RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02687
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150722
SEPARATION DATE:  20060515	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was active duty O-2 (Communications and Information Officer) medically separated for Crohn’s disease.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standards.  She was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB).  The “Crohn’s disease” condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “Crohn’s disease” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.   

CI CONTENTION:  “Condition has worsened over time as documented by VA to include surgery in 2012.  Others with this condition have a rating above 10%.  Chronic Pain.”  [sic] 

 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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:    

 IPEB – Dated 20060301	VA* - (~4 Mos. Pre/Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Crohn’s Disease…	7399-7323	10%	Crohn’s Disease	7399-7323	10%	20060913	
Other x 0 	Other x 2	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20061206 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Crohn’s Disease.  The CI presented in September 2005 with a month history of fatigue and abdominal distress.  She was begun on medications (Asacol and Prednisone) for a presumptive diagnosis of inflammatory bowel disease (which includes Crohn’s disease) during her evaluation.  Subsequently, a colonoscopy and tissue examination confirmed the diagnosis of Crohn’s disease.  Although she continued to do well in garrison, as reported by her commander on 19 January 2006, she was not deployable with this diagnosis and entered into the MEB process.  The narrative summary (NARSUM) was dated 7 February 2006, 3 months prior to separation.  It noted that she had multiple visits to the emergency room and had been admitted twice prior to her diagnosis (and treatment).  At the time of the dictation, she was not yet pain free, but was on a tapering dose of medications (Prednisone).  Her weight was within 2 pounds of her accession weight and extra-intestinal manifestations of Crohn’s disease were absent.  She was noted to be in no acute distress.  

At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI reported that she remained on Asacol, but had been tapered off the Prednisone.  She took daily fiber and vitamins, but had no dietary restrictions.  She did report that her symptoms were aggravated by stress, dairy products, wheat, beef and pork.  On examination, her weight remained stable and her examination was unremarkable for manifestations from the Crohn’s disease.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the Crohn’s disease at 10%, coded 7399-7323 (analogous to ulcerative colitis).  The Board found no better coding option to describe her condition.  It also observed that she was essentially asymptomatic and off of Prednisone by the time of the VA C&P.  She reported symptoms with some foods, but had no specific restrictions.  Her commander noted that she functioned well in garrison.  The description for a 10% level of disability is “moderate; with infrequent exacerbations.”  The Board found no route to a higher rating using this or any other code.  It observed that the VA retained this rating when the CI was reconsidered 2 years after 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 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 20131217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXX

Dear XXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02687.

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,

XXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR