RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00840
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070201

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

CI CONTENTION:  “Review all 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 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 - 20061218	VARD - 20071012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease Irritable Bowel Syndrome and Colitis	7319-7323	10%	STR	
Major Depressive Disorder and Dysthymia	CAT III	Mood Disorder with Depressive Features	9435	0%	20070605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

Crohn’s Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s gastrointestinal condition dates back to May 2002.  She was evaluated by gastroenterology with complaints of intermittent bloody stools, white mucous stools and abdominal soreness.  In August 2003 the CI was completely asymptomatic.  She was initially treated with one medication, Asacol, three times per day and the PEB found her fit for duty in April 2004 since she was handling symptoms well with infrequent exacerbations.  By May 2005 while on ship, she experienced a flare-up with multiple episodes of diarrhea and abdominal pain, requiring treatment with steroids.  Her condition steadily improved.  By July 2005, the CI reported no abdominal pain, solid bowel movements 3-5 times a day and was “doing well.”  At the September 2005 Gastro appointment the CI continued to report solid bowel movements.  She was again found fit for duty by the PEB in October 2005.  Treatment notes from February and March 2006 noted the CI was in remission.  The April 2006 Gastro follow-up appointment noted symptoms were well controlled with minimal abdominal pain and three bowel movements a day.  In May 2006, the records indicated the CI remained in remission.  After return to duty, she had multiple episodes of diarrhea and abdominal pain and required steroid therapy to improve symptoms.  She reported a lot more fatigue and increase in bowel movements to the point she could not do her job.  She believed this was due to stress aboard her ship as well as altered sleep associated with her duties.  At the June 2006 Gastro follow-up, the CI reported she was getting better with the prednisone, but not back to normal.  The MEB forwarded “regional enteritis of unspecified site” for PEB adjudication.  

At the 6 October 2006 Gastro appointment, the CI reported doing “OK” since the steroid taper and was back to baseline.  The MEB NARSUM examination on 10 October 2006, 4 months prior to separation, noted the CI required chronic medication that included immunosuppressive medication which required monthly lab evaluation.  The CI failed to report for her VA Compensation and Pension (C&P) evaluations.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 10%, coded 7399-7323 (colitis, ulcerative).  The VA also rated the Crohn’s disease 10%, coded 7399-7323 (irritable colon syndrome-colitis, ulcerative), based on the STR citing infrequent exacerbations, specifically noting a flare in May-June 2006 and a VA treatment note dated May 2007 with findings of no abdominal pain, no melena and no diarrhea.

The VASRD rates Crohn’s disease analogously to ulcerative colitis.  Moderate illness with infrequent exacerbations is rated 10%, moderately severe with frequent exacerbations is rated 30% and severe with numerous attacks per year and malnutrition is rated 60%.  As noted above, the CI had a long history of Crohn’s disease with periods of remission and flares which the board deliberated at length.  Although she required chronic medication including immunosuppressive medication, which required monthly laboratory evaluations, this was to make sure she did not develop serious medication side effects (hepatitis and low white cell count).  Although this illness can flare to the point in which significant complications can develop (fistulas, abscesses, removal of the colon), the CI did not suffer from these complication at the time of separation.  The Board noted the follow-up Gastro evaluation on October 2006, 2 months prior to separation, noting  her symptoms had returned to baseline.  The Board majority felt the periods of exacerbations more nearly approximated the 10% rating for infrequent exacerbations.  There was no evidence of malnutrition to meet criteria for 60% disability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends no change to the disability rating of 10% for the Crohn’s disease, coded 7399-7323.   

Contended PEB Conditions:  Major Depressive Disorder and Dysthymia in Remission.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.   The commander did note the CI’s ability to function was impaired due to her medical condition and daily emotional stress.  However, the CI noted on the MEB examination, dated October 2006 that she had been diagnosed with major depressive disorder in 1999 that was treated.  She stated she had no current symptoms and was taking no medications for these illnesses.  The contended condition was not profiled 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.  The DD Form 2807 noted no current symptoms and taking no medications. 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 Crohn’s disease condition, the Board majority recommends a disability rating of 10%, coded 7399-7323 IAW VASRD §4.114.  The single voter for dissent submitted the appended minority opinion.  In the matter of the contended major depressive disorder 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 20150604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MINORITY OPINION

The CI was found fit for duty (FFD) twice while being treated by Asacol, a salicylate class of medication for a moderate level of illness) for her Crohn’s Disease.  While assigned to ship duties and under more stress, her condition deteriorated with more frequent episodes of abdominal pain and bloody diarrhea.  A 3-month course of prednisone (including taper) was required to control her symptoms that occurred over a 6-month period.  During this time the addition of a medication, immunosuppressive agent (6-MP) was required to achieve stability as the prednisone was tapered.  This higher level of intervention was required due to the escalated frequency of symptoms that were requiring prednisone.  The Commander acknowledged she was not able to perform her duties in the face of the exacerbations, which began in February 2005 and persisted until both steroids and immunosuppressive agents were added.  She was found Unfit for Duty at this point, still requiring the use of 6-MP (an agent used to treat more severe cases of Crohn’s Disease), which is associated with life-threatening side effects and monthly lab evaluation to document threatening changes.  Her disease became moderately severe, thereby qualifying her for the 30% VASRD rating.

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 13 Dec 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:

		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 

XXXXXXXXXXXXXXXXXX	     	
Assistant General Counsel
				    	                          (Manpower & Reserve Affairs)