RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00700
BRANCH OF SERVICE:  Army	BOARD DATE:  20150205
DATE OF PLACEMENT ON TDRL:  20020313
Date of Permanent SEPARATION:  20070118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Multichannel Transmissions Systems Operator-Maintainer) medically separated for Crohn’s disease.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  Crohn’s disease was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated Crohn’s disease post partial colectomy as unfitting rated 40% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was placed on the Temporary Disability Retirement List (TDRL).  Approximately 2 years later, the IPEB adjudicated Crohn’s disease as not improved to the extent for the CI to return to duty.  Over a year later, the IPEB adjudicated Crohn’s disease as not stabilized for final adjudication.  Approximately 18 months later, the Final IPEB adjudicated Crohn’s disease as unfitting, rated 10% with application of the VASRD.  The CI did not appeal and was medically separated.

CI CONTENTION:  “On going complications with Crohn’s disease.”

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:

Final Service PEB - 20070108	VA* - (~2 Mo. Post-TDRL Placement) - Effective 20020314	
On TDRL - 20020313	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
Crohn’s Disease	7399-7323	40%	10%	Crohn’s Disease	7323	30%	20020502	
Other x 0  (Not in Scope)	Other x 2	
Combined:  40% → 10%	Combined:  40%	
*Reflects VA rating exam proximate to TDRL placement

ANALYSIS SUMMARY:

Crohn’s Disease Condition.  The discovery of Crohn’s disease was made during an appendectomy procedure in June 2001 and the CI had his right-sided large intestine removed at that time.  In August 2001, he had additional surgery to further remove diseased intestine.  His medications included an immunosuppressant (6-Mercaptopurine), antibiotics, and prolonged use of steroids.  Summary documents indicated that from a surgical perspective the CI recovered quite well, but he continued to experience a variety of adverse gastro-intestinal (GI) symptoms.  On 19 October 2001, he was issued a permanent profile and was referred for an MEB.

Approximately 5 months prior to placement on TDRL, the initial MEB examination dated 29 October 2001, the CI endorsed “6-7” bowel movements (BMs) per day associated with spontaneous loss of stool (fecal incontinence) and anal soreness.  Additionally, he complained of excessive fatigue and decreased appetite.  His physical examination (PE) performed by the general surgeon remained normal.  The MEB’s diagnosis remained Crohn’s disease.  The commander’s statement noted, “[The CI] is totally incapable of performing his MOS duties in a combat environment as well as duties expected of other soldiers.”  On 16 January 2002, the PEB rated the CI at 40% with TDRL placement stating “Crohn’s disease status post partial colectomy resulting in fecal incontinence and 6-7 bowel movements daily.”

An IPEB dated 17 February 2004 (11 months after TDRL placement) noted a summary of an additional abdominal surgery that occurred 2 months after TDRL placement.  The IPEB stated that the CI’s condition remained unstable and recommended continued TDRL.

The first TDRL examination was performed on 19 May 2005, approximately 20 months prior to TDRL removal, the CI complained of intermittent abdominal pain occurring several times a week with 5-6 loose non-bloody BMs daily.  He equated his present symptoms as baseline since his last surgery.  He denied recent fevers, chills or other concerning symptomatology.  The PE and laboratory analysis was normal.  The examiner stated, “I would strongly consider medical discharge versus continuation on TDRL status for this particular case.”  The corresponding IPEB on 15 July 2005 noted, “The [CI’s] impairment has not sufficiently stabilized to permit final adjudication at this time.  Retention on the TDRL for an additional period is considered appropriate.”  At the second TDRL examination on 11 September 2006, 4 months prior to TDRL removal, the CI complained of intermittent abdominal spasm and discomfort with 5-10 loose stools per day.  His PE was completely normal.  The examiner stated, “I would strongly consider medical discharge versus continuation on TDRL.”  The final IPEB of 18 January 2007 permanently rated the CI’s condition at 10% citing moderate and infrequent exacerbations.

At the VA Compensation and Pension examination on 13 August 2007, 7 months after TDRL removal, the CI reported 4-6 BMs per day associated with a moderate severity of abdominal pain.  He reported “flares” appear “less than monthly” with four or more days duration with each episode.  He denied any loss of work in the past year and his general occupational functional status was listed as, “No significant effects.  His PE was normal.

The Board directed its attention to its rating recommendations based on the evidence just described.  The PEB analogously coded the condition using 7399-7323 (colitis; ulcerative) and rated it under code 7329 (resection large intestine) at 40% IAW VASRD §4.114 (digestive system) and §4.7 (the higher of two evaluations) with placement into TDRL based on surgical resection.  The VA utilized the single code 7323 for a 30% rating citing frequent exacerbations of the Crohn’s condition.  Board members first considered if there was evidence for a §4.114 rating higher than the PEB’s 40% at time of TDRL placement.  Absent malnutrition, the maximum rating allowed under the two codes in question is 40% for the surgical resection.  Board members agreed that the records at TDRL placement supported the 40% PEB rating IAW §4.114.  The Board then considered if there was evidence for a §4.114 rating higher than the 10% permanent rating adjudicated by the PEB at TDRL removal.  VASRD code 7323 is proportioned in regards to symptom severity of moderate with infrequent exacerbations (10%), moderate severe with frequent exacerbations (30%), and severe: associated with malnutrition (60%).  The Board agreed that the CI’s overall condition had improved during the period of TDRL noting less daily BMs and infrequent (less than monthly) exacerbations.  The Board determined the severity of the GI symptoms near the time of permanent separation was more closely in line with “moderate” which equates to 10% under code 7323 (moderate; with infrequent exacerbations) and 20% under 7329 (moderate symptoms).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), the Board recommends no change in the 40% TDRL-placement rating; and a 20% rating for the Crohn’s disease condition at TDRL removal, coded 7399-7329 IAW VASRD §4.114.

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 Crohn’s disease condition, the Board unanimously recommends no change in the rating for the period of TDRL and a 20% permanent rating, coded 7399-7329 IAW VASRD §4.114.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified to reflect a permanent 20% rating effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
		PERMANENT	
Crohn’s Disease	7399-7323	--	
Crohn’s Disease	7399-7329	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140203, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

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, AR20150010398 (PD201400700)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     

CF: 
(  ) DoD PDBR
(  ) DVA