RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02196
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070702

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Satellite and Wideband Communication Equipment Apprentice, medically separated for “ulcerative colitis” with a disability rating of 10%. 

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 - 20070518	VARD - 20080711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis	7323	30%	20080402	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Ulcerative Colitis (UC).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s digestive disorder began in approximately February 2006, and he was diagnosed with UC after a colonoscopy on 8 March 2007.  He was treated with a non-steroidal anti-inflammatory medication (oral mesalamine) which improved his symptoms. At the 15 December 2006 MEB NARSUM examination, 7 months prior to separation, the CI denied repeat episodes of rectal bleeding since being prescribed mesalamine, and had no abdominal pain or similar symptoms.  Physical examination of the abdomen was normal, and the CI was noted to be doing well on current medication and in clinical remission; return to duty was recommended.  
At the 29 March 2007 gastroenterology follow-up, 3 months before separation, the CI reported improvement after increasing the mesalamine dose from 9 to 12 pills per day, but still had “somewhat loose bowel movements twice daily and occasionally a slight bit of blood per rectum” as well as “some mid-abdominal cramping at times.”  Physical examination of the abdomen was normal, and a weight of 230 pounds was recorded.  The 11 April 2007 NARSUM addendum, 3 months prior to separation, noted complaints of “some abdominal discomfort and occasional episodes of blood in his stool,” and that the CI was still taking the same dose of mesalamine.  

At the 2 April 2008 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported stomach cramps and bloody diarrhea twice a week, but denied any incapacitation.  Physical examination showed a height of 71 inches and weight of 247 pounds, and no abnormal abdominal sounds, masses, tenderness, or guarding; medication included mesalamine (12 tablets daily).  Blood work performed on 2 April 2008 showed no anemia or evidence of nutritional deficiencies (normal protein and electrolyte levels).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the UC 10%, coded 7323 (UC).  The VA rated the UC 30%, coded 7323, based on the C&P examination, citing frequent exacerbations.  Panel members agreed that a 10% rating was supported for moderate colitis with infrequent exacerbations.  The increased episodes of abdominal pain and blood reported at the VA examination may have reflected post-separation worsening of the UC, however, proximate to separation, there was no evidence of frequent exacerbations or weight loss, anemia or malnutrition reflecting “health only fair during remissions” to support 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 UC.  

BOARD FINDINGS:  In the matter of the ulcerative 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 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02196.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXX	

Attachment:
Record of Proceedings