RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00167
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Contracting Journeyman, 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 - 20041013	VARD - 20060201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn's Disease	7323	10%	Crohn's Disease	7399-7323	10%	STR	
Hypertension 	7101	Cat II	Hypertension 	7101	0%		
Paroxysmal Supra-Ventricular Tachycardia (PSVT)	7010		Sinus Tachycardia	7010 	NSC		
Overweight	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Crohn's Disease.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s inflammatory bowel disease began in October 2003 when she started having painless rectal bleeding.  A December 2003 colonoscopy showed extensive colonic and terminal ileum inflammatory changes with inconclusive biopsies.  After treatment, follow-up colonoscopy in February 2004 showed complete resolution.  Rectal bleeding recurred in March 2004 and recurred in June 2004 with vague abdominal pain requiring additional treatment with systemic steroids.  August 2004 colonoscopy revealed diffuse inflammatory changes with skip lesions within the colon with biopsies consistent with idiopathic inflammatory bowel disease.  Internal medicine consultant indicated the disease pattern was most consistent with Crohn's disease with inconclusive biopsies.  The CI was treated with oral Asacol (mesalamine) and oral and rectal steroids “with moderation (but not resolution) of her symptoms.”  

The 22 September 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of painless rectal bleeding.  The physical examination showed mild left lower quadrant tenderness with no guarding, rebound or masses.  Bowel sounds were normal.  A complete blood count showed no indications of infection or anemia.  Medication included Asacol and oral steroids on a slow taper.  The diagnosis was “inflammatory bowel disease (IBD), likely Crohn's Disease.”  

The 15 November 2004 primary care treatment note indicated that the CI had a flare of rectal bleeding and abdominal pain after stopping her steroids and oral steroids were restarted with the addition of rectal steroids.  On 16 December 2004, the CI related symptoms of full body aches “feels very uncomfortable.”  

At the 21 December 2004 gastroenterology evaluation, 4 months prior to separation, the CI complained of severe fatigue, arthralgias and morning weakness along with her rectal bleeding and abdominal pain.  The physical examination showed the CI was well-developed and well-nourished with mild acute distress.  There was mild right lower quadrant tenderness, with otherwise normal findings.  The specialist indicated that the CI had some improvement of her symptoms on oral steroids, but had essentially been on oral steroids since July 2004, and noted several side effects of chronic steroid use.  Removal from steroids and addition of 6-Mercaptopurine (6-MP is a chemotherapy drug, classified as an "antimetabolite").  

On 19 January 2005 the CI complained of abdominal pain and bloody stools 3-4 times a day, while on a steroid taper and that Asacol was not working.  The physical examination showed mild diffuse lower abdominal tenderness.  The physician started the CI on 6-MP per the consultant’s recommendation.  Follow-up one week later showed improving symptoms with minimal blood in the stool.  On 28 January 2005, the CI related increased symptoms and rectal bleeding while tapering her steroids and her oral steroids were increased.  The abdominal examination was benign, and the physician indicated the CI was steroid-dependent.  On 11 March 2005, the CI was seen for a Crohn’s flare-up and axillary pain diagnosed as acute lymphadenitis (infection), which was treated with antibiotics.  

There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  

The PEB rated the Crohn's disease 10%, coded 7323 (colitis, ulcerative), citing DOD and VASRD guidelines.  The VA initially rated the Crohn's disease 10%, analogously coded 7399-7323, based on the STR, citing a minimum compensable evaluation since the CI failed to report for two VA examinations.  Following VA examination of 25 June 2007 (over 2 years after separation) and review of records, the VA awarded the CI a 30% rating effective the day after separation, citing frequent exacerbations.  

The next higher 30% rating under code 7323 is for “moderately severe; with frequent exacerbations.”  The panel adjudged that the CI had frequent rectal bleeding and abdominal pain.  Symptoms recurred during attempted decrease of prolonged systemic steroid use and the CI had some complications from prolonged steroid use.  The panel adjudged that there was sufficient evidence of frequent exacerbations or of moderately severe disease, and that the CI’s disability picture at separation more nearly approximated the 30% disability picture under code 7323.  There was no evidence of malnutrition, anemia, general debility, or serious complications to warrant any rating higher than 30% under code 7323.  Analogous rating under code 7319 (irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.)) would not be of benefit to the CI.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the Crohn's disease condition, coded 7399-7323.  

Contended PEB Conditions:  Hypertension, Paroxysmal Supra-Ventricular Tachycardia (PSVT), Overweight.  The overweight condition is not a disability condition and is not subject to rating.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions of hypertension and PSVT were not unfitting.  Both conditions were found to be, and rated as, category II - conditions that can be unfitting but are not currently compensable or ratable, by the PEB.  Overweight is not a physical disability condition.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the Crohn's disease condition, the panel unanimously recommends a disability rating of 30%, coded 7399-7323 IAW VASRD §4.114.  In the matter of the contended hypertension, PSVT, and overweight conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting and/or not ratable.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Crohn's Disease	7399-7323	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160330, 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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00167.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings