Civilian Doc recommends surgery, pending formal board. What are my options?

jokinawa

PEB Forum Regular Member
So, I was sent to the formal board once and returned without action due to lack of medical information.

I had my knee cartilage removed almost 2 years ago and was boarded because I will never be deployable, etc. I was sent to another medical facility to get scheduled for a procedure to fix or relieve my pain. The surgeon there did not think I was a candidate for the surgery. When I returned my original surgeon was still trying to find someone to do the procedure. My original surgeon had to PCS before I was referred. This was one of the main reasons for my return. So I went back to my ortho department to get my options but the new doc just stared at me like she didn't know what was going on. On my follow up to that to get the information AFPC requested for the follow up FPEB she still did not have any recommendations and even said she cannot make a recommendation without my surgical pictures and apparently, they do not keep them in my ortho records. They are only kept in my surgery records in a different part of the hospital. In 2 month she was not able to get them to make a determination on my request for a knee replacement to improve my quality of life. So I went to a civilian doctor here in Japan. While waiting for my appointment I received my next FPEB date.

During my civilian appt the doc said I need another knee surgery to remove the remaining bits of cartilage and several acid treatments to smooth out the remaining cartilage. The doctor also indicated I now have 2nd stage osteoarthritis in my knee. Looking back through my records the only reference to arthritis before was, "patient shows degenerative changes in knee." So in the year since the "shows signs" I have gone to stage 2 or 3 osteoarthritis. The doctor also noted that if my osteoarthritis worsens I will need a total knee replacement (which I was asking for since my return from Hawaii).

Appointment Summary:
-IPEB: 10% for pain
-FPEB 1: returned without action (need more medical opinions)
-Follow up ortho appt 1 (military): Blank stare, no referral.
-Follow up ortho appt 2 (military): Did basic exam, no referral after 2nd request, no recommendations for treatment given after 2nd time requesting. Noted in medical notes that decision cant be made without surgical pics after 2 month wait (Pics are down the hall, never attempted to help).
- Follow up ortho appt (civilian): Recommended surgery to fix residuals from original surgery. Recommended Knee replacement if next surgery fails to repair problem. Added additional diagnosis of osteoarthritis stage 2.
- Next FPEB: ??


So I was given a 10% rating for pain. Have new diagnosis and recommendation. Recommendation of knee replacement would entitle me to 100% disability for 1 year following surgery, with a minimum of 30% after that (if I understand that rating).

What would you fellow PEB'ers recommend?

Thank You,
Josef
 
Josef,

Did they not do a ROM evaluation? Do you have other conditions? How many years of service do you have?

Seems to me, one course is to get the surgery scheduled. Try to get doc to say that result of surgery may be return to duty. See what happens after surgery. That way, you have the whole gamut of options, from Fit, to getting knee replacement and getting retired.
 
Jason,

They did do a ROM measurement but the doctor forced my leg past the point of pain. I do not know why, my ROM before I naturally stop due to pain is much smaller than the ROM I can force my leg. I have been in service 8.5 years. I want to schedule the surgery but the civilian doctor is a Japanese doctor. I was not referred so TRICARE probably will not cover it, still waiting to hear back. I paid for the MRI, Xray and visit out of my pocket. Luckily for all 3 in Okinawa was only $250. The surgery is significantly more. I have said on several occasions to the Navy ortho here that I want my knee replacement now instead of 5 years to improve my quality of life, reduce my pain and thus reliance on narcotic pain killers. It will also allow me to have a more normal fitness routine (cycling, etc), and a significantly more active lifestyle. My original surgeon told me I would need one in 5-10 years. My knee has apparently changed drastically in 2. I still need to follow up with a patient advocate at the Navy hospital for in action from my ortho doc on referral request, recommendation request, etc.

The doctor is verging on the down right negligent to me. No follow up when she stated she will research, nothing. I was able to find "another military" doctor that specialized in a specific surgery in a 5 minute Google session after she returned no information in 2 months. It takes a minimum of 1 month to get an appointment at the military ortho clinic so anything I need from the doctor I have to know about well in advance. Just a bad situation all around.

Thank you for the info,
Josef
 
Sounds like they did your ROM wrong (though, I don't know what they wrote, so it may be okay...since I see a lot of errors in measuring ROM, I would be suspicious).
 
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