RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-02026
BRANCH OF SERVICE:  Army	BOARD DATE:  20140925
SEPARATION DATE:  20060922

SUMMARY OF CASE:  The available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92M/Mortuary Affairs Specialist) medically separated for multiple reoccurring episodes of heat exhaustion.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded heat exhaustion condition, characterized as “heat exhaustion, unspecified,” to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (chronic low back pain [LBP], bilateral shoulder pain and dysthymic disorder) for PEB adjudication.  The Informal PEB adjudicated the heat exhaustion condition as unfitting, rated at 0%.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting heat exhaustion condition and not unfitting and contended chronic low back pain, bilateral shoulder pain and dysthymic disorder conditions are addressed below.  Any condition 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 Military Records.

RATING COMPARISON:

Service IPEB – Dated 20060623	VA* - (~11 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Heat Exhaustion	7999-7900	0%	Heat Exhaustion	8999-8911	NSC	20070829	
Chronic Low Back Pain	Not Unfitting	Osteoarthritis of the Lumbar Spine…	5243	10%	20070829	
Bilateral Shoulder Pain	Not Unfitting	Residuals of AC Joint Separation Surgery, Right Shoulder	5201-5024	10%	20070829	
		Residuals of AC Joint Separation Surgery, Left Shoulder	5201-5024	10%	20070829	
Dysthymic Disorder	Not Unfitting	Post-Traumatic Stress Disorder	9411	30%	20070910	
Other x 0 (Not in Scope)	Other x 2 (Not in Scope)	20070829	
Rated:  0%	Combined:  50%	
*Derived from VA Rating Decision (VARD) dated 20080307 (most proximate to the date of separation)

ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention for ratings of his chronic LBP, bilateral shoulder pain and dysthymic disorder noted above which were determined to be not unfitting by the PEB; and, emphasizes that disability compensation may only be offered for those conditions that cut short the member’s career.  Should the Board judge that any contested conditions were most likely incompatible with specific duty requirements; a disability rating IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD) and based on the degree of disability evidenced at separation, will be recommended.

Heat Exhaustion Condition:  The evidence documented that the CI had at least four episodes of heat injury/exhaustion within a 5-year period prior to his separation.  There are no service treatment records (STR) present for review that was generated during his acute episodes.  The narrative summary prepared (approximately 6 months prior to separation), noted his first episode occurred in the summer of 2003.  He stated he lost consciousness due to the heat and was revived at the battalion aid station with conventional cooling techniques followed by light duty profiling.  He subsequently had three-to-four more episodes of heat exhaustion, all treated with outpatient cooling techniques and profiling.  The physical examination was normal.  All laboratory tests including thyroid function tests were essentially normal.  The examiner diagnosed heat exhaustion and made to following statement concerning functional status:

“Service member states that he can perform his MOS both in garrison and in the field.  He is able to carry and fire a weapon.  He is able to wear a Kevlar helmet, ride in tactical vehicles and work in cold environments.  He is not able to wear MOPP gear, load-bearing equipment, Kevlar vest or 40-pound rucksack.  He is not able to work in hot environments.”

At the VA Compensation and Pension examination (performed 11 months after separation), the CI reported during the acute heat injury he was hydrated and he had some heat intolerance; otherwise, he has no functional impairment, no residuals from heat exhaustion since 2004.  The examiner made the following concluding statement concerning the heat injury:

“DIAGNOSIS: Heat exhaustion/dehydration, resolved.  Subjective Factors: The patient states he is intolerant to hot weather.  Objective Factors: Physical exam is unremarkable.  The patient did not have the stroke.  Had dehydration and that resolved with the IV fluids.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the recurrent heat intolerance and injury condition by applying the analogous VASRD code of 7999-7900 (hyperthyroidism) and rating it 0%.  The VA applied the analogous code of 8999-8911 (petit mal epilepsy) and did not grant service-connection for heat exhaustion.  There is no specific VASRD code for heat intolerance or injury so IAW VASRD rating principle §4.20 analogous ratings were applied.  This principle states, “When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous.”  

The Board reviewed the VA coding and rating scheme and members agree that the CI’s heat injuries were incurred while in service and did not “closely represent” petit mal epilepsy.  The symptomatology aspect of the hyperthyroid condition is what will form the basis for the Board’s rating recommendation.  Rating under VASRD code 7900 takes into consideration the symptoms manifested or need for continuous medication for disease control.  There were no STRs evident that documented any physical findings during the acute episodes but there were STRs that documented normal vital signs and temperature with no residual problems in between episodes.  CI manifested intermittent elevated heart rate as a symptom only during the acute phase of his heat injury and did not have the tremor or continuous medication requirement as necessary for a 10% rating.  Therefore, IAW VASRD §4.31, which states, “in every instance where the schedule does not provide a 0% evaluation for a diagnostic code, a 0% evaluation shall be assigned when the requirements for a compensable evaluation are not met;” this condition warrants a 0% evaluation.  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 exhaustion condition.
Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the chronic LBP, bilateral shoulder pain and dysthymic disorder conditions were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, and requires a preponderance of evidence.  The chronic LBP, bilateral shoulder pain and dysthymic disorder conditions were not profiled prior to entry into the disability evaluation system or implicated in the commander’s statement and the dysthymic disorder condition was specifically judged not to fail retention standards.  All were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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 any of the contended conditions and so no additional disability ratings are recommended.

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 the matter of the heat exhaustion condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended chronic LBP, bilateral shoulder pain and dysthymic disorder 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.

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 20140430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

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 XXXXXXXXXXXXXXXXX, AR20150006377 (PD201402026)

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:

Encl						     XXXXXXXXXXXXXXXXX