RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXX        BRANCH OF SERVICE: marine corps
CASE NUMBER:  PD1000035           SEPARATION DATE: 20020731
BOARD DATE: 20100602


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was an  active  duty  Corporal/E4
(0151, Administrative Clerk) medically separated from the  Marine  Corps  in
July 2002.  The medical basis for the separation was  heat  related  injury.
In October 2001, the CI suffered a heat injury  with  a  witnessed  loss  of
consciousness  during  a  physical  fitness  test.  The  initial  evaluation
revealed heat stroke with acute renal failure  secondary  to  rhabdomyolysis
and the CI was hospitalized for  two  days  and  rehydrated.   Although  the
severe heat injury resolved, it was felt that the CI would be  at  risk  for
future heat related injuries,  would  not  be  able  to  meet  the  physical
requirements of the Marine Corps and underwent a  Medical  Evaluation  Board
(MEB).  Heat related illness,  rhabdomyolysis  (resolved)  and  acute  renal
failure  (secondary  to  rhabdomyolysis)  were  forwarded  to  the  Physical
Evaluation Board (PEB) as medically  unacceptable  IAW  SECNAVINST  1850.4E.
The informal PEB adjudicated the heat related  injury  as  unfitting,  rated
0%,  with  application  of  SECNAVINST  1850.4E,   Department   of   Defense
Instruction (DoDI) 1332.39 and Veteran’s Administration Schedule for  Rating
Disabilities  (VASRD),  respectively.   The  informal  PEB  categorized  the
status  post  acute  renal  failure  and  resolved  rhabdomyolysis  as   not
unfitting  Category  II  conditions  that  contributed  to   the   unfitting
condition.  The CI made no appeals, and was thus medically separated with  a
0% disability rating.


CI’s CONTENTION (20100119):  The CI makes no specific contention but lists
“acute renal failure and rhabdomyolysis” on the DD Form 294.  A contention
for their inclusion in the separation rating is therefore implied.


RATING COMPARISON:

|Service IPEB – 20020515            |VA ( 1 Mo. Pre-Separation) – All Effective –  |
|                                   |20020801                                      |
|Condition                          |Code                                          |
|TOTAL Combined:  0%                |TOTAL Combined: 40%                           |

_
ANALYSIS SUMMARY:

Heat Related Injury Condition.  The CI was admitted to Naval  Hospital  Camp
Lejeune on 1 October 2001 after a witnessed loss of consciousness  during  a
physical fitness test.  There was  no  reported  seizure  activity  or  head
trauma. The patient was brought to the battalion aid station, had  a  rectal
temperature  of  106  degrees  and  was  treated  for  heat  stroke.   After
treatment with intravenous fluids and transportation to the  Emergency  Room
(ER) the CI became awake and oriented.  ER evaluation revealed heat  injury,
acute renal failure secondary to rhabdomyolysis and he was admitted  to  the
hospital.  While hospitalized his workup  was  negative  for  acute  tubular
necrosis  and  his  creatinine  began  to  decrease.   Due  to  persistently
elevated creatinine kinase and serum creatinine levels the CI  was  referred
to nephrology and had a muscle biopsy done.  The  muscle  biopsy  showed  no
evidence of a metabolic myopathy.  At the January 2002 nephrology  exam  his
kidney function had returned to near normal and no  further  evaluation  was
recommended.  Due to  the  severity  of  the  heat  injury  and  chance  for
recurrence, it was decided to keep the CI on limited  duty  and  a  MEB  was
initiated.  At his MEB exam (20020307), four  months  prior  to  separation,
the CI had no specific complaints relating to his resolved heat  injury  and
was able to perform low impact, mild exercise as well as the duties  of  his
MOS.  The VA compensation and  Pension  (C&P)  exam  (20020619),  six  weeks
prior to separation, revealed that the CI had  no  recurrence  of  his  heat
injury, was doing well  on  his  limited  profile  and  had  no  significant
urinary complaints.  On exam it was noted that the  CI  was  overweight  but
otherwise appeared healthy.  His laboratory results  were  basically  normal
and the examiner felt his heat stroke and renal failure had  resolved.   The
VA  rating  decision  was  0%  for  status  post  heat  stroke  and  service
connection for status post renal failure was denied.

The PEB and VA chose different coding option for  the  condition,  but  this
did not bear on rating. The PEB rated the  heat  related  injury  under  the
analogous VASRD code 7999-7900 (hyperthyroidism) with  a  disability  rating
of 0% and the VA rated the condition heat stroke using the  analogous  VARSD
code 8999-8911 (epilepsy), also with a 0% rating.  The Board  felt  the  PEB
used the correct analogous code and the rating was appropriate.   The  Board
then turned its attention to rating any residuals from the heat injury.   As
noted above in both exams the CI had fully  recovered  from  the  event  and
there was no evidence of any residual unfitting health problems at the  time
of separation.  After due deliberation  and  in  consideration  of  all  the
evidence, the Board recommends 0% as the fair  permanent  separation  rating
for the heat related injury condition  appropriately  coded  7999-7900  (IAW
VASRD §4.20).

Migraine Headaches.  The CI had migraine headaches since  November  of  2001
that  were  mostly  controlled  with  non-narcotic   medication   prior   to
separation.  Review of the  service  treatment  records  revealed  that  the
headaches occurred less than once per month  and  although  he  was  put  on
quarters several times there was no evidence that he was ever  profiled  for
migraine headaches.  The CI was  not  on  prophylactic  medication  for  the
headaches and had not exhausted medical treatment  options.   There  was  no
mention in the commander’s statement that the headaches prevented  him  from
fulfilling  the  duties  of  his  military  occupational  specialty.    This
condition was reviewed by the action officer and considered  by  the  Board.
It was determined that it could not be argued as unfitting at  the  time  of
separation.

Remaining  Conditions.   Other  conditions  identified  in  the   Disability
Evaluation System (DES) file included left knee pain and several  additional
non-acute conditions.  The CI had successful  arthroscopic  surgery  on  his
left knee in July of 2000  and  was  removed  from  limited  duty  following
rehabilitation.  Although he complained  of  occasional  swelling  and  pain
(after prolonged running or walking) at his C&P exam there  is  no  pain  or
abnormal  findings  noted.   None  of  these  conditions  carried   attached
profiles and none were  implicated  in  the  commander’s  statement.   These
conditions were reviewed by the action officer and considered by the  Board.
 It was determined that none could be argued as  unfitting  and  subject  to
separation rating.  Left shoulder scar and lumbar spine  strain  were  noted
in the VA rating decision but were not found in the  DES  file.   The  Board
does not have the authority under DoDI 6040.44 to render fitness  or  rating
recommendations for any conditions not considered by the  DES.   The  Board,
therefore,  has  no  reasonable  basis  for  recommending   any   additional
unfitting conditions for separation 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.

In the matter of the heat related injury condition and IAW VASRD §4.20, the
Board unanimously recommends no change in the PEB adjudication.

In the matter of the migraine headaches, left knee pain or any other
medical conditions eligible for Board consideration; the Board unanimously
agrees that it cannot recommend any findings of unfit for additional rating
at separation.


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 |
|Heat Related Injury                                |7999-7900   |0%     |
|COMBINED    |0%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20100119, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.



                                        Deputy Director
                                                                    Physical
Disability Board of Review


MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
                                             BOARDS

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION ICO  XXXXX,
FORMER USMC

Ref:   (a) DoDI 6040.44
          (b) PDBR ltr dtd 13 Jun 11

      I have reviewed the subject case pursuant to reference (a) and, for
the reasons set forth in reference (b), approve the recommendation of the
Physical Disability Board of Review Mr. XXXXX’s records not be corrected to
reflect a change in either his characterization of separation or in the
disability rating previously assigned by the Department of the Navy’s
Physical Evaluation Board.




                                        Assistant General Counsel
                                          (Manpower & Reserve Affairs)