RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02938
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-5 (Veterinary Food Inspection Specialist) medically separated for a “heat injury” condition, rated at 0%

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 20040331	VA* - (~1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Injury	7999-7900	0%	History of Heat Exhaustion	8999-8911	0%	20040526	
Other x 0 (Not In Scope)	Other x 0 	
RATING:  0%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20040807 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:    

Heat Injury Condition.  A series of notes in the service treatment record (STR) dated 15 May 2003 supplemented and supported the MEB Narrative Summary (NARSUM) dated 18 January 2004.  The STR indicated that when the CI was deployed to the Middle East he complained of weakness and “shakiness” for 3 days.  He appeared “pale” and was not focused.  He was slow to respond during conversation and responded somewhat inappropriately as when told his pulse was racing, the CI responded:  “You want to race?”  His vital signs were stable and his temperature was 100.8 degrees F. orally and 101 degrees F. rectally.  The diagnosis of heat exhaustion with mental status changes was made and treatment with three liters of Ringer’s lactate and cooling processes were instituted before he was transferred.  On arrival at a MTF his rectal temperature was 99.4 degrees F.  After four additional liters of Ringer’s lactate he was responsive to commands and answered questions appropriately.  Baseline laboratory studies demonstrated elevations of chloride and creatinine (markers of renal status) and glucose (blood sugar) and the CK (creatine kinase, a measure of muscle inflammation or injury) was 135 U/L [Normal 57-374]).  By the next day he felt better, had good urine output, and creatinine and glucose had improved from the time of admission.  By 19 May 2003 he was stable and basic laboratory studies were within normal limits.  On 28 May 2003, prior to transfer to CONUS, the CI denied muscle pain, right upper quadrant pain and mental changes, but did complain of fatigue, however, he felt he was nearly back to normal.  A physical examination was normal as were basic laboratory studies.  However, on 31 July 2003 the CK was elevated at 699 U/L (suggestive of muscle inflammation) while other laboratory studies were normal.  On 15 January 2004, glucose, BUN, creatinine were normal as were the electrolytes except for bicarbonate, which was minimally elevated.  The NARSUM examiner’s diagnosis was heat injury, most likely heat stroke.

The CI reported on the DD Form 2807-1 dated 16 December 2003 for the MEB examination that he was treated for a heat injury and that during hot weather he felt susceptible to being reinjured.  The examiner noted, however, that there was no recurrence since the episode and the CI “denied any problems at this time.”   The medical examination report on the DD Form 2808 dated 16 December 2003 was normal and listed the diagnosis as history of heat stroke.  A permanent P3 profile was issued on 18 December 2003 for heat injury with limitations of no vigorous physical exercise for periods longer than 15 minutes as well as no maximal efforts, no Army physical training or testing, no significant heat exposure or use of MOPP (Mission Oriented Protective Posture) gear, and no exposures to heat greater than 95 degrees.  The commander’s statement dated 13 January 2004 indicated that heat injury prevented the CI from meeting his MOS requirements as a food inspector or to deploy and fight in all types of environments.

At the VA Compensation and Pension (C&P) examination dated 26 May 2004, performed a month after separation, the CI reported that at the time he became ill the temperature outside was 120 degrees F.  He had mental changes and an amnesic spell, which he felt lasted around 6 hours and was hospitalized for 2 days for heat exhaustion.  At the time of the VA C&P examination he was receiving no treatment and was going to college and working in a warehouse.  The detailed physical examination was within normal limits and the impression was that the CI was a normal healthy male with a history of heat exhaustion.  Laboratory studies for CBC, electrolytes, urinalysis, thyroid (TSH-0.940 μIU/mL [Normal 0.465-4.680]), liver and renal functions studies were normal except for the BUN (a test to determine kidney function), which was slightly elevated.  Remote VA examinations more than 6 years post-separation were reviewed and offer little or no probative value, but did indicate the CI reported he had persistent sensitivity to temperatures greater than 80 degrees and had to find work with air conditioning; however, there was no medical evidence or other records proximate to separation in the case file to document or support that remote report.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating using code 7999-7900 (hyperthyroidism) for status post heat injury.  The VA likewise assigned a 0% rating using code 8999-8911 (petit mal) for a history of heat exhaustion.  The Board sought a route for a higher rating and noted that the analogous code used by the PEB is inconsistent with a normal TSH (a measure of thyroid status) level and the absence of any symptoms related to hyperthyroidism IAW VASRD code 7900 (tachycardia, which may be intermittent, and tremor, or, continuous medication required for control), while the VA code (8911) for petit mal captures one of the acute symptoms, a brief interruption in consciousness, but the CI did not have epilepsy.  However, the Board was not able to find a route to a higher rating in the absence of any residual symptoms of significance proximate to separation.  While VASRD §4.20 indicates “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 does not recommend a change of the coding if there is no change in the rating, although the Board did discuss code 8045 (Brain disease due to trauma), albeit due to heat and the symptoms of which resolved after treatment.  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 adjudication for the heat injury condition.   

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 20140616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

13 JUL 2016

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 XXXXXXXXXXXXXXXXXXXX, AR20160005454  (PD201402938)

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