RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00445
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Cavalry Scout, medically for “exertional rhabdomyolysis/heat injury, recovered,” with a disability rating of 0%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20051017	VARD - 20091218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exertional Rhabdomyolysis/Heat Injury,  Recovered	7999-7900	0%	Exertional Rhabdomyolysis	5099-5021	NSC	20091027	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Exertional Rhabdomyolysis/Heat Injury:  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s heat injury began in May 2005 after heavy exertion in a hot environment.  He developed leg cramps, fatigue and developed dark urine (myoglobin in urine; with other abnormal lab tests) that led to a diagnosis of exertional rhabdomyolosis (breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation).  He was Medivaced from theater, all symptoms resolved, and he remained stable.  Profile restricted exertional activities and indicated “avoid heat environment.”  The MEB forwarded “exertional rhabdomyolysis” for PEB adjudication.  The MEB NARSUM examination on 29 August 2005, 5 months prior to separation, noted a chief complaint of “exertional rhabdomyolysis secondary to over exertion in heat environment,” and the CI’s desire to remain on active duty.  Physical examination showed no abnormal findings.  The physician stated the CI could not perform the duties of his MOS secondary to his history of exertional rhabdomyolysis in a heat environment.  

At the 27 October 2009 VA Compensation and Pension (C&P) evaluation, performed 46 months after separation, the CI reported exertional rhabdomyolosis with injury to both thigh muscles, with loss of strength and easy fatigability.  The CI also reported renal failure with urinating eight times a day and a problem starting his stream.  Physical exam showed normal gait and normal muscle examination with no weakness, wound, scar, signs of lowered endurance, or impaired coordination.  Laboratory testing was normal aside from a urinalysis showing the presence of sugar “findings are insignificant.”  There was no diagnosis for either exertional rhabdomyolosis or renal failure as there was “no pathology to render a diagnosis.”  The physician indicated that both conditions were likely related, “however, on today's exam there is no objective evidence to diagnosis either renal failure or rhabdomyolysis; the conditions have resolved.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the exertional rhabdomyolysis/heat injury condition 0%, coded 7999-7900 (hyperthyroidism [Table of analogous codes recommendation for heat injuries]), citing the condition had resolved, but that profile restrictions precluded duty as a cavalry scout.  The VA denied service-connection for “exertional rhabdomyolisis with renal failure” coded 5099-5021 (myositis), based on the VA C&P examination 46 months after separation, citing absence of any current pathology and no disability diagnosis.  The CI had no symptoms or permanent residuals from his single episode of exertional rhabdomyolysis/heat injury, and the condition was resolved.  There was therefore no ratable disability condition at separation.  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 exertional rhabdomyolysis/heat injury condition.  

BOARD FINDINGS:  In the matter of the exertional rhabdomyolysis/heat injury condition and IAW VASRD §4.71a, §4.73, and §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 20150601, 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

08 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000105 (PD201500445)

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