RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02787
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Air Traffic Controller, medically separated for “Crohn’s Disease, controlled with medications” with a disability rating of 10%. 

CI CONTENTION:  “Review all conditions.”  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 - 20041123	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with Crohn’s Disease in October 2004 after presenting with epigastric discomfort and a 20-pound weight loss in the previous 5 months.  A small bowel series revealed findings of the distal colon consistent associated with Crohn’s.  He was 146 pounds prior to the onset of symptoms.  

The 7 October 2004 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of abdominal pain rated at 2/10 without any exacerbations since starting an ulcerative colitis medication.  He was doing well and felt ready to return to full-time duties.  Physical examination showed stable vital signs and normal examination.  The provider noted the CI had responded to treatment and should be returned to duty with an assignment limitation for follow-up exacerbations.  

At primary care examinations on 15 and 29 October 2004, the CI reported ongoing weight loss down to 110 pounds, but that he was still able to eat and had normal bowel movements with no nausea.  On 26 December 2006, he was seen in the emergency room after 2 days of nausea, vomiting and diarrhea, and then hospitalized from 26 to 29 December 2004.  He was treated with prednisone (steroid) with a 7-week taper and felt better, but still had about three loose stools per day.  At a primary care visit on 8 March 2005, 13 days prior to separation, the provider noted stable weight (123 pounds) and no significant abdominal pain or bloody diarrhea.  

There was no VA Compensation and Pension examination proximate to separation.  The CI underwent an ileal resection and ileostomy at a VA clinic on 8 October 2005, 7 months after separation, due to a perforated terminal Crohn’s ileitis.  He then underwent an ileostomy takedown, cecal resection, appendectomy and anastomosis at a VA clinic on 3 January 2006, 10 months after separation. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 10%, analogously coded 7399-7323 (colitis, ulcerative), citing disease controlled by medication.  Members noted that Crohn’s disease is rated analogously to ulcerative colitis with “moderate; with infrequent exacerbations” warranting a 10%; and “moderately severe; with frequent exacerbations” for a 30%.  While the CI had an exacerbation 3 months before separation and received inpatient treatment, at 2 weeks prior to separation, he reported no significant abdominal pain or bloody diarrhea, and his weight was stable.  Although he required surgery 7 months after separation, the panel agreed there was no evidence of frequent exacerbations at the time of separation to meet the criteria for a 30% rating.  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 condition.

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 20170418, 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-2017-02787.

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