RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02581
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Combat Engineer, medically separated for “recurrent heat exhaustion” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 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 or non-compensable.  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 determination 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 progression or complications of service-connected conditions after separation.  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 - 20061206	VARD - 20070404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Heat Exhaustion	7999-7900	0%	Recurrent Episodes of Heat Stroke and Heat Exhaustion	8999-8911	NSC	20070227	
Hypertension	Not Unfitting	Hypertension	7101			
Dyslipidemia		Hyperlipidemia	7199-7114			
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Recurrent Heat Exhaustion.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s heat injuries began in 1993 during Basic Training with subsequent incidents occurring in 1997 and 2003.  

On 19 August 2006 the CI was seen in the Emergency Room with complaints of headache and dizziness associated with being very hot while participating in a three mile road march.  Symptoms improved with drinking some fluids and getting in a cool environment.  However, the headache persisted and it was treated with intramuscular Toradol (ketorolac, a nonsteroidal anti-inflammatory drug (NSAID)).  The diagnosis of heat exhaustion was made.  At a follow-up clinic evaluation the examiner noted the CI was at high risk for heat injuries based on his previous history of heat stroke and recurrent heat exhaustion.  Tylenol replaced the NSAIDs and fluids were emphasized.  At a follow-up medical visit on 7 September 2006, physical examination was normal and an electrocardiogram on 19 September 2006 was normal.  

During September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808) less than 4 months prior to separation, the CI reported heat exhaustion last August 18, 2005.  The examiner noted “heat stroke” in the notes section of the clinical evaluation, but listed “heat exhaustion” in the summary of defects and diagnoses section.  

The 28 October 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of recurrent heat exhaustion over the years with a potential deployment to a very high temperature area, but the CI had limitations of wearing MOPP (mission oriented protective posture) equipment.  Physical examination was normal as were screening laboratory studies except for lipids (see below).  The examiner noted that although the CI had a history of recurrent heat exhaustion, he subsequently recovered from each; however, he felt the CI “most likely will suffer recurrent problems with heat in the foreseeable future.”

At the 27 February 2007 VA Compensation and Pension (C&P) evaluation, almost 2 months after separation, the CI reported heat stroke in 1993 and heat exhaustion episodes in 1997, 2004 and August 2006.  The CI had no further episodes but noted he felt tired all the time without doing any exercise and he restricted his exposure to the sun and exercises to avoid another episode.  Physical examination showed a normal gait and was otherwise normal excepted for degenerative arthritis in both shoulders and knees, which are not in the scope of review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heat injuries 0%, analogously coded 7900 (hyperthyroidism), citing Army Regulation 635-40, paragraph B-15.  The VA did not service connect the heat injuries, analogously coded 8911 (epilepsy, petit mal), citing no permanent residual or chronic disability subject to service connection was shown.  

Because the heat stroke and recurrent heat exhaustion episodes are coded analogously to hyperthyroidism, a 10% rating requires “tachycardia, which may be intermittent, and tremor, or; continuous medication required for control.”  However, the CI did not have tachycardia between or after episodes, and did not take medication for hyperthyroidism nor did he have tachycardia, tremor, and increased pulse pressure or blood pressure in combination for a 30% rating, but he did have high blood pressure.  

Using the VA approach to rating with code 8999-8911, a 10% rating requires “a confirmed diagnosis of epilepsy with a history of seizures” a 20% rating requires “at least one major seizure in the past 2 years; or at least two minor seizures in the last 6 months.”  However, the CI did not have epilepsy or a history of seizures, but had an episode of heat exhaustion on 19 August 2006 less than 5 months before separation.  Therefore, with use of code 8999-8911, the CI could come close to warranting a 10% rating, albeit he did not nor does he have a history of a seizure disorder or in particular petit mal epilepsy; however, he did have one episode of heat exhaustion, presumably analogous to a minor seizure, but did not have two episodes.  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 injuries.   

Contended PEB Conditions:  Hypertension and Dyslipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the heat injuries and IAW VASRD §4.119, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension and dyslipidemia, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were 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 20150605, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013334, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX

	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,					      
						      					
Enclosure