RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02060
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060326

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Radio Operator-Maintainer, medically separated for “chronic left toe pain” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition has worsened, and he requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20060303 	VARD - 20060405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Left Toe Pain	5281	10%	Fractured Distal Tuft Distal Phalanx, Status Post Interphalangeal Joint Fusion; Left Great Toe	5299-5281	10%	20060125	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Toe.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fractured his left hallux (big toe) while running in February 2005.  The CI underwent fusion of the fractured site in June 2005 and was placed in a CAM boot until the surgical screw was removed in September 2005.  During the 12 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic left great toe pain.  The examiner noted pain, edema, deformity, and decreased left hallux range of motion (ROM).  The 19 October 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent left hallux pain.  Physical examination showed no edema, erythema, or cellulitis, bilaterally.  ROM showed plantar flexion to 45 degrees (normal 45) and dorsiflexion was 25 degrees (normal 20); painful motion was not addressed.  Radiographs demonstrated a well fused left hallux interphalangeal joint that was slightly angled medially.  

At the 25 January 2006 VA Compensation and Pension (C&P) general examination, 2 months before separation, the CI reported persistent left great toe pain.  Physical examination showed a gait with a mild limp.  There was left great toe dorsal interphalangeal (DIP) joint tenderness.  The left great toe DIP joint was medially angulated 20 degrees with a space of 2 cm between the tip of the big toe and the tip of the 2nd toe.  The left great toe was 1 cm shorter than the right.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left great toe condition 10%, coded 5281 (hallux rigidus, unilateral, severe), citing loss of ROM (flexion less than 5 degrees) status post interphalangeal joint fusion, with pain.  The VA rated the left great toe condition 10%, analogously coded 5299-5281, based on the C&P examination, citing severe hallux rigidus equivalent to amputation of the great toe.  The panel noted that the PEB and the VA coded the left great toe injury 5281, which defaults to code 5280 (hallux valgus) rating criteria with a maximum rating of 10%.  The panel considered alternative VASRD codes, but given the specific diagnosis, members agreed that alternate coding to achieve a higher rating was not justified and the disability was most appropriately rated under 5281.  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 great toe condition.  

BOARD FINDINGS:  In the matter of the left great toe 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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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,					       

Enclosure