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AF | PDBR | CY2013 | PD-2013-02625
Original file (PD-2013-02625.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02625
BRANCH OF SERVICE: Air Force     BOARD DATE: 20140813
SEPARATION DATE: 20040519


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active 1Lt/O-2 (02TO/Student Pilot) medically separated for ulcerative colitis. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The MEB characterized her condition as inflammatory bowel disease and was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated the condition as “ulcerative colitis, EPTS without service aggravation,” Category II, (a condition that can be unfitting but is not currently compensable or ratable). The CI requested a Formal PEB that convened on 3 December 2004 and adjudicated the conditions “ulcerative colitis” and rated it at 10%. The CI made no further appeals and was medically separated.


CI CONTENTION: “When I went to the FPEB my initial motivation was getting back to my planned out life of being an Air Force pilot. It was all I wanted. Downplaying the severity of my ulcerative colitis probably led the board to their finding of a 10%. In retrospect the decision to discharge me was probably the best thing for the service and for me as well because I have had quite a number of flare ups over the years. At the time of my initial diagnosis in May of 2003, I had been dealing with the symptoms for some time and coaxing my body into remission took some time as well. The VA rating was more accurate at the time to the symptoms of my ulcerative colitis, so I would appreciate another review of my case. Thank you for your time & consideration.”


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 ulcerative colitis condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Correction of Military Records.


 RATING COMPARISON :

Service FPEB – Dated 20031204
 VA - (6 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Ulcerative Colitis 7323 10% Ulcerative Colitis 7323 30% 20031104
Other x 0 (Note in Scope)
 Other x 0 (Not in Scope)
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 40608 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veterans Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all 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’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the VA Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation.

Ulcerative Colitis Condition. The CI was diagnosed with ulcerative colitis in May 2003 after a month of symptoms including diarrhea, blood in the stool and abdominal cramping. Laboratory testing was normal including blood count. Colonoscopy with biopsies confirmed the diagnosis and the CI was begun on oral medication and enemas at the end of May 2003. At the time of follow-up appointments on 6 June 2003 and again on 14 July 2003, her gastroenterologist indicated resolution of symptoms. There was no diarrhea, blood in the stool, abdominal pain or other symptoms. Physical examinations were normal. The MEB narrative summary in August 2003, reported the CI remained symptom free on medication. At the time of the VA Compensation and Pension (C&P) examination on 4 November 2003, a month prior to the Formal PEB, the CI reported experiencing occasional cramping and pain in the left abdominal area which occurred less than 1/3 of the year. She reported experiencing diarrhea constantly. However, there was no functional impairment and no lost time from work. The physical examination and laboratory testing were normal (including blood count and chemistries). In her letter of appeal to the Secretary of the Air Force Personnel Council (SAFPC) dated 18 December 2003, the CI noted her symptoms had been eliminated since beginning treatment. SAFPC affirmed the unfit determination of the FPEB on 5 March 2004. The CI presented to clinic on 26 March 2004 reporting recurrent symptoms of ulcerative colitis for 2 weeks. The examiner noted the CI had been on medications for a year without flare. Physical examination was normal and enema treatment was resumed (oral treatment was continued).

The Board directs attention to its rating recommendation based on the above evidence. The Formal PEB rated the ulcerative colitis condition 10% (coded 7323). The VA rated the ulcerative colitis 30% (coded 7323) citing occasional abdominal pain and constant diarrhea recorded in the November 2003 VA C&P examination. The Board undertook to ascertain the severity of the ulcerative colitis/proctitis condition. All members agreed the condition was not pronounced (100%) or severe (60%) as there was no evidence of malnutrition, anemia, debility or only fair health between exacerbations. The Board considered whether the ulcerative colitis condition more nearly approximated the 30% rating than the 10% rating. The 30% rating is supported when the condition is moderately severe with frequent exacerbations. The Board noted the CI’s report of constant diarrhea and occasional cramping at the time of the VA C&P examination in November 2003 was not consistent with the evidence of the service treatment record and the CI’s statement to SAFPC indicating resolution of symptoms since June 2003 after starting treatment. Following the SAFPC decision in March 2004, the CI presented to the clinic for recurrent symptoms of 2 weeks duration. The examiner noted the CI had not had a flare since starting medications the year before. At that time the physical examination was unremarkable. The Board concluded the preponderance of evidence supported a conclusion that the condition was well controlled with medications and exacerbations were infrequent consistent with the 10% rating adjudicated by the PEB. 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 ulcerative colitis 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. In the matter of the ulcerative colitis 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 20131210, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAF/MRB
Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-02625.

         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

                                                               Sincerely,






 XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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