RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01526
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Calvary Scout, medically separated for “heat stroke,” with a disability rating of 0%.

CI CONTENTION:  The CI contended for elevated CPK levels and muscle fatigue.  The CI’s 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 Physical Evaluation Board (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 confined to 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 – 20050104	VARD - 20050516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Stroke, Resolved	7999-7900	0%	Residuals of Heat Stroke	7999-7900	0%	20041209	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Heat Stroke.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s first heat injury was approximately 2 years prior to referral for MEB.  The 3 November 2004 NARSUM, 5 months before separation, documented two episodes of heat exhaustion (October 2002 in Germany and August 2003 in Iraq) and one episode of heat stroke (May 2004 in Iraq).  The first episode of heat injury occurred after physical training.  The CI reported he experienced a 10-15 minute loss of consciousness, but stated he felt normal and fine upon regaining consciousness.  He denied any warning signs, symptoms of dizziness, lightheadedness, palpitations, chest pain, seizure activity, nausea/vomiting, weakness, postictal symptoms, tongue biting, or incontinence.  It was unclear as to whether the CI had an elevated oral temperature.  
He was diagnosed by a physician assistant (PA) with heat exhaustion, treated with intravenous (IV) fluids and cooling mist, and released from the Battalion Aid Station (BAS) 6 hours later.  The second episode of heat injury occurred during physical training while deployed in Iraq.  The CI reported weakness, dizziness, shortness of breath, and sweatiness, and fell to the ground.  He denied loss of consciousness, nausea, or vomiting.  The CI had an oral temperature of 101 at the BAS, was diagnosed with heat exhaustion by the battalion surgeon, and treated with oral hydration.  The third episode of heat injury occurred upon returning from a security convoy.  The CI was noted to have hot dry skin, sticky mucous membranes, an oral temperature of 101.5, and was minimally responsive to yelling at the BAS.  Cooling and resuscitation was initiated with fans, wet clothing, cold packs, ice, and IV fluids.  He was noted to have a core temperature of 104.8 and worsening mental status (Glasgow Coma Scale decreased from 13-14 to 10).  The CI was transferred to the Forward Surgical Team (FST) where he complained of multiple muscle aches and fatigue.  He was diagnosed with heat stroke and improved with cooling, IV fluid resuscitation, and medications.  The CI was evacuated out of theater via a Combat Support Hospital (CSH).  The findings from the physical exam were noncontributory and the examiner recounted the findings of the unremarkable muscle biopsy (minimal histologic change).  Heat injuries can be associated with rhabdomyolysis (syndrome of muscle necrosis and release of intracellular muscle constituents).  Serum muscle enzyme levels (creatine phosphokinase [CPK] also known as creatine kinase [CK]) may remain elevated for weeks.  Labs showed the CI was biochemically euthyroid (normal thyroid function) with a mid-normal thyroid stimulating hormone (TSH) level and serial CPK levels were elevated.  The diagnoses listed history of heat exhaustion (10/02 and 8/03) and heat stroke (5/04).  The examiner opined his prognosis was fair as he was at risk for recurrent heat injury.  The 9 December 2004 VA Compensation and Pension (C&P) examination recounted the history of heat injuries.  The CI denied current problems relating to his history of heatstroke and heat exhaustion.  In general, he could sustain heavy physical activities without immediate distress.  The physical examination was unremarkable and revealed no palpable thyroid mass and the heart had a regular rate and rhythm.  The examiner recounted the findings from the historical muscle biopsy, CK lab, and thyroid lab.  The diagnosis listed the above mentioned history of heat exhaustion and heatstroke.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 7900 code (hyperthyroidism) citing the resolved heat stroke occurrence with core temperature of 104 degrees, and the two occurrences of heat exhaustion as now asymptomatic but with increased risk for recurrence if exposed to high temperatures.  The VA assigned a 0% rating under an analogous 7900 code (hyperthyroidism) based on the VA C&P exam 4 months before separation, citing heat stroke with loss of consciousness in October 2002, recurrent heat stroke in August 2003 and May 2004 requiring hospitalization, increased risk for recurrent heat strokes if exposed to high temperatures, no current residuals of heat stroke, and no objective findings to warrant a compensable evaluation.  There was no tachycardia, which may be intermittent, and tremor, or continuous medication required for control consistent with the 10% rating under 7900.  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 heat stroke condition.  

BOARD FINDINGS:  In the matter of the heat stroke condition and IAW VASRD §4.71a, the Board unanimously or majority recommends no change in the PEB adjudication.  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 20140324, 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 AR2016001 0360 (PD201401526)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA