RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00810
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Signal Collection Identification Analyst Trainee, medically separated for “heat exhaustion” with a disability rating of 10%.

CI CONTENTION:  The CI contends for his unfitting heat exhaustion condition.  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 - 20050929	VARD - 20060109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Exhaustion	7999-7900	10%	Residuals of Heat Exhaustion	7999-7911	0%	20051220	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Heat Exhaustion.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) there was documentation of a pre-existing exertional intolerance and an early presentation of a heat illness episode in basic training (summer of 2004).  The CI continued to manifest exertional and heat intolerance with a persistent elevation of muscle enzyme (creatine kinase, or CK) by serial laboratory testing.  He was suspected of having primary muscle disease from a metabolic deficiency (a glycolytic pathway disorder with a normal biopsy and normal electrophysiologic studies).  There was no evidence for any serious episode or requirement for hospitalization; and, there was no associated systemic disease or organ involvement.  The CI was not prescribed any medication, nor were any indicated for his diagnosis.  

The 20 September 2005 NARSUM examination, 1 month before separation, documented “problems with weakness and easy fatigability [also muscle cramps] with mild to moderate exertion ... [and] ... unable to do any significant running  ... [but] ... able to walk at a slow pace for prolonged periods of time.”  The physical examination was reported as “completely normal.”  

The 20 December 2005 VA Compensation and Pension examination, 2 months after separation, documented the development of symptoms (cramps, shortness of breath, lightheadedness) with running “about one-and-a-half miles.”  There were no pertinent findings on physical examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 7999-7900 (analogous to hyperthyroidism) did not cite a rationale.  The VA’s 0% rating under the similar code 7999-7911 (analogous to thyroid toxicity) cited “residual symptoms” that did not meet a compensable threshold.  The VASRD does not provide for a specific or entirely applicable code for heat-related illness when it is not associated with significant renal, metabolic or neurologic sequelae.  

The PEB’s analogous code is in common use for heat illness, and the VA’s related code offers the same rating criteria as 7900.  The 10% criteria are “tachycardia, which may be intermittent, and tremor, or; continuous medication required for control.”  None of these were specifically in evidence, and it was unclear what criterion was conceded by the PEB.  All of the higher ratings under 7900 and 7911 stipulate symptoms and complications of hyperthyroidism or thyroid crisis that were not in evidence.  There are no additional coding options under the VASRD which are applicable to this case, even for analogous 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 of the heat exhaustion condition.

BOARD FINDINGS:  In the matter of the heat exhaustion condition and IAW VASRD §4.119, 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/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007398, 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,