RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-04020
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090315

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “right great toe pain” with a disability rating of 10%.

CI CONTENTION: “I still deal with pain and can’t do long periods of standing.” 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 - 20090130	VARD - 20090508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Great Toe Pain	5024	10%	Pes Planus with First Metatarsophalangeal Joint Degenerative Disease (Right)	5003-5276	10%	20081212	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Right Great Toe (GT) Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced discomfort in his right GT without any direct trauma in November 2007 while deployed. In June 2008, imaging studies showed a cyst in the first metatarsal head, which led to the diagnosis of flexor hallucis longus tendinitis. The CI declined the option to surgically excise the cyst. During the 25 November 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, he reported ongoing right GT joint pain. Physical examination revealed a slight decrease in extension and flexion, but

no swelling or discoloration of the foot. Sensation to light touch over the dorsal aspect of the GT was slightly decreased.  There was full range of motion (ROM) of the right ankle.

At the 12 December 2008 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported he experienced flare-ups of sharp, aching pain, associated weakness, and fatigue of the right GT. Physical examination showed dorsiflexion to 5 degrees and plantar flexion to 60 degrees. There was pain at the ROM extremes but no additional limitation of motion. There was no skin breakdown, calluses or unusual shoe wear, tenderness, spasm, weakness or fatigue.

The 16 December 2008 MEB NARSUM examination noted complaints of right GT pain. There was tenderness over the GT interphalangeal and metatarsophalangeal joints and the sesamoid area, but no right foot swelling or discoloration.  Right GT flexion and extension were decreased.

At the 25 November 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported daily stiffness, swelling and pain in the right GT after the cyst was removed in April 2009. Cold weather and walking increased the pain, but he had no pain at rest or with standing. On examination, flexion was to 30 degrees and extension to 10 degrees, both limited by stiffness. The joint was not painful on motion and the joint function was not additionally limited by pain, fatigue, weakness or lack of endurance following three repetitions.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the right toe condition 10%, coded 5024 (tenosynovitis), citing painful motion with functional loss (§§§4.40, 4.10. 4.59). The VA rated the right foot condition 10%, analogously coded 5003-5276 (arthritis degenerative-flatfoot acquired) based on the C&P examination, citing pain on manipulation and findings of a pes planus deformity with 5 degrees pronation. Panel members agreed that a 10% rating, and no higher, was justified for the right GT pain under either code 5024 or 5273 (analogous). There was no appropriate code that would result in a higher 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 right toe condition.

BOARD FINDINGS: In the matter of the right 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.

AR20190012696, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.