SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05103.

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.

					

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05103
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aircraft Armament Systems Journeyman, medically separated for “Crohn’s disease” with a disability rating of 10%.  

CI CONTENTION:  “An incurable disease that requires frequent monitoring.  Effects entire GI tract.  Medication only maintains symptoms occasionally.”  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 - 20050304	VARD - 20060203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7323-7399	10%	Crohn’s Disease	7323	10%	20060104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s Crohn’s disease began in August 2003 after several episodes of hematochezia (blood in the stool).  The CI described having episodic hematochezia that would last four-to-six weeks at a time, then he would have a month or two where he was asymptomatic, and then have another bout of four-to-six weeks of hematochezia.  Additionally he endorsed having two-to-three episodes per day associated with uncomfortable abdominal cramping.  A colonoscopy performed on 24 September 2004 noted a final diagnosis of “suspected Crohn’s disease.”  Ongoing medication and dietary changes greatly improved the CI’s symptoms.     

The 21 October 2004 MEB NARSUM examination, 10 months prior to separation, simply summarized the CI’s clinical treatment with no new subjective complaints.  The physical examination (PE) was detailed and normal.   The 20 January 2005 MEB NARSUM gastroenterology addendum, 7 months prior to separation noted no new complaints with regard to the gastro-intestinal condition.  Daily bowel movements were described as formed and non-bloody.  A PE was not performed.  A gastro-intestinal clinic encounter on 4 April 2005, 5 months prior to separation, indicated a normal abdominal examination.   

At the 4 January 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported being stable on medications without any adverse symptoms as previously described.  The detailed PE was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 10% under code 7323 (Colitis, ulcerative), citing “condition is incompatible with the long-term rigors of military service and best rated at 10%.”  The VA also rated the Crohn’s disease 10%, coded 7323, based on the C&P examination, citing requirement for daily medication.  

Panel members first agreed that the PEB and VA coding of 7323 clearly represented the pathology of the CI’s condition.  Members deliberated between 10% (moderate; with infrequent exacerbations) and 30% (moderately severe; with frequent exacerbations) impairment rating for the CI’s condition near the time of separation and agreed that the level of “frequent exacerbations” was not reached based on the long-term medication controlled condition resulting in formed and non-bloody stools.  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.

BOARD FINDINGS:  In the matter of the Crohn’s 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.