RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00118
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-3, Trainee, medically separated for “rhabdomyolysis,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends the MEB refused to diagnose several other conditions which he asserts are service connected and acknowledged by the Veterans Administration as such.  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:  

IPEB - Dated 20050510	VARD  - 20070103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rhabdomyolysis	7999-7900	0%	Rhabdomyolysis	7999-7900	0%	20061122	
COMBINED RATING:  0%	COMBINED RATING of ALL VA CLAIMED CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Rhabdomyolysis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s rhabdomyolysis condition began in January 2006 (4 months pre-separation) after repetitive physical exercise, with symptoms of shortness of breath, chest tightness, wheezing, and laboratory evidence of elevated liver and muscle enzymes.  By February 2006 laboratory studies showed no evidence of liver or kidney compromise, with a normal muscle enzyme (creatine kinase) levels (for rhabdomyolysis).  The MEB forwarded “rhabdomyolysis” for PEB adjudication.  At a cardiology consultation in February 2006 (3 months pre-separation), the CI reported inability to tolerate training due to multiple joint pains.  He denied chest pain except for occasional flashes of pain across his chest and into his left arm.  His physical examination was normal without evidence of lung or cardiac disease and no evidence of musculoskeletal pain.  A cardiac ultrasound showed normal function and no evidence for disease from rhabdomyolysis.  At the MEB NARSUM examination on 21 April 2006 (a month pre-separation), the physical examination showed a normal heart with normal rhythm, and the lungs were clear without wheezing.  

At the 22 November 2006 VA Compensation and Pension (C&P) examination (7 months post-separation, the CI denied any heart, lung, or muscle symptoms.  Physical examination showed normal heart and lungs with no evidence of muscle weakness or atrophy.  The October 2006 laboratory studies showed no evidence of liver or kidney compromise, with normal muscle enzyme levels.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the rhabdomyolysis condition 0%, analogously coded 7999-7900 (hyperthyroidism), citing a normal physical examination and normal laboratory values.  The VA also rated the rhabdomyolysis condition at 0% coded similarly, based on the November 2006 VA C&P examination (7 months post-separation), citing absence of disabling residuals, and a disease which was cured or in remission and not requiring therapy.  The Board considered the evidence for rating and noted there is no specific VASRD diagnostic code for the rhabdomyolysis condition.  The Board considered the rating recommendation using several VASRD analogous codes in accordance with VASRD §4.20 (analogous ratings).  

There was no evidence of kidney disease, such as renal tubular disorders, nephropathy, or nephritis causing hypertension for rating under renal dysfunction (IAW VASRD §4.115a/b).  There was no evidence of long term drug therapy, 1-2 hospitalizations per year, or kidney disease requiring intermittent intensive management for a higher rating under analogous coding for urinary tract infections.  There was no evidence of heart disease resulting in dyspnea, fatigue, angina, dizziness, or syncope, and no evidence of continuous medication requirements for analogous coding under the cardiovascular codes 7001, 7006, 7007, or 7020 (IAW VASRD §4.104).  There was no evidence of tachycardia, tremor, increased pulse or blood pressure, or continuous medication for a higher rating under code 7900.  The Board concluded that there was no other more closely related option with regard to function affected, anatomic localization, and symptomatology, and that there were no residuals in evidence for a higher rating using alternative analogous codes.  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.  

Contended PEB Conditions:  Low Back Pain, Bilateral Carpal Tunnel Syndrome, Knee Pain, and Elbow Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled.  The Commanders statement implicated the “chronic knee, elbow, shoulder, lower back pain and numbness in his hands.”  However, none were judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the rhabdomyolysis condition and IAW VASRD §4.104 and §4.20 (analogous ratings), the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended low back pain, bilateral carpal tunnel syndrome, knee pain, and elbow pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140518, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 
XXXXXXXXXXXXXXXXXX, AR20160018476 (PD201500118)

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