RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01981
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20141231
SEPARATION DATE:  20030315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Fire Support) medically separated for heat related injuries with subsequent cardiovascular instability.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The “heat related injuries with subsequent cardiovascular instability” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “heat related injuries with subsequent cardiovascular instability)” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.  Also, heat related illness, knee and back.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  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/Naval 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:

IPEB – Dated 20020115	VA* - (~13 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Related Injuries w/Subsequent Cardiovascular Instability	7999-7900	10%	Status Post Heat Exhaustion	8999-8911	0%	20020204	
Other x 0 (Not In Scope)	Other x 11 	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20100923 (original VARD not in record).

ANALYSIS SUMMARY:

Heat Related Injuries.  The service treatment record contained few, but detailed documents with regard to the heat injury.  The CI experienced multiple heat-related physical symptoms to include syncope (passing out) during the period of 1999 and the summer of 2000.  His symptoms were lightheadedness, dizziness, weakness and nausea.  There were no reported persistent altered mental changes or active seizure activity.  Occasionally, he was treated in the emergency room without overnight stay.  Intermittent tachycardia was present with heat-related diagnoses.  All abnormal vital signs or laboratory values were normalized either before release from the medical facility or upon follow-up evaluation.  Extensive laboratory metabolic work-up and tilt-table (blood pressure response) testing revealed no pathologic heat-related or cardiovascular residuals.  He was referred for an MEB in January 2001.  The narrative summary examination performed on 25 July 2001 (8 months prior to separation) was a historical recap of his condition without new or present complaints.  The physical examination (PE) was normal.  His pulse was normal at 66 beats per minute and his pulse pressure also normal at 54 (normal range = 40-60).  At the VA Compensation and Pension examination, performed 6 weeks prior to separation, the CI reported continued pre-syncope symptoms with full body cramps when he “fully exerts himself” in hot environments.  The PE was normal including vital signs and blood pressure parameters.  His diagnosis was heat exhaustion on multiple occasions without residuals.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10%, coded 7999-7900 (analogous to hyperthyroidism).  The VA rated the condition at 0% coded 8999-8911 (analogous to epilepsy).  There is not a specific VASRD code for such a heat-related injury and, the PEB’s 7900 thyroid code is often analogized for such conditions.  Board members considered that in the absence of abnormal functional residuals or significant impact on occupational and social activity, the heat-related condition was of mild severity.  Board members also agreed that the analogized VASRD 7900 code most accurately depicted the CI’s condition and that the PEB’s 10% rating was supported IAW VASRD §4.119 for intermittent tachycardia and associated full-body cramping.  The Board was unable to find any pathway to a higher rating than the PEB’s 10%.  Code 7900 at 30% criteria is not applicable in this case having retained a normal pulse pressure.  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 recurrent heat injury 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.  In the matter of the heat-related condition and IAW VASRD §4.119, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 18 May 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC

			  XXXXXXXXXXXXXXX
	     		  Assistant General Counsel
			  (Manpower & Reserve Affairs)