RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXX   	CASE:  PD-2020-00193
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Hospital Food Service Specialist , medically separated from the Temporary Disability Retired List (TDRL) for “Crohn’s disease…” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20050803	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease…	7399-7323	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Crohn’s Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s Crohn’s disease began in the summer of 1999 with an average of five bowel movements (BM) per day with some days up to 10-12 BM per day.  He was diagnosed with Crohn’s disease.  The CI was separated and placed on the TDRL on 12 August 2004.

The 5 July 2005 TDRL examination, 2 months prior to TDRL removal, noted the CI was in clinical remission.  He denied bouts of diarrhea, bloody stools, abdominal pain, or weight loss.  Appetite was normal.  Physical examination showed normal general appearance, and non-tender abdomen.  Laboratory studies were normal (CBC, WBC, BUN, Creatinine, and liver panel).

On 9 August 2005, approximately 1 week before TDRL removal, the CI was referred to the emergency room from the VA for evaluation of appendicitis with complaint of abdominal pain.  The CI noted he had been off Crohn’s medication for a year, and had been in remission for 2 years.  Physical examination noted absence of fever, and normal blood indices.  There were no complaints of diarrhea, frequent BMs, or bloody stools.  There was a provisional diagnosis of Crohn’s due to history, but final diagnosis was not available.

The STR documented an admission to the hospital on 7 March 2006, 7 months after TDRL removal, with admission diagnoses of Remicade (infusion drug to treat Crohn’s) Serum Sickness, Crohn’s disease and pain management.  Although admission note or treatment notes for the admission were not available, the primary reason for admission was serum sickness.

On 19 May 2006, 9 months after TDRL removal, a note showed the CI was discharged from the hospital after being treated for Crohn’s; however, there were no admission or treatment notes describing the admission.

There was no VA C&P examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Crohn’s disease condition 10%, analogously coded 7399-7323 (ulcerative colitis), citing the condition as “under good control with 2 oral medications.  No hospitalizations, relapses, weight loss or anemia since entering TDRL status.  Present imaging and Labs normal.” and “Stable for final adjudication purposes. Rated as moderate·”

Panel members noted at the time of TDRL removal, the condition had been in remission for a significant period of time.  The STR demonstrated one possible exacerbation that occurred in May 2006, 9 months after TDRL removal.  There was no evidence of frequent exacerbations correlating to moderately severe disease activity.  Therefore, panel members concluded, a 10% for moderate disease, with infrequent exacerbations was justified.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the Crohn’s disease condition at the time of TDRL removal.

BOARD FINDINGS:  In the matter of the Crohn’s disease condition and IAW VASRD §4.114, the panel recommends no change in the PEB adjudication at the time of TDRL removal.  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 20200811, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20210017046,XXXXXXXXXX

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,