I need advice on my MEB. (Patella Femoral Syndrome, Arthrosis.)

[Ourst1951]

Hello, I'm an E4 in the Army, 25N (commo guy), stationed in Hawaii, and started my MEB process in late June. I tore my medial meniscus last July of 2015 training for Air Assault. I was coming down a steep hill too fast, planted, twisted, and a loud pop came from my knee accompanied by pain. I did X-rays, some physical therapy, took MRI's, and killed bottles of Motrin. Throughout this year long debacle there were two instances where my command had me hiking up rough terrain because my profile had expired maybe a week prior. The first instance was last November of 2015 during a hike to a water fall. Despite me informing my NCO's of my recovering condition they wanted me to participate, so I gave the "hooah roger" and marched on. Sure enough not 30 minutes in, I felt that same popping sensation in my knee while coming down a dirt hill and my leg buckled. So once again I got on profile, took pain killers, did light duty, limited PT, etc. Fast forward to February of 2016, my profile is up again, I'm feeling a bit better, starting to run at my own pace, but my command decides they want to go to Koko Head, which is basically stairs that go about a mile and a half upwards. Once again, I tell them this is a terrible idea given my condition, but regardless give the "hooah roger" and make the trek. This time, I get half way up and there's a sharp pain in my knee cap that's relatively unfamiliar so I decide to make my way down.

However, now the pain doesn't subside. Instead my PCM sends me in for a second MRI and an ultrasound. They come back showing the meniscus tear is healing, however the pain persists in the front of my right knee. May 2016 rolls around and a new PCM sends me to the Ortho doctor again at Tripler Medical and upon examination of this new MRI he tells me that the crepitus, or cracking in my knee, is caused by deterioration of the cartilage behind my knee cap. He points to the strands of cartilage on the image and says that he wont do surgery because the chances of it fixing my knee are very slim and I'm too young for a knee cap replacement (I'm 27). I talk to my PCM and she advises that I'm not eligible to re-class because at this point my condition makes me non-deployable, so instead she started the MEB paper work in late June 2016. I've been on profile for a year, just recently put on P3, I've had injections, done physical therapy, and have been denied for surgery because it "wouldn't help".

I just came back from my general VA appointment and the doctor said I have 45 degrees ROM for extension in my right knee. I have a good idea of what the VA will give me for this, but I'm worried the PEB is going to say I'm fit for duty. I didn't join the Army to get hurt all the time, so this entire process has caught me off guard and I'm just frustrated. I feel like I had these awesome plans to kill Air Assault and then Ranger school and now I'm broken because a few NCO's wouldn't listen to me. I don't want the PEB decision to come back saying that I have to keep limping around on crutches or a cane for the remainder of my contract. Frankly, it's embarrassing to go from a 285 PT score to not being able to even run a 2 mile. My job entails climbing a small ladder to get into a shelter where I basically have to maintain equipment that you would find in a server room like switches and routers. I have to bend at the knees often and also move stacks that weigh about 150 lbs, which are used for field exercises.

Questions:

What do you guys think my chances are of being found unfit?
Should I insist on surgery at this point?
Have you heard of an Ortho doctor denying someone a knee cap replacement because they were too young?
I was told I may be home by December at the latest, is the Army just blowing more smoke up my butt?
How many more VA appointments will I be looking at now that I've taken the general?


Thanks ahead of time, I've been lurking on this site for a while now and have gotten some good info.


I also have a digital copy of all of my medical records as well if that can help anyone.

 

[gsfowler]

One quick point, you state that the doctor stated that your knee extension is 45*, are stating that you cannot straighten your leg? If that is the case, then 45* will equate to a 50% rating, if it is the opposite, where the leg can straighten, but cannot bend to more than 45*, then the rating is 10%.

If you have been given a P3 and MEB initiated, they will look at AR 40-501 to determine if you condition meets retention standards.

Chapter 3-13 (d) covers lower extremities and has specific language regarding range of motion.

d. Joint ranges of motion. Motion that does not equal or exceed the measurements listed below. Measurements must be made with a goniometer and conform to the methods illustrated and described in TC 8–640.

(2) Knee—flexion to 90 degrees or extension to 15 degrees.

If you cannot straighten your knee and the extension is 45* (meaning it cannot be extended to 30*, 15* or 0*), it is likely that you will not be found fit for duty and referred to the PEB. If the leg can be straightened, you may be found fit for duty, but there are numerous factors that come into play (most of them not favorable to keep you in the Army).

Air assault training may potentially qualify as combat related for the purpose of CRSC, it will depend on what maneuver cause the injury.

You can try to request surgery, it is not likely that the Army will want to perform it, since it is more likely than not you wont return to duty within 12 months after the surgery. You can push the issue.

The orthopedist correct, patellofemoral replacement rarely takes place under the age of 40

If everything works out perfectly, it may be possible for your MEB/PEB to be completed by November, but everything would have to go perfectly, the official advertised time is 295 days.

When you state "general" VA appointment, was this a compensation & pension appointment for the purpose of rating? Typically these are the only VA appointments you have during the IDES, unless you are actually being treated for your injuries at the VA through Tricare.

 

[Ourst1951]

Right I can't straighten my knee out past about 45 degrees, give or take a few degrees. So I figure my VA rating will be about 40-50%.

Yes this was the C&P I believe.