RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04359
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, UH 60 Helicopter Repairer, medically separated for “irritable bowel syndrome [IBS]” with a disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested.  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 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 - 20050228	VARD - 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
IBS	7319	10%	IBS	7319	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

IBS.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first developed complaints of abdominal pain and bloating with loose stools in May 2003 while deployed to Iraq.  She was treated in theater and successfully completed the deployment, but the symptoms persisted after redeployment.  An extensive evaluation (including serial ultrasounds, CT, upper and lower endoscopy) did not yield any positive findings and she was diagnosed with IBS.  Provider entries in the STR indicated a waxing and waning course with overall improvement on medications.  An entry of 8 October 2004 characterized the pain (“bloating and cramping”) as “very infrequent” with loose stools but no diarrhea.  An entry a month later and 2 weeks before the NARSUM noted there was “a bit more” bloating and cramping, but no diarrhea or constipation.  There was no STR evidence for nausea or vomiting, severe pain, acute abdomen, hospitalization, or other features in support of rating criteria under any alternate VASRD code to 7319 (see below).

The 24 November 2004 MEB NARSUM examination, 7 months prior to separation, documented complaints of pain, cramping, and bloating with no note of bowel changes or other associated symptoms.  The examiner stated the CI “is currently only on two medications [an acid blocker and antispasmodic] but has yet to report significant overall changes in her abdominal pain.”  The pain was rated as “constant [and] moderate.”  There was no further elaboration of frequency or severity.  The commander’s performance statement documented that the CI continued to perform satisfactorily in her specialty, although unable to satisfy rigorous soldiering requirements, and did not note any work loss.  The NARSUM and MEB DD Form 2808 physical examinations were normal.  The final gastroenterology entry in the STR was on 2 February 2005, 2 months after the NARSUM, and documented “bloating and cramping is frequent but not as severe as in the past” with daily loose stools but no diarrhea.  The examiner opined that the IBS symptoms were exacerbated by the stress of military separation, but overall “doing better on current medications.”  

There was no VA Compensation and Pension examination proximate to separation in evidence, although there were VA provider notes that captured the early post-separation clinical course.  The IBS remained well controlled on the same medications (one entry noting that the symptoms were “not bothersome” on “most days”), until a mild flare 9 months after separation, followed by prompt resolution.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the IBS condition 10%, coded 7319 (irritable colon syndrome).  The PEB cited the applicable “moderate” criterion for the code (elaborated below).  The VA based the rating on the STR, citing findings from the C&P examination.  The panel agreed that code 7319 was the most applicable code for rating, being fairly specific to the condition, and given the absence of favorable rating criteria under any alternate code (as above).  The VASRD §4.114 criteria for a 10% rating under code 7319 are “moderate; frequent episodes of bowel disturbance and abdominal distress.”  Those for 30% (the highest rating) are “severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.”  

The panel deliberated the NARSUM evidence and concluded the symptoms were not sufficiently probative to be characterized as constant as required to meet the 30% criteria.  The NARSUM evidence for symptom frequency was not sufficiently detailed, and there was no evidence for the “diarrhea, or alternating diarrhea and constipation” that, by logical interpretation of the overall 30% wording, were requisite criteria.  Furthermore, the NARSUM evidence for symptom frequency was closely flanked by contrary evidence from the STR, with characterizations ranging from infrequent to frequent (triggered by stress).  The latter was also corroborated by the post-separation VA evidence.  Members therefore concluded that the evidence was better aligned with the above 10% criteria of code 7319 than with those for 30%.  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 IBS condition.

BOARD FINDINGS:  In the matter of the inflammatory bowel syndrome 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 there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

AR20200002314

Dear XXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.