RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-03168 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20061215

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Maintenance Management Specialist, medically separated for “hallux limitus” with a disability rating of 10%.

CI CONTENTION: “I still have pain in my feet while attempting standing, running or walking for extended periods of time” The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20061004	VARD - 20070503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hallux Limitus [Left]	5299-5280	10%	HV, Left	5280	10%	20070324	
HV Post Bilateral Bunion Surgery	Cat II	HV, Right	5280	0%	20070324	
Pain	Cat II	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Hallux Limitus [Left]. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right bunion (hallux valgus [HV], deformity at the first metatarsophalangeal joint [MPJ]) surgery in February 2005 and left bunion surgery in December 2005. Following the second surgery the CI developed left foot pain in approximately February 2006 after running for long periods and with boots and certain types of shoes. A bone scan on 19 June 2006 showed degenerative changes at the distal metatarsal head consistent with post- surgical changes. Despite treatment, the CI’s left foot pain continued.

The 18 August 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of left foot pain after bilateral bunion surgeries that prevented walking, running, or normal weight bearing. Physical examination of the left foot showed pain on the bottom of the foot localized to the tibial sesamoid bone (medial aspect of great toe). There was no HV rigidity or pronounced symptoms. There was no contracture of the MPJ with loss of function (hallux

rigidus). There were arthritis changes with range of motion (ROM) and audible crepitus. The examiner commented, “There is limited plantar flexion [hallux limitus] of the involved joint which may preclude the satisfactory performance of duty.” Left foot X-rays showed post-surgical change without evidence of fracture or dislocation. The bone scan was reportedly consistent with degenerative change. During the 13 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, physical examination showed a surgical scar over the first metatarsal and tenderness of the left first MPJ with ROM limited by pain.

At the 24 March 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported doing relatively well with her right foot, but had ongoing pain and stiffness in her left toe with difficulty standing for more than 15 minutes. The CI wore orthotics but did not use a cane. Physical examination showed a well healed surgical incision on the top of the foot. There was painful motion of the left great toe and mild antalgia of the left foot with walking. There were no abnormal callosities or abnormal shoe wear. Some paresthesia over the incision and a positive Tinel’s sign (reproduction of paresthesia with tapping) over the incision was suggestive of neuroma. The CI had normal posture standing and squatting. She was able to heel and toe rise. There was a 10-degree angle of HV and limited and painful motion of the great toe with no additional loss of motion with repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the hallux limitus condition 10%, analogously coded 5299-5280 (HV, unilateral). The PEB listed pain and HV post bilateral bunion surgery as related Category II diagnoses contributing to the disability in this case. The panel concluded the Category II diagnoses were not separate conditions of the left foot which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the left foot condition 10% and the right foot condition 0%, both coded 5280, based on the C&P examination, citing the criteria that severe HV, if equivalent to amputation of the great toe on the left and for the right, is assigned a non-compensable evaluation unless the metatarsal head has been surgically resected or the condition is functionally equivalent to an amputation of the great toe.

The panel agreed a 10% rating was supported coded 5280 for HV operated with resection of the metatarsal head, the only rating available under 5280. The panel considered other VASRD foot codes and all were less applicable and/or not advantageous for rating. 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 hallux limitus condition.

The panel acknowledges the reference to bunion surgery of the right foot is a separate condition than the Category I hallux limitus condition of the left foot. There was no evidence in record of any problem with the right foot following the bunion surgery in February 2005 and the panel concluded there was a preponderance of evidence that overcame the panel’s presumption that the Category II right foot condition could be reasonably considered unfitting at separation and no additional rating is recommended.

BOARD FINDINGS: In the matter of the hallux limitus condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the pain and hallux valgus post bilateral bunion surgery conditions, the panel recommends no change from the PEB determination that these are Category II conditions. 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.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
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:	XXXXXXXXXXXXXX

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 ofno 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.