RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04079
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20041216 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “heat injury with rhabdomyolysis and elevated enzymes,” 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 upon a 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 - 20041015	VARD - 20060608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Injury with Rhabdomyolysis and Elevated Enzymes	7999-7900	0%	Rhabdomyolysis	7541	Not Service Connected (NSC)	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Heat Injury with Rhabdomyolysis and Elevated Enzymes.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s rhabdomyolysis (acute breakdown of skeletal muscle) condition began in August 2004 during basic training when he passed out and reported muscle soreness in his neck, upper extremities, and chest.  The CI was seen in the ER on 18 August 2004 and admitted to the base hospital the next day after passing out and having difficulty breathing.  Laboratory testing demonstrated progressive elevation of a muscle breakdown product diagnostic of rhabdomyolysis.  The CI was treated with fluids and discharged after 10 days.  The CI was seen in the ER on 7 September 2004 for a severe headache and whole body aches.  The examiner noted diffuse tenderness in the cervical spine and neck muscles.  He was given an injection for pain control and had good muscle pain and headache relief.  He was issued a profile for recurrent rhabdomyolysis and heat exhaustion and referred for a MEB.  The MEB forwarded “rhabdomyolysis needing 10 days hospitalization & mild heat injury” for PEB adjudication.  

At the MEB examination dated 15 September 2004, approximately 3 months before separation, the CI reported that he had no complaints of muscle soreness as his condition had improved.  Laboratory testing was slightly abnormal but the physical examination was unremarkable.  An incidental heart murmur was noted, but an echocardiogram was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 7900 code (hyperthyroidism).  The VA assigned a NSC rating using the 7541 code (renal dysfunction) based on lack of evidence in the STR showing that the CI was currently suffering from rhabdomyolysis.  The coding analogous to 7900 was likely due to use of the historical DoD Table of Analogous Codes where heat injuries (which often have aspects of muscle damage) are rated under code 7900.  At the time of separation, the CI was asymptomatic and his laboratory values were almost back to normal.  He was found unfit due to the risk of recurrence.  The Board found no route to a higher rating.  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:  In the matter of the heat injury with rhabdomyolysis and elevated enzymes 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.  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, 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 
AR20160011802 (PD201404079)

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