IN THE CASE OF: 

		BOARD DATE:  30 September 2022

		DOCKET NUMBER: AR20220000563


APPLICANT REQUESTS: correction of her DA Form 199-1 (Formal Physical Evaluation 
Board (PEB) Proceedings) to show she was found fit for continued military service. 

APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD:

*	DD Form 149 (Application for Correction of Military Record)
*	Exertional Exercise Test Results (Heat Tolerance Test)
*	Appeal to Formal PEB Decision and Request for Reconsideration of Formal PEB 
Results with supporting documents 

FACTS:

1.  The applicant states she was hospitalized in June 2020 because of an elevated 
creatine kinase (CK) level, which they diagnosed as a heat-related injury instead of 
exertional rhabdomyolysis, and which started the Integrated Disability Evaluation 
System (IDES) process resulting in her medical separation.

2.  Following service in the Army National Guard, the applicant enlisted in the Regular 
Army on 28 August 2014. 

3.  On 19 July 2021, a Formal PEB found the applicant unfit for further military service 
due to recurrent heat stroke. The DA Form 199-1 shows she first sought treatment for 
this condition in April 2019. The condition started during a 5-mile run and it was 
aggravated by participating in the Army Physical Fitness Test (APFT) in August 2019. In 
accordance with Army Regulation 635-40 (Disability Evaluation for Retention, 
Retirement, or Separation) she was unfit because the DA Form 3349, Physical Profile 
Record, Section 4, functional activity limitations associated with the condition make her 
unable to reasonably perform required duties.

4.  The PEB recommended a 0% disability rating and the applicant's separation with 
severance pay. 

5.  The DA Form 199-1 also shows the following statement:

FORMAL:  A formal hearing was held via adobe connect call on 25 May 2021, and 
was recessed, and then reconvened on 17 July 2021. Regarding the Soldier's 
contention that she is FIT for her recurrent heat stroke (condition):  The Board 
performed a review of the entire casefile, to include the Formal Board Contention 
Memorandum with exhibits, dated 24 May 2021, and the Formal Board was 
recessed on 25 May 2021 to gather additional information from the Military 
Treatment Facility [MTF] regarding the Soldier's condition. The MTF's responded 
that the Soldier has clearly had three episodes of exertional heat Illness in 24 
months, the last episode diagnosed as exertional rhabdomyolysis. The MTF further 
stated that if the Soldier is deployed and develops another episode of exertional heat 
illness in an austere environment, there is risk to the Soldier and the mission is now 
at risk because of the need for treatment and evacuation in addition to the risk of the 
Soldier's life. In sworn testimony, the Soldier testified that she developed this 
condition as a result of three separate events: training for Special Operation 
placement, medication, and fasting for weight loss for a body building competition. 
Based upon a review of the objective evidence of record, including the Soldier's 
testimony, testimony from Dr of the Uniformed Services University of the Health 
Sciences [USUHS] and exhibits provided during Formal Board proceedings, and 
medical evidence provided by the MEB [Medical Evaluation Board]; and considering 
the requirements for reasonable performance of duties required by rank and military 
specialty, the PEB finds this condition unfitting. The MEB found no evidence to 
support permanent profile downgrading to result in termination of DES process. 
Therefore, the current profiling restrictions did not support reversal of the findings of 
the Informal Board regarding the Soldier's condition. The Board recommends the 
Soldier be separated with severance pay at a combined rating of 0%. This case will 
be forwarded to the U.S. Physical Disability Agency [USAPDA] for further review and 
processing.

6.  On 18 August 2021, the applicant indicated she did not concur with the Formal 
PEB's findings and recommendation and that she was submitting a written appeal.

7.  The applicant, through counsel, submitted an appeal to the Formal PEB decision, 
dated 18 August 2021, arguing that while she did suffer heat related injuries in April and 
August 2019, both happened for explainable reasons with no lasting sequelae. The 
appeal also asserts that the applicant is fit for duty and can perform any and all of her 
duties, including deploying. The complete appeal to the Formal PEB was provided to 
the Board for their review and consideration.

8.  On 31 August 2021, the USAPDA provided the applicant's counsel with a response 
regarding the applicant's appeal to the PEB findings. It states:

   a.  In the Soldier's appeal, the results of a Heat Tolerance Test (HTT) performed at 
the USUHS on 8 November 2019 was presented. The medical evaluation at USUHS 
concluded that the Soldier could be gradually reintroduced to the heat in accordance 
with appropriate service-specific heat acclimatization guidelines and in consultation with 
the referring provider. However, the USUHS evaluation added a precautionary note in 
view of the previous heat strokes, advising maximum acclimatization to the local 
environment.

   b.  The Formal PEB was recessed to obtain additional medical information from the 
MEB, specifically if the Soldier's heat stroke and separate exertional rhabdomyolysis 
episodes required duty limitations and if they failed medical retention standards. On 
14 June 2021, the MEB responded to the PEB that while it could not say with total 
certainty that the Soldier would have another episode of heat injury and/or 
rhabdomyolysis, she was definitely at increased risk of recurrent heat injury as 
evidenced by the three episodes that had occurred in the previous 24 months. 
Therefore, the MEB declined to downgrade the permanent profile, which would have 
resulted in termination of the IDES process. The MEB noted full appreciation and 
consideration of the appeal documents, including the USUHS HTT results, and both the 
Director, Disability Evaluation System, and the Chief Medical Officer, Womack Army 
Medical Center concurred that the Soldier's condition fails to meet retention standards. 
As such, the PEB determined that the condition of recurrent heat stroke is an unfitting 
condition, thereby affirming its earlier findings.

   c.  On 18 August 2021, the Soldier appealed the PEB finding, requesting that she be 
found fit for duty for her recurrent heat stroke. In consideration of the totality of evidence 
presented by the Soldier, we requested a review of this case by the U.S. Army Office of 
the Surgeon General (OTSG). In its 27 August 2021 reply, the OTSG Consultant in 
Internal Medicine states that the Soldier had been found not fit for duty. As such, we 
concur with the PEB's finding that the condition of recurrent heat stroke is unfitting.

   d.  Our conclusion is that this case was properly adjudicated by the PEB, which 
correctly applied the rules that govern the Army Disability Evaluation System in making 
its determination. The findings and recommendations of the PEB are supported by a 
preponderance of evidence and are therefore affirmed. The issues raised in your 
18 August 2021 appeal were adequately addressed by the PEB in its formal board 
proceedings and we concur with the findings of the PEB. If your client feels that our 
findings are in error, any future submission for correction may be directed to the Army 
Board for Correction of Military Records (ABCMR).

9.  On 30 November 2021, the USAPDA provided a second response to the applicant's 
appeal and added the following statement:

The case was submitted again for review on the basis of a 24 November 2021 
report of an evaluation by the Department of Neurology, Walter Reed National 
Military Medical Center. This evaluation found the presence of no genes associated 
with susceptibility to exertional rhabdomyolysis and heat injury. On the basis of this 
testing, the examiner stated that in view of the Soldier's normal gene testing and 
her continued physical performance over the past year, it would be "reasonable" to 
downgrade her physical profile limitations. However, in view of the previously 
documented, recurrent episodes of heat injury including rhabdomyolysis 
experienced by the Soldier and the OTSG determination that the Soldier is unfit for 
the condition of recurrent heat stroke, we concur with the PEB finding that recurrent 
heat stroke is an unfitting condition.

10.  The applicant's DD Form 214 (Certificate of Release or Discharge from Active Duty) 
shows she was discharged on 30 December 2021 under the provisions of Army 
Regulation 635-40, paragraph 4-27c(3), by reason of disability, severance pay, 
non-combat related.

11.  MEDICAL REVIEW:

The Army Review Boards Agency (ARBA) Medical Advisor was asked to review this 
case. Documentation reviewed included the applicant’s ABCMR application and 
accompanying documentation, the military electronic medical record (AHLTA), the VA 
electronic medical record (JLV), the electronic Physical Evaluation Board (ePEB), the 
Medical Electronic Data Care History and Readiness Tracking (MEDCHART) 
application, and/or the Interactive Personnel Electronic Records Management System 
(iPERMS).  The ARBA Medical Advisor made the following findings and 
recommendations:  

    a.  The applicant has applied to the ABCMR requesting reversal of the Army’s 
physical evaluation board’s finding that her “Recurrent heat stroke” was an unfitting 
medical condition for continued military service.  She states: “I was hospitalized on 6 
June 2020 because of an elevated CK level which they diagnosed as a Heat-related 
injury instead of exertional rhabdomyolysis which started the IDES process to me 
getting medically separated.” 

    b.  The Record of Proceedings details the applicant’s service and the circumstances 
of the case.  Her DD 214 for the period of Service under consideration shows she 
entered the Regular Army on 28 August 2014 and was honorably discharged with 
$54,489.60 of disability severance pay on 30 December 2021 under provisions provided 
in paragraph 4-27c(3) of AR 635-40, Physical Evaluation for Retention, Retirement, or 
Separation (19 January 2017).  

    c.  A Soldier is referred to the Integrated Disability Evaluation System (IDES) when 
they have one or more conditions which appear to fail medical retention standards 
reflected on a duty liming permanent physical profile.  At the start of their IDES 
processing, a physician lists the Soldiers referred medical conditions in section I the 
VA/DOD Joint Disability Evaluation Board Claim (VA Form 21-0819).  The Soldier, with 
the assistance of the VA military service coordinator, lists all other conditions they 
believe to be service-connected disabilities in block 8 of section II of this form, or on a 
separate Application for Disability Compensation and Related Compensation Benefits 
(VA Form 21-526EZ).   

    d.  Soldiers then receive one set of VA C&P examinations covering all their referred 
and claimed conditions.  These examinations, which are the examinations of record for 
the IDES, serve as the basis for both their military and VA disability processing.  The 
medical evaluation board (MEB) uses these exams along with AHLTA encounters and 
other information to evaluate all conditions which could potentially fail retention 
standards and/or be unfitting for continued military service.  Their findings are then sent 
to the physical evaluation board for adjudication.  

    e.  All conditions, both claimed and referred, are rated by the VA using the VA 
Schedule for Rating Disabilities (VASRD).  The physical evaluation board (PEB), after 
adjudicating the case, applies the applicable ratings to the Soldier’s unfitting 
condition(s), thereby determining his or her final combined rating and disposition.  Upon 
discharge, the Veteran immediately begins receiving the full disability benefits to which 
they are entitled from both their Service and the VA.

    f.  On 18 June 2020, the applicant was referred to the IDES for “Recurrent heat 
stroke.”  The applicant claimed six additional conditions on a separate Application for 
Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ).  

    g.  A medical evaluation board (MEB) determined her recurrent heat stroke failed the 
medical retention standards of AR 40-501, Standards of Medical Fitness and that eight 
other conditions met medical retention standards.  Her recurrent heat stroke as 
documented on his MEB narrative summary:

(1) “RECURRENT HEAT STROKE

(2)  Medical Basis for Diagnosis: In Apr 2019, SM {Service Member} suffered a 
heat injury (had loss of consciousness after exertion in an outdoor environment).  
Core temperature was recorded at 105.4 degrees Fahrenheit at the time of 
evaluation by EMTs.  See AHLTA notes dated 24 Apr 2019, 21 Aug 2019 and 10 
Dec 2019.  She has not had ongoing symptoms of heat intolerance with exertion 
since this occurrence; however, she did have an episode or rhabdomyolysis, in 
Jun 2020, following intense exercise that required admission to the hospital for 
treatment with intravenous fluids (IVFs).  In Dec 2019, she had a heat tolerance 
test that was normal.

(2)  On 29 Oct 2020, WRNMMC {Walter Reed National Military Medical Center} 
Neurophysiologist recommended that the SM have further laboratory work up 
and that her profile ‘can be advanced to: Physical training and running, walking, 
swimming, or bicycling at own pace and duration not to exceed 60 minutes per 
day.  No maximal effort; no APFT {Army Physical Fitness Test}; no wear of 
Interceptor Multi-Threat Body Armor (IBA); no mission oriented protective posture 
(MOPP) gear; no ruck marching.  No airborne operations (AO).  Would wait for 
genetic testing to further advance profile.’ These changes have been made to her 
profile.”

(3)  Prognosis Statement:  SM has had heat strokes during her Military service. 
With continued modification of activity and lifestyle changes, it is possible that the 
condition will remain stable over the next 3-5 years.  However, the rigors of 
Soldiering would most likely aggravate the condition.

(4)  Selection of Applicable AR 40-501, Chapter 3 Provision with Discussion: 

(5)  Recurrent heat stroke does not meet retention standards per AR 40-501; 
paragraph 3-27a(1), because SM continues to necessitate significant limitations 
of duty. The SM’s inability to comfortably and effectively perform certain physical 
requirements of MOS duties and/or certain Soldier Functional Activities (as noted 
in Sections 6, 7c, and the Commander’s Statement) is unlikely to improve with 
continued military service. The condition(s) significantly limit or interfere with 
Soldier’s performance of duties and would compromise or aggravate Soldier’s 
health or well-being if SM were to remain in the military.

    h.  The applicant appealed the MEB’s finding, requesting her condition be found to 
meet medical retention standards and her IDES case be administratively terminated.  
Her appeal was denied, and her case, along with her appeal, was forwarded to a 
physical evaluation board (PEB) for adjudication.

    i.  On 8 October 2021, the applicant’s informal PEB found her recurrent heat stroke to 
be the sole unfitting for continued military service.  They found the eight remaining 
medical conditions not unfitting for continued service.  The PEB applied the Veterans 
Benefits Administration (VBA) derived rating of 0% and recommended the applicant be 
separated with disability severance pay.  The applicant non-concurred with the PEB’s 
recommendation and demanded a formal hearing.

    j.  The applicant was electronically present for and represented by regularly 
appointed counsel at her formal PEB on 17 July 2021.  This Board affirmed the informal 
PEB’s finding that the applicant’s recurrent heat stroke was an unfitting medical 
condition for continued military service:

(1)	FORMAL: …  Regarding the Soldier’s contention that she is FIT for her 
recurrent heat stroke (condition): The Board performed a review of the entire 
case file, to include the Formal Board Contention Memorandum with exhibits, 
dated 24 May 2021, and the Formal Board was recessed on 25 May 2021 to 
gather additional information from the Military Treatment Facility {MTF} 
regarding the Soldier’s condition. 

(2)	The MTF’s responded that the Soldier has clearly had three episodes of 
exertional heat Illness in 24 months, the last episode diagnosed as exertional 
Rhabdomyolysis. The MTF further stated that if the Soldier is deployed and 
develops another episode of exertional heat illness in an austere 
environment, there is risk to the Soldier and the mission is now at risk 
because of the need for treatment and evacuation in addition to the risk of the 
Soldier’s life. 

(3)	In sworn testimony, the Soldier testified that she developed this condition as a 
result of three separate events: training for Special Operation placement, 
medication, and fasting for weight loss for a body building competition. Based 
upon a review of the objective evidence of record, including the Soldier’s 
testimony, testimony from Dr. of the Unified Services University of the Health 
Sciences, and exhibits provided during Formal Board proceedings, and 
medical evidence provided by the MEB; and considering the requirements for 
reasonable performance of duties required by rank and military specialty, the 
PEB finds this condition unfitting. 

    k.  The applicant non-concurred again and appealed to the United States Army 
Physical Disability Agency with a written appeal.  The  USAPDA reconfirmed the formal 
PEB’s unfit finding in their 30 November 2021 response: “The case was submitted again 
for review on the basis of a 24 November 2021 report of an evaluation by the 
Department of Neurology, Walter Reed National Military Medical Center.  This 
evaluation found the presence of no genes associated with susceptibility to exertional 
rhabdomyolysis and heat injury.  On the basis of this testing, the examiner stated that in 
view of the Soldier's normal gene testing and her continued physical performance over 
the past year, it would be "reasonable" to downgrade her physical profile limitations. 
However, in view of the previously documented, recurrent episodes of heat injury 
including rhabdomyolysis experienced by the Soldier and the OTSG {Office of the 
Surgeon General} determination that the Soldier is unfit for the condition of recurrent 
heat stroke, we concur with the PEB finding that recurrent heat stroke is an unfitting 
condition.”

    l.  While the applicant’s desire to remain in the United States Army in both 
understandable and commendable, her retention in the Army was not in the best 
interest of her health, her fellow Soldiers, or the Army.  According to paragraph of 3-1 of 
AR 40-504, Standards of Medical Fitness (27 June 2019), the applicant’s condition 
failed medical retention standards several reasons:

“3-1.  General …To be deployable, Soldiers should be ready to deploy within 72 
hours of receipt of an assigned mission as defined in Army and DOD policy. 
These medical conditions and/or physical defects, individually or in combination, 
are those that have met the clinical or administrative medical retention decision 
point —

a.  Significantly limit or interfere with the Soldier’s performance of their duties 
(either basic Soldier skills or MOS specific) as substantiated by the Soldier’s 
commander or supervisor. 
c.  Restrict performance of any of the profile functional activities listed in 
Section 4 of DA Form 3349 (Physical Profile); prevent the performance of all 
aerobic events of the APFT (see AR 40 – 502 for descriptions and 
instructions on physical profiles); have met a clinical medical retention 
determination point (MRDP); or have been temporarily profiled for more than 
365 days, meeting the administrative MRDP. 
d.  May compromise or aggravate the Soldier’s health or well-being if they 
were to remain in the military Service.” 

    m.  Review of his PEB case file in ePEB revealed no substantial inaccuracies in or 
discrepancies.

    n.  It is the opinion of the ARBA Medical Advisor there is no probative evidence upon 
which to base a reversal the PEB’s finding of unfitness and thus the application should 
be denied.     


BOARD DISCUSSION:

After reviewing the application, all supporting documents, and the evidence found within 
the military record, the Board found that relief was not warranted. The applicant’s 
contentions, the military record, and regulatory guidance were carefully considered. The 
evidence of record shows an informal PEB found the applicant’s recurrent heat stroke to 
be unfitting. The PEB applied the VA derived rating of 0% and recommended the 
applicant be separated with disability severance pay. The formal PEB affirmed the 
informal PEB’s finding that the applicant’s recurrent heat stroke was an unfitting medical 
condition for continued military service. The USAPDA reconfirmed the formal PEB’s 
unfit finding in their response after a determination was made that she is in fact unfit for 
the condition of recurrent heat stroke. The Board agreed with the medical advisor’s 
finding that the PEB revealed no substantial inaccuracies in or discrepancies and 
determined there is no probative evidence upon which to base a reversal the PEB’s 
finding of unfitness. 

BOARD VOTE:

Mbr 1	Mbr 2	Mbr 3

:	:	:	GRANT FULL RELIEF

:	:	:	GRANT PARTIAL RELIEF

:	:	:	GRANT FORMAL HEARING

:X	:X	:X	DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or 
injustice.  Therefore, the Board determined the overall merits of this case are insufficient 
as a basis for correction of the records of the individual concerned.1. 

		  
I certify that herein is recorded the true and complete record of the proceedings of the 
Army Board for Correction of Military Records in this case.
REFERENCES:

1.  Army Regulation 40-501 (Standards of Medical Fitness) provides information on 
medical fitness standards for induction, enlistment, appointment, retention, and related 
policies and procedures. Chapter 3 lists the various disqualifying medical conditions 
and/or physical defects which may render a Soldier unfit for further military service and 
which fall below the standards required. To be deployable, Soldiers should be ready to 
deploy within 72 hours of receipt of an assigned mission as defined in Army and 
Department of Defense (DoD) policy. These medical conditions and/or physical defects, 
individually or in combination, are those that have met the clinical or administrative 
medical retention decision point and:

	a.  Significantly limit or interfere with the Soldier’s performance of their duties (either 
basic Soldier skills or military occupational specialty specific) as substantiated by the 
Soldier’s commander or supervisor. 

	b.  Require medication for control that requires frequent monitoring by a physician 
due to debilitating or serious side effects, medical care, or hospitalization with such 
frequency as to interfere with the satisfactory performance of duty. 

	c.  Restrict performance of any of the profile functional activities listed in Section 4 of 
DA Form 3349; prevent the performance of all aerobic events of the APFT; have met a 
clinical medical retention determination point (MRDP); or have been temporarily profiled 
for more than 365 days, meeting the administrative MRDP. 

	d.  May compromise or aggravate the Soldier’s health or well-being if they were to 
remain in the military Service. This may involve dependence on certain medications, 
appliances, severe dietary restrictions, frequent special treatments, or a requirement for 
frequent clinical monitoring. 

	e.  May compromise the health or well-being of other Soldiers (for example, a carrier 
of communicable disease who poses a health threat to others). 

	f. May prejudice the best interests of the U.S. Government if the individual were to 
remain in the military Service.

2.  DoD Instruction 1332.18, Appendix 2 to Enclosure 3, paragraph 2.a states a Service 
member will be considered unfit when the evidence establishes that the member, due to 
disability, is unable to reasonably perform duties of his or her office, grade, rank, or 
rating, including those during a remaining period of Reserve obligation.

3.  Army Regulation 635-40, chapter 5, section I (Policies for Determining Fitness and 
Permanence and Stability of Unfitting Conditions) states that in making a determination 
of unfitness, the following criteria may be included in the assessment:

	a.  The medical condition represents a decided medical risk to the health of the 
Soldier or to the welfare of other Soldiers were the Soldier to continue on active duty or 
in an active Reserve status.  

	b.  The medical condition imposes unreasonable requirements on the Army to 
maintain or protect the Soldier.  

	c.  The Soldier’s established duties during any remaining period of Reserve 
obligation.

4.  Section 1556 of Title 10, U.S. Code, requires the Secretary of the Army to ensure 
that an applicant seeking corrective action by ARBA be provided with a copy of any 
correspondence and communications (including summaries of verbal communications) 
to or from the Agency with anyone outside the Agency that directly pertains to or has 
material effect on the applicant's case, except as authorized by statute. ARBA medical 
advisory opinions and reviews are authored by ARBA civilian and military medical and 
behavioral health professionals and are therefore internal agency work product. 
Accordingly, ARBA does not routinely provide copies of ARBA Medical Office 
recommendations, opinions (including advisory opinions), and reviews to ABCMR 
applicants (and/or their counsel) prior to adjudication.

//NOTHING FOLLOWS//
ABCMR Record of Proceedings (cont)	 AR20220000563


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ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

RECORD OF PROCEEDINGS


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