RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00997
BRANCH OF SERVICE:  aIR fORCE	SEPARATION DATE:  20061010

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

CI CONTENTION:  No specific contention made.  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 - 20060810	VARD - 20110713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	10%	20110208	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to service treatment record and MEB narrative summary (NARSUM), the CI presented for medical treatment in May 2006 with a 3-week history of a “stomach ache” in the right lower quadrant.  Examination revealed mild abdominal tenderness with a palpable, indurated (hardened) mass approximately 8 cm x 4 cm in size.  Bowel sounds were present with no abnormal organ enlargement or skin changes.  Computerized tomography on 16 May 2006 revealed an inflammatory process involving the terminal ileum and the cecum as well as the proximal ascending colon diffusely, with the overall appearance most suggestive of Crohn’s disease.  The CI was admitted to the hospital with an extremely high white blood count and initially treated with antibiotics and a steroid.  A colonoscopy showed mild to moderate colitis that was most compatible with an acute process, but could not exclude inflammatory bowel disease.  A small bowel follow-through showed very slow transit and terminal ileum appearance indicating Crohn’s disease.  Surgery was not recommended and the CI was discharged on 19 May 2006 and directed to continue using the antibiotics and steroid.  By 22 May 2006, he no longer had abdominal pain, fever, or chills, and denied bleeding, nausea, vomiting, or abdominal distention.  He did have loose stools and was advised to stay on a low residue diet.  Long-term maintenance use of 6-MP (immunosuppressive medication) was considered.

The 9 June 2006 MEB NARSUM examination, 4 months prior to separation, showed mild tenderness over the right lower quadrant but no masses, peritoneal signs, or induration.  Bowel sounds were present in all quadrants and the skin was normal without rashes or jaundice.  The examiner noted the CI’s condition was responding to medication and could allow for full duties if it went into remission, but that the course of the inflammatory disease and flares were impossible to predict.  There was no VA examination in evidence proximate to separation.

At a 28 June 2006 gastroenterology visit, the CI stated all symptoms had resolved and that he was back on a regular diet.  Examination of the abdomen showed it to be soft, non-distended, and non-tender throughout.  A steroid taper was commenced and 6-MP was started with follow-up blood tests ordered.  At a family practice visit on 28 August 2006, the CI reported feeling well with no complaints of bloating, abdominal swelling or pain, changes in the stools, bright red blood per rectum, or diarrhea.  On examination, the abdomen was normal on visual inspection, soft, and without tenderness or masses.  The liver and spleen were normal to palpation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease condition 10%, analogously coded 7399-7323 (colitis, ulcerative), citing incompatibility with the rigors of military service.  Members noted the CI had minimal symptoms proximate to separation, and thus a 10% rating (moderate; with infrequent exacerbations), but no higher, was justified under code 7323.  The panel also considered code 7325 (enteritis, chronic) and code 7326 (enterocolitis, chronic) which are rated as code 7319 (irritable colon syndrome).  However, a 30% rating require “severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress” which was not warranted with the CI’s mild symptoms.  After due deliberation, considering all of 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 disease condition.   

BOARD FINDINGS:  In the matter of the Crohn’s disease condition 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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00997.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings