RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03449
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150625
SEPARATION DATE:  20051018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Nondestructive Inspection, Journeyman) medically separated for ulcerative proctitis.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was issued a permanent P4 profile and referred for an Medical Evaluation Board (MEB).  Ulcerative proctitis was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The initial Informal PEB (IPEB) adjudicated ulcerative proctitis condition as not unfitting citing that it existed prior to service (EPTS) without service aggravated.  A second IPEB adjudicated ulcerative proctitis rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining history of alcohol dependency, currently in remission condition was determined to be Category III (not separately unfit and compensable/ratable).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please rate 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:

Service IPEB – Dated 20050830	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Proctitis, Moderate Severity	7399-7323	10%	Ulcerative Colitis	7323	0%	20051215	
Alcohol Dependency	Category III	No VA Placement	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 15	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060412 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Ulcerative Proctitis.  The CI was first evaluated for what was eventually diagnosed as ulcerative proctitis on 31 October 2003.  She reported a positive family history and a personal history of episodic abdominal discomfort, bloating, diarrhea, and blood in her stool.  Colonoscopy was advised, but the CI did not pursue this recommendation initially.  On 26 May 2004, she was again seen for the similar, but increased symptoms.  A colonoscopy on 10 June 2004 was suggestive of ulcerative proctitis and the diagnosis confirmed by pathology.  She was treated with medications with an improvement of symptoms and referred for MEB.  She was found unfit by the PEB on 9 November 2004 and separation for an EPTS condition was recommended.  Her management was complicated by personal and occupational stressors and an examination on 3 January 2005 showed that her disease was not well controlled.  Her medication regimen was adjusted and she “gained control of her stressors” with an improvement in her symptoms.  Repeat examination of the lower colon showed very mild disease.  She appealed the PEB decision and was retained on active service.  However, she again had increased stress at work with additional responsibilities as well as personal stress secondary to the deployment of her husband and pregnancy by another man.  She subsequently sought discharge from the military.

The MEB narrative summary was dated 11 July 2005, 3 months prior to separation.  The CI reported a significant family history of ulcerative colitis/proctitis, a history of alcoholism, and mental health issues including depression.  She reported abdominal cramping and bloating, frequent loose stools, and blood in her stools.  She denied fever or chills and had a stable weight.  Her anxiety and depression were increased and she had recently divorced (it is unclear from the record if her divorce was final at this time).  Bowel sounds were increased on abdominal examination, but otherwise no pathology was documented.

At the VA Compensation and Pension (C&P) examination dated 16 December 2005, 2 months after separation, the CI reported some rectal bleeding, but that her symptoms were “pretty much under control” and that her condition was much better since separation from the military and being back home.  She had intermittent lower abdominal cramping and bloating with loose stools/diarrhea on occasion.  The source of the rectal bleeding was not specified.  The action officer observed that the CI was 6 months pregnant at this time and bleeding from hemorrhoids is not uncommon at this stage in pregnancy.  The abdominal examination was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the ulcerative proctitis condition at 10%, coded 7399-7323 (analogous ulcerative colitis).  The VA, relying on the C&P examination, rated the condition at 0%, coded 7323.  The PEB observed that her primary stressor which aggravated her ulcerative proctitis was continued military service.  The VA evaluation supported this opinion and warrants a 0% rating.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  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 proctitis condition.

Contended PEB Conditions.  The PEB adjudicated the history of alcohol dependency, currently in remission, as a Category III condition, one which is not compensable or ratable.  IAW DoDI 1332.38 E5.1.3.9.1., uncomplicated alcoholism or substance abuse disorder do not constitute a physical disability.  The CI reported a problem with alcohol prior to service and was in remission at the time of separation.  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 fitness determination for the contended alcohol dependency condition and so no additional disability rating is recommended.

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 proctitis condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended alcohol dependency condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20140702, 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

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03449.

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,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR