RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03008
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard (Temporary Tour of Active Duty) E-4 (Heavy-Wheel Vehicle Mechanic) medically separated for “episodic heat exhaustion manifested in exposure to high environmental temperatures with symptoms of headaches and lightheadedness…” rated at 0%. 

CI CONTENTION:  The CI commented on the frequency of his heat exposure condition and his skin condition and requested that the Board review all conditions.  The 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 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 Veterans Affairs Schedule for Rating Disabilities 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 20040629	VA* - (~5 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Episodic Heat Exhaustion…	7999-7900	0%	Heat Exhaustion 	8999-8911	0%	20050411	
Atypical Chest Pain			Abn EKG (Claimed as heart)	7099-7005	NSC	
Depression	Not Unfitting	Depression…	9434	NSC	
Alcohol Dependence	Not Ratable	No VA Placement	
Poly Substance Abuse	Not Ratable	No VA Placement	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 21	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20051021 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Episodic Heat Exhaustion Condition.  The CI deployed in April 2003.  He first reported headaches and dizziness in theater at an evaluation on 2 June 2003.  He was determined to have been dehydrated and increased fluids were recommended.  No comment was made of a heat injury.  He also reported long standing problems with ulcers.  He was thought to have GERD (gastro-esophageal reflux disease) and he was given an antacid and continued on a reflux medication (AcipHex).  He was seen 2 days later for dehydration, headache, nausea, and diarrhea.  His blood pressure was noted to be elevated.  He next was evaluated on 4 July 2003 when he reported a 2 week history of headaches and dizziness.  His blood pressure was noted to be normal.  No comment was made regarding a heat injury.  At appointments on 9 and 16 July, he continued to report headaches, dizziness, nausea, and vomiting.  He was noted to have been a heat casualty 4 times at both appointments.  He continued to have problems and was restricted to an indoor environment.  Thyroid function tests were normal.  On 1 September 2003, he was medically evacuated from theater as he was unable to handle the hot environment.  He was next evaluated on 29 September 2003, in internal medicine (IM) at his home station.  He was noted to have been a heat casualty by history although no definitive laboratory testing was performed while deployed.  He was also diagnosed with COPD (present prior to deployment) and a chest CT showed a pulmonary nodule.  This was ultimately biopsied and was benign.  He was referred to neurology for evaluation of the headaches and found to have non-prostrating headaches which met retention standards.  He was referred for MEB due to the heat casualty condition on 16 March 2004.  The narrative summary (NARSUM) was dated 26 May 2004, 3 months prior to separation, and noted severe heat intolerance.  However, his prognosis was thought to be excellent as long as he avoided temperatures in excess of 140 degrees F.  At the VA Compensation and Pension (C&P) examination performed on 11 April 2005, 7 months after separation, the CI reported 4 episodes of being light headed, dehydrated, and short of breath while deployed.  He stated that he was still short of breath when walking over ½ mile or climbing two flight of stairs.  He was also symptomatic in very hot weather.  The action officer observed that the CI had smoked cigarettes for decades and that tobacco abuse is the most common cause of the lung problems (emphysema) which the CI had prior to activation.  The CI also reported daily headaches.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB noted that the episodic heat exhaustion had not resulted in end organ damage and that it had not resulted in hospitalization.  The PEB rated the condition at 0%, coded 7999-7900 (analogous to hyperthyroidism).  The VA also rated the condition at 0%, but coded it 8999-8911 (analogous to petit mal epilepsy).  The Board determined that the code 7900, which was utilized by the PEB, was a better clinical description, but that neither code provided a rating advantage over the other.  The record shows that the CI had increased sensitivity to high ambient temperatures, but did not show permanent injury after recovery from his symptoms.  No route to a rating higher than the 0% adjudicated by the PEB and VA was found.  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 episodic heat exhaustion condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the atypical chest pain was not unfitting.  The PEB did not specifically address the conditions in the second MEB, but the final date was one day after the second MEB implying that the depression, alcohol dependence and poly-substance abuse conditions were not separately unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

The Board noted that the CI had been evaluated for chest pain in an emergency room on 9 June 2001, 20 months prior to activation.  An echocardiogram showed borderline left ventricular hypertrophy and some mild diastolic dysfunction.  The Board observed that these findings are consistent with high blood pressure which was both present prior to activation and poorly controlled.  An exercise tolerance test done prior to separation and again 7 months after separation was negative for cardiac ischemic disease.  The CI had undergone a lung biopsy; however, his complaints of atypical chest pain preceded this by over 2 years.  The MEB determined that the condition did not meet retention standards.  The NARSUM examiner awarded the P3 profile for the atypical chest pain and due to the heavy utilization of medical services.  The CI was allowed to exercise at his own pace and distance; he met military requirements other than deployment.  No etiology for the atypical chest pain was found; a cardiac evaluation was essentially normal other than changes from the long standing hypertension.  The PEB determined that the condition was not unfitting.  There was not a preponderance of evidence to overcome the PEB adjudication.  

The depression was not profiled until 23 August 2003, 2 months after the after the initial PEB.  The Board noted that this is an implicit presumption of fitness IAW DoDI 1338.32 E3.P3.5.  The commander noted excellent duty performance.  The CI was on an anti-depressant for depression at the time of activation.  The mental health NARSUM does not indicate that the examiner was aware of this at the time of the dictation.  The CI did endorse substance abuse prior to this evaluation and that he had gone through detoxification over 10 years earlier.  The examiner determined that the depression was “existed prior to service” no, but this is clearly erroneous and was based on the history provided by the CI that his depression started with his first episode of heat exhaustion in June 2003.  The Board considered the totality of evidence and determined that there was not a preponderance of evidence to overcome the implied PEB adjudication that the depression was not unfitting.  

In accordance with DoDI 1332.38 E5.1.3.9.1, uncomplicated alcoholism or substance abuse disorders do not constitute a physical disability and are not ratable.  Neither the drug or alcohol abuse was linked to the depressive disorder by the NARSUM psychiatrist.  

All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions was separately unfitting at separation.  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 atypical chest pain condition or the implied determination for the depression, alcohol abuse, and poly-substance abuse 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 episodic heat exhaustion condition and IAW VASRD §4.120, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended atypical chest pain conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  In the matter of the contended depression, alcohol abuse, and poly-substance abuse conditions, the Board unanimously agrees that it cannot recommend these for additional disability ratings.  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 20140509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160004999 (PD201403008)

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