RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04084
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070306

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Fire Support Specialist, medically separated for “heat stroke manifested by headache” with a disability rating of 0%. 

CI CONTENTION:  Review of headaches was requested along with an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070702	VARD - 20070619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Heat Stroke Manifested by Headache	7900	0%	Migraine Headaches	8100	30%	20070329	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Heat Stroke Manifested by Headache.  According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered a heat stroke in August 2006 after a 6-mile road march and was admitted to the hospital with a creatine kinase (CK) level greater than 33,000 with elevated liver enzymes.  He did well but developed frequent and severe headaches.  He was evaluated during basic training due to an irregular heartbeat.  No significant pathology was found.  Electrocardiogram on August 2006 showed a sinus rhythm with a rate in the 70s and no evidence of cardiac dysfunction.  

The 15 November 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of “recurrent headaches after episode of heat exhaustion and rhabdomyolysis last summer.”  He reported a headache occurring with any exertion, even walking rapidly for half a block.  He could walk slowly without developing a significant headache.  A headache could last for up to 4 days.  The headaches were unchanged in the 3 months since the heat injury.  Physical examination did not address cardio-pulmonary function.  The examiner noted headaches were due to heat stroke.  

At the 29 March 2007 VA Compensation and Pension (C&P) examination, one month after separation, the CI noted he was evaluated 21 November 2006 for headaches.  Documentation noted intense headaches were due to heat stroke, which was resolved.  He noted the headaches occurred mainly with activity.  He reported migraine headaches twice weekly.  Medications to treat migraines were not effective.  Marijuana was the only remedy that relieved the headaches.  He denied a history of migraines prior to service.  Physical examination showed vital signs, including pulse and blood pressure, essentially within normal limits.  The cardiac and eye examinations were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heat stroke condition 0%, analogously coded 7999-7900 (hyperthyroidism), citing heat stroke manifested by headache, syncope, and elevated CK levels but near normal body temperature…the headaches could not be separately rated because they were manifestations of the same condition… rated as analogous to hyperthyroidism at 0% IAW AR 635-40, para B-15.  The VA rated the headaches 30%, coded 8100 (migraines), based on the C&P examination, citing migraines which occurred daily or every other day and necessitated a quiet, dark room and rest.

The panel agreed with the PEB determination that the headaches could not be separately rated from the heat stroke condition.  The panel also noted neither the NARSUM nor the C&P examination provided evidence of tachycardia, tremor or continuous medication required for control to meet criteria for a 10% disability rating under VASRD code 7900.  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 no modification or re-characterization of the CI’s disability and separation determination.  

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Dear XXXXXXXXXXXXXXXXXXXX:

	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.