NAME:  XXXXXXXXXXXXXX

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

CASE: PD-2017-03998

BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090602

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Operations, medically separated for “heat injury with rhabdomyolysis” with a disability rating of 0%.

CI CONTENTION: “My career was cut short due to this illness. I suffered anxiety over the ordeal and it affected me mentally as well as my physical illness got worse after discharge.” 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 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 - 20090217	VARD - 20090701	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Injury with Rhabdomyolysis	7999-7900	0%	Status Post Exertional Rhabdomyolysis with Residual of Chronic Myalgias	5099-5025	20%	20090921	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Heat Injury with Rhabdomyolysis. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s heat injury occurred while deployed to Iraq in September 2008. He was hospitalized for 2 days in intensive care for significantly elevated creatine kinase and positive urine myoglobin. He subsequently continued to experience occasional muscle aches, fatigue, weakness, and some difficulty with thinking and memory, despite normal lab data.

During the 28 January 2009 MEB NARSUM examination, 4 months prior to separation, the CI reported chronic fatigue, lethargy, muscle pain, and weakness which were worsened when attempting to work a full day or exert himself physically. He also had difficulty remembering things at times without using notes and reminders. Physical examination showed some tenderness about the Achilles up to the leg muscles, but normal muscle strength, tone, and mass.

At the 11 May 2009 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain over the entire body as well as loss of strength, weakness, and easy fatigability. Physical examination showed tenderness of both calves and Achilles tendons, but no decreased muscle tone, strength, endurance or coordination. During the 21 September 2009 VA C&P muscle examination, 4 months after separation, the CI complained of tightness, soreness and bilateral ankle and leg pain when climbing stairs or with exertion. He also reported throbbing all over his muscles. He did not have any pains in the back or arms, but he did have pains in both legs. He was only taking over-the-counter pain medications which he found helpful.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the heat injury with rhabdomyolysis 0%, analogously coded 7999-7900 (hyperthyroidism), citing risk of recurrence. The VA rated exertional rhabdomyolysis with residuals 20%, analogously coded 5099-5025 (fibromyalgia), based on the C&P examination, citing the 20% VASRD rating criteria for fibromyalgia. Panel members noted that there is no specific VASRD code for rhabdomyolyis, and that a 10% rating under code 7900 or 5025 requires continuous use of medication for control of the condition. However, there was no evidence in the record to support this criterion. Additionally, the NARSUM examiner found no shoulder, arm, back or leg muscle pain, and thus there was no evidence of widespread pain to warrant the use of code 5025. The panel also considered a rating under code 5021 (myositis), which requires limitation of motion, painful motion (§4.59) or pain with use (§4.40) for a compensable rating, and agreed that a 10% rating was warranted based on functional loss and painful motion. The panel. Panel members discussed other VASRD muscle and analogous codes, but all were less applicable and/or not advantageous for rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the heat injury with rhabdomyolysis, coded 5021.

BOARD FINDINGS: In the matter of the heat injury with rhabdomyolysis, the panel recommends a disability rating of 10%, coded 5021 IAW VASRD §4.119.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Heat Injury with Rhabdomyolysis	5021	10%	

2	PD-2017-03998

AR20200000243,

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

Dear XXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure

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