RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04215
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20041006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Active Sonar Level Technician, medically separated for “Crohn’s disease,” with a disability rating of 10%.  

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 based upon a 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:  

SERVICE PEB - 20040416	VARD - 20041123   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s and Pyloric Ulcer Inflammatory Disease	7305-7323	30%	20040709	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA RATINGS:  50%	

ANALYSIS SUMMARY:  

Crohn’s Disease Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was treated for reflux and anemia prior to service at age 17.  A stomach biopsy showed he had moderate chronic active gastritis.  He was treated with over the counter medications to enlist in the military without being on prescription medications.  The CI then presented on 9 September 1999, with a history of abdominal pain for 1 year and was treated with Prilosec (a prescription medication for heartburn and ulcers).  The record then falls silent until July 2002 when it was noted his symptoms had continued after enlistment and that he had recently been treated by his home town physician.  He was noted to be anemic and an evaluation for gastro-intestinal (GI) bleeding was begun.  An X-ray study (upper GI with small bowel follow through) study was consistent with Crohn’s Disease.  Endoscopy studies with biopsies were also consistent with Crohn’s and an MEB was initiated.  The MEB NARSUM examination was accomplished by a gastro-enterologist on 24 October 2003, 11 months prior to separation, noted the CI had improved on minimal medications (Pentasa) from five-six bowel movements per day to one, tolerated solid food, and was gaining weight; malaise persisted though.  On examination, ocular and oral ulcers were absent.  The weight was 190 pounds and the abdominal examination was unremarkable.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 12 April 2004, 6 months prior to separation, the 72 inch CI weighed 195 pounds and again, had an unremarkable abdominal examination without oral or ocular ulcerations.  At the VA Compensation and Pension (C&P) evaluation, performed on 9 July 2004, 3 months before separation, the CI reported he continued Pentasa but was begun on prednisone (a steroid) 2-3 days earlier for a recent flare manifested by increased abdominal discomfort and decreased appetite.  On examination he weighed 224 pounds, an increase of 29 pounds since the MEB examination 3 months earlier.  Ulcerations were absent and the abdominal examination was unremarkable.  Slight anemia persisted.  An examination on 29 October 2004, less than a month after separation, the CI reported a flare of pain as his steroids were titrated down to 10 mg, but without recurrent diarrhea.  On examination, he was in no acute distress and his weight was 230 pounds.  The examination of the eyes and oral mucosa was normal and the abdomen showed minimal tenderness above the pubic bone.  A GI evaluation on 12 July 2005, 9 months after separation, showed the CI was doing well on medications and in remission.  His weight was back to 196 pounds (baseline) and the abdominal examination was “really unremarkable.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease condition at 10%, coded 7399-7323 (analogous to ulcerative colitis), for moderate impairment with infrequent exacerbations.  The VA rated the Crohn’s disease and pyloric ulcer inflammatory disease condition 30% (moderately severe disease with frequent exacerbations) coded 7305-7323 (duodenal ulcer disease and ulcerative colitis), based on the VA C&P examination 3 months before separation, citing frequent exacerbations of moderately severe symptomatology as noted by the C&P examiner.  The Board did not find this recorded upon review of the C&P evaluation and also noted that this is not consistent with the comments by gastroenterologists before or after separation.  The CI actually gained weight in the months prior to separation (aside from steroid use) and remained stable off steroids.  He was treated with one steroid burst in the months prior to separation.  The evidence does not support the definition for a 30% rating (moderately severe disease with frequent exacerbations).  The VA also used the 7305 code for duodenal ulcer disease; however, this was not an active diagnosis in the MEB or PEB process.  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 Crohn’s Disease condition.  

BOARD FINDINGS:  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.  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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 22 Sep 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN