RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03407
BRANCH OF SERVICE:  Army	BOARD DATE:  20141017
SEPARATION DATE:  20050217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (11B10/Infantry) medically separated for heat exhaustion/heat intolerance.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The heat exhaustion and atypical chest pain conditions were the only conditions forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “recurrent episodes of heat exhaustion/heat intolerance” including atypical chest pain in its disability description as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please review all conditions.”

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 those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI.  The ratings for the unfitting heat exhaustion/heat intolerance and atypical chest pain conditions are addressed below.  Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20050131	VA* - (3.5 Yrs. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Episodes of Heat Exhaustion/Heat Intolerance Including Atypical Chest Pain	7999-7900	10%	Sinus Tachycardia (Claimed as Heat Exhaustion)	7099-7010	0%	20080730	
Other x 0 (Not in Scope)	Other x 1 	20080730	
Combined:  10%	Combined:  0%	
*Derived from VA Rating Decision (VARD) dated 20090429 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

Recurrent Episodes of Heat Exhaustion/Heat Intolerance.  The CI experienced recurrent episodes of heat-related illness while deployed to Egypt that required aeromedical evacuation to Landstuhl Medical Center in October 2004.  Medical notes dated 2004 indicated a prior history of heat illness in 1999 and 2002 that involved loss of consciousness, but evaluations from those dates were not in evidence.  The last episode of heat illness was accompanied by sinus tachycardia (fast heart rate) and atypical chest pain which continued to recur after resolution of the heat illness.  Cardiology and endocrinology evaluations rendered normal results.  Although initial thyroid tests suggested possible hyperthyroidism, the endocrinologist concluded this was not present.  The CI reported in November 2004 that 2-3 episodes of chest pain occurred per week and lasted 2-15 minutes.  An exercise treadmill test in November 2004 reported normal cardiac functional capacity and heart rate response to exercise.  Chest pain occurred during the test, which was stopped due to shortness of breath; but there was no evidence of cardiac disease.  A review of the service treatment record noted consistently normal blood pressure measurements.  The narrative summary on 7 December 2004, 2 months prior to separation reported that although the condition had stabilized since removal from theater, his recurrent sharp, stabbing chest pain persisted.  It was confirmed that the chest pain began while deployed to Egypt.  He was taking a medication to control tachycardia and the only profile restriction was to allow exercise at his own pace and distance.  Physical exam was normal.  Diagnoses included heat exhaustion and atypical chest pain.  At a clinic visit in January 2005 for a profile update, the CI denied current chest pain.  There was no evidence of a VA Compensation and Pension examination proximal to separation.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB identified the condition as recurrent episodes of heat exhaustion and heat intolerance and rated it 10% coded analogously to hyperthyroidism (7999-7900).  The Board agreed that the PEB appropriately subsumed atypical chest pain under this rating.  The VA identified the condition as sinus tachycardia (claimed as heat exhaustion) and applied an analogous 7010 code (supraventricular arrhythmia).  Board members noted that the CI’s unfitting condition did not correlate directly with a VASRD disability code, and rating by analogy to hyperthyroidism was a reasonable option. The next higher 30% rating requires “tremor, and increased pulse pressure or blood pressure” in addition to the presence of tachycardia; these criteria were not reflected in the evidence, so a higher rating was not justified on this basis.  Although the CI experienced some sinus tachycardia, the Board considered the code 7010 a poor choice for the unfitting condition.  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 recurrent episodes of heat exhaustion and heat intolerance condition.

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 recurrent episodes of heat exhaustion and heat intolerance 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.

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 20140629, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150011222 (PD201403407)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA