RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03183
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20061113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Vehicle Operations and Tactical Aircraft Maintenance, Journeyman, medically separated for “right hallux valgus” and “left foot pain, status-post [S/P] surgery for hallux valgus,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  The VA rated conditions higher to include 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 - 20060929	VARD - 2008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Hallux Valgus	5280	10%	Right Hallux Valgus	5280	10%	20070123	
Left Foot Pain, S/P Surgery for Hallux Valgus	5280	10%	Residuals of Left Foot Hallux Valgus Surgery with Scar	5280	10%		
			Left Foot Neuritis Associated with Left Foot Hallux Valgus Surgery Residuals	8628	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Right Hallux Valgus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced bilateral foot pain due to hallux valgus (bunions) on both feet.  He underwent surgical resection of the left bunion with placement of hardware in 2005 and removal of the same in 2006.  Secondary to continued significant pain, a surgical revision was performed in 2007.  Eventually, a painful, right-sided bunion developed, for which he did not have surgery.  During the 17 August 2006 MEB NARSUM examination, 3 months prior to separation, the CI endorsed a history of bilateral foot pain.  Physical examination revealed a mild right-sided bunion with no local edema or erythema.

At the 23 January 2007 VA Compensation and Pension (C&) examination, 2 months after separation, the CI reported bilateral foot pain with right foot pain rated at 4-5/10.  Physical examination revealed a mild right hallux valgus.  There was no evidence of right foot weakness, stiffness or swelling but there was fatigability and lack of endurance in both feet.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hallux valgus 10%, coded 5280 (hallux valgus, unilateral).  The VA also rated the right hallux valgus 10%, coded 5280, based on the C&P examination, citing right foot pain.  Panel members agreed that code 5280 was appropriate and correctly characterized the primary pathology of the right foot.  The sole impairment rating under this coding option is 10%.  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’s adjudication for the right foot condition.  

Left Foot Pain.  As described above, the CI underwent several surgeries for left hallux valgus.  At the MEB NARSUM examination, his chief complaint was, “2 year history of left foot pain.”  The examiner noted tenderness along the medial side of the left foot, but no local edema or erythema.

At the C&P examination, the CI reported constant pain and numbness on the inside aspect of the left foot, as well as weakness, but was able to accomplish activities of daily living with moderate discomfort.  Physical examination revealed a normal gait; left foot weakness was not addressed.  The CI was able to stand on his heels and squat without difficulty, and there was a slight decrease in dorsi and plantar flexion of the left great toe.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left foot condition 10%, coded 5280.  The VA rated the left foot hallux residuals 10%, coded 5280, and additionally rated left foot neuritis 10%, based on the C&P examination, citing left foot pain and mild, decreased left foot sensation.  Panel members agreed that the pre-surgical condition of left-sided hallux valgus and its minimal post-surgical adverse physical effects only supports a 10% rating under code 5280.  After due deliberation, considering all the evidence and mindful of VASRD §4.3, 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 right hallux valgus and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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:

SAF/MRB

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03183.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.