RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00807
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Human Resource Specialist, medically separated for “heat injury” and “chronic daily headaches  which are brought on by exercise and sunlight,” rated 0% and 0%, respectively, with a combined disability rating of 0%.  

CI CONTENTION: “His conditions continue to worsen and negatively impact his daily activities.”  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.  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 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 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 - 20070823	VARD -  20071212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Injury	7999-7900	0%	Rhabdomyolysis	5299-5021	Not Service Connected 
(NSC)	20071004	
			Residuals of Heat Injury	7999-7900	NSC	20071004	
Chronic Daily Headaches…	8199-8100	0%	Headaches	8199-8100	0%	20071004	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Heat Injury.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s heat stroke condition began in May 2006 after a 4- mile run.  He was hospitalized overnight after developing an altered mental status for 3 minutes with a body temperature of 102 degrees F.  Creatine kinase (CK) levels ranged from 283 to 656 Units/Liter (normal 26-174 U/L) at diagnosis and subsequently over the next year and never returned to normal.  There was no evidence of liver dysfunction (normal direct bilirubin, coagulation studies, blood glucose levels) or kidney disease (normal urinalysis, serum electrolytes and creatinine).  Neuropsychiatric testing in June 2006 and in June 2007 was inconclusive for any specific deficits. 

At a 1 May 2007 internal medicine consultation, the CI denied muscle pain and weakness but reported feeling “worn out” even with no exertion in warm ambient temperatures.  The examiner opined that the CK elevations were “minimal,” the CI lacked any symptoms referable to the muscles, and recommended against further testing of the “asymptomatic hyper-CK-emia.”   

At the 30 July 2007 MEB NARSUM examination, 4 months prior to separation, the CI reported fatigue, nausea, and twice daily headaches since May 2006.  He reported dizziness, and headaches after 15-20 minutes of exercise.  He denied problems with memory, attention span, concentration, and depression.  The examiner referenced a normal physical examination performed on 24 July 2007 (DA Form 2808).  

At the 4 October 2007 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI denied any complications from the condition.  The physical examination showed obesity, hypertension, and normal muscle strength; and there was a normal mental status examination.  The examiner concluded that the condition had resolved with no current pathology on examination.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the heat stroke condition, analogously coded 7999-7900 (hyperthyroidism).  The VA did not grant service connection for the rhabdomyolysis condition, analogously coded 5999-5021 (myositis), based on the C&P examination 2 months before separation, citing resolution with no evidence of chronic disability.  

The panel 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 documented episode was characterized by altered mental status and elevated body temperature consistent with “heat stroke.”  Symptoms resolved with intravenous hydration during hospitalization.  Neuropsychiatric testing was inconclusive and, therefore, there was no clinical documentation to support any neurocognitive deficits.  

There were no subsequent clinical findings that would qualify as persistent “end organ” damage.  At the time of separation, 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, one-to-two 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 heat stroke/ rhabdomyolysis condition.  

Chronic Daily Headaches.  According to the STR and the MEB NARSUM, the CI’s headache condition began in the fall of 2006 after resolution of an episode of heat stroke.  The MEB forwarded “chronic daily headaches” for PEB adjudication.  At a 27 March 2007 neurology consultation, 8 months prior to separation, the CI reported chronic headaches occurring 2-3 times per day that “did not appreciably interfere with work,” although they “kept him from performing well.”  They also interfered with exercise.  Radiographic imaging (CT) of the head was normal.  

At the 30 July 2007 MEB NARSUM examination, 4 months prior to separation, the examiner noted complaints of chronic daily headaches treated with over-the-counter medications only.  At the 4 October 2007 VA C&P evaluation, 2 months before separation, the CI reported an average of four headaches per week.  He was able to work, but required medication sometimes; and, at other times, was unable to do anything (“hard to function”).  He denied missed work days due to headaches and was taking over-the-counter medications.  The neurological and physical examinations were normal.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the headache condition, analogously coded 8199-8100 (migraine), citing a “nonfocal” [normal] neurologic examination.  The VA also rated 0% for the headache condition, analogously coded 8199-8100 (migraine), based on the C&P examination 2 months before separation, citing that the frequency and severity (relieved by medication) did not support a compensable evaluation.  

The panel adjudged that the STR, NARSUM, and VA examinations did not reflect occurrence of prostrating attacks averaging once in 2 months over the last several months in support of the next higher 10% rating.  Members agreed that the ratable threshold was met for “less frequent attacks” in support of a 0% rating.  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 headache condition.  

BOARD FINDINGS:  In the matter of the heat stroke/rhabdomyolysis condition and IAW VASRD §4.119, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the headache condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007396 , 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,