RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02594
BRANCH OF SERVICE:  Army	BOARD DATE:  20141024
SEPARATION DATE:  20080708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV2/E-2 (Basic Trainee) medically separated for heat stroke.  The condition could not be adequately rehabilitated to meet the physical requirements of basic training or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The heat stroke condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded four other conditions.  The Informal PEB adjudicated “heat injury” as unfitting, rated 0% with likely application of the VA Schedule for Rating Disabilities (VASRD) and the remaining conditions as not unfitting.  The CI appealed to the Formal PEB which increased the rating to 10%.  The CI made no further appeals and was medically separated.

CI CONTENTION:  “Permanent muscle deterioration due to my heat stroke.  I lost fibers in my muscles that are unable to grow back.  This loss of fibers leaves me in a weakened state when I do any physical activity large or small.  Because of this I am unable to perform any work that requires physical exercise.  My extreme case of heat stroke has also left me with hypertension.  My hypertension can’t be taken care of without regular dosage of prescribed medicine from my doctor twice a day.  During my operations at Richland doctors got my personal information wrong including my age and ethnicity.”  

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 injury condition and the not unfitting hypertension 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.

RATING COMPARISON:

Service FPEB – Dated 20020080414 | VA -  based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Heat Injury | 7999 7900 | 10% | Residuals Of Rhabdomyolysis | 7999-7900 | 10% | STR
Hypertension | Not Unfitting | Hypertension | 7101 | 0% | STR
Other x 3 (Not in Scope) | Other x 0 | STR
Combined:  10% | Combined:  10%
Derived from VA Rating Decision (VARD) dated 20091113 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  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, operating under a different set of laws.  The Board also acknowledges the CI’s contention for ratings of his hypertension condition, which was determined to be not unfitting by the PEB and, emphasizes that the disability compensation may only be offered for those conditions that cut short the member’s career.  Should the Board judge that any contested condition was most likely incompatible with the specific duty requirements; a disability rating IAW the VASRD and based on the degree of disability evidenced at separation, will be recommended.  Finally, the Board noted the comment by the CI that the records at Palmetto-Richland hospital (civilian) had his age and ethnicity incorrect.  It is beyond the scope of the Board to correct this; regardless, this had no bearing on the adjudication of this case.

Heat Injury Condition.  On 3 October 2007, the CI became overheated and had an alteration of consciousness on his first day of training at Fort Jackson.  He was transported by ambulance to a local emergency room and was admitted to a local civilian hospital for acute heat stroke.  His admission was complicated by acute renal failure requiring dialysis, a bleeding disorder and a requirement for intubation.  He was later transferred to the local Army hospital on 29 October 2007 for continued care, but then developed a fungal infection and was transferred to a second Army hospital (a higher care level) on 1 November 2007.  He was subsequently discharged on 7 November 2007.  He was noted to have had acute renal failure secondary to muscle tissue breakdown (rhabdomyolysis) requiring dialysis, liver toxicity secondary to one of his medications (which resolved after it was discontinued), a fungal infection (treated) and persistent nausea and vomiting (also thought to be secondary to a medication).  He had anemia (secondary to the bleeding disorder) which was treated with one transfusion and oral medications, as well as high blood pressure, also treated with oral medications.  Although he gradually improved following discharge from the hospital, he was thought to be at risk for future heat injury and an MEB was initiated.  At the MEB examination on 10 December 2007, the CI reported some of the findings of the heat stroke without acute complaints.  

The narrative summary dated 12 December 2007, 7 months prior to separation and dictated by the attending physician, noted the heat stroke to be medically unacceptable, but anemia, high blood pressure (hypertension), protein in the urine (after the acute renal failure), and liver injury (hepatotoxicity) were all determined to be medically acceptable for retention.  At the time of the dictation, resolution of some of his problems related to the heat injury was noted.  However, he remained on medications for the high blood pressure, remained “somewhat” anemic and had “slight” proteinuria (excess protein in the urine).  He was noted to be overweight on examination.  Laboratory findings showed normal kidney function, but persistent anemia and trace protein in the urine.  The physical examination was unremarkable with normal strength.  The blood pressure and heart rate were both within normal limits at 127/81 and 98, respectively.  The MEB examination on 17 December 2007 was not in evidence, but the clinical note showed strength at 3/5 under musculoskeletal examination.  However, under the neurological examination, the strength was recorded as normal.  These are inconsistent.  The blood pressure and heart rate were both within normal limits at 130/74 and 62, respectively. 

At the VA Compensation and Pension examination performed 3 months after separation, the CI reported night sweats twice a week and heat intolerance.  The history was negative for specific kidney complaints, musculoskeletal complaints and neurological issues.  He took one medication for his blood pressure.  On examination, he had gained weight and was now 277 pounds, a gain of 43 pounds since the MEB examination.  His gait was normal as were the cardiac, musculoskeletal, neurological and psychiatric examinations.  The blood pressure was normal (122/70, average of three) and heart rate 98, also within the normal range.  Laboratory findings showed resolution of the kidney and liver damage and the anemia.  The effects of the heat stroke were thought to be resolved with the exception of the residual night sweats.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both coded the heat stroke condition as 7999-7900, analogous to hyperthyroidism and rated it at 10%.  The Board observed that there is no code for heat stroke or heat injury in the VASRD and found no better coding option than that chosen by the PEB and VA.  The effects of the heat stroke were limited to night sweats twice a week.  The CI also was treated for high blood pressure, but was well controlled.  His heart rate, although at the upper limit of normal (100), remained in normal limits on medication.  The CI contended for residual muscle weakness, but this was not demonstrated on examination except for the MEB physical which noted both a normal examination and also noted weakness, internally inconsistent.  The other two examinations, including the more proximate VA examination, were normal.  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 heat stroke condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that high blood pressure was not separately unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The high blood pressure was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  It was well controlled on medications.  It was reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that it significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination it and so no additional disability rating is recommended.

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 stroke condition and IAW VASRD §4.120, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20131204, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
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, AR20150007069 (PD201302594)

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-2013-02594