RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03269
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated for “recurrent heat exhaustion,” with a disability rating of 0%.  

CI CONTENTION:  “Please consider all conditions.”  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 on 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 - 20070126	VARD - 20070719   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Heat Exhaustion	7999-7900	0%	S/P Heat Exhaustion with Neurocognitive Deficits and Behavior Changes	8099-8045	10%	20070326	
RATING:  0%	RATING:  30%	

ANALYSIS SUMMARY:  

Recurrent Heat Exhaustion.  The service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) documented three separate “heat exhaustion” incidents in May, June and July 2006.  The CI reported nausea, abdominal cramps, and lightheadedness during the episodes.  There was no documentation of loss of consciousness, altered mental status, seizures, flushing or alterations in sweating.  Body temperature, heart and respiratory rates were all within normal limits.  All lab findings were normal without evidence of kidney, liver, or muscle damage.  All were treated at the troop medical clinic or emergency room with oral and intravenous hydration.  No episode required hospital admission.  At a consultation with internal medicine, the examiner documented normal speech and behavior, normal cognitive function, and normal thought processes and content.  His appearance, grooming, behavior, attitude, mood and affect were also normal.  Further evaluation did not result in a treatable cause.  An MEB was initiated and “recurrent heat exhaustion” was forwarded for adjudication.  

On the MEB DD Forms 2807-1 and 2808, both dated 6 August 2008, 5 months prior to separation, the CI denied dizziness, fainting, headaches, head injuries, memory loss, seizures, loss of consciousness, concussion or other neurological problems.  He denied counseling, depression, excessive worry, or being evaluated for a mental condition.  The examiner documented “normal” neurologic and psychiatric exams.  The commanders statement (dated 25 August 2006) recommended the CI be declared fit for duty as he was “physically capable,” had served “honorably,” and did not have any limitations that would adversely impact the unit’s readiness or the safely of himself or his fellow soldiers.  The MEB narrative summary (NARSUM) exam was performed on 29 September 2006, 3 months pre-separation.  The CI reported having “blacked out” during an episode.  The examiner noted no documentation of any period of loss of consciousness, and further recorded normal mental status, adequate mentation and recovery “without sequelae” (resulting from a previous injury).  

At the VA Compensation and Pension (C&P) exam performed on 26 March 2007, 3 months after separation, the examiner documented the CI was cooperative, alert and oriented.  Cranial nerve testing and coordination were normal.  He was able to remember 2 out of 3 objects after 5 minutes.  Further neuropsychiatric testing documented normal testing of most verbal tasks, borderline-deficient visual- spatial scores, average memory, “psychological stress with anxiety,” and no indication of depression.  The psychologist opined that the deficits shown were “probably” caused by heat stroke.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the “recurrent heat exhaustion” at 0%, analogously coded 7999-7900 (analogous to hyperthyroidism) citing no indication of hyperpyrexia or end organ damage.  The VA rated the “heat exhaustion with neurocognitive deficits and behavior changes” at 10%, analogously coded 8099-8045 (residuals of traumatic brain injury).  There is no VASRD code for heat exhaustion, and therefore it is rated analogously and according to its sequelae, if any.  The Board noted that all episodes were characterized by nausea, abdominal cramping with dizziness consistent with “heat exhaustion.”   All symptoms resolved with oral or intravenous hydration.  There was no clinical findings that would qualify as “heat stroke,” in that there was no documentation of abnormal body temperatures, abnormal mental status or head trauma, abnormal lab investigations, or persistent “end organ” damage.  There was no documentation of persistent sequelae at the time of separation.  The commander’s statement did not reference any mental disabilities or limitations that interfered with his safety and performance or with unit readiness.  There were no cognitive findings in the record, no referral for formal neurological examination, and no documentation of head injury, and therefore, no clinical documentation to support any neurocognitive deficits.  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.  

BOARD FINDINGS:  In the matter of the heat exhaustion condition and IAW VASRD §4.119, 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 20140625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160011323 (PD201403269)

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