RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201293 DATE OF PLACEMENT ON TDRL: 19990303 

BOARD DATE: 20130220 DATE OF PERMANENT SEPARATION: 20030429 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty, CPL/E-4, (75B/Personnel Admin Specialist), medically 
separated for ileocolonic Crohn’s Disease (CD) with degenerative joint disease (DJD). Records 
indicate the CI began complaining of abdominal pain in late 1992 and was eventually diagnosed 
with CD with ileocolonic fistulization. She also suffered from DJD, thought to be secondary to 
the Crohn’s ileocolitis. The CI did not improve adequately with treatment to meet the physical 
requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The 
MEB forwarded no other conditions for Informal Physical Evaluation Board (IPEB) adjudication. 
The IPEB adjudicated the CD, status post (s/p) ileocolonic resection with secondary DJD as 
unfitting, rated 30%, with application of the Veteran’s Affairs Schedule for Rating Disabilities 
(VASRD). The CI was placed on the Temporary Disability Retired List (TDRL) with ratings as 
reflected in the chart below. The IPEB re-evaluated the CI in March 2000 and July 2001 and was 
retained on the TDRL. In February 2003, the IPEB rated the CD with DJD at 10%. The CI 
appealed to the Formal PEB (FPEB) which affirmed the IPEB decision. The CI did not concur 
with the FPEB findings and her non-concurrence was reviewed by the U.S. Army Physical 
Disability Agency (USAPDA), which affirmed the FPEB findings. Shortly before final separation, 
the CI filed a Congressional inquiry which was addressed by the USAPDA without a change to 
any findings. She was then medically separated with a 10% disability rating. 

 

 

CI CONTENTION: The application stated “See attached petition from previously retained 
counsel. (no longer represented by an attorney).” The Board reviewed all correspondence 
submitted to the Army Board for Correction of Military Records (ABCMR) on behalf of the CI 
and associated responses. (applications, denials, reconsiderations, etc covering 2006-2008). All 
documents were reviewed by the Board and considered in its recommendations. 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. 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 Army Board for Correction of Military Records. 

 

 

 

 

 

 

 

 

 

 


TDRL RATING COMPARISON: 

 

Service FPEB – Dated 20030402 

VA* – (2 Mo. Prior to Separation) – Effective 19990304 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

20030429 

 

TDRL 

Sep. 

Ileocolonic 
Crohn’s 
Disease w/ DJD 

7399-7323 

30% 

10% 

Crohn’s Disease s/p 
ileocolonic resection 

7323 

30% 

19990106 

Inflammatory Arthritis 
Secondary to Crohn’s 

5009-5002 

20%* 

19990106 
and 

20050301 

.No Additional MEB/PEB Entries. 

 

20020531,20030305, 
and 
20050810 

Other x 5 

Combined: 10% 

Combined: 70%** 



*The VA increased the rating for inflammatory arthritis to 20% effective 5 August 2002. ** Initial VA rating was 40% 

 

 

ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application 
regarding the gravity of her condition and the significant impairment with which her service-
connected condition continues to burden her. It is a fact, however, that the Disability 
Evaluation System (DES) has neither the role nor the authority to compensate members for 
anticipated future severity or potential complications of conditions resulting in medical 
separation. This role and authority is granted by Congress to the Department of Veterans 
Affairs (DVA). The DVA, operating under a different set of laws (Title 38, United States Code), is 
empowered to compensate service-connected conditions and to periodically re-evaluate said 
conditions for the purpose of adjusting the Veteran’s disability rating should the degree of 
impairment vary over time. The Board utilizes DVA evidence proximal to separation in arriving 
at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special 
consideration to post-separation evidence. The Board’s authority as defined in DoDI 6044.40, 
however, resides in evaluating the fairness of DES fitness determinations and rating decisions 
for disability at the time of separation. Post-separation evidence therefore is probative only to 
the extent that it reasonably reflects the disability and fitness implications at the time of 
separation. The Board further acknowledges the CI’s assertions that the PEB’s final decision 
was “nothing more than a money issue” and “was not based on the facts given but their own 
biases;” but, must note for the record that it has neither the jurisdiction nor authority to 
scrutinize or render opinions in reference to such allegations. The Board’s role is confined to 
the review of medical records and all evidence at hand to assess the fairness of service rating 
and fitness determinations at separation, as elaborated above. 

 

Ileocolonic Crohn’s Disease with Degenerative Joint Disease. The PEB combined ileocolonic CD 
and DJD as the single unfitting and solely rated condition, coded analogously to 7323. Although 
this approach complies with AR 635.40 (B.24 f.); the Board must apply separate codes and 
ratings in its recommendations, if compensable ratings for each condition are achieved IAW 
VASRD §4.114 and §4.71a. If the Board judges that two or more separate ratings are warranted 
in such cases, however, it must satisfy the requirement that each ‘unbundled’ condition was 
unfitting in and of itself. Not uncommonly this approach by the PEB reflects its judgment that 
the constellation of conditions was unfitting; and, that there was no need for separate fitness 
adjudications, not a judgment that each condition was independently unfitting. Thus the Board 
must exercise the prerogative of separate fitness recommendations in this circumstance, with 
the caveat that its recommendations may not produce a lower combined rating than that of the 
PEB. The CI was treated for CD symptoms since 1993. She underwent resection of the terminal 
ileum and repair of two internal fistulas in January 1996. A gastroenterology note a year prior 
to separation noted “lots of joint pains and back pain/hip pain” but without any history of 
swelling or redness. The assessment was that arthralgias were associated with the CD, but that 


actual arthritis was not evident. The MEB narrative summary (NARSUM) in October 1998, 4 
months prior to entry of TDRL-entry, noted monthly flare-ups that lasted 1-2 weeks. Diarrhea 
alternating with constipation was not associated with abdominal pain. Nausea was frequent, 
and uncomfortable bloating occurred with every meal. There was no bleeding or weight loss. 
The report also noted “debilitating” DJD involving the back, hips, and knees, probably 
secondary to the CD. Joint discomfort limited physical fitness activity and was treated with 
acetaminophen. She was taking one medication specific for treatment of the inflammatory 
bowel disease (mesalamine), a medication for intestinal spasm (hyoscyamine). The physical 
exam noted a weight of 204 pounds. Right-sided abdominal tenderness was present. Vitamin 
B12 and folate levels were normal, and hemoglobin was 13.4 g/dL (female normal range 12-16 
g/dL). The Erythrocyte Sedimentation Rate (ESR) test (a marker of inflammation) was 28 
(normal to 15). The report cited a normal magnetic resonance imaging study (MRI) of the spine 
in January 1998 and lumbar X-rays which were normal except for scoliosis. Right hip and right 
knee X-rays (July 1997) were also normal. In a separate note on the same day, the NARSUM 
examiner indicated that the CI had been on a profile “since January” for “no PT” due to joint 
pain. A concurrent permanent profile dated 26 October 1998 listed “Crohn’s Disease / 
Inflammatory Arthritis” and stated “Walk at own pace and distance.” At the VA Compensation 
and Pension (C&P) exam in December 1998, 2 months prior to TDRL-entry, the CI reported 
abdominal distention, constipation, diarrhea, nausea, cramping, and constant tiredness. She 
also reported constant back and hip pain since the start of her Crohn’s condition; pain severity 
was described as 7-9 on a 0-10 point scale. The physical exam noted generalized abdominal 
tenderness with mild distention. Posture and gait were normal. The back was non-tender and 
range-of-motion (ROM) was normal with pain at extremes of ROM. Muscle strength and the 
neurologic exam were normal. At the first TDRL re-evaluation NARSUM exam in February 2000 
(11 months after placement on TDRL), the CI reported continued CD symptoms that included 
intermittent bloody diarrhea. She also continued to have back discomfort. The examiner 
considered her to be the same or somewhat worse compared to the time of entry on TDRL. A 
second TDRL re-evaluation NARSUM examiner in April 2001 reported recent treatment with 
oral steroid medication for a flare-up. The CI reported stable back and hip pain. Her 
hemoglobin was 12.9 g/dL. At an outpatient VA gastroenterology follow-up visit on 19 June 
2002 (10 months prior to permanent separation) the CI stated that she experienced two flares 
annually since 1999. Her current complaints were bloating, cramping and diarrhea after eating. 
She experienced occasional nausea and rare vomiting. She reported a good appetite and 
denied weight loss. She continued mesalamine. The abdominal exam was normal, except for 
mild lower quadrant tenderness. Weight was 201 pounds. A rheumatology evaluation 
performed on 28 August 2002 (8 months prior to permanent separation) stated that the CI had 
experienced chronic low back pain (LBP) since basic training in 1992, and that hip, leg, knee, 
foot and ankle pain were a problem “over the past year or so.” She indicated that until 2000 
she was able to remain physically active and walked and worked out in an exercise facility. 
Beginning in 2001 she experienced more soreness and stiffness, but the lower extremity 
symptoms were described as unpredictable “flashes of sudden pain” that radiated from the 
anterior and lateral groin area down the anterior thighs to the knees. The right foot 
experienced numbness relieved somewhat by walking. She noted that her back was more 
painful when the CD was more active. Physical examination reported that hip flexion was 
resisted beyond 100 degrees bilaterally, but internal and external rotation was normal. Knees 
showed no swelling, were not tender and exhibited no crepitus. Ankles were normal. Back 
extension and lateral flexion was normal bilaterally, with pain on extension. Flexion was 
somewhat limited and (14 inches fingertip to floor), and paraspinous muscles were tight and 
tender. The impression was that the CI had chronic LBP and pains in her lower extremities, but 
that there was no indication these symptoms were on the basis of CD-associated inflammatory 
arthritis. The final TDRL NARSUM dictated in January 2003, 4 months prior to permanent 
separation, noted continued abdominal discomfort after eating, stable weight, and no joint 
pain, chills or night sweats. The CI reported variable bowel movement frequency and loose 
stools without bleeding. Symptoms of possible fistula formation were absent. Mesalamine was 


 

The Board directs attention to its rating recommendation based on the above evidence. As 
previously elaborated, the Board must first consider whether DJD remains separately unfitting, 
having de-coupled it from a combined PEB adjudication. In analyzing the intrinsic impairment 
for appropriately coding and rating the DJD condition, the Board is left with a questionable 
basis for arguing that it was indeed independently unfitting. In this regard, the Board 
considered conflicting evidence. The NARSUM examiner stated that “degenerative joint 
disease” was present, and linked this to the CD; and a permanent profile listed “inflammatory 
arthritis” as a reason for restricted activity. However, not only was there no radiographic 
evidence of arthritis, but a gastroenterologist stated there was no physical examination 
evidence of arthritis. The later rheumatology evaluation prior to permanent separation also 
confirmed that inflammatory arthritis associated with CD was not present. This examiner 
furthermore indicated that until 2000 (after placement on TDRL) she remained physically active 
and walked and worked out in an exercise facility; and finally that hip, leg, knee, foot and ankle 
pain were a problem only “over the past year or so” (i.e. since placement on TDRL). After due 
deliberation, the Board agreed that evidence does not support a conclusion that degenerative 
arthritis, as an isolated condition, would have rendered the CI incapable of continued service 
within her MOS; and, accordingly cannot recommend a separate service rating for it. Regarding 
the CD condition, at the time of entry on TDRL, the PEB and the VA assigned a 30% rating under 
the 7323 code (“ulcerative colitis”; analogous coding by the PEB). Board members agreed that 
“moderately severe, with frequent exacerbations” was an accurate description of the clinical 
condition at that time; and that the next higher 60% rating described by “numerous attacks a 
year and malnutrition, the health only fair during remissions” was not reflected in the evidence. 
Next the Board turned its attention to a permanent rating at the time of removal from TDRL. 
Board members readily concluded that objective data showed no evidence of anemia, general 
debility or malnutrition supportive of ratings higher than 30%. In deliberating between the 10% 
(“moderate; with infrequent exacerbations”) and the 30% rating criteria, Board members 
considered the VA gastroenterologist’s letter just prior to separation, which indicated frequent 
loose stools, missed work and an “uncontrolled condition” that could warrant the addition of 
immunosuppressive medication. However, later evidence showed such medication was not 
required; and the same gastroenterologist 10 months previously stated that symptoms were 


limited to bloating and diarrhea after eating, and flares occurred only twice per year. This 
evidence appeared consistent with the NARSUM report, which indicated no recent need for 
steroids or hospitalizations. The Board majority concluded that the evidence at the time of 
permanent separation describes the presence of gastrointestinal symptoms best depicted by 
“moderate, with infrequent exacerbations” under the 7323 code. The Board majority finally 
considered that the only other applicable coding pathway under VASRD §4.114 (7319; irritable 
colon syndrome) likewise did not support a rating higher than 10%. 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 ileocolonic CD with DJD 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 ileocolonic CD condition and IAW VASRD §4.114, the 
Board by a vote of 2:1 recommends no change in the PEB adjudication. The single voter for 
dissent (who supported a 30% rating under code 7399-7319) submitted the appended minority 
opinion. In the matter of the DJD condition, the Board agrees that it cannot recommend a 
finding of unfit for an additional rating at separation. There were no other conditions within 
the Board’s scope of review for consideration. 

 

 

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

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

PERMANENT 

Ileocolonic Crohn’s Disease 

7399-7323 

10% 

Degenerative Joint Disease 

Not Unfitting 

RATING 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120725, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 


MINORITY OPINION: 

 

Based on 4.7 (higher of two evaluations), the minority recommends rating the CI’s condition 
based on 7399-7319 criteria, which should be rated at 30% based on the severity of the CI’s 
diarrhea and frequency of abdominal distress; and, not on the CI’s Crohn’s Disease rated at 10% 
by the majority. 

 

7319 Irritable colon syndrome (spastic colitis, mucous colitis, irritable bowel, etc.): 

Severe; diarrhea, or alternating diarrhea and constipation, with more 

or less constant abdominal distress……………………………………………………………………………30 

 

Focusing on the CI’s diarrhea and abdomen distress conditions during her TDRL period, 4.30 
(reasonable doubt) is applicable. The evidence clearly demonstrates that that the CI did 
experience severe (30%) diarrhea, with more or less constant abdominal distress as specified in 
the 7319 criteria. 

 

A gastroenterology (GI) evaluation, less than a month prior to separation, documented that the 
CI has missed 30 days of work over the last 12 months due to cramping and diarrhea. She also 
requires a restroom in close proximity due to her diarrhea. 

 

An ER visit, approximately a month prior to separation, indicated that the CI had bouts with 
diarrhea and chronic abdominal pain and was prescribed Melamine (anti-inflammatory 
medication). 

 

TDRL NARSUM reevaluation #3, approximately 3.7 months prior to separation, recorded a 
history of significant gas and abdominal bloating after meals as well as discomfort. The 
examiner further documented that the CI’s present condition consisted of abdominal 
discomfort and frequent bowel movements, “which is a typical scenario for individuals with 
long standing CD.” Her CD condition was stable, however, the examiner recommended that the 
CI continue CD medications and a “trial of Levsin or Bentyl to treat gas and cramping pain.” 
This evidence suggests that her symptoms of daily abdominal discomfort and frequent bowel 
movements would continue and require medication therapy to control the symptoms. 

 

The VA GI exam, approximately 9 months prior to separation, noted that the CI’s condition 
worsened with CD flares twice a year, no blood in stool, abdominal pain persistent and “worse 
with flare and made worse after eating with bloating and abdominal cramping… diarrhea after 
eating.” 

 

An Army community hospital visit, approximately 14 months prior to separation, indicated that 
the CI was evaluated with severe abdominal pain (8/10), vomiting, and diarrhea. 

 

An Army community hospital visit, approximately 17 months prior to separation, documented 
severe abdominal pain (10/ 10). 

 

TDRL NARSUM reevaluation #2, approximately 24 months prior to separation, recorded a 
history of “6-8 bowel movements per day after meals, with stools that are rather mushy and 
abdominal pain due to bloating”. The CI’s prognosis for her CD indicated that her CD was not 
stable “with possible flares anywhere from 30% to 80% over the next couple of years.” This 
evidence clearly suggests that her daily abdominal discomfort and frequent bowel movements 
will continue. 

 

TDRL NARSUM reevaluation #1, approximately 38 months prior to separation, recorded a 
history stating, “Over the last year since her board, she has continued to have intermittent 
bloody diarrhea followed by constipation, along with abdominal pain.” “Currently at this time, 


she is a constipation phase of about a week. She does still notes bloating with every meal.” 
Additionally, her present condition states, “Currently she is noting exacerbations of her disease, 
constipation followed by bloody diarrhea every few weeks. When the diarrhea starts, she does 
have four to five bowel movements a day.” “She has had recurrences and symptomatically is 
the same if not somewhat worse than when her board started.” 

 

The fact that over 3 years after being placed on TDRL, there is evidence that the CI still had 
severe symptoms of diarrhea and frequent if not daily abdominal distress, clearly proves a 30% 
rating should be rendered under 7399-7319. 

 

I respectfully submit that the Secretary consider the following Minority recommendation in this 
case: 

 

The Minority Opinion member recommends that the CI’s prior determination be modified as 
follows; and, that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of her prior medical separation. 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

PERMANENT 

Ileocolonic Crohn’s Disease 

7399-7319 

30% 

Degenerative Joint Disease 

Not Unfitting 

COMBINED 

30% 



 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXX, AR20130006065 (PD201201293) 

 

 

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 XXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)