RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03624
BRANCH OF SERVICE: Army	BOARD DATE:  20150521
SEPARATION DATE:  20070409

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Carpentry Masonry Specialist) medically separated for rhabdomyolysis.  The rhabdomyolysis could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “recurrent exertional rhabdomyolysis,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB (IPEB) adjudicated “recurrent exertional rhabdomyolysis, w/o significant residuals” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB (FPEB), which affirmed the PEBs finding and rating.  She was then medically separated.

CI CONTENTION:  “Please consider 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 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/Naval 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:

FPEB – Dated 20070119	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Exertional Rhabdomyolysis, without Significant Residuals	7999-7900	0%	Exertional Rhabdomyolysis	7599-7540	0%	20070918	
Other x 0 (Not In Scope)	Other x 9	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20071105 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Recurrent Exertional Rhabdomyolysis, w/o Significant Residuals.  The first symptoms of rhabdomyolysis occurred during basic training in 2004.  The CI was admitted to the hospital for a week and a half, diagnosed with rhabdomyolysis, treated and discharged.  In August 2006, the CI was again admitted to the hospital after reporting pain in her upper arms as well as in the chest.  On admission, laboratory studies revealed muscle enzymes (CK) extremely elevated (6363), and negative urine myoglobin.  The CI was administered IV fluids and on the second day of hospitalization CK enzymes decreased to 5670 with reported improvement in musculoskeletal symptoms.  Despite continued hydration, the CK spike to 6777 on day three of hospitalization; however, by day four her symptoms resolved and the CK was on a downward trend.  She was discharged with the diagnosis of recurrent rhabdomyolysis, and returned to duty on a limited profile.  The commander’s statement dated 28 August 2006, stated the CI “thoroughly completes essential missions and tasks”; however, she was unable to work in her specialty area (carpentry and masonry) due to her profile limitation.  Her profile allowed walking at own pace and distance, and upper and lower body weight training, but did not allow running, biking, marching, swimming, and any rigorous activity greater than 15 minutes.  She also could not participate in any activity that could create a risk of dehydration.  The MEB narrative summary dated 26 September 2006, approximately 7 months prior to separation, documented the presence of exertional rhabdomyolysis since basic training in 2004 that presented with diffuse muscle aches, heaviness in the arms and stiffness.  At the time of the 2004 hospital admission her enzymes were over 62,000.  After discharge she was given a profile for about 8 weeks and was allowed to recycle with the next basic training class.  She was admitted to the next class without any profile that would reflect her episode of heat injury; however, she was able to complete her basic training.  Prior to the second hospital admission, the CI noted that she was doing regular physical training and her normal wok duties.  However, during the time of admission there were environmental temperatures of over 100 degrees Fahrenheit, and symptoms of rhabdomyolysis returned.  She noticed a sensation in her arms and was unable to move them.  The examiner recorded the CI was not on medications, had not required any medical consultations for the condition, and had no other illnesses or problems.  The physician opined that her overall condition was good, but that her prognosis was poor for continued military service.  At the end of October 2006, the CI presented to the emergency department with complaint of bilateral thigh pain.  Her enzymes were elevated but responded to re-hydration.  She was discharged from the emergency department and assigned to quarters for a day.  Clinic entry dated 1 November 2006 noted that her thighs were still painful but had improved.  The examiner documented that the CI indicated her pain can be controlled but the CI had not reported that she was taking any medications.  The VA Compensation and Pension (C&P) examination dated 18 September 2007, approximately 5 months after separation documented there had been no functional residuals of her condition, and the CI was working security in a night club.  Physical examination was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The IPEB used the analogous code 7900 (hyperthyroidism) and rated the condition at 0%, noting absence of significant residuals.  The CI appealed to the FPEB, and the FPEB agreed with the finding of the IPEB.  The analogous coding involving 7900 used by the PEB and analogous code use of 7540 (disseminated intravascular coagulation with renal cortical necrosis) by the VA reflects the fact that there is no code specific for rhabdomyolysis.  However, both the PEB and VA rated the condition at 0%.  A 10% rating under the 7900 code requires continuous use of medication for control of the condition.  The Board noted there was no evidence in the record to support the continuous use of medication for pain and agreed this criterion was not met.  A compensatory rating under code 7540 requires evidence of renal dysfunction; not supported by the evidence.  The records indicated last prescribed pain medication occurred 9 months prior to separation, and the C&P examination 5 months after separation, indicated she was not on any medication.  Since the CI experienced predominantly upper extremity muscle symptoms, the Board considered an alternate rating pathway using muscle codes 5303 (muscle Group III).  Under this code, a rating higher than 0% requires at least “moderate” impairment of function.  After deliberation, the Board agreed there was no residual impairment to justify rating the condition under this code.  In conclusion, the Board members agreed at the time of separation the condition was exceptionally mild, noting the absence of dark urine, absence of need for medication, and a condition that had been responsive to rehydration.  The Board also considered a rating under code 5021 (myositis) which requires limitation of motion, painful motion (§4.59) or pain with use (§4.40) for a compensable rating.  Board members agreed there were no examination findings supporting a higher rating using this code.  There was no path to coding higher than a 0% rating level.  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 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 rhabdomyolysis 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.

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 20140416, 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 XXXXXXXXXXXXXXXXXXXX, AR20160003061  (PD201403624)

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 ( ) OVA