RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01132
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20040515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Infantry Unit Leader, medically separated for “partial amputation of his left foot” with a disability rating of 20%.  

CI CONTENTION:  No specific contention made.  The 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 Medical Evaluation Board (MEB), but determined by the PEB 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 Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040312	VARD - 20040813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Partial Amputation of His Left Foot	5172	20%	Partial Amputation Left Foot	5284-5172	20%	STR	
Traumatic Partial Amputation of Left Metatarsals Four and Five	Cat II					
Split-Thickness Skin Grafting Left Foot	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Partial Amputation of Left Foot:  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgical debridement in June 2003 after a grenade wound during combat.  The CI had a split-thickness skin graft on 11 July 2003.  

During the 20 January 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported pain with left foot partial amputation and skin graft.  Physical examination revealed an intact gait despite left foot second, fourth, and fifth toe amputations.  There was a normal motor and sensory examination except for a left foot sensory defect.  

The 27 January 2004 MEB NARSUM examination, 4 months prior to separation, showed left foot toes three through five were missing, including the proximal and distal interphalangeal joints and partial metatarsal amputation on digits four and five.  The left lower extremity was neurovascularly intact with no evidence of infection.  There was a 100% skin-graft take-over of the lateral aspect of the left foot.  Footwear, including a customized orthotic, was used.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 20%, coded 5172 (toes, other than great, amputation of, with removal of metatarsal head).  The PEB also listed traumatic partial amputation of left metatarsals four and five, and split-thickness skin grafting left foot, as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the traumatic partial amputation of left metatarsals four and five, and split-thickness skin grafting left foot, were properly subsumed under the overall rating for the partial left foot amputation IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also rated the left foot condition 20%, dual coded 5284-5172 (foot injury, other - toes, other than great, amputation of, with removal of metatarsal head), based on the STR, citing amputation of one or two toes with removal of the metatarsal head.  

There was no loss of the great toe and gait was observed as intact.  There was no indication that the CI would be better served by a higher level amputation (IAW VASRD §4.68 – amputation rule); that the injury approximated equivalence to loss of use of the foot; or that the left foot injury and partial amputation exceeded the moderately severe foot criteria for any rating higher than that awarded by the PEB.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the left foot condition.  

BOARD FINDINGS:  In the matter of the left foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160928, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

							XXXXXXXXXXXXXXXXXX
	     				Assistant General Counsel
						(Manpower and Reserve Affairs)