RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02341
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20060620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Munitions Systems Craftsman, medically separated for “irritable bowel syndrome” with a disability rating of 10%.  

CI CONTENTION:  “IBS is debilitating, humiliating, and painful…Finding me eligible for disability retirement would greatly change my life and my family’s life.”  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 - 20060403	VARD - 20061218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Irritable Bowel Syndrome	7399-7319	10%	Irritable Bowel Syndrome With Gastro Esophageal Reflux Disease	7346-7319	30%	20061113	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Irritable Bowel Syndrome (IBS).  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with IBS-diarrhea predominant type in 2003.  Colonoscopy and upper endoscopy results in 2003 and 2005 showed no evidence of colitis, IBS or upper gastrointestinal tract abnormalities, except for mild gastroesophageal regurgitation (GERD); testing for infectious causes was negative.  The CI tried multiple medication combinations to control diarrhea and abdominal pain.  
The 3 March 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of 3-4 episodes of diarrhea per day, with intermittent rectal bleeding and stomach cramps at night.  The CI had had gained approximately 40 pounds in the prior 2 years.  Physical examination showed a non-tender abdomen with normal bowel sounds and no liver or spleen enlargement.  Rectal examination showed no masses or hemorrhoids, and stool was negative for occult blood.  The examiner noted the CI continued to be symptomatic, but was able to do his regular duties, and recommended that he be stationed near facilities with access to specialty medical care.  The 10 March 2006 commander’s statement indicated that the CI’s condition did not affect his ability to satisfy his duty requirements, he could work full duty shifts, and had lost approximately a half day per month of work time due to appointments.  The commander recommended he be retained in his current career field. 

In a 17 February 2006 letter, 4 months before separation, the gastrointestinal (GI) specialist indicated the CI was “fairly well managed with medical therapies.  However, he does have exacerbations that will need to be dealt with at times.”  Continued limitation of physical activities was recommended as well as duty assignments only where specialty medical care was available.  At the 22 February 2006 GI clinic visit, 4 months before separation, the examiner noted the CI had three to four bowel movements per day on a good day and “bouts of three to four days of increased diarrhea and cramping.”  His diarrhea and abdominal pain had improved since a medication change in January 2005.  He reported right lower abdominal pain and a fever since his last visit, but that he had not lost any weight.  Physical examination showed a soft abdomen with pain in the right lower quadrant, and no wincing, rebounding, or guarding.  Bowel sounds were quiet with no masses or enlargement of the liver or spleen.  The assessment was diarrhea predominant IBS which was difficult to control, and one of the CI’s two IBS medications was adjusted.  An abdomen CT scan was ordered to check for chronic appendicitis and was negative.  

At the 13 November 2006 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported loose stools daily, diarrhea and bleeding in stools at times, and flare-ups 7-8 times per month with pain.  Prescription medications were unchanged since separation and he was using a daily over-the-counter medication for diarrhea as well.  His weight was stable and he was employed in a sales position.  Physical examination showed the abdomen was soft and non-tender with no masses or liver/spleen enlargement.  There was minimal pain on deep palpation to the right lower quadrant and bowel sounds were present throughout.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the IBS condition 10%, coded 7399-7319 (irritable colon syndrome).  The VA rated the IBS condition 30%, coded 7346-7319 (hiatal-hernia-irritable colon syndrome), based on the C&P evaluation, citing symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.  Members agreed there was evidence of frequent episodes of bowel disturbance with abdominal distress at times to support a “moderate” 10% rating under code 7319.  However, based on the MEB NARSUM examination, the GI specialist’s assessment and the C&P evaluation, there was no evidence of “severe” IBS with constant abdominal distress proximate to separation.  Additionally, the commander noted that the CI’s IBS did not cause him to lose work time except for appointments, and did not interfere with his ability to do his job.  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 irritable bowel syndrome condition.  

BOARD FINDINGS:  In the matter of the irritable bowel syndrome 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 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 Applicant:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02341.

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