RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-04234
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20040902

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Motor Transpiration Operator, medically separated for “recurrent heat exhaustion, without heat stroke or systemic complications” with a disability rating of 0%.

CI CONTENTION: “Condition which I was separated from military among other conditions have rendered me unemployable total and permanent.”  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 - 20040630	VARD - 20050309	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Heat Exhaustion…	7999-7900	10%	Residuals, Recurrent Heat Exhaustion	6399-6354	NSC	

20050112	
Residual Abdominal Wall Tenderness	

Not Unfitting	Residuals, Status Post Appendectomy	7804	10%		
Recurrent Low Back Pain		Recurrent Low Back Pain	5237	NSC		
Dysthymic Disorder		
PTSD, Dysthymic Disorder, Paranoid Personality Disorder	
9433-9411	
10%		
Post-Traumatic Stress Disorder (PTSD)						
Paranoid Personality Disorder						
Gastroesophageal Reflux		Gastroesophageal Reflux	7346	10%		
Vision Defect		No VA Placement		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Recurrent Heat Exhaustion. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced dehydration associated with diarrhea in June 2003 while deployed to Iraq, and his temperature was documented at 98.3 degrees. In August 2003, he reported an episode of near syncope related to heat, and developed weakness and nausea, with a rectal temperature of 101.8 degrees.   He was cooled with ice packs, but vomited and was

admitted to intensive care for a few hours. Lab results showed low potassium levels, but no evidence of renal insufficiency, and he was placed on quarters for 48 hours. During the last 2 weeks of August, he developed recurring nausea, vomiting and headaches associated with abdominal cramps. His temperature was documented at 98.6 degrees, and dehydration was noted; he was placed on quarters for 72 hours, and later given temporary profiles. The CI had no further episodes of significant heat-related illness, but a possible MEB was recommended by the time of his redeployment. In February 2004, he experienced severe left-sided abdominal pain and underwent a diagnostic laparoscopy with excision of infected left lower quadrant fat tissue and an incidental appendectomy. He was placed on convalescent leave for 30 days and given a permanent P3 physical profile for recurrent heat exhaustion.

The 11 May 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, noted blood pressure of 140/80 and pulse of 87, with left lower quadrant abdominal tenderness. The 4 June 2004 commander’s statement noted the CI was an exemplary soldier that experienced a gastrointestinal infarction in February 2004 that severely immobilized him. Following exploratory surgery most of the symptoms were addressed. Despite the CI’s hard work to rehabilitate, he was severely handicapped as a “fuel handler” and soldier. The 7 June 2004 MEB NARSUM examination, 3 months before separation, noted complaints of heat exhaustion with headaches, sweating, and increased fatigue during elevated environmental temperatures. He had persistent abdominal wall tenderness related to the surgery but did not require follow- up care nor a permanent duty limitation. He had not worked in his military specialty since re- deployment, but did perform office work. His prognosis was estimated as stable with no indication of noncompliance. Physical findings referenced the MEB examination and no residual heat stroke problems were recorded.

At the 12 January 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported that was not able to eat on a regular basis and had lost ten pounds in the last month. He vomiting blood daily, had blood in his stools, and smoked marijuana which stimulated his appetite.  Physical examination showed blood pressure of 110/70 with a pulse of
63.  No residual heat stroke problems were noted.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the heat exhaustion 0%, analogously coded 7999-7900 (hyperthyroidism), citing US Army Regulation 635-40, paragraph 8-15 (zero percent ratings and minimum ratings). The VA did not service connect the heat exhaustion, based on the C&P examination, citing no permanent residual or chronic disability documented by the STR or demonstrated by the VA evidence following service. Panel members noted the STR documented recurrent heat exhaustion episodes from August 2003 to September 2004, but none after that period. There was no STR or VA evidence proximate to separation of rapid heartbeat, tremor, and increased pulse or blood pressure to support a 30% rating under code 7900. Additionally, there was no evidence of chronic fatigue which was “nearly constant and restricted routine daily activities by less than 25 percent of the pre-illness level, or; which wax and wane, resulting in periods of incapacitation (requiring bed rest and treatment by a physician) of at least two but less than four weeks total duration per year” to support a 20% rating under code 6354. 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 exhaustion.

Contended PEB Conditions: Residual Abdominal Wall Tenderness, Recurrent Low Back Pain, Dysthymic Disorder, PTSD, Paranoid Personality Disorder, Gastroesophageal Reflux, and Vision Defect. 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 or implicated in the commander’s statement, and did not 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 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 exhaustion and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication. In the matter of the residual abdominal wall tenderness, recurrent low back pain, dysthymic disorder, PTSD, paranoid personality disorder, gastroesophageal reflux, and vision defect, 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:

AR20200002311, XXXXXXXXXXXXX 

Dear XXXXXXXXXX:

	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.