RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01666
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Utilities Systems Craftsman, medically separated for “Crohn’s Disease” with a disability rating of 10%.  

CI CONTENTION:  The Crohn’s disease has worsened.  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 - 20060221	VARD - 20070207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7319	10%	20060728	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s symptoms of Crohn's disease began in August 2000. 

The 30 December 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of diarrhea that caused sudden unpredictable incapacitation due to bouts of bloody diarrhea which could be life threatening in an austere environment.  Physical examination showed a well-nourished and well-developed male in no acute distress.  His abdomen was soft and flat with normal bowel sounds and no tenderness or hepatosplenomegaly.

The 20 January 2006 colonoscopy showed possible low-grade inflammation of the cecum, descending colon and rectum.  There was no obvious rectum evidence of inflammatory bowel disease.  Biopsies all showed minor inflammatory changes consistent with minimally active chronic inflammatory bowel disease.  

At the 28 July 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported diarrhea 3 to 4 days a month with stools otherwise soft with no blood.  Physical examination showed the abdomen had normal reflexes and bowel sounds.  There was some tenderness in the right upper quadrant, but no enlarged organs.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn's disease 10%, coded 7323 (ulcerative colitis), citing the unpredictable course of the disease and the possibility of exacerbations at times and places that could jeopardize the mission of the Air Force.  The VA rated the Crohn's disease 10%, coded 7319 (irritable colon syndrome), citing diarrhea 3 to 4 days a month with stools otherwise soft with no blood.  There was no evidence of numerous attacks a year, malnutrition and only fair health fair during remissions to support a 60% rating.  Therefore, the panel deliberated between a rating of 30% (moderately severe; with frequent exacerbations) and a rating of 10% (moderate; with infrequent exacerbations).  The frequency and severity of symptoms was adjudged as closer to moderate and infrequent.  The panel consensus was that the CI’s condition more nearly approximated the disability picture for a 10% rating under the analogous 7323 code.  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.  

BOARD FINDINGS:  In the matter of the Crohn’s disease 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 20170304, 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-2017-01666.

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