RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02103
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Command Post Craftsman, medically separated for “Crohns Disease,” with a disability rating of 10%.

CI CONTENTION:  The CI made no contention.  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 - 20070302	VARD - 20070501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7323	10%	Crohn’s Disease	7399-7319	0%	20070409	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Crohn’s Disease began in October 2006 after the CI was admitted to the hospital for 5 days during which time he underwent a colonoscopy with biopsy. Results were consistent with Crohn's colitis or ulcerative colitis.  The MEB forwarded “Crohn’s disease” for PEB adjudication.  

On 6 October 2006, 6 months prior to separation, the CI presented to the emergency department with complaints of abdominal pain with episodes of non-bloody, non-mucousy diarrhea and an elevated white blood cell count.  Physical examination demonstrated mild tenderness in the left lower quadrant of the abdomen upon palpation without rebound or guarding.  Computer tomography (CT) showed colitis in the cecum and ascending colon which supported the physiologic findings.  The CI was admitted for gastroenterology (GI) consult.  The GI consult noted complaints of diarrhea with loose stools, 16 episodes per day, waking up in the night for stooling, loss of 10 pounds of weight over the past week.  Prior to this, the CI stated he had always had a problem with constipation and never with diarrhea.  Physical examination of the abdomen was within normal limits and unremarkable, although the CT findings were found to be suspicious of inflammatory bowel disease (IBD), in other words Crohn’s disease.  A small bowel radiographic study showed cobblestone nodularity of the distal terminal ileum supportive of the diagnosis of inflammatory bowel disease (IBD).  At a GI examination on 6 November 2006, the CI stated that he was feeling well, had one bowel movement every 2-3 days, but then sometimes had multiple bowel movements within several hours.  Physical examination of the abdomen revealed a soft, non-tender abdomen with normoactive bowel sounds in all four quadrants.  A follow-up GI examination on 13 December 2006, 4 months prior to separation, reported laboratory findings of the CI being p-ANCA positive which was correlated with the diagnosis of Crohn’s disease.  The CI reported having one bowel movement per day without blood, abdominal pain or diarrhea.  The CI was taking Asacol and Entocort to control the disease’s symptomology.  At a primary care clinic evaluation on 29 January 2007, 3 months prior to separation, the CI reported that he had not had any recent flares of the Crohn’s disease.  He reported that he had one bowel movement per day, normal appetite, no abdominal pain, no flatus, no pain on defecation, no change in stool, no diarrhea, no constipation and able to pass gas.  Physical examination findings were normal on visual inspection.  The abdomen was non-distended, soft and non-tender to palpation and bowel sounds were present.  The MEB NARSUM examination on 31 January 2007, 3 months prior to separation,  CI reported having one bowel movement per day with no diarrhea, cramping or abdominal pain.  His weight remained steady and his appetite was normal.  The CI was taking three tablets of Asacol daily and six milligrams of Entacort per day.  Physical examination showed the abdomen was soft, non-tender, non-distended with good bowel sounds.  There was no peritoneal rebound or hepatosplenomegaly.  At the 9 April 2007 VA Compensation and Pension (C&P) evaluation, performed the month of separation, the CI reported that he had a colonoscopy suggestive of Crohn’s and that he was taking Asacol 1200 three times per day (t.i.d.).  He also stated that the course of this condition had improved since taking the medications.  Physical examination showed bowel sounds were normal without abdominal guarding.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s Disease 10%, coded 7323 (colitis, ulcerative), citing improved symptoms asymptomatic since October 2006; stable weight and normal appetite; with one bowel movement per day with no diarrhea, cramping, or abdominal pain.  The VA rated the Crohn’s disease at 0%, coded 7399-7319 (analogous to irritable colon syndrome), based on the C&P examination the month of separation, citing disturbances of bowel function with occasional episodes of abdominal distress.  The CI reported disturbances of bowel function with occasional episodes of abdominal distress at the VA C&P examination during the month of separation.  Therefore, the Board found that the criteria for a rating of 10% was met under code 7323.  The evidence did not support moderately severe disease with frequent exacerbations for a 30% rating.  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 Crohn’s disease.  

BOARD FINDINGS:  In the matter of the Crohn’s disease 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 20150724, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02103.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings