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AF | PDBR | CY2012 | PD2012 01153
Original file (PD2012 01153.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201153
BRANCH OF SERVICE: Army  BOARD DATE: 20130416
DATE OF PLACEMENT ON TDRL: 20020128
Date of Permanent SEPARATION: 20030917


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (63B/Vehicle Operator) medically separated for colitis. In 2000, he was diagnosed with ulcerative colitis (UC). He underwent a total proctocolectomy. The CI did not improve adequately to fully perform his military duties, or meet physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The UC condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB found the UC condition unfitting, and placed the CI on the Temporary Disability Retired List (TDRL) with a rating of 30%. In August 2003, a second PEB convened and determined that the colitis condition was sufficiently stable for final adjudication. The colitis condition was found unfitting, and was rated at 10%. The CI made no appeals and was medically separated.


CI’s CONTENTION: The CI elaborated no specific contention in his application.


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 colitis 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 his application, or otherwise outside the Board’s defined scope of review, may be eligible for future consideration by the Army Board for Correction of Military Records.


 RATING COMPARISON :

Final Army PEB - 20030820
 VA (4 mo. Prior to Adjudication Date*) - Effective 20020128
On TDRL - 20020128
 Code Rating Condition Code Rating Exam
Condition
 TDRL Sep.
Ulcerative Colitis, S/P Proctocolectomy 7323-7329 30% 10% GERD & Ulcerative Colitis, S/P Proctocolectomy 7329-7323 30% 20030502
No Additional MEB/PEB Entries.
 Other x 3 20010508
Combined: 30% → 10%
 Combined: 50%
*Reflects VA rating exam proximate to TDRL placement


ANALYSIS SUMMARY:

Ulcerative Colitis. In 2000, the CI developed gastrointestinal (GI) symptoms. Endoscopy was performed, and he was diagnosed with UC. He was treated with medication, but continued to have frequent flare-ups consisting of cramping pain and bloody stools. In January 2001, the CI underwent a total colectomy. He was issued a permanent profile and an MEB was initiated. On 8 May 2001, he had a VA Compensation and Pension (C&P) exam. At that time he was having left lower quadrant (LLQ) abdominal pain on a daily basis. Physical examination (PE) of the abdomen was normal. His MEB clinical evaluation was on 16 July 2001. The CI reported constant lower abdominal discomfort, and frequent loose bloody stools. The abdominal pain fluctuated in severity. PE of the abdomen was essentially normal. Initially, he reported severe LLQ tenderness. However, when distracted during the abdominal exam, he had no pain or noticeable discomfort. In November 2001, the Army PEB found the UC condition unfitting, but not sufficiently stable for final, permanent adjudication. The CI was placed on the TDRL with 30% disability.

In April 2003, the CI had a clinical re-evaluation. He reported that he was doing well since the ilio-anal anastomosis surgery in January 2002. He denied any significant abdominal pain or discomfort. He was having 6-7 small, non-bloody, formed stools daily. He denied any flares of his UC since having the anastomosis surgery. His weight was 128 lbs, which was a return to his weight prior to the UC diagnosis. Abdominal exam was unremarkable. Blood tests revealed a normal complete blood count (CBC) and normal chemistries. He was working full time as a commercial truck driver. He made frequent stops to use the bathroom, or sometimes used a bucket for bowel movements. On 2 May 2003, the CI had a C&P exam. The examiner noted that the CI was in no acute distress. PE of the abdomen was essentially normal. The CI said he was not taking medication for the UC, and he could perform all the basic activities of daily living. The examiner considered the UC condition to be mild.

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Board agreed that there was evidence of fairly significant GI symptoms when the CI was placed on TDRL, and the rating of 30% at that time was appropriate. However, in 2003 he was doing much better. His weight was stable, he was off his colitis medication, and he was working full time as a truck driver. He denied any significant abdominal pain or discomfort, and was having 6-7 small, non-bloody, formed stools per day. Based on the evidence in the service treatment record, the Board determined that IAW VASRD §4.114, a rating of 10% was warranted. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.7 (higher of two evaluations), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the UC, status post GI surgery.


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. 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
TDRL PERMANENT
Ulcerative colitis, status post intestinal surgery 7323-7329 30% 10%
COMBINED
 30% 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120609, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010828 (PD201201153)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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