RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02737
BRANCH OF SERVICE: Army	BOARD DATE:  20150630
DATE OF PLACEMENT ONTO TDRL:  20021106
DATE OF REMOVAL FROM TDRL:  20040721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Line Of Sight-Forward-Heavy Crewmember) medically separated for ulcerative colitis.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allows for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB), which was conducted by the Navy.  The “ulcerative colitis” and “inflammatory bowel disease,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Army concurred with the Navy MEB.  The Informal PEB combined the two MEB conditions and adjudicated “ulcerative colitis” as unfitting, rated 30%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was placed on the Temporary Disability Retired List (TDRL).  Almost 2 years later, the PEB adjudicated the ulcerative colitis condition as unfitting, rated 10% with likely application of the VASRD.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions”

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 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 PEB – 20040421	VA Rating Decision1 - 20030123	
TDRL Placement – 20021106	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL
Placement	Exam	
Ulcerative Colitis	7323	30%	10%	Ulcerative Colitis	7323	10%	20030113	
Other x 0 (Not in Scope)	Other x 1	
RATING: 30% → 10%	RATING:  10%	
1. Most proximate to TDRL Placement.

ANALYSIS SUMMARY:  The MEB forwarded two conditions to the PEB – ulcerative colitis (UC) and inflammatory bowel disease (IBD), the narrative summary (NARSUM) referred to the CI’s condition with both terms, and the PEB adjudicated one unfitting condition of UC.  The Board makes note that the CI’s condition was diagnosed as UC, confirmed by biopsies and that UC is a specific IBD.  The evidence in record supports that the CI was diagnosed with one gastrointestinal condition that was unfitting hereinafter referred to as UC.

Ulcerative Colitis Condition.  The NARSUM notes the CI had acute onset of frequent bloody diarrhea, abdominal and rectal pain, fatigue, low grade fever, mouth ulcers and joint pains in late May 2002.  Blood work and stool studies were normal, without evidence of anemia or infection.  Sigmoidoscopy performed on 3 June 2002 showed chronic active colitis consistent with IBD confirmed by biopsies.  The diagnostic impression was “acute colitis, probable ulcerative colitis” and the CI was started on anti-inflammatory oral medication and enemas.  Colonoscopy was performed on 19 July 2002 and the diagnosis of UC was continued and biopsies were pending at the time of the MEB examination.

At the MEB examination on 19 July 2002, the CI reported some improvement in his symptoms with low back pain, joint pains, and frequent, painful bowel movements (BM) without blood.  The MEB physical exam noted mouth ulcers and a rash on the CI’s upper and lower extremities, but the abdominal exam was normal and non-tender.  An addendum to the NARSUM on 31 July 2002, noted the colon biopsies confirmed a diagnosis of UC, with pancolitis (affecting all parts of the colon).  The CI’s medications were changed to oral immunosuppressive medication.  The PEB placed the CI on TDRL because a permanent evaluation was judged not possible yet.

At the VA Compensation and Pension examination on 13 January 2003, 2 months after placement on the TDRL, the CI reported episodes of bloody BM, the last in October 2002.  He was taking the immunosuppressive medication and was in remission at the examination.  The exam noted weight of 189 pounds, without fever, skin rash, mouth ulcers, or signs of anemia.  The abdominal was soft, with mild tenderness and joint pain of the right knee and wrist was noted.

At the TDRL re-evaluation on 17 December 2003, the CI reported that his UC symptoms improved with the immunosuppressive medication and he discontinued the medication in early to mid-2003 and had a recurrence of symptoms in September 2003.  He started the medication again and symptoms improved.  The CI had a colonoscopy on 17 October 2003, which was reportedly normal.  At the evaluation the CI reported current symptoms of fatigue, mouth ulcers, and two non-bloody BM per day.  He reported some daily back pain, but no fever, and noted that he had lost 25-30 pounds (200 pounds down to 170 pounds), but was slowly regaining weight.  Screening blood work was normal.  The exam noted a mouth ulcer and the abdomen was mildly tender, without other abnormality.

The Board directed attention to its rating recommendation at TDRL placement based on the above evidence.  The PEB rated the UC condition 30%, coded 7323 (UC).  The VA rated the UC condition 10%, coded 7323, three months after TDRL placement.  The Board agreed that at TDRL placement the evidence supports a 30% rating specified as “moderately severe, with frequent exacerbations.”  The Board reviewed to see if the next higher evaluation of 60% was supported, but noted that the CI had only recently been diagnosed with UC, with an acute onset, and the attacks were responding to sequential medication changes and members did not think this was appropriately characterized as “severe, with numerous attacks a year,” and additionally there was no evidence of malnutrition.  Thus, the Board agreed that the UC condition at TDRL placement met a 30% rating and no higher.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the UC condition at TDRL placement.

The Board directed its attention to its rating recommendation at TDRL removal based on the above evidence.  The PEB rated the UC condition 10% at TDRL removal, coded 7323.  The only VA rating in record was the original VARD which rated the UC 10% as noted above.  The Board agreed that the evidence at the TDRL re-evaluation supports a 10% rating specified as “moderate, with infrequent exacerbations.”  The Board reviewed to see if the 30% rating was supported but the CI reported that since starting his medication again three months earlier, his current bowel function was within normal and the TDRL examiner noted that a recent surveillance colonoscopy was also normal.  Members agreed that this was not consistent with the disability characterized by the 30% criteria noted above.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the UC condition at TDRL removal.

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.  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 20140606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB		0 6 JUL 2016
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 XXXXXXXXXXXXXXXXXXXX, AR20160003084 (PD201402737)

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:

CF:
( ) DoD PDBR ( ) OVA