RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-02716
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20051130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Logistic Vehicle Systems Operator, medically separated for “neuroma symptoms, right second and third intermetatarsal space” with a disability rating of 10%.

CI CONTENTION: “I believe my rating should change because damage to my foot effect my quality of life….” 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 - 20050927	VARD - 20070125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuroma Symptoms, Right Second and Third Intermetatarsal Space	5279	10%	
Right Foot Neuroma, Status Post Third Metatarsal Osteotomy with Residual Numbness in Toes	

5279	

10%	

20061107	
Status Post Third Metatarsal
Osteotomy	Cat II					
Pes Planovalgus	Cat II					
Metatarsal Fracture	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Neuroma Symptoms, Right Second and Third Intermetatarsal Space. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neuroma condition

began in 2004 with physical training. From 2004 to 2005 the CI was diagnosed and treated for numerous right foot conditions including plantar fasciitis, pes planus, right tibial sesamoid fracture, second and third metatarsal (MT) stress fractures, and second and third interspace neuromas secondary to the MT stress fractures. A podiatry examination on 21 October 2004 noted that X-rays showed the second MT and sesamoid fractures were healed. In January 2005 surgery was recommended for the right foot neuromas (also known as Morton’s neuroma or Morton’s disease) and the CI was referred to a network podiatrist. The CI underwent right foot surgery in March 2005 but a neurectomy was not performed, instead the CI underwent a third MT osteotomy for shift of the third MT. On 20 May 2005, the CI dropped a 50 caliber bolt on his right foot and X-rays showed no fractures. At a podiatry examination on 26 July 2005, physical examination showed the persistence of the right foot neuromas and indicated the CI was to see the network podiatrist in a week.

The 9 August 2005 MEB NARSUM examination, 4 months prior to separation, physical examination showed the third MT surgery scar was well healed without any binding. There was no discoloration or evidence of capsulitis. The distal forefoot was very tender around the third MT. Testing for second and third intermetatarsal neuromas was positive (positive Mulder’s signs). The foot was neurovascularly intact.

At the 7 November 2006 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported numbness and weakness of the right third and fourth toes. He reported stiffness, swelling of the right foot pain and pain aggravated by weight-bearing activities. He reported flare-ups five or six times per week that lasted for1-2 hours. He did not wear special shoes or use shoe inserts because they were not helpful. Physical examination showed no tenderness or swelling of the right foot or ankle. Ankle range of motion was dorsiflexion of 20 degrees (normal) and plantar flexion of 45 degrees (normal). There was no pain on motion or additional limitation of motion on repetition. The scar below the third MT was well healed and non-tender. There was numbness of the third and fourth toes to pinprick and the CI did not move the toes much. He was unable to walk on his toes, but did not complain of pain. The examiner noted the CI was able “to do tandem.” He could also walk on his heels and stand on one leg. Right foot X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the right foot neuroma condition 10%, coded 5279 (metatarsalgia, anterior (Morton’s disease). The VA based the rating on the C&P examination, citing anterior metatarsalgia. The Navy PEB listed status post third MT osteotomy, pes planovalgus and MT fracture conditions as related diagnoses (Category II) contributing to the disability in this case.

The panel concluded the Category II diagnoses were not conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). A 10% rating was supported coded 5279 for the right foot neuroma condition, and 10% is the only available rating under this code. The panel considered other foot codes and all were less applicable and/or not advantageous for rating. The panel concluded no higher than a 10% rating was supported under any applicable code. 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 neuroma condition.

BOARD FINDINGS: In the matter of the neuroma symptoms, right second and third intermetatarsal spaces 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.

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DEPARTI!ENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS
'	720 KENNON STREET SE STE 309
I	WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.