RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01285
BRANCH OF SERVICE:  Army	BOARD DATE:  20141028
SEPARATION DATE:  20060511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B10/Infantry) medically separated for a colitis condition.  This condition could not be adequately rehabilitated 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).  Ulcerative colitis was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated ulcerative colitis as unfitting, rated 10% with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My condition has worsened.  I have more pain now and it has become harder to do the things I used to love doing.  I am also now taking drugs that have more side effects and suppress my immune system, making more susceptible to infection.  Thanks for reviewing my case!”

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 ulcerative colitis condition is addressed below.  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 20060316	VA - (2.5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis/Proctitis	7323	10%	20060803	
Other x 0 (Not in Scope)	Other x 0 	20060803	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20070205 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:  The Board acknowledges the CI’s sentiment regarding the significant impairment with which his service-connected condition continues 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.  The Board considers VA evidence within 12 months only to the extent that it reasonably reflects the disability at the time of separation.

Ulcerative Colitis.  The CI developed abdominal pain with blood diarrhea in November 2005.  He was evaluated by a gastroenterologist who performed a colonoscopy with biopsies in December 2005.  The results were consistent with ulcerative colitis and he was started on medication specific for treating inflammatory bowel disease.  At a follow-up exam in January 2006, the CI denied any problems with rectal pain, abdominal pain, diarrhea, melena, fever, or weight loss.  At the MEB narrative summary (NARSUM) examination approximately 3 months prior to separation, the CI reported treatment had been somewhat helpful but had not alleviated his symptoms.  He continued to have several stools per day and not uncommonly contain blood.  He was unable to go to the field because of his abdominal cramps loose stools.  He was unable to eat regular Army rations because of his dietary restrictions.  His maximum number of stools per day had never been greater than four; however, he did have considerable pain with his stools and with abdominal cramping.  The physical exam revealed very slight right lower quadrant tenderness but otherwise was essentially normal.  At the VA Compensation and Pension (C&P) exam approximately 3 months after separation, the CI reported his bloody diarrhea had disappeared.  He avoided spicy foods and dairy products.  He did well on that regimen and was otherwise asymptomatic with no nausea, vomiting, or constipation.  The pertinent physical exam was normal.  The examiner made the following concluding statement:

“This patient will need lifelong care and dietary limitations and will certainly have exacerbations in the future.  This will not limit his activities of daily living, but it may limit some of his employability, because stress certainly plays a part in the exacerbations and remissions of this disease.  At present he is in school, and not having troubles with his activities of daily living at this time.”

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and VA applied VASRD code 7323 (ulcerative colitis) and rated it 10% citing “moderate with infrequent exacerbations.”  Rating options for Colitis are based on health during remissions, complications and frequency of attacks/exacerbations.  The VASRD rating criteria for code 7323 are documented here for the reader’s convenience: 

7323 Colitis, ulcerative:
Pronounced; resulting in marked malnutrition, anemia, and general debility, or with serious complication as liver abscess ........................................ 100

Severe; with numerous attacks a year and malnutrition, the health only fair during remissions ……………………………………………………………………………………..60

Moderately severe; with frequent exacerbations …………30

Moderate; with infrequent exacerbations ...................... 10

The C&P exam and final NARSUM were both prepared within 3 months of separation with the PEB being prior to separation and the C&P exam after separation.  Both exams are sufficient for rating purposes and both document a similar level of disability due to ulcerative colitis, infrequent exacerbations.  Both exams document that he was on medications and the C&P exam documented the CI was almost asymptomatic.  There was no weight loss, evidence of malnutrition or fatigue noted.  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:  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 ulcerative colitis 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 20140311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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, AR20150007671 (PD201401285)

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		     
						         
CF: 
(  ) DoD PDBR
(  ) DVA