RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00019
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20061122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Cryptologic Linguist, medically separated for “bleeding hemorrhoids,” with a disability rating of 20%.

CI CONTENTION:  “This applicant requests all MEB/PEB conditions considered for being unfit for duty and rated.  Request per Wounded Warriors Act.”  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 - 20060811	VARD - 20070921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bleeding Hemorrhoids	7336	20%	Chronic Manifestation of Gastrointestinal Bleeding and Anemia	7700	0%	20070410	
Mood Disorder	Not Unfitting 
	Depressive Disorder	9434	30%	20070325	
Left Great Toe MPT Joint Gout		Left Great Toe Gout	5017	0%	20070410	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bleeding Hemorrhoids.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bleeding hemorrhoids condition began in October 2004.  Despite treatment, the condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “secondary anemia from occult gastrointestinal (GI) bleeding causing extreme fatigue” for PEB adjudication.
the MEB NARSUM examination on 13 March 2006 (8 months prior to separation) noted complaints of fatigue. The examiner referenced surgery examination performed on 17 August 2005 which demonstrated a normal abdominal examination and external rectal hemorrhoids.  

At the 10 April 2007 VA Compensation and Pension (C&P) examination, performed 5 months after separation, the CI reported no complaints with regard to his anemia and hemorrhoids.  Physical examination showed normal abdominal and genitourinary evaluations.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 7336 code (hemorrhoids, external internal), citing bleeding hemorrhoids causing severe anemia requiring blood transfusions and parenteral iron replacement.  The VA assigned a 0% rating using the 7700 code (anemia, hypochromic-microcytic and megaloblastic, such as iron-deficiency and pernicious anemia), citing hemoglobin is recorded as 10 gm/100 ml or less with no symptomatology.  The Board noted laboratory findings of hemoglobin of 13.3 gm/100ml 9 months prior to separation and 15.1 gm/100ml one month after separation.  Board members agreed that the evidence did not support a compensable rating under 7700 and that the highest rating for 7336 is 20%.  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 secondary anemia condition.

Mood Disorder.  According to STR and the MEB NARSUM, the CI’s mood disorder began in September 2005 secondary to his anemia and the extensive work up which did not result in finding a definitive cause.  The MEB NARSUM Behavioral Health examination on 20 March 2006 (8 months prior to separation) the CI reported a positive response to Lexapro.   The mental status examination was normal except for a slightly restricted affect.  The examiner rendered a diagnosis of mood disorder (depressed), secondary to the general medical condition (GI bleed).  At the 25 March 2007 VA C&P examination, performed 5 months after separation, the CI reported the use of Ambien for sleep and Citalopram for depression.  The mental status examination showed that a stooped seated posture, slowed body movements, intermittent eye contact, depressed mood, restricted affect.  He denied suicidal and homicidal ideations.  The examiner rendered a diagnosis of depressive disorder not otherwise specified.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB noted that the mood disorder secondary to a general medical condition fell below retention standards, but that the condition was a natural consequence of the medical condition and, as such, did not qualify for a separate rating.  The VA assigned a 30% rating using the 9434 code (depressive disorder), citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  Board members agreed that the mood disorder secondary to a general medical condition is not separately compensable.  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 mood disorder.

Contended PEB Conditions: Left Great Toe Gout.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bleeding hemorrhoids condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the mood disorder secondary to a general medical condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left great toe gout condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20150103, w/attachments
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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018464 (PD201500019)

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