RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04923
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20091027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Information Systems Client Support Administrator, medically separated for “ulcerative colitis” with a disability rating of 10%.

CI CONTENTION:  “I was only given a percentage for some disabilities and given nothing for others.”  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 – 20090203	VARD - 20091228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Internal Biliary Stent Placement Secondary to Jaundice/Ulcerative Colitis	7345-7323	30%	20090505	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Ulcerative Colitis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), in July 2006 the CI began having bright red, bloody stools with nearly every bowel movement.  A colonoscopy in January 2007 led to a diagnosis of ulcerative colitis, and he was started on sulfasalazine (anti-inflammatory) 3 times a day at 1000mg.

The 22 October 2008 MEB NARSUM examination, 12 months prior to separation, noted the CI was doing well, although he still had a small amount of blood in the stools at times. He was still taking sulfasalazine daily and had no abdominal pain or other symptoms.   Physical examination revealed no acute distress and a soft, non-tender, non-distended abdomen with positive bowel sounds throughout.  Radiologic and laboratory findings were unremarkable.  The physician stated the condition was stable and only required follow-up with a gastroenterologist in 12 months.  He opined that the CI would continue to do well as long as he followed treatment recommendations and continued taking prescribed medication.  Deployment was not recommended due to the potential for flare ups in a higher stress environment.  

In the 4 November 2008 performance statement, 11 months before separation, the commander documented that the CI was one of his “best Airman” who excelled in all primary duties and was selected as the squadron Airman of the Year in 2007.  Additionally, the commander noted that the medical condition had not required schedule modifications or missed days at work, and recommended the MEB return him to duty.  

At the 5 May 2009 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported rectal bleeding, bloating, cramps, and urgent bowel movements, and that he had gained 30 pounds in the previous 3 years.  The examiner noted he was well-developed and nourished, and in no acute distress, with no abdominal tenderness.  Hemoglobin hematocrit testing indicated no anemia or abnormal red blood cell volume.  Effect of the condition on the CI’s occupation was recorded as “mild.”  

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 7345-7323 (chronic liver disease without cirrhosis-colitis, ulcerative), based on the C&P examination, citing frequent exacerbations. Members noted that a 30% rating requires a moderately severe condition with frequent exacerbations.  Although the CI reported rectal bleeding, bloating, cramps and urgent bowel movements during the VA examination, there were no objective STR evidence of ulcerative colitis exacerbations at the time of separation.  Red blood cell testing was normal and military job performance was outstanding.  The panel agreed the condition was not more than moderate and exacerbations infrequent.  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 ulcerative colitis condition.

BOARD FINDINGS:  In the matter of the ulcerative colitis and IAW VASRD §4.114, the panel majority 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.

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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-2017-04923.

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,