Bunions (Hallux Valgus)

Bunions, rated by VA as hallux valgus, are one of the more disappointing conditions to claim if you go in expecting a rating that matches the pain. The diagnostic code that covers them, DC 5280 under 38 CFR § 4.71a, has a single 10 percent maximum per foot. There is no higher tier. Not for a severe deformity, not for a failed surgery, not for daily pain that limits how far you can walk. Ten percent is the ceiling under that code, and it is the single most important fact to understand before you file.

That cap is why so many bunion claims end in disappointment, and why the denial numbers run high. In Claim Raven's analysis of BVA decisions involving bunions, the largest share of cases were denied outright. A claim that asks the Board to award more than 10 percent under DC 5280, or to find a bunion service-connected on thin evidence, runs into a wall built into the regulation itself. The interesting part of a bunion claim is almost never the bunion. It is everything the bunion sets in motion: the altered gait, the collapsing arch, the stressed knee, the aching low back, and the surgical scar that can carry its own rating.

This page walks through DC 5280 and its 10 percent cap, the bilateral math when both feet are involved, the codes that pick up broader foot impairment (DC 5284 for foot injuries, DC 5276 for associated pes planus), separate scar ratings under 38 CFR § 4.118, the pyramiding rule that stops you from rating the same impairment twice, and the secondary chains under 38 CFR § 3.310 where the real rating value usually sits.

TL;DR

• Bunions are rated by VA as hallux valgus under 38 CFR § 4.71a, DC 5280, with a single 10 percent maximum per foot. There is no higher tier under this code.
• The 10 percent applies if the bunion is operated with resection of the metatarsal head, OR if it is severe and equivalent to amputation of the great toe. Both criteria pay the same 10 percent.
• Bilateral bunions can each get up to 10 percent per foot, combined with the bilateral factor under § 4.26.
• Where the foot impairment is broader than the bunion itself, DC 5284 (foot injuries, other) may apply: moderate 10 percent, moderately severe 20 percent, severe 30 percent. Associated pes planus rates under DC 5276.
• A surgical scar can pick up a separate rating under § 4.118, including DC 7804 for painful scars. That does not pyramid with the bunion rating because the scar and the joint are different impairments.
• The real rating value in most bunion claims is the secondary chain: bunions both cause and are caused by altered gait and pes planus, and the value usually sits in the secondary foot, ankle, knee, and back conditions rather than DC 5280 itself.
• In Claim Raven's analysis of 513 BVA bunion cases, 60.4% were denied, 20.9% were remanded, and 18.7% were granted. Of 390 cases with a C&P adequacy determination, 41.8% had the exam flagged as inadequate. The dataset codes overall outcome rather than a per-code breakdown, so I can't read the DC 5280 versus DC 5284 split directly from it.

DC 5280 and the 10 Percent Cap

The whole story of a standalone bunion claim is DC 5280, and the whole story of DC 5280 is the cap. The regulation is short:

Hallux valgus, unilateral: Operated with resection of metatarsal head, 10% Severe, if equivalent to amputation of great toe, 10%

That is the entire code. Two ways to qualify, one rating. If you had bunion surgery that removed the metatarsal head, that is 10 percent. If your bunion is severe enough that the disability is equivalent to having the great toe amputated, that is also 10 percent. There is no 20 percent, no 30 percent, no escalation for bilateral severity within this code. A foot can carry exactly 10 percent under DC 5280 and not a point more.

This is where expectations and regulation collide. A veteran with painful, deformed bunions on both feet, who has had surgery on one and faces surgery on the other, who cannot wear normal shoes and cannot stand a full shift, often expects something in the 30 to 50 percent range. Under DC 5280 alone, the most that picture supports is 10 percent per foot. The pain is real and the limitation is real, but the code does not scale with severity past that threshold.

The practical consequence: if your claim lives entirely inside DC 5280, you are fighting over 10 percent per foot and nothing else. That is a low ceiling for the effort a claim takes. The reason to file is rarely the bunion rating in isolation. It is to establish service connection for a foot condition that opens the door to broader foot codes, scar ratings, and the secondary chain.

When the Foot Impairment Is Broader: DC 5284 and DC 5276

If your foot disability is more than the bunion, the rating may not belong under DC 5280 at all. DC 5284 covers other foot injuries on a scaling tier:

Foot injuries, other: Severe, 30% Moderately severe, 20% Moderate, 10%

DC 5284 is the code that actually scales. A foot disability that is moderate rates 10 percent, moderately severe rates 20 percent, and severe rates 30 percent. This matters because a bunion that has progressed into a broader forefoot deformity, with multiple toe involvement, chronic pain, and functional loss across the whole foot, may be more accurately captured under DC 5284 than under the single-tier DC 5280. The Board has used DC 5284 by analogy for foot conditions that do not fit neatly into the named codes, and the higher tiers are only available there, not under DC 5280.

The other broad-foot code that often appears alongside bunions is DC 5276, acquired flatfoot (pes planus). Bunions and pes planus travel together. The collapse of the arch changes the load across the forefoot, and the altered mechanics of a bunion can accelerate arch collapse. When both are present and service-connected, the pes planus rates under DC 5276 on its own tiers, which run higher than DC 5280 and reach 30 percent for severe bilateral and 50 percent for pronounced bilateral. The flat feet page walks through DC 5276 in detail.

The catch is pyramiding, covered below. You cannot rate the same impairment twice. If the pain and limitation are attributed entirely to the bunion under DC 5280 and then again under DC 5284 for the same anatomical problem, the VA will collapse it to one rating. The codes coexist only when they capture genuinely different impairments.

The Bilateral Factor When Both Feet Are Involved

Bunions are frequently bilateral, and that brings in the bilateral factor under 38 CFR § 4.26. 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."

For two feet each rated 10 percent under DC 5280, the mechanics work like this. Combine 10 and 10 under the combined ratings table at 38 CFR § 4.25: 10 combined with 10 comes to 19. Then add 10 percent of that combined value, which is about 1.9, for a bilateral-adjusted value of roughly 21. That value then enters the overall combined rating with everything else before final rounding.

The bilateral factor is a small add-on, not a separate rating, and on two feet at 10 percent it does not move the needle much in isolation. Where it matters is when the bilateral feet ratings combine with everything else the veteran carries and the total sits near a rounding threshold. A combined rating pushed from 49 to a true value that rounds to 50 changes the monthly payment. The factor applies any time both feet are service-connected, even with different ratings on each side.

Surgical Scars and a Separate Rating Under § 4.118

Bunion surgery leaves a scar, and that scar can carry its own rating separate from the bunion. Scars are rated under 38 CFR § 4.118. The most commonly relevant code for a surgical scar is DC 7804, unstable or painful scars:

One or two scars that are unstable or painful, 10% Three or four scars that are unstable or painful, 20% Five or more scars that are unstable or painful, 30%

A painful surgical scar from a bunionectomy can support a separate 10 percent rating under DC 7804. That does not pyramid with the DC 5280 rating because the scar and the joint deformity are different impairments. The joint rating addresses the hallux valgus. The scar rating addresses the painful scar tissue. They coexist under § 4.14 because they are not the same symptom.

This is one of the few places a bunion claim can pick up an extra increment of rating without stretching the regulation. If you have had surgery and the scar is painful, unstable, or large, the scars page walks through the full set of scar codes, including DC 7801 and DC 7802 for area-based ratings and DC 7805 for scars that cause other functional limitation. The scar should be examined and rated as its own line item, not folded into the foot rating.

The Pyramiding Rule and Where It Stops You

38 CFR § 4.14 is the pyramiding rule. The same impairment cannot be rated twice. In bunion claims, pyramiding shows up in a few predictable places.

First, DC 5280 versus DC 5284. Both can describe a painful, limited forefoot. If the same pain and limitation get rated under both, the VA collapses it. The codes coexist only when DC 5280 captures the hallux valgus specifically and DC 5284 captures a separate, broader foot injury. Rating the identical impairment under both is pyramiding.

Second, DC 5280 versus DC 5276. The bunion and the flatfoot are different deformities and can both be service-connected, but if the functional loss being rated is the same load of forefoot pain attributed once to the bunion and once to the arch, that is a pyramiding problem. The cleaner the medical record separates the hallux valgus findings from the pes planus findings, the easier both ratings are to sustain.

What pyramiding does not block is the scar rating. A painful surgical scar under DC 7804 is a genuinely different impairment from the joint deformity, so it stacks. It also does not block the secondary chain. A knee or back condition caused by the altered gait the bunion produces is a different disability of a different body part, rated on its own.

The pyramiding arguments in bunion cases usually run in the VA's favor: a decision finds the bunion rated under DC 5280 and declines to rate the broader foot impairment or the scar as "encompassed." Whether that is correct depends on whether the additional rating addresses a separate impairment or the same one. When it addresses something genuinely separate, the supplemental claim that adds it should succeed.

C&P Exam Mechanics: What the Examiner Has to Document

The bunion C&P exam follows the DBQ for foot conditions. Because DC 5280 is a single-tier code keyed to two qualifying criteria, the exam has a narrower job than a range-of-motion exam, but the details still decide the outcome. The examiner should document:

• Whether the hallux valgus has been operated with resection of the metatarsal head
• Whether the deformity is severe and the disability equivalent to amputation of the great toe
• The degree of the hallux valgus angle and the severity of the deformity
• Any associated forefoot or whole-foot impairment that might fall under DC 5284
• Any associated pes planus findings relevant to DC 5276
• Pain on use, weight-bearing limitation, and functional loss after repetitive use
• The surgical scar: location, size, whether it is painful or unstable, for a § 4.118 rating

The functional-loss principles from DeLuca v. Brown still apply: where pain, weakness, or fatigability cause additional functional loss on use, the examiner is supposed to address it, and where flare-ups are reported, Sharp v. Shulkin requires the examiner to estimate the additional loss during a flare or explain why an estimate is not feasible. The wrinkle is that DC 5280 has no higher tier for functional loss to climb into, so on a standalone bunion the DeLuca and Sharp analysis often cannot raise the rating above 10 percent. Its real value is in supporting a DC 5284 characterization, the pes planus rating, or the severity findings that feed a secondary nexus opinion.

In Claim Raven's analysis, of the 390 bunion cases with a C&P adequacy determination, 41.8% had the exam flagged as inadequate. That is a substantial share, and it tracks with the remand rate: when the exam fails to document the surgical history, the deformity severity, the associated foot findings, or the scar, the Board sends the case back for development rather than deciding it.

Secondary Chains: Where a Bunion Claim Actually Pays

This is the part of a bunion claim worth the most attention, because DC 5280 caps at 10 percent but the conditions a bunion drives do not. 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). Bunions sit in the middle of a foot-and-gait chain that runs in both directions.

The chain runs both ways

A bunion both causes and is caused by altered foot mechanics. A service-connected pes planus or gait abnormality can produce or worsen a bunion. And a bunion, once it deforms the forefoot, changes how you load the foot and how you walk, which pushes stress up the kinetic chain. The direction of causation has to be argued with a medical opinion, but the mechanics are well recognized.

The downstream chains

Bunion to pes planus. The altered forefoot load from a bunion can accelerate arch collapse, and a collapsing arch can worsen a bunion. When both are present and a medical opinion ties them together, the pes planus rates under DC 5276, which scales higher than DC 5280. See the flat feet page.

Bunion to ankle. A deformed forefoot changes the foot-strike pattern and can stress the ankle over time. Recognized when the gait alteration is documented and an opinion connects the mechanics. See the ankle page.

Bunion to knee. Altered gait shifts load to the knee, producing or aggravating knee pathology. This is the same gait-compensation logic that drives the knee-to-knee and knee-to-hip chains, running the other direction up from the foot. See the knee page.

Bunion to low back. The most valuable and most litigated downstream chain. Chronic altered gait and posture from a painful foot can contribute to lumbar strain and, over years, degenerative changes. The Board has gone both ways depending on the quality of the nexus opinion and the time interval. See the back page.

A veteran with bilateral bunions at 10 percent each, plus a secondary pes planus, a secondary ankle condition, and a secondary low-back disability, can build a combined rating well beyond what the feet alone would ever support. The underlying problem is the foot. The rating value is downstream.

The standard for nexus opinions

For any of these chains, the same standard applies. The nexus opinion has to identify the mechanism, address the time course, and rule out other causes. "Back pain is secondary to bunions" with no rationale is not probative. A factually accurate, fully articulated opinion that explains the altered gait, the chronic load shift, and the time course from the foot deformity to the downstream condition carries the case. A generic opinion does not.

Common Evidence Gaps in Bunion Claims

A few patterns I see across BVA decisions involving bunions, tied to the high denial rate and the inadequate-exam share.

Filing the bunion as the whole claim. The most common strategic gap is treating DC 5280 as the destination. The claim establishes a 10 percent bunion and stops, leaving the pes planus, the broader foot impairment under DC 5284, the surgical scar, and the entire secondary chain unclaimed. With a hard 10 percent cap on the code, a bunion-only claim is structurally limited from the start.

No documentation of the qualifying criterion. DC 5280 pays only on resection of the metatarsal head or severity equivalent to amputation of the great toe. When the record shows a bunion but does not document either the surgical resection or the equivalent-to-amputation severity, the rater has no basis to grant even the 10 percent. This is a frequent denial driver: the bunion is acknowledged but the specific regulatory hook is missing from the exam.

No scar examination after surgery. Veterans who had bunion surgery often have a painful or unstable scar that would support a separate 10 percent under DC 7804, but the scar was never examined or rated. The foot exam addressed the joint and never looked at the scar as its own impairment.

Missing nexus for the secondary chain. The secondary conditions are where the value sits, but they require a medical opinion connecting the mechanics. When the record has a bunion and a bad knee or back but no opinion explaining the gait pathway between them, the secondary claim fails for lack of nexus even though the chain is medically plausible.

Service-connection and effective-date gaps. A bunion that began or worsened in service may have spotty STRs covering the period. Without that documentation, service connection can be denied or the effective date can default to the date of claim rather than the date the disability arose, costing back pay. Buddy statements about foot problems during service can fill some of the gap.

I don't know exactly what percentage of bunion claims have one or more of these gaps. What I can say from Claim Raven's analysis of 513 BVA bunion cases is that 60.4% were denied, 20.9% were remanded, and 18.7% were granted, and that of the 390 cases with a C&P adequacy determination, 41.8% had the exam flagged as inadequate. The high denial share lines up with the structural problem in this post: a bunion claim standing alone runs into a 10 percent cap and a narrow set of qualifying criteria, so the cases that recover real value are the ones that develop the secondary conditions and surgical residuals rather than fighting for more under DC 5280.

Bottom Line

Bunions are a low-ceiling rating dressed up as a painful, disabling condition, and the gap between the two is where claims go wrong. DC 5280 pays a single 10 percent per foot, full stop. It does not scale with severity, with bilateral involvement within the code, or with failed surgery. If your claim lives entirely inside DC 5280, you are fighting over 10 percent per foot, which is why the denial rate in the dataset runs above 60 percent. The cases that recover meaningful value treat the bunion as the starting point, not the destination: a broader foot impairment under DC 5284, associated pes planus under DC 5276, a separate painful-scar rating under DC 7804, and above all the secondary chain into the ankle, knee, and low back under § 3.310. Same foot, different paper trail, very different combined rating.

Related Conditions

Bunion claims commonly connect to flat feet because pes planus and hallux valgus travel together and share gait mechanics, and to ankle, knee, and back pages because the altered gait a bunion produces drives stress up the kinetic chain. If you have had surgery, review the scars page for the separate rating a painful surgical scar can carry, and the arthritis page for degenerative changes that can develop in the foot and the joints downstream. Veterans with bilateral foot involvement should work through the secondary conditions tool before assuming a single bunion rating tells the whole story.

Methodology and Limitations

• Data source: Rating criteria quoted from 38 CFR § 4.71a, DC 5280 (hallux valgus), DC 5284 (foot injuries, other), and DC 5276 (acquired flatfoot). Scar criteria from § 4.118, DC 7804. Bilateral factor from § 4.26. Combined ratings math from § 4.25. Pyramiding from § 4.14. Secondary service connection from § 3.310. Functional-loss case law from DeLuca v. Brown and Sharp v. Shulkin, secondary aggravation from Allen v. Brown.
• 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 513 bunion cases. Within that bunion subset, outcomes ran 60.4% denied, 20.9% remanded, and 18.7% granted. Of the 390 cases with a C&P adequacy determination, 41.8% had the examination flagged as inadequate. The dataset captures overall outcome rather than a per-diagnostic-code (DC 5280 versus DC 5284 versus DC 5276) breakdown.
• Classification approach: Diagnostic code definitions drawn from the regulatory text. Cap and qualifying-criteria analysis follows DC 5280 as written. Secondary-chain analysis follows § 3.310 and the gait-mechanics rationale common to orthopedic claims. 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.
• DC 5280 has a hard 10 percent maximum per foot. Worked examples and the secondary-chain discussion describe how value is built outside that code, not above it.
• Whether a foot disability is better captured under DC 5280 or DC 5284 is fact-specific, and rating practice on the analogy varies.
• Selection bias: BVA-level patterns reflect cases that appealed. Most bunion claims resolve at the RO level and aren't in any BVA dataset, and the denial share at the Board may not match the RO-level grant rate.
• Application of the DeLuca and Sharp functional-loss framework adds little to a standalone DC 5280 rating because the code does not scale past 10 percent.
• These observations reflect patterns from the regulatory text, case law, and BVA decisions. They are not predictions of individual outcomes.