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AF | PDBR | CY2013 | PD-2013-02178
Original file (PD-2013-02178.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02178
BRANCH OF SERVICE: Army  BOARD DATE: 20150203
SEPARATION DATE: 20040507


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Army E-4 (Licensed Vocational Nurse) medically separated for a bowel condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The bowel condition, characterized as “Crohn’s Disease” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “Crohn’s disease” as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated


CI CONTENTION: “Multiple visits to SickCall for GI symptoms. 0 GI consult. Major surgery needed in July 03. I believe could have been avoided if treatment was started or GI consult was ordered. Crohns Disease affects me on a daily basis and I was given 10%. I know others Dx [with] crohns and did not have surgery and received 40%. I would like to have my past medical records reviewed.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20040317
 VA - (76 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Crohn’s Disease 7399-7323 10% Crohn’s Disease 7399-7323 30% 20100917
Other x 0 (Not in Scope)
 Other x 1
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 20101709 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Crohn’s Disease. In July 2003, the CI underwent surgery to remove a portion of diseased intestine due to Crohn’s disease. His post-operative course was intermittently complicated with the formation of an anal abscess that required surgical drainage. His non-surgical treatment remained oral anti-inflammatory medication. He did not require immunosuppressant agents or prolonged use of steroids. Post-operatively, the CI continued to have occasional episodes of copious and watery diarrhea with abdominal pain. Throughout the service treatment record (STR) there was no evidence of malnutrition or clinical anemia due to Crohn’s. An emergency room visit on 20 October 2003 for a one-day history of diarrhea and abdominal cramps did indicate “mild” as for the severity of his symptoms.

At the MEB narrative summary (NARSUM) examination on 25 February 2004, 10 weeks prior to separation the CI endorsed “having loose stools and abdominal pain since January 2002.” Specifically, he noted 3 to 10 bowel movements (BMs) per day tending to occur when running or during times of stress. He denied heartburn, painful swallowing, or the presence of black or bloody stools. The physical examination (PE) and laboratory analysis were normal. The commander’s letter of 10 February 2004 included, “Due to [the CI’s] medical condition and physical limitations, he is not currently assigned any duties.” His permanent profile dated 24 November 2003 listed Crohn’s disease as the sole diagnosis. The VA Compensation and Pension examination of 17 September 2010 was greater than 6 years after separation and therefore, too remote as to be included in the Boards final impairment rating.

The Board directed attention to its rating recommendation based on the above evidence. Both the PEB and the VA rated the Crohn’s condition analogously using 7399-7323 (Colitis, ulcerative) at 10% and 30%, respectively. The PEB cited no specific reasoning for its 10% rating and the VA citied frequent exacerbations of the primary condition. The remoteness of the VA clinical examination afforded no probative value with regards to the Board’s disability impairment recommendation IAW §4.114. Board members assigned the highest probative value to the 10-week pre-separation NARSUM coupled with STR submissions from the CI’s gastroenterologist and primary care providers.

Board members deliberated between 10% (moderate; with infrequent exacerbations) and 30% (moderately severe; with frequent exacerbations) impairment rating for the CI’s condition near the time of separation and agreed that the wide range of BMs coupled with known initiators of running and stress was best supported at the 10% impairment level. 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 Crohn’s 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 Crohn’s 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 re-characterization of the CI’s disability and separation determination.
The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131104, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150010570 (PD201302178)


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                       XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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