RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200799 SEPARATION DATE: 20011114 BOARD DATE: 20130305 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E1/PVT, Initial Entry Trainee, medically separated for exertional rhabdomyolysis with myoglobinuria with renal failure and coagulopathy. The CI developed an episode of rhabdomylosis during her first week of training. Although she recovered, the condition was disqualifying for continued military service due to the risk for recurrence. She was issued a permanent P3/L2 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the exertional rhabdomyolysis with myogolbinuria with renal failure and coagulopathy condition(s) as unfitting, rated 0% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD)/Department of Defense Instruction (DoDI) 1332.39. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: “These conditions were a result of active duty and retirement should be warranted.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20010904 VA (25 Mos. Post-Separation) – NSC Condition Code Rating Condition Code Rating Exam Exertional Rhabdomyolysis w/myoglobinuria w/renal failure and coagulopathy 5099-5021 0% Exertional Rhabdomyolysis w/myoglobinuria w/renal failure and coagulopathy 7599-7502 NSC 20031215 .No Additional MEB/PEB Entries. 0% X 0 / Not Service-Connected x 1 Combined: 0% Combined: NSC ANALYSIS SUMMARY: Exertional Rhabdomyolysis with Myoglobinuria with Renal failure and Coagulopathy. The MEB narrative summary (NARSUM) dated 14 August 2001 noted that on 25 June 2001 the CI collapsed after performing strenuous activity (sit-ups, push-ups and running). The MEB NARSUM noted there was a pre-service history of difficulty tolerating physical activity; “overheats” and needs a time out. Laboratory testing immediately in the emergency room evidenced rhabdomyolysis, the abnormal breakdown of muscle tissue causing myoglobinuria (muscle protein in the urine), acute renal failure and coagulopathy. She was hospitalized for treatment. The CI responded well to the treatment and was discharged a few days later in a stable condition with the recommendation to follow up regularly with her civilian physician. Although the CI’s medical condition completely resolved and there were no complications or residuals such as coagulopathy or compartment syndrome, a permanent profile and subsequent MEB evaluation were recommended. The MEB exam dictated 11 July 2001 noted a normal physical exam with normal blood pressure, and no edema. There was minimal tenderness of the quadriceps muscle, but without any evidence of muscle complications. Full recovery without sequelae was anticipated. At the VA Compensation and Pension (C&P) exam performed on 15 December 2003, 2 years after separation, complete resolution of the episode of rhabdomyolysis was recorded, physical examination and laboratory testing was normal. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition 0% analogously to code 5021 (myositis). The VA adjudicated a coding analogously to 7502 (chronic nephritis) but denied service-connection citing a condition that completely resolved. The Board considered the episode of exertional rhabdomyolysis with myoglobinuria with renal failure and coagulopathy as well as short term and long term consequences of it. However, it was an isolated episode that resolved completely with adequate medical care and no residual disability was demonstrated. In July 2001, 4 months prior to separation both the physical exam and laboratory work returned to normal and the CI continued to maintain a healthy state 2 years after separation, when the C&P exam was performed. No rating could be assigned under either codes 5021 or 7502 chosen by the PEB and respectively VA given the fact that patient did not have edema, high blood pressure or abnormal laboratory results, included in the rating criteria. No other rating options could be considered as the CI recovered without impairment. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the exertional rhabdomyolysis with myoglobinuria with renal failure and coagulopathy condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the exertional rhabdomyolysis with myoglobinuria with renal failure and coagulopathy condition and IAW VASRD §4.115b, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Exertional Rhabdomyolysis with Myoglobinuria with Renal Failure and Coagulopathy 5099-5021 0% Rating 0% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120617, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20130005089 (PD201200799) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)