RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01677
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Paralegal Specialist, medically separated for “hallux valgus of the left foot,” with a disability rating of 0%.

CI CONTENTION:  “Condition got worse.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel's scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the panel for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 - 20071119	VARD - 20080825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hallux Valgus, Left Foot…	5280	0%	Pes Planus with Mild Hallux Valgus and Bunion, Left Foot	5276	0%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Hallux Valgus, Left Foot.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s hallux valgus (bunion) of the left foot began in May 2006.  The CI claimed her condition began after wearing military boots and walking over rugged terrain in Iraq.  There was no surgery indicated or advised and despite treatment, the hallux valgus condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “left hallux valgus” for PEB adjudication.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 27 August 2007, 9 months prior to separation, the CI reported left foot constant pain with intermittent numbness and swelling.  Physical examination showed bilateral flat feet with marked tenderness of the plantar fascia especially on the left foot.  Final findings were left foot pain and numbness, pes planus, and plantar fasciitis.  The MEB NARSUM examination on 8 November 2007, 7 months prior to separation, noted complaints of sharp left foot pain that felt like pens and needles which varied from 6-9/10 and was made worse with standing or wearing hard sole shoes.  Physical examination showed a left ankle with normal range of motion, left foot Pes planus, and mild to moderate hallux valgus.  X-ray of the left foot revealed a mild hallux valgus deformity of the left great toe.  Final impression was a left foot bunion causing continued pain despite medical intervention.  There was no VA Compensation and Pension (C&P) evaluation in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the hallux valgus, left foot condition 0%, coded 5280 (hallux valgus, unilateral), citing pain, physical examination and radiographic studies confirming hallux valgus.  The VA also rated the hallux valgus, left foot condition 0% coded 5276 (flatfoot, acquired, mild), based on STR review, citing a non-compensable evaluation was awarded due to mild symptoms relieved by built-up shoe or arch support.  There was no history of surgery for resection of the metatarsal head, nor severity equivalent to amputation of the great toe to rate 10%.  The hallux valgus was mild to moderate and no surgery was indicated.  However, there was evidence of painful motion with functional loss, however it did not involve a major joint per VASRD and thus did not support a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the hallux valgus condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the hallux valgus 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 20150622, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170003943, XXXXXXXXXXXXXXXXXX. 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,