RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01136
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140829
SEPARATION DATE:  20090729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Second Lieutenant 2LT/O-1 (92T0/Student Pilot) medically separated for Crohn’s Disease.  The gastrointestinal condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was placed on administrative duty and referred for a Medical Evaluation Board (MEB).  The MEB forward the Crohn’s Disease condition to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “Crohn’s Disease,” as unfitting, rated at 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: The CI writes: “Crohn’s disease is a chronic, relapsing-remitting disease without cure.  Prognosis includes a risk of future surgery and immunomodulating medicine.  Furthermore the long term risk of colon cancer is increased.  Diarrhea occurs daily due to bowel resection to remove terminal ileum and cecum.  This is accompanied by sharp abdominal pain.”

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 Crohn’s disease 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 IPEB – Dated 20090408	VA - (Same month as Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	10%	20090729	
Other x 0 (Not in Scope)	Other x 1	20090729	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20090817 (most proximate to date of separation)

ANALYSIS SUMMARY:

Crohn’s Disease.  The record indicated that the CI had abdominal pain onset in June 2008 with a colonoscopy demonstrating inflammation of the distal part of his small bowel (terminal ileitis, with biopsies indicating severe chronic active ileitis with possible small granulomas) consistent with Crohn’s Disease.  The CI was started on oral medication (Pentasa [mesalamine]).  Symptoms worsened with abdominal pain and fever in July 2008 and the CI underwent surgical resection of the end of his small bowel and where it connected to the large bowel (6 cm of cecum and 36 cm of the terminal ileum).  Pathology report was “consistent with chronic active colitis consistent with Crohn’s Disease” and gastroenterology consult confirmed the diagnosis of Crohn’s Disease.  Following partial bowel resection, the CI denied symptom of abdominal pain or abnormal bowel movements and service exams documented normal abdominal exams.  The CI was considered high risk for further flares and the gastroenterologist was recommending starting immunomodulation medication, Imuran.

At the VA Compensation and Pension exam performed the same month as separation, the CI reported the onset of Crohn’s symptoms prior and surgery as in the records.  Symptoms had been weekly diarrhea and mild cramping abdominal pain in the right lower quadrant lasting minutes.  He stated he was taking Pentasa which “alleviated symptoms of diarrhea and abdominal pain.”  Abdominal exam was normal (aside from noted surgical scar) and there was no evidence of any Crohn’s symptoms or findings outside of the gastrointestinal tract.  The examiner summarized as “current level of severity is mild as symptoms are controlled on medications.”

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the Crohn’s disease at 10% with analogous coding to 7323 (colitis, ulcerative) IAW VASRD §4.20 (analogous ratings) for a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous.  Rating under disability code 7323 is based on symptom severity and exacerbations.  The CI was without symptoms, or had diarrhea once a week depending on the source exam and history.  For a rating higher than the 10% awarded by the PEB (10% criteria, moderate; with infrequent exacerbations) there would have to be moderately severe symptoms with frequent exacerbations, which were not described in the record proximate to separation.  The Board noted the CI’s application dated February 2014 indicated daily diarrhea; however, this was considered post-separation worsening and not indicative of the CI’s condition proximate to separation.  The Board considered alternative coding analogous to 7319 (irritable colon syndrome) (spastic colitis, mucous colitis, irritable bowel, etc.), 7328 (intestine, small, resection of), and 7329 (intestine, large, resection of), but there was insufficient evidence of symptoms or impairment of health for a higher rating under any coding schema.

Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the Crohn’s Disease condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140228, 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-2014-01136.

	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