Outcomes for FAI with and without laberal tears?

jd101proof

PEB Forum Regular Member
If you have gone through the MEB process for FAI and/or laberal tear (with and without corrective surgeries) please post your percentages here.
 
I have underwent arthroscopy for laberal debridement and correction of FAI (left hip). I am now 5 months post op, still having issues with simple tasks like walking. At least once to twice per day my hip will "lock up". My civilian doc has issued a letter stating that I am able to use a cane as I feel necessary to help with the residual problems post op.

I have been told several times, by several different medical professionals that, in their professional opinion, I should not return to running, or the other physical demands of military service as it will result in negative consequences (hip-wise).

I am currently waiting to have the FAI surgery done in my opposite hip, hoping it will turn out better than the other. I wish I could at least estimate what my MEB rating would most likely be, as I feel I need to prepare for a transition to civilian life as much as I can. I am also curently awaiting transfer to WTU, due to the extended period of time the recovery from each proceedure is going to take.

Does anyone have any guess at what rating this would receive? This is difficult all around as I don't want to leave the military, but it is appearing as if I have no other choice in the matter. Especially now with the reductions in numbers, I highly doubt I will be able to stay in.
 
forgot to mention in other thread, Friend of mine had BIL FAI and was rated at 20% but she also had DDD and early OA ( no surgeries however) that pushed her over total 30% DOD, I have not spoke to her since retirment and she was legacy so no clue what VA gave.
 
My next question is: how difficult is it to have a THR done to correct a bad scope? I dont really want to get the THR, but after having the scope and being 5 months postop I only feel about 10% better. The docs put me back on norco due to my horrible limp and pain that Im experiencing. I was initially told 4 months and I would be fully recovered, as of right now, Im not even close and I have "catches" in the hip joint that nearly send me to the ground.
 
Ask for a referral to a hip replacement doc and ask their opinion, I have zero fai pain any more, zero catching although i have had 1 or 2 episodes of the psoas muscles ( that one that hurts in your groin down to your knee and sometimes around to your tailbone) flare up like would happen with the fai, but they have gone away quickly and I am just 4 weeks post op come the 18th. I have started riding an incumbent bike 3 rimes a week for 15 minutes along with my physical therapy and I actually feel like im healing unlike i did after the last 3 surgeries. BUT the THR is a big deal and a game changer for long term stuff some people can run etc afterowrds or play higher sports. I gladly gave up the chance to be a professional athlete in exchange for a pain free life ( no chance of ever being one anyway lol)
 
Ask for a referral to a hip replacement doc and ask their opinion, I have zero fai pain any more, zero catching although i have had 1 or 2 episodes of the psoas muscles ( that one that hurts in your groin down to your knee and sometimes around to your tailbone) flare up like would happen with the fai, but they have gone away quickly and I am just 4 weeks post op come the 18th. I have started riding an incumbent bike 3 rimes a week for 15 minutes along with my physical therapy and I actually feel like im healing unlike i did after the last 3 surgeries. BUT the THR is a big deal and a game changer for long term stuff some people can run etc afterowrds or play higher sports. I gladly gave up the chance to be a professional athlete in exchange for a pain free life ( no chance of ever being one anyway lol)

Would you happen to know if the Birmingham Hip Resurfacing procedure is something tricare will allow? This looks to be a very viable option, but given the fact that they deem the scope procedure as "unproven", it looks to be the best option for me. Im honestly trying to stay in the military, and this may be the ticket to an option other than THR and a permanent fix at my age.
 
No clue if resurfacing is a tri-care option or not as with my tears and retro-version it was not an option, however unlike what it sounds the resurfacing still counts as a prosthetic device under VA rules, so the results on your career would be the same.
 
No clue if resurfacing is a tri-care option or not as with my tears and retro-version it was not an option, however unlike what it sounds the resurfacing still counts as a prosthetic device under VA rules, so the results on your career would be the same.

Understood, but it is less invasive then a THR, and doesn't pose the same risks of wear replacement. It would be an ideal avenue for those not in the age bracket for a THR. I think I am going to pursue this route as much as possible, the quality of life benefits alone far outweigh the risks of having to end a career early.
 
Good luck, i just reviewed the tricare no pay list and from what i can find for surgery codes partial and full hip resurfacing falls under codes 0085/86/87 and are listed as no pay, unproven as of december 2011. But the code list i could find was from 2007 so maybe the number changed.
 
Ok found out what i was looking for, Currently tri-care uses the ICD-9 Cm list for diseases/procedures, hip resurfacing is still code 0085/0086 and is still considered unproven as of December 2011

Online ICD9/ICD9CM codes for the code list
and just google december 2011 tricare NO GOVERNMENT PAY PROCEDURE for the reason/denial.
 
Not sure what you are interpreting. when I read what you posted it looks like they are talking about some kind of "parcel" replacment.
BUT..... I had 1 hip "resurfaced in OCT 2009 and the 2nd hip resurfaced in FEB 2010. Madagan Army Medical Center. the company that makes the parts is called striker.
Active duty tricare payed for all the way!

Technically I can run and do whatever sports I want(granted it will wear out my hips faster)
So when you say Tricar unproven I dont understand!
 
Not sure what you are interpreting. when I read what you posted it looks like they are talking about some kind of "parcel" replacment.
BUT..... I had 1 hip "resurfaced in OCT 2009 and the 2nd hip resurfaced in FEB 2010. Madagan Army Medical Center. the company that makes the parts is called striker.
Active duty tricare payed for all the way!

Technically I can run and do whatever sports I want(granted it will wear out my hips faster)
So when you say Tricar unproven I dont understand!


ALOT has changed for the government no pay procedures through tricare and TMA as of July 2011, I know several members even on this board that had the regular FAI repair done paid for by tri-care with just the CMO waiver done at the local MTF level, that are now denied. I am not saying his wouldnt be approved I am just saying that according to the tri-care list full or partial hip resurfacing is not covered and would require a waiver ( just like the fai arhtroplasties currently being denied or better yet left in limbo for months/years) that may or may not be approved. I could not find a specific code for " Birmingham hip resurfacing" but since it is just a method under the generic "resurfacing" headline and is in fact a prosthetic it would fall under that with the VASRD and his respective service retention standards.

ALSO: if you had the procedure done at the army medical center tricare approval was not required, if tri-care denies the resurfacing and he can find a military medical center that does the procedure he can still have it done.
 
Not sure what you are interpreting. when I read what you posted it looks like they are talking about some kind of "parcel" replacment.
BUT..... I had 1 hip "resurfaced in OCT 2009 and the 2nd hip resurfaced in FEB 2010. Madagan Army Medical Center. the company that makes the parts is called striker.
Active duty tricare payed for all the way!

Technically I can run and do whatever sports I want(granted it will wear out my hips faster)
So when you say Tricar unproven I dont understand!

Was your procedure done by an Army doc? If so, where is Madagan located? The only thing really stopping me from getting the surgeries I need is (was) the lack of a doc in network (and the "no longer authorized" scope). Supposedly, from what I understand there is now an Army doc in my network that can do the plastys, THR, etc. Being that the plastys are no longer authorized, as per the surgeon general, if this doc can do the resurface, what is involved in getting this approved? Would I need to submit anything for review, or ask for a waiver etc?

Also, if the doc in my network is unable to perform the procedure, where is Madagan located? If I absolutely had to, I would go so far as to put in ordinary leave to get there and have this done, provided I had all the paperwork and necessary approvals lined up. If I recall correctly, on one of my intial visits with Ortho at BACH it was mentioned that I could travel to another MTF to get the procedure I need if it was offered. I would greatly appreciate any info and help figuring out how to go about accomplishing this. My goal is to get back to work so I can take my soldiers on deployment.

I realize that some of these questions that I am asking can easily be answered by the docs here, however, the current wait times for appointments here are running about 1 month. Which essentially means 1 month for PCM, then another month for referral to Ortho, 2 weeks for Xray/MRI (to re-verify) what they already know and so on. Typical Army medical bureaucracy.

I am halfway through a 20 year career, and I refuse to be put out without a fight.
 
Madagan is in FT Lewis Washington, Yes it was an Active Army doctor in an Army hospital that put them in an Active Air Force guy, they recommended in fact!

Just to be straight these are metal on metal implants, there is literally no issue of pulling or popping your hip out like a normal THR, Run,ski whatever! not a recommended thing as it will wear them out but can be done.

NOTE: not everyone is a good candidate for resurfacing!.... alot depends on if there is a problem with the bones strength or age (to old)

if you have any other question I check back here all the time!
 
I will have to keep an eye on this with you JD has i have the snapping/popping in my left hip but no pain yet so putting off anything that would speed up having it replaced, if you get approved for the BHR i'd like to look into it more as well.
 
Thanks MSgtRon, its much appreciated! TSgt, I will keep this as my thread regarding FAI stuff, just in case there are others out there who are fighting this same issue. Im hoping maybe It will turn into a good resource for others to use. Ill be sure to update whenever anything changes.
 
That said... I am compiling a central FAI guide for people like myself who cant find any info on the subject. If anyone has anything of value to add to this, please PM me the info and I will incorporate it into this post.

Please note: This is NOT medical advice. I am not a doctor! This is only a summary of my many hours of research into my FAI. Hopefully this will help others!

First update as of today. I called the BCAC again (beneficiaries counseling assistance coordinator) and found out that I was given the wrong information.

(A) MEDICAL PROBLEM OR DIAGNOSIS: Femoroacetabular Impingement

1. Arthroscopic surgery ("scopes" or "plastys") are not covered or to be approved by any network provider. (network meaning: civilian or outside the military medical community).
1A. Civilian or non-military surgical procedures: NOT approvable, NOT covered.
2. Scopes (arthroscopic) and plastys (femoroplasty etc) ARE covered and approvable as long as they are performed by a military doc OR at a MTF.
2A. Military or MTF performed surgical procedures: approvable, covered if medically necessary.
3. If there is no doc in your area to perform the procedure, you can arrange through your BCAC to be put on TDY to the MTF that does perform these procedures.

Note: Regulations and approvals/denials change all the time, cross reference and verify accuracy. This information can be obtained by calling the BCAC (Army) representative.

(B) SURGICAL OPTIONS FOR FAI:

1. Arthroscopic surgery (aka plastys or scope) procedures are the least invasive and "should" be very conservative.
2. Hip resurfacing (from what I have been reading) is best for younger individuals or if deemed better for you, is not the same as THR, but can be converted to THR later on if necessary. (Also known as Birmingham Hip Resurface or BHR)
3. Total Hip Replacement (THR) is best for those who are older, as the prosthetic wears out and may need to be replaced @15-20 years (also varies on individual and lifestyle). This is a "big deal" surgery.
4. There may be other procedures that I have not listed. Again, this is only what I have found so far.
5. If you have a procedure done, ask if you can have it video recorded and obtain a copy for your records!

NOTE: If you are going through the med board, or are about to be recommended for one because of FAI, and you have the option of getting the surgery while you are still in the military... Look into what is/isn't covered outside of the service!! I cannot even begin to stress the importance of this!


(C) SURGERY INFORMATION: In progress...


(D) RECOVERY INFORMATION:

1. Most of the websites I have researched claim the recovery from the arthroscopic procedure lasts approximately 4 months give or take. (Im on 6 months. Still painful, still have catching/popping/pinching, still walk with a heavy limp, and am approved to use a cane)
2. I was on crutches for 3 1/2 months after surgery. This depends alot on the individual and the surgeon's recommendations.
3. Stick with your Physical Therapy. There are days that I want to quit because it is too painful, just do what they want and push yourself within reason.
4. Stretch and stay as flexible as you can during recovery. In my case, my leg muscles are always stiff, and I lose my range of motion from it.
5. Take your time, dont try to be a hero and be up and running too quickly. Make sure your body can heal, what you do now may make the difference between Prosthetic Hip Replacements or a normal life later on (as my surgeon put it)
6. Realize that depending on your procedure you may be at a high risk for early osteoarthritis. (I am. Because of the torn labrum, arthroscopy, and cam/pincer impingement etc)

* During the surgical recovery period you may want to consider or look into WTU as an option. The recovery timeline for these procedures is often longer than 6 months, and can have a lot of extreme ups and extreme downs. If you are considering a surgery to correct FAI, ask your PCM about WTU as a place to go while you recover (I chose to go there due to the numerous appointments, physical therapy sessions, and ease of getting seen in case "Private Murphy" shows up. Make sure you educate yourself on the options WTU offers, especially when it comes to the "return to duty" orders. WTU has many programs available for those who do not successfully recover and are forced to consider changing their MOS or entire career path for civilian employability...

Note: Dont give up on getting it fixed! Dont give in to the docs that are just pushing for the MEB/PEB without regard to your quality of life (either while you are in service or out). Remember, you have to live with this diagnosis and letting it get worse increases your chances of early osteoarthritis and prosthetic hips. I recommend reading the Patient Bill of Rights for military health care.

(E) IS FAI SURGERY COVERED AFTER I LEAVE THE MILITARY? (with or without medical benefits):

1. Even if your FAI was incurred during your military service, it may not be covered on the outside, even if you leave with over 30% and take your health benefits with you!
2. Refer to the exclusions under tricare or VA!
3. Take the time to carefully read all applicable insurance documents to make sure you know what is fact and what is fiction. Do not take someone else's word that "you can always go back to the VA after you are out..." unless you see it in writing. There are others on this forum who have gone through hell trying to get their FAI taken care of after they were retired/seperated for it.
4. Call the BCAC or Tricare to verify the facts for after service surgical options
5. Call the VA to verify the facts for after service surgical options

(F) IF PEB/MEB IS INITIATED FOR FAI:

1. First, refer to section (E) listed above.
2. I would immediately consult with someone who knows the PEB/MEB process thoroughly. (Lawyer, PEBLO etc)
3. If you are thinking about accepting severance pay, and getting the surgery done in the final months before you lose Tricare coverage, refer to section (E) listed above. (Many service members are told they still have Tricare for approx. 3-6 months before coverage expires after exiting service)
4. Dont get in a rush due to a slow PEB/MEB process and miss the opportunity to get your condition corrected before "getting out". If this statement doesn't make sense: refer to section (E) listed above!
5. As with any PEB/MEB, make sure you have personal copies of ALL your medical records!
6. Ask for, and obtain, all of your MRI and X-RAY images. Be specific and state "you would like a copy of all of your IMAGES." This will get you every single image ever taken (of anything) during your time in the military. Images are for any issues with the VA asking you to show proof.

Note: The cost that tricare paid for 1 single arthroplasty procedure on my hip came to $30,000.00 (I have a bilateral diagnosis, which comes to about $60,000.00 if I ever had to pay out of pocket) Severance pay isn't so attractive after seeing these numbers!

(G) KNOWN FAI/TORN LABRUM PEB/MEB/VA OUTCOMES AND RATINGS:
Keep in mind that everyone's specific diagnosis is unique, and may contain a combination of other conditions.

Forum member submitted outcomes and findings:
1. TXNVYMOM - Here's what the VA wrote about her son's FAI: "The disability is not specifically listed in the rating schedule (VASRD); therefore, it is analogous to a disability in which not only the functions affected, but anatomical localization and symptoms are closely related".

Also: Get familiar with the VASRD! Notice that FAI has not found its way to the rating schemes... Dont be surprised when you go through arthroplasty and you are awarded a WHOPPING 10%.


(H) IMPORTANT PEOPLE TO KNOW AND HAVE PHONE NUMBERS FOR (Army):

1. BCAC (Beneficiaries counselor and assistance coordinator).
2. The supervisor of the BCAC rep.
3. Tricare
4. Patient Advocacy
5. Post I.G. (if you ever need it... Hopefully not)
6. An experienced orthopeadic doctor off post (for second opinion or initial FAI diagnosis if needed). This may or may not be at your own expense, so be aware of this. FAI is a relatively new diagnosis and not all ortho docs are familiarized with it or its diagnosis.
7. A good lawyer. (Anything that puts my career in jeopardy is reason enough for me to have an attorney on speed dial. And no, not a "barracks lawyer". Im referring to the paid kind)


(I) DENIAL OF COVERAGE APPEAL LETTER TEMPLATES, OTHER MISC. DOCUMENT TEMPLATES: In progress...




(J) GOOD WEBSITES FOR INFORMATION ON FAI, RECOVERY, OTHERS WHO HAVE HAD IT, ETC:

1. This forum. Use the "search" button.
2. Femoroacetabular Impingement (FAI)
3. Hip Chicks - Hip Dysplasia and Impingement Support Group
4. New UnderstandingFAI Forum





OP Disclaimer: And again, I am not a doctor, and none of this should be taken as medical advice. This is only to help those with FAI due to the complete lack of resources and information on it (especially within the military!)
 
JD..Outstanding job on your post!!!!

Here's what the VA wrote about my sons FAI condition..."The disability is not specifically listed in the rating schedule; therefore, it is analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related.
 
JD..Outstanding job on your post!!!!

Here's what the VA wrote about my sons FAI condition..."The disability is not specifically listed in the rating schedule; therefore, it is analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related.

So what condition did the VA base his rating off of?
 
The VA based it off his service treatment records and Predischarge examination (Range of motion). The report also says "A 10 percent evaluation is assigned for painful motion of a major joint."

Also....The Navy never told him he had FAI...just a torn cartlidge. But the VA did find it and put it in their report. The VA findings were received about 8 months after discharge. So while trying to get treatment from an ortho....all we could say
was that he had a torn labral cartlidge. Although he did get 10% for it from the Navy. We didn't have a clue that Tricare would not pay for his surgery post discharge because the term FAI didn't come into play until the VA findings were received. However, a second opinion civilian doctor he saw while still in the military did recommend arthoscopy and by the time the opinion came back from the Navy about the second opinion (appx 5 months for their decision) my son has already received his PEB results.

You were so correct in advising others to check what Tricare what surgeries will pay for..I never thought in this day and time that a repair of this nature would not be paid for by Tricare and didn't check it out. But I think if I had known about the diagnosis of FAI I would have done research on what it was...and then would have researched it....and then....might have found that Tricare would not pay for the surgery and my son would have then taken a different route and possibly have had it done at a MTF.
 
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