RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX					                          CASE:  PD-2014-04255
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20070210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Tactical Aircraft Maintenance) medically separated for Crohn’s disease.  This condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  “Crohn’s disease” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated Crohn’s disease as unfitting rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requests the Board consider all conditions.  His complete submission is at Exhibit A.

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:  

IPEB – Dated 20070126	VA* – (~1 Mo. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7323	10%	Crohn’s Disease	7323	100%	20070314	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1 	
RATING:  10%	RATING:  100%	
*Derived from VA Rating Decision (VARD) dated 20070328 (most proximate to date of separation [DOS])  

ANALYSIS SUMMARY:  

Crohn’s Disease.  In September 2006, while he was in aircraft maintenance training, this CI was having rectal pain and bloody diarrhea.  He was referred to see a gastrointestinal (GI) specialist.  Numerous tests were done, including esophagogastroduodenoscopy, colonoscopy, and biopsy.  Based on test results, the CI was diagnosed with Crohn’s disease, which is a form of chronic inflammatory bowel disease.  He was also found to have an anal fissure.  In October 2006, he was started on appropriate medications.  On 20 November 2006, 3 weeks later, he was seen for follow-up.  The CI responded well to treatment.  The rectal pain and bleeding had stopped.  He was having a bowel movement (BM) every other day and denied abdominal cramping.  On 8 January 2007, the CI was seen by the GI specialist.  He reported that he was eating well.  Occasionally he would have a loose stool, but most of the time it was one BM per day.  His fissure was better and he was having occasional pain with BM.  On physical examination (PE), the abdomen was soft and non-tender.  Bowel sounds were normal.  The CI’s weight was down to 175 pounds, but the CI was not concerned about that stating he was feeling a lot better.

Due to the chronic, persistent nature of Crohn’s disease, the CI was found unfit for military service.  He was medically separated in February 2007.  A month later, on 14 March 2007, he had a VA Compensation and Pension (C&P) exam.  The CI reported rectal pain and diarrhea.  His GI symptoms were having a moderate effect on his usual daily activities.  Body weight was 180 pounds, and body mass index (BMI) was 22.5 (normal).  On PE, there was tenderness at the anus; the anal fissure was present.  Blood tests showed that his hemoglobin and hematocrit were slightly low.  Based on the data from this C&P examination, the VA rated the Crohn’s disease at 100% disabling.  

The Board directed attention to its rating recommendation based on the 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 7323, since Crohn’s disease is analogous to ulcerative colitis.  The Board carefully reviewed the clinical information in the treatment record.  The Board found certain discrepancies and inconsistencies in the March 2007 C&P examination.  It appeared that the examiner did not differentiate between the Crohn’s disease and the anal fissure.  The examiner may not have understood the difference between anal fissure and fistulous tract.  The examiner also stated that the CI was diagnosed with ulcerative colitis (UC), but this was not true.  It appeared that the C&P examiner may not have understood the difference between UC and Crohn’s disease.  Furthermore, the C&P examiner stated that there had been a weight loss of 50 pounds in less than 3 months.  The Board could not find sufficient evidence to substantiate this degree of weight loss.  

Due to the many discrepancies and inconsistencies, the Board determined that the March 2007 C&P examination had diminished validity and minimal probative value.  The Board determined that of the examinations in the treatment record, the 8 January 2007 exam had greatest probative value.  It was performed by a GI specialist, and was just a month before the DOS.  At that exam, the CI reported that he was eating well.  Occasionally he would have a loose stool, but most of the time it was one BM per day.  His anal fissure was better, and he was having occasional pain with BM.  On PE, the abdomen was soft and bowel sounds were normal.  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.”  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, 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 20140603, 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

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XXXXXXXXXXXX

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-04255.

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,

XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings