RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04185
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090830

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Organizational Automotive Mechanic, medically separated for “malunion of the second metatarsal fracture left foot” with a disability rating of 10%.

CI CONTENTION: “Review all conditions.” 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 - 20090603	VARD - 20091229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Malunion of the Second Metatarsal Fracture Left Foot	5279	10%	Stauts Post Surgical Repair Fracture Left 2nd Metatarsal and Hallux Valgus Repair	5280-
5283	20%	20090713	
Hallux Valgus Deformity of the Left Foot	Cat II					
Left Shoulder Rotator Cuff Tendinitis	Cat III	Left Shoulder Bursitis	5020	10%	20090713	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Left Second Metatarsal Fracture Malunion. According to the service treatment record and MEB narrative summary (NARSUM), the CI injured his left foot while rucking in July 2005 and ultimately underwent an osteotomy to repair a fractured left second metatarsal in June 2007. After hardware removal in November 2008, he underwent a left first metatarsal cuneiform arthrodesis. At the 9 April 2009 MEB NARSUM examination, 5 months prior to separation, the CI reported good function with walking and standing; however, he could not run, tolerate prolonged standing or lift heavy items. A thorough physical examination (PE) of the left foot was completely normal.

Repeat X-rays of the left foot revealed postsurgical changes of the first metatarsal head consisting of removal of prominent bone over the dorsal and medial aspects.

At the 13 July 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported severe left foot pain. The PE revealed an abnormal gait and the CI was “unable to put pressure on left foot.” There was tenderness of the left metatarsal heads, and although the examiner noted limited function for standing/walking, and that the CI was unable to put pressure on the left foot without pain, he was able to walk one-quarter of a mile.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left foot condition 10%, coded 5279 (metatarsalgia). The Category II condition of hallux valgus deformity of the left foot, is part and parcel of the unfitting left foot condition and a separate rating cannot be supported without pyramiding (VASRD §4.14). The VA rated the left foot condition 20%, dual coded 5280-5283 (unilateral hallux valgus and malunion or non-union of the tarsal or metatarsal bones), based on the C&P examination, citing malunion or nonunion of the metatarsal bones with moderately severe symptoms. Panel members agreed that the historical evidence of surgical correction of a fractured metatarsal resulting in chronic pain was clearly best supported by the PEB’s chosen code of 5279 and its sole rating level of 10% was appropriate in this case. 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 left foot condition.

Contended PEB Condition: Left Shoulder Rotator Cuff Tendinitis. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. Although the contended condition was judged to fail retention standards, it never required limited duty and was not implicated in the non-medical assessment. There was no performance- based evidence from the record that the condition significantly interfered with satisfactory duty performance at or near separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the left foot condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended left shoulder condition, the panel recommends no change from the PEB determination as not unfitting. 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:

2	PD-2017-05613

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 REFLY REFER TO:
1850
CORB: 003
10 Sep 20

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

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.