thankyou, someone else's post scared the crap out of me and your made me feel better. I was fine before I came in.
Outcomes for FAI with and without laberal tears?
- Thread starter jd101proof
- Start date
I have not seen a case in my history where FAI was listed as EPTS, unless there was clear evidence it did, however, if fai is your only UNFITTING condition even bilat, you are likely to only get a total of 20% unless you otherwise qualify for retirement.
no, it will not be my only unfitting condition
Just gotta watch it, technically my hips were my only unfitting conditions, but mine was a bit more complicated due to the prosthetic, so I was "appeased" with the 60% rating even though I was boarded for more than my hips.
so I am not really following what you just said to me. can you explain it another way?
You stated your hips will not be your only unfitting condition. My reply was basically "so you think", I was "boarded" for 5 different items (hips/back/neck/thigh), utlimately only my hips where originally returned by the IPEB as unfitting conditions. However because I have a fake hip that was to repair the FAI, my rating was 60% (50% right hip 10% left hip with just FAI,) So I did not appeal for any higher as I am 90% with the VA and will easily get 100% on my appeal as I found they were missing over a year of medical records, so just getting out after my board took 2+ years was all I cared about.
What other terms are used besides FAI?
I doing my MEB, after 11 years of pain, finally got a diagnosis for my hip (FAI) - which appeased the MEB people enough to move forward with their paperwork shuffle.
In the interim, though, I ended up at Bethesda for a scope to try and delay THR because - let's be honest - that socket is junk. Bones are still junk, cartilage is still crap, and femoral head still looks like crab meat, after the surgery.
Do I have range of movement? Yes. Does it hurt like hell? Yes.
I've now got my 199 in hand, and am about to start writing my appeal (FAI and two other things) - I am wondering what other angles I can take in attacking how and what they have called this hip mess. It's not snapping hip syndrome, that's for sure.
Ideas? "Crappy hip condition" doesn't seem to be in the medical journals.
I doing my MEB, after 11 years of pain, finally got a diagnosis for my hip (FAI) - which appeased the MEB people enough to move forward with their paperwork shuffle.
In the interim, though, I ended up at Bethesda for a scope to try and delay THR because - let's be honest - that socket is junk. Bones are still junk, cartilage is still crap, and femoral head still looks like crab meat, after the surgery.
Do I have range of movement? Yes. Does it hurt like hell? Yes.
I've now got my 199 in hand, and am about to start writing my appeal (FAI and two other things) - I am wondering what other angles I can take in attacking how and what they have called this hip mess. It's not snapping hip syndrome, that's for sure.
Ideas? "Crappy hip condition" doesn't seem to be in the medical journals.
FAI is a buzz word condition, the next closest thing that actually explains it is "adult hip dysplasia" but, if a doctor said FAI then FAI it is, however the VASRD does not have a code for that, so it is rated as like thigh strain, or painful motion of a joint with radio graphical evidence of degeneration. It may hurt, it may hurt all the time, but if you can move it, it will be rated at 10%, occasionally 20% for sever cases. However, even as an "unlisted condition" in 2013 most service surgeon generals published guidance that the condition was to be found unfitting for continued service(not verified just what was told to me by AF and Army Doctors).
I wish the news was better, I really believe with some fighting, some kicking and screaming it should be changed to a muscular rating, since it is the tendons (illipsoas and Isotabular band) crossing over each other as in snapping hip syndrome that cause the most pain, however the reason is due to femoral retroversion and degeneration of the labral and forward tilt of the pelvis, Additionally it could be argued that the bursitis that is a constant issue due to these tendons crossing/popping/falling into the pelvic cup area of the illiatic is more of a muscular condition. However, that is just based on my years dealing with the issue, and the doctors may have a stronger argument that its the cause not the symptom that's the disability.
Just with FAI a patient may actually never get diagnosed with FAI, they may be boarded for Snapping hip, or chronic bursitis, or the labral tears etc. and the surgery may/may not work, treatment may/may not work. In my case I got more relief from the snapping hip treatment of lengthening the psoas than I did from the femorplasty on my left side. Additionally after working closly with this issue the last 4 years, I find that tricare may be right in their denial of the surgery as I am seeing an incredibly low success rate amongst the male population with the issues and only a sligtly higher yet still below 30% in the adult female population, and I have been tracking one very petite, female who has no had revisions on both sides after just 5 years (basically another scope to adjust/rebuild/cleanup), Telling me that it isn't activity level or weight that plays such a major role, but almost just luck of the draw, playing against the house of course.
Now why is all of this important to you, well it probably wont help your case to much, but, it may help all of us if we all get educated and fight. The bad news is, if FAI is your only unfitting condition, your looking at non-retirement and little to no chance of staying in, The good news is, once you have the THR's, your va will be 100% for 13 months and be moved to atleast 30% probable 50% thereafter.
Actually, without FAI, I'm 80% / 100% on my IPEB. Just irritated, more than anything. Through the MEB, I finally got the attention of the docs, for them to look hard enough to see that - no sh*t - something was wrong in the joint, and post MEB and in PEB, ended up in Bethesda for the scope. Still a wild mess -- and they're calling it 0%. Crazy frustrating.
Mine started with breaks. Chips of bone then had more than a decade of freedom in the socket, tearing it up. I'm still unclear why they scoped vice just doing FHR now.
In the grand scheme of things, with my ratings, it's not going to matter much. I'll include it in the appeal -- there are two other issues that need to be addressed, and are driving me and the team to think I will appear -- more to get them to look at what the surgery did and what the records have added since the time of the MEB exams, but FAI sucks. Will have to look at surgeon notes re: bursitis.
Mine started with breaks. Chips of bone then had more than a decade of freedom in the socket, tearing it up. I'm still unclear why they scoped vice just doing FHR now.
In the grand scheme of things, with my ratings, it's not going to matter much. I'll include it in the appeal -- there are two other issues that need to be addressed, and are driving me and the team to think I will appear -- more to get them to look at what the surgery did and what the records have added since the time of the MEB exams, but FAI sucks. Will have to look at surgeon notes re: bursitis.
how are they calling your FAI 0%. That is impossible.
My bad. Relooked at the paperwork. 10%.
Son of a....
I need to get some sleep.
Son of a....
I need to get some sleep.
you have it bilaterally or not?
No, right side. Did a scope on it, coming up on 3 months ago, with little benefit.
Wow! I just saw this thread and I am going thru the MEB now for this. I guess ill start my story..
Last year getting to JBLM, took a APFT in June(June 2013). During said test while doing sit-ups, it felt like my right hip was popping out of place(and the noise was horrible! the look of shock on the others faces..lol) and after the run, I had very sharp pain in my groin so I went to my clinic. PA thought I had snapping hip syndrome. Did physical therapy and all that and did not improve. My doc(awesome btw! not the PA I saw) ordered xrays, leg length xrays and a MRI. Well from the xrays showed I had moderate degenerative OA of the lower SI joint. Leg length xrays showed that my right leg was shorter by a half inch and this could be causing me pain in my hip. My MRI showed I had a labral tear, small FAI and a impingement.
Went to ortho at Madigan and had a hip scope done march of this year. I was not healing well and physical therapy was not promoting my recovery. Had my post op and surgeon said my hip was worse than expected. They weren't able to full repair my tear, I had a wave sign he couldn't fix..so he had to make the suture tighter to try to accommodate the wave sign. Also my FAI was a combination impingement so it was more complicated. Scheduled me to see him again.
Pain got worse, more xrays taken. during the time waiting to see him again, I went to my doc and we both decided it would be best for a MEB. My unfitting condition is per my initial MEB physician is: Right hip impingement and degenerative arthritis s/p labral tear repair. Everyone I talked to, doc..peblo...MEB physician said if it was knees and ankles I could be found fit, but hips are a no go.
Went back to ortho and they stated there is scar tissue and he might have not "taken as much off as needed bone wise" wanted to schedule another surgery. Told then I couldn't due to board. So...they ordered a MRA to see what's going on.
Those came back and it has gotten worse, there is a cleft in the cartilage, bluntness and fraying at the repair site and now there is moderate chondrosis.
I guess I am trying to see how this is going to rate me. With this as my unfitting, I have claimed 25 other things as well. I go see ortho again on the 18th and want a THR. They have already stated I would have to have one in about 4 years, but this was before my MRA came back. What would be a good way to ask about this. Any input would be appreciated. Thanks!
Last year getting to JBLM, took a APFT in June(June 2013). During said test while doing sit-ups, it felt like my right hip was popping out of place(and the noise was horrible! the look of shock on the others faces..lol) and after the run, I had very sharp pain in my groin so I went to my clinic. PA thought I had snapping hip syndrome. Did physical therapy and all that and did not improve. My doc(awesome btw! not the PA I saw) ordered xrays, leg length xrays and a MRI. Well from the xrays showed I had moderate degenerative OA of the lower SI joint. Leg length xrays showed that my right leg was shorter by a half inch and this could be causing me pain in my hip. My MRI showed I had a labral tear, small FAI and a impingement.
Went to ortho at Madigan and had a hip scope done march of this year. I was not healing well and physical therapy was not promoting my recovery. Had my post op and surgeon said my hip was worse than expected. They weren't able to full repair my tear, I had a wave sign he couldn't fix..so he had to make the suture tighter to try to accommodate the wave sign. Also my FAI was a combination impingement so it was more complicated. Scheduled me to see him again.
Pain got worse, more xrays taken. during the time waiting to see him again, I went to my doc and we both decided it would be best for a MEB. My unfitting condition is per my initial MEB physician is: Right hip impingement and degenerative arthritis s/p labral tear repair. Everyone I talked to, doc..peblo...MEB physician said if it was knees and ankles I could be found fit, but hips are a no go.
Went back to ortho and they stated there is scar tissue and he might have not "taken as much off as needed bone wise" wanted to schedule another surgery. Told then I couldn't due to board. So...they ordered a MRA to see what's going on.
Those came back and it has gotten worse, there is a cleft in the cartilage, bluntness and fraying at the repair site and now there is moderate chondrosis.
I guess I am trying to see how this is going to rate me. With this as my unfitting, I have claimed 25 other things as well. I go see ortho again on the 18th and want a THR. They have already stated I would have to have one in about 4 years, but this was before my MRA came back. What would be a good way to ask about this. Any input would be appreciated. Thanks!
Sounds like par for the course, a combo pincer and cam impingement is easy to fix for an experienced doctor, problem is, there are not many experienced doctors. You can file for a request to have the surgery through your PEBLO, problem is, a THR has an extremely long heal time, and your HQ may deny it. I would immediately request an off base ortho surgeon referral, for a second opinion, and talk to that doc about the THR. I would also ask for MRA of the left hip to check for impingement, as that will also be an unfitting condition and help your DoD rating, it sounds like you have a moderate range of motion issue with yours, so you may get rated higher than the 10%, but you may not because FAI carries a kind of "default" since its acceptance as medical fact. Do not worry about your VA rating so much, as if you get a THR after getting out, you will get 100% for 13 months and then a suitable rating according to reovery, I of course had a ultra rare and ultra painful complication from my THR, but I still recommend it to folks because if not for those complications, I would have been back to about 80% of my former self.
Attempting to reopen a new thread because it seems that I share similar pain as you all.
A little about me, I am 30 years old and have been in the USMC for 11 years.
I have been complaining about some hip pain over the years here and there with medical providing minimal feedback (i believe they didn't know they answers) so I kept moving on. It started a few years ago with a clicking hip during the crunches for my PFT, I didn't think anything of it a few years ago because it was a click, that click eventually turned into a pop and that pop became extremely painful. The older I got and the longer I stayed in, the more pain I was in.
The information below is a mass amount of appointments from March of 2019 to present.
I kept returning to medical and I went to physical therapy several times and left with a diagnosis of "internal snapping hip syndrome" and was reminded to stretch often. I got little relief (at best) and kept going back to medical. I was x rayed and referred to orthopedics who review x-rays and recommended injections and stop doing "Marine stuff" I took some injections in my illiosoas tendon sheath to help relieve some of the pain, again with little relief (at best). I continued to go to medical to receive the same stretching routine and a few days of light duty.
Fast forwarding after several months of the same routine, my hips are killing me and my back pain is also getting worse. As soon as I brought up back pain, I was quickly placed on my first LIMDU and scheduled for a MRI (Jan of 2020 and results are below) After the MRI results posted I was referred to pain management for a shot in my back, which I believe has brought me some relief but it has only been a week so its still fresh.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
MRI on Lower Back JAN 2020
FINDINGS:
Vertebral bodies: Bright T1 and T2 degenerative endplate changes at the leftward aspect of L5/S1 with posterior directed osteophyte from the L5 vertebral body. Otherwise the vertebral bodies demonstrate normal height, signal and alignment.
Disc Spaces: Disc desiccation at L4/L5 and L5/S1 with loss of height. Posterior T2 hyperintensity also noted.
Spinal Cord: Normal in signal and morphology with the conus medullaris positioned posterior to the L1 vertebral body.
Paraspinal soft tissues: Unremarkable.
Limited abdomen/pelvis: Normal.
T12-L1: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L1-L2: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L2-L3: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L3-L4: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L4-L5:Broad-based disc bulge with small annular tear contacts the anterior thecal sac and traversing L5 nerve roots in the subarticular zones. Mild ligament flavum hypertrophy. These combine to cause mild spinal canal stenosis. The neural foramina are patent.
L5-S1: Focal midline disc extrusion slightly eccentric to the right with annular tear. The disc extrusion extends 6 to 8 mm below the disc space and contacts the traversing right S1 nerve root in the subarticular zone and deforms anterior thecal sac. There is mild spinal canal stenosis. Asymmetric left endplate degenerative changes and osteophytes. Moderate left neural foraminal narrowing. The right neural foramen is patent.
IMPRESSION:
Lower lumbar degenerative disc disease with contact on the traversing L5 nerve roots at L4/L5. A focal disc extrusion at L5/S1 extends below the disc space and contacts the right traversing S1 nerve root. Annular tears are noted at both levels.
Focal degenerative endplate changes at the leftward aspect of L5/S1.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
After continuing to return to medical almost weekly with the same complaints I was finally scheduled for a MRI with contrast. They injected me and rolled me in for my MRI, left hip first and a few days later my right hip. (Last week) Results are posted below. The MRI does not note FAI on right side, but the x ray and consults reference a known FAI on right with with cam deformity.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
Left Hip MAR 2020
FINDINGS:
BONE/CARTILAGE: Unremarkable.
LABRUM: There is an anterior superior labral tear with small adjacent para labral cyst.
TENDONS: Unremarkable
Limited views of lower lumbar spine, sacroiliac joints, pubic symphysis and intra-pelvic organs are normal. Neurovascular structures are normal. No adenopathy.
IMPRESSION:
Anterior superior left labral tear.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
Right Hip MAR 2020
FINDINGS:
BONE/CARTILAGE: No fracture, stress reaction, or avascular necrosis. There is full-thickness chondral fissuring along the superior acetabulum with adjacent subchondral bone marrow edema. Alpha angle of greater than 50 degrees with several small synovial herniation pits at the femoral head neck junction.
LABRUM: Abnormal signal in the superior labrum extending to the anterosuperior labrum.
JOINT/BURSAL EFFUSION: Joint effusion secondary to the intra-articular injection. No iliopsoas or trochanteric bursal effusion.
MUSCLES/TENDONS: Rectus femoris, iliopsoas, proximal hamstrings, quadratus femoris, and hip abductors are intact.
OTHER: Limited views of lower lumbar spine, sacroiliac joints, pubic symphysis and intrapelvic organs are normal. Small hydrocele in the right hemiscrotum. Neurovascular structures are normal. No adenopathy.
IMPRESSION:
Cam deformity with an associated labral tear and full-thickness chondral fissuring along the acetabulum with adjacent subchondral bone marrow edema, as described above.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
I am reaching out for advice at this point, my primary care manager reviewed the MRI results with me and advised I begin a MEB process. My EAS is July of 2021, which is right at my 12 year mark. I am about 3 months into my first LIMDU period. He put a referral to orthopedics for their input and surgery options. I guess I am just shocked at it all. Lastly I would like to add that I am in Okinawa, Japan with a limited MTF.
Thank you so much for your time and opinion.
A little about me, I am 30 years old and have been in the USMC for 11 years.
I have been complaining about some hip pain over the years here and there with medical providing minimal feedback (i believe they didn't know they answers) so I kept moving on. It started a few years ago with a clicking hip during the crunches for my PFT, I didn't think anything of it a few years ago because it was a click, that click eventually turned into a pop and that pop became extremely painful. The older I got and the longer I stayed in, the more pain I was in.
The information below is a mass amount of appointments from March of 2019 to present.
I kept returning to medical and I went to physical therapy several times and left with a diagnosis of "internal snapping hip syndrome" and was reminded to stretch often. I got little relief (at best) and kept going back to medical. I was x rayed and referred to orthopedics who review x-rays and recommended injections and stop doing "Marine stuff" I took some injections in my illiosoas tendon sheath to help relieve some of the pain, again with little relief (at best). I continued to go to medical to receive the same stretching routine and a few days of light duty.
Fast forwarding after several months of the same routine, my hips are killing me and my back pain is also getting worse. As soon as I brought up back pain, I was quickly placed on my first LIMDU and scheduled for a MRI (Jan of 2020 and results are below) After the MRI results posted I was referred to pain management for a shot in my back, which I believe has brought me some relief but it has only been a week so its still fresh.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
MRI on Lower Back JAN 2020
FINDINGS:
Vertebral bodies: Bright T1 and T2 degenerative endplate changes at the leftward aspect of L5/S1 with posterior directed osteophyte from the L5 vertebral body. Otherwise the vertebral bodies demonstrate normal height, signal and alignment.
Disc Spaces: Disc desiccation at L4/L5 and L5/S1 with loss of height. Posterior T2 hyperintensity also noted.
Spinal Cord: Normal in signal and morphology with the conus medullaris positioned posterior to the L1 vertebral body.
Paraspinal soft tissues: Unremarkable.
Limited abdomen/pelvis: Normal.
T12-L1: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L1-L2: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L2-L3: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L3-L4: No significant posterior disc herniation or spinal canal stenosis. The neural foramina are patent.
L4-L5:Broad-based disc bulge with small annular tear contacts the anterior thecal sac and traversing L5 nerve roots in the subarticular zones. Mild ligament flavum hypertrophy. These combine to cause mild spinal canal stenosis. The neural foramina are patent.
L5-S1: Focal midline disc extrusion slightly eccentric to the right with annular tear. The disc extrusion extends 6 to 8 mm below the disc space and contacts the traversing right S1 nerve root in the subarticular zone and deforms anterior thecal sac. There is mild spinal canal stenosis. Asymmetric left endplate degenerative changes and osteophytes. Moderate left neural foraminal narrowing. The right neural foramen is patent.
IMPRESSION:
Lower lumbar degenerative disc disease with contact on the traversing L5 nerve roots at L4/L5. A focal disc extrusion at L5/S1 extends below the disc space and contacts the right traversing S1 nerve root. Annular tears are noted at both levels.
Focal degenerative endplate changes at the leftward aspect of L5/S1.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
After continuing to return to medical almost weekly with the same complaints I was finally scheduled for a MRI with contrast. They injected me and rolled me in for my MRI, left hip first and a few days later my right hip. (Last week) Results are posted below. The MRI does not note FAI on right side, but the x ray and consults reference a known FAI on right with with cam deformity.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
Left Hip MAR 2020
FINDINGS:
BONE/CARTILAGE: Unremarkable.
LABRUM: There is an anterior superior labral tear with small adjacent para labral cyst.
TENDONS: Unremarkable
Limited views of lower lumbar spine, sacroiliac joints, pubic symphysis and intra-pelvic organs are normal. Neurovascular structures are normal. No adenopathy.
IMPRESSION:
Anterior superior left labral tear.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
Right Hip MAR 2020
FINDINGS:
BONE/CARTILAGE: No fracture, stress reaction, or avascular necrosis. There is full-thickness chondral fissuring along the superior acetabulum with adjacent subchondral bone marrow edema. Alpha angle of greater than 50 degrees with several small synovial herniation pits at the femoral head neck junction.
LABRUM: Abnormal signal in the superior labrum extending to the anterosuperior labrum.
JOINT/BURSAL EFFUSION: Joint effusion secondary to the intra-articular injection. No iliopsoas or trochanteric bursal effusion.
MUSCLES/TENDONS: Rectus femoris, iliopsoas, proximal hamstrings, quadratus femoris, and hip abductors are intact.
OTHER: Limited views of lower lumbar spine, sacroiliac joints, pubic symphysis and intrapelvic organs are normal. Small hydrocele in the right hemiscrotum. Neurovascular structures are normal. No adenopathy.
IMPRESSION:
Cam deformity with an associated labral tear and full-thickness chondral fissuring along the acetabulum with adjacent subchondral bone marrow edema, as described above.
-----------------------------------------------------------------------------------
-----------------------------------------------------------------------------------
I am reaching out for advice at this point, my primary care manager reviewed the MRI results with me and advised I begin a MEB process. My EAS is July of 2021, which is right at my 12 year mark. I am about 3 months into my first LIMDU period. He put a referral to orthopedics for their input and surgery options. I guess I am just shocked at it all. Lastly I would like to add that I am in Okinawa, Japan with a limited MTF.
Thank you so much for your time and opinion.
JMLS, I have a pretty much identical situation to you about back, and hip labral tears except for my EAS. I was also overseas and had to come back early for a MTF to treat me. The Navy instruction states you can not be going through a MEB/PEB and be overseas. I highly recommend you do your research on the Range of motion for hip and back so you know what you’re getting into.
I appreciate it, the issue I may run into is I have pretty good ROM but it is just with pain... Where are you currently at with the process? How long after the MEB was started did you get orders? I am brand new, just had my appointment yesterday where the Dr advised a MEB.
I am currently just wrapping up my VA C&P exams I have my NARSUM, and my NMA all I am waiting on now is my package to be sent off. I kind of had to talk with my surgeon about doing the MEB I am going into as well basically because my hip conditions didnt show any sign of getting better if I stayed in which I am sure is similar to you being a marine.
I had to wait about 3 weeks after my billet code changed to get orders. Your MTF will have to generate an early return request and youll have to find somewhere on the west or east coast to go through your MEB at that has all the things you need like PEBLO, lawyers, VA etc.
I will say this though the ROM tests they will have you do, do no justice to the pain caused by FAI labral tears. I recommend you get a couple different opinions prior to your C&P and MEB write up with the doc.
Oh wow, the timeline is super quick... I appreciate the information, at this point I am so new so I don't know what questions to ask. I definitely appreciate the advice. I would love to get retired, I joined the military with the intent of doing at least 20. These issues came up and was hard for me to accept, but at this point I don't even care if I get separated. I just want the pain to stop and I need a huge lifestyle change.. The pain and limitation are actually depressing. I looked at the different charts for hip ROM, I can (with severe pain) go through the motions, not quite all the way but enough to get around 10-20%. When doing the C&P, do they force any movements or leave it to you?