BRANCH OF SERVICE:  MARINE CORPS 
SEPARATION DATE:  20031021 

 
NAME:  XX 
CASE NUMBER:  PD1200883 
BOARD DATE:  20130207 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty LCPL/E-3 (3043/AFSC, JOB), medically separated for 
moderate  bunion  deformity,  left  foot,  status  post  (s/p)  surgery,  and  moderate  bunion 
deformity,  right  foot,  patient  refused  surgery.    The  CI  was  diagnosed  with  a  diagnosis  of 
bilateral bunions, (left operated) on March 3, 2003.  The CI refused surgery on the right foot 
after  experiencing  significant  pain  after  surgery  on  the  left  bunion.    He  did  not  improve 
adequately  after  treatment  to  meet  the  physical  requirements  of  his  Military  Occupational 
Specialty (MOS) or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) 
and referred for a Medical Evaluation Board (MEB).  The MEB forwarded no other conditions 
for  Physical  Evaluation  Board  (PEB)  adjudication.    The  PEB  adjudicated  the  moderate  bunion 
deformity, left foot, operated as unfitting, rated 10%, with application of the Veterans Affairs 
Schedule for Rating Disabilities (VASRD.  The “moderate bunion deformity, right foot, patient 
refused surgery” condition was determined to be willful neglect IAW SECNAVINST 1850.4E and 
not ratable.  The CI made no appeals and was medically separated with a 10% disability rating.   
 
 
CI CONTENTION:  “Other medical conditions which were physical and mental that are in medical 
record.” 
 
 
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.  Only the bunion conditions are within the 
Board’s purview.  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 
Board for Correction of Naval Records. 
 
 
RATING COMPARISON:   
 

Service PEB – Dated 20030429 

VA (16 Mos. Post-Separation) – All Effective Date 20031022 

Condition 

Mod. Bunion Deformity, 
Left Foot,  
Mod. Bunion Deformity, 
Right Foot,  

Code 
5280 

Rating 
10% 

Condition 

Mod. Bunion Deformity, L Foot 
Scar, Residual … Left Foot 

 

IM/WN  Mod. Bunion Deformity, R Foot 

Code 
5280 
7804 
5280 

Rating 
10% 
10% 
0% 

Exam 

20040920 
20040920 
20040920 

RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

 Not Service-Connected x 2 
Combined:  20% 

 

 
 
ANALYSIS SUMMARY:   
 
Moderate  Bunion  Deformity,  Left  Foot  Operated  Condition.    The  first  documented  visit  for 
bunions was on 7 February 2002, 14 months after accession, when he noted a 2 year history of 

bilateral  foot  pain.    A  family  member  had  recently  had  a  bunionectomy  and  he  desired  the 
same.    He  was  next  seen  on  7  August  2002  when  he  noted  a  history  of  bunions  since  high 
school which had gradually worsened over time.  On 23 October 2002, a left bunionectomy was 
performed.  A second procedure on the right was anticipated after the CI had recovered from 
the  first  surgery.    Recovery  was  complicated  by  significant  post-operative  pain  for  which  he 
underwent hardware removal without significant relief.  A local steroid injection relieved the 
pain temporarily.  The narrative summary (NARSUM) dictated on 3 March 2003, 7 months prior 
to  separation,  and  noted  that  the  CI  had  declined  surgery  on  the  right  toe  due  to  the  post-
operative  pain  on  the  left.    The  examiner  noted  that  there  was  no  discernable  swelling  or 
increased warmth of the left great toe and that the motion was satisfactory.  He was noted to 
have had no improvement in his pain “despite the fact that there are not objective reasons for 
the pain.”  At the MEB examination on 25 March 2003, the CI reported that he had residual 
pain and reduced movement of the left great toe after surgery.  The only comment on the right 
was  to  note  the  presence  of  a  bunion.    The  MEB  physical  exam  documented  no  specific 
findings.  At the VA Compensation and Pension (C&P) examination on 20 September 2004, 11 
months  after  separation,  the  CI  reported  that  his  symptoms  began  in  boot  camp  and  were 
aggravated by the use of boots.  He stated that he could walk ½ to a mile before developing 
pain  in  his  feet.    He  did  not  require  the  use  of  special  shoes.    On  examination,  his  gait  was 
normal.    There  was  tenderness  over  the  distal  left  great  toe  and  the  scar;  the  latter  was 
otherwise well healed.  The range-of-motion (ROM) was noted to be normal.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB and VA both rated the left bunionectomy condition at 10% and coded it as 5280, hallux 
valgus (bunion).  The Board determined that this is the appropriate code and that no higher 
rating  is  available  under  this  code.    The  VA  also  rated  the  scar.    There  was  no  impairment 
attributed to the scar in the service treatment records (STRs).  The use of shoe of comfort was 
only in the post-operative period.  The VA examination documented a normal gait and that the 
CI  did  not  require  the  use  of  special  shoes.    By  precedent,  the  Board  does  not  recommend 
separation rating for scars unless their presence imposes a direct limitation on fitness.  No such 
permanent limitation was in evidence.  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 left bunionectomy condition.   
 
Moderate Bunion Deformity, Right Foot Surgery Refused by the Patient Condition.  As noted 
above, the CI endorsed a history of bilateral bunions since high school and that other family 
members also had bunions.  The CI reported a history of pain which preceded accession at the 
initial visit in 2002.  The CI declined surgery.  His decision was thought to be unreasonable and 
he  signed  a  Form  6100/4,  Certificate  of  Counseling,  indicating  such.    The  Board  found  no 
evidence that there had been more than natural progression of the condition while in service 
and that the CI had declined reasonable treatment.  Accordingly, the record does not support a 
finding that the right bunion was separately unfitting.  After due deliberation in consideration 
of the preponderance of the evidence, the Board concluded that there was insufficient cause to 
recommend  a  change  in  the  PEB  fitness  determination  for  the  right  bunion  condition.    The 
Board  concluded  therefore  that  this  condition  could  not  be  recommended  for  additional 
disability rating.   
 
 
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  rating  the  left  bunion.    As  discussed  above,  PEB  reliance  on  SECNAVINST 
1850.4E was operant in this case in the fitness determination of the right bunion.  In the matter 

2                                                           PD1200883 

of  the  left  and  right  bunion  conditions  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:   
 

UNFITTING CONDITION 
Moderate Bunion Deformity, L Foot Operated 
Moderate Bunion Deformity, R Foot, Surgery Refused by the 
Patient 

VASRD CODE  RATING 

5280 
N/A 

10% 

IM/WN 

COMBINED 

10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120620, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 

 

 
 

 

 

xx 
Acting Director 
Physical Disability Board of Review 

3                                                           PD1200883 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW  
                                        BOARDS  

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

Ref:   (a) DoDI 6040.44 

             (b) CORB ltr dtd 22 Mar 13 
 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, approve the recommendations of the 
PDBR that the following individual’s records not be corrected to reflect a change in either 
characterization of separation or in the disability rating previously assigned by the Department of 
the Navy’s Physical Evaluation Board: 
 
 
 

 
 

 

 

     
 
 
 
 

-   former USMC 
-   former USN  
-   former USMC 
-   former USMC 
-   former USN  
-   former USMC 
-   former USMC 
  

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  xx 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

4                                                           PD1200883