RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03230
BRANCH OF SERVICE:  aIR FORCE	SEPARATION DATE:  20090729

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

CI CONTENTION:  He requested review of a left shoulder condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090618	VARD - 20090825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis with Gastroesophageal Reflux	7346-7323	30%	20090601	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Ulcerative Colitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s ulcerative colitis condition began in March 2008 during technical school when he started having blood in his stools with abdominal pain.  He was diagnosed with ulcerative colitis in June 2008 and treated with Asacol (reduces swelling in colon) and Nexium (reduces stomach acid) with good resolution of symptoms until he stopped taking the medications.  His symptoms recurred in August 2008 and he was restarted on his prescriptions with a course of prednisone (corticosteroid) added in October 2008.  Some symptoms of abdominal pain and diarrhea continued until January 2009 when he started on a live culture bacteria treatment and had complete resolution of symptoms.  

The 19 February 2009 MEB NARSUM examination, 5 months prior to separation, noted no complaints with regards to the ulcerative colitis.  Physical examination showed the abdomen was soft and nontender without any hepatosplenomegaly.  The examiner noted that although the CI’s symptoms were well-controlled at the time, he was likely to have occasional exacerbations.  

The 1 June 2009 VA Compensation and Pension (C&P) evaluation, 2 months before separation, noted CI complaints of lower quadrant abdominal pain occurring one to two-thirds of the previous year with the symptoms described as “constant” during those periods.  Physical examination showed he was well developed, well nourished, and in no acute distress.  The abdomen was normal with no distension of superficial veins, ostomy, tenderness, splenomegaly, ascites, liver enlargement, or aortic aneurysm.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ulcerative colitis condition 10%, coded 7323 (colitis, ulcerative).  The VA rated the ulcerative colitis condition 30%, coded 7346-7323 (hernia hiatal-colitis, ulcerative), citing frequent exacerbations.  Members agreed a 10% rating was justified for “moderate” ulcerative colitis with infrequent exacerbations under code 7323.  A 30% rating requires “moderate severity” with frequent exacerbations, and the panel noted that while several treatment regimens had a varying amount of success with intermittently recurring symptoms over a 10-month period, once on the proper treatment, the CI was symptom-free and could expect no more than occasional exacerbations. Neither the NARSUM nor the C&P evaluation revealed any evidence of malnutrition, nausea, vomiting, prolonged hospitalizations, or the need for blood transfusions.  Additionally, the CI continued to work full-time in his specialty and was able to perform all military duties with no restrictions due to his medical condition.  Thus, members agreed criteria for the higher 30% rating were not met.  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 ulcerative colitis condition.

BOARD FINDINGS:  In the matter of the ulcerative colitis 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 20170508, 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-2017-03230.

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