RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02871
BRANCH OF SERVICE:  Army	BOARD DATE:  20150423
DATE OF PLACEMENT ONTO TDRL:  19971215
DATE OF REMOVAL FROM TDRL:  20011217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Medic) medically separated for Crohn’s disease.  The condition did not improve adequately to meet the physical requirements of his Military Occupational Specialty, but he was authorized to perform an alternate physical fitness test.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic relapsing Crohn’s disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “chronic relapsing Crohn’s disease” as unfitting, rated 30%.  The CI was placed on the Temporary Disability Retired List (TDRL).  A second IPEB convened 46 months later.  The Crohn’s disease condition was found unfitting, and rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals at that time 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 – dated 20011026	VA Rating Decision1 - 19980116	
Placed on TDRL: 19971214	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL3 Removal	
Crohn’s Disease	7399-7323	30%	10%	Crohn’s Disease	7399-7323	60%	10%	
Other x 0 (Not in Scope)	Other x 2	
RATING:  30% → 10%	RATING:  60%	
1. Most proximate to TDRL Placement
2. Rating based on service treatment record (STR).
3. Rating derived from C&P exam dated 20011019, ~2 mos. pre-TDRL removal.

ANALYSIS SUMMARY:

Crohn’s Disease.  This CI presented for care in December 1994, complaining of lower gastro-intestinal (GI) symptoms.  In April 1995, a colonoscopy was done and it was normal.  However, in 1997, a repeat colonoscopy (with biopsy) was positive for Crohn’s disease.  Due to the chronic, relapsing nature of his symptoms, a MEB was initiated.  The MEB physical examination (PE) was on 14 July 1997.  At that exam, the CI was in no acute distress.  The PE of his heart, lungs, and abdomen was normal.  In the MEB narrative summary, the examiner’s diagnosis was: “Chronic, relapsing Crohn’s disease of the colon.”  In October 1997, the Army PEB found him unfit for military service.  The CI was placed on the TDRL at 30%.

The Board carefully examined all available evidence.  In the VASRD, there is no diagnostic code (DC) specifically for Crohn’s disease.  The Board determined that it was appropriate to use DC 7399-7323 (analogous to ulcerative colitis).  The CI was temporarily retired at 30%, effective ON 14 December 1997.  At that time, a rating higher than 30% was not warranted.  The CI’s GI disorder was not severe enough to justify being classified as “severe.”  IAW VASRD §4.114, a rating of 60% would require numerous attacks a year, and malnutrition, with his health only fair during remissions.  Since the treatment record did not show sufficient evidence of these findings, the Board had no basis to recommend a rating higher than 30%, when he was placed on TDRL.

In February 2000, after approximately 26 months of being placed on TDRL, the CI had a VA Compensation and Pension (C&P) exam.  At that visit, he reported that he was employed full-time as a truck driver.  There had been no symptom flare-ups since November 1999.  He was taking sulfasalazine to keep symptoms under control.  On PE, the CI was in no acute distress.  The PE of his heart, lungs, and abdomen was normal.

On 27 July 2001, after 43 months on the TDRL, the CI had a re-evaluation exam.  He reported intermittent symptoms, including lower abdominal cramping and bloody diarrhea, every 3 to 4 months.  His last flare-up had been in March 2001, and was treated on an outpatient basis.  The CI reported that he had not been hospitalized since his initial diagnosis (1997).  He reported that he was not taking any medications.  On PE, his abdomen was soft with mild tenderness in the lower quadrants bilaterally.  Shortly after that exam, he was on the road driving his truck, and he experienced a flare-up of symptoms.  He went to a hospital and received treatment in the emergency room (ER).  He was started on oral Prednisone therapy, and his symptoms responded to the Prednisone.  The CI stopped taking the Prednisone after two weeks of treatment.

On 19 October 2001, after 46 months on the TDRL, the CI had another C&P exam.  He reported that he continued to experience intermittent lower GI symptoms.  His last flare-up had been in July 2001.  He was driving a truck, sometimes eight hours a day, about 4 days a week (average).  His weight was stable, around 170 pounds.  During the year 2001, he had had two flare-ups and no hospitalizations.  On PE, his abdomen was soft with moderate tenderness in the left lower quadrant.  The VA lowered its rating of the CI’s Crohn’s disease (analogous to ulcerative colitis) to 10% effective on 1 May 2002 (apparently from this exam; this VARD was not in evidence but the Board ascertained this information from a subsequent VARD which was in evidence).  A week later, on 26 October 2001, a second Army PEB was convened.  The CI was found unfit, and was removed from TDRL, and was permanently separated with a 10% rating.

The Board directed attention to its permanent rating recommendation based on the above evidence.  The 19 October 2001 C&P exam was closest to the date of separation (DOS), and therefore had significant probative value.  The Board determined that, at DOS, the severity of the CI’s disease was best described as “moderate, with infrequent exacerbations.”  There was insufficient evidence to justify a classification of “moderately severe, with frequent exacerbations.”  During the year 2001, he had experienced just two flare-ups and no hospitalizations.
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the Crohn’s disease.

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 20140606, 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 XXXXXXXXXXXXXXXXXXXX, AR20150018721 (PD201402871)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA