RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01333
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an Air National Guard E5, Aerospace Ground Equipment Apprentice, medically separated for “chronic diarrhea” with a disability rating of 10%.  

CI CONTENTION:  Review requested of unfitting condition as well as several additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050718	VARD - 20060626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Diarrhea	7399-7319	10%	Irritable Bowel Syndrome [IBS]	7319	10%	20060605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Diarrhea.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced chronic diarrhea for a duration of 1 year starting in June 2004 while activated for a school tour.  An acute abdominal X-ray series on 28 June 2004 and laboratory studies (CBC, C. difficile, ova and parasites, and H. pylori) were negative.  Fecal leukocyte esterase activity showed rare white blood cells, and a stool culture was negative for salmonella.  At a gastroenterology visit on 2 September 2004, the presence of fecal leukocytes raised the question of whether the CI had inflammatory bowel disease or an obscure infection.  Further studies were ordered, and while a celiac antibody panel was negative, he seemed to improve on a gluten restricted diet. An esophagogastroduodenoscopy with biopsy in September 2004 was basically normal with very minor non-specific inflammatory changes of unclear clinical significance.  Empirical antibiotic therapy was instituted to see if he had additional improvement.  

In February 2005, the CI reported 3-5 daily bowel movements sometimes triggered by fatty or Mexican food.  A colonoscopy was normal in February 2005, and biopsies from the terminal ileum, right colon, and left colon were benign without any significant pathologic changes.  In March 2005, the gastroenterologist felt the chronic bowel symptoms were likely from IBS for which dietary fiber was recommended along with avoidance of caffeine, sorbitol, and lactose.  A trial of hyoscyamine for cramping and loperamide for persistent diarrhea was instituted.  A fiber rich diet afforded limited success and the CI reported 2-3 explosive diarrhea stools/day; the chronic diarrhea demonstrated resistance to therapy.  The 18 May 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic diarrhea.  No physical examination was performed, but the NARSUM author noted “the physicians seen by this member performed appropriate problem oriented physical exams.”

At the 5 June 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported IBS with chronic diarrhea.  He also noted being nauseous almost daily and had stomach pain that caused him to double over about once a month.  When he ate, he often had a bowel movement within 10 minutes, and it consisted of undigested food.  He was very rarely constipated.  Physical examination showed the abdomen to be flat, soft, and nontender with bowel sounds in all quadrants, and there was no liver or spleen enlargement.  The examiner’s diagnosis was IBS.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic diarrhea condition 10%, analogously coded as 7319 (irritable colon syndrome), citing general DoD and VASRD guidelines.  The VA also rated the chronic diarrhea condition 10%, coded 7319, based on the C&P examination, citing “frequent episodes of bowel disturbance with abdominal distress.”  Members noted the CI’s reports of frequent episodes of bowel disturbance with abdominal distress for which he was assigned a 10% rating by both the PEB and the VA.  Although he did report stomach pain that caused him to double over about once a month, he did not have diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress, which is required for a 30% rating.  Therefore, a rating higher rating than 10% at the time of separation is not achievable using code 7399-7319, and there were no other applicable digestive codes which could warrant a higher rating.  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 chronic diarrhea condition.   

BOARD FINDINGS:  In the matter of the chronic diarrhea 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.  

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01333.

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.