RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-05810
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Automated Logistics Specialist, medically separated for “celiac disease in the setting of irritable bowel syndrome (IBS)” with a disability rating of 10%.   

CI CONTENTION:  Review requested of “abdominal pain, fatigue, diarrhea and severe acid reflux,” which continues to worsen and negatively impact daily activities.  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 - 20090826	VARD - 20091221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Celiac Disease in the Setting of IBS	7319	10%	Lower Digestive Condition, Diagnosed as Celiac Sprue Disease	7399-7319	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Celiac Disease in the Setting of IBS.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s gastrointestinal (GI) symptoms began while deployed to Iraq from September 2004-Novmeber 2005, with an initial diagnosis of IBS.  In August 2006, a duodenal biopsy showed changes consistent celiac disease (gluten sensitivity) which were confirmed by blood work.  She eliminated wheat products from her diet, and symptoms improved, but mild to moderate fatigue with intermittent abdominal pain and diarrhea persisted.  
At the 18 May 2009 MEB NARSUM examination, 6 months prior to separation, the CI reported continued fatigue with intermittent abdominal pain and diarrhea, and that she had not regained lost weight.  While she had “good” days when she could perform her military duties, she also had “bad” days with debilitating and unpredictable (4-5/day) episodes of diarrhea with severe abdominal cramping.  A recent endoscopic examination in August 2008 noted intestinal changes consistent with celiac disease and mild H. pylori (type of bacteria) gastritis, as well as a small hiatal hernia.  The examiner noted a gastroenterologist’s evaluation which showed a negative H. pylori breath test after antibiotic treatment, but that the CI still had a “component of IBS” with reports of worsening symptoms with stress.  A trial of anti-anxiety medication was not helpful, and the examiner opined that dietary restrictions and GI exacerbations from the celiac disease would “remain unchanged” and prohibit performance in her military specialty.    Physical examination in March 2009 showed thin body habitus and mild to moderate abdominal tenderness in the left upper quadrant.  The abdomen was soft and non-distended with no rebound tenderness.  There was no VA examination proximal to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the GI condition 10%, coded 7319 (irritable colon syndrome).   The VA also rated the GI condition 10%, analogously coded as 7319, based on the STR.  Panel members noted IBS and celiac disease are both coded 7319 as GI medical conditions and agreed symptoms were moderate, meeting criteria for a 10% disability. There was no evidence of severe diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress to achieve 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 the GI condition.    

BOARD FINDINGS:  In the matter of the celiac disease/irritable bowel syndrome 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXX 

Dear XXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      

Enclosure