RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01393
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Weather Forecaster, medically separated for “celiac sprue” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was 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 – 20080530	VARD - 20090710	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Celiac Sprue	7325-7319	0%	Celiac Disease with Associated Chronic Iron Deficiency	7319-7700	10%	20090629	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Celiac Sprue.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s celiac disease began insidiously in 2007 during basic training when he noticed being tired and fatigued all the time.   At an 18 September 2007 primary care visit, the provider noted a hemoglobin count of 10.4 g/dL (normal 13.5-17.5) consistent with iron deficiency anemia.  Laboratory tests on 7 February 2008 demonstrated elevated IgA antibodies consistent with celiac disease.   The 5 March 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of anemia.  The examiner documented that the CI was asymptomatic and had normal physical findings, but that “biopsies of the small bowel from the duodenum showed flattening of villi consistent with celiac sprue.”

At the 29 June 2009 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported fatigue and adherence to a gluten free diet.  Gastrointestinal evaluation was normal, and the hemoglobin count was 16.1 g/dL (within the normal range).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the celiac disease 0%, coded 7325-7319 (enteritis, chronic-irritable colon syndrome) citing celiac sprue with anemia and the requirement to maintain a gluten free diet.  The VA rated the celiac disease 10%, analogously coded 7319-7700 (irritable colon syndrome-anemia), based on the C&P examination, citing weakness and fatigue.   Members agreed that the evidence did not support a 10% rating under 7325-7319 for moderate disease with “frequent episodes of bowel disturbance with abdominal distress.”  The panel noted that the primary signs and symptoms of the condition were tiredness, fatigue, and iron deficiency anemia; however, the evidence did not support a 10% under code 7700 for rating for “hemoglobin 10gm/100ml or less with findings such as weakness, easy fatigability or headaches.” 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 celiac disease.  

BOARD FINDINGS:  In the matter of the celiac sprue 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-2017-01393.

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.