RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

BRANCH OF SERVICE:  MARINES 
SEPARATION DATE:  20030715 

 
NAME:  XX 
CASE NUMBER:  PD1201029 
BOARD DATE:  20130201 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty LCpl/E-3 (0861/Artillery Scout Observer), medically 
separated  for  irritable  bowel  syndrome  (IBS),  diarrhea  predominant.    After  initial  onset  of 
symptoms in early 2002 he was treated with medication and surgery.  Despite this course of 
treatment the CI could not be adequately rehabilitated to meet the requirements of his Military 
Occupational  Specialty  (MOS)  or  physical  fitness  standards.    He  was  consequently  placed  on 
limited  duty  and  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB  made  four 
diagnoses;  1)  IBS,  diarrhea  predominant;  2)  Chronic  functional  abdominal  pain;  3)  Chronic 
diarrhea;  and  4)  Status  post  (s/p)  hemorrhoidectomy  with  subsequent  fecal  and  urinary 
urgency.  No other conditions were submitted by the MEB.  The Physical Evaluation Board (PEB) 
adjudicated  “Irritable  bowel  syndrome,  diarrhea  predominant”  as  Category  I  (unfitting)  and 
rated 0%.  The PEB determined MEB Diagnoses 2 and 3 (Chronic functional abdominal pain and 
chronic diarrhea) were Category II (conditions that contribute to the unfitting condition) and 
Diagnosis  4  (s/p  hemorrhoidectomy  with  fecal  and  urinary  urgency)  was  Category  III  (not 
separately unfitting and do not contribute to unfitting conditions).  The CI made no appeals, 
and was medically separated with that 0% disability rating.   
 
 
CI CONTENTION:  “Medical condition never solved, only treatment for symptoms.  I have and 
continue to have incurred additional medical expenses for additional medical evaluation” [sic].   
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of  Defense Instruction  (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 rating for the unfitting IBS is addressed below.  MEB diagnoses 
2,  3,  and  4  (chronic  functional  abdominal pain, chronic  diarrhea,  and  s/p  hemorrhoidectomy 
with  fecal  and  urinary  urgency),  which  were  adjudicated  as  not  unfitting  by  the  PEB,  are 
likewise addressed below.  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 Board for the Correction of Naval Records. 
 
RATING COMPARISON:   
 

VA (6 Mo. Post-Separation) – Effective 20030716 

Condition 

Code 

Rating 

Exam 

Service PEB – Dated 20030515 
Code 
Condition 
7319 

Rating 

0% 

Irritable bowel syndrome, 
diarrhea predominant 
Chronic diarrhea 
Chronic functional abdominal 
pain 
Status post hemorrhoidectomy 
with subsequent fecal and 
urinary urgency 

Cat II 
Cat II 

Irritable bowel syndrome (claimed 
as abdominal pains, chronic 
diarrhea and transverse colon) 

7319 

10% 

20031117 

Cat III 

S/P Hemorrhoidectomy 

7336 

0% 

20031113 

↓No Additional MEB/PEB Entries↓ 

Combined:  0% 

Bilateral Hearing Loss  

6100 

NSC 

20031113 

Combined:  10% 

ANALYSIS SUMMARY:  The abdominal symptoms, disability and rating of the chronic IBS with 
diarrhea  predominant,  chronic  abdominal  pain  and  the  fecal  and  urinary  urgency  following 
hemorrhoidectomy  were  not  separable  for  rating  purposes  and  are  combined  in  a  single 
analysis  section  below.    The  hemorrhoid  condition  itself  is  discussed  separately  IAW  VASRD 
§4.114, Schedule of ratings—digestive system.   
 
Abdominal Condition (Including Chronic irritable bowel syndrome with diarrhea predominant, 
chronic abdominal pain, and fecal and urinary urgency s/p hemorrhoidectomy).  The narrative 
summary  (NARSUM),  (3  months  prior  to  separation)  noted  a  chief  complaint  of  chronic  soft 
bowel  movements  since  Feb  2002  without  pain  and  with  scant  blood.    Abdominal  CT  scan, 
blood and stool evaluations, esophagogastroduodenoscopy (EGD), small bowel follow through, 
colonoscopy  with  biopsy  were  essentially  normal.    Despite  treatment  with  medications,  the 
member  still  noted  increased  frequency  of  stools  (3-5  times/day)  and  abdominal  discomfort 
with exercise.  His hematochezia (scant blood in stools) resolved after the hemorrhoidectomy 
surgery 5 months prior to separation.  Following surgery the CI complained of occasional fecal 
incontinence and urgency as well as urinary incontinence and urgency.  He tried to increase his 
physical exertion level at several points in the 6 months prior to his MEB and each attempt was 
met  with  increasing  abdominal  discomfort  and  stool  frequency.    Physical  examination  was 
without  abnormalities  including  abdominal  examination  which  was  noted  to  show  “soft, 
nontender, nondistended, normoactive bowel sounds.”  Follow-up treatment notes found no 
recurrent hemorrhoids.   
 
The  VA  Compensation  and  Pension  (C&P)  exam  (6  months  after  separation)  indicated 
complaints of fecal urgency especially with physical exertion and that the CI was taking several 
medications  for  this  condition.    Abdominal  examination  was  normal  and  there  was  good 
sphincter  tone  with  no  abnormalities  noted  at  the  rectal  area.    There  was  no  evidence  of 
recurrent hemorrhoids.  The examiner’s diagnosis was IBS  with chronic functional abdominal 
pain,  and  occasional  diarrhea  under  control  with  intestinal  sedatives.    The  Board  noted  that 
page 1 of the C&P exam was missing from the record and attempts to retrieve this information 
were made.  The VA rating determination supplied the missing history in adequate detail.   
 
The Board directs attention to its rating recommendation based on the above evidence.  Both 
the PEB (0%) and VA (10%) rated the CI’s abdominal conditions under the disability code 7319, 
Irritable  colon  syndrome  (spastic  colitis,  mucous  colitis,  etc.).    The  Board  deliberated  on  the 
severity  and  frequency  of  the  CI’s  bowel  function  and  abdominal  distress.    Although  the 
NARSUM indicated fecal and urinary incontinence on occasion, it was referenced in context of 
post-operatively  and  there  were  no  other  notes  indicating  continued  incontinence.    The  VA 
evidence also indicated decreased symptoms post-separation.  There was insufficient evidence 
for either severe symptoms or “more or less constant abdominal distress” (40%).  The Board 
considered  that  the  disability  picture  in  the  treatment  records  more  closely  approached  the 
level of “Moderate; frequent episodes of bowel disturbance with abdominal distress (10%) than 
the “Mild; disturbances of bowel function with occasional episodes of abdominal distress” (0%) 
level.   
 
After due deliberation, considering all of the evidence and mindful of VASRD §4.7 (higher of 
two  evaluations),  the  Board  recommends  a  disability  rating  of  10%  for  the  IBS  with  chronic 
abdominal pain and diarrhea condition.   
 
Contended  PEB  Condition  (Status  post hemorrhoidectomy  with  subsequent fecal  and urinary 
urgency).    Any  abdominal  disability  from  this  condition  was  appropriately  considered  as  a 
comprehensive  abdominal  condition  under  the  CI’s  unfitting  7319  abdominal  condition 
discussed above.  The Board’s main charge with respect to the hemorrhoidectomy condition is 
an assessment of the fairness of the PEB’s determinations that it was not unfitting or separately 
compensable.  The Board’s threshold for countering fitness determinations is higher than the 

2                                                           PD1201029 
 

VASRD  §4.3  (reasonable  doubt)  standard  used  for  its  rating  recommendations,  but  remains 
adherent to the DoDI 6040.44 “fair and equitable” standard.   The hemorrhoid condition (s/p 
hemorrhoidectomy) was reviewed by the action officer and considered by the Board.  The CI 
had  surgical  removal  of  internal  hemorrhoids  and  there  was  no  evidence  of  post-surgery 
recurrence in the treatment records or proximate VA records.  There was good sphincter tone.  
There was insufficient evidence that the condition significantly interfered with satisfactory duty 
performance, aside from as it was considered in the abdominal condition as noted above.  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 s/p hemorrhoidectomy 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  chronic  abdominal  pain  condition  (encompassing  IBS, 
diarrhea predominant; including diarrhea and abdominal pain, with fecal and urinary urgency 
s/p hemorrhoidectomy), the Board by a vote of 2:1 vote recommends a disability rating of 10%, 
coded  7399-7319,  IAW  VASRD  §4.114.    The  single  voter  for  dissent  (who  recommended  no 
change in the PEB determination) did not elect to submit a minority opinion.  There were no 
other conditions within the Board’s scope of review for consideration.   
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows, effective as of the date of his prior medical separation:   
 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120615, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans Affairs Treatment Record. 
 
 
 
 
 
 
 
 
 

 

           xx 
           Acting Director 
           Physical Disability Board of Review 

UNFITTING CONDITION 

Irritable bowel syndrome, diarrhea predominant; including 
diarrhea and abdominal pain, with fecal and urinary urgency s/p 
hemorrhoidectomy  

VASRD CODE  RATING 

7399-7319 

COMBINED 

10% 

10% 

3                                                           PD1201029 
 

      

             

                                       

b. former USMC:  Disability retirement with a final disability rating of 30 percent 

a. former USMC:  Disability separation with a final disability rating of ten (10) percent 

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS 
 
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS           
 
Ref:   (a) DoDI 6040.44 
          (b) PDBR ltr dtd 11 Feb 13 ICO 
          (c) PDBR ltr dtd 7 Feb 13 ICO   
          (d) PDBR ltr dtd 27 Feb 13 ICO   
          (e) PDBR ltr dtd 7 Mar 13 ICO   
                                         
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of 
Review set forth in references (b) through (d). 
 
2.  The official records of the following individuals are to be corrected to reflect the stated 
disposition: 
 
 
(increased from zero percent) with entitlement to disability severance pay effective 5 April 2002.  
 
 
(increased from 20 percent) with retroactive placement on the Permanent Disability Retired List 
effective 31 January 2002. 
 
 
c.  former USMC:  Disability separation with a final disability rating of ten (10) percent 
(increased from 0 percent) with entitlement to disability severance pay effective 15 July 2003. 
 
 
(increased from 20 percent) with retroactive placement on the Permanent Disability Retired List 
effective 31 July 2003. 
 
3.  Please ensure all necessary actions are taken, included the recoupment of disability severance 
pay if warranted, to implement these decisions and that subject members are notified once those 
actions are completed. 
 
 
 
 
 
 
 

  xx 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

d. former USMC:  Disability separation with a final disability rating of 40 percent 

 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

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