RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01787
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140626
SEPARATION DATE:  20051024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (1N1/Imagery Analysis Craftsman) medically separated for Crohns disease.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB).  The Crohns disease condition, characterized as medically unacceptable was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated Crohn’s disease as unfitting rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II conditions. The CI made no appeals and was medically separated.

CI CONTENTION:  “My Crohn’s is worse than at the time of separation and I frequently miss work due to flare ups, which occur more frequently.  Also my knees & carpal tunnel have worsened to the point of the ability to use my hands for short periods of time.” 

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 Crohns disease, condition is addressed below; as well as contended conditions of carpal tunnel and knee pain; 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.

RATING COMPARISON:

Service IPEB – Dated 20050830	VA1 - (3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7399-7323	10%	200601302	
Carpal Tunnel Syndrome	8699-8615	Cat II	Right Carpal Tunnel Syndrome	8515	0%	200601302	
			Left Carpal Tunnel Syndrome	8515	NSC	200601302	
Patellofemoral Syndrome	5099-5003	Cat II	PFS, Right Knee	5299-5257	0%	200601302	
			PFS, Left Knee	5299-5257	0%	200601302	
Other x 0 (Not in Scope)	Other x 3 (Not in Scope)	200601302	
Combined:  10%	Combined:  10%	
1  Derived from VA Rating Decision (VARD) dated 20060410 (most proximate to date of separation (DOS))
2.  VA C&P exam dated 20060130 most proximate to DOS was not in evidence; therefore, the Board utilized VARD 20060410 which contained the exam’s notes

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him.  The Board acknowledges the CI’s contention that suggests a higher rating should have been granted on the unfitting medical condition documented at the time of separation.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

The Board noted the absence of the VA Compensation and Pension (C&P) exam from the record performed most proximity to the date of separation.  The Board further noted that the VARD referenced the results of this exam in the explanation of its rating decision.  Members deliberated if the absence of the original VA document would negatively impact their ability to render a fair assessment.  The Board unanimously agreed that the evidence referenced in the available VARD was sufficiently probative such that the missing document would not materially affect the Board’s final recommendation.

Crohn’s Disease Condition.  The CI was referred to a gastroenterologist on 6 September 2001 for a history of chronic abdominal pain, nausea, vomiting and diarrhea.  He reported that at age 17, he had been diagnosed with irritable bowel syndrome (IBS) after an extensive work up for a one-year history of intermittent rectal bleeding.  He was again evaluated with X-ray studies and endoscopy (viewing the bowel with a lit fiber-optic instrument) of the small and large intestine with biopsies of the tissue.  He was suspected of having Crohn’s disease, but no definitive diagnosis could be made.  The CI reported a partial response to Asacol, a medication used to treat Crohn’s disease.  He did have one episode of a partial small bowel obstruction in January 2005, just over 9 months prior to separation.  He was issued a P4 profile on 21 May 2005 and noted to be in the MEB process.  The narrative summary (NARSUM) was accomplished on 29 July 2005, 3 months prior to separation.  The CI did not have a firm diagnosis of Crohn’s disease despite multiple studies and it was also noted that IBS remained a possible diagnosis.  However, he did have a family history of Crohn’s disease in one grandmother.  On examination, the oral ulcers or skin problems associated with inflammatory bowel disease (such as Crohn’s) were not present.  The working diagnosis was Crohn’s disease.  The VA C&P exam was performed 3 months after separation on 30 January 2006, but is not in evidence.  The VA rater recorded some of this examination on the 10 April 2006 rating decision.  The CI reported a loss of 5 days of work over the previous 12 months and that he was allowed to work from home when symptomatic.  The abdomen was tender in the right upper quadrant, a chronic problem.  There were no extra-gastrointestinal signs of Crohn’s disease present.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both assigned a 10% disability rating for infrequent exacerbations, analogously using the code 7323 (ulcerative colitis).  The Board determined that the criteria for the next higher rating, moderately severe with frequent exacerbations, were not met.  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 Crohns disease condition.

Contended PEB Conditions. The CI also contended for the bilateral knee condition and for bilateral carpal tunnel syndrome.  The Board’s main charge is to assess the fairness of the PEB’s determination that these conditions were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Neither condition was specifically profiled at the time of separation nor implicated in the commander’s statement.  While the commander did not cite the Crohn’s disease either, he commented on the CI’s condition rather than conditions in his letter.  Neither contended condition was judged to fail retention standards and neither was addressed by the MEB or in the NARSUM, other than under past medical history.  Both were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance in the year prior to separation.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination either contended conditions and so no additional disability ratings are recommended.

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 condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral carpal tunnel and patella-femoral syndrome conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01787.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

	
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings