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AF | PDBR | CY2014 | PD-2014-01053
Original file (PD-2014-01053.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-01053
BRANCH OF SERVICE: Army  BOARD DATE: 20150113
SEPARATION DATE: 20030802


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-7 ( Weapons Sergeant) medically separated for heat intolerance. 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 “heat Intolerance” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501, and no other condition was submitted by the MEB. The Informal PEB adjudicated “ heat intolerance, following a significant heat injury in Jun 00…” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI appealed to the U.S. Army Physical Disability Agency, which affirmed the PEB finding and rating, and he was medically separated.


CI CONTENTION: “Noted to have a condition similar to hyperthyroidism but is actually a combination of problems whose follow up isn't as simple as a blood test and management is more than a pill. Management has required implementation of lifestyle modifications, limitations of physical activity, and attempts to control environmental factors. Many of the symptoms are noted by multiple providers throughout my medical records and include recurrent headaches, persistent fatigue after exertion, insomnia, difficulty with memory recall, mood swings, decline in interpersonal skills, impatience, difficulty learning new tasks. These problems are noted to be worsened with recurrent exposure to heat and or stress. Due to the recurrence, it was recommended to avoid exposure to heat, reduce exposure to exertion (avoid even working out in gym). If exerting, then require close supervision. Records note, may require medical management of multiple issues to control symptoms, unlike a problem with a solitary problem like hyperthyroidism. It notes the condition as permanent and similar to what is expected after an injury such as heat stroke.” [sic]


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20030414
 VA* - (~7 Mos. Post-Separation)
Condition
Code Rating Condition Code Rating Exam
Heat Intolerance 7999-7900 10% Residuals of Heat Stroke 8199-8100 10% 20040224
Other x 0 (Not In Scope)
 Other x 8
RATING: 10%
 RATING: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 40423 (most proximate to date of separation ( DOS ) ).


ANALYSIS SUMMARY:

Heat Intolerance. The narrative summary (NARSUM) note d the CI experienced a heat stroke in June 2000. Notes i n the service treatment record indicated the CI ’s temperature reached 106 degrees and was associated with mental status changes . F ollowing fluid resuscitation he was a dmitted for observation and there was no evidence of heart, muscle or liver damage. According to the NARSUM , initial symptoms of heat intolerance of mood swings and mental slowing resolved with time, but when the CI’s activity level increased he report ed residual headaches (HA) provoked by increased activity , which subsided in 3 to 8 hours. Neurological consultation on 5 September 2001 diagnosed HA secondary to past heat injury. A primary care note during a subsequent deployment on 28 August 2002 indicated the CI reported gradual recovery from the heat stroke until “3 recent deployments to hot, humid climates which caused a recurrence of symptoms , ” including long and short - term memory difficulty, mood swings,   September 2002 noted a normal mental status examination (MSE) including intact memory and normal complete neurological examination. The n eurologist indicated that the CI should not be exposed to heat stress and that symptoms should, but may not, resolve completely . The neurologist did not recomm e nd any medications , noting environmental modification was the primary treatment and the CI was medically evacuated.

At a neuropsychological (NP) evaluation for the MEB on 6 November 2002 the CI reported that following a run he passed out while sitting on the ground and fell backwards. He did not remember the end of the race and awoke while receiving treatment after an unknown period of unconsciousness. The NP evaluation noted findings as excerpted:

Current neuropsychological functioning is within normal limits across domains of memory, concentration, problem solving and processing speed. He had scores in the high average to superior range in many areas, with no indications of decline in cognitive abilities.

The examiner indicated that treatment of reported sleep difficulties may improve the CI’s overall functioning, but indicated that behavioral a nd emotional issues may be related in part to other issues of personal and post-traumatic stress . The Axis I diagnosis was personality change due to heat injury (by patient report) with a G lobal A ssessment of F unctioning of 60 (on the cusp of mode rate to mild impairment ranges) . Four annual performance evaluation reports (NCOER) for the period from February 1999 to December 2002 indicated excellent duty performance by the CI , following the heat injury, including during his last deployment. The December 2002 NCOER noted the CI was able to maintain average physical condition after the heat stroke, with consistent , successful performance documented o n four physical fitness tests in 2001 and 2002.

At the MEB examination on 18 December 2002, 8 months prior to separation, the CI reported the same symptoms as reported at the recent neurological evaluation cited above. The MEB examiner noted that others in the unit noted the CI’s fatigue, mood swings, and difficulty with memory and task performance. The MEB physical exam noted a normal MSE with a perfect score (30/30) on the Mini-MSE and a normal neurological evaluation.

At the VA Compensation and Pension (C&P) Neurological examination on 24 February 2004, approximately 7 months after separation, the CI reported HA two to three times per week, more in the summer than the winter, that usually last a day and are relieved by rest. The CI reported that he did not miss any work due to the HA and that he could drive during a HA if needed. The examination noted a normal neurological evaluation.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the heat intolerance 10%, coded 7999-7900 (analogous to hyperthyroidism –analogous code for heat intolerance) and the VA rated it 8199-8100 (analogous to migraines). The evidence in record supports that at the time of separation the CI had residual heat intolerance symptoms secondary to heat stroke. The CI’s symptoms recurred with heat exposures, but there were no persistent abnormalities noted on neurological evaluation or neuropsychological testing and evaluation. The PEB used analogous coding of hyperthyroidism for heat injury and rated 10% based on analogy to intermittent hyperthyroid symptoms versus persistent symptoms and the Board agreed that coded IAW §4.119 (endocrine system) as 7900, the 10% rating was achieved. At the C&P examination the CI reported residual HA and the VA rated the HA 10%. However, according to the rating criteria for migraines, the CI’s HA were reported as frequent but not prostrating, did not meet the 8100 rating criteria threshold for a 10% rating IAW §4.124a (neurological conditions), specified as “characteristic prostrating attacks averaging one in 2 months over the last several months.” Members discussed coding as 8999-8911 (analogous to minor seizure activity), but there was no evidence in the record of any seizure activity. After discussion Board consensus was that even if conceding that mental changes the CI reported associated with heat exposure could be analogized to minor seizures, there was no evidence in record to meet the 8911 20% rating criteria of “at least 2 episodes …in the last 6 months” [of heat intolerance associated with altered mental status in the 6 months prior to separation]. The Board next considered that the CI’s reported symptoms mirrored those of 8045 (traumatic brain injury [TBI])–with reported change in personality, mood swings, irritability, memory problems, HA, fatigue, and insomnia. The Board investigated if coding as analogous to 8045 would result in a higher evaluation, but found that according to the current VASRD 8045 facets for rating TBI in effect at the time of separation, the CI’s disability did not meet a higher evaluation. There were no objective findings on neurological or neuropsychological examination for any of the noted symptoms and the NCOER evaluations indicated continued superior performance and maintenance of adequate physical fitness after the heat injury. The Board concluded that there was insufficient support for the 8045 40% rating for more than mild or occasional interference with work and/or social interactions. After deliberations, Members agreed there was no path to a higher evaluation for the heat intolerance condition . 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 for the heat intolerance 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 heat intolerance condition and IAW VASRD §4.119, 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 20140225, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXX
President
DoD 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, AR20150009587 (PD201401053)


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

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