RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01043
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070205

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

CI CONTENTION:  “Review all conditions.”  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:  

SERVICE PEB - 20061109	VARD - 20071221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anhidrosis	7999-7900	0%	Anhydrosis	7999-7900	NSC	20070411	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Anhidrosis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented for medical attention for the anhidrosis condition (inability to sweat) on 18 May 2004, 1 week after he deployed to a high temperature location.  He reported feeling light-headed while exerting himself during the heat of the day.  He reported he never sweat, even with exertion.  He denied a history of heat injury though.  He was initially treated with increased fluids and duty modifications (night shifts), but subsequently re-deployed less than 1 week later.  Evaluation showed he had β-thalassemia trait, an unrelated inherited condition of the blood.  It was determined he had anhidrosis and referred for MEB.  The MEB NARSUM examination was dated 1 August 2006, 6 months prior to separation. The CI reported he had never been able to sweat even with intense workouts, but had controlled his body temperature by drinking plenty of water and shedding clothes.  He had been returned from two deployments due to heat stroke (the actual records are not in evidence and the contemporaneous records do not record actual heat stroke, but symptoms of it).  His physical examination was unremarkable.  He was unable to deploy to a warm environment and wear normal combat gear.  Retraining and restriction from deployment were recommended.  

The MEB forwarded anhidrosis for PEB adjudication.  The Informal PEB, on 17 October 2006, determined the condition was Category II, could be unfitting but was not currently compensable or ratable.  It was noted to be an existed prior to service (EPTS) condition without permanent service aggravation (PSA).  The CI non-concurred and requested retention or removal of the EPTS finding.  

On 31 October 2006, the CI was evaluated by dermatology.  It was noted he did sweat slightly in the armpits and intertriginous areas (between skin folds such as the groin, etc.)  The CI was not thought to fit a diagnosis of anhidrosis, but rather of tropical anhidrotic asthenia, a rare variation of “prickly heat.”  This is a self-limited condition.  Evaluation by neurology was also suggested.  This was accomplished 3 days later on 2 November 2006.  The CI reported he grew up in southern California and had no trouble, from the heat, playing high school sports, but he did not sweat as much as other players.  He reported that since his deployment he was very heat intolerant.  The neurological examination was normal.  He was diagnosed with hypohydrosis (decreased sweating) which was not related to an underlying neurological problem (autonomic dysfunction).  It was specifically noted the condition was unlikely to be related to his deployment, which the CI contended, as his condition made itself manifest shortly after arrival in country.  

The Formal PEB met on 9 November 2006 and changed the condition to a Category I, unfitting and compensable and ratable, but continued the EPTS without PSA, but rated the condition 0%, coded 7999-7900 (analogous to hyperthyroidism).  The CI again non-concurred and appealed to the USAF Personnel Council (SAFPC).  It upheld the FPEB adjudication and noted there was permanent service aggravation due to a lowered threshold for heat injury secondary to the history of heat strokes (not specifically documented in contemporaneous records in evidence).  

At the VA Compensation and Pension (C&P) evaluation performed on 11 April 2007, 2 months after separation, the CI reported his symptoms began shortly after arriving in theater.  He denied receiving specific treatment and reported he completed his deployment despite frequent periods of discomfort.  The Board noted the CI was actually re-deployed within 2 weeks of arrival in-theater.  He stated he could perform all the activities of daily living including pushing a lawn mower.  His physical examination was normal other than obesity (the 71 inch CI weighed 250 pounds, an increase of 86 pounds from accession.  The medical officer observed that obesity can increase heat intolerance.)  The anhidrosis condition was thought to be “quiescent.”  

The Board directed attention to its rating recommendation based on the above evidence.  As noted, the PEB rated the anhidrosis condition 0%, coded 7999-7900.  The VA also coded the anhidrosis condition 7999-7900, but determined that it was non-service connected (not ratable) based on the VA examination 2 months after separation.  The Board considered the evidence.  It shows the CI had a reduced ability to sweat (either anhidrosis or hypohydrosis) which preceded service.  Service aggravation was conceded based on a presumptive history of heat strokes on two occasions; however, contemporary records do not show this nor does a review of clinical notes up to the final note weeks before separation.  Nonetheless, the CI demonstrated an ability to function normally in all but environments of extreme heat and was separated due to deployment restrictions.  The Board found no route to a higher rating than the 0% adjudicated by the FPEB and upheld by SAFPC.  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 anhidrosis condition.  

BOARD FINDINGS:  In the matter of the anhidrosis condition and IAW VASRD §4.120, 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 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01043.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings