RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2016-00836
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040729

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “Crohn’s Disease” with a disability rating of 10%.   

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact his daily activities.  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 - 20040712	VARD - 20030423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	30%	20030301	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s complaints of frequent diarrhea with intermittent bright red blood in his stools began in March of 2000, prior to entering the US Army.  After a colonoscopy sometime prior to 30 August 2001, he was diagnosed with Crohn’s disease.  The CI was placed on the TDRL on 1 January 2003.  

At the 1 March 2003 VA Compensation and Pension (C&P) evaluation, 2 months after placement on the TDRL and 16 months before removal from the TDRL, the CI reported chronic diarrhea, sometimes up to 10 times per day, with perianal fistulae.  The fistulae were without fecal discharge but with occasional purulent (pus) drainage.  Physical examination showed 2 anal fistulae at 12 o’clock and 4 o’clock round the anus with clear drainage.  The abdominal examination was otherwise normal.  

The 12 April 2004 TDRL NARSUM examination, 4 months prior to removal from TDRL, the CI reported that all symptoms had resolved since starting an immune modulating drug.  He noted that he had gained weight and that he denied night sweats, fevers, bloody bowel movements, abdominal cramping, abdominal pain, bloating, urgency or feeling of incomplete emptying.  Physical examination showed bowel sounds were present, abdomen was soft, non-tender and non-distended.  No perianal fistulae were present.  

The panel directed attention to its permanent disability rating recommendation at the time of removal from the TDRL based on the above evidence.  The PEB rated the Crohn’s disease condition 10%, coded 7399-7323 (analogous to colitis, ulcerative), citing moderate with infrequent exacerbations.  The VA rated the Crohn’s disease condition 30%, also coded 7399-7323, based on the C&P examination 16 months before TDRL removal, citing frequent exacerbations.  

The panel noted that by the time of TDRL removal, the CI’s condition was well controlled and he no longer complained of bloody stools, abdominal cramping, abdominal pain, bloating, urgency or tenesmus.  Panel members agreed that this description was more compatible with infrequent exacerbations.  At the time of TDRL removal, there was no evidence of moderately severe disease with frequent exacerbations to justify the next higher 30% rating.  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 at TDRL removal.  

BOARD FINDINGS:  In the matter of the Crohn’s condition and IAW VASRD §4.114, the panel unanimously recommends no change in the PEB adjudication at the time of TDRL removal.  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 20160916, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015823 XXXXXXXXXXXXXXXXXX. 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure