RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02762
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Chemical Operations Specialist, medically separated for “history of heat stroke” with a disability rating of 0%.  

CI CONTENTION:  “I am not healthy.”  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 - 20051006	VARD - 20060925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Heat Stroke 	7999-7900	0%	Residuals of Heat Stroke	8999-8911	NSC	20060809	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

History of Heat Stroke.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a heat stroke (loss of consciousness, core temperature 107, 4-day admission) in September 2004.  This occurred in the setting of significant exertion, but was preceded by an extended period of daily use of stimulant supplements (including ephedra) that might have been implicated.  Provider entries in the STR documented that he recovered without any systemic or neurological sequelae, was asymptomatic at rest and was able to perform routine duties and activities.  He reported various symptoms, including nausea and non-specific dizziness, precipitated by any significant exertion or prolonged heat exposure.  There was no note of syncope, near-syncope or tremors.  The absence of tachycardia was well confirmed by recorded vital signs throughout the STR.  There were sporadic elevations of blood pressure (none critical), but this preceded the heat stroke and could not be attributed to it without considerable speculation.  The medication profile confirmed the absence of any prescribed medications for treatment or complications of heat stroke.

The 25 August 2005 MEB NARSUM examination, 4 months prior to separation, noted the above symptoms.  The CI’s denied any subsequent loss of consciousness.  The examiner stated that he “is now asymptomatic [but]…unable to participate in any vigorous activity or work in temperatures above 85 degrees [Fahrenheit] for more than 15 minutes per day.”  The physical examination recorded a normal heart rate without note of tremor or any probative finding.

At the 9 August 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported similar symptoms to those in the NARSUM with exertion or heat exposure, but added it “has caused him to have momentary losses of consciousness, he says, for a minute or so.”  The examiner noted “he is able to walk 200 meters rather briskly” and the only other documented functional limitations were ascribed to coexisting orthopedic complaints.  No active medications were listed.  On physical examination, the vital signs were normal and the examiner specified that there were no positive findings relative to heat stroke.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heat stroke condition 0%, coded 7999-7900 (analogous to hyperthyroidism), documenting the above association with over-the-counter stimulant use; but, there was no indication of a deduction or other effect on rating due to this issue.  The VA rated the residuals of heat stroke “not service connected,” coded 8999-8911 (analogous to epilepsy, petit mal), citing the CI’s report of ongoing transient syncopal events and “objective residuals...that can be specifically related to [his] historical heat stroke”.

There is no VASRD code specific to heat illness.  There are alternate codes for various other conditions (or systemic complications of heat stroke) that might be considered for analogous rating, but all of these require at least continuous medication and/or other criteria not in evidence to justify the minimum rating.  The PEB’s code of 7900 is a common analogous choice in this circumstance; and, although not citing a rationale for its 0% rating, the 10% criteria are “tachycardia, which may be intermittent, and tremor, or; continuous medication required for control.”  Criteria for the next higher 30% rating additionally include “increased pulse pressure or blood pressure.”  Panel members agreed that there was insufficient corroboration of episodes analogously equivalent to minor seizures for rating under the VA’s code 8999-8911.  The panel thus concluded that, although the activity and environmental restrictions present at the time of separation were not inconsequential, there was no evidence for any ratable criterion to support a minimum 10% rating (analogous or otherwise) under code 7900 or any other applicable code available in the VASRD.  Therefore, IAW VASRD §4.31 (no-percent rating), a 0% rating must be recommended.  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 adjudication for the heat stroke condition.  

BOARD FINDINGS:  In the matter of the heat stroke condition and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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 20170422, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007172, 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.