RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00279
BRANCH OF SERVICE:  Air Force	Separation:  20070613

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Airman, medically separated from the Temporary Disability Retired List (TDRL) for “Crohn’s disease” with a disability rating of 10%.

CI CONTENTION:  The Veteran Affairs (VA) rating greater than 12 months from separation supports a higher rating.  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 VA 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 - 20050811	VARD - 20060628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7323-7399	10%	Crohn’s Disease	7327	60%	20060509	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Crohn’s Disease.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Crohn’s disease condition began in May 2003.  The CI’s was not considered worldwide deployable, was referred to the MEB, and placed into TDRL on 02 March 2005.

At the 9 May 2006 VA Compensation and Pension (C&P) Intestines evaluation, 13 month before TDRL removal, the CI reported a 1 month history of worsening nausea, headache, feeling “bad”, gas, bloating, cramping, and 3-6 episodes of diarrhea per day.  Physical examination revealed mild diffuse lower abdominal tenderness.

The 19 March 2007 TDRL Evaluation, 3 months before TDRL removal, noted complaints of Crohn’s disease.  The examiner referenced the medication management findings (CI prescribed Remicade for treatment of Crohn’s disease) performed in September 2005 documenting the CI with complaints 1 bowel movement a day with rare abdominal cramps after Remicade infusions were performed every 8 weeks.  The abdominal cramps were described as dyspeptic (unset stomach) and nauseating.  If the medication infusions were not timely the CI reported recurrent diarrhea, with 6 to 7 watery stools per day and suprapubic cramping pain that developed 5 minutes before the bowel movement and lasted for about 30 minutes after.  The March 2007 TDRL physical examination showed the CI had gained 35 pounds since TDRL placement.  There was mild right abdominal lower quadrant tenderness with normal bowel sounds.  There were no masses palpated, organomegaly or peritoneal signs.  The examiner opined that the CI was “stable” and had “fewer gastrointestinal complaints since starting Remicade in 2005.”  However, the examiner stated that the back pain and hip arthralgia appeared to be related to the Crohn’s disease “as they partially respond to Remicade therapy.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease condition 10%, coded 7323-7399 (colitis, ulcerative) citing Crohn’s disease improved since Remicade.  The VA rated the Crohn’s disease condition 60%, coded 7327, (diverticulitis) based on the C&P examination 13 months before TDRL removal, citing numerous attacks a year with malnutrition and the CI’s health only fair during remissions.

The panel noted that at the CI reported rare abdominal exacerbations with administration of medication infusions (Remicade) beginning in March 2005.  The CI gained 35 pounds since TDRL placement.  The CI continued to receive Remicade without changes in bowel function as noted by the 14 June 2007 physical medicine and rehabilitation evolution 1 day after TDRL removal.  The panel also noted that at the VA examination the CI reported a 1 month history of exacerbation and that his weight was stable.  Panel members agreed that the evidence supports a 10% rating for moderate Crohn’s disease with infrequent exacerbations.  The evidence did not support a higher rating for frequent exacerbations or numerus attacks a year with malnutrition and only fair health during remissions.  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 Crohn’s disease condition.

BOARD FINDINGS:  In the matter of the Crohn’s disease condition and IAW VASRD §4.114a 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 20160705, 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-2016-00279.

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,

Attachment:
Record of Proceedings