RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02416
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Infantryman) medically separated for a great toe joint condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards but was authorized to perform alternate aerobic activities.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “hallux rigidus right great toe joint” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “hallux rigidus right first (great toe) metatarsophalangeal [erroneously entered as ‘metacarpophalangeal’] joint,” as unfitting, rated 10% citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.  

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 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/Naval 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 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:  

IPEB – Dated 20030411	VA* - (~4 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hallux Rigidus Right First (Great Toe) Metatarsophalangeal Joint	5281	10%	Hallux Rigidus Of Right Great Toe	5280	10%	20050412	
Other x 0 (Not In Scope)	Other x 1	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050714 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  
Hallux Rigidus Right First Toe Condition.  The narrative summary (NARSUM) detailed that the CI had resection of the head of the proximal phalanx (first or proximal bone) of the right first toe prior to entering active duty, from which he recovered fully.  In August 2004 (2 months after entering active duty and 4 months prior to separation) the CI stubbed his boot on a large stone while rucking, with immediate pain and swelling of the right first toe.  He had persistent, limited, painful motion of the toe, and inability to walk.  The CI was left with functional impairment of the involved joint, so as to preclude the satisfactorily performance of duty, and was referred to the MEB.  The DD Form 2808, Report of Medical Examination, was accomplished on 31 August 2004 (4 months prior to separation) and showed tenderness of the “1st and 2nd metatarsal,” a scar on the anterior foot, and decreased (4/5) strength.  The NARSUM was completed on 27 September 2004, 3 months prior to separation, and showed redness and tenderness of the metatarsophalangeal joint (base of the toe).  There was crepitance of the joint with 5 degrees dorsal flexion and no evidence of plantar flexion.  An X-ray showed the proximal phalangeal head resection and arthritis of the metatarsophalangeal joint.  The diagnosis was hallux rigidus of the right first toe.  

At the VA Compensation and Pension exam was performed on 12 April 2005, 4 months after separation, the CI reported “very great continuing pain,” inability to stand for more than 5 or 10 minutes, and inability to run.  On examination, the CI had normal gait for 125 feet, exquisite tenderness of the toe and metatarsophalangeal joint, no flexion or extension, and pain with any passive movement of the toe.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded 5281 (hallux rigidus), citing very limited and painful range of motion of the toe joint.  The VA rated the condition at 10%, coded 5280 (hallux valgus).  The VASRD directs that hallux rigidus be rated as hallux valgus (5280), and it cannot be rated higher than 10%.  The record does not describe any other deformity or deficiency of the foot, so no other codes are available under §4.71a.  Since the pain is localized at the joint and there is no documentation of a complex regional pain syndrome, rating under a peripheral nerve code is not supported.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the hallux rigidus right first (great toe) metatarsophalangeal joint 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the hallux rigidus right first toe 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 20140520 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAMR-RB						

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 XXXXXXXXXXXXXXXXXX, AR20160000292 (PD201402416)

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