RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04934
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O2, Personnel Officer, medically separated for “hallux limitus right great toe” 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 - 20060522	VARD - 20070508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hallux Limitus Right Great Toe	5280	10%	Residuals, Sesamoid Bone Fracture, Right Foot	5003-5284	10%	20070411	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Hallux Limitus Right Great Toe.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent right fibular sesamoidectomy in April 2005.  However, the CI continued to have right toe pain.  During the 14 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported stiffness and pain in the right toe.  Physical examination showed normal neurosensory function and normal motor strength.  The CI was able to heel/toe walk.   The 14 April 2006 MEB NARSUM examination, 5 months prior to separation, noted limitations in ambulation and prolonged standing.  The examiner was unable to reproduce the CI’s pain with palpation or range of motion (ROM) testing of the right hallux.  Physical examination showed a non-antalgic gait, but there was pain with tiptoe walking.  The ROM study showed right great toe dorsal flexion of 25 degrees and plantar flexion of 20 degrees, compared to 40 and 45 degrees, respectively in the contralateral great toe. 

At the 11 April 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI complained of pain with walking and running activities, which was unimproved with orthotics.  The examiner stated the CI neither had nor required assistive devices.  Physical examination showed subtle antalgia/limp in gait.  Passive ROM was 40 degrees of dorsiflexion and 20 degrees of plantar flexion without crepitance.  Active motion was not recorded.  There was joint line tenderness, but no painful motion, edema, weakness or instability.  Weight-bearing was normal without abnormal shoe wear pattern or callosities.  The examiner opined that the CI’s walking ability, standing ability and distance tolerance was mildly limited.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the great toe condition 10%, coded 5280 (hallux valgus, unilateral).  The VA also rated the great toe condition 10%, analogously coded 5003-5284 (arthritis-foot injuries, other), based on the C&P examination, citing moderate symptoms.  Panel members agreed a 10% rating and no higher was justified for the right toe condition under the 5280 code and there were no other appropriate codes 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 great toe condition.  

BOARD FINDINGS:  In the matter of the right great toe condition and IAW VASRD §4.72, 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.   

XXXXXXXXXX 

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Dear XXXXXXXXXX:

	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.

Sincerely,					      
						      					
Enclosure