechanical link.

The ankle as a primary that drives other conditions

The chain also runs upward. A bad service-connected ankle changes how you walk, and that altered gait stresses joints above it.

Ankle to knee, hip, and back. Limited or painful ankle motion produces a compensatory gait that loads the knee, hip, and lumbar spine on one or both sides. The same nexus standard applies: the opinion has to describe the mechanism, the time course, and rule out other causes.

The standard for nexus opinions on ankle chains

For any of these chains, in either direction, the same standard applies. The nexus opinion has to identify the mechanism, address the time course, and rule out other causes. A bare-bones "more likely than not" without rationale isn't probative. A factually accurate, fully articulated medical opinion based on sound reasoning carries the case. A generic one-liner doesn't.

Because a single ankle is capped at 20 percent unless it's fused, the secondary chain is often where the real combined-rating movement comes from. An ankle that drives a knee secondary and a back secondary can build a combined rating well beyond what the ankle itself could ever reach alone.

The Bilateral Factor When Both Ankles Are Rated

If both ankles are service-connected, the bilateral factor under 38 CFR § 4.26 applies. The regulation:

"When a partial disability results from disease or injury of both arms, or of both legs, or of paired skeletal muscles, the ratings for the disabilities of the right and left sides will be combined as usual, and ten percent of this value will be added (i.e., not combined) before proceeding with further combinations."

The mechanics: combine the right ankle rating with the left ankle rating using the regular combined-ratings table under § 4.25. Then add 10 percent of that combined value arithmetically. Then the adjusted value enters the overall combined rating with everything else.

Example. A veteran with 10 percent in each ankle. Combining 10 and 10 gives 19. Add 10 percent of 19 (1.9) for a bilateral-adjusted value of about 21 before further combinations. The addition runs once on the combined value, not on each individual rating.

The bilateral factor is small in isolation, but it matters most near rounding thresholds, where a few points decide which 10-point band the total rating lands in. The factor applies any time both ankles are service-connected, even with different ratings on each side. It also applies when the ankle pairs with other lower-extremity disabilities such as bilateral knee, hip, or foot conditions, since those are all disabilities of the legs.

Common Evidence Gaps in Ankle Claims

A few patterns I've noticed across BVA decisions involving ankle conditions.

The exam gives a number but no narrative. This is the central ankle gap. Because DC 5271 has no degree thresholds, a measurement alone doesn't tell the rater whether the motion is moderate or marked. An exam that records dorsiflexion and plantar flexion degrees but says nothing about weight-bearing, gait, standing tolerance, or walking distance leaves the moderate-versus-marked call unsupported, and the default tends to be moderate.

No flare-up estimate. The C&P exam captures one day. Sharp requires the examiner to estimate functional loss during flare-ups, but without the veteran's own documentation the examiner has little factual basis. Swelling photos, giving-way logs, work-absence records, and brace or cane use expand the record beyond the snapshot of the exam, and they're often what pushes a rating from moderate to marked.

Imaging stops at X-ray. X-rays show bone, not soft tissue. A veteran with significant ligamentous instability or recurrent sprains may have a clean X-ray and a real impairment that the rating analysis never picks up. Without an MRI or a documented stability assessment, those soft-tissue findings don't make it into the file.

No documentation of recurrent instability or giving-way. Chronic ankle instability after repeated sprains is a common service-related pattern, but if the record only says "reports occasional rolling of the ankle" without stress testing or a sprain history, the functional impairment is hard to credit and the rating stays low.

Effective date documentation gaps. A veteran whose ankle was injured in service (a fall, a jump, a parachute landing, a training sprain) may have spotty service treatment records covering the period. Without that documentation, the effective date can default to the date of claim filing rather than the date of separation, costing potentially years of back pay. Buddy statements from fellow service members can fill some of the gap.

I don't know exactly what percentage of ankle claims have one or more of these gaps. What I can say from Claim Raven's analysis of 586 BVA ankle cases is that, of the 515 cases with a C&P adequacy determination, 70.3 percent had the examination flagged as inadequate, and remands ran at 40.3 percent, the largest share of any outcome in the ankle subset. That pattern is consistent with the evidence-gap dynamics in this post: with an undefined two-word rating scale putting heavy weight on the exam narrative, a sparse exam gives the Board a ready reason to send the case back for more development rather than grant or deny it outright. The cases that succeed at the Board on increased-rating claims tend to have a far more developed record than the cases that originate at the RO level with minimal documentation.

What to Push For on a DC 5271 Claim

The ankle rating fight is narrower than the knee but just as winnable. Because the single-ankle motion code tops out at 20 percent, the goal on most claims is getting moderate moved to marked, and making sure the functional-loss and § 4.59 painful-motion analysis is in the file.

The way to do that is to make the record about function, not just degrees. The C&P exam should record dorsiflexion and plantar flexion against the Plate II norms with a goniometer, repetitive-use measurements, the point in the arc where pain begins, and a quantified flare-up estimate under Sharp. It should also describe what the limited motion does to weight-bearing, standing tolerance, walking distance, and gait, plus any brace, cane, or assistive-device use and any history of recurrent instability. That functional narrative is what gives the rater a basis to call the motion marked.

When a decision calls your motion "moderate" with no engagement with pain, flare-ups, or functional loss, that's the opening. Cite § 4.59 and DeLuca/Sharp, attach the functional documentation, and file the next step. An evidence checklist for ankle claims should separate the bare degree measurement from the functional impact, because the second one is what moves the rating.

Use C&P exam prep for the ankle DBQ and track ankle swelling, giving-way, and bad days before the exam. A flare log with dates, swelling photos, falls, brace and cane use, missed work, and reduced motion on bad days gives the examiner the facts to record, and gives the rater the context to choose the higher tier.

Bottom Line

Ankle ratings at the VA are simpler than the knee in structure but harder in the place that matters. There's one motion code, DC 5271, that caps a single non-fused ankle at 20 percent, and it rates on two undefined words, moderate and marked, with no degree threshold separating them. That makes the examiner's narrative the whole game. The cases that get to marked tend to have an exam that describes function, weight-bearing, gait, and flare-ups, not just a degree number, plus the veteran's own documentation of swelling, giving-way, and bad days. The higher ratings live in DC 5270 ankylosis, where a fused ankle at a bad angle reaches 40 percent, and the real combined-rating movement usually comes through the secondary chains the ankle opens up into the knee, hip, and back. Same condition, different paper trail, different outcome.

Related Conditions

Ankle claims commonly connect to knee, flat feet, and back pages, because altered gait runs the secondary chain in both directions and the same proof issues repeat across orthopedic claims. The ankle also shares rating logic with other limited-motion joints like shoulder, wrist, and elbow, where the C&P exam has to document function and not just a degree measurement. Veterans with both ankles involved should review the secondary conditions tool and the bilateral-factor math before assuming a single ankle rating tells the whole story.

Methodology and Limitations

• Data source: Rating criteria quoted from 38 CFR § 4.71a, DCs 5270 through 5274. Normal range of motion from § 4.71, Plate II (dorsiflexion 0 to 20 degrees, plantar flexion 0 to 45 degrees). Painful motion from § 4.59. Bilateral factor from § 4.26. Combined ratings math from § 4.25. Secondary service connection from § 3.310. Case law from DeLuca v. Brown and Sharp v. Shulkin.
• Sample size: Patterns in this post are drawn from Claim Raven's analysis of 101,518 condition records drawn from the analyzed subset of Claim Raven's 501,000+ Board-decision library, including 586 ankle cases. Within that ankle subset, outcomes ran 40.3% remanded, 35.7% granted, and 24.1% denied. Of the 515 cases that had a C&P adequacy determination, 70.3% involved an examination flagged as inadequate. The dataset captures overall outcome rather than per-diagnostic-code (DC 5270-5274) breakdown.
• Classification approach: Diagnostic code definitions drawn from the regulatory text. The moderate-versus-marked analysis reflects that DC 5271 leaves both terms undefined. Compensation math uses the VA combined ratings table and 2026 rate tables.
• Limitations:
• Compensation figures are based on 2026 VA disability rates. They adjust annually with COLA.
• "Moderate" and "marked" under DC 5271 are not defined in the regulation. Application is a fact-specific judgment that varies between examiners and raters, which is the central source of inconsistency in ankle ratings.
• Worked examples use approximate rating values to illustrate the math.
• Selection bias: BVA-level patterns reflect cases that appealed. Most ankle claims resolve at the RO level and aren't in any BVA dataset.
• Application of the Sharp v. Shulkin framework at the RO level is uneven.
• These observations reflect patterns from the regulatory text, case law, and BVA decisions. They are not predictions of individual outcomes.