Outcomes for FAI with and without laberal tears?

Thank you for the information in this thread. I am having scope surgery for FAI on my right hip next week. The surgery is being done by the ortho docs at Navy Medical Center Balboa. I also have FAI in my right hip as well. The docs know there is cartiledge damage, but they don't know the extent. No talk of a med board yet, but it will definately depend on the outcome of this surgery.

-Josh
 
TSgt Twitch said:
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.
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Do you happen to know if your friend got rated separately for OA and the BIL FAIs? Because I was told they will only rate one condition for the hip, and also Title 38 says OA has to be in two or more major joints to get 20%. I'm having a LOT of anxiety over this...in my "bad" (disqualifying) hip, I have grade III and IV chondrosis, microfractures (that didn't work), osteochondroplasty to correct FAI, labral debridment (which is still catching, so will be getting another revision next month), and moderate osteoarthritis. In my "good" hip, I have FAI with possible labral tear and moderate osteoarthritis (from compensating for so long). I am having a VERY hard time stomaching the fact that I may only get a 20% rating, and thus no retirement, from the Army when I am now crippled for life...especially since this is a deployment injury. The surgeon has already told me that I will definitely need a new hip but he wants to wait as long as possible for that because I'm too young (31yrs old) and it will only cause more problems for me in the long run. The stress is literally keeping me up at night and I can't stop myself from tearing up every time I talk to someone about it...just doesn't seem right. I have my VA evaluation tomorrow and won't lie about anything, but I wish I had some advice about the best way to approach this with the VA doc to that he or she will write it in a way that will most benefit me.
 
Breanna Trexler said:
Do you happen to know if your friend got rated separately for OA and the BIL FAIs? Because I was told they will only rate one condition for the hip, and also Title 38 says OA has to be in two or more major joints to get 20%. I'm having a LOT of anxiety over this...in my "bad" (disqualifying) hip, I have grade III and IV chondrosis, microfractures (that didn't work), osteochondroplasty to correct FAI, labral debridment (which is still catching, so will be getting another revision next month), and moderate osteoarthritis. In my "good" hip, I have FAI with possible labral tear and moderate osteoarthritis (from compensating for so long). I am having a VERY hard time stomaching the fact that I may only get a 20% rating, and thus no retirement, from the Army when I am now crippled for life...especially since this is a deployment injury. The surgeon has already told me that I will definitely need a new hip but he wants to wait as long as possible for that because I'm too young (31yrs old) and it will only cause more problems for me in the long run. The stress is literally keeping me up at night and I can't stop myself from tearing up every time I talk to someone about it...just doesn't seem right. I have my VA evaluation tomorrow and won't lie about anything, but I wish I had some advice about the best way to approach this with the VA doc to that he or she will write it in a way that will most benefit me.
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My friend got 20 % total for the hip(s) and 10% back, she more than likely got more from the VA but the unfitting conditions were the ddd and FAI, now in reality it came out to a little higher because the bi-lateral of the fai, but it is listed as a thigh injury not hip. I wish i had asked her more questions but once she got the unfit rating at 30% she out processed and left while i was on convalescent leave from my surgeries. sadly reading everyone's case history 10% seems the standard for FAI because whereas you may be in pain it really does not limit your range of motion. I too stay awake still fearing being screwed over and loosing "everything" due to bad doctors, hence why I opted for the hip-replacement which has a minimum 30% rating, it was one of those if i am going to need it anyway deals I might as well go ahead and "secure" my retirement and stop extra damage from being done ( limping and bad gate has caused the other hip to wear down faster and back problems started getting worse). I still feel i made the "best" decision even with the major complications i had. The fai pain is gone and I am about 50-60% back to "normal". I still use a cane and am still on pain pills and anti-inflamitories but I am able to get around my small farm and use my tractor again and even went horseback riding. ( not gonna buy a motorcycle any time soon though).
 
oops just noticed this was earlier in the week sorry i missed it, how did your va appt go?
 
TSGT TWITCH or anyone; you seem knowledgable here, do you know if this condition is being rated as service connected? thanks
 
I am very interested in following this thread as well. Diagnosed with FAI in left hip (also told right hip was worse than left one, but left one hurt more at the time) and had left hip surgery in Jan 2010. Whole year of rehab. Able to run again in Jan 2011, passed full fitness test in September 2011, but think by "getting back in shape", both of my hips now hurt. I vnow have another profile for no running, walking, swimming, pushups, crunches, etc. until next month. I meet with Ortho in 2 weeks. Not to mention I have bone chips in big toes, diagnosed with carpal tunnel, etc. I am most interested in the hips issues, but if an MEB is required, do they look entirely at record and give you x% for hips, y% for carpal tunnel, etc.?

Thanks for any assistance you could provide. I have been in over 17 years now. Ready to retire since I do not think I could pass another fitness test because of my health issues.

Big Country
 
"TSGT TWITCH or anyone; you seem knowledgable here, do you know if this condition is being rated as service connected? thank"

In my case and the other 5 cases I have seen, it has been service connected, however every case I have seen i believe the member has been over 8 yrs time in service so EPTS was irrelevant. There are birth/adolescent growth defects that can "lead" to FAI so it is possible if you have less than 8 yrs time in service that they could try to say it existed prior to service, but i feel with the amount of running/marching etc on top of our chosen for us footwear (combat boots) it could just as easily be argued that the member did not know about the growth issues and that the service aggravated the condition.
 
Big Country:

I am pretty sure the va invented and coined the term "fuzzy logic" but ill try to break down my understanding of it.

1. If you are put in for an MEB, you and your PCM fill out paperwork covering every condition that has ever happened to you in your career, you can add things here if you feel they need to be checked out for possible consideration.

2. Your PCM/DAWG team/Peblo etc. set up appts with va certified doctors to conduct examinations that meet the va guidelines, and this information is forwarded both to the VA and to your MEB counsel.

3. The local MEB counsel meets and determines if your conditions are "fit or unfit for continued service" This is a grey area as the individual service regulations give specific lists and "gray area" terms. I.E> all services currently OSA (obstructed sleep apnea) requiring the use of cpap machine, wheras is an automatic %50 disability rating, it is also "fit for continued service" for certain branches.

4. If ANY of your listed conditions are found unfit, the entire package is forwarded to the VA regional offices for review and rating, once this is complete the individual MEB counsel will use the VA numbers in consideration to apply percentages to JUST THE UNFITTING CONDITIONS. and make their recommendation.

There are several other "steps" in the process that will require decisions on your behalf, you can ask for independant medical reviews etc if you do not agree with the findings at any stage, and once the MEB ( actually the IFPEB after they get your va numbers back) notifies you of final decision you can appeal to a formal board, if you disagree with the formal board you can appeal to the secretary of the (service branch here).

Now as to your ratings, as mentioned above there are actually two ratings given now under the IDES, DOD and VA and it is important to remember that if they assign somethign 0% it is still a rating. DOD ratings are based solely upon the condition(s) that make you unable to serve in your AFSC/MOS. This is actually the most important number to many as it determines rather you receive severance pay (base payx2xyears of service) or medical retirement. (<30% severance >30% retirement) so it is possible you could get 20% for your hip and 0% for your carpal tunnel from dod but get 20% hip and 20% carpal tunnel from VA.
 
Separated post to separate thoughts.

I too have FAI in both hips, but one hurt more than the other due to the amount of labral tearing/tendonitis caused by the condition.

The best advice i can give is that after the military, there is hopefully a great number of years that's its just you, your family and your friends. I am not cheapining my or anyone else service but its a sad truth that once we pass the saber to those we have hopefully trained to be at our above our level of competency/abilities that we are no longer needed. We can still be useful and an assett, but not needed in the roles we once assumed.

I say this because my wife who is an absolute goddess and has been by my side since we were high school sweethearts, told me after my third surgery that if I did not get relief that she would rather live in a box in an alley with me, than to see me suffer and further hurt myself playing the profile/pt test game. Your long term quality of life is so much more important than putting your body/mind/soul through the process to make it to that magic 20 (if its going to cause further injury). If your gonna be in pain no matter what you do then suck it up :)
 
TSgt Twitch said:
My friend got 20 % total for the hip(s) and 10% back, she more than likely got more from the VA but the unfitting conditions were the ddd and FAI, now in reality it came out to a little higher because the bi-lateral of the fai, but it is listed as a thigh injury not hip. I wish i had asked her more questions but once she got the unfit rating at 30% she out processed and left while i was on convalescent leave from my surgeries. sadly reading everyone's case history 10% seems the standard for FAI because whereas you may be in pain it really does not limit your range of motion. I too stay awake still fearing being screwed over and loosing "everything" due to bad doctors, hence why I opted for the hip-replacement which has a minimum 30% rating, it was one of those if i am going to need it anyway deals I might as well go ahead and "secure" my retirement and stop extra damage from being done ( limping and bad gate has caused the other hip to wear down faster and back problems started getting worse). I still feel i made the "best" decision even with the major complications i had. The fai pain is gone and I am about 50-60% back to "normal". I still use a cane and am still on pain pills and anti-inflamitories but I am able to get around my small farm and use my tractor again and even went horseback riding. ( not gonna buy a motorcycle any time soon though).
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Thanks for getting back to me...sorry about the delay in my response--haven't logged on since that last post. The VA appointment went...well, it "went." I don't really know what to think about it. The doc didn't seem overy thorough on doing ROM and other assessments on my hips, which is really where I needed to "sell" my case. I asked if he would consider my "good" hip a disqualifying condition (a second disqualifying condition which is, at this point, the only way I'm getting a retirement). He said they don't make that determination because they have to remain an objective party in the rating system. I suppose I understand that logic, but it would have been nice to have walked out of the office with a little hope. :(

I have my next hip surgery in about a week, and I think I'm going to ask the surgeon what his honest opinion is on how long I have left until I will need the full replacement, and then discuss having it done before my discharge. Yes, it will definitely put my MEDBOARD on hold, but it might be worth it in the long run. Were you already in the MEDBOARD process when you had yours done?
 
Actually i'm a bit shocked your able to plan surgeries etc while still scheduled for surgeries typically a med board can not take place while you are still in a "treatment" phase and you havent had a suitable convalescent period from major surgeries. IF you have issues with both hips you should be eligible for the bi-lateral addition which adds a few percentage points but if they just rate both at 10 and you have no other disqualifiers you would be stuck at 21%, BUT the FAI is rated as well as the OA as separate conditions in most cases i believe. one being a muscle/bone injury condition and the other being a cartilage. Good luck on your next surgery I really wish that the debridements and plasties where more than band-aids, because as i write this I'm considering putting in my SSDI paperwork due tot he fear i will not be able to sit/stand/lift etc for long periods of time after i get out.
 
Let me clarify the rating of the OA and the fai separately.
It would look something like this

FAI right hip =Impairment of muscle group xix LR=10%
FAI Left hip=Impairment of muscle group xix LL=10%
Osteo-arthritis secondary to bi-lateral conditions=20%

bi-laterals for both hips with bil factor=21%+ OA 20%=37% raised to 40% for rating purposes.
 
TSgt Twitch said:
Actually i'm a bit shocked your able to plan surgeries etc while still scheduled for surgeries typically a med board can not take place while you are still in a "treatment" phase and you havent had a suitable convalescent period from major surgeries. IF you have issues with both hips you should be eligible for the bi-lateral addition which adds a few percentage points but if they just rate both at 10 and you have no other disqualifiers you would be stuck at 21%, BUT the FAI is rated as well as the OA as separate conditions in most cases i believe. one being a muscle/bone injury condition and the other being a cartilage. Good luck on your next surgery I really wish that the debridements and plasties where more than band-aids, because as i write this I'm considering putting in my SSDI paperwork due tot he fear i will not be able to sit/stand/lift etc for long periods of time after i get out.
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What they told me about having another surgery is that, if it was for a condition that would NOT "fix" the disqualifying condition (and, thus, not change the indication for a med board in the first place) then it would not delay the process and the two could happen simultaneously. Because the surgery I'm having tomorrow is just to hopefully repair the labrum a little more (it's still pinching/tearing...I believe they were just too conservative with it the first time around), it won't fix the overall damage that disqualified me in the first place. I hope they didn't misinform me...I certainly don't want to start this process over again--it's already been 6 months and I don't even have the results from my first VA appointment yet.

You give me hope with that last post about the percentage ratings. :) The only thing is, if the ARMY doesn't consider both the FAIs *and* the osteoarthritis "disqualifying" conditions, then they won't rate both. Of course, money from the VA will be nice, but I am REALLY hoping for a retirement so that I can keep Tricare for myself and my family.

I really appreciate you keeping up on this post for me. I will let you know how things go so that we can help Soldiers facing this problem in the future. I'm sorry to hear your recovery isn't going well...I wish you nothing but the best of luck!
 
Best of luck with surgery tomorrow, keep us informed, and yes retirement with tricare is the goal. I am unsure how somethings work still i need to figure out like:
1. does a condition itself have to stand alone as unfitting for dod to rate it or does it hae to include secondaries i.e. FAI itself is unfitting, arthritis may not be but since it is secondary to the unfitting condition does it get included that way or not.
2. can you atcually "prove" something is unfitting in a rebuttal, the only evidence you could present really would be letters from peers/supervisors/commanders/spouse.
3. Still confused on the would it be unfitting IF x=y: I.E. a back injury may not be itself unfitting but because of a knee injury that is unfitting causes the back to be in more pain. Like a persons back hurts but it hurts substantially more after walking a while on a bad knee that causes poor gait/radiating pain. etc. in question 1 the injuries are clearly defined as connected arthritis is secondary to fai. but in the question the back injury is seperate and is further worsened by the knee issue.
 
I can't believe how informative this thread is. After searching (I have plenty of time for that while I'm on profile...) for days trying to find information on what path I am heading down, I am very relieved to find this forum.

Now for my question(s):

I am an Air Force TSgt with 14.5 years TIS in CE. I am a heavy equipment operator so I am practically useless with my hip pain. My dilemma started with what I thought was a pulled groin in November of 2009. After several unsuccessful attempts from the military staff to correct the groin that wouldn't heal--and several bouts with physical therapy--I finally got an MRI and was sent to ORTHO. They diagnosed me with FAI and two labral tears in the right hip, which was where the groin pain was located. I also have a large calcium deposit in the groin region which the surgeon said was a byproduct of the FAI. I reluctantly agreed to do the surgery in April 2011 at an MTF and they performed an arthroscopic/minimally invasive technique that supposedly corrected the problem. Well, I managed to escape that base before my 6-month recovery ended and tried to start fresh at a new base before there was any talk of an MEB. I manage to pass my PT tests by doing the 1-mile timed walk and only exempting sit-ups (the calcium deposit is right in the hip flexor which makes situps impossible). Well, around September, my left groin started hurting in the same way my right was. I have been on continuous profile for these problems so the squadron is really on my case about PT and what I'm doing to correct the problem. After jumping through hoops to get my referrals to check-out the left hip, an MRI with dye discovered that I have two tears in the left labrum and worse FAI than my right. It also revealed that my right was torn again because the MTF didn't properly shave the femur to prevent future FAI. The orthpaedics surgeon here tried to schedule me for sugery but suddenly TRICARE won't pay for it.

What am I supposed to do now???? I haven't met with my PCM about this yet but I am afraid to discuss it because it will almost certainly start an MEB discussion. If I had a couple more years in, I wouldn't be so worried. But with only 14, I am afraid I will be booted with nothing.

Any advice you may have would be greatly appreciated.

Thanks,

TSgt C
 
According to the information compiled in this thread and elsewhere FAI with labral tears even with the femoralplasty, arthroplasties etc. barring any major complications typically becomes unfitting especially with your AFSC. the rating is based on actualy impairment on range of motion, which sadly with the plasties may be perfect even though your in constant pain. the ratings that have been posted with the repairs being conducted have been 10% for moderate impairment to muscle group for each thigh which would be 22% total including bi-lateral. now becuase you have multiple tears and will likely end up with multiple surgeries this may up your % to 30%. I wish i could say you had a shred of hope getting tri-care to pay for the repair of the other hip and fix the original but It is highly unlikely. ( it has been 1yr technically since i put my appeal in and it was denied at every level but never officially denied before i decided for the total hip replacement.)

But after seeing a broader range of cases in the last year, i am understanding tricares side a bit more. It seems that at least in the ones I have read and studied that the true success rate ( 100% return to normal life pain free) is much lower than is being reported. Maybe in the civilian world where their jobs do not rely on physical fitness, or the have less demanding lifestyles ( in my case i believe hip implants have such a high "success" rate because they are basing it on the age of the patient and not necessarily the activity level.)

Unless you try to hide your injuries and pain and fail the pt test/get admin'd out or rank reduced below high year tenor you will not leave with nothing as a result of your med board. You may leave with retirement which is the same/or better than 20 yr retirement depending on percentages or with severance. At your years of service by the time a med board completes/if you are found less than 30% appeal your ass off since you have nothing to loose with unfit at 0-20%) you will be looking at $100K+ severance pay -28% federal taxes which you will get that back eventually. the downside to this is no tri-care for life for you+ family no bx commissary etc. and honestly $100K isnt a whole lot if you were to be making 2k a mos retired pay. Keep us updated I really am interested in tracking peoples case.
 
TSgt Twitch said:
According to the information compiled in this thread and elsewhere FAI with labral tears even with the femoralplasty, arthroplasties etc. barring any major complications typically becomes unfitting especially with your AFSC. the rating is based on actualy impairment on range of motion, which sadly with the plasties may be perfect even though your in constant pain. the ratings that have been posted with the repairs being conducted have been 10% for moderate impairment to muscle group for each thigh which would be 22% total including bi-lateral. now becuase you have multiple tears and will likely end up with multiple surgeries this may up your % to 30%. I wish i could say you had a shred of hope getting tri-care to pay for the repair of the other hip and fix the original but It is highly unlikely. ( it has been 1yr technically since i put my appeal in and it was denied at every level but never officially denied before i decided for the total hip replacement.)

But after seeing a broader range of cases in the last year, i am understanding tricares side a bit more. It seems that at least in the ones I have read and studied that the true success rate ( 100% return to normal life pain free) is much lower than is being reported. Maybe in the civilian world where their jobs do not rely on physical fitness, or the have less demanding lifestyles ( in my case i believe hip implants have such a high "success" rate because they are basing it on the age of the patient and not necessarily the activity level.)

Unless you try to hide your injuries and pain and fail the pt test/get admin'd out or rank reduced below high year tenor you will not leave with nothing as a result of your med board. You may leave with retirement which is the same/or better than 20 yr retirement depending on percentages or with severance. At your years of service by the time a med board completes/if you are found less than 30% appeal your ass off since you have nothing to loose with unfit at 0-20%) you will be looking at $100K+ severance pay -28% federal taxes which you will get that back eventually. the downside to this is no tri-care for life for you+ family no bx commissary etc. and honestly $100K isnt a whole lot if you were to be making 2k a mos retired pay. Keep us updated I really am interested in tracking peoples case.
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Thank you for the quick reply. I will definitely keep you updated. Tricare hasn't officially denied my surgery yet so I still have time. The surgeon said the VA actually sources this surgery out through them so now I am trying to work it out where I can be seen at the VA (not even sure active duty can do this) by the ortho doc there. It is a long shot but definitely worth a try.
 
Always worth a try, you could also go the route of going through the MTF at your last base or one closer where a military doc offers the surgery. JD101 would be the expert ont hat though and i have not seen him in some time.
 
Im still around, if anyone wants to send me a PM feel free to do so and Ill help as much as I can. I am not a doc, but hopefully I can point somebody in the right direction, or at least enough that it may help tham to save a career.
 
Well how are things going on your end JD? any updates after your surgery?
 
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