RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX	CASE: pd-2014-00798  
BRANCH OF SERVICE:  Army	SEPARATION DATE: 20081212 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Radio Operator/Maintainer, medically separated for “rhabdomyolysis” and was medically separated with a 0% disability rating.  

CI CONTENTION:  The CI requested a review of all conditions: those unfitting and contended which included a large number of conditions not listed or considered by the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB). His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.   

RATING COMPARISON:  

 SERVICE PEB - 20080903	VA - 20090217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rhabdomyolysis	7999-7900	0%	Rhabdomyolysis, Myoglobinuria	7532	NSC	20081028	
Anterior Knee Pain	Not Unfitting	Left Knee Condition	5260	NSC		
		Right Knee Condition	5260	NSC		
Plantar Fasciitis	Not Unfitting	Bilateral Plantar Fasciitis	5024	0%		
Attention Deficit Disorder	Not Unfitting	Adjustment Disorder with Anxiety	9440	30%	20081112	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:   

Rhabdomyolysis.  According to the service treatment records (STR) and the September 2007 MEB narrative summary (NARSUM), the CI was hospitalized for 3 days in July 2007 for his condition of myoglobinuria.  It was noted that in July 2007, after completing his workout, he had aching pain over his upper body that gradually improved over the course of about a week.  Approximately 2 days after the workout he noticed that his urine was much darker than normal.  He was referred to a German doctor and subsequently admitted to the hospital for re-hydration therapy.  He was discharged to outpatient follow-up.  The NARSUM recorded the diagnosis of exertional rhabdomyolysis and noted that he took no medication for his condition.  The first post-hospitalization follow-up note dated 10 July 2007 documented normal urine color; however, he had continued to have shoulder pain.  He was prescribed 72 hours of quarters.  Laboratory results dated 12 July 2007 documented a creatine kinase (CK) level of 29, 106 (normal is 55-170).  A clinic entry dated 24 July 2007 noted his CK and liver function tests were still elevated but were “showing decreasing pattern.”  There was an entry in the treatment record dated 13 December 2007 that cited the reason for the appointment as “Part II MEB” however, the examiner noted this was actually a re-evaluation Board.  The examiner recorded a history of exertional rhabdomyolysis.  At the visit, the CI reported no symptoms and indicated that he performed moderate activity without symptoms.  It was concluded that the CI was recovering well but had residual CK elevation.  Lab work in March and June 2008 documented CK value of 107.  

The final NARSUM was accomplished in August 2008.  The CI noted he had continued to experience arm pain; however, it had gotten better with time.  The pain he experienced was described as a “soreness pain.”  He noted he had taken a few tablets of Motrin after he was discharged from the hospital, and was not taking any medication.  He had continued to ride his bike, rollerblade, and play baseball, racquetball, and soccer. He also water skied and worked out with weights.  Physical examination was unremarkable.  The physician diagnosed recurrent myoglobinuria/rhabdomyolysis and noted his condition was stable.

The VA Compensation and Pension examination was conducted approximately 10 weeks before separation.  That examination also noted the condition was stable.  The CI reported at times he had mild increases in muscle enzymes after activity, but his urine was not dark.  His CK value that day was slightly elevated (206) and his urinalysis was normal.  The physical examination was unremarkable.

The PEB used the analogous 7900 code (hyperthyroidism) and rated the condition at 0%, citing the CK level had returned to normal, and the CI had returned to regular activities.  His condition was considered unfit for further military service due to risk of recurrence.  As noted above, the VA did not service connect this condition, noting the absence of permanent residual or chronic disability.  A 10% rating under the 7900 and 5025 (fibromyalgia) codes requires continuous use of medication for control of the condition which was not supported by the evidence.  In the 12 months before separation, the medication profile recorded two, 30-day prescriptions (June and August 2008) for Ibuprofen, prescribed for pain as needed.  The final NARSUM and the VA examination noted the CI was not taking any medication for this condition.  The Board could not find justification for considering a rating under any of the muscle codes since there was no residual impairment.  The Board also considered a rating under the 5021 code (myositis) which requires limitation of motion, painful motion (§4.59) or pain with use (§4.40) for a compensable rating.  Board members agreed there were no examination findings supporting a higher rating.  There was no path to coding higher than a 0% rating level.  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 rhabdomyolysis condition.  

Contended PEB Conditions: Anterior Knee Pain, Plantar Fasciitis, and Attention Deficit Disorder (ADD). The Board’s main charge is to assess the fairness of the PEB’s determination that the anterior knee pain, plantar fasciitis, and attention deficit disorder were not unfitting.  The Board undertook a careful review of the available record and first considered the knee condition.  The record documented the report of bilateral knee pain right greater than left, since 2004.  Radiographs and imaging studies were negative.  The orthopedic examination in September 2008 documented normal range of motion in both knees and no evidence of knee instability.  The STRs related to the plantar fasciitis condition were silent.  The Board acknowledged the ADD diagnosis; however, IAW DoDI 1332.38, the condition of ADD is not a condition that constitutes a physical disability and therefore is not eligible for service disability rating.  The conditions of anterior knee pain, plantar fasciitis, and ADD were not profiled nor implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the rhabdomyolysis condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anterior knee pain, plantar fasciitis, and ADD conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140220, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160010623 (PD201400798)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA