RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01274
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Intelligence Analyst, medically separated for “irritable bowel syndrome,” with a disability rating of 10%.

CI CONTENTION:  “The conditions should be changed due to them being more severe than previously determined.”  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 on 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 - 20030228	VARD - 20030526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Irritable Bowel Syndrome…	7913	10%	Irritable Bowel Syndrome with Hiatal Hernia and Gastroesophageal Reflux Disease	7399-7346	30%	20030325	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Irritable Bowel Syndrome (IBS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s IBS symptoms began in February 2001, however the CI did not seek treatment until September 2001.  She was not diagnosed with IBS until August 2002 by gastroenterology.  She was evaluated with an upper endoscopy and sigmoidoscopy (nonsurgical procedures to examine using a flexible tube) that revealed gastroesophageal reflux disease with intestinal metaplasia but no esophageal dysplasia.  Her sigmoidoscopy was unremarkable with normal biopsies.  She was treated with Aciphex and Imodium and had a marginal to good response.  Yet she continued to have worsening of her diarrhea.  The MEB forwarded “irritable bowel syndrome” for PEB adjudication.  

The MEB NARSUM examination on 2 January 2003, 5 months prior to separation, noted complaints of diarrhea accompanied by bad cramping, headache, and dehydration.  In the 2 weeks prior to the examination, the CI reported bowel movements 6 times per day on average but it would get worse, up to every 5-10 minutes with large watery stool.  She stated that the Lomotil didn't work and that she just kept up with it by drinking lots of fluids.  The CI’s general physical exam was normal.  Her abdomen was obese, soft, and non-tender with normal bowel sounds.  The MEB NARSUM specialty evaluation on 29 January 2003, 4 months prior to separation, noted complaints of continued diarrhea and heartburn symptoms.  Physical examination was normal.  Her abdomen was soft, non-tender, normal bowel sounds, no hepatosplenomegaly or masses were appreciated.  At the 25 March 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported that on some days she “had to go 3 times a day and sometimes 3 times an hour.”  Physical examination showed the abdomen was soft with no organomegaly present or tenderness elicited.  No scars or varicosities identified. No hernia was present.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the IBS condition 10%, coded 7913 (diabetes mellitus), citing frequent bowel movements.  The VA rated the IBS condition 30%, coded 7399-7346 (hiatal hernia), based on the VA C&P examination 2 months before separation, citing irritable bowel syndrome by history with no current pathology identified.  The board agreed that symptoms in the proximate examinations (MEB and C&P) more closely approximated the 10% (moderate) rating with frequent episodes of bowel disturbance with abdominal distress.  The higher 30% (severe) rating would require diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.  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 IBS condition.  The Board noted the incorrect coding used by the PEB.  The correct code is 7319 (irritable colon syndrome) however, there would be no rating benefit to CI in changing codes.

BOARD FINDINGS:  In the matter of the IBS 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 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005978 , XXXXXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,