RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03488
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-5, Automated Logistical Specialist, medically separated for “ulcerative proctitis,” with a disability rating of 10%.  

CI CONTENTION:  The CI requested that the Board review all of his conditions.  The CI’s complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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:  

SERVOCE PEB – Dated 20040915	VARD - 20041108  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Proctitis	7399-7323	10%	Ulcerative Proctitis	7399-7323	30%	20041108	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Ulcerative Proctitis.  The narrative summary (NARSUM) noted that the CI was diagnosed by gastroenterology (GI) with ulcerative proctitis (UP) with marked, uniform disease of the distal colon and rectum noted on colonoscopy and biopsies 28 June 2002.  He was prescribed oral and suppository forms of anti-inflammatory medication.  When the CI was next seen in February 2003 with recurrent symptoms he was not taking the medications as prescribed and was advised to do so.  His symptoms improved for a time, but recurred when he ran out of his medications.  During this time he was treated with oral steroids to bring the UP flare-up under control.  A repeat colonoscopy 29 July 2003 noted the disease was still active and he was given another tapering course of steroids.  The CI was evaluated by GI in December 2003 during readiness processing and reported feeling well with symptoms of two bowel movements (BM) per day, with waxing and waning abdominal cramping and occasional blood per rectum.  He was off profile and had passed his last physical fitness test and he was cleared for deployment.  The CI did well while deployed until mid-April 2004, when he ran out of his medications.  He was medically evacuated 19 May 2004 because they were not equipped to continue his treatment.  After his return, he was placed back on oral and suppository forms of anti-inflammatory medication with gradual improvement in his symptoms.  A GI note 15 June 2004 indicated that the bleeding had resolved, but occasional abdominal cramping continued, with two BM per day, and noted the UP flare had resolved.  Notes in the service treatment record indicated the CI’s weight was stable (120-126 pounds) during his deployment and following his return.

At the Medical Evaluation Board (MEB) exam 25 August 2004, 3 months before separation, the CI reported bloody diarrhea.  The MEB physical exam noted weight of 125 pounds mild abdominal tenderness bilaterally with normal bowel sounds and no masses.  Rectal exam was deferred but normal rectal tone was noted on prior examinations.  Blood work showed no evidence of anemia, liver disease, or nutritional deficiencies.  The MEB examiner indicated that the CI had had multiple disease flares which required increasing doses of medications and occasionally courses of oral steroids to control and described the CI’s diagnosis as UP, “moderately severe with frequent exacerbations.”  The CI submitted a statement from the GI specialist following the PEB.  The GI memorandum 21 September 2004 noted that since his original diagnosis in June 2002, the CI had been treated by GI for numerous exacerbations of his UP symptoms.  The GI specialist highlighted the difference between his assessment of the CI’s condition as moderately severe and the PEB’s assessment as moderate.

At the VA Compensation and Pension (C&P) exam 8 November 2004 less than a month before separation, the CI reported two BMs per day and continued symptoms, with regular treatment by a GI specialist.  The VA examiner noted that the CI was started on treatment after his return from deployment, and had “some improvement however continues to experience symptoms”.  The VA exam noted weight of 116 pounds.  There was no abdominal tenderness, or masses, and full exam was otherwise normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both coded the UP condition 7399-7323 (analogous to ulcerative colitis).  The PEB rated it 10% and the VA rated it 30%.  The Board noted that the evidence indicated the CI continued with symptoms despite compliance with medications, although he continued to function, and the follow-up colonoscopy 13 months after the initial diagnosis noted the persistence of active disease.  The CI reported residual GI symptoms prior to his deployment, and the Board considered in its recommendation that the CI was medically evacuated due to a UP flare.  After return from deployment and resumption of an effective medication routine, the CI reported improved, but continued symptoms at the C&P exam.  According to the NARSUM, the CI experienced multiple flares of the UP symptoms, at times because he was not taking medication as prescribed or had run out of medication, but in the opinion of the treating GI specialist, the CI had “frequent exacerbations.”  After deliberations, the Board agreed that the disability due to the UP condition was more closely approximated by the 30% rating criteria, specified as “moderately severe; with frequent exacerbations,” than the 10% criteria, specified as “moderate; with infrequent exacerbations,” IAW VASRD §4.7 (Higher of two evaluations).  The Board reviewed to see if either the 100% or 60% 7323 ratings were supported, but there was no evidence in record of malnutrition with poor health in between exacerbations or complications, such as liver disease.  The Board determined that the evidence supports a 30% rating for the UP condition IAW VASRD §4.114 (Digestive system) and no higher.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 30% for the UP condition.  

BOARD FINDINGS:  In the matter of the UP condition, the Board unanimously recommends a disability rating of 30%, coded 7399-7323IAW VASRD §4.114.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Ulcerative Proctitis Condition	7399-7323	30%	
COMBINED	30%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140625, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160008659,  XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with
severance pay.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large
number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.   Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHAC-00), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,