RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01499
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Track Vehicle Repairer, medically separated for “exertional rhabdomyolysis,” (breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation) with a disability rating of 0%.  

CI CONTENTION:  “Rhabdomyolysis.”  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 upon a 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 - 20041207	VARD - 20050919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Exertional Rhabdomyolysis	5099-5021	0%	Rhabdomyolysis	8099-8023	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Exertional Rhabdomyolysis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s condition began in April 2004 after engaging in a 5-mile run.  The CI developed severe lower extremity swelling, pain, cramps, and weakness.  He was emergently treated and hospitalized with elevated creatine kinase (CK) levels over 30,000 (normal 55-170) indicating muscle breakdown.  The MEB forwarded “rhabdomyolysis without associated myoglobinuric renal failure” for PEB adjudication.  

The MEB NARSUM examination on 26 October 2004, 6 months prior to separation, noted exertional rhabdomyolysis requiring hospitalization.  His only residual symptom was tightness in the calf muscles bilaterally.  CK level was down from 625 to 288 (normal 55-170).  Physical examination showed no muscle tenderness.  There were no signs of exertional compartment syndrome, patellar tendonitis, or calf muscle atrophy, and no focal neurologic findings.  Examination was otherwise unremarkable.  The physician stated that there was no significant residual sequelae as a result of the CI’s episode of rhabdomyolysis, and that kidney function and electrolytes had remained essentially normal.  The examiner indicated that the CI had not been stretching his calf muscles on a daily basis, and had been advised to begin frequent, gentle, stretching of the calf muscles and Achilles tendon, as indicated.  

The CI failed to report for his scheduled 9 September 2005 VA Compensation and Pension (C&P) evaluation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the exertional rhabdomyolysis condition 0%, coded analogously to 5021 (myositis), citing “recovered, minimal residual.”  The VA did not service connect this condition, citing no evidence of a permanent chronic disability or residual.  The CI had no symptoms or permanent residuals from his episode of exertional rhabdomyolysis, and there was no renal, muscular or other permanent residual on examination.  Alternative rating analogous to 7900 (hyperthyroidism) would not support any higher rating as there was no tachycardia, tremor, or continuous medication required for control.  There was therefore no avenue to any higher rating than the 0% awarded by the PEB.  

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 rhabdomyolysis condition.  

BOARD FINDINGS:  In the matter of the exertional rhabdomyolysis condition and IAW VASRD §4.124a, 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 20150619, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002497 (PD201501499)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA