RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

  BRANCH OF SERVICE:  ARMY 
 
TDRL ENTRY:  19981117 
SEPARATION DATE:  20030219 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1201217 
BOARD DATE: 20130215 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SGT/E-5  (12C2P/Bridge  Crew  Chief),  medically 
separated for  Crohn’s  disease.    The  CI  had  a  sudden  onset  of  right  lower  quadrant  pain  and 
diarrhea in 1997 and was diagnosed with Crohn’s disease.  He received two surgical procedures, 
but did not improve adequately to meet the physical requirements of his Military Occupational 
Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3 profile and 
referred for a Medical Evaluation Board (MEB).  Crohn’s disease was forwarded to the Informal 
Physical  Evaluation  Board  (IPEB)  as  medically  unacceptable  IAW  AR  40-501.    The  MEB 
forwarded  no  other  conditions  for  IPEB  adjudication.    The  IPEB  adjudicated  the  Crohn’s 
condition as unfitting, rated 30%, with application of the Veteran’s Affairs Schedule for Rating 
Disabilities (VASRD).  The CI was placed on Temporary Disability Retired List (TDRL) with ratings 
as reflected in the chart below.  Nearly 4 years later, the Formal PEB (FPEB) adjudicated the 
Crohn’s condition as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for 
Rating  Disabilities  (VASRD).    The  CI  appealed  to  the  US  Army  Physical  Disability  Agency 
(USAPDA),  which  affirmed  the  FPEB  findings;  and  was  then  medically  separated  with  a  10% 
disability rating.   
 
 
CI CONTENTION:  “Rating was unfair for the severity of condition.  I was rated 30% for 4 years 
on TDRL and final decision was 0% (SIC) with no change in my diagnosis and condition.  It seems 
that  at the  5  year TDRL  decision  mark, the  Army  made  a decision  that was  beneficial to  the 
Army  and  not  my  well  being.    At  the  time  decision  was  made,  I  had  15  years  of  service.    I 
appealed their decision and was told that I was unfit for retention standards, yet was given a 
0% disability rating for a condition I was have (sic) the rest of my life.” 
 
 
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.  The Crohn’s disease condition requested 
for  consideration  meets  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview,  and  is 
accordingly addressed below.  Any condition 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 USAPDA – Dated 20030124 

VA – All Effective Date 20050429*  

Condition 

Code 

Rating 

Exam 

Condition 
Enter TDRL  
 (19981117) 
Crohn’s Disease 

Code 

 

7326-7319 

Enter 
TDRL 
30% 

Rating 

Sep 

(20030219) 

10% 

No Additional MEB/PEB Entries 

Crohn’s Disease 
Lumbar Strain w/ 
DDD 

7323 

60%** 

5010-5242 
Not Service Connected x 8 

40% 

19990707 
20050929 
20050929 
20050929 

Combined:  10% 

Combined:  80% 

* VA rating based on exam most proximate to date of permanent separation. 
** Crohn’s disease effective date 19981118; VARD 20060421 (continue @ 60%); C&P (rectum and anus) exam 20050929 most 
proximal to DOS, no change to subsequent VARDs 
 
 
ANALYSIS  SUMMARY:    The  Board  notes  the  CI’s  opinion  that  he  had  not  improved  over  the 
course of TDRL; but, clarifies that subjective improvement or worsening during the period of 
TDRL  does  not  provide  the  basis  for  its  disability  rating  recommendation  at  the  time  of 
permanent separation.  The Board assesses the fairness of the TDRL rating decision based on 
the evidence proximate to temporary retirement; and, assesses the fairness of the permanent 
rating decision  based  on  the  evidence  proximate  to  final  separation.   IAW  DoDI  6040.44 the 
Board may not recommend a lower rating (TDRL or permanent) than that conferred by PEB; 
and,  the  TDRL  rating  is  not  considered  a  benchmark  for  the  Board’s  permanent  rating 
recommendation.  The sole basis for the Board’s permanent recommendation, therefore, is its 
assessment  of  disability  based  on  evidence  proximate  to  the  date  of  permanent  separation 
compared to VASRD criteria in effect on that date. 
 
Crohn’s  Disease  Condition. 
  The  suspicion  of  Crohn’s  disease  was  made  during  an 
appendectomy procedure in 1997.  Subsequent radiologic tests, colonoscopy, and a history of 
abdominal  pain,  frequent  diarrhea  with  rectal  bleeding  confirmed  the  diagnosis.    The  CI 
developed  a  chronic  anal  fistula  with 
leakage,  as  well  as  symptoms  of 
pneumaturia.  In April 1998, he had surgery to remove a portion of diseased small intestine and 
repair  an  abnormal  connection  of  bowel  to  the  bladder.    His  postoperative  course  was 
additionally  complicated  with  forming  a  variety  of  lower  colon/anal  fistulae.    His  medication 
treatments were many and included an immunosuppressant (6-Mercaptopurine), Imuran, and 
prolonged use of steroids.   Postoperatively, the CI continued to have frequent watery bowel 
movements  at  an  average  of  6-8  times  per  day.    Approximately  3  months  prior  to  entering 
TDRL, the initial MEB exam dated 5 August 1998, the CI complained of 6-7 watery stools per day 
with occasional mild right lower quadrant abdominal pain.  Laboratory studies revealed mild 
anemia and his weight was approaching levels to that before surgery.  The examiner concluded 
that  the  CI’s  condition  was  “relatively  well  controlled”  and  the  GI  examiner  added  relatively 
well controlled “…with an aggressive regimen.”  The physical examination listed the presence of 
an anal fistula.  The PEB rated the CI at 30% with entry into TDRL based on this exam stating 
“Crohn’s  disease  status  post  resection  of  the  terminal  ileum  and  repair  of  an  enterovesical 
fistula.    Service  member  is  undergoing  therapy  of  immunomodulating  and  anti-inflammatory 
therapy.”  At the second TDRL examination on 4 February 2002, approximately 12 months prior 
to  separation,  the  CI  complained  of  groin  and penile pain.   Medication  use  was  intermittent 
with  pulses  of  Prednisone  when  the  CI  felt  he  may  be  having  a  flare.    “He  reported  having 
approximately 4-6 semiformed bowel movements each day, which are about the consistency of 
oatmeal  or  watery,  but  not  bloody  and  never  solid.    As  noted,  the  standard  antidiarrheals, 
Lomotil and Imodium, have had no impact nor has Questran for the suspicion of his bile salt 
mediated diarrhea.  He has no joint aches now since being off the 6-Mecaptopurne.  Overall, he 
states that he feels much better than he did over the 1997-98-99 timeframe, but still reports 

intermittent 

2                                                           PD1201217 
 

some good days and bad days.”  Functional status included functioning “within his current job 
as a Fayetteville police officer without any missed days of work due to this Crohn's illness.  He 
states that his employer is “understanding and accommodating with his illness.”  The examiner 
discussed past unsuccessful medication trials as well as “He has tried an infusion of Infliximab, 
which  is  currently  the  state-of-the-art  medication  for  refractory  Crohn's.  This  medication  did 
not influence his symptoms.  We have discussed the possibility of entering a research protocol 
that  is  being  approved  at  other  military  treatment  facilities…;”  he  declined  the  offer.    The 
physical  examination  revealed  oral  apthous  ulcerations  and  mid  to 
lower  abdominal 
tenderness.   No  labs  were  drawn.    There  was  no  report  of  a  rectal  exam  and  reference  was 
made to a small bowel follow through completed in August of 2001 that “revealed no evidence 
of  active  Crohn’s  disease.”    The  CI’s  weight  was  listed  as  “stable  at  175  pounds.”    Urology 
evaluation  including  cystoscopy  and  voiding  cystourethrogram,  found  no  evidence  of  any 
vesicoenteric  fistula.    Communications  from  the  CI’s  treating  Gastroenterologist  (1  and  3 
months pre DOS) indicated the CI was “currently able to work, he continues to have 4-6 stools a 
day which are loose and diarrheal on his best days.  He continues to have a nagging, aching pain 
that radiates down into his groin and penis area which I feel is likely related to complications he 
had with his Crohn’s fistulizing to his bladder.”  The latest physician communication indicated 
the CI experienced “pain and tenderness and daily diarrhea.  He has recently had to leave work 
early  due  to  his  symptoms,  but  overall  he  has  been  tolerating  his  illness  I  would  put  him 
somewhere between mild and moderate as per the nomenclature used therefore.”  At the VA 
Compensation and Pension (C&P) examination on 7 July 1999, approximately 8 months after 
entry  into  TDRL  (nearly  42  months  prior  to  date  of  separation),  the  CI  complained  of  loose, 
watery and bloody diarrhea multiple times per week.  Physical examination revealed palpatory 
tenderness in both lower abdominal quadrants without guarding or rebound pain.  The VA cited 
“numerous attacks” in assigning their 60% rating for code 7323. 
 
The  Board  directs  its  attention  to  its  rating  recommendations  based  on  the  evidence  just 
described.    The  Army  rated  the  condition  using  coding  of  7326-7319  [7326  (Enterocolitis, 
chronic) using the criteria of 7319 (Irritable colon syndrome), while the VA coded the condition 
as 7323 (Colitis, ulcerative).  The Board clarifies that there is a significant interval between the 
VA evidence and ratings and the date of permanent separation; and, the Board’s permanent 
rating recommendation is based on the disability in evidence at final separation.  DoDI 6040.44 
specifies a 12-month interval for special consideration to VA findings, and thus little probative 
value  can  be  assigned  to  the  clinical  evidence  rated  by  the  VA  with  regards  to  the  Board’s 
permanent recommendation.  Since there was a paucity of clinical record evidence on or about 
the CI’s DOS in February 2003, the Board must rely heavily on the 12 month prior to DOS exam 
as well as submissions from the CI’s Gastroenterologist as the having the most probative value 
in  its  deliberation  to  assess  the  severity  of  symptoms  relevant  to  its  permanent  rating 
recommendation  IAW  §4.114.    Other  service  treatment  records  (STR’s)  did  not  reveal  any 
evidence  of  malnutrition,  weight  loss  greater  than  10%,  nausea  or  vomiting,  prolonged 
hospitalizations, nor the need for blood transfusions.  The record at TDRL entry supported the 
30%  PEB  rating  IAW  §4.114.    However,  predominate  coding  was  analogous  to  7323  (Colitis, 
ulcerative) which more nearly represented the CI’s diagnosis, pathology and disability picture.  
The Board then focused on the permanent separation rating at the end of the TDRL period.  The 
Board  agreed  that  the  CI’s  condition  exceeds  the  “moderate”  symptoms  and  “infrequent 
exacerbations”  corresponding  to  the  10%  rating  under  VASRD  code  7399-7323.    The  Board 
concluded  that  the  CI’s  6  or  more  watery  (occasional  bloody)  bowel  movements  per  day, 
frequent  flare-ups  requiring  episodic  immunosuppressant  medication,  and  persistent  lower 
abdominal  pain,  more  nearly  supported  a  30%  rating  for  code  7323.    Although  the  CI  had 
episodes of slight anemia, there was insufficient evidence of numerous attacks or malnutrition 
to support a 60% or higher rating. 
 
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  recommends  no  change  in  the  30% 

3                                                           PD1201217 
 

TDRL-entry  rating,  with  a  disability  rating  of  30%  for  the  Crohn’s  disease  condition  upon 
termination of TDRL, coded 7399-7323 IAW VASRD §4.114. 
 
 
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  Crohn’s  disease  condition,  the  Board  unanimously 
recommends a TDRL and permanent disability rating of 30%, coded 7323 IAW VASRD §4.71a.  
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 to 
reflect a permanent combined 30% disability retirement effective as of the date of the prior 
medical separation: 
 

VASRD CODE 
7399-7323 
COMBINED 

RATING 

30% 
30% 

Crohn’s Disease 

UNFITTING CONDITION 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120612, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 

XXXXXXXXXXXXXXXXXXXXXXX, DAF 
Acting Director 
Physical Disability Board of Review 

4                                                           PD1201217 
 

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 XXXXXXXXXXXXXXXX, AR20130003773 (PD201201217) 
 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay.   
 
2.  I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum: 
 
a.  Providing a correction to the individual’s separation document showing that 
 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 
 
 
disability effective the date of the original medical separation for disability with 
severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 
 
 
and medical TRICARE retiree options. 
 
 
 
 
 
 
3.  I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

b.  Providing orders showing that the individual was retired with permanent 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 

5                                                           PD1201217 
 

 
 
Encl 
 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

 

6                                                           PD1201217