RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX				             		            CASE:  PD-2014-00931
BRANCH OF SERVICE:  AIR FORCE		SEPARATION DATE:  20090102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Security Forces Craftsman ) medically separated by the Formal Physical Evaluation Board for “ulcerative colitis, ” with a combined disability rating of 10%.

CI CONTENTION: His condition was not controlled by medication prior to separation.  His complete submission is at Exhibit A.

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 condition 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 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 PEB - 20080929	VA - 20090710	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis…	7323	10%	20090604	
RATING:  10%	RATING:  20%	

ANALYSIS SUMMARY:

Ulcerative Colitis.  Service treatment records (STR) note the CI reported abdominal pain and bloating, followed by mucus and blood in the stool the day after Thanksgiving 2006.  He was given suppositories and fiber to treat constipation and hemorrhoids.  A gastroenterologist performed a colonoscopy which showed ulcerative colitis in August 2007.  Rectal bleeding stopped that day and he noted one episode of bleeding and mucus.  He was treated with medication and worked normal duties without exacerbations.

A gastroenterology (GI) evaluation 1 May 2008 noted, “His disease process was stable for the last six months…not had a flare…in a quiescent state…on a stable dose of ulcerative colitis medication.”   The GI examiner noted deployment to an industrialized western nation was possible but not to a severely depressed developing country without modern medicine. He only missed duty due to medical appointments.  A colonoscopy performed on 15 May 2008, revealed “moderate chronic active colitis.”

At the narrative summary (NARSUM) exam, dated June 2008, the CI reported gas-like rumbling in the intestines; some heartburn resolved with cessation of eating spicy food; no nausea, vomiting or abdominal pain; and no bright red blood per rectum in over 9 months.  Exam of the abdomen was unremarkable.  An STR entry dated 18 June 2008, noted “CI was doing extremely well at present…symptoms seem to be stable.”  Two of the CI’s commanders endorsed retention.  Their letters stated the CI’s medical condition did not interfere with his ability to perform day-to-day duties, “needing neither work-arounds nor requiring any limitations…had not missed any duty days as a result of his medical condition and indicated he wishes to stay on active duty.”

At the VA Compensation and Pension (C&P) examination dated 4 June 2009 (5 months post-separation) the CI reported acid reflux controlled by medication daily or as needed.  He denied abdominal pain, nausea, vomiting, blood from rectum, or anemia and stated his weight was relatively stable.  His was assigned to a civil service job doing security forces.  He had lost 15-20 pounds after receiving the diagnosis of ulcerative colitis in 2007.  He had loose, watery bowel movements after each meal and they occurred about 8-10 times per day.  He did have urgency and was taking medications three times per day and enemas as needed.  He denied constipation, cramping and rarely had abdominal pain.  His occupation and activities of daily living were affected in that he still had accidents from time-to-time.  He denied hospitalizations due to GI issues.

Prior to the final PEB proceedings, the treating gastroenterologist noted the CI had been able to function in his duty assignment and should be able to still function in that assignment.  The CI submitted a memo to the Medical Evaluation Board to request the retention in military service.

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the condition at 10%, rated at 7323 (Colitis, ulcerative.)  Under code 7323 a 10% rating is assigned for moderate severity with infrequent exacerbations.  A 30% rating requires moderate severity with frequent exacerbations.  Neither the NARSUM nor the C&P exam revealed any evidence of malnutrition, nausea, vomiting, prolonged hospitalizations, or the need for blood transfusions.  A submission from the CI’s gastroenterologist noted he was doing well and his condition was stable.  The CI continued to work full-time in his MOS.  Two of his commanders and gastroenterologist recommended retention on active duty.  The Board members agreed the CI did not meet criteria for the higher 30% rating.

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 ulcerative colitis condition.

BOARD FINDINGS:  In the matter of the ulcerative colitis condition and IAW VASRD §4.114, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  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 20140221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00931.

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.

Sincerely, 

Attachment:
Record of Proceedings