RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

SEPARATION DATE:  20080724 

 
NAME: XXXXXXXXXXXXXXX                                                                     BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200342 
BOARD DATE:  20121120 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  Soldier,  SGT/E-5  (68W/Combat  Flight  Medic), 
medically separated for left foot hammer toes of the 2nd 3rd, and 4th toes.  The CI had a long 
standing  history  of  foot  pain  which  failed  conservative  management  and  was  then  treated 
surgically in 2006.  He continued conservative treatment and also had surgical removal of the 
screws  in  2007.    Despite  this,  he  did  not  improve  adequately  with  treatment  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).    Chronic  postoperative  foot  pain  and  hammer  toes,  left  foot,  were  forwarded  to  the 
Physical  Evaluation  Board  (PEB)  as  medically  unacceptable  IAW  AR  40-501.    Hallux  valgus, 
myopia, and astigmatism, identified in the rating chart below, were forwarded by the MEB as 
medically acceptable.  The PEB adjudicated left foot hammer toes of the 2nd, 3rd, and 4th toes, 
and  the  pain  from  his  previous  joint  releases  in  toes  2  and  3  as  unfitting,  rated  10%,  with 
application  of  the  Veteran’s  Affairs  Schedule  for  Rating  Disabilities  (VASRD).    The  PEB 
adjudicated  the  hallux  valgus,  myopia,  and  astigmatism  as  not  unfitting.    The  CI  made  no 
appeals and was medically separated with a 10% disability rating.   
 
 
CI  CONTENTION:  The  CI  states:  “Rating  should  be  changed  due  to  the  extreme  amount  of 
hardship  these  disabilities  have  created  for  me  and  my  family.    See  attached  letter.”  The  CI 
attached  a  1  page  statement  to  his  application  which  was  reviewed  by  the  Board  and 
considered in its recommendations.  In it, he also contends for his left hip and shoulder.   
 
 
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 Board 
determined that only the left foot hammer toe condition is within its purview in this case.  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:   
 

Rating 

0% 
10% 
0% 
NSC 

Exam 
STRs 
STRs 
STRs 
STRs 

Service PEB – Dated 20080702 
Condition 

Code 
5282 

Rating 
10% 

Left Foot Hammer Toes … 
 
Hallux Valgus 
 
Myopia 

Not Unfitting 

Not Unfitting 

VA* – All Effective Date 20080725 

Condition 
L Foot, Hammer Toes … 
Hallux Valgus, L Foot, s/p bunionectomy 
Hallux Valgus, R Foot 
Astigmatism and Myopia Bilateral Eyes 

Code 
5282 
5280 
5280 

6099-6079 

Astigmatism 

Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

0% X 0 / Not Service-Connected x 1 

Combined:  10% 

STRs 

*CI failed to report for C&P Exam on 7/21/08. 
ANALYSIS SUMMARY:   
 
Left Foot Hammer Toes and Pain.  The CI had complained of painful feet for several years when 
he was found to have bunions and painful toe joints.  He had left foot surgery on 1 May 2006 
for hallux valgus (bunion) and hammer toes of the 2nd and 3rd digits.  His post-operative course 
was complicated only by sub-optimal compliance in keeping his foot elevated and continuing to 
use tobacco.  He healed well after the surgery both clinically and on X-ray examination, but had 
persistent  pain  which  lead  to  the  removal  of  screws  on  5  October  2007.    Again,  the  post-
operative course was unremarkable, but the pain persisted.  Magnetic resonance imaging (MRI) 
performed on 28 February 2008 showed mild arthritic changes in the base of left great toe.  On 
11 March 2008, it was determined that he had stabilized post-operatively, but did not meet the 
requirements of his MOS.  An orthopedic examination the next day determined that he should 
be given a P3 profile and referred to MEB for persistent “claw toes and bunion” of the left foot 
with pain.  The range-of-motion was reduced in both flexion and extension for the toes of the 
left foot.  At the MEB examination performed on 13 February 2008, the CI reported arthritis 
and limited use of the left foot.  The MEB physical examiner noted that the toes curled upward 
and annotated bilateral hammer toes.  The narrative summary (NARSUM) was dictated 25 June 
2008,  a  month  prior  to  separation.    It  noted  that  the  CI  had  reached  maximal  medical 
improvement and could not meet the requirements of his MOS.  The CI reported that his pain 
was tolerable unless exacerbated by activity.  On examination, he was noted to have bilateral 
hallux valgus (bunions), bilateral hammer toes of digits 2-4, and to be tender to palpation over 
the plantar aspect of the left 2nd and 3rd toes.  He was noted to fail retention standards for 
chronic post-operative pain of the left foot and left foot hammer toes.  The CI did not report for 
the  VA  Compensation  and  Pension  (C&P)  exam.    The  Board  directs  attention  to  its  rating 
recommendation based on the above evidence.  The single unfitting condition was the painful, 
persistent left hammer toe condition after surgical correction.  Rating the CI for both pain and 
for  the  presence  of  the  hammer  toes  is  not  permitted  under  VASRD  §4.3  (avoidance  of 
pyramiding).  The maximal disability for this condition is 10% under the code 5282.  Both the 
PEB  and  VA  used  this  code,  but  rated  the  condition  at  10%  and  0%,  respectively.    No  other 
coding option better fit the condition.  After due deliberation, considering all of the evidence 
and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient 
cause to recommend a change in the PEB adjudication for the painful left foot hammer toes 
condition.   
 
 
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. The Board did not surmise 
from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD  were 
exercised.  In the matter of the left hammer toes condition and IAW VASRD §4.71a, the Board 
unanimously recommends no change in the PEB adjudication.  There were no other conditions 
within the Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows:   
 

Left Foot Hammer Toes of the 2nd, 3rd and 4th Toes 

UNFITTING CONDITION 

 
 

 

VASRD CODE  RATING 

10% 
10% 

5282 

COMBINED 

 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120306, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXX, AR20120021437 (PD201200342) 
 
 
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 and hereby deny the individual’s application.   
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)