RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01968
BRANCH OF SERVICE:  Army	BOARD DATE:  20141010
SEPARATION DATE:  20050908

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/Infantryman) medically separated for heat exhaustion.  The heat exhaustion condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, he was permitted to take the alternate (aerobic portion) Army physical fitness test.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  Heat exhaustion was forwarded by the MEB to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “heat exhaustion, recurrent” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I am confused by this as well.  I was med board from the military becase I had a heat stroke.  I was given a 10% for Asthma which I acquired in Iraq.  I don’t know what the real reason why I was med boarded.  According to the VA doctors it was because of my asthma.  That is not why I was med boarded.  I also don’t understandard why I have had feet probems and is documented since basic training but is not considered chronic.  I would just want a fair rating I have moved to a one a day med.  I do not get this from the VA. I get it through tri care prime.”  

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 heat exhaustion condition is addressed below.  The contended exercise induced asthma condition, which was forwarded as medically acceptable by the MEB, was not specifically adjudicated per the PEB's DA Form 199; but, the Board judged that this was likely an erroneous omission and should be assumed to constitute a de facto PEB determination that the condition was not unfitting, and thus will be reviewed by the Board as well.  The contended feet problems were not identified by the PEB, and thus are not 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 Board for Correction of Military Records.  

RATING COMPARISON:

Service IPEB – Dated 20050719 | VA - (2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Heat Exhaustion, Recurrent | 7999-7900 | 0% | Heat Stroke | 8099-8019 | NSC | 20051107
Other x 0 (Not in Scope) | Other x 6 | 20051107
Rating:  0% | Combined:  10%
Derived from VA Rating Decision (VARD) dated 20060418 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

Heat Exhaustion.  Overall, the service treatment record contained a few documents with regard to his heat injury.  The record revealed frequent references of the CI having “multiple heat injuries,” but there was documentation of only a single episode of diagnosed heat exhaustion that occurred on 1 July 2004.  At that time there was no loss of consciousness or seizure activity and he was treated and released without overnight hospitalization.  All abnormal vital signs were normalized before being released from the medical facility and persistent abnormal labs were addressed in follow-up evaluations.  He developed no medical complications from the heat-related condition and was placed on a P3 profile secondary to “heat exhaustion (multiple episodes)” and referred for an MEB in May 2005.  At the narrative summary examination, performed on 12 May 2005, (4 months prior to separation) the CI reported the inability to run for any distance beyond 400 meters without leg cramps.  He endorsed no new or current heat-related symptoms.  Other than obesity, the physical examination (PE) was normal.  His medical assessment vital signs indicated that he was not tachycardic (fast heartbeat) and his pulse pressure was normal at 58 (normal range = 40-60).  At the VA Compensation and Pension examination, performed on 7 November 2005, (2 months after separation) the CI reported respiratory symptoms of shortness of breath in walking up a single flight of stairs.  There were no heat-related subjective complaints at that time.  His vital signs and PE were normal.  One of many diagnoses was, “History of heat stroke, no residuals at the present time.”

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0%, coded 7999-7900, analogous to hyperthyroidism.  The VA rated the condition as not service-connected, code 8019, analogous to cerebrospinal meningitis.  Board members first deliberated on the VA’s reasoning as to the use of a meningitis code and concluded that it was likely an error in documentation.  There is not a specific VASRD code for such a heat-related injury; and, the PEB’s 7900 thyroid code is often analogized for such a condition.  Board members considered that in the absence of abnormal functional residuals or significant impact on occupational and social activity, the heat-related condition was of mild severity and was resolved near the time of separation.  Board members agreed that the analogized VASRD 7900 code most accurately depicted the CI’s condition.  The Board is unable to find any pathway to a higher rating than the PEBs 0%.  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 recurrent heat injury condition.

Other Contended Condition.  The CI’s application asserts that a compensable rating should be considered for the asthma condition.  The record clearly implicated the historical presence of “exercise induced asthma” but, the condition was not profiled, implicated by the commander, or judged to be medically unacceptable.  Based on these facts, the condition was reviewed by the action officer and considered by the Board.  It was determined that the asthma condition could not be argued as separately unfitting.

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 heat exhaustion condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended asthma condition, the Board unanimously agrees that it was not unfitting and therefore, cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131027, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20150006952 (PD201301968)

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						     XXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01968