RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05306
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080416

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

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20071218	VARD - 20081209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease with Associated Stomach Pain	7323	30%	20081020	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was seen in the emergency room in June 2007 for abdominal pain, bloody diarrhea, and vomiting, and an abdominal CT scan showed terminal ileum thickening indicating irritable bowel disease.  He was treated with medication and referred to gastroenterology where a colonoscopy showed ulceration of the ileocecal valve and an endoscopy revealed multiple ulcerations in the ileum, erosions in the proximal small intestine, and stricture in the distal ileum.  Serum antibody testing for colitis biomarkers was also positive.  

The 26 October 2007 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of abdominal cramping managed with additional anticholinergic medication, but no further diarrhea or blood in the stool.  Physical examination showed a weight of 198 pounds, body mass index of 26.8 (normal 25), and diffuse direct tenderness with no guarding, muscle rigidity or masses.  Treatment included three prescriptions which specifically targeted symptoms of Crohn’s disease, and the examiner noted a typical course of intermittent exacerbation followed by periods of remission.  While the CI had no fitness restrictions and mostly favorable results from treatment, symptom stability was unknown.  The November 2007 commander’s statement noted he missed 3 days over the previous 90 due to the condition.  

At the 20 October 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported constant abdominal pain with cramping and bloating as well as nausea, vomiting and diarrhea every 3-4 months. He had blood in his stools during flare-ups, which were short lived, and daily bowel movements produced soft, but not formed stools without blood or mucus.  Once a month he had breakthrough symptoms of severe heartburn that was well-controlled on daily Nexium (proton pump inhibitor), and he had gained about 60 pounds in the previous 2 years.  Physical examination showed slight bilateral upper quadrant tenderness but no evidence of “surgical 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 (ulcerative colitis), citing general DoD and VASRD guidelines.  The VA rated the Crohn’s disease 30%, coded 7323, based on the C&P examination, citing an established diagnosis, continued frequent exacerbations, and no malnutrition with weight gain.  The NARSUM examination noted some abdominal tenderness, but few complaints, and that the CI was taking medications and had no restrictions.  The C&P examination showed occasional brief flare-ups followed by remission and weight gain.  Thus, panel members agreed there was no evidence of a moderately severe condition with frequent exacerbations to meet criteria for a higher 30% 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 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.  

 

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05306.

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.

						Sincerely,