RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                  BRANCH OF SERVICE:  marine corps
CASE NUMBER:  PD201000525               SEPARATION DATE:  20090601
BOARD DATE:  20110315             TDRL DATE:  20070531
___________________________________________________________________________

SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual (CI) was an active  duty  2LT,  (9901,
Basic Officer) medically separated from the Marine Corps in 2009  after  one
year of service.  The  medical  basis  for  the  separation  was  ulcerative
proctitis.  The CI was diagnosed with acute colitis in May 2006, just  prior
to graduation from the  Naval  Academy.   Based  on  the  premise  that  the
condition might be temporary and self-limiting, it  was  determined  the  CI
was  fit  for  full  duty  and  commissioning.   The  CI  was  treated  with
medications but  continued  to  have  symptoms  once  on  active  duty.   In
December 2006, the CI was diagnosed with chronic ulcerative proctitis  which
precluded his attendance at the Marine Officer Basic School (TBS).   He  was
placed on limited duty and referred to the Medical Evaluation  Board  (MEB).
The MEB referred chronic ulcerative proctitis  to  the  Physical  Evaluation
Board (PEB) as medically unacceptable  IAW  SECNAVINST  1850.4E.   No  other
conditions appeared on the NAVMED 6100/1 or  in  the  Disability  Evaluation
System (DES) packet.  The informal PEB adjudicated the ulcerative  proctitis
condition as unfitting.  The CI  was  placed  on  the  Temporary  Disability
Retired List (TDRL) effective June 1, 2007 with  a  30%  disability  rating.
On re-evaluation in December 2008, the CI was believed  to  be  sufficiently
stable for final adjudication.  The chronic ulcerative  proctitis  condition
rating was lowered to 10%.   The  CI  appealed  to  the  Reconsideration-PEB
without change to the original adjudication, and was removed from  the  TDRL
with a 10% disability rating.
_________________________________________________________________________

CI CONTENTION:  The CI states: “I believe my condition should  be  rated  at
30%.  All the information I have gathered  says  with  the  condition  I  am
suffering from (ulcerative proctitis/colitis) deserves to  be  at  30%.   My
condition is chronic and has not gone away since I was  diagnosed  with  it.
I got my rating back from the VA and they rated me at 30%.”
__________________________________________________________________________

RATING COMPARISON:

|Service Reconsideration PEB -    |VA (2 weeks prior to TDRL) –         |
|20090213                         |Effective 20070601                   |
|Condition                        |Code                        |Rating  |
|Final Combined:  10%             |TOTAL Combined:  10%                 |


*Increased 7323 to 30% effective 20090416
________________________________________________________________

ANALYSIS SUMMARY:  The Board acknowledges the  sentiment  expressed  in  the
CI’s application regarding the significant impact that his  service-incurred
chronic condition has had on his current  quality  of  life.   The  inferred
indication that he had not improved over the course of his TDRL  period  can
be both supported and questioned  by  various  provider  notes.   The  Board
takes the position that  subjective  improvement  or  worsening  should  not
influence its coding and rating recommendation at the  time  of  separation.
It is recognized, in fact, that PEBs across the Services sometimes apply  an
overly generous initial rating in order  to  meet  the  requirement  of  30%
disability for placement on TDRL.  This is in the member’s best interest  at
the time and does not mean that a final lower rating is unfair, even if  the
applicant does not  perceive  any  improvement.   The  sole  basis  for  the
Board’s recommendation  is  the  optimal  VASRD  rating  for  disability  at
separation, and the VA examinations proximal to  separation  are  considered
in arriving at its recommendations.

Ulcerative Proctitis.  There are several exams in evidence which  the  Board
weighed in arriving at a final rating determination.   In  addition  to  the
MEB exam at the time of TDRL placement, there is  a  concurrent  initial  VA
rating exam, a TDRL exam conducted six months prior to exit from  TDRL,  and
a final VA rating exam conducted two weeks prior to exit from  TDRL.   There
is also an examination documented by the CI’s  civilian  gastroenterologist,
four months prior to exit from TDRL.  The first three exams  all  documented
similar histories; however, the final VA rating exam differed  significantly
in terms of severity of symptoms.  The PEB and the VA used the  same  coding
option for this condition, coding for ulcerative  colitis,  but  arrived  at
different ratings based upon dissimilar histories at time of separation.

The initial MEB and VA exams, at time of entry into  TDRL,  both  documented
moderate symptoms which would rate no higher than 10% IAW VASRD §4.114.   At
the time of the initial MEB exam, the CI complained of bright red  blood  in
his stools, but denied any weight loss, tenesmus  or  abdominal  pain.   His
laboratory studies were all normal and the examiner concluded that the  CI’s
“symptoms are minimal and can be well controlled with his  medication.”   At
the VA exam  two  weeks  prior  to  TDRL  entry,  the  CI  endorsed  similar
symptoms.  The VA assigned a rating of 10% based  upon  mild  symptoms  that
were managed with medication.

On the TDRL re-evaluation exam, six months prior to exit from TDRL,  the  CI
denied bloody stools, abdominal pain, unintentional weight  loss  or  extra-
intestinal manifestations of inflammatory bowel disease.  The CI was  having
formed stools, had not had any fecal accidents and was  working  full  time.
It was determined that the chronic ulcerative  proctitis  condition  was  in
remission,  well-controlled  with   medication   and   not   affecting   him
occupationally.  The exam with his gastroenterologist, four months prior  to
separation, documented  a  similar  clinical  course  with  the  CI  denying
abdominal cramping or urgency.  The CI reported having three  small,  normal
stools per day, with occasional blood streaking.  The  CI  did  not  endorse
any unintentional weight loss complaints at this exam.  The PEB  noted  that
the CI “could potentially be considered fit.”

Conversely, at the VA final rating exam, two weeks prior to being  finalized
from TDRL, the CI reported worsening symptoms.   He  complained  of  six  to
seven stools per day, with blood, occurring approximately five days  out  of
each month.  The CI also reported  abdominal  pain  and  a  20-pound  weight
loss.  He estimated having “bad days” 60 – 70 times  per  year,  but  stated
that he had not had to miss work due to his condition.  The  CI  denied  any
hospitalizations and his laboratory studies were within normal  range.   The
examiner opined that it was “at least as likely as  not  that  his  service-
connected condition” had increased in severity, and the VA  assigned  a  30%
rating on the basis of this examination.

The Board turns its attention to the permanent rating recommendation on  the
basis  of  the  evidence  presented.    The   most   proximate   source   of
comprehensive evidence on which to base the permanent rating  recommendation
is the final VA rating exam two weeks prior to  exit  from  TDRL.   However,
the Board found this examination to be of limited probative  value  for  the
following reasons:  1) The symptom severity reported by the CI at this  exam
was inconsistent with all of the other prior exams;  and  2)  there  was  no
objective evidence to lend credibility to  the  CI’s  claims  of  moderately
severe symptoms.  The CI had no associated laboratory  abnormalities,  there
was no documentation of worsening by his  gastroenterologist  and  the  CI’s
report of a 20-pound weight loss was not supported  in  the  medical  record
with weights documented May 2007 – 215 pounds, December 2008 –  208  pounds,
and May 2009 – 210 pounds.  Finally, despite the reported  severity  of  his
symptoms, the CI had not had to miss  any  work  or  be  hospitalized.   The
Board felt that the history reported at the  VA  separation  exam  may  have
reflected a natural tendency to  exaggerate  symptoms  under  the  secondary
gain pressure of  VA  rating  examinations.   Therefore,  the  Board  placed
highest probative value on the TDRL exam, six  months  prior  to  exit  from
TDRL combined with the report of the CI’s  gastroenterologist,  four  months
prior to exit from TDRL.  Both of these exams documented a  stable  clinical
course with mild to moderate symptoms and  infrequent  exacerbations,  well-
controlled with medications.  There was no  evidence  to  indicate  the  30%
rating: “moderately severe;  with  frequent  exacerbations.”   All  evidence
considered, there is not reasonable doubt in the  CI’s  favor  supporting  a
change  from  the  PEB’s  rating  decision  for  the  ulcerative   proctitis
condition.

Other Conditions.  No other conditions were noted in the narrative  summary,
identified by the CI on the MEB physical, or  found  elsewhere  in  the  DES
file.  No other conditions were contended in the application  and  no  other
conditions were service connected  with  a  compensable  rating  by  the  VA
within 12 months of separation.   The  Board  therefore  has  no  basis  for
consideration of any other conditions eligible for additional rating at  the
time of separation.


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 ulcerative proctitis  condition,  the  Board
unanimously recommends no change in the permanent separation rating  of  10%
coded 7323 IAW VASRD §4.114.  The Board unanimously agrees that  there  were
no  other  conditions  eligible  for  Board  consideration  which  could  be
recommended as additionally unfitting for rating at separation.
____________________________________________________________________________
__

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

|UNFITTING CONDITION                   |VASRD CODE  |TDRL    |PERMANENT  |
|                                      |            |RATING  |RATING     |
|Ulcerative Colitis                    |7323        |30%     |10%        |
|COMBINED    |30%     |10%        |


____________________________________________________________________________
__

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20100415, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.





                                        Deputy Director
                                                                    Physical
Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL
                                        OF REVIEW BOARDS

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION


Ref:   (a) DoDI 6040.44
                   (b) PDBR ltr dtd 8 Apr 11

      I have reviewed the subject case pursuant to reference (a) and, for
the reasons set forth in reference (b), approve the recommendation of the
Physical Disability Board of Review xxxxxx records not be corrected to
reflect a change in either his characterization of separation or in the
disability rating previously assigned by the Department of the Navy’s
Physical Evaluation Board.



                                        Assistant General Counsel
                                          (Manpower & Reserve Affairs)