Expert: Cynthia Bedell - 8/4/2008

Question
I seem to be in a rather frustrating quagmire. Perhaps you can help me. Please allow me to explain. I have been desirous to sign up to The Army for quite some time. Recently, I have met with an Army recruiter regarding enlisting in The Army. Consequently, I have taken the ASVAB, scoring a 99 QT and 134 GT.

However, my dealings with MEPS have not been so promising. I have had multi-ligament knee surgery on my right knee and with one ACL reconstruction on my left knee. (The first surgeon who has operated on my right knee misdiagnosed the problem, requiring another to fix his err.)

During the physical examination (e.g., duck walk, crouching tec.), I had performed the tasks with no problems. Afterwards, I had seen a MEPS physician who examined me, finding that I was healthy. However, due to the fact that I was NOT in possession of my medical records (i.e., surgical and post operative exams on knees) at the time of my examination, he referred me to an orthopedic consul.

During my visit with the orthopedic consul, I still was not in possession of my medical records (due to the rather long process of requiring them). Thus, he did not of certainty know what type of knee surgeries that I had, due to my lack of medical records. But some rather strange things took place during his examination. That is,  although I had no problem jumping and/or performing the tasks that this orthopedic consul required, based on his examination of my right and left knees, he concluded that my knee joints “felt loose” and that they were “unstable.” He also asked me whether I was a “welfare case,” presumably implying that my doctor was somehow incompetent. (My orthopedic surgeon, as a matter of fact, is actually a renowned surgeon. His name Dr. Tyler Lucas for those interested.) The orthopedic consul ultimately concluded that my prognosis was “poor.” I was therefore PDQ’d. Eventually, a medical waiver was requested, ultimately being denied, due to this orthopedic consul’s evaluation (albeit improper evaluation due to insufficient evidence – i.e., lack of medical records) of my knees.


Now this is indeed strange to me. Since my last two surgeries (i.e., March 2007 right knee and June 2006 left knee), my knees have been rather strong. (Actually, I have been playing basketball and jogging with no problems). Further, naturally, I have always possessed some laxity or translation in most of my joints, especially within my knees, even as noted by my orthopedic surgeon. In fact, the very orthopedic surgeon who has performed my last two surgeries on my knees has reevaluated my knee (07/31/08) and has concluded that my knees are “very stable” and that “despite the laxity in my right knee, I have good end-points.” (In other words, there is no problem with the laxity within my knees.)

Furthermore, my orthopedic surgeon has not only written a letter of approval for me but he has provided me with a copy his medical notes of his reevaluation of both of my knees, that I may rebut this orthopedic consul’s evaluation – as requested by MEPS. Through my recruiter, based on the counsel of my recruiter’s superiors, I have resubmitted my orthopedic surgeon’s reevaluation of my knees, including his surgical and post operative reports, to MEPS – as requested by MEPS. Nevertheless, my resubmission was promptly disapproved by a MEPS doctor, citing that “the orthopedic consul has authority” over any outside doctor’s opinions.

Now I am truly perplexed. It seems to me that regarding this orthopedic consul’s examination of my knee, his examination has been rather “incomplete”, to say the best. (For, admittedly, at the time of his evaluation of me, he was not in possession of my medical records.) Further, his examination seems to be diametrically opposed to the individual(s) who actually have examined, operated, and rehabilitated my knees.


My questions are as follows:

1. Is a MEPS doctor’s, or a Medical consul’s, evaluation subject to an independent review (from whosoever legally qualified)? If so, how does one facilitate this process? If not, how does the Military insure that it properly admits any applicant examined by MEPS? Considering that I have actually met individuals while at MEPS who possess broken bones etc., yet who deny any of these problems to MEPS, and have consequently been approved by MEPS, baffles me. These people have even sworn into the Military. Go figure.

2. What recourses may I take, or channels do I follow, to seek a reasonable/fair judgment in this matter?  My recruiter’s superiors, apparently, are talking to their superiors to see that which may be done regarding this matter, for they are indeed upset; for something is patently faulty with this MEPS screening system.  


3. I have read the Standards of Medical Fitness. According to the Standards of Medical Fitness, Disqualifying Medical Conditions, specifically to the lower extremities, include:

a. Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less that the measurements listed below. Methods of measurement appear in TC 8-640.
.c. Leg, knee, thigh, and hip.
(1) Loose or foreign bodies within the knee joint (717.6).
(2) Physical findings of an unstable or internally deranged joint (717.9). History of uncorrected anterior (717.83) or posterior (717.84) cruciate ligament injury.
(3) Surgical correction of any knee ligaments if symptomatic or unstable (P81).
(4) History of congenital dislocation of the hip (754.3), osteochondritis of the hip (Legg-Perthes disease) (732.1), or slipped femoral epiphysis of the hip (732.2).
(5) Hip dislocation (835) within 2 years before examination.
(6) Osteochondritis of the tibial tuberosity (Osgood-Schlatter disease) (732.4), if symptomatic.



If any of the above criteria pertains even remotely to me, it is either (2) or (3).  Have the doctors who have examined me from MEPS using the above as a criterion or are they using some other criteria(on)?


I humbly thank you for your time. - ewashington  

Answer
Dear E --

You have been disqualified by the orthopaedic consulting doctor due to a history of knee surgery with continued knee instability -- which are aspects of your points 2 and 3 above.

Generally a single knee surgery will disqualify you, if you have any laxness in the joint or a McMurray shift.  It sounds like you have both conditions in both knees.

You should never have gone to the consulting physician without your surgical records.  Since he had no prior examples of your physical attributes by which to compare your current lower extremity abilities, he compared them to the average male, and found your joints to be too loose.

Your only recourse would be to appeal to the consulting doctor and have him review your records and your surgeon's statement, and then re-examine you.  It is unlikely he would change his mind, but it is possible.  You will have to work through your recruiting command to get this new appeal for a waiver request submitted.

Broken bones that have healed are not disqualifying.  A healed bone is generally stronger than before the break.  So your point about enlistees who had had broken bones join the service, is irrelevant to your circumstances.

Good luck getting the consulting physician to review your case.  I hope you get the opportunity to serve.