38 CFR Part 4 — 38 CFR § 4.71a

Hallux rigidus, unilateral, severe — VA Diagnostic Code 5281

Musculoskeletal

Diagnostic code

5281

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38 CFR § 4.71a lists Diagnostic Code 5281 in the table captioned “The Foot.” The title is “Hallux rigidus, unilateral, severe:”. The next cell is “Rate as hallux valgus, severe.” That cell ends with a period, and its rating cell is empty. The note under it reads: “Not to be combined with claw foot ratings.” Appendix B to Part 4 indexes “Hallux rigidus.” and does not say “unilateral” or “severe.”

Reviewed 2026-10-05. Text checked against the eCFR versioner full-text XML for 2026-10-01 on 2026-10-05. Title 38 was up to date as of 2026-10-01 and last amended on 2026-08-27. The § 4.71a source note prints 29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 2003; 69 FR 32450, June 10, 2004; 80 FR 42041, July 16, 2015; 85 FR 76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 2021. The § 4.69 source note prints 62 FR 30239, June 3, 1997. The § 4.63 source note prints 29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978. The § 4.71 source note prints 29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978; 67 FR 48785, July 26, 2002. The § 4.26 source note prints 29 FR 6718, May 22, 1964, as amended at 88 FR 22917, Apr. 14, 2023.

The rating criteria at each level

5281 Hallux rigidus, unilateral, severe

Rating %: —

Criteria (verbatim). Rate as hallux valgus, severe.

Rating %: —

Criteria (verbatim). Note: Not to be combined with claw foot ratings.

Rating %	Criteria (verbatim)
—	Rate as hallux valgus, severe.
—	Note: Not to be combined with claw foot ratings.

The rating cell on “Rate as hallux valgus, severe.” is empty. The 10 percent severe line is printed on DC 5280, “Severe, if equivalent to amputation of great toe.” DC 5281 does not reprint that 10.

The note ends with a period. It says “claw foot ratings.” It does not name DC 5278 in the note itself.

The title includes “unilateral” and “severe.” Appendix B drops both words.

DC 5280 is “Hallux valgus, unilateral:”. Its severe line is 10. Its other line, operated with resection of the metatarsal head, is also 10. DC 5281 names “hallux valgus, severe,” which is the severe line, not the operated line. DC 5278 is “Claw foot (pes cavus), acquired:”. The DC 5281 note says hallux rigidus is not to be combined with claw foot ratings. 38 CFR § 4.14 says the evaluation of the same disability under various diagnoses is to be avoided. The same section says the evaluation of the same manifestation under different diagnoses are to be avoided.

DC 5282 is hammer toe. Its 10 percent line is “All toes, unilateral without claw foot.” Its 0 percent line is “Single toes.” DC 5171 is amputation of the great toe. DC 5281 does not cite DC 5171. 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just.

DC 5281 prints no percentage of its own and no 0 percent line. The severe hallux valgus line it points to is 10. 38 CFR § 4.31 says that in every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.

Source: 38 CFR § 4.71a, Diagnostic Code 5281, eCFR full-text XML for 2026-10-01.

What the words mean in your records

The percentage is on DC 5280

DC 5281’s rating cell is empty. It says to rate as hallux valgus, severe. That severe line, on DC 5280, is 10.

The note names claw foot

“Not to be combined with claw foot ratings” is printed under DC 5281. Acquired claw foot is DC 5278. The note does not assign a second percentage.

Appendix B shortens the title

The rating title is “Hallux rigidus, unilateral, severe:”. Appendix B says “Hallux rigidus.”

Evidence that speaks to each level

Rated as hallux valgus, severe

What the rater needs to see. Unilateral severe hallux rigidus, which is the DC 5281 title, rated as the severe hallux valgus line. That line on DC 5280 is 10.

Where that usually lives. The examination of the great toe. The DC 5281 rating cell itself is empty.

Claw foot

What the rater needs to see. The note says not to combine with claw foot ratings. Claw foot is DC 5278.

Where that usually lives. The same decision, if it also discusses claw foot.

Level	What the rater needs to see	Where that usually lives
Rated as hallux valgus, severe	Unilateral severe hallux rigidus, which is the DC 5281 title, rated as the severe hallux valgus line. That line on DC 5280 is 10.	The examination of the great toe. The DC 5281 rating cell itself is empty.
Claw foot	The note says not to combine with claw foot ratings. Claw foot is DC 5278.	The same decision, if it also discusses claw foot.

VA’s public DBQ list, checked October 5, 2026, names “Foot Conditions Including Flatfoot (Pes Planus)” under Musculoskeletal. The file is Foot Conditions Including Flatfoot (Pes Planus).

The exam form

DC 5281 does not print its own percentage. It points to hallux valgus, severe. This page does not say the foot form replaces that sentence.

Related codes and how they interact

The severe hallux valgus line is one of two 10s.

DC 5280 prints 10 for resection of the metatarsal head and 10 for severe hallux valgus if equivalent to amputation of the great toe. DC 5281 names the severe line. It does not name the operated line.

Secondary conditions and presumptions

The 2026-10-01 text of 38 CFR § 3.309 does not contain “hallux.” DC 5281 is a rating-schedule line.

A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.

Short answers

How does VA rate unilateral severe hallux rigidus under DC 5281?

Under 38 CFR § 4.71a, the row says to rate it as hallux valgus, severe. That severe line is DC 5280 at 10 percent. The note says not to combine with claw foot ratings. Education only. VA decides on the evidence.

Is the operated hallux valgus line part of DC 5281?

DC 5281 names “hallux valgus, severe.” The operated line, resection of the metatarsal head, is a separate 10 percent line on DC 5280. DC 5281 does not name that operated line.

FAQ

What percentage does DC 5281 print?

None on its own row. The cell says “Rate as hallux valgus, severe.” The severe line of DC 5280 is 10. Education only.

Can hallux rigidus be combined with claw foot?

The note under DC 5281 says: “Not to be combined with claw foot ratings.” Acquired claw foot is DC 5278. The note does not print a substitute percentage.

Does Appendix B include “severe”?

No. Appendix B indexes “Hallux rigidus.” The rating title is “Hallux rigidus, unilateral, severe:”.

Next steps

Read the decision for DC 5281 and whether it used the severe hallux valgus line.
The free worksheet is a place to write the code, the findings, and the records you already have. It does not file a claim or protect a filing date. An accredited representative is at find a VSO.
Other musculoskeletal codes are on the musculoskeletal diagnostic-code index. The foot page is the foot guide.

Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.

Other codes in this body system

Nearby catalog entries in Musculoskeletal, ordered by diagnostic code number. All Musculoskeletal codes

Also: DC code lookup (tools) lists the same index in a compact layout.

Source: 38 CFR Part 4, Diagnostic Code 5281 • va.gov

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