RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01026
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141009
SEPARATION DATE:  20080830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflect that this covered individual (CI) was an active duty Marine LCpl/E-3 (3521/Motor Transport Mechanic) medically separated for hallux limitus and bilateral first metatarsal head metatarsalgia, or bilateral “great toe” condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty and was eventually referred for a Medical Evaluation Board (MEB).  The hallux limitis condition, characterized as “enthesopathy of ankle and tarsus, unspecified, and hallux rigidus” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB adjudicated “hallux limitus” as unfitting rating each great toe separately at 10% with a 20% combined rating, which included the bilateral factor.  The PEB determined “bilateral first metatarsal head metatarsalgia” as category II (contributing to the unfitting condition). The PEB used the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Conditions have become much worse leaving me unable to work.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting hallux limitus is addressed below. The category II condition of the bilateral first metatarsal head metatarsalgia will be considered by the board as part of the unfitting condition.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20080718	VA - (6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hallux Limitus	5281	10%	Residuals, Left Foot Fracture with Residual Scar of Great Toe	5299-5279	10%	
20080910
	
Hallux Limitus	5281	10%	Status Post Bunionectomy, Right Foot with Residual Scar of Great Toe	5280	10%	20080910	
Bilateral First Metatarsal Head Metatarsalgia	Cat II	No VA Entry	
Other x 0  (Not in Scope)	Other x 6	
Combined:  20% (incl bilateral factor)	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20090212 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:

Bilateral Hallux Limitus Condition.  According to the MEB narrative summary (NARSUM) and treatment records, the CI experienced chronic right foot pain since recruit training.  Podiatry evaluation diagnosed hallux valgus (great toe abnormally angled with a painful bony prominence) and fracture of the sesamoid bone (attached to one of the tendons for the great toe) and recommended corrective surgery.  On 10 May 2007, the CI underwent bunionectomy (removal of excess bone at the base of the toe and correction of the toe angle) and removal of the painful sesamoid bone.  The CI injured the left foot in November 2007 and developed similar symptoms in the left foot.  On 23 January 2008, the CI underwent left foot surgery including shaving of excess bone at the base of the great toe (he did not undergo bunionectomy) and removal of a painful sesamoid bone at the great toe.  According to the MEB NARSUM performed on 22 April 2008, the CI continued to experience pain at the surgical sites which limited running, jumping and prolonged standing.  On examination, dorsiflexion of the great toes was limited to 30 degrees (normal is approximately 60 degrees), with pain at 30 degrees.  The remainder of the foot and ankle examination was normal.  The MEB NARSUM concluded with diagnoses of hallux limitus (decreased motion of the toe) and metatarsal head metatarsalgia (pain at the base of the great toe).  The VA Compensation and Pension examination performed on 10 September 2008, a week after separation, recorded foot pain aggravated by activity.  The examiner noted the CI could function (standing and walking) with medication.  The CI did not require any additional orthotic supports in his shoes.  On examination, the gait was normal.  There was painful motion of the great toes, but the remainder of the foot examination was normal (plantar foot non-tender, normal alignment).   X-rays of both feet noted the right foot bunionectomy but were otherwise reported as normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated each foot 10% coded 5281 (hallux rigidus).  The VA also rated each foot 10% but using different VASRD diagnostic codes (right foot coded 5280 hallux valgus and the left foot coded 5299-5279 metatarsalgia).  The Board noted that except for pain and limitation of motion of the great toe, the remainder of the foot examination was normal.  The Board noted that no other VASRD diagnostic codes more nearly described the condition than the three chosen by the PEB and VA.  All three diagnostic codes used by the PEB and the VA (5279, 5280, and 5281) provide for a maximum rating of 10%.  There were no other coding options which better described the condition and resulted in a higher rating.  After due deliberation, considering all of the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right and left hallux rigidus condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the right and left hallux rigidus condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 8 Apr 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXX, former USN