Author: JOHN J. D'ORAZIO
Last saved by: BARKSDALE, JAMEILL M GS7 USAF SAF SAF/MRBE
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201484
BRANCH OF SERVICE:  Army	BOARD DATE:  20130503
DATE OF PLACEMENT ON TDRL:  19980412
Date of Permanent SEPARATION:  20030412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflect that this covered individual (CI) was an active duty SSG/E-6 (95B/Military Policeman) medically separated for Crohn’s disease.  The CI was diagnosed with Crohn’s in 1995.  He underwent a Physical Evaluation Board (PEB) at that time and was found fit.  He continued with steadily increasing complaints of fatigue, joint pains, daily diarrhea and abdominal pain.  The Crohn’s disease could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty, so he was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “Crohn’s disease status post (s/p) ileocecectomy, chronic diarrhea and abdominal pain secondary to the Crohn’s disease and migratory poly-arthritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions (see rating chart below) for PEB adjudication.  The PEB adjudicated the Crohn’s disease as unfitting, rated 30% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD), and placed the CI on the Temporary Disability Retired List (TDRL).  The remaining conditions were determined to be not unfitting.  After 5 years on TDRL, the CI’s Crohn’s disease remained unfitting.  He was removed from the TDRL in 2003 and permanently separated, without appeal, with a 10% disability rating IAW the VASRD.

CI CONTENTION:  “Based on the nature of medical condition and inability to continue military service without restrictions, I feel the rating should have been significantly higher than 10%.  I served almost 12 years.” 

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting Crohn’s disease is addressed below.  The elevated liver enzymes and scarring of the right lung, identified as not unfitting by the PEB, were not requested for review and thus are not within the defined scope.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Military Records (BCMR).  

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him, but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws (Title 38, United States Code).

RATING COMPARISON:

Final Service PEB - 20030725 | VA - Effective 19980412
On TDRL - 19980412 | Code | Rating | Condition | Code | Rating | Exam
Condition | | TDRL | Sep. | | | |
Crohn’s disease | 7399-7323 | N/A | 10% | Crohn’s disease | 7346-7323 | 10%* | 19980506
| | | | Migratory Polyarthritis | 5002 | NSC | 19980506
Crohn’s disease with peripheral arthritis | 7399-7323-7326 | 30% | N/A |
Elevated liver enzymes | Not Unfitting | NO VA ENTRY
Scarring of right lung | Not Unfitting |
No Additional MEB/PEB Entries. | Other x 5 | 19980506
Rating:  30% → 10% | Combined: 30%
*7346-7323 increased to 20% effective 20010905; code changed to 7346-7328.

ANALYSIS SUMMARY:

Crohn’s Disease with Peripheral Arthritis.  The CI was initially diagnosed with Crohn’s disease in 1995, following 4 years of episodic abdominal pain that became constant and was associated with a 30 pound weight loss.  He was evaluated by surgery and underwent a right hemicolectomy/ileocecectomy for obstructive symptoms.  He did well post-operatively and a subsequent MEB in May of that year found him fit for continued military service, although he was placed on a permanent duty-limiting profile.  The CI continued to have chronic diarrhea, abdominal pain and cramping that required intermittent escalated medical care but remained relatively stable with medication.  He also began to complain of increasing fatigue and joint pain that were felt to be related to his inflammatory bowel disease.  All these factors, combined with his strict dietary restrictions and inability to tolerate military rations, led to another MEB referral in November 1997.  The CI was placed on the TDRL in April 1998 with a rating of 30% under the VASRD criteria for moderately severe colitis.  At the time of the VA Compensation and Pension (C&P) examination, 6 May 1998, the CI was doing well, experiencing one stool per day with up to three non-bloody stools approximately two days per week.  He denied abdominal pain or fevers.  The physical examination was normal.  The VA rating decision of 12 June 1998 assigned a 10% disability rating for the CI’s Crohn’s disease.  Service-connection/rating for migratory polyarthritis was denied as no evidence of this condition was found at the C&P examination (6 May 1998).  Gastroenterology clinic notes from 21 December 1998 and 8 February 1999 reflected continued control of the Crohn’s disease without flares.  The CI experienced a disease flare in the March 2000 time frame treated with corticosteroids (gastroenterology exam 13 March 2000).  Subsequent bowel imaging studies performed at that time demonstrated chronic partial small bowel obstruction and the CI underwent ileal stricturoplasty surgery in October 2001.  Laboratory testing from February 2002 was normal without evidence of chronic inflammation indicating good disease control.  According to the C&P examination of 8 April 2002, his condition improved following the surgery, and the CI was able to tolerate a reasonably normal diet, gain weight, and reduce the frequency of his bowel movements to 2 or 3 per day, with non-bloody, semi-formed stools.  His abdominal pain had substantially diminished or disappeared.  The examiner noted the CI had not been treated with corticosteroids since June 1999 and that the disease was controlled.  The gastroenterology TDRL evaluation was on 17 March 2003, a month preceding the CI’s removal from the TDRL.  The examiner (who was the CI’s gastroenterologist) stated that he had been “following him on a 3-monthly basis” and that the CI “has not had any flares of his Crohn’s disease since stricturoplasty in 2001.”  The examiner also stated: ”His weight is stable and he has had no abdominal pain, nausea/vomiting or diarrhea.  He also has had no ocular pain, back aches, new skin rashes, or headaches; …. labs reveal a normal blood count and liver function tests.”  On examination the CI’s weight was stable with a normal body mass index.  Abdominal exam was unremarkable and there was no evidence of malnutrition.  The gastroenterologist concluded that the CI’s Crohn’s disease was stable and advised to continue his usual medication regimen.  The CI was removed from the TDRL and separated with 10% disability for Crohn’s disease (VASRD code 7399-7323).

The Board directs attention to its rating recommendation based on the above evidence.  The Board first considered if a higher rating than that adjudicated by the PEB was supported at the time of placement on the TDRL.  At the time of the CI’s placement onto the TDRL, the PEB and VA both evaluated his Crohn’s disease under code 7323, colitis, but at different ratings.  The PEB rated 30%, moderate severity, with frequent exacerbations.  The VA rated at 10%, considering the CI’s condition to be generally stable, with infrequent exacerbations.  All Board members agreed the preponderance of evidence did not support a rating higher than the 30% adjudicated by the PEB for moderate disease at the time of placement on TDRL.  The Board next considered the permanent rating at the time of removal from the TDRL, 5 years later (the maximum time allowed by law).  Under code 7323 that was utilized by the PEB at the time of the CI’s separation, a 10% rating requires moderate disease, with infrequent exacerbations.  A 30% rating requires moderately severe disease with frequent exacerbations.  The evidence of treatment records for the 5 years on TDRL reflected one flare treated with corticosteroids in March to June 2000 and a surgery in October 2001 for residual bowel strictures.  At the time of the GI examination in March 2003, proximate to the time of removal from TDRL, the CI was doing well with no additional exacerbations and no laboratory evidence of inflammation, no malnutrition, and mild symptoms of two to three stools.  The Board noted the CI to have no diarrhea, bloody stools or abdominal pain and to be in good general health at the time of removal from the TDRL.  All Board members agreed the evidence of the record more nearly approximated the 10% rating at the time of removal from the TDRL and concluded there was no evidence to support a higher rating.  The Board noted the disease exacerbation requiring oral steroids in the months following removal from TDRL.  Subsequent VA examinations did not document a worsening of the overall disease pattern and the VA rating remained unchanged.  The Board also noted that the VA increased its rating to 20% following the CI’s repeat surgery in October 2001 under code 7328 for loss of small bowel.  Evidence of the records indicated an ileocecectomy with hemicolectomy (large bowel) in 1995 and release of strictures in 2001, however there was no resection of significant portion of the small bowel.  Further, under code 7328 a rating of 20% requires the presence of diarrhea, anemia or inability to gain weight, none of which were evident in the CI’s medical record at the times of placement or removal from TDRL.  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 unfitting condition of Crohn’s disease both at the time of placement on TDRL and permanent disposition at the time of removal from the 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 Crohn’s condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  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
Crohn’s Disease | 7323 | 30% | 10%
RATING | 30% | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 201213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130010947 (PD201201484)

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						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA

PD1201484