RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04648
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Special Investigation Craftsman, medically separated for “celiac disease” with a disability rating of 0%. 

CI CONTENTION:  In addition to the celiac disease, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  

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 - 20090828	VARD - 20100420 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Celiac Disease	7399-7319	0%	Celiac Disease	7346-7323	10%	20091015	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Celiac Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had an 8-year history of celiac disease, a chronic disease of the digestive tract that interferes with the digestion and absorption of nutrients from food.  The condition requires a gluten-free diet.  The 5 May 2009 MEB NARSUM examination, 7 months prior to separation, noted complaints of nausea, vomiting, abdominal pain, and diarrhea as well as a 7-10 pound weight loss in the prior 2 weeks.  He reported the symptoms were not as severe if he maintained the ability to self-prepare foods rather than eating out.  His general physical examination (PE) was unremarkable. 

At the 15 October 2009 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI’s current condition was noted as “stable.”  However, he complained of urgency with bowel movements that required him to remain near a bathroom, and he had to provide his own gluten-free diet.  A detailed PE was normal.  His diagnosis remained celiac disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the celiac disease 0%, analogously coded 7399-7323 (irritable colon syndrome), citing clinically stable symptoms.  The VA rated the celiac disease 10%, dual coded 7346-7323 (hernia hiatal-ulcerative colitis), based on the C&P examination, citing infrequent exacerbations.  The VASRD mandates that celiac sprue (celiac disease) be analogously coded and rated under code 7319 (irritable colon syndrome) based upon the intensity of bowel function disturbance.  The measure of bowel function disturbance under this code is either mild (0%), moderate (10%) or severe (30%).  Panel members noted the disease was “stable” at 2 months prior to separation, the PE was normal, and the CI had the knowledge to control his symptoms with diet.  Therefore, members agreed that the CI’s condition supported the VASRD criteria of “mild, disturbances of bowel function with occasional episodes of abdominal distress,” for a 0% 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 celiac disease.  

BOARD FINDINGS:  In the matter of the celiac 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:

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Dear XXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04648.

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.