RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201347 SEPARATION DATE: 20030905 BOARD DATE: 20130227 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPT/O-3 (56A/Chaplain) medically separated for Crohn’s colitis. He was treated, but was unable to fully perform his military duties. He was issued a permanent profile and underwent a Medical Evaluation Board (MEB). The MEB found his Crohn’s colitis medically unacceptable, and referred him to a Physical Evaluation Board (PEB). No other conditions were listed on DA Form 3947. The PEB found the Crohn’s colitis unfitting, and rated it 10%. The CI made no appeals, and was medically separated with a 10% disability rating. CI’s CONTENTION: “My disability board rating of 10% for Crohn's Colitis was inconsistent with the 30% rating awarded by the VA immediately upon my discharge. While self-employed from 2003 until 2006 I was forced to buy one health insurance policy for my family and a separate high risk plan for myself because of my diagnosis of Crohn's. VA care was insufficient for acute and/or emergency care. Although I had several good years with only minor flares, since 2008 I have had several flares. The most recent began in November 2011 and is ongoing. I have lost over 40 pounds in that time period and missed numerous days of work because of illness and medical appointments. My civilian doctor has prescribed Lialda to control the flare (Flagyl was used to get the severe onset under control). I am currently petitioning the VA to change my disability rating to the 60% level because of these latest developments. I am currently working as a DA Civilian employee. A big factor in that decision was the health insurance. I was a chaplain in the army and am a minister by profession, but the need to carry high risk insurance has a significant financial impact on my career choices since church work normally requires a pastor to maintain private health insurance. Having Tri-Care available to me would allow me to make career decisions without undue concern for health insurance cost. Note also that the PEB standards at the time of my discharge did not recognize Crohn's Colitis and instead used the standard for Irritable Colon Syndrome, rather than the higher standards for Ulcerative Colitis, which would been more comparable as one of the types of Inflammatory Bowel Disease. The "Reasons and Bases" section of my VA Rating Decision form gives a concise summary of the state of my Crohn's at the time of my discharge.” SCOPE OF REVIEW: The Board’s scope of review as defined in DoDI 6040.44 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 unfitting gastrointestinal condition (Crohn’s colitis) meets the criteria prescribed in DoDI 6040.44, and is accordingly addressed below. No other conditions are within the Board’s purview. Any condition outside the Board’s defined scope of review may be eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Army PEB – dated 20030423 VA (18 days Pre-Separation) – All Effective 20030906 Condition Code Rating Condition Code Rating Exam Crohn’s Colitis 7399-7326 10% Crohn’s Colitis 7399-7323 30% 20030710 .No Additional MEB/PEB Entries. Right Shoulder Pain 5201-5010 10% 20030710 0% x 3 Combined: 10% Combined: 40% ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his Crohn’s colitis continues to burden him, and the significant impact it has had on his quality of life. It is noted for the record that the Board is subject to the same laws for Service disability entitlements as those under which the Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate the CI for future severity or potential complications of conditions. That role and authority is granted to the Department of Veterans Affairs (DVA). The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. Compensation can only be granted for the degree of severity present at separation. The DVA, however, is empowered to re-evaluate a CI’s conditions for the purpose of adjusting the disability rating should the degree of impairment change over time. Crohn’s Colitis. In October 2001, the CI developed gastrointestinal (GI) symptoms. He was having diarrhea about 15 minutes after eating a meal. Over the next several weeks the diarrhea problem got worse, and the CI was losing weight. He was sent to Gastroenterology for evaluation and was diagnosed with Crohn’s disease (CD). He was treated, and his symptoms improved. However, in spite of treatment, the CI was not able to fully perform his duties as a military chaplain and an MEB was initiated. His GI narrative summary was dictated by Dr. F. on 18 February 2003. At that time, the CI was having about 3-5 non-bloody stools per day with episodic abdominal cramping. Symptoms were aggravated by running and other impact aerobic exercise. Body weight had returned to his pre-illness weight. Dr. F. recommended regular follow up and daily medications. Because of the transverse colon disease, Dr. F. opined that the CI may need surgery in the future. On 11 March 2003, a physical exam (PE) was done by Dr. H. and it was essentially normal. The CI had a VA Compensation and Pension (C&P) exam in July 2003, 2 months prior to separation. At that time, he reported that the number of stools per day varied from 1 to 10. Abdominal exam was normal. As noted above, the CI was found unfit for military service and was medically separated from the Army in September 2003. The PEB and the VA chose different coding and rating options for the CD condition. The PEB used code 7326 (chronic enterocolitis), and assigned a rating of 10% (moderate). The VA used diagnostic code 7399-7323 (chronic condition analogous to ulcerative colitis), and rated it 30% (moderately severe). The Board carefully examined all evidentiary information available, and directs attention to its coding and rating recommendations based on the above evidence. The Board determined that the VA had in fact, used the most appropriate coding option. Crohn’s colitis is an inflammatory bowel disease. It is appropriate to consider it analogous to ulcerative colitis (UC). The Board then determined that, based on the evidence in the treatment record, the CI’s colitis condition was best described as moderate, with infrequent exacerbations. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends by majority decision (2:1 vote) a disability rating of 10% for the CD condition. It is appropriately coded 7399-7323, and IAW VASRD §4.114, meets criteria for the 10% rating level. 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 Crohn’s disease, the Board recommends by majority decision (2:1 vote) a disability rating of 10%, coded 7399-7323 IAW VASRD §4.114. The single voter for dissent (who recommended 30%) did not elect to submit a minority opinion. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Crohn’s Disease, moderate 7399-7323 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120727, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxx, AR20130006289 (PD201201347) 1. 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 to modify the individual’s disability description without modification of the combined rating or recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)