RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00850
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Single Channel Radio Operator, reflects that this covered individual (CI) was an active duty E4, Motor Transportation Operator, medically separated from the Temporary Disability Retired List (TDRL) for “Crohn’s disease,” with a disability rating of 10%.

CI CONTENTION:  The CI makes no contentions.  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 – 20031209	VARD - 20010117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Crohn’s Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Crohn’s disease condition was diagnosed in September 2000.  He was placed on TDRL December 2000 with a rating of 30%.  The 06 May 2003 TDRL Re-evaluation NARSUM, 9 months prior to TDRL removal (separation), noted complaints of mild 3/10 abdominal pain which occurred only for 2-3 seconds and only a couple of times per week.  He had two soft non-bloody stools daily and weight was stable.  It had been several months since he had fatigue, recurrent diarrhea and right lower quadrant pain.  His medication (Imuran) had provided good results.  Therefore he had stopped his medication but was being followed by a gastroenterologist.  The examiner urged him to return to his 6-mercaptopurine medication.  Physical examination showed a soft, non-tender, non-distended abdomen with normal bowel sounds.  He weighed 163 lbs.  The examiner noted his illness was clinically quiescent.  He was advised to stop smoking, which exacerbates Crohn’s disease.  

The July 2003 Pain Center visit, 6 months prior to separation, noted loose stools.  His abdominal pain and knee pain were helped by narcotic medication.  Examination of the abdomen showed gentle palpation could illicit pain but bowel sounds were present.  He was warned regarding the effect of narcotic medication on the Crohn’s.  The 27 October 2003 Pain Center visit, 3 months prior to separation, noted complaints of abdominal pain for which he took a narcotic pain medication.  He reported adverse reactions with other medications.  Physical examination did not include an examination of the abdomen.  He was to take the pain medicine up to three times per day as needed.  The 26 January 2004 Pain Center visit, less than 1 month after separation, noted no complaints of nausea, vomiting, constipation or diarrhea.  If he gets constipated he took a mild laxative.  Physical examination showed no abnormalities of the abdomen.  By March 2004 he weighed 168 lbs.  The 11 May 2004 emergency room (ER) visit noted a soft and non-tender abdomen with good bowel sounds and no rebound tenderness, guarding or rigidity.  There was no VA Compensation and Pension examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease condition 10% at the time of TDRL removal, analogously coded 7399-7323 (colitis, ulcerative), citing infrequent exacerbations.  The VA rated the Crohn’s disease condition 30% at the time of TDRL placement, also coded 7399-7323, based on the CI’s STR, citing frequent exacerbations.  The NARSUM examination noted the CI was doing so well he had stopped his medication.  At that time he reported few symptoms of his illness.  Subsequent notes documented some abdominal pain, controlled by narcotic medication.  Proximal to separation there were no significant abdominal findings or report of bloody diarrheal stools.  He denied abdominal problems of nausea, vomiting and diarrhea.  The panel agreed there was no evidence of moderately severe illness with frequent exacerbations to achieve a 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 condition.  

BOARD FINDINGS:  In the matter of the Crohn’s disease condition 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 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017096, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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