RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00527
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic pain due to left great toe sesamoid arthritis,” with a disability rating of 10%.  

CI CONTENTION:  “Chronic foot pain and inability to run.  Interferes with sleep at times.”  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 on 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 - 20030923	VARD – 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain due to Left Great Toe Sesamoid Arthritis	5099-5003	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  	

ANALYSIS SUMMARY:  

Chronic Pain due to Left Great Toe Sesamoid Arthritis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left great toe pain condition was reported in February 2000 after having pain since basic training.  The CI had a symptomatic bunion (hallux valgus) not responsive to larger shoes and a nonsteroidal anti-inflammatory drug (NSAID) and underwent a left Bunionectomy with transection of the hypertrophied medial eminence of the first metatarsal on 31 March 2000.  The CI had some relief of pain, but with heavy activities he developed plantar left great toe metatarsophalangeal (MTP) pain, which was treated with Indocin (indomethacin, an NSAID) in November 2002.  Radiographic (X-rays) studies of the left foot in February 2003 demonstrated a bifid sesamoid below the distal first metatarsal and a follow-up bone scan revealed left medial sesamoiditis.     Despite treatment, the left foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “left great toe sesamoid arthritis” for PEB adjudication.

At the MEB examination (recorded on DD Forms 2807-1 and 2808) in May 2003, 7 months prior to separation, the CI reported a Bunionectomy with two screws in the left big toe in 2000 and sesamoid arthritis in his left foot.  Physical examination revealed “post left Bunionectomy” and “tender under left head first hallux.”  At the MEB NARSUM examination on 14 August 2003 there was a well-healed surgical scar and no tenderness to palpation about the joint.  Dorsiflexion of the MTP was 25 degrees with 0 degrees of plantar flexion.  There was point tenderness along the medial sesamoid of the plantar surface.  Sensation to light touch was intact and the remainder of the left foot examination was normal.  The CI was unable to stand, walk or run without severe left great toe pain, which interfered with his ability to perform his job as well as perform any required or recreational physical activities and which was minimally relieved with medication.  The prognosis was unclear.  An MTP fusion was discussed, which did not guarantee relief of his foot pain, but the CI had no desire for any surgical procedure.  

There was no VA Compensation and Pension examination in evidence. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing the US Army Physical Disability Agency pain policy (AR 635-40).  Board members considered alternative rating options involving the great toe, but in the absence of severe unilateral hallux valgus (code 5280) rated as amputation with removal of the metatarsal head (code 5171) or claw foot (pes cavus) (code 5278), neither offered a route to a higher rating.  Board members also considered use of foot injuries (code 5284) and agreed that the condition did not rise to the level of moderately severe rating of 20%.  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 chronic pain due to left great toe sesamoid arthritis condition.  

BOARD FINDINGS:  In the matter of the chronic pain due to left great toe sesamoid arthritis 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 20150601, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

22 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018744 (PD201500527)

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