RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01535
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20031205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve Warrant Officer (WO1), Rotary Wing Aviator, medically separated for “Crohn’s disease” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20030910	VARD - 20040804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease Status Post Terminal Ileum Resection and Ileocolonic Anastomosis	7399-7323	10%	Crohn’s Disease Status Post Excision of Terminal Ileum and Cecum	7328-7323	10%	20040213	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Crohn’s Disease Status Post Terminal Ileum Resection and Ileocolonic Anastomosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Crohn’s Disease began in November 2002 when he experienced severe abdominal pain and underwent surgery for a small bowel obstruction with removal of part of the small bowel (terminal ileum).  Biopsies revealed Crohn’s disease.  Following the surgery the CI was evaluated by a gastroenterology specialist on 9 December 2002.  He reported that he had done well since surgery and episodes of diarrhea had recently decreased to one or two per day.  He denied any pain, blood in his stools, or any other relevant gastrointestinal (GI) symptoms.  The CI underwent a colonoscopy on 22 January 2003 to document the full extent of the Crohn’s disease and determine the need for medications.  The colonoscopy showed “mild” changes in the ileum and cutaneous findings in the rectum with an open anastomosis between the ileum and the colon.  The CI was treated with an immunosuppressive medication (Remicade) and after two treatments the perianal fissuring was well healed and the medication was stopped.  At the GI follow up visit on 19 May 2003, the CI reported he was doing “fairly well” with two bowel movements per day, but approximately every other day he would experience two to three episodes of diarrhea.  He denied abdominal pain or blood in his stools.  He was given medication for the diarrhea, but was unable to continue taking it due to side effects.  Notes in the record documented the CI had gained weight since the surgical procedure.  

The 25 August 2003 MEB NARSUM examination, 3 months prior to separation, noted no new gastrointestinal complaints.  Physical examination showed a well healed abdominal surgical scar.  The abdomen was non-tender and was not distended with normal bowel sounds.  The MEB NARSUM examiner noted that the CI had recovered very well from the November 2002 surgery.  The CI could perform strenuous physical activity, including the Army physical fitness test; however, he was permanently suspended from flight duty due to the high likelihood of recurrence of the Crohn’s disease.  

At the 13 February 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported a flare-up of the Crohn’s disease after the medical board was completed.  The CI was hospitalized in October 2003 for abdominal pain.  A small bowel series was normal and a repeat colonoscopy was unchanged from the January 2003 colonoscopy, but noted a small ulceration in the rectum again (which had healed after treatment with Remicade).  The CI was treated with a tapering course of oral steroids, which he had completed a month earlier.  He was not on any other therapy for Crohn’s disease.  He reported a current status of three loose bowel movements per day without pain or blood.  His appetite was good, his weight was stable, and he had no systemic symptoms.  Physical examination showed normal bowel sounds without masses.  There was “slight periumbilical tenderness to palpation, with no tenderness in the right lower quadrant.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease condition 10%, coded 7399-7323 (ulcerative colitis), an analogous code for Crohn’s disease, citing moderate disease, with infrequent exacerbations.  The VA also rated the Crohn’s disease condition 10%, coded 7328-7323 (small intestine resection-ulcerative colitis) based on the C&P examination 2 months after separation, citing infrequent exacerbations.  There was evidence to support the 10% rating under 7323 for infrequent exacerbations.  The panel agreed that based on the evidence of one exacerbation in 15 months after surgery documented at the VA examination, the CI’s Crohn’s disease could not be described as “moderately severe, with frequent exacerbations” for the next higher rating.  The panel also considered if rating under 7328 supported a higher rating, but there was no evidence of nutritional impairment, weight loss, or inability to gain weight to warrant rating under this code. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the Crohn’s disease condition.   

BOARD FINDINGS:   In the matter of the Crohn’s disease condition and IAW VASRD §4.114, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20170008580, XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure