RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02395
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Imagery Analysis Journeyman, medically separated for “ulcerative colitis” with a disability rating of 10%.  

CI CONTENTION:  The CI requests the panel consider 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 - 20090409	VARD - 20111229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis	7323	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Ulcerative Colitis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI noted bloody diarrhea beginning in late June 2008 and presented for evaluation in mid-July.  Laboratory testing that day was unremarkable.  He was referred to gastroenterology and a colonoscopy was performed on 11 August 2008.  It showed inflammatory changes which were found to be from ulcerative colitis (UC) on pathology review.  He was begun on medications with resolution of the blood in his stools and resumption of a normal bowel pattern.  He was then entered into the MEB process as UC is a medically unacceptable condition.  When seen in family practice on 15 December 2008, he denied symptoms from the UC condition.  His physical examination was unremarkable and his weight stable.  The MEB NARSUM was based on the family practice note and also dated 15 December 2008.  

In family practice on 5 January 2009, 7 months prior to separation, the CI had a stable weight.  No symptoms related to the UC condition were documented.  The CI did not present for the scheduled VA Compensation and Pension (C&P) evaluation scheduled for 22 December 2011.  

The record then falls silent until the CI presented for follow up in gastroenterology on 28 May 2010, 10 months after separation.  He noted that he was well controlled during a recent deployment by a combination of medications, increased exercise, and increased (food) intake.  He noted a change in his lifestyle since return from deployment and an increase in his symptoms.  He noted 2-4 bowel movements a day and recent blood in his stools.  The panel observed that this is the first recurrence documented since the initiation of treatment almost 2 years previously.  His weight remained stable and examination was unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ulcerative colitis 10%, coded 7323 (colitis, ulcerative]), citing Department of Defense guidance for applying the Veterans Administration Schedule for Rating Disabilities guidelines.  The VA did not service-connect the ulcerative colitis coded 7323 (colitis, ulcerative), based on the service treatment records 27 months after separation, citing no objective medical evidence of a chronically disabling impairment.  A 10% level of impairment is supported by moderate symptoms with infrequent exacerbations.  For a higher 30% level, the symptoms need to be moderately severe with frequent exacerbations.  The panel observed that no exacerbations were recorded after the initial presentation until almost 2 years after the initial presentation.  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 ulcerative colitis.  

BOARD FINDINGS:  In the matter of the ulcerative colitis and IAW VASRD §4.114, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20150810, with attachments
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-2015-02395.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings