RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02494
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20020715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Field Radio Operator, medically separated for “bilateral metatarsalgia” and rated 10%.  

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 - 20020425	VARD - 20030127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Metatarsalgia	5279	10%	Bilateral Pes Cavus with Bilateral Metatarsalgia	
5278-5279	
10%	
STR	
Pedis Cavus	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bilateral Metatarsalgia Condition.  The Medical Evaluation Board (MEB) narrative summary (NARSUM) documented bilateral foot pain beginning in May 2001, with no history of trauma.  Despite treatment the bilateral foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and an MEB referral was made.  The MEB forwarded “bilateral metatarsalgia,” with “pedis cavus” as a category II condition for PEB adjudication.  

Three separate visits to podiatry in May 2001, 14 months pre-separation, and to orthopedics in February and March 2002, 5 and 4 months pre-separation, documented normal or near normal ranges of motion (ROM) of the foot or ankle.  The MEB NARSUM examination was performed on 21 March 2002, 4 months pre-separation.  The physical examination showed “very moderate” pes cavus.  He had diffuse pain with full ROM in the ankle, mid-foot, hind-foot, and forefoot.  There was no tenderness and no abnormalities of the plantar surfaces of the feet.  On the MEB DD Form 2807-1 Report of Medical History dated 26 March 2002, the CI reported tingling of his feet.  The CI did not appear for the VA Compensation and Pension (C&P) examination.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the “bilateral metatarsalgia” and associated category II condition “pedis cavus” at 10%, coded 5279 (metatarsalgia, anterior [Morton’s disease], unilateral, or bilateral).  The VA also rated 10% for the “bilateral pes cavus with bilateral metatarsalgia,” analogously coded 5278-5279 (claw foot [pes cavus], acquired; metatarsalgia…).  The Navy PEB listed the “pedis cavus” condition as a related (Category II) diagnosis contributing to the disability in this case.  The Board concluded the Category II diagnosis was not a separate condition which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  

The Board next considered the evidence for higher than a 10% rating.  There was no unilateral or bilateral evidence of limitation of dorsiflexion at the ankle, shortened plantar fascia, or marked tenderness of the metatarsal heads for a higher rating under 5278 (claw foot [pes cavus], acquired).  There was no objective evidence of unilateral or bilateral marked deformity, pain on manipulation, indication of swelling on use, or characteristic callosities for a higher rating under 5276 (flatfoot, acquired).  And there was no evidence describing a “moderately severe” disability for a higher rating under 5284 (foot injuries, other).  Although the bilateral condition could reasonably be found as separately unfitting, there are no VASRD coding options that would support a higher rating and therefore separate ratings would be of no benefit to the CI.  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 bilateral metatarsalgia and pedis cavus conditions.  

BOARD FINDINGS:  In the matter of the bilateral metatarsalgia and pedis cavus conditions 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.  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 20140411, 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 Aug 16

      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:

	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USN
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC
	- XXXXXXXXXXXXXXXXXXXX, former USMC

		XXXXXXXXXXXXXXXXXXXX
	     	Assistant General Counsel
		(Manpower & Reserve Affairs)