BUMED

[tygoerlitz]

Hey everybody,

Heres my issue hoping for some input and some advice. I am currently trying to apply for USMC PLC. I have had surgeries for compartment syndrome in my lower legs and I had surgery for a torn meniscus. As most of you know I need a waiver for the surgeries. Apparently they are ok with the knee surgery, but are having issues with the compartment syndrome. I was told they are having issues because somewhere in my medical records it states that it is possible that I still have compartment syndrome. I have gotten a letter from my primary doctor as well as the doctor that did the surgery saying that I am asymptomatic and there is nothing wrong with me. The latest I heard is that this is not good enough and the docs want what is called a pressure test to confirm that I do not have compartment syndrome. Here is where I am having the problem. No doctor wants to give me that test because they say that it is not medically necessary, since I am not showing symptoms. As a side the test is a hassle, they pretty much stab you with a giant needle and measure the pressure in your muscles. Its painful and expensive. We have tried to send another letter from the doc saying the test is not necessary and what not. Currently I have not heard anything back since the latest letter, but my OSO strongly believes only the pressure test will get me the waiver. I just got back from seeing another doc that could give me the pressure test he again is telling me he does not recommend it and does not want to do it since I don't have symptoms.

I am not really sure what to do at this point. The doctor visits are becoming expensive and the process is frustrating. My two questions are, does this seem reasonable that BUMED is being this difficult even after multiple letters? Also lets say they don't want to give me the waiver, does that mean I won't be able to get it through the USMC? What if I want to go Navy will it be the same process?

Thanks
Tyler

 

[jcj]

I'm a civilian general & trauma surgeon at a Level I trauma center, civilian pilot and former corpsman in my younger days. I deal with compartment syndrome a lot, we see it pretty often in trauma patients with leg fractures and vascular injuries. We do compartment pressure tests pretty often, usually they're done in the context of a patient with a severe leg injury or vascular injury that we can't do a reliable history or physical exam on becasue they are on a ventilator, have a severe head injury, etc.

I am assuming from your posting above that you are fully recovered, fully healed and are able to run well enough to have a PFT score competitive for PLC without pain in your legs. I'm also assuming we're talking about compartment syndrome of your lower leg(s). If this is true, you absolutely do not have compartment syndrome. In someone who is awake and alert, compartment syndrome is painful. The pain is aggravated by passive range of motion of joints distal to the compartment - in other words, for the lower leg - the symptoms/signs would be noticeable pain in the muscles of your lower leg that is worsened when someone moves your great toe up & down. I suppose if you are having pain in your lower legs after a long run you could be having intermittent exercise-induced compartment syndrome - which would be a problem for military training - but you don't say that so I'm assuming that's not the case.

If you are asymptomatic, have a normal physical examination of your legs (other than the scars from your surgery-those are expected) and have no pain in your legs with extended runs (> 3 miles), you don't have compartment syndrome and I agree with the doctors you've seen that a compartment pressure test is not only unnecessary, but it has some (fairly minor) risk to the test itself and I would say it's medically contraindicated.

Because I'm not a military physician I will be of less help in suggesting how to work with your OSO and BUMED. But a request for compartment pressure testing in an asymptomatic patient in this scenario seriously makes no sense and I can't help but wonder if there hasn't been some type of miscommunication between your OSO and whatever medical person he/she is talking to. My advice would be to have one of the physicians you've seen (ideally the surgeon who did your surgery, who is probably an orthopedic surgeon) write a letter for you that says (in these specific words) "this patient currently has no history of leg pain at rest or with long distance running, and has no physical examination evidence of compartment syndrome, therefore the diagnosis of compartment syndrome can be excluded. Compartment pressure testing is not indicated in this patient". Those words have a specific medical meaning, and if you are asymptomatic your physician should have no problem with dictating them into your letter just like that. Even if your OSO or BUMED requires additional workup, nothing in those words will hurt you.

There are some current and former Flight Surgeons, as well as OSO's, who frequent the forum and you'll probably get better advice from them. Also you may want to ask the mods to move your post over to the Flight Doc forum, more people with knowledge that may help will see it there.

good luck.

 

[tygoerlitz]

Thank you so much for your reply here. That really helps out a lot. Yes I am fully recovered and have zero signs of compartment syndrome. I remember what it felt like when I had it and it was terrible. Thanks again, I will ask for this to be moved.