RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02584
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20030817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-3 (Mortarman) medically separated for toe web infections.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  “Bilateral toe web space maceration” and “skin breakdown & recurrent infection” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “toe web infections” as a Category I unfitting condition, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  “Please consider all conditions”  

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 20051101	VA* -  based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Toe Web Infections	7899-7806	10%	Tinea Pedis of Both Feet	7813	0%	STR	
Other x 0 (Not In Scope)	Other x 4	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20061220 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY: 

Toe Infections Condition.  Review of the available STR found that the CI first presented for a bilateral foot infection in April 2003.  Treatment over the course of several months included activity and footwear modification, multiple topical medications and a 9-day course of oral steroids.  Despite ongoing management by a dermatologist, maceration (abnormal softening from moisture) of the skin persisted in all web spaces except between the great and second toes.  This was due to closely opposed toes that did not allow adequate ventilation.  Because of the CI’s unusual toe anatomy, the use of any occlusive footwear was deemed likely to result in recurrence of infections.  The narrative summary on 10 May 2005 (6 months prior to separation) reported that when the CI did not wear boots on a consistent basis, the feet did “fairly well.”  However, skin breakdown and itching between toes occurred when wearing boots.  Physical exam showed maceration of all web spaces except the first, worse in the left foot than the right.  Some redness, swelling and drainage was present in the left foot web spaces, but was improved compared to a recent visit.  A VA follow-up clinic evaluation on 21 September 2006 (10 months after separation) noted a moist rash between the toes and a normal gait.  Oral and topical anti-fungal agents were prescribed. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under an analogous 7806 code (dermatitis or eczema) was presumably based on a judgment that at least 5 percent, but less than 20 percent, of the entire body was affected by the condition.  The VA arrived at a 0% rating based on the STR and used the 7813 code (dermatophytosis), which defaults to 7806 criteria.  The Board agreed that the next higher 30% rating was not warranted, since 20-40% of the entire body or 20-40% of exposed skin surface areas were not affected.  Moreover, systemic therapy (corticosteroids or immunosuppressive agents) was not required for a total duration of 6 weeks or more during the year prior to separation; thus a 30% rating was not justified on this basis.  Other routes to a higher rating were considered; however, additional coding options either defaulted to 7806 coding criteria (7820-infections of the skin not listed elsewhere), or were clinically inapplicable.  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 toe web infections 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 toe web infections condition and IAW VASRD §4.118, 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 20140530, 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 Jan 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:

- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN   
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 

				XXXXXXXXXXXXXXX
	     			Assistant General Counsel
				(Manpower & Reserve Affairs)