RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02194
BRANCH OF SERVICE:  Army	BOARD DATE:  20150204
SEPARATION DATE:  20060620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-3 (Health Service Officer) medically separated for ulcerative colitis (UC).  The UC could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “ulcerative colitis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “ulcerative colitis” 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:  “Please consider all conditions.”

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 Veterans Affairs Schedule for Rating Disabilities (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 20060224	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis	7323	10%	20060913	
Other x 0 (Not In Scope)	Other x 6 	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20070130 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Ulcerative Colitis.  The narrative summary notes the CI experienced episodes of abdominal pain and bloody diarrhea since April of 2002.  The symptoms began while the CI was deployed and continued until January 2003 and there was a period of symptom remission during pregnancy.  The CI was seen again in May 2004 for recurrence of the symptoms and had colonoscopy on 18 June 2004, which diagnosed UC.  The CI was treated with specific medication for UC (Sulfasalazine).  Following the diagnosis and initiation of treatment two treatment notes in the service treatment record indicated the CI continued to report abdominal cramping with intermittent loose stools, without bleeding, and abdominal tenderness was noted on one of the two examinations.  Abdominal computed tomography (CT) in June 2004 was normal.

At the MEB examination performed in January 2006, the CI reported episodes of generalized abdominal pain three to four times per day and bouts of bloody diarrhea every few weeks.  The MEB physical exam noted a normal abdominal examination without tenderness.  A complete blood count indicated the CI was not anemic.  A handwritten attachment to the DD Form 2807 by the CI, dated 23 January 2006, indicated UC medications had recently been changed or added, but new medications were discontinued due to side-effects.

At the VA Compensation and Pension (C&P) examination on 13 September 2006 performed 3 months after separation, the CI reported that she had been off medication for 6 months and symptoms of loose stool, fatigue, decreased appetite and weight loss returned.  The CI restarted her medication in August 2006 and noted abdominal pain and diarrhea without bleeding at the C&P.  The abdominal examination was normal, without tenderness.  Under separate heading of C&P examination intestines, apparently the same day, the history noted episodic diarrhea and abdominal pain less than weekly, with eight to twelve attacks per year, lasting 4 days.  On examination the CI noted mild weight gain and there was no abdominal tenderness or evidence of anemia.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the UC condition 10%, coded 7323 (ulcerative colitis)  The Board noted that the criteria for rating under 7323 are subjective and described as moderate UC, with infrequent exacerbations for 10% and moderately severe UC, with frequent exacerbations for the next higher evaluation of 30%.  The Board deliberated whether the evidence in record was sufficient to support the 30% rating.  However, at the C&P exam the CI reported once monthly attacks of UC for less than a week, despite being off medication for 6 months and having restarted medication approximately 6 weeks prior to the examination.  The Board also noted that the CI’s report of not taking medication for 6 months prior to August 2006 indicated that she may not have been taking her medication regularly prior to separation.  This may have been an unintended consequence of the noted medication adjustments on the DD Form 2807.  In any case, there was no evidence of anemia to support significant effects due to bleeding, or weight loss to suggest significant loss of appetite or difficulty with absorption of nutrients due to diarrhea.  The Board concluded that the disability due to the UC at the time of separation was best described as moderate and did not meet the 30% evaluation for moderately severe UC.  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 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 UC 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 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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, AR20150010560 (PD201402194)
.

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