RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05745
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060925

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

CI CONTENTION:  “Review all conditions.”  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 - 20060811	VARD - 20071025	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	30%	20070420	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI presented with a several month history of intermittent abdominal pain associated with nausea, vomiting and loose stools in September 2005.  She was eventually diagnosed with Crohn’s Disease.  

The 4 May 2006 MEB NARSUM examination, 5 months prior to separation, noted the Crohn’s disease was well controlled on medications.  There was no physical examination recorded.  The commander’s letter, dated 4 days later, indicated the CI was working as an effective member of her squadron and wing.  In primary care on 11 December 2006, the CI reported that her weight was stable and she was doing well.  She denied abdominal pain, nausea, vomiting, diarrhea or constipation.  She had a low-grade fever and blood in the stool, but had been treated for an anal fissure.  On examination, she was in no acute distress and the abdominal examination was unremarkable.  At the 10 January 2007 VA gastroenterology examination, almost 4 months after separation, the CI reported she was doing well.  The examination was unremarkable other than a persistent anal fissure.  The CI was seen in primary care on 27 March 2007 and reported that for the past 2-3 weeks she had been sick with abdominal cramps and diarrhea, but these symptoms had resolved.  Her weight was stable at 152 pounds and the abdominal examination was normal.  

At the 20 April 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported constant abdominal pain which was incapacitating and occurred over two thirds of the year.  The examiner noted no functional impairment from the condition.  The panel could not reconcile this internal inconsistency.  No limitations in the activities of daily living were recorded.  The physical examination was unremarkable other than a persistent anal fissure.  She did not have anemia and her weight was stable.  Malnutrition was not present.  Serial weights showed:  149	pounds on 5 January 2001 (accession); 135 pounds on 24 September 2005; 136 pounds on 8 March 2006; 157 pounds on 11 December 2006; 152 pounds on 27 March 2007 and 159 pounds on 27 July 2007.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 10%, analogously coded 7323 (colitis, ulcerative), citing an absence of symptoms on treatment.  The VA rated the Crohn’s disease 30%, analogously coded 7323, based on the C&P examination 7 months after separation, citing frequent exacerbations.  The panel observed that this history was internally inconsistent as well as inconsistent with the NARSUM and the clinical notes between the NARSUM and C&P examinations.  The panel determined that the preponderance of evidence supported the 10% rating adjudicated by the PEB and that the probative value of the C&P examination was reduced by internal and external inconsistencies.  After due deliberation, considering all of 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170811, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05745.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings