RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02231
BRANCH OF SERVICE:  Army	BOARD DATE:  20141008
Separation Date:  20050412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (42L/Administration) medically separated for a Crohn’s disease condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) but could perform a modified physical fitness test.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The Crohn’s disease condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The informal PEB adjudicated “Crohn’s disease status post right hemicolectomy” as unfitting, rated 10%.  The CI appealed to the Formal PEB which affirmed the PEB finding and rating.

CI CONTENTION:  “Veteran has Crohn's disease, which was not diagnosed as frequently but only as occasionally.”

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 condition is addressed below; 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 FPEB – Dated 20050202	Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease	7399-7323	10%	Crohn’s Disease	7328-7323	10%*	STR	
Other x 0 (In scope)	Other x 11	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20050809 (most proximate to date of separation)
Increased to 30% by VARD dated 20121104 effective 20120112

ANALYSIS SUMMARY:  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.  The Board considers VA evidence within 12 months only to the extent that it reasonably reflects the disability at the time of separation.
Crohn’s Disease Condition.  The CI initially presented with possible appendicitis which was ruled out in September 1999.  He reported a 2-year history of intermittent right lower quadrant abdominal pain and loose stools.  In July 2002, he presented with severe abdominal pain and during surgical exploration, he was found to have an intestinal perforation secondary to Crohn’s disease and underwent a resection of his right colon.  In August 2002, the CI had a follow-up colonoscopy which showed an ulcer in the small intestine.  He was followed by gastroenterology (GI) routinely and GI noted that since his surgery he complained of some constipation and nausea.  An upper GI series with a small bowel follow-through showed recurrent Crohn’s disease in the distal portion of the small bowel.  To manage the Crohn’s disease, the CI was started on a treatment regimen of Asacol (anti-inflammatory drug for inflammatory bowel disease).  The GI noted that despite some mild tenderness he continued to do well.  The GI added Remicaid (a drug for auto-immune disorders) infusions with maintenance doses done every 8 weeks along with Purinethol (immunosuppressive drug).  Throughout 2003, the CI continued on a treatment regimen of Remicaid infusions and dosage adjustments to the Asacol and Purinethol.  The CI did well for the next 11 months noting regular bowel movements with occasional constipation and minimal right lower quadrant tenderness without rebound.

The commander’s statement indicated that the CI’s physical condition interfered with his MOS performance in that he could not take a pulmonary function test and he could have difficulty with heavy lifting due to his abdominal surgeries.  

The MEB narrative summary exam (approximately 10 months prior to separation), documented that the CI was clinically stable, had normal bowel function but would complain of occasional twinges of abdominal pain two to three times per week.  His treatment regimen remained the same and the American Medical Association pain rating was “minimal and occasional.”  The GI note (obtained less than 2 months prior to separation), documented that the CI had minimal right lower quadrant pain and had bowel movements two to three times daily and that he was doing well with his treatment regimen.  

The CI did not have a VA Compensation and Pension exam for his Crohn’s disease until 7 years after separation which resulted in a rating increase to 30% for the Crohn’s disease.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the Crohn’s disease condition as code 7399 analogous to code 7323 (uncreative colitis) and rated at 10% (moderate) with infrequent exacerbations.  The VA applied the combination code of 7328 (resection of small intestine) with 7323 and also rated the Crohn’s disease at 10% based on the STR.  The Board considered the criteria for 10% versus the 30% rating which is “moderately severe; with frequent exacerbations.”  All documents in the STR proximate to separation noted that the CI’s condition was stable and he was doing well with his treatment regimen.  The MEB examiner rated the pain as minimal and occasional.  The VA also rated the condition at 10% effective the day after separation using the STRs.  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 Crohn’s disease condition.

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.  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 20131106, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150004772 (PD201302231)

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						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA