RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00513
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060309

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Basic Trainee, medically separated for “exertional rhabdomyolysis, recovered,” with a disability rating of 0%.  

CI CONTENTION:  The CI contends the condition was not evaluated properly by the PEB.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060110	VARD - 20061101	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exertional Rhabdomyolysis, Recovered	7999-7900	0%	Exertional Rhabdomyolysis with Exertional Myalgia	5099-5025	0%	20060131	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Rhabdomyolysis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s rhabdomyolysis condition began on 1 October 2005 during the first day of basic training.  

At a follow up visit, 4 October 2005, the CI had reported improved arm and abdominal pain and denied urinary abnormalities.  Physical examination documented tenderness of the upper extremities with normal vital signs (blood pressure, heart and respiratory rate, and body temperature) and a normal neurologic examination (normal speech, sensation, gait, and motor testing).  Creatine kinase (CK) levels ranged from 16,654 Unit/Liter (normal 26-174 U/L) at initial diagnosis, to 55,527 U/L on follow up.  Liver enzymes were elevated without evidence of liver dysfunction (normal direct bilirubin, coagulation studies, blood glucose levels).  There was no evidence of kidney disease (normal urinalysis, serum electrolytes and creatinine). At a follow up visit, 18 October 2005, 5 months prior to separation, the CI reported being “100% better” with resolution of abdominal and muscle pains.  The physical examination noted normal vital signs.  All laboratory findings were normal with near normal CK and liver enzymes.  There was no evidence of neurologic, kidney or liver dysfunction.    

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 4 November 2005, 5 months prior to separation, the physical examination was “normal” with a normal urinalysis.  The 8 November 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of lightheadedness with exertion and easy fatigability.  The physical examination showed normal vital signs and was “completely normal.”    

At the 31 January 2006 VA Compensation and Pension (C&P) evaluation, performed a month before separation, the CI reported muscle pain, elicited by physical activity (prolonged standing, running, or strenuous activity) that resulted in loss of strength, weakness, easy fatigability and impairment of coordination and inability to keep up with his normal work requirements.  The physical examination showed normal vital signs, and a normal musculoskeletal exam (normal tone, strength and no evidence of lowered endurance or impaired coordination).  There was a normal mental status examination and a normal laboratory evaluation of the liver, kidney, and muscles.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the rhabdomyolysis condition 0%, analogously coded 7999-7900 (hyperthyroidism).  The VA also rated the rhabdomyolysis condition 0% analogously coded 5025 (fibromyalgia), based on the VA C&P examination a month before separation, citing “absence of widespread musculoskeletal pain and tender points.”  The panel considered the evidence for rating and noted that there is no specific VASRD diagnostic code for the rhabdomyolysis condition and therefore considered the rating recommendation using several VASRD analogous codes in accordance with VASRD §4.20 (analogous ratings).  The single episode was characterized by light headedness and dizziness consistent with “heat exhaustion.”  Symptoms resolved with oral and intravenous hydration within 2 weeks.  There were no clinical findings that would qualify as “heat stroke,” in that there was no documentation of abnormal body temperatures, kidney or liver dysfunction, head trauma, or persistent “end organ” damage.  There were no cognitive findings in the record, and no documentation of head injury, and therefore, no clinical documentation to support any neurocognitive deficits.  

At the time of separation, there was no documentation of persistent sequellae in that 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 panel concluded that there was no other more closely related option with regard to functions 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 panel 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 rhabdomyolysis condition and IAW VASRD the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006499, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure