RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01300
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O1, Adjutant General Officer, medically separated for “metatarsalgia of the first MTP joint” with disability rating of 10%.

CI CONTENTION:  The CI contends his condition has worsened and continues to interfere with his daily activities.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  
SERVICE PEB - YYYYMMDD	VARD - 20090630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Metatarsalgia of the First MTP Joint …..	5279	10%	Left Hallux Valgus to include  Left Foot Bunionectomy	5278	10%	20080902	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Metatarsalgia of the First Metatarsophalangeal (MTP) Joint Following Bunion (Hallux Valgus) Surgery.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s metatarsalgia of the first MTP Joint condition began in 2002 while a cadet at the United States Military Academy Preparatory School.  In 2005, the CI had a bunionectomy which resulted in persistent left foot pain.  Despite treatment with shoe inserts and joint injections, the left foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “metatarsalgia MTP joint left foot, metatarsus adductus with hallux valgus left foot, hallux limitus left foot and pes planus left foot” for PEB adjudication.  At the MEB examination dated April 2008, 5 months prior to separation, the CI reported 9/10 sharp, throbbing, and intermittent left foot pain.  The pain worsened with walking at a fast pace and greater than 15 minutes.  Physical examination showed a normal gait without left foot tenderness to palpation.  The examiner noted moderate pes planus and well healed scars. Radiographic evaluation demonstrated fusion of the first tarsometatarsal joint and degenerative changes, metatarsus adductus, and hallux valgus of the first MTP joint.  The VA Compensation and Pension (C&P) examination in September 2008, performed 2 weeks before separation showed bilateral pes planus (flatfeet), tenderness at the left first metatarsal head, and moderate bilateral hallux valgus (15 degrees on the left).  The examiner noted a normal gait and well healed scars.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5279 code (Metatarsalgia, anterior [Morton’s disease], unilateral, or bilateral), citing persistent pain.  The VA also assigned a 10% rating coded 5278 (Claw foot [pes cavus], acquired:) based on the VA C&P examination 2 weeks before separation, citing the great toe is dorsiflexed with some limitation of dorsiflexion at the ankle and definite tenderness under the metatarsal heads.  The Board noted that the highest rating for metatarsalgia and hallux valgus is 10%.  There was no evidence of dorsiflexion of all toes, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads for a higher rating under 5278.  There was no evidence of severe pes planus for a higher rating under 5276 (flatfoot acquired).  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 left foot metatarsalgia condition.  

BOARD FINDINGS:  In the matter of the left foot metatarsalgia condition and IAW VASRD §4.71a, the Board unanimously no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140309, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160013467 (PD201401300)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA