RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02743
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20090515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Student Trainee) medically separated for Rhabdomyolysis.  This condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  An alternate aerobic event was authorized to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  “Rhabdomyolysis” and “seizure disorder,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were forwarded for adjudication.  The Informal PEB adjudicated “Rhabdomyolysis,” as unfitting, rated 0%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The seizure disorder condition was determined to be EPTS (existed prior to service), not permanently aggravated by military service beyond normal disease progression and was not rated.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests the Board consider all conditions.  His complete submission is at Exhibit A. 

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 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 20090325	VA* - (~64 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rhabdomyolysis	7999-7900	0%	Rhabdomyolysis	7540	**NSC	20140821	
Seizure Disorder 	EPTS w/No PSA	No VA Entry	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  0%	RATING:  NSC	
*Derived from VA Rating Decision (VARD) dated 20140930 (Only VARD in evidence).  **Condition was determined to be resolved.

ANALYSIS SUMMARY:  

Rhabdomyolysis Condition.  The narrative summary (NARSUM) noted the CI reported his first incident of heat injury occurred in 1989 shortly after engaging in a training exercise.  He was treated and fully recovered.  A year later, he again collapsed during the summer training activity and after this event he was placed in an air-conditioned environment for completion of his training.   In June 2006, the CI returned to the National Guard after a 4-year absence, but due to several issues, he was removed from the assigned tour of duty.  He returned in September 2007 and began having symptoms of rhabdomyolysis.  On 28 October 2007, the CI was admitted to the intensive care unit due to extremely high creatine kinase (CK); this was the first time the diagnosis of rhabdomyolysis was made.  On the day prior to admission, the CI had performed muscle failure exercises during physical training.  He remained hospitalized for 5 days with subsequent recovery; however, was placed on a highly restricted profile that remained in place for 8 months.  The CI was given a “trial of duty” although a MEB was considered.  Meanwhile, he was assigned to another facility and was required to take a diagnostic physical fitness test.  Once again, at the end of the training exercise, he had muscle aches that were slow to recover.  On 6 June 2008, the medical clinic reported on the CI’s rhabdomyolysis status since being on “trial of duty”.  At this examination, the CI reported he had not had any problems with exercise, muscle pain or repeated seizures.  At the NARSUM exam on 10 February 2009 (approximately 3 months prior to separation) the physician stated that despite adequate rest and non-exposure to exertional activity “he is still unable to participate at a level now expected of an active duty Soldier without experiencing muscle ache.”  Physical examination of the muscles was normal for tone and strength (no atrophy, fasciculation, and 5/5 strength).    In the addendum to the MEB dated 19 March 2009, the physician opined that the CI’s condition is not “so much that he has recurrent rhabdomyolysis, but rather muscle aches and subjective heat intolerance.”  The service treatment record (STR) demonstrated a declining pattern of elevated CK values beginning in September 2007 through September 2008, and normal values occurring in October.  

The PEB used the analogous 7900 code (hyperthyroidism) and rated the condition at 0%, noting the CI was asymptomatic but unable to work in hot environments, perform strenuous physical tasks or perform his duties in his current MOS.  It was noted that the CI took no medication for his condition.  Five years later, the VA did not service-connect the condition, noting the absence of permanent residual or chronic disability.  A 10% rating under the 7900 and 5025 codes requires continuous use of medication for control of the condition.  The Board noted there was no evidence in the record to support the continuous use of medication and agreed this criterion was not met.  The records indicated last prescribed pain medication (Ibuprofen) occurred more than a year prior to separation.  On the DD Form 2807, Report of Medical History, (4 months prior to separation), the CI indicated he was not on any medication for pain.  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 using this code.  There was no path to higher than a 0% rating.  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 Seizure Disorder. As documented above, the PEB regarded the condition as EPTS, not permanently aggravated by military service beyond natural progression, based on the CI’s own report of two seizures prior to entering active duty.  The Board found no evidence to indicate this was not correct.  The Board next considered whether or not there was evidence of permanent service aggravation.  The STR recorded the CI’s denial of seizure history during the Report of Medical History entry examination in 1988 and on entry in 2007.  An evaluation dated 27 March 2008 entitled “Medical Evaluation Board” recorded that the CI’s first seizure was in 1995, and noted that he had a neurology evaluation then, but it was not clear what had been done after he was tested and there was no apparent treatment rendered.  The next seizure occurred in 2000 and again no treatment was rendered after he left the emergency room.  It appeared that both seizures were related to poor sleep. The CI reported a family history of seizures.  The CI’s EEG was abnormal and suggested a focal electrical disturbance in the left temporal lobe.  The neurologist noted the abnormal EEG finding and a normal brain MRI scan.  It was documented that the CI had a history of recurrent seizures and although sleep loss may have provoked seizures, it was opined that his abnormal EEG was consistent with an underlying seizure disorder not fully explained by the loss of sleep or stress.  The physician documented his belief that the CI’s condition existed prior to his current active duty service. Neurological examination in November 2008 documented that the CI was diagnosed with a seizure disorder after having a seizure in March 2008; however, he reported having 4-5 such events over the past 10-15 years (pre-military service).  The neurologist noted that the CI had intermittently used anti-convulsant medication for a year or so at a time, and in each case it would be discontinued and he would remain seizure free often for several years.  At the time of this examination, the CI was taking Dilantin which was started after he had a generalized seizure in March 2008, and he has not had a seizure since being on this medication (March).  The NARSUM, 9 February 2009 recorded the condition of seizure disorder, noting that the condition existed prior to service (EPTS) and was not service aggravated.  The examiner documented the CI’s report that in 1995 while working in a civilian position, he collapsed with a seizure and was taken via ambulance to the emergency room.  Over the course of the next 12 years he had four seizures and with medication he has been seizure free since March 2008.  Although the condition was profiled, the CI was allowed access to weapons, he was able to carry and fire his weapon and there were no specific seizure related limitations on his profile.
  
After due deliberation, considering all of the evidence the Board concluded the EPTS seizure disorder condition was not permanently aggravated by service beyond the natural progression of the condition and therefore recommends no change in the PEB’s adjudication.

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 Rhabdomyolysis condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended seizure condition and IAW VASRD §4.124a, 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 20140611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXX, AR20160003839 (PD201402743)

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