RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201246 SEPARATION DATE: 20030731 

BOARD DATE: 20130305 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (11B, Infantry), medically separated for 
Chronic pain in left hallux, first metatarsal (foot pain). The CI injured his left foot great toe 
jumping out of his bunk while in training in April 2002 and was diagnosed with metatarsalgia of 
the left great toe. The CI did not improve adequately with treatment and was unable to meet 
the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness 
standards. He was issued a permanent L3 Profile and referred for a Medical Evaluation Board 
(MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) 
adjudication. The PEB adjudicated the chronic pain in left hallux, first metatarsal condition as 
unfitting, rated 0%. The CI made no appeals, and was medically separated with disability 
severance pay. 

 

 

CI CONTENTION: “Metatarsalgia is a permanent condition which initially occurred during a 
training exercise while on duty. The onset was acute and well-documented. The condition was 
the reason for my medial (sic) board separation and it painfully persists almost I0 years later. I 
also received a disability rating from Veterans' Affairs within 12 months after my medical 
discharge.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. The rated condition chronic pain in left 
hallux, first metatarsal, as requested for consideration is the only condition that meets the 
criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. Any conditions 
or contention not requested in this application, or otherwise outside the Board’s defined scope 
of review, remain eligible for future consideration by the Army Board for Correction of Military 
Records. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20030625 

VA (3 Mos. Post-Separation) – All Effective Date 20030801 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Chronic Pain in Left Hallux, 
First Metatarsal 

5099-5003 

0% 

Chronic Myoligamentous Strain, 
Left Foot 

5284 

10% 

20031119 

Combined: 0% 

Combined: 10% 



 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. While the DES considers all of the member's medical conditions, 


compensation can only be offered for those medical conditions that cut short a member’s 
career, and then only to the degree of severity present at the time of final disposition. The DES 
has neither the role nor the authority to compensate service members for anticipated future 
severity or potential complications of conditions resulting in medical separation nor for 
conditions determined to be service-connected by the Department of Veterans Affairs (DVA) 
but not determined to be unfitting by the PEB. However the DVA, operating under a different 
set of laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating determinations, compared to VASRD standards, based on severity at the time of 
separation. 

 

Chronic Pain in Left Hallux, First Metatarsal Condition. The narrative summary (NARSUM) notes 

the CI reported complaints of left foot pain for 7 to 8 months that had progressively worsened 
since initial onset. The first note in his medical records of left foot pain was on 18 April 2002 
after “jumping out of a bunk bed” and injuring his left great toe. At that time he was diagnosed 
with left first metatarsalgia, painful left great toe metatarsal phalangeal joint (MTP joint). The 
X-rays were normal and a bone scan (October 2002) demonstrated “minimal increased 
radiotracer activity in the greater toe as opposed to other toes.” Activity limiting pain persisted 
despite treatment with rest, immobilization, medication and injection. The 9 December 2002 
Podiatric evaluation recommended continued non-surgical treatment. A clinic examination on 
3 January 2003 recorded no swelling, full range-of-motion (ROM) but with pain with great toe 
MTP joint flexion beyond 60 degrees. At the time of the MEB history and physical examination, 
10 March 2003, the CI reported left toe pain with weight bearing. The left first MTP toe joint 
was tender on examination. The MEB NARSUM examination on 3 April 2003 also recorded 
tenderness. At the VA Compensation and Pension (C&P) examination, 19 November 2003, 3 
months after separation, the CI reported chronic left foot pain, aching in nature and varying in 
intensity depending on activity. The pain was localized adjacent to the left great toe. On 
examination there was painful soft tissue swelling on palpation of the dorsum of the left foot 
immediately adjacent to the great toe. There was normal dorsiflexion and plantar flexion of the 
great toe. Gait was “steady.” X-ray of the left foot showed no fracture, dislocation, or any 
other bone abnormality. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB rated the left toe pain condition 0% coded 5003. The VA rated left foot pain 10% coded 
5284 for other foot injuries. The Board noted the unfitting condition was pain of the left first 
MTP joint. There was no hallux rigidus, hallux valgus, or fractures. The Board agreed that 
VASRD diagnostic code 5279, metatarsalgia best matched the unfitting left great toe pain 
condition. Although there was no limitation of motion, there was pain to palpation and with 
use supporting the 10% rating available under diagnostic code 5279. The board considered the 
5284 diagnostic code used by the VA however a rating higher than 10% was not supported by 
the preponderance of evidence. After due deliberation, considering all of the evidence and 
mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability 
rating of 10% for the left hallux chronic metatarsalgia condition (5279). 

 

 

BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or 
guidelines relied upon by the PEB will not be considered by the Board to the extent they were 
inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the 


chronic pain left hallux first metatarsal condition, the Board unanimously recommends a 
disability rating of 10% coded 5279 IAW VASRD §4.71a. There were no other conditions within 
the Board’s scope of review for consideration. 

 

 


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Chronic Pain Left Hallux First Metatarsal 

5279 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120703, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130007738 (PD201201246) 

 

 

1. I have reviewed the enclosed Department of Defense Physical Disability Board of 
Review (DoD PDBR) recommendation and record of proceedings pertaining to the 
subject individual. Under the authority of Title 10, United States Code, section 1554a, 
I accept the Board’s recommendation to modify the individual’s disability rating to 10% 
without recharacterization of the individual’s separation. This decision is final. 

 

2. I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum. 

 

3. I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)