RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200862 DATE OF PLACEMENT ON TDRL: 20010514 BOARD DATE: 20121219 DATE OF PERMANENT SEPARATION: 20030903 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (12B1O/Combat Engineer), medically separated for ulcerative colitis (UC). The CI developed abdominal pain, watery and bloody diarrhea in 1999 during Advanced Individual Training (AIT). He was diagnosed with UC and was treated with Prednisone (steroid) and Sulfasalazine with adequate control after 18 months of treatment. However, given the unpredictable nature of UC and the need for access to medical care during exacerbations, the CI did not meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the UC condition as unfitting but unstable, and CI was placed on Temporary Disability Retired List (TDRL) with a 30% rating. On reevaluation, after approximately 3 years on TDRL, the PEB determined the UC condition was sufficiently stable yet remained unfitting, and rated it at 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating. CI CONTENTION: “The VA has rated me at 30% for ulcerative colitis.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. TDRL RATING COMPARISON: Service TDRL Exit IPEB – Dated 20030808 VA* – All Effective Date 20031023 Entry on TDRL – 20010514 Rating Condition Code Rating Exam Condition Code TDRL Sep. Ulcerative Colitis 7323 30% 10% Ulcerative Colitis 7323 10% 20040122 .No Additional MEB/PEB Entries. Not Service Connected x 2 20040122 Combined: 10% Combined: 10% * VA rating based on exam most proximate to date of permanent separation. UC, 7323, was originally rated 0% effective 20010530 and increased to 10% effective 20031023. UC, 7323 was increased to 30% (based on exam of 20101216); effective 20101119 (combined 30%). ANALYSIS SUMMARY: Ulcerative Colitis Condition. The narrative summary (NARSUM) notes that the CI began having problems with diarrhea, abdominal cramping and bright red blood in his stool in October 1999. In February 2000 he underwent a colonoscopy and was diagnosed with “pancolonic UC.” The CI had a one week hospitalization for acute management of his condition (treatment with IV nutrition and steroids). He was started on steroids, antimicrobial medications, and Sulfasalazine (Mesalamine, Azulfidine). He was placed on TDRL May 2001 for stabilization of his condition. At the MEB exam performed prior to TDRL entry (approximately 3 years prior to separation), the CI reported monthly exacerbations of his UC characterized by abdominal cramping, bloody diarrhea, low grade fever, and nausea. He continued to report 4-10 stools per day. The MEB physical exam, noted diffuse mild tenderness to palpation in all four quadrants of the abdomen with slightly increased bowel sound. At the TDRL NARSUM dictated, 6 months prior to permanent separation (TDRL exit), the CI reported that he had not required acute medical treatment since his hospitalization (pre-TDRL entry). He reported that he had watery diarrhea about once every 2 months, but otherwise he had normal, regular bowel movements. He denied medication use since being placed on TDRL and reported being without active colitis symptoms since January 2002. At the focused VA Compensation and Pension (C&P) exam closest to the time of permanent separation (4 months after removal/exit from the TDRL), the CI reported an episode of non-bloody diarrhea every 2 weeks. His abdominal exam was documented as negative with a diagnosis of “ulcerative colitis with profound remission, with minimal symptoms at this time.” There was a C&P exam greater than 5 years remote from separation which indicated worsening of the CI’s UC symptoms in 2010, and the VA rated that exam at 30%. The Board directs attention to its rating recommendation based on the above evidence. The Board considered that the exams proximate to TDRL entry would have been independently rated at 10% to 30%. At TDRL exit, the PEB adjudicated the ulcerative colitis condition as unfitting, rated at 10%, and coded 7323, Colitis, Ulcerative. The VA initially rated the UC condition, coded 7323, at 0% based on service treatment records (STR). The VA increased the rating to 10%, moderate; with infrequent exacerbations, effective 23 October 2003. A higher evaluation of moderately severe; with frequent exacerbations, rated at 20% is not supported by the evidence of record proximate to TDRL exit. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the ulcerative colitis condition on entry into or exit from TDRL. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the UC condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication for TDRL entry or permanent separation at TDRL exit. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING TDRL PERMANENT Ulcerative Colitis 7323 30% 10% COMBINED 30% 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120619, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxx President Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130000024 (PD201200862) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)