RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00389
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “Crohn’s disease,” with a disability rating of 10%.

CI CONTENTION:  The CI contends that his condition has continued to worsen and “totally” interferes with his ability to work.  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 - 20041104	VARD – 20041220 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	30%	20041102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bowel condition began in August 2003 while deployed.  The CI reported abdominal cramping and diarrhea after every meal or snack.  He reported variable numbers of episodes often in the range of five to twelve episodes per day with blood at times, with an episode of 32 BM per day reported in July 2004.  The CI was diagnosed with inflammatory bowel disease (IBD), likely Crohn’s disease, by colonoscopy with biopsies in July 2004.  He was started on anti-inflammatory medication for IBD and there was some decrease in the number of daily episodes, but they remained at several per day with blood in stool at times.  The NARSUM noted that the CI was being treated at the VA and had been admitted to the hospital and treated with IV and oral steroids, as well as rectal steroids and other medications.  The CI was being monitored at the time of the MEB NARSUM examination, before use of immunosuppressive medications were considered.  Blood work showed no anemia or evidence of malnutrition. After starting on medications for the IBD, the CI’s weight was stable.  A gastroenterology note in September 2004 noted the CI had “active Crohn’s colitis” with a poor response to treatment and a MEB was recommended.  The MEB forwarded “Crohn’s disease” for PEB adjudication.  

The MEB H&P and NARSUM were done on the same day by the same physician.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 7 October 2004, 2 months prior to separation, the CI reported constant stomach pain due to Crohn’s disease and that he was “unable to do anything.”  At the MEB NARSUM examination, 2 months prior to separation, physical examination of the abdomen and rectum was normal, without tenderness to palpation.  

At the 2 November 2004 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported constant abdominal pain and diarrhea alternating with constipation, with vomiting at times.  The condition did not affect his body weight and his nutritional status was “good.”  Physical examination of the abdomen was normal without tenderness.  Screening blood work showed the CI was not anemic and there were no other significant abnormalities.  

At the 27 June 2005 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported daily diarrhea, even with medications, six to seven times per day, with blood and cramping pain.  In the previous two weeks he reported mucus and blood in his stool and some vomiting.  He reported weight gain due to his medications.  Physical examination showed abdominal tenderness throughout.  The CI was going to see his personal GI specialist.  Outpatient VA treatment notes indicated that between early June 2005 and 4 January 2006 (within 12 months of separation), the CI was being treated for multiple exacerbations with stool frequencies of six to twelve BM per day with blood at times, and occasionally nausea/vomiting.  He was tried on alternate medications including oral immunosuppressive medication (Imuran) but continued with poor control.  High dose oral steroids were added with improvement, however, his symptoms flared again as he was tapered to lower steroid doses (20 mg per day).  The CI was considered a candidate for an alternate immunosuppressive medication (Remicade).  A colonoscopy in January 2006 showed continued areas of active colitis in the rectum and colon.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 10%, coded 7399-7323 (analogous to ulcerative colitis), citing that the CI’s condition did not require “immunosuppressive treatment.”  The VA rated the Crohn’s disease 30% coded 7399-7323, based on the VA C&P examination 1 month before separation, citing “objective evidence of frequent exacerbations.”  The VARD dated 22 August 2005 continued the 30% rating based on the VA C&P examination 6 months after separation.  There was evidence in record to support a 30% rating for moderately severe disease with frequent exacerbations.  Although the PEB noted the CI did not require immunosuppressive agents, the evidence supports that the Crohn’s disease was not well controlled on the initial medication regimen at the time of separation and within 4 months of separation the CI was placed on immunosuppressive medication because of poorly controlled disease.  There was no evidence of malnutrition and poor health during remissions for the next higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the Crohn’s disease condition, coded 7399-7323.  

BOARD FINDINGS:  In the matter of the Crohn’s disease, the Board unanimously recommends a disability rating of 30%, coded 7399-7323 IAW 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Crohn’s Disease	7399-7323	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/atchs
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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20160018716 (PD201500389)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA