RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02753
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “rhabdomyolysis with residual left shoulder pain,” with a disability rating of 0%.

CI CONTENTION:  The CI contended for his left shoulder. 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 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 - 20050802	VARD – 20050927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rhabdomyolysis... Residual Left Shoulder Pain...	5099-5021	0%	Tendonitis; Left (Non-Dominant) Shoulder	5024-5304	10%	20050712	
			Rhabdomyolysis	5099-5025	NSC	20050712	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Rhabdomyolysis with Residual Left Shoulder Pain Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s rhabdomyolysis first manifested in October 2004 when the CI reported left shoulder pain following a work-out preparing for an upcoming physical fitness test.  He was evaluated for persistent pain over several days and then was found to have an elevated protein from muscle breakdown.  He was diagnosed with rhabdomyolysis (a condition of rapid muscle break-down with release of a muscle protein, myoglobin, which can lead to kidney failure) and hospitalized for 4 days.  The rhabdomyolysis resolved, but his left shoulder pain persisted.  An injection provided partial relief.  He was also treated with duty restrictions, medications, and physical therapy (PT).  On examination, he had full range of motion (ROM) and normal or near normal strength.  Signs of impingement were present.  An MRI on 10 February 2005 noted that there was possible strain of tendonitis to some of the rotator cuff muscles.  The ROM was full in PT the same day and the CI was thought to have a rotator cuff (muscles that rotate the shoulder) strain.  Following a two mile hike a few days earlier, the CI again developed diffuse muscle aches and was admitted from 21-25 April 2005 for recurrent rhabdomyolysis.  The CI was concerned that he was at risk for future episodes and requested an MEB.  At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 24 May 2005, 3 months prior to separation, the CI reported rhabdomyolysis and a left shoulder injury.  On examination, both were noted without specific physical findings.  In orthopedics on 2 June 2005, the CI was noted to have mild discomfort with movement, but full ROM.  Tenderness to palpation was also noted.  The CI was thought to have inflammation from the muscle breakdown (rhabdomyolysis) and no (further) intervention was warranted.  The commander noted in the 10 June 2005 Commander’s Statement that the CI was limited in duty by the rhabdomyolysis, but no comment was made on the left shoulder.  The MEB NARSUM examination on 1 July 2005, 2 months prior to separation, noted (2) episodes of rhabdomyolysis and the left shoulder pain.  Laboratory testing indicated that the rhabdomyolysis condition was resolved.  The MEB forwarded rhabdomyolysis for PEB adjudication.  It also noted left shoulder pain which met retention standards.  

At the VA Compensation and Pension (C&P) evaluation, performed on 12 July 2005, 6 weeks before separation, the examiner noted that there were no residual complications from the rhabdomyolysis.  The CI reported that his shoulder was improved since he had stopped lifting furniture and weights.  It was now intermittent and he hoped that it would “resolve in the near future.”  On examination, he had full ROM but with discomfort.  Laxity and tenderness were absent.  X-rays were normal.  On 13 July 2005, the rhabdomyolysis was profiled P3.  The left shoulder was not profiled.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the rhabdomyolysis condition at 0%, coded 5099-5021 (analogous to myositis), noting the absence of permanent sequelae.  It also noted the presence of left shoulder pain which was not ratable.  The Board noted that the left shoulder met retention standards, was not profiled and was not cited by the commander as impairing duty.  The ROM was normal proximate to separation.  The evidence does not support a finding that the left shoulder was separately unfitting and, accordingly, no rating is recommended.  The VA found the rhabdomyolysis condition to be not service connected, coded 5099-5025 (analogous to fibromyalgia), based on the VA C&P examination 6 weeks prior to separation, citing an absence of residua on the examination.  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 with residual shoulder pain condition.  

BOARD FINDINGS:   In the matter of the rhabdomyolysis with residual shoulder pain condition and IAW VASRD §4.71a, the Board unanimously 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 20140609, 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

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
, AR20160016972 (PD201402753)

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