RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX	CASE:  PD-2013-01269
BRANCH OF SERVICE: AIR FORCE	BOARD DATE:  20140618
SEPARATION DATE:  20041105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (1A151/Flight Engineer) medically separated for ulcerative colitis (UC).  The UC could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  “Ulcerative colitis” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB (IPEB) adjudicated “ulcerative colitis” as unfitting, rated 10% with application of the VA Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB, which affirmed the IPEB’s finding and rating.  The CI was then medically separated.

CI CONTENTION: The CI writes: “Initial rating did not consider overall medical condition”.

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 UC 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 Board for Correction of Military Records.

RATING COMPARISON:

Service FPEB – Dated 20040818	VA - (4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis	7323	10%	20050315	
Other x 0 (Not in Scope)	Other x 5	20050315	
Rating:  10%	Combined Rating:  40%	
Derived from VA Rating Decision (VARD) dated 20050502 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

ULCERATIVE COLITIS.  The narrative summary (NARSUM) notes the CI developed severe bloody diarrhea five to six times per day associated with abdominal cramping and was diagnosed with ulcerative colitis confirmed by colonoscopy on 20 January 2004.  He was also found to be positive for clostridium difficile infection and was treated with antibiotics for eradication.  The CI was initially treated with oral steroids but required hospitalization twice for dehydration due to diarrhea and was treated with intravenous fluids and steroids and oral immunosuppressive medication.  The UC symptoms improved initially, but were found to be refractory to steroid treatment.  The CI was started on an intermittent intravenous immunosuppressive medication and oral immunosuppressive and anti-inflammatory medications with significant improvement in his symptoms.  Records did indicate significant weight loss during the most symptomatic period, which the CI regained when his symptoms went into remission.  The CI was noted to be mildly anemic once during this period, but did not require therapy.  The gastroenterology MEB consult was attached to the NARSUM and noted that “ulcerative colitis is a chronic disease which is punctuated by periods of exacerbations and remissions.”  The gastrointestinal specialist indicated that the CI was anticipated to require the intermittent intravenous immunosuppressive medication every eight weeks for maintenance.  At the MEB exam on 27 April 2004, approximately 6 months prior to separation, the CI reported that he had been asymptomatic for 6 weeks and denied nausea, vomiting, diarrhea, constipation and abdominal cramping.  The MEB physical exam noted the CI was well developed and well-nourished with a normal abdominal examination.  VA treatment visits 3 months after separation noted that the CI continued to have “some exacerbations with cramping and discomfort but no further bloody diarrhea.”

At the VA Compensation and Pension (C&P) exam on 15 March 2005, 4 months after separation, the CI reported resolution of his diarrhea on the medications noted above, but persistent abdominal cramping, worse with stress and dietary factors.  The VA examination noted a diffusely tender abdomen and an otherwise unremarkable examination.  At a VA rheumatology consult on 29 March 2005, the CI reported constant left-sided abdominal discomfort, noted on examination to be mild.  A clinic visit dated 11 December 2005 noted that the CI reported 5 weeks of bloody diarrhea and colitis was noted on sigmoidoscopy.  Repeat colonoscopy on 24 March 2005 was normal with no evidence of acute or chronic inflammation on surveillance biopsies.

The Board directs attention to its rating recommendation based on the above evidence.  The Formal PEB rated the UC condition 10%, coded 7323 (colitis, ulcerative), as did the VA.  The Board deliberated the rating of the UC condition.  The Board noted that the CI required IV maintenance medication for resolution of his symptoms and that he did experience frequent UC exacerbations with “numerous attacks a year” until the effective treatment regimen was determined 8 to 9 months prior to separation.  At both the MEB NARSUM and C&P examinations, the CI reported resolution of diarrhea episodes, with mild residual abdominal pain affected by stress and dietary factors.  The evidence in records indicates the first exacerbation of colitis occurred approximately a year after separation.  The Board agreed that at the time of separation the CI’s disability due to UC met the 10% rating criteria of 7323, specified as moderate with infrequent exacerbations and did not meet the higher evaluation of 30% which specifies “with frequent exacerbations.”  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 UC 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 UC condition and IAW VASRD §4.114 the Board unanimously recommends no change in the PEB adjudication.

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 20131009, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-01269.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Attachment:
Record of Proceedings