Expert: MARK A. HOWELL - 9/8/2010

Question
Greetings veterans,

I am an active duty 0311 Infantry Marine and have been part of an ongoing process for about a year. My EAS is just months away, and I am on my second term limited duty. I am on it due to my knee, I have patellofemoral dysfunction and osteochondritis dissecans. Both of which I have attempted to overcome through physical therapy. I maxed out my physical therapy and nothing was working. She told me as well as the orthepedic surgeon to take some of the tools they had and take them home and do it at home. She told me to come in at the end of my first term which was 2 weeks ago to get reevaluated to see if the condition has gotten better. They took an xray and mri of my knee only to find that the condition has worsened. So I am now on my second term limited duty.

My question was, my command, thinks I'm lying and malingering. As a result of my condition, doctors have made sure I dont run or do anything that could worsen my knee, as we are trying to avoid surgery at all cost, knee surgery 9 times out of 10 makes things worse. Can they even put me on the Body Fat Composition program if I'm on limited duty, where it states before the injury I was within weight and height standards. Secondly, if they do, can I be kicked out through the Body Fat program if I don't make the weight in 6 months, I heard I would be unfit for discharge because I have a medical condition I received while I was in the Corps, and until that's solved, I would stay in.

Lastly, does my command even have the right to access my medical records? I've handed in every piece of medical paperwork I've gotten about my knee and they still treat me as if I am malingering. Just not sure how to go about this, and it's not information that's taught to you by your command.

Thank you to whoever answers this. I've got a wife and kid, and it's affecting them as well.

Semper Fi.


Answer
Ryan,
I'm really sorry to hear about your illness and problems.  I once had a young troop with exactly the same conditions so I know what you're going through.  Normally the doctor recommends
discontinuance of all activity that causes the problems, thus the limited duty.  As symptoms subside, about the only thing that works is physical therapy and/or surgery.  Have they mentioned surgery yet?

Patellofemoral Dysfunction is bad enough but curable.  However combined with Osteochondritis Dissecans (OCD) [rare, and is the worst of the two] the combination can make the pain unbearable.  75% of all OCD cases involve the knee.  OCD usually causes pain and swelling of the knee and sometimes catches and locks during movement.

Doctors always try non-surgical procedures first, which in your case involves physical therapy for stretching and strengthening exercises, and range of motion, and pain killers.  It usually takes 6-8 weeks of physical therapy after the immobilization period has ended.  During this time, you're usually advised to avoid running and jumping, but are permitted to perform low impact activities, such as walking or swimming.

I am not a big believer in physical therapy.  It's like having a Personal Trainer in a gym.  Over the years I've been to therapy many times for knees, shoulder, and back problems.  It never works.  A very smart doctor once told me that all physical therapy does is speed-up the healing process a little bit.  Time and rest will eventually do the job all by itself, and I believe him.

Since therapy didn't work for you, why not give surgery a try?  I can't believe that 90% of the time it fails.  In my experience it’s just the opposite, and I've known lots of people that had it.

It's a shame your supervisors didn't bother to do their homework and see just how serious your condition is.  I'll bet none of them came to visit you while you were immobilized, right?  What a sorry bunch of … A good commander would always care about the health of his men first.  And you can tell him I said that!

No, they cannot put you on the Body Fat Composition program while you're on limited duty,  That's totally against the regs.  However, once you come off limited duty, you have 6 weeks to conform to standards.

About the only way they can put you out is to claim your problems were a pre-existing condition, because OCD is usually undiagnosed in children.  Kinda weak, but they might try it.

What you heard about being "unfit for discharge because you have a medical condition you received while in the Corps," is only true for retirement.  They won't let you retire until they've done all they can do to fix you medically.  It doesn't pertain to you.

Lastly, yes, your command can access your medical records.  I don't know why they would want to, you've already told them everything.  Your visits to a doctor are not covered by confidentiality rules.  Only a lawyer or chaplain has those privileges.

I'm sure your wife and child are under a lot of stress also, worrying about you and uncertain about your family's future.  I wish I could tell all of you not to worry, but every situation is different.

There's an old trick you can try.  Next I'd go to the base Chaplain.  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 and he knows how to do it.  It may sound unusual but that's what I'd do.  There's an old saying in the military, "No commander …..(screws) with the chaplain.  He'll ensure your supervisors back off.

Bottom line, if I were you I'd definitely go for the surgery.  Should it not solve your problem, the worst they can do is discharge you and that might happen even without the surgery.

Good luck and let me know what happens.
Colonel H