RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00427
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20031203

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 “Crohn’s disease” with a disability rating of 10%.

CI CONTENTION:  Current condition supports a higher rating.  Additional unfitting conditions were not considered.  The CI’s 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 - 20030903	VARD - 20040722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7323-7399	10%	Crohn’s Disease with GERD	7346-7323	10%	20040525	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Crohn’s Disease.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Crohn’s disease was diagnosed in April 2003 after he was evaluated for persistent diarrhea.  At a gastroenterology visit on 21 April 2003 the CI reported he had weight loss and chronic diarrhea for about a year.  In the spring of 2001 he was diagnosed with acid reflux as an explanation for epigastric pain.  Symptoms eventually resolved with Aciphex (rabeprazole for ulcers and GERD (gastrointestinal reflux disease).  However, the CI had intermittent oral ulcers and a weight loss of 20 pounds since June 2001 with frequent bowel movements up to six to seven per day, which were exacerbated by dairy products.  There was no blood in the bowel movements, although there was bright red when he wiped.  He also had fatigue, felt bloated, and had post-prandial periumbilical pain.  Endoscopy revealed a left posterior skin tag with a tender, large ulceration/fissure in the posterior midline.  Colonoscopy revealed segmental colitis with an ulcerated mucosa in the ileum suggestive of Crohn’s disease.  Pathology revealed chronic active enteritis with evidence of ulceration and acute colitis with ulceration.  Treatment was instituted with mesalamine, Entocort (budesonide, a steroid) for 10 weeks and furosemide (a diuretic for side effects from mesalamine) on 12 June 2003.  The CI also was found to have iron deficiency anemia, which was treated with iron on 24 June 2003.

The 30 July 2003 MEB NARSUM examination on 30 July 2003, 4 months prior to separation, noted complaints of 2 to 4 episodes of non-bloody diarrhea whereas prior to being started on medication he was having 3 to 6 episodes of non-bloody diarrhea.  Physical examination showed a well-developed, well-nourished man in no acute distress.  His height was 65.5 inches, and weighed 125 pounds.  His oropharynx was clear and the abdomen was soft, nontender, nondistended without hepatosplenomegaly (enlargement of the liver and spleen) or masses.  The examiner suspected that with continued medication, the current episode of Crohn’s disease should resolve.  However, he noted the natural history of Crohn’s disease is usually characterized by periods of remission and exacerbation, which would be treated accordingly.

During the 15 September 2003 gastrology examination, 3 months prior to separation, the CI reported intermittent abdominal pain relieved by passing gas.  He had one bowel movement per day and no bowel urgency, melena, hematochezia, and no red blood on the surface of the stool.   The stools were formed with no diarrhea, no rectal soreness and no anal pain.  He had no fever, chills, or recent change in weight and no skin lesions or arthralgias (joint pain).  The examiner noted the Crohn’s disease was “presently in remission” and noted the CI required steroids to induce remission of the Crohn’s disease, which is characterized by exacerbations and remissions of symptoms.

At the 25 May 2004 VA Compensation and Pension (C&P) evaluation, the CI reported he had a sudden urge to have a bowel movement and time lost from work was about 10 to 15 times per year.  Physical examination showed a normal general appearance.  The abdomen was normal without tenderness and the liver and spleen were not palpable.  There was no ascites (fluid in the abdominal cavity).  There was a tag in the anal area, but the rectal examination was otherwise normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 10%, coded 7323-7399 [sic] (colitis, ulcerative), citing continued bouts of diarrhea, even when using steroids IAW DoD and VASRD guidelines.  The VA also rated the Crohn’s disease 10%, coded 7346-7323 (hiatal hernia-colitis, ulcerative) based on the C&P examination 6 months after separation, citing infrequent exacerbations.  Crohn’s disease is also known as regional enteritis and on colonoscopy the CI had involvement of both the small intestine and colon.  Therefore, code 7326 (enterocolitis, chronic) is more appropriate and is rated for irritable colon syndrome (code 7319), which requires “Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress” for a 30% rating.  However, at the time of separation the CI’s condition had improved with medications to be more consistent with a 10% rating, which requires “moderate; frequent episodes of bowel disturbance with abdominal distress.”  Additionally, the gastroenterologist examiner noted that the CI’s Crohn’s disease was in remission controlled with medications.  Both the PEB and the VA based their rating on code 7323, which for a 30% rating requires “moderately severe; with frequent exacerbations.”  At the time of separation the CI was in remission and the VA recorded the CI had been out of work 10 to 15 times a year, but did not specify whether that was prior to separation or post-separation or a combination of the two.  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 condition.
BOARD FINDINGS:  In the matter of the Crohn’s disease condition 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 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-2016-00427.

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,

Attachment:
Record of Proceedings