RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01780
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040701

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “Crohn’s colitis” 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040429	VARD - 20041210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Colitis	7323	10%	Crohn’s Colitis	7399-7323	10%	20041101	
			Sacroiliitis Associated with Crohn’s Colitis	5236	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Crohn’s Colitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s inflammatory bowel condition began in August 2003 after he noticed bright red blood in his stool and thereafter had rectal bleeding and low back pain.  During an emergency room visit on 16 December 2003, laboratory tests showed iron level at 16 ug/ml (normal 42-186), hemoglobin at 9.1 g/dL (normal 14-18), and hematocrit at 28.0% (normal 42-52).  Surgical evaluation revealed severe proctitis for which mesalamine (anti-inflammatory) enemas and iron were prescribed; pathology results revealed active chronic colitis.  A gastroenterologist attempted a colonoscopy but had to abort the procedure due to the severity of the colitis, which was assessed to be secondary to an underlying inflammatory bowel disease.  The CI was treatment with mesalamine, prednisone (steroid), and calcium, and on 28 January 2004, a small bowel follow-through test was unremarkable.  A note dated 20 February 2004 indicated biopsy findings were consistent with active ulcerative colitis or Crohn’s disease, and laboratory studies showed a hemoglobin of 13.7 and hematocrit of 41.  A follow-up colonoscopy on 26 February 2004 found resolving colitis and intervening areas of normal mucosa mainly from 20 cm from the anal verge to the descending colon.  Histopathologic findings showed moderate active chronic colitis with crypt destruction consistent with Crohn’s colitis in the left colon, and mild nonspecific chronic colitis with lymphoid aggregates in the right colon.  

During the 20 February 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI noted “my illness of ulcerative colitis.”  Physical examination revealed “normal rectal tone, nontender.”  The MEB NARSUM examination the same day noted complaints of “painful colon flare-up if not on medication,” but no abdominal or back pain, and no rectal bleeding over the prior month.  He felt well and did not have any limitations in performing physical activities or military specialty duties.  Physical examination revealed normal active bowel sounds, no tenderness, masses, or guarding, and a normal digital rectal examination.  The examiner noted stable and improving symptoms.  

At the 1 November 2004 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported a history of Crohn’s colitis, but that he felt better after starting medications.  He had gained 15 pounds since discharge, and had no pain, nausea, vomiting, constipation or diarrhea, or fistula, and no signs of malnutrition, anemia, or debility.  Physical examination showed a soft abdomen that was nontender and non-distended.  Bowel sounds were present and there was no organomegaly or hernia. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s colitis 10%, coded 7323 (colitis, ulcerative), citing “moderate with infrequent exacerbations.”  The VA also rated the Crohn’s colitis condition 10%, analogously coded 7399-7323, based on the C&P examination, citing Crohn’s colitis in remission and symptoms managed by medication, which suggested infrequent exacerbations.   Members noted that a higher rating of 30% requires a “moderately severe” condition with “frequent exacerbations.”  However, both the NARSUM and VA examinations recorded that the CI felt well, with no pain or symptoms, and thus a higher rating is not applicable.  As Crohn’s disease is also known as regional enteritis or ileitis, the panel considered code 7325 (enteritis, chronic), which is rated in accordance with coded 7319 (irritable colon syndrome).  A 30% rating requires “severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress,” however, the CI did not meet this criteria.  No other digestive disease codes were applicable.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the Crohn’s colitis.  

BOARD FINDINGS:  In the matter of the Crohn’s colitis and IAW VASRD § 4.114, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161125, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180014201, 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