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AF | PDBR | CY2013 | PD-2013-02781
Original file (PD-2013-02781.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02781
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141216
SEPARATION DATE: 20070105


SUMMARY OF CASE: The evidence of record indicates this covered individual (CI) was an active duty E-6 (Munitions Technician) medically separated for a bowel condition, which could not be adequately rehabilitated to meet the requirements of his Air Force Specialty. He was issued a P4-L3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “ulcerative colitis (UC),” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The MEB also identified and forwarded one other condition (mild obstructive sleep apnea [OSA]) for PEB adjudication. The PEB adjudicated UC as unfitting (Category I), rated 10%, referencing the VA Schedule for Rating Disabilities (VASRD). The remaining condition ( OSA requiring use of continuous positive airway pressure ) w as determined to be Category II ( a condition that can be unfitting but is not c urrently compensable or ratable ). The CI made no appeals and was medically separated.


CI CONTENTION: The application states, “ Ulcerative-colitis (UC) was the condition in which I was rated from a medical board. Since then, I have been diagnosed with Ankylosing Spondylitis - produces pain and stiffness in the lower spine and sacroiliac joints (Knees, Hips, Ankles) which is directly associated with UC. ”

His complete submission, along with additional documentation submitted in support of his appeal, is at Exhibit A.


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 PEB – Dated 20061116
 VA (2 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Ulcerative Colitis 7323 10% Ulcerative Colitis and Reflux 7232* 10% 20061101
No Additional MEB/PEB Entries in Scope
 Other x 9 (Not in scope.)
Combined: 10%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 70430 .
* Presumptive transcription error in VARD. Code 7232 does not exist, and criteria of 7323 (ulcerative colitis) quoted in decision.

ANALYSIS SUMMARY:

Ulcerative Colitis. The service treatment record (STR) documents an initial complaint of abdominal pain with bloody stools in March 2005, which likely heralded the onset of the ultimately diagnosed UC. In February 2006 (11 months prior to separation) the CI experienced acute localizing abdominal pain which resulted in surgery for appendicitis (quite possibly a complication of UC). Six weeks later there was another flare of pain and bloody diarrhea, which was subsequently diagnosed as UC (colonoscopy, biopsy). Medications (Asacol maintenance, Levsin as needed) were started and the STR reflects a waxing, waning, but improving course leading to separation. Various entries reflect 1-4 loose stools daily and intermittent pain, with an entry from June 2006 (7 months prior to separation) documenting the absence of any recent flares; followed 2 weeks later by a mild flare, with follow-up notes documenting resolution and no diarrhea or bleeding. There are no STR entries after that (6-month period preceding separation) documenting any UC flares. An entry on 11 September 2006 records, “Patient feels well. Bowel movements regular. No blood in stools. Occasional low abdominal cramping, urgent stools. Not using Levsin.” The last STR clinical entry (10 weeks prior to separation) records abdominal pain rated 3/10 that day, without elaboration of pain cycles or bowel symptoms.

The narrative summary (NARSUM) was conducted on 28 September 2006 (3 months prior to separation) and described the recent clinical course as “patient has done well with no recurrent bloody stools and is considered stable per GI [gastroenterology consultant].” The examiner noted “occasional episode of loose stools,” but did not comment on recurrence or severity of abdominal pain. The commander’s performance statement indicated that the CI was working full shifts but could not deploy, and was missing 4 hours of work a week for medical appointments (should be noted that there were various non-UC medical issues in play at this time).

A VA Compensation and Pension (C&P) examination was conducted on 1 November 2006 (2 months prior to separation), and describes a contrasting clinical acuity as excerpted below.
He reports cramping pain, frequent bowel movements and bloody stools. It has not affected his body weight. He has abdominal pain more than two-thirds of the time, in the lower abdomen. He also reports diarrhea. These symptoms occur on a constant daily basis. He is treated with Asacol currently. ... He has no specific functional impairment other than the frequent pain that he has to live with on a daily basis.
The Board directed attention to its rating recommendation based on the above evidence. VASRD §4.114 provides the specific code 7323 for rating UC. This provides a 10% rating for “moderate; with infrequent exacerbations” and a 30% rating for “moderately severe; with frequent exacerbations.” The higher ratings require numerous attacks, malnutrition and other elements clearly not in evidence for this case. The VARD, citing the C&P evidence, stated that its 10% determination “is granted for infrequent exacerbations.” Members deliberated whether the 30% criteria were reasonably satisfied, especially considering the evidence from VA C&P examiner which was closest to separation. Members agreed, however, that the relatively stable and controlled symptoms portrayed in the NARSUM were strongly corroborated by the STR evidence; and, that the daily pain and diarrhea referenced by the VA examiner was not a fair representation of the overall and baseline acuity reflected by the total evidence from the period proximate to separation. It was further concluded that, even conceding the acuity described in the C&P examination, a “moderately severe” characterization is not convincingly justified; a conclusion shared by the VA rater. 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 of 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. The Board surmised from the PEB ruling in this case that no prerogatives outside the VASRD were exercised. 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 no re-characterization of the disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140222, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







XXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02781.

         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,




XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings




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