RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201725 SEPARATION DATE: 20020429 BOARD DATE: 20130328 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B/Airborne Infantry) medically separated for heatstroke. The CI passed out during a physical training run in 2001. He was diagnosed with heatstroke and treated conservatively. He suffered another heatstroke incident while waiting for a parachute jump after which it was determined he could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or meet physical fitness standards. He was issued a permanent P3 profile and was referred for a Medical Evaluation Board (MEB). The heatstroke condition, characterized as the same, was forwarded to the Physical Evaluation Board (PEB) as not meeting medical retention standards in accordance with AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated heatstroke as unfitting rated 10%. The CI made no appeals, and was medically separated with that disability rating. CI CONTENTION: The CI elaborated no specific contention in his application. However in block 15 of the application he stated: “My recommended disability percentage was 10% by the PEB but it was later changed to 0%. I have received no monies for this disibility.” [sic] SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting heatstroke condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 respective Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20020212 VA - (3 Mos. Post-Separation) Condition Code Rating Condition Code Rating Exam Heatstroke 7999-7900 10% Heat Exhaustion 8999-8911 NSC 20020729 No Additional MEB/PEB Entries Nephrolithiasis 7508 0 20020729 Combined: 10% Combined: 0% Derived from VA Rating Decision (VARD) dated 20020807 (most proximate to date of separation [DOS]). ANALYSIS SUMMARY: Records indicate that the separation rating was at the 10% level and remained unchanged. The VA rating was noted to be “Not Service Connected, Not Incurred, or Caused by Service” with a 0% combined rating due to nephrolithiasis (kidney stones). Heatstroke Condition. The CI had a single episode of heatstroke with loss of consciousness during physical training in April 2001. He was treated in the emergency room and following a thorough evaluation he was issued a temporary profile with the goal of returning to full, unrestricted duty. He was returned to full duty after 3 months. While waiting for a parachute jump he had rapid breathing, dizziness, sweating and required medical treatment. He was put back on P3 profile with restricted activity to limit exposure to temperatures contributing to recurrence of heat injury. MEB exam 5 months prior to separation was normal with no sensory or motor deficits and normal routine laboratory tests. At the VA Compensation and Pension (C&P) exam performed 3 months after separation, the CI reported that he had no further recurrence of symptoms (after the pre-parachuting incident noted above). “He reports that his symptom have resolved. He denies any headaches, dizziness, loss of consciousness or seizure activity.” Exam was normal including labs and EKG. The diagnosis was “status post heat stroke without residuals.” The Board directs attention to its rating recommendation based on the above evidence. The PEB found the heat stroke unfitting, coded it analogously to hyperthyroidism (7999-7900), and rated at 10%. The VA adjudicated the condition (Heat Exhaustion) as necessary sufficient condition (NSC) as there was no residual or chronic disability from either heatstroke or heat exhaustion. Their NSC coding of 8999-8911 was analogous to petit mal epilepsy. The PEB’s analogous code is in common use for heat illness and is noted in both the military and VA tables of analogous code recommendations. The code requires at least intermittent tachycardia and tremor or the need for continuous medication to achieve the minimum compensable rating (10%). None of these requirements were met and the CI had no residuals of heatstroke or heat exhaustion. The CI’s initial heatstroke episode with loss of consciousness was a year prior to separation and there was no mention of generalized tonic-clonic convulsion for potential analogous rating to major seizures. Independent rating of the condition would favor a 0% rating; however, the Board cannot lower the PEB’s combined 10% adjudication. There is no evidence that would justify a different coding, rating recommendation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the heatstroke condition. The Board concluded therefore that this condition could not be recommended for additional disability rating. 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 heatstroke condition and IAW VASRD §4.119, 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 Heatstroke 7999-7900 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120730, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130008752 (PD201201725) 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 xxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)