RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02421
BRANCH OF SERVICE:  Army	BOARD DATE:  20140820
SEPARATION DATE:  20060307

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 1LT/0-2 (88A/Transportation Officer) medically separated for heat stroke and rhabdomyolysis, resolved and a mild cognitive disorder.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3S3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “heat stroke” and “cognitive disorder” to the Physical Evaluation Board (PEB) IAW AR 40-501, both failing retention standards.  The Informal PEB adjudicated “heat stroke and rhabdomyolysis, resolved…heat stroke has resulted in a mild cognitive disorder manifested by mild impairments in memory and verbal fluency” as a single unfitting condition, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION: “I, XXXXXXXXXX served in the U.S. Army with a goal in mind to make or have a 20-yr. career.  But when I had my heatstroke injuries in 2004 and another in 2005 it abruptly ended.  I was then found unfit.  Being found unfit, and no longer a resource by the U.S. Army I thought I would receive a more meaningful compensation.  I was wrong.  I don’t understand a system that finds someone medically unfit and doesn’t reward them with more meaningful compensation.  I receive $395.00 a month from the VA, and I have memory problems.  My life has significantly spiraled down since getting reduced by the U.S. Army and DOD.  I am suffering from many ailments – i.e. chronic heat stroke related problems, memory etc… all because the ‘Board’ didn’t or doesn’t understand my illness.”

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 heat stroke and cognitive disorder conditions are addressed below; 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 Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service  IPEB – Dated 20051102 | Based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Heat Stroke …mild cognitive disorder… | 7999-7900 | 10% | Residuals of Heat Stroke Times 2 with cognitive Disorder | 9326 | 30% | STR
Rating:  10% | Rating:  30%
Derived from VA Rating Decision (VARD) dated 20060616(most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Heat Stroke and Rhabdomyolysis Condition with Mild Cognitive Disorder.  The CI initially had a heat injury on 16 June 2004 when he suffered a heat stroke during a run and suffered a loss of consciousness and disorientation for 10-20 minutes.  He had a viral illness the previous few days and was not fully recovered at the time of the run.  He was returned to duty with limitations.  He did well until he had a second heat injury under similar circumstances (preceding illness and then running) on 1 April 2005.  He was disoriented for about 20 minutes after stopping the run.  Subsequently, he noted some cognitive impairment manifested by short-term memory problems, as well as awakening with nausea, being more sensitive to heat and chronic fatigue, tiredness and headaches as noted at the 20 May 2005 Occupational Health Clinic visit.  He was noted to be asymptomatic, but only at the cost of “severely limited activity.”  
He was not able to increase his physical activity to pre-injury levels or improve strength or stamina since the injury.  It was determined the CI was no longer able to perform the duties or functions of his MOS, failed to meet criteria for retention, was issued a P3 profile and referred for re-evaluation in neuropsychology.  The CI was evaluated in neuropsychology with an interview on 30 June 2005 and completion of testing on 1 August 2005.  The formal testing showed there was indication of mild impairment noted in both immediate and delayed visual memory.  There was mild impairment noted in perceptual-organizational ability.  A measure of executive functioning and cognitive flexibility was mildly impaired.  Verbal fluency was also mildly impaired.  The overall assessment was that the results suggest mild neuropsychological impairment and meet the criteria for cognitive disorder, not otherwise specified (NOS), mild.  In addition, the examiner noted that the CI had “some mild decline in nonverbal problem solving due to the effect of the heat strokes,” but “all other neuropsychological abilities measured were essentially within-normal-limits (WNL).”  These were thought to “exert a mild level of impairment in social and occupational functioning,” but were not disqualifying and there was no need for an MEB from a purely neuropsychological perspective.  He was diagnosed with a “Cognitive Disorder, NOS (not otherwise specified), Mild.”  The commander noted physical limitations from the profile in his 31 August 2005 statement however it was noted this was prior to the S3 profile dated 29 September 2005.  No VA Compensation and Pension examination was performed.  The CI was rated based on his STR.

The MEB was dated 22 September 2005 and determined that heat stroke and cognitive disorder did not meet retention standards.  The CI was issued a permanent P3S3 profile on 29 September 2005 for “heat injury, cognitive disorder.”  The CI was seen in the neuropsychological clinic on 21 October 2005, just over 4 months prior to separation, to discuss the results of his testing.  On mental status examination, he was noted to have no behavior abnormalities, a normal mood and affect and to display no impairment of his thought processes or thought content.  He was released without limitations.  The PEB was dated 2 November 2005, 2 weeks later.  It noted that the heat stroke and rhabdomyolysis condition was resolved.  It also noted the “Heat stroke has resulted in a mild cognitive disorder manifested in mild impairment in memory and verbal fluency.  Soldier now asymptomatic but with increased risk for recurrence if exposed to high temperature.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the heat stroke and cognitive disorder as a single unfitting condition, rated 10% using an analogous code, 7999-7900, hyperthyroidism.  The VA rated the CI at 30% for residuals of heat stroke times two with cognitive disorder and coded the condition 9326, a code for dementia, and rated the condition IAW VASRD §4.130.  The Board noted that there is not a diagnostic code in the VASRD for heat stroke and considered the two coding options used.  The commander stated that the CI was performing his job well and only cited the inability to deploy and perform physical activities as duty limiting.  The formal neuropsychological testing suggested mild neuropsychological impairment and met the criteria for cognitive disorder NOS, mild and “are expected to exert a mild level of impairment in social and occupational functioning,” but stated these deficits by themselves do not indicate a disqualifying neuropsychological condition.  However, the MEB did list the cognitive disorder as an additional disqualifying condition and the PEB combined the heat stroke and cognitive disorder conditions for rating as a single unfitting condition.  The Board considered if separately unfitting conditions existed.  It noted that the physical manifestations of the heat stroke had resolved with a residual risk of recurrence in high heat stress environments.  However, absent disability beyond risk of recurrence, there is no ratable condition present, even if separately unfitting, providing no advantage to the CI.  As already noted, the PEB rated the condition as analogous to hyperthyroidism, a metabolic abnormality.  The Board then discussed the cognitive disorder at length.  It noted that the neuropsychologist documented a cognitive deficit at the time of testing, several months after the second heat injury, but that the evaluator also stated that the neuropsychological deficits by themselves did not indicate a disqualifying neuropsychological condition.  The MEB, however, determined that cognitive disorder was disqualifying and referred it to the PEB.  The final note in the record, a neuropsychological appointment written after the MEB but prior to the PEB, noted that the thought processes and content were not impaired.  The PEB noted that the CI was asymptomatic but at increased risk of further heat injury.  The Board could not determine if the PEB intended the “asymptomatic” descriptor to apply to the primary heat stroke condition, the cognitive disorder or both.  Regardless, the Board determined the evidence does not support the 30% rating adjudicated by the VA under VASRD §4.130 for a cognitive disorder.  The Board also noted that the records in evidence proximate to separation would support only a 10% rating for a cognitive disorder if determined to be separately unfitting and separately ratable.  Again, this provides no advantage to the CI.  It considered changing the coding option to 9326 as used by the VA at 10%, but again, this provides no advantage to the CI.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  Therefore, 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.

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 “heat stroke and rhabdomyolysis, resolved…and a mild cognitive disorder” and IAW VASRD §4.120, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131117, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150003577 (PD201302421)

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

PD-2013-02421