RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXX	CASE:  PD-2022-00003
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040921

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “Crohn’s Disease” with a disability rating of 0%.   

CI CONTENTION: “I have been on non-stop steroids since being diagnosed. I am currently still on steroids as of today.”  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 - 20040921	VARD - 20060410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	0%	Crohn’s Disease	7399-7323	30%	20050830	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), in March 2003, the CI began experiencing recurrent episodes of loose watery stools 3-4 times a day with weight loss.  Despite conservative treatment, she continued to have exacerbations, which led to a near-syncopal episode during training in April 2003.  She was admitted to a civilian hospital for over a month and diagnosed with ulcerative colitis.  After initial treatment with oral (daily prednisone) and rectal steroids, she did well, but symptoms returned once the medications were tapered.   In December 2003, her diagnosis was changed to Crohn’s disease after the results from a repeat colonoscopy.  In the same month, the CI experienced a major flare-up requiring convalescent leave, and by January 2004, she was still symptomatic on high doses of prednisone and unable to be tapered off the medication.  She was started on azathioprine (immunosuppressant) at the time but stopped the medication herself due to concern for pregnancy.  She was tapered off prednisone in March 2004, but restarted on the steroid after bloody diarrhea, abdominal cramping, and pain recurred.  

During the March and April 2004 MEB examinations (recorded on DD Forms 2807-1 and 2808), the CI reported using the bathroom frequently due to Crohn’s disease, and the examiner noted a tender abdomen.  The 1 April 2004 MEB NARSUM gastroenterology examination, 6 months before separation, noted that after 6 months on medication, the CI’s symptoms were poorly controlled and led to frequently missed work and the inability to deploy or eat MREs [Meal, Ready-to Eat].  Physical findings were not documented.  

The 27 May 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of recurrent diarrheal episodes due to Crohn’s disease.  The examiner noted that intensive treatment with steroids resulted in initial control, however, attempts to reduce the medication dosage resulted in the exacerbations becoming “extreme.”  Physical examination showed the CI was “somewhat overweight (considered to be secondary to steroid treatment),” but no other gross abnormalities.  The colonoscopy results were summarized, and present medications included:   Aciphex (for GERD), 20 mg daily; Asacol (rectal steroid), 1600 mg, 3 times daily, and prednisone, 5 mg daily.  Physical limitations included no field duty and no MREs as they caused exacerbations.  The examiner stated that control was “less than optimal in spite of close follow-up and evaluation and maximal compliance of the patient.” 

Treatment notes following the CI’s separation indicated she was 32 weeks pregnant in May 2005, and as a result was not taking the immunosuppressants recommended by her gastrointestinal specialists; however, she continued taking oral steroids.  She then became seriously ill around July 2005 and was hospitalized for a MRSA [methicillin-resistant staphylococcus aureas] infection.  A referral note from her provider on 12 July 2005 discussed a plan to begin immunosuppressant medications once she and her military spouse had moved to the CONUS.

At the 30 August 2005 VA Compensation and Pension examination, 11 months after separation, the CI reported abdominal pain, generalized weakness, diarrhea, and weight fluctuations occurring more than two-thirds of the year and treatment with prednisone.  She recounted over 20 attacks in the past year, with limited ability to perform daily functions during flare-ups.  On examination, the CI was well developed, well-nourished (BMI was above average) and in no acute distress.  The abdomen was tender with hyperactive bowel sounds, and blood work showed anemia.  The VA examiner determined there was no functional impairment from the condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease 0%, analogously coded 7399-7323 (colitis, ulcerative), citing non-compliance with medical treatment.  The VA rated the Crohn’s disease 30%, also coded 7399-7323, citing frequent exacerbations.  Panel members noted that the CI had variable but persistent symptoms despite treatment with high doses of oral steroids, and frequent exacerbations after attempting to taper off these medications.  Following separation, her medical course was complicated by pregnancy and an intercurrent infection requiring hospitalization proximate to the VA examination and a military move.  This delayed her transition to treatment with disease modifying immunosuppressant medications.  The panel agreed the CI’s impairment due to Crohn’s disease was best characterized as moderately severe, with frequent exacerbations to support a 30% rating, coded 7399-7323.  There was no evidence of persistent malnutrition, or only fair health during remissions, to justify the next higher rating of 60%.   After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the Crohn’s disease, coded 7399-7323.  

BOARD FINDINGS:  In the matter of the Crohn’s disease, the panel recommends a disability rating of 30%, coded 7399-7323 IAW VASRD §4.114.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Crohn’s Disease	7399-7323	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20211227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20230002062,  

Dear XXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability retirement.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a permanent disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 1835 Army Boulevard, Building 2000, JBSA, Fort Sam Houston, TX 78234.

Sincerely,