RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02721
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070615

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

CI CONTENTION:  “The conditions have not improved or gone away.  If anything some have gotten worst.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070508	VARD - 20070823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Injury	7999-7900	0%	Heat Exhaustion	8999-8911	10%	20070727	
Low Back Pain	Not Unfitting	Lumbar Paravertebral Muscle Spasm 	5237	10%	20070727	
Headaches	Not Unfitting	Migraine Headaches	8100	10%	20070727	
Adjustment Disorder 	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Heat Injury:  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI fell out of a road march because of muscle cramps in May 2005.  He fell out again during a live fire exercise with cramps but did not lose consciousness.  He fell out a third time during a road march and lost consciousness and was transported to the emergency room.  An electrocardiogram performed in March 2007 was normal and revealed a pulse rate of 58 beats per minute.  At the 11 April 2007 MEB NARSUM examination, 2 months prior to separation, the CI’s chief complaint was documented as “heat injury.”  His physical examination (PE) was normal except for an elevated pulse rate (tachycardia) of 103 beats per minute (normal is less than 100).  The muscle enzyme of creatine kinase, which was previously elevated, was now normal.  

At the 27 July 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported being intolerant to heat.  His PE revealed a normal pulse rate of 68 beats per minute.  All other physical parameters involving the neurological, cardiovascular or endocrine systems were normal.  He was not taking any prescription medications.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heat injury 0%, analogously coded 7900 (hyperthyroidism), citing elevated body temperature, unconsciousness, muscle cramps and weakness on at least two occasions.  The VA rated the heat injury 10%, analogously coded 8911 (epilepsy, petit mal), based on the STR and C&P examination, citing STR diagnosis of heat exhaustion with loss of consciousness two times during the last five months of service.  

There is not a specific VASRD code for a heat-related injury, but the 7900 thyroid code is often analogized for such conditions.  Panel members considered that in the absence of abnormal functional residuals or significant impact on occupational and social activity, the CI’s heat-related condition was of mild severity.  Additionally, panel members agreed that the analogized 7900 code most accurately depicted the CI’s historical condition.  The panel is unable to find a higher rating than the PEB’s current 0%.  Although tachycardia was clinically present at the NARSUM examination, all panel members agreed that the normal pulse rate 1 month before and 1 month after the NARSUM examination showed that the single episode of tachycardia was simply an incidental and isolated finding and not related to or with a heat-related injury.  Therefore, code 7900 at the 10% level is not applicable in this case having the absence of diagnostically-related tachycardia or the requirement for continuous medication.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the heat injury.  

Contended PEB Conditions:  Low Back Pain, Headaches and Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or failed retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the heat injury and IAW VASRD §4.120, the panel recommends no change in the PEB adjudication.  In the matter of the contended back condition, headaches and adjustment disorder, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170323, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007093, XXXXXXXXXXXXXXXXXX

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.