Mild chondromalacia of the patella

[cagg011]

I've been told I need to get the SG to sign off on a knee scope I had almost 10 years ago for mild chondromalacia of the patella before I can go to MEPS. Does anyone know why this is a big deal? The only thing I can think of is my medical file is missing a sheet with post-surgery/therapy evaluation. I have an appointment with my doctor slated for next week to take care of that, but any advice on what is needed to get the SG to sign off on it would really be appreciated.

[deaddebate]

They may be suspicious that the scope also treated a torn ligament.  Would a scope be justified for first round treatment of "mild" chondromalacia, or was it more symptomatic and chronic, after other care?  Did you continue care with PT or an Orthopedist, and where is that documentation?

Anyway, get the doc to document your memory of the injury and treatment, then assess for instability, weakness/strength, range of motion, ability to run/jump/bear weight, and pain.

When civ doc's write shit like "Joey's knee is recovered and he is able to fully participate in military duties," it means nearly nothing.  A good note might look like this: "Joey injured his left knee during the summer of 2004 during a basketball tournament, and it worsened through the season.  He was evaluated by his PCM in the fall of 2004, referred to Physical Therapy, and later diagnosed with mild/moderate chondromalacia.  He attended PT for 2 months, and then evaluated by an Orthopedic Specialist, who recommend MRI.  An MRI in Nov 2004 identified moderate chondromalacia and probable bucket-handle tear of the meniscus.  He underwent corrective arthroscopy in Dec 2004 and continued PT through Apr 2005 to full recovery, never requiring retained hardware.  My assessment today shows no complications/no sequalae from this injury.  He has full, pain-free range of motion, no weakness nor instability, 5/5 strength, and able to run and jump without limitation.  He can maintain an active lifestyle, and recommend he continue to exercise regularly."

[cagg011]

That's great to know, thank you!

The surgery was recommended since I was going into my senior year of high school with a full schedule of sports ahead and because there was already a decent amount of grinding due to the frayed cartilage. I originally went to a PT who thought there wasn't much he could do (I don't think he knew what was going on), so he referred me to my surgeon. I did an MRI and the decision was made after the results came back to do the surgery. All of my ligaments were noted to be intact during arthroscopy, and it was specified in my medical file as so.

Ha, you were dead on with the pointless surgeon note, and that was my suspicion that it wasn't sufficient enough when I got him to write it a few months ago. I will be sure to have him write something similar to what you posted.

[mrgrey]

Cagg011,

Let me know how this goes. I got PDQ that I'm trying to fight for a shoulder surgery that was done in 2007, Posterior labral repair and chondoplasty for grade 2 chondromalacia. I was suppose to see a consultant after MEPS but it went straight to DQ. I had my surgeon give a good letter too, saying " no symptoms in right shoulder and full range of motion and strength.

Strange thing is, my recruiter is saying it was an automatically disqualifier, but I had to submit all my docs beforehand and get a waiver to even "floor"/ be able to take the physical, so if it was an automatically disqualifier, why would they even let someone go to MEPS if they are just going DQ them. Drs at MEPS don't really check you a whole lot, pretty much just write down what's in your medical files that you provide them.

Edited February 22, 2016 by mrgrey

[cagg011]

Just got word back that a history of chondromalacia, no matter how many years ago it was, is considered a non-waiverable condition military-wide, not just Air Force or Air Guard. Thus, NGB/SG did not approve my waiver.

[cagg011]

Bringing this back from the dead. In my last post, I was evidently given bad information, as I found out today that I was able to obtain an approved SG waiver for mild chondomalacia! Although, it did take a lot of work and persistence, but what seemed to work was having a very supportive and patient unit and also a second opinion on hand from another orthopedic surgeon saying everything was clear.

[Pat]

@cagg011

what unit helped you get your waiver? I went through 5 years of ROTC at the University of Arkansas, got my flight physical and security clearence but then had a wreck and got medically disqualified for chondromalacia. I have been trying to get a waiver from the Air Force active duty, Air national guard, Army,Navy, etc and have not had any luck. I can run and lift weights just fine and have no pain. Any help would be greatly appreciated.

[DifferentViper]

Kind of am old one but looking for some info on this.

I had a basketball related knee injury in college. The cartilage on my femur was damaged and through years of not taking care of it the cartilage on my knee cap was also lightly damaged. It was surgically repaired with no hardware and after physical therapy have no symptoms or weakness in my knee. Surgery was 5 years ago. 

I am a AFR UPT hire and was DQ at MEPS for chondromalacia. We are planning on getting a waiver at the flight physical. Is this something that will be a challenge? 

 

[DifferentViper]

Returning to answer my own question. I was denied from going to the flight physical. I appealed with an evaluation from another doctor saying everything was good and it was also denied. It appears this is not something they mess with.

[jonlbs]

 

10 hours ago, DifferentViper said:

Returning to answer my own question. I was denied from going to the flight physical. I appealed with an evaluation from another doctor saying everything was good and it was also denied. It appears this is not something they mess with.

You check out the Navy yet? My brother had a very similar injury (knee cartilage issues, not sure if exactly the same though) and with a little grunt work was approved with them. Other option is ETP if you can get the support. Keep with it brotha, it'll be worth it.

[DifferentViper]

No I haven't. I'm kind of stuck where live because of family reasons and there are only air force units around. I just wish i could get more of an explanation about what they are concerned with even if it was that they are not doing waivers for that condition at all, just something. 

I am pursuing ETP. I think the unit will be willing to do it but I left it up to them since they are the ones doing the work. Just sucks to be DQ because of an injury that I've fully recovered from without any evaluation. 

Don't plan on quiting but I see that I'm starting to run out of options.

[DifferentViper]

Maybe I'm misreading things but the Medical Standards Directory item K44 says that chondromalacia is disqualifying if symptomatic or has history of joint effusion, interference with function, or residuals from surgery. I have not had any of that since the surgery which was 5 years ago. The Aeromedical Waiver Guide does not have anything about chondromalacia that I could find so I guess they are standing by the DODI in this situation and ignoring the MSD?

Anyone have any insight into this if I'm not applying the MSD correctly? 

[WannaBpilot]

Received my second waiver denial today for Chondromalacia and the Microfracture surgery. Submitted very detailed ortho letters and physical exams stating that my functionality is perfect, full strength, full mobility, no limitations, not likely to occur again or impact military service, etc. Sounds like chondromalacia alone might be OK but based on my research/experience and others on this forum the Microfracture surgery is the kicker. Open to any suggestions if people have them, but it appears like I'm at the end of the line for this journey. I also considered potentially looking into the other branches but it doesn't seem likely that we would get through since this is the general MEPs clearance that is holding up the process.  Appreciate all the intel on this forum, been an avid follower over the last 1 1/2 years! 

[iwilson12345]

Hey I’ve been looking around the internet and this forum hits home with my situation right now lol. I tore my acl back in 2015 playing basketball. I had surgery for it in 2017 and completed physical therapy and everything. The past few months I’ve been working with my recruiter trying to gather all my medical documents, surgery notes, and physical therapy notes and finally got everything submitted to meps. Just got a text from the recruiter today saying that I was DQd for Chondromalacia showing up on my medical record back in 2017. I’ve never even heard of this and was never told by my doctor that I had or have this condition. But like I previously said I got a letter of release from the doctor who did my surgery AND the physical therapist that said I was clear to go to the military with no restrictions. He said it’s up to the surgeon general to approve me. Is there anything else I can do ?

[DifferentViper]

Depends how bad it was. Me and wannabe had grade 3 going to the bone. Chondromalacia is just cartilage damage so it can be mild fraying or severe. You will need to get details about it from your surgeon to either defend it as not a problem or have it removed as misdiagnosed. It doesn't heal though so that is the biggest issue with it. Sometimes it can be degenerative even if caused by an injury. This leads to arthritis later in life. I'm still fighting this but easiest path is probably convincing the doctor it was misdiagnosed but you can't tell it's conditon without surgery so you will need to talk to your original surgeon. 

FYI not a doctor but been fighting a DQ on this for a year. They let me go to meps though just dq me while i was there even though i passed all the other tests no problem. 

Hope you have better luck than us.

[WannaBpilot]

Following up on my own process here and hopefully it will help others. I contacted my Congressperson through their website and was able to eventually connect with a Congressional Liaison who submitted an inquiry on my behalf with the NGB/SG's office. I had to provide my MEPs paperwork and physical exams, clearance letters, and rehab report (this was a letter I wrote about my rehab process as I did all of it myself, and I also detailed by current level of physical activity).

After 6 weeks, we received a response to the Congressional Inquiry that the NGB/SG Senior Branch Provider and Medical Director reviewed my case and determined they would recommend a waiver. I haven't connected yet with my unit on this-our last waiver attempt was 1 year ago and we haven't been in contact since as my recruiter thought there was no point to try a third waiver request (and I agreed based on 2 failed attempts)-but hopefully this will lead to the official waiver approval and next steps, finally.

The big lesson here is to not take no for an answer, even if you have to go at it alone. Also, take care of your knees while you're young... 

[abc1]

6 minutes ago, WannaBpilot said:

Following up on my own process here and hopefully it will help others. I contacted my Congressperson through their website and was able to eventually connect with a Congressional Liaison who submitted an inquiry on my behalf with the NGB/SG's office. I had to provide my MEPs paperwork and physical exams, clearance letters, and rehab report (this was a letter I wrote about my rehab process as I did all of it myself, and I also detailed by current level of physical activity).

After 6 weeks, we received a response to the Congressional Inquiry that the NGB/SG Senior Branch Provider and Medical Director reviewed my case and determined they would recommend a waiver. I haven't connected yet with my unit on this-our last waiver attempt was 1 year ago and we haven't been in contact since as my recruiter thought there was no point to try a third waiver request (and I agreed based on 2 failed attempts)-but hopefully this will lead to the official waiver approval and next steps, finally.

The big lesson here is to not take no for an answer, even if you have to go at it alone. Also, take care of your knees while you're young... 

That's awesome man, I love hearing stories like this. Congratulations! 

[stuckindayton]

2 hours ago, WannaBpilot said:

Following up on my own process here and hopefully it will help others. I contacted my Congressperson through their website and was able to eventually connect with a Congressional Liaison who submitted an inquiry on my behalf with the NGB/SG's office. I had to provide my MEPs paperwork and physical exams, clearance letters, and rehab report (this was a letter I wrote about my rehab process as I did all of it myself, and I also detailed by current level of physical activity).

After 6 weeks, we received a response to the Congressional Inquiry that the NGB/SG Senior Branch Provider and Medical Director reviewed my case and determined they would recommend a waiver. I haven't connected yet with my unit on this-our last waiver attempt was 1 year ago and we haven't been in contact since as my recruiter thought there was no point to try a third waiver request (and I agreed based on 2 failed attempts)-but hopefully this will lead to the official waiver approval and next steps, finally.

The big lesson here is to not take no for an answer, even if you have to go at it alone. Also, take care of your knees while you're young... 

Congrats.  As Mover says "Make them tell you no!"....and then ask again.

[WannaBpilot]

Annnnnnd they no longer have a spot for me.....back to the drawing board. 

[Ligma]

I'm curious why you would disclose such history when you didn't have to (unless you went to a military doctor), and potentially ruin your dream job?