RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01472
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “rhabdomyolysis, resolved without residuals,” with a disability rating of 0%.

CI CONTENTION:  The CI contends that he was cured of his illness and requests that his enlistment restriction be removed so that he can re-enlist.  He also indicated that he would like all of his conditions reviewed.  The CI’s 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 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 – 20060627	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Rhabdomyolysis, Resolved without Residuals	5099-5021	0%	
No VA Examination in Evidence
 	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Rhabdomyolysis Condition.  According to service treatment records (STR) and the medical evaluation board (MEB) narrative summary (NARSUM), the CI was diagnosed with rhabdomyolysis (syndrome of muscle necrosis and the release of intracellular muscle constituents) in the first week of basic military training (BMT).  The 6 June 2006 NARSUM, 1 month before separation, documented the CI experienced epigastric cramping and nausea during the first week of BMT.  He was unable to tolerate meals without vomiting and presented to the emergency department.  A 4 May 2006 abdominal ultrasound revealed a gallbladder neck polyp, non-shadowing gallstones, and sludge.  Labs revealed biomarkers of muscle (elevated creatine kinase [CK]) and hepatic (elevated transaminases [AST/ALT]) injury, he was diagnosed with rhabdomyolysis, and hospitalized (05-08MAY06).  The initial CK (normal 24-195 IU/L) was markedly elevated with a value of 20,572 High (H).  Serial CK values were 3533 H (08MAY06), 3962 H (10MAY06), 2215 H (11MAY06), and 185 (17MAY06).  Serial AST (0-37 U/L)/ALT (0-40 IU/L) values were 1158 H/217 H (04MAY06), 683 H/234 H (06MAY06), 429 H/214 H (07MAY06), and 27/42 H (17MAY06).  Following discharge, the CI reported feeling much better, but still had abdominal cramping after meals.  He denied a history of musculoskeletal disorders/illnesses.  The abdominal examination revealed a flat appearance, soft consistency, and bowel sounds present in all quadrants.  There was right upper quadrant tenderness to palpation with no rebound tenderness, mass, liver enlargement, or spleen enlargement.  The neuromuscular examination revealed intact cranial nerves (CN II-XII), cerebellar function, strength (5/5), and deep tendon reflexes (2+).  The examiner recounted the findings of the labs and abdominal US and the diagnosis listed rhabdomyolysis.  The examiner documented “Since Rhabdomyolysis is a disqualifying illness, the CI was processed for an Entry Level Separation (ELS). … During the course of his hospitalization, he had extremely high CK values and elevated liver function tests.  On subsequent reassessments, all previously elevated lab tests have returned to be within the normal ranges.  No end organ damage was noted.  He appears to have recovered well without evidence of sequelae or neuromuscular compromise.  His extraordinary high CK values and liver enzymes indicate a strong likelihood of recurrence and potential for serious end organ damage under strenuous conditions such as BMT.  He required an MEB because his illness did not exist prior to service.  Based on review of the medical record, interview with the patient and considering that he had a disqualifying illness, I hereby recommend separation from the United States Air Force.”  There was no VA examination in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5021 code (myositis) citing rhabdomyolysis, resolved without residuals.  Rhabdomyolysis can result in residual end organ damage such as muscle weakness, liver inflammation, or impaired kidney function.  At the time of the MEB NARSUM, the CI was relatively asymptomatic, had normal strength, and transient lab abnormalities had resolved.  There is no specific code for rhabdomyolysis.  The 5021 code is rated according to the 5003 code (arthritis, degenerative) and rating under the analogous 5021 code requires limitation of motion, painful motion (§4.59) or pain with use (§4.40) for a compensable rating.  There was no residual muscle weakness for rating under muscle codes (§4.73) or any other residuals warranting consideration under other diagnostic codes.  Panel members agreed there were no examination findings supporting a higher rating using this or any other VASRD diagnostic code.  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 §4.71a, the panel 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 20150611, w/atchs
Exhibit B.  Service 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-2015-01472.

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