RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02388
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20050715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E5, Rifleman, medically separated for “irritable bowel syndrome” (IBS), with a disability rating of 10%.

CI CONTENTION:  The CI contends that the main source of his physical disability was not IBS, but rather PTSD and that he should have been retired due to PTSD.  The 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 - 20050511	VARD – 20050919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Irritable Bowel Syndrome	7319	10%	Irritable Bowel Syndrome 	7399-7319	30%	20050709	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Irritable Bowel Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s IBS was first diagnosed in September 2004 after a 1 year history and clinical work-up for symptoms of postprandial diarrhea, constipation, abdominal pain, frequent gas, and bloating.  

The 3 February 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued abdominal pain and diarrhea.  The NARSUM encounter did not quantify the current severity of CI’s abdominal distress or diarrhea, but did indicate the frequency of diarrhea to be usually 1-2 times per day and increased to 4-6 times a day when under stress.
The time period for said increased symptoms was 9 months prior to separation.  The CI’s body weight was 215 pounds and his physical examination (PE) was normal.  At the 9 July 2005 VA Compensation and Pension (C&P) evaluation, 1 week prior to separation, the provider documented the following:  “[The CI] currently reports having intermittent nausea, diarrhea, constipation, and alternating diarrhea and constipation.  He can have loose stools up to 12 to 15 times per day.”  His PE revealed a body weight of 217 pounds and there was mild tenderness about the abdomen.  

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the CI’s condition at 10% and 30%, respectively and under the same primary code of 7319 (irritable colon syndrome) with the VA citing symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.  The panel first agreed that the PEB’s chosen VASRD code of 7319 was most appropriate for the subjective and clinical findings in this case.  Panel members were left to decide if the CI’s condition met the 30% impairment rating criteria of “severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress”.  Members extensively considered that given the CI’s usual quantified amount of gastrointestinal symptoms (1-2 times per day) as described in the NARSUM coupled with the interpretive vagueness of “can have” 12-15 stools a day versus actual stool frequency, and concluded that such findings did not reach the definitive level as to satisfy the criterion of “with more or less constant abdominal distress”.  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’s adjudication for the IBS condition.

BOARD FINDINGS:  In the matter of the IBS 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 20150922, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

		
		XXXXXXXXXXXXXXXXXX