RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01323
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060616

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Structural Maintenance Journeyman, medically separated for “probable Crohn’s Disease, status post perforation, bowel resection,” 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 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 - 20060426	VARD - 20061229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Probable Crohn’s Disease 	7399-7323	10%	Crohn’s Disease with Residuals, Status Post Bowel Resection for Perforation	7399-7323	30%	20061121	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Probable Crohn’s Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented to primary care on 4 May 2005 with a 3-day history of right lower quadrant (RLQ) pain.  His initial evaluation was not consistent with an acute (surgical) abdomen and he was treated with dietary modification and counseled on the signs and symptoms of appendicitis.  His pain persisted and a CT scan was accomplished on 19 May 2005.  It was consistent with a prior rupture from appendicitis.  The CI was treated with a 10-day course of intravenous antibiotics and then had an appendectomy on 27 June 2005.  He did well post-operatively and was returned to full duty; however, he had recurrent RLQ pain and was thought to have constipation for which he was treated.  He then apparently did well until 9 January 2006 when he presented with a different type of abdominal pain and was thought to have an acute abdomen.  A CT scan showed thickened small bowel and the CI was then taken to surgery where a portion of the small bowel (ilium) and colon (cecum) were resected.  The diagnosis of Chron’s Disease was made based on surgical pathology findings.  The CI was then referred for an MEB.  The MEB NARSUM examination on 17 February 2006, 4 months prior to separation, noted the CI had been asymptomatic since surgery and denied fever, diarrhea, constipation, bloody stools, or abdominal pain.  The CI was on an antibiotic (metronidazole).  The CI requested retention on active duty.  On examination, he was noted to be in no acute distress and weighed 165 pounds (his weight had varied between 160 and 170 over the prior 7 months).  The abdominal examination was remarkable only for the surgical scar.  On 28 February 2006, the CI presented with abdominal pain, vomiting, and diarrhea.  He was thought to have an acute gastroenteritis (rather than a flare of his Chron’s Disease).  He was found to be in no acute distress and his abdominal examination was unremarkable.  His weight was 153 pounds.  He was then seen a few days later in the emergency room for recurrent abdominal pain and found to have a moderately tender RLQ.  A CT scan showed inflammatory changes around the prior bowel excision which were possibly due to Chron’s Disease.  The next day he underwent endoscopy.  A slight amount of inflammation at the site of the anastomosis (the connection of the bowel after the removal of the segments discussed above).  A biopsy was consistent with Chron’s Disease, but there was no significant inflammation.  The commander’s assessment was dated 21 Mach 2006 and noted the CI had no limitations in performing his normal, assigned duties, but was not deployable with the diagnosis of Chron’s Disease.  An update to the NARSUM was prepared on 30 March 2006.  It noted a recent colonoscopy showed he was healing well.  The CI was on two medications, Asacol (an aspirin-like compound) an Entocort (a steroid).  He denied current symptoms and his weight was stable at 165 pounds.  The abdominal examination was unremarkable.  He was thought to be well controlled on medications.  It was again noted the CI desired to remain on active duty.  The MEB forwarded “probable Crohn’s disease” for PEB adjudication.  The separation examination was accomplished on 8 May 2006, 5 weeks prior to separation.  He reported no recent flares of the Chron’s Disease and was found to have a normal examination with a weight of 160 pounds.  He did endorse stress over the upcoming separation from active duty.  The final performance report closed out on 11 July 2006, 5 days prior to separation.  He received the highest rating in all categories except communication (a rating of 4 with a maximum of 5).  Immediate promotion was recommended.  The Board noted at multiple clinical encounters, laboratory testing showed anemia was not present.  

At the VA Compensation and Pension (C&P) evaluation performed on 21 November 2006, 5 months after separation, the CI reported that eating was difficult and that his weight had dropped from 170 to 158 pounds.  The Board noted that the majority of his weights were between 160-165 pounds in the year prior to separation.  He was recorded to weigh 170 on one occasion (10 August 2005), but had been measured at 160 the day prior.  The weight of 158 was recorded in February 2006 at which time the CI had been diagnosed with gastroenteritis.  He reported RLQ abdominal pain which occurred 1/3 to 2/3 of the year.  He reported flares lasting up to 2 hours occurring 100 times the past year as often as daily.  He was working as a sheet metal mechanic, the same job he held on active duty.  On examination, his weight was 160 pounds and he was in no acute distress.  The abdomen was non-tender.  No oral lesions (sometimes seen in Chron’s) were present.  Anemia was not present.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bowel condition 10%, coded 7399-7323 (analogous to ulcerative colitis).  The VA rated the bowel condition 30% coded 7399-7323, based on the VA C&P examination 5 months after separation, citing “evidence of frequent exacerbations.”  The Board considered the evidence.  The pre-separation service records consistently show the CI was under good control after the initial presentation and surgery in January 2006.  He had one episode of abdominal distress in late February, but this was attributed to a (viral) gastroenteritis.  An endoscopy showed no evidence of inflammation other than at the site of the prior surgical anastomosis done less than 2 months previously.  The CI denied symptoms or flares at the time of the separation examination accomplished 5 weeks prior to discharge.  The final fitness report indicated outstanding performance.  The VA examiner recorded a history of frequent exacerbations over the prior years which were not evident in the STRs.  Moreover, there were no clinical notes after separation to support the level of impairment reported by the CI to the C&P examiner.  The VA physical examination was unremarkable with a stable weight, benign abdomen, and normal blood indices (no anemia).  A level of impairment at the time of separation is best described as at the moderate level with infrequent exacerbations based on the totality of the evidence.  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 bowel condition.  

BOARD FINDINGS:  In the matter of the bowel 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 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01323.

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,

Attachment:
Record of Proceedings