RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01871
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve O3, Armor Officer, medically separated from the Temporary Disability Retired List (TDRL) for “ulcerative colitis,” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of 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 – 20020430/20060421	VARD – 20020620/20060313	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Ulcerative Colitis…	7323	30%	10%	Ulcerative Colitis	7323	30%	30%	
Iritis	Not Unfitting	Iritis	6003	0%	0%	
Sacroiliitis	Not Unfitting 	Sacroiliitis	5294	10%	10%	
		Painful Motion, Right Hip, Due to Sacroiliitis	5099-5021	10%	10%	
		Painful Motion, Left Hip, Due to Sacroiliitis	5099-5021	10%	10%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Ulcerative Colitis (UC).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s UC condition began in October 1996 with complaints of bright red blood per rectum for 3-4 weeks prior to evaluation.  The CI had ongoing symptoms and had a sigmoidoscopy on 18 June 1997, which diagnosed UC.  The CI suffered from 2–4 flares per year of his UC which was complicated by the development of low back pain and history of iritis.  Despite treatment, the condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “ulcerative colitis” and “inflammatory bowel disease” for PEB adjudication.  The CI was placed on the Temporary Disability Retired List (TDRL) on 19 June 2002, 4 years prior to TDRL removal with a disability rating of 30% coded 7323 (ulcerative colitis).  The MEB NARSUM examination on 17 August 2005, 10 months before TDRL removal noted complaints of a current severe flare and had ongoing progression and exacerbation of his lower back pain and stiffness.  The examiner noted that since July 2003 the CI had had numerous recurring off and on flares and multiple hospital admissions.  Physical abdominal examination showed soft abdomen.  The examiner’s final findings were inflammatory bowel disease and UC with multiple flares since 1996 with ongoing treatment and sacroiliitis with iritis secondary to the inflammatory bowel disease and UC.  

At the 26 January 2006 VA Compensation and Pension (C&P) evaluation, performed 4 months before TDRL removal, the CI made no specific complaints.  The examiner noted that at time of examination the CI was in partial remission.  The CI was experiencing two stools per day without the blood or mucous typically present with flare-ups.  His appetite was reported as good with no particular food intolerance and his weight was at the CI’s baseline normal.  His most recent colonoscopy revealed active colitis but it was not actively flaring.  His abdomen examination revealed no masses, organs or tenderness.  The examiner’s final findings were UC, controlled by medication, and a history of sacroiliitis and iritis both secondary to the UC.  At the gastroenterology (GI) consult on 4 April 2006, 2 months before TDRL removal the examiner noted that the CI had had a variable clinical course characterized by flare activity in August/September 2004, December 2004/January 2005, and August/October 2005 lasting 2 months each.  He had failed oral steroids, local topical therapies, and 5 aspirin compounds and had only most recently at the time responded well to a combination of potent immunomodulatory agent IV infusions every 8 weeks but was dependent on both these agents.  Due to the potentially short term and long term side effects of these agents, he required regular lab work to monitor for medication related toxicity.  He was dependent on these agents and his condition remained moderately severe requiring regular follow-up.  His long term prognosis remained unclear as his disease was expected to follow a variable course with periods of relative quiescence alternating with flares.  

The Board directed attention to its rating recommendation based on the above evidence.  The Board considered its recommendation for permanent disability rating at the time of removal from the TDRL.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 10% coded 7323 (ulcerative colitis), based on the NARSUM examination 10 months before TDRL removal, citing a history of two exacerbations in the last TDRL period (Feb 2004- April 2006).  The VA rated the UC condition 30% coded 7323 (ulcerative colitis), based on the VA C&P examination 4 months before TDRL removal, citing frequent exacerbations.  The Board noted that the criteria for rating under 7323 are subjective and described as moderate UC, with infrequent exacerbations for 10% and moderately severe UC, with frequent exacerbations for the next higher evaluation of 30%.  The Board deliberated whether the evidence in the STR was sufficient to support a 30% or higher rating.  At the above noted GI examination the CI reported 2-4 yearly attacks of UC for lasting 6-8 weeks each.  The Board also noted the examiner stated that the CI’s condition remained moderately severe, he had initially failed several oral and topical therapies and had only recently responded well to a combination of daily oral medication and IV infusions every 8 weeks.  There was no evidence of anemia to support significant effects due to bleeding, or weight loss to suggest significant loss of appetite or difficulty with absorption of nutrients due to diarrhea.  The Board concluded that the recurring frequency (three flares in the previous 18 months) and duration of the CI’s UC flare symptoms were consistent with infrequent exacerbation of UC and met the 10% criteria for Moderate; with infrequent exacerbations.  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 UC condition at the time of TDRL removal.  

Contended PEB Condition: Iritis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the iritis was not unfitting.  The iritis was not profiled, implicated in the commander’s statement or was not 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.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended iritis condition and so no additional disability rating is recommended.  

Contended PEB Condition: Sacroiliitis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the sacroiliitis was not unfitting.  The sacroiliitis was profiled, and implicated in the commander’s statement.  However, at a rheumatology evaluation on 31 July 2001, 11 months prior to TDRL placement specifically to evaluate his sacroiliitis and his profile status, the CI was able to perform well on the ATFT at that time and that in the future he may need a modification in his profile due to function limiting active inflammatory back pain.  The CI’s 29 March 2002 profile still had his back listed as a PULHES 1, indicating no permanent limitations, thus he was not 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.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended sacroiliitis condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the UC condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication at TDRL removal.  In the matter of the contended iritis and sacroiliitis conditions, the Board unanimously recommends no change from the PEB determinations 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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005293, 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