RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXX	CASE:  PD-2017-04950
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090120

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Air Traffic Control Apprentice, medically separated for “Crohn’s disease” with a disability rating of 10%. 

CI CONTENTION:  His condition continues to worsen, and worsens his anxiety and depression.  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 - 20081114	VARD - 20090521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	60%	20090409	
History of Major Depressive Disorder	Cat II	Adjustment Disorder	9440-9434	Deferred	20090409	
Adjustment Disorder	Cat III					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was first evaluated for irritable bowel syndrome in May 2007 after a history of abdominal pain, intermittent diarrhea, anemia and failure to gain weight.  A CT scan showed “inflammation involving the small bowel and patchy areas of the colon,” and a colonoscopy confirmed “patchy colitis and ileitis.”  Pathology findings revealed “chronic colitis with sparing of the rectal area consistent with inflammatory bowel disease, specifically Crohn's disease.”
At the 4 June 2008 MEB NARSUM examination, 7 months prior to separation, the provider documented that the CI was “…doing well on his current [medication] regime” but that he could not be “guaranteed that he will be able to reliably perform his full military duties and obligations” due to the unpredictable nature of the disease. The overall physical examination (PE) was normal.  

At the 9 April 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported lower abdominal cramping 1-2 times a week, bloody stools, generalized weakness and feelings of anorexia.  The PE revealed tenderness across the entire lower abdomen. 

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).  The VA rated the Crohn’s disease 60%, also analogously coded 7399-7323, based on the C&P examination, citing evidence of constant pain, current weight, general weakness, rectal bleeding and abdominal cramps.  Members noted that VASRD guidelines dictate that the diagnosis of Crohn’s disease be analogized to code 7323, and that the difference between 10% and 30% ratings are determined by severity and the frequency of exacerbations.  The panel agreed that the CI’s condition near the time of separation was below the level of moderately severe (with frequent exacerbations), and was more appropriately in line with a moderate condition with infrequent exacerbations for a 10% 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 Crohn’s disease. 

Contended PEB Conditions:  History of Major Depressive Disorder and Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were noted on the duty limiting form, or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the STR that either condition significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the Crohn’s disease and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication.  In the matter of the contended history of major depressive disorder and adjustment disorder, the panel recommends no change from the PEB determinations as not unfitting.  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.   

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04950.

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,