RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03020
BRANCH OF SERVICE:  NAVY		SEPARATION DATE:  20020906

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Seaman (Undesignated), medically separated for “residual right forefoot pain, status post bunion correction and hardware removal,” with a disability rating of 10%.

CI CONTENTION:  The applicant makes no specific contention in her application.  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 - 20020403	VARD - 20090914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Residual Right Forefoot Pain…	5279	10%	Status Post Surgical Repair of Hallux Valgus, Right Foot, with Arthritis of the 1st Metatarsophalangeal Joint	5010-5280	10%	20090803	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Residual Right Forefoot Pain.  The service treatment record, which had very limited documentation, and the Medical Evaluation Board (MEB) narrative summary (NARSUM) dated 7 January 2002 indicated the CI had right forefoot pain that failed conservative treatment with wide toe shoes and rest.  On 1 June 2000 the CI underwent surgery to correct a hallux valgus/bunion.  She improved slowly, had physical therapy, and was placed on limited duty.  After removal from limited duty she complained of pain over the foot, which was felt to be due to tightness at the metatarsophalangeal joint and capsular pain.  Treatment with a nonsteroidal anti-inflammatory drug and range of motion (ROM) therapy failed to improve the condition.  Subsequently, hardware removal was carried out on 16 October 2001.  She remained very sensitive to palpation about the wound and had difficulty with normal shoe wear, but finally resumed wearing boots.  However, the CI had difficulty aboard ship due to pain in the foot with physical activities.  On examination there was a well-healed surgical incision over the medial dorsal aspect of her foot with mild keloid formation, but other surgical wounds were well healed.  She was diffusely tender to palpation about the dorsum of her foot especially over the first metatarsal and first metatarsal web space and was somewhat tender to palpation about the metatarsophalangeal joint with somewhat limited ROM.  Sensation was intact to light touch.  She did have a correctable pes planus of the right lower extremity.  X-rays showed no arthritis of the first metatarsal phalangeal joint and complete hardware removal with bony healing of the crescentic osteotomy.  The diagnosis was residual right forefoot pain, status post bunion correction and hardware removal.  Despite 18 months of limited duty and surgery, the CI remained uncomfortable with physical activity and was felt to be not fit for shipboard duty.  She was referred to an MEB.  The MEB forwarded “right foot pain,” “status post hardware removal, right foot,” and “status post bunionectomy for hallux valgus” to the Physical Evaluation Board (PEB) for adjudication.

At the MEB examination dated 11 January 2002, the CI reported on DD Form 2807-1, Report of Medical History, that she had corrective surgery on her right foot due to a bone deformity (bunion), which was always swollen and sore.  “The surgery required that my foot be broken and a rod and pin inserted.”  The MEB physical examiner noted on DD Form 2808, Report of Medical Examination, a “right foot scar secondary symptoms.”  The non-medical assessment dated 25 February 2002 indicated the CI was on limited duty and was unable to perform activities involving prolonged standing, squatting or running and was not worldwide or sea duty assignable.  A request for permanent limited duty until 15 October 2002 was approved on 31 July 2002.

At the remote VA Compensation and Pension (C&P) examination dated 3 August 2009, performed almost 7 years after separation, the CI reported she had pain, swelling, fatigability, and stiffness status post-surgical repair of a hallux valgus of the right foot with arthritis of the 1st metatarsophalangeal joint.  Three surgical scars were present on the right foot on the dorsal surface of the 1st metatarsal, the lateral metatarsophalangeal joint, and between the 1st and 2nd toes.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating coded 5279 (metatarsalgia, anterior (Morton’s disease), unilateral or bilateral) for residual right forefoot pain, status post bunion correction and hardware removal.  The VA assigned a 10% rating analogously coded 5010-5280 (arthritis due to trauma to hallux valgus) based on the C&P examination 7 years after separation, citing status post-surgical repair of hallux valgus, right foot, with arthritis of the 1st metatarsophalangeal joint.  The Board sought a route to a higher rating; however in the absence of a claw foot (pes cavus) (5278), tarsal or metatarsal bones malunion or nonunion, or a moderately severe or severe foot injury (5282), which the Board discussed in depth, the Board was unable to find a higher rating.  After due deliberation, and in consideration of all 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 residual right foot pain condition.

BOARD FINDINGS:  In the matter of the residual right foot pain 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.  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 20140619, 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 24 Jun 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)