RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00108
BRANCH OF SERVICE:  Army	BOARD DATE:  20141015
SEPARATION DATE:  20061109

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (42A/Human Resources Specialist) medically separated for rhabdomyolysis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB referred “rhabdomyolysis” to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded “retropatellar pain syndrome” (knee pain syndrome), “chronic LBP” (low back pain) and “latent tuberculosis,” all meeting retention criteria.  The PEB adjudicated “rhabdomyolysis” as unfitting, rated 0%.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION: “Factors that contributed to Medical Discharge diagnosis of rhabdomylosis were not considered (Restrictive Lung Disease).  Effects of disability still present and have increased in intensity since discharge.  Service injury has created additional health issues such as Severe Sleep Apnea (currently being evaluated by the VA) and Active Depression.

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 rhabdomyolysis is addressed below.  The CI also contended for restrictive lung disease, sleep apnea and depression.  These were not documented by the PEB or MEB and are therefore not within the purview of the Board.  In addition, the Board determined that the preponderance of evidence does not support the VA determination that the restrictive lung disease condition was a residual condition resulting from the unfitting rhabdomyolysis condition.  None of the remaining MEB conditions were contended by the CI; therefore, these 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 20060807 | VA - (11 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
No MEB/PEB entry | Restrictive Lung Disease…Associated with Rhabdomyolysis | 6899-6845 | 60% | 20070929
Rhabdomyolysis | 5099-5021 | 0% | | | |
| | | Rhabdomyolysis | 5021-5321 | 0% | 20070929
Other x 3 (not in scope) | Other x 4 | 20070929
Combined:  0% | Combined:  70%
Derived from VA Rating Decision (VARD) dated 20071026 (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 (DES) 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.  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.

Rhabdomyolysis condition.  At accession, the CI was noted to have pectus carinatum (pigeon chest, an abnormality of the chest wall), but no symptoms from this were recorded.  He was also seen one time for chest wall pain in the first year of active duty.  No further visits related to the unfitting condition were recorded until he was evaluated for the rhabdomyolysis.  The CI presented with anterior chest wall pain on 6 April 2003.  He was found to have an elevated muscle protein and the diagnosis of rhabdomyolysis (rapid breakdown of skeletal muscle; this can be due to a number of causes) was made.  He responded well to intravenous hydration and was discharged to duty.  However, he continued to have pain in the chest wall and upper arms as well as weakness.  He was not able to meet full duty requirements although he did his job (administrative) well in garrison.  At a 22 November 2004 physical medicine evaluation, he had a normal neurological examination without muscle atrophy.  Electrodiagnostic testing was normal.  No etiology was determined for either the rhabdomyolysis or the subjective complaints.  He continued to be seen periodically for his complaints until it was noted that the condition required an MEB at a 2 March 2006 internal medicine appointment and he was entered into the DES.  The narrative summary on 5 June 2006, 5 months prior to separation, noted that the CI had exertional rhabdomyolysis in April 2003 after an intense upper body work-out.  He did well until October 2004 when he had upper extremity weakness and pain after exertion which could last up to 2 weeks dependent upon the level of effort.  He was also noted to have exertional chest pain similar to the initial presentation.  He had a normal examination.  It was determined that he was non-deployable and an MEB indicated.  

At the VA Compensation and Pension exam performed 11 months after separation, the CI reported that the symptoms were primarily upper body and that he could run for 30 minutes without experiencing any chest pain.  The pain was reproducible by palpation of the chest muscles; the examination of the lungs and heart was normal.  The condition was thought to limit his ability to perform jobs which required a high degree of physical exertion, but to not have an effect on the activities of daily living.  A cardiology evaluation that same day determined that the pain was not of cardiac origin.  A respiratory evaluation that day noted that the CI had restrictive lung disease (on pulmonary function tests) which was thought to be “as likely as not” secondary to the rhabdomyolysis condition.  No comment was made on the chest wall deformity which had been noted at accession (pectus carinatum).  A subsequent VA pulmonary evaluation performed on 30 April 2009, determined the chest wall pain to be costo-chondritis, an inflammation of the bone cartilage junction of the anterior rib cage, also the area affected by pectus carinatum.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the rhabdomyolysis condition at 0% using an analogous code 5099-5021 for myositis.  The VA also used the 5021 code, but added 5321 (respiratory group muscles) and rated it at 0%.  The Board noted that the CI had pain after strenuous upper body exercise, but was not limited in the routine activities of daily living and was able to run 30 minutes.  The functional limitation was minimal and the limitation slight.  This does not support a rating higher than the 0% adjudicated by both the PEB and VA.  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 rhabdomyolysis 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 rhabdomyolysis condition and IAW VASRD §4.71a and §4.73, 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 20131218, 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, AR20150006836 (PD201400108)

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-2014-00108