Expert: MARK A. HOWELL - 9/11/2009

Question
QUESTION: Good evening, sir. To give a brief rundown of a long story, I'm an active duty Marine Corporal who has been chasing the medical system for 13-14 months now to try to get my knees fixed. I was diagnosed with Patellofemoral Pain Syndrome (a condition, not a disability for which I could be medically seperated) and I'm currently on Limited Duty. The physical therapy isn't helping, when I can attend, seeing as my old unit constantly had me out of it for classes, duty, etc, and my new unit is going on a month long field training exercise for a month in October. The custom orthotic inserts for my flat feet "which are causing my knee pain" aren't doing a thing either. I've told the Med Officer this, but he keeps insisting that I continue to attend physical therapy. As far as I know (which isn't much), I'm going to be sitting here for a year doing nothing but making medical appointments until my limited duty term is up, then -possibly- go on a medical board, however, I've done research and I personally don't feel that the 10% disability (for joint pain) which I'm likely to get IF I even get medically separated isn't worth the one year wait. I'm really wanting to push for an admin sep if possible and I would like to know where to begin in achieving that end. I love the Marine Corps, and I love my job, sir, but I feel like my hands are tied either way it goes and I'll end up getting out within a year anyways. I greatly appreciate your time and look forward to your response.

ANSWER: Robert,
First of all, if you really like the USMC forget about an admin separation.  It'll cause you nothing but trouble later on.  Let's work on getting you healed.

Patellofemoral Pain Syndrome (PPS) is commonly called runner's knee and it very common in Basic Military Training where new recruits not used to the running and marching end up with very painful knees.  If you do indeed have flat feet, the shoe inserts is about all they can do for that.

PPS is a temporary condition and I've never heard of anyone being discharged because of it.  It sounds like your Med Officer is not experienced in this area.  I know it seems like you're getting the run-around but the only real cure is rest.  It takes about 6-8 weeks for PPS to completely heal.  Usually they put a "boot" or brace on your leg for awhile.  Be honest with yourself, have you really been off your feet as much as possible?  I mean totally, except going to the bathroom.  I'll bet you're sitting at a desk reading this on a computer, right?

Typically the doctor prescribes the R-I-C-E formula:
Rest - Avoid putting weight on the painful knee or knees.
Ice - Apply cold packs or ice wrapped in a towel for short periods of time, several times a day.
  Ice the hell out of it, until it ALMOST feels numb and starts to turn blue.
Compression - Use an elastic bandage such as a simple knee sleeve with the kneecap cut out that
  fits snugly without causing pain.
Elevation - Keep your knees raised up higher than your heart.

Hopefully you've had a CT Scan or an MRI to determine if the kneecap is out of alignment. If so, vigorous activities can cause excessive stress and wear on the cartilage of the knee and will require surgical correction.

Next I'd go to the base Chaplain.  This is an old trick that works wonders.  Whether or not you're religious, the Chaplain can be a powerful ally and I guarantee he'll listen to your plight.  Right now you need someone to intervene on your behalf rather quickly and he knows how to do it.  Any good commander knows you don't (mess) with the chaplain.  No commander wants a potential religious issue on their hands so they'll almost always give in to the chaplain.
It may sound unusual but that's what I'd do.
Good luck Marine.
Colonel H


---------- FOLLOW-UP ----------

QUESTION: Good evening, sir,

    The reason I ask about an admin sep is because I've been chasing this around for a year and, for a while, my condition only continued to worsen. Now it's evened out, but it still causes me almost unbearable pain which restricts me from participating in almost everything my unit does with no sign of getting better.

    I understand about the rest, but I'm an Arty FO, sir. Taking it easy simply isn't possible even in garrison. I don't move when I don't have to, however, and I'm not nearly as physically active as I used to be back in January/February of this year. My weight stays well in check, so that's not even an issue.

    I've been going to physical therapy with no results at all and I just keep being sent back regardless of whatever I tell the Med Officer. He keeps telling me that I'm not going consistently enough for him to count that out as a treatment option, but it's sort of difficult to stay consistent when your old unit and your new one are yanking you along on every training exercise that comes up. Would requesting mast on this issue be a wise/valid option?

    In the past I've gone through all of it; Take this pill, do this stretch, use these crutches, do this exercise, etc. Any help it may have been was immediately negated by all the heavy running and PT I had to do at the time. "Fighting through the pain", as they say. I did that for 9 months from July of last year to February of this year, constantly pushing myself, ignoring the pain as best I could until I couldn't run anymore at all because my knees were unstable and hurt immensely. I went to medical for it each time and got put on light duty every time until I could run again, then went right back at it, participating in unit PT until I "broke" myself again. I "broke" myself 4 times. Twice at Arty School, once at Naval Guns school, then once when I got to my unit. The last time it happened, that was it. I haven't been able to run or do much that involves my knees at all since February.

    I had one bone scan done once back when I was in MOS school at Ft Sill, OK, but the only thing they told me that wasn't regular was that both of my tibia were swollen. "Stress reactions", they called it.

    To be directly honest, sir, I really would like to pursue an admin sep. I've thought this through very thoroughly and I'm certain it's what I want to do. I've only been in the Marine Corps for a year and a half and a little more than a year of it has been fighting to get better. If I genuinely felt there was a good chance of recovery on my part, I'd be much more willing to stick it out to get better, then continue my career, however given my current circumstances, I honestly don't think that's going to happen, sir. I'll definitely go talk to the Chaplain soon.

   Do you have any more ideas on what I can do? Getting healed really doesn't seem to be an option so long as I'm still in the Marine Corps.

Thanks again for your time, sir.  

Answer
Robert,
I understand your frustration.  If you think separation is what you want I'd caution you.  Just because you want out doesn't mean they'll give you an "easy out" like an admin separation.  You roll the dice and you take your chances.  You could get a much worse discharge that will haunt you for years, long after your knees have healed.  You run the risk of getting a General (under honorable conditions) (GUHC) characterization.  This may jeopardize your future GI and VA benefits.  Plus, you normally cannot reenlist or enter a different military service later, after you've healed, if you choose to do so.

Administrative discharges are not voluntary.  All administrative discharges take into account your conduct and performance while in the USMC. If you've been unable to complete some tasks because of a medical condition, your performance may be considered below par (even though it's not really your fault) and it may result in a General (under honorable conditions) discharge.

The USMC has a substantial investment in you so far ($ invested for training, medical care, clothing, food, pay, etc.).  The Separation Authority, or sometimes an Administrative Board, reviews your entire military record and your doctor's opinion on your potential for rehabilitation and further useful military service.  (Seldom will a doctor admit that he can't "fix" you and agree to a discharge.  As I said previously, PPS is temporary.)

In your case, you would hope to be separated for disability under the provisions of 10 U.S.C., Chapter 6l (reference (n)). Disability separations usually results in an Honorable Separation.
However, you could possibly be separated for Unsatisfactory Performance which usually result in
a GUHC) discharge.

Now, having said all that, personally I don't think you have a snowball's chance in hell of getting an administrative discharge.  Nor should you try to get one.  If you persist with that route they may think you're just a constant complainer that wants to go home.

I honestly believe you should concentrate on fixing your medical problem.  I agree with you about physical therapy - it's a joke.  I've been there many times for various problems and it's like having a personal trainer at a gym.  I once expressed my opinion to a doctor and he said, "The body is very efficient at healing itself and given time, it will heal with or without PT."

"Fighting through the pain" is likely what got you in this mess.  Your body was never given the time it needs to heal properly before somebody it demanding you push yourself again.

I don't understand why your old unit has you doing anything.  You're no longer their asset and they can't "make" you do anything.  If that happens again, talk to your supervisor in your new unit.  I'll bet he'd be pissed if he knew that was happening to one of "his" men.

A bone scan won't really show much.  It only shows bone, and unless you've caused enough damage to have some bone chips floating around in your kneecap, of course it'll just show some inflammation.  You need a CT Scan or an MRI which will actually give them a picture of the muscle and fluid in your knee.  I know you're only a Corporal, but you absolutely have the right to demand one.  You need a real doctor who knows what he's doing.  Your Med Officer sounds like an idiot.  He's trying to lump you into the category of minor problems that he's capable of dealing with.  I don't know where you're stationed, but usually the Navy provides medical care for the USMC at a nearby hospital.  You need to see an Orthopedic Surgeon soon, before your condition requires surgery, if it doesn't already.  The next time you see your doctor, request a referral to see an Orthopedic Surgeon.  I can't imagine he'll say no, but if he does simply state "Then I'm going to the IG."  That should scare him enough to get action.

When you go see the Chaplain he may want you both to go see you commander.  If so, that's great.  Don't be afraid to speak up for yourself.  It's your body and you have to live in it for the rest of your life.  What's the worst they can do...kick you out?  You were considering that anyway.

This is the time to get serious.  The wrong folks have been screwing around with your health and your life long enough.  Be a prick if you have to, but don't give in until you get satisfaction.  You can't dig an ammo pit and a powder pit with bad knees.

Please keep me updated on your progress.  I want to see you back in Arty, lobbing shells on some bad guys.
Colonel H