RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD1300168
BRANCH OF SERVICE:  Army	BOARD DATE:  20130724
SEPARATION DATE:  20041210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Guard SGT/E-5 (11B20/Infantryman) medically separated for a bowel condition.  The CI had a history of chronic abdominal aching, dizziness, tiredness and reflux with irritable bowel syndrome (IBS) first diagnosed in 2004.  He did not adequately respond to treatment 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 IBS condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated the IBS condition as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: “My rating was increased by the Veteran's Affairs as well as additional service-connected conditions which were not considered at the time of my MRB.”

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 IBS condition is addressed below.  The esophagitis reflux and gastritis, liver cysts, eczema and insomnia, as per the contention, were not identified by the MEB or PEB; and, thus are not within the DoDI 6040.44 defined purview of the Board.  These, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20020411	VA* - (2.8 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
IBS	7319	10%	IBS w/Fatigue & Dizziness	7399-7319	30%	20050302	
No Additional MEB/PEB Entries	Other x 9	20050302	
Combined:  10%	Combined:  50%	
* Derived from VA Rating Decision (VARD) dated 20050602 (most proximate to date of separation)

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue 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.

Irritable Bowel Syndrome Condition.  Service treatment records indicated the CI reported abdominal symptoms in December 2003, and continued with chronic abdominal pain, fatigue and diarrhea despite medications, lifestyle and dietary modification.  He underwent extensive medical evaluations including biopsies and studies to rule out autoimmune and liver conditions.  All were negative and no features of colitis were identified.  Stool studies were negative.  In February 2004, the CI presented to the gastrointestinal (GI) clinic with report of 3 to 5 times daily bowel movements (BM) associated with cramping.  The pain had been constant, located in the lower abdomen with no other associated symptoms such as nausea or vomiting.  He reported early satiety at times and a 19-pound weight loss over the preceding year, but indicated increased physical activity may have contributed to weight loss.  The CI denied fevers and chills and stated he had noticed mucus in his watery BM.  On one occasion there was blood in his stool.  On physical exam the CI was in no apparent distress and the abdomen was soft with mild generalized tenderness.  On 16 March 2004, mild esophagitis and mild gastritis was diagnosed via upper GI study.  Tissue examination of the large bowel was normal without evidence of colitis.  At this time, the CI reported no generalized pain, no weight loss and the abdominal examination was negative.  A GI clinic note dated 15 July 2004, noted CI report of feeling worse.  He reported decreased appetite, heartburn and periods of diarrhea fluctuating with constipation.  The CI reported abdominal pain that was “constant,” increased with BM and was not associated with meals.  Physical examination recorded weight increase of 14 pounds in 4 months, normal bowel sounds, no guarding or tenderness or related discomfort during palpation.  The examiner noted abdominal CT scan to be normal and laboratory tests to show no evidence of hepatitis, dehydration or anemia.  The MEB narrative summary dated 19 August 2004, approximately 4 months prior to separation, noted the CI may have had three to six BM’s daily, disruptive sleep, dizzy spells and fatigue.  IBS was diagnosed on 5 August 2004 after all other pathological causes had been ruled out.  There was no documentation of dehydration or electrolyte imbalances in the treatment record.  There were no episodes necessitating emergency room visits or hospitalization in the treatment records.  Treatment entries recorded no significant weight loss, no signs of anemia, no episodes of fever and no significant decrease in blood pressure.  Episodes of watery stools occurred intermittently at a frequency of 3 to 6 per day alternating with 3 to 5 days of constipation.  Abdominal pain was recorded as chronic with aching usually in the right upper quadrant as well as below the umbilicus.  He also indicated he suffered from tiredness, sense of dizziness at times, often bothered by reflux and a 19-pound weight loss over the past year.  Physical examination revealed weight of 165 pounds, height of 67 inches and blood pressure 125/76.  The CI was in no distress, but the abdomen was tender to palpation without rebound or guarding.  The examiner noted the CI had pain throughout the day, but was able to do his staff work.

The VA Compensation and Pension evaluation completed on 2 March 2005, approximately 3 months after separation, recorded CI report of 4 to 6 loose BMs a day during flare-ups, but usually between 2 to 3 or none a day.  Flare ups were accompanied by abdominal pain in the right upper and lower quadrants, without identifiable triggers.  On examination the CI was noted to be in no distress and the examination of the abdomen was non-tender.  The CI indicated he was a full-time student working three part time jobs and was not taking any preventive medication for his condition.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10% for moderate severity coded 7319 (irritable colon syndrome).  The VA rated the condition at 30% (severe), coded analogously to 7319.  The Board deliberated whether the CI’s IBS met the 10% or the 30% 7319 rating.  A 30% rating (severe) requires diarrhea documented as severe or alternating diarrhea and constipation in a severe pattern, with constant or near constant abdominal distress.  The Board undertook a careful review of the treatment records and noted the report of constant abdominal pain in every entry; however, clinical examinations noted no distress during physical exams, and examination of the abdomen was generally reported as normal.  The Board noted the record to document no malnutrition, anemia, weight loss, serious complications, emergency room visits, and that the intermittent frequency of 4 to 6 times a day only during ‘flare ups’ was most consistent with a degree of disease burden moderate in nature.  The Board unanimously agreed that the chronicity of the severe pain was most accurately supported as intermittent in nature by the record in evidence.  The Board opined that the evidence in the record did not approach the 30% rating criteria of 7319.  The Board unanimously agreed the preponderance of evidence supported the condition to be moderate and consistent with the 10% rating under code 7319.  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 IBS 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 IBS condition, and IAW VASRD §4.114, 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	
Irritable Bowel Syndrome	7319	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130408, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SFMR-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 XXXXXXXXXXXXXXXXXXXXXXXXX, AR20140000307 (PD201300168)

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