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AF | PDBR | CY2012 | PD2012 01332
Original file (PD2012 01332.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201332
BRANCH OF SERVICE: Army  BOARD DATE: 20130402
SEPARATION DATE: 20030505


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (77F/Trainee) medically separated for list unfitting PEB conditions rhabdomyolysis. The CI stated that his pain began in November 2002 during his first week of Basic Training. He began to experience diffuse muscle aches and chest pains after his first episode of physical training. The CI was diagnosed with 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 rhabdomyolysis condition, characterized as not medically acceptable was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated rhabdomyolysis as unfitting, rated 0%. The CI made no appeals, and medically separated with a 0% Service disability rating.


CI CONTENTION: “Can’t work long hours get dehydrated fast. After getting discharged I contracted diabetes which really makes it hard on me. Muscles in my legs and arms go numb after hours of work.”


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 Service rating for the unfitting rhabdomyolysis condition is addressed below; and, 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 respective Service Board for Correction of Military Records.


RATING COMPARISON:

Service IPEB – Dated 20030411
 VA - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Rhabdomyolysis
 7999-7900 0% Rhabdomyolysis 5099-5025 10% STR
Combined: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 30527 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him. It is a fact, however, 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. This role and authority is granted by Congress to the Department of Veterans Affairs (DVA). The Board utilizes DVA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. The Board’s authority as defined in DoDI 6040.44, however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation.

Rhabdomyolysis Condition. The first symptoms of rhabdomyolysis occurred during basic training in November 2002 manifested by chest wall pain and diffuse muscle pain after strenuous activities. The CI was admitted to the hospital, diagnosed with rhabdomyolysis, treated and discharged. He continued to report chest pain for several days post hospitalization. The CI’s muscle enzyme (CK) remained elevated for some time but was decreasing over time. The commander’s statement, dated 6 January 2003 stated the CI completed no training and his illness prevented him from conducting physical training, and foot marches. At the narrative summary (NARSUM), 13 December 2002, 5 months prior to separation, the CI reported continued diffuse muscle aches and chest wall pain. The CI denied shortness of breath, swelling or weakness. The examiner documented an essentially normal physical exam, but noted “significant muscle mass.” On lab testing, the CK blood test, an index of rhabdomyolosis was slightly elevated, but much improved. The physician opined, “It appears that the patient’s signs and symptoms are still clinically present; the patient’s body mass and deconditioning puts him at a significant risk for further rhabdomyolysis at this time.” The PEB used the analogous 7900 code (hyperthyroidism) and rated the condition at 0%, citing the CI was stable but was unable to complete basic training due to profile restrictions. The 7900 code used by the PEB and 5025 rating code by the VA reflects the fact that there is no code specific for rhabdomyolysis. The VA used the service treatment records (STRs) and rated the condition at 10% based on the use of pain medication for control. A 10% rating under the 7900 and 5025 codes requires continuous use of medication for control of the condition. The Board noted there was no evidence in the record to support the continuous use of medication for pain and agreed this criterion was not met. The records indicated last prescribed pain medication occurred 6 months prior to separation, and the DD Form 2807 (medical history report) by the CI, 2 months after separation, indicated he was not on any medication. Since the CI experienced predominantly upper extremity muscle symptoms, the Board considered an alternate rating pathway using muscle codes 5321 (muscle group 21). Under this code, a rating higher than 0% requires at least “moderate” impairment of function. After deliberation, the Board agreed there was no residual impairment to justify rating the condition under this code. The Board also considered a rating under the 5021 code (myositis) which requires limitation of motion, Painful motion (§4.59) or Pain with use (§4.40) for a compensable rating. Board members agreed there were no examination findings supporting a higher rating using this code. In conclusion, the Board members agreed the condition was exceptionally mild, noting the absence of dark urine and the relatively small increase in muscle enzymes and there was no path to coding higher than a 0% rating level. 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, 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Rhabdomyolysis
 7900 0%
COMBINED
 0%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120711, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




        
         Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130008716 (PD201201332)


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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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