RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03495
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4 (Assault Amphibious Vehicle Crewmember) medically separated for “hallux rigidus, right foot” with a disability rating of 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 - 20051116	VARD - 20060728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hallux Rigidus, Right Foot	5281	10%	Status Post Bunionectomy with Scar, Right Foot	5280-5284	10%	20060619	
Residual Hallux Valgus, Status Hallux Valgus Surgery	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Hallux Rigidus, Right Foot and Associated Category II Condition.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an onset of right foot pain in July 2004 with rigorous training activities.  The CI was diagnosed with hallux limitus (restricted motion of the great toe, equivalent to the PEB diagnosis of hallux rigidus) complicating congenital hallux valgus (bunion deformity of the great toe).  He underwent a right bunionectomy in February 2005 (12 months before separation) with hardware removal 6 months later.  Outpatient notes in the STR documented an uncomplicated recovery with improved range of motion (ROM) of the great toe to about 50% of normal, and restoration of a normal gait.  Post-operative X-rays revealed surgical changes (shortened 1st metatarsal) with normal alignment.  Further surgery was not indicated; continued conservative treatment did not result in sufficient improvement to allow unrestricted duty; and, the CI was referred for MEB which in turn forwarded “congenital anomaly of toes” to the PEB.  

The NARSUM (podiatry) examination on 19 August 2005 (5 months before separation) documented “does well in stiffer soled shoes ... [but] ... continues to have pain [with walking].”  The physical examination recorded “still an abduction component to his gait” but adequate great toe purchase (toe-off with ambulation), and tenderness of the great toe joint.  Measured ROM of the great toe was unchanged from the STR evidence.  

A general VA Compensation and Pension (C&P) examination on 7 October 2005 (3 months before separation) documented bilateral “hallux valgus with residual pain” limiting standing to 15 minutes and prohibiting running.  The physical examination recorded a normal gait, “no valgus deformity of the foot,” tenderness at the base of the great toe, and painless “dorsiflexion of the toes.” 

A podiatry C&P examination on 19 June 2006 (5 months after separation) documented pain localized to the right great toe rated 7-9/10 and exacerbated by prolonged standing, walking, or heavy load bearing.  The physical examination recorded a “nonantalgic” gait but inability to toe-off secondary to pain, a nontender surgical scar, and a “mild bunion deformity.”  Measured ROM at the ankle was normal (20 degrees dorsiflexion, 45 degrees plantar flexion), and ROM of the great toe was improved over the measurements in the earlier STR and NARSUM.  At both VA examinations, the CI reported a shipboard injury to the right foot (not corroborated by the STR and occuring later than the atraumatic onset documented in the STR); and, the C&P examiner consequently diagnosed “status post injury right foot with surgical intervention, i.e. bunionectomy.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated 10% under the specific code 5281 (hallux rigidus).  This defaults to criteria of 5280 (hallux valgus) which confers a maximum rating of 10%.  The PEB additionally adjudicated “residual hallux valgus, status [post] hallux valgus surgery” as a Category II condition (contributes to the unfitting condition but is not separately ratable).  Members agreed that the Category II condition could not be separately coded and rated without violation of VASRD §4.14 (avoidance of pyramiding), and thus it was appropriately subsumed in the rating for the unfitting condition.  The VA rated under code 5284 (foot injuries, other), presumably relying on the C&P diagnosis based on the conflicting history.  The VA’s 10% rating was for “moderate” disability under 5284, which also confers ratings of 20% for “moderately severe” and 30% for “severe” disability.  Members agreed that the code itself was not supported by the evidence; and, furthermore, even if conceded, the disability in evidence did not justify a rating higher than 10% under 5284.  Given the specific diagnosis and applicable VASRD code, members agreed that alternate coding to achieve a higher rating was not justified; and, that the disability in evidence was most appropriately rated under 5281.  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 of the hallux rigidus condition.

BOARD FINDINGS:  In the matter of the hallux rigidus right foot 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 20140502, 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 21 Oct 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC