IN THE CASE OF:	  

		BOARD DATE:	 11 February 2014 

		DOCKET NUMBER:  AR20130021257 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests active duty medical extension (ADME) orders for treatment of his total knee replacement which was caused by an injury/illness that occurred while he was serving on active duty and resulted in a line-of-duty (LOD) determination.

2.  The applicant states an LOD injury/illness occurred while he was serving on active duty orders for an authorized Army training course in Falls Church, Virginia, on or about 3 June 2013.  In June 2013, he was hospitalized at Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Maryland, where he was diagnosed with a septic right knee joint.  He underwent three separate surgeries to remove soft tissue, meniscus, and all remaining cartilage and lining of his right knee.  He was placed on temporary limited active duty orders for recovery and rehabilitation of his right knee surgery and was instructed to file a request to be placed on active duty for treatment of his LOD injury.  The Medical Review Board (MRB) disapproved his request for ADME and attachment to a Warrior Transition Unit because his current physical therapy was near completion.  Additionally, if he wanted ADME for a total knee replacement, he needed to submit a new packet closer to when the surgery would be performed.  The MRB recommended that he continue to seek treatment through the Department of Veterans Affairs (VA) or utilize his Reserve Component health care initiatives if he could not perform his civilian or military duties and he should consider applying for incapacitation pay.  He resubmitted his application, which was denied.  When he attempted to resubmit the application with new medical information, it was rejected and he was informed that he had exhausted his appeals.  He believes that his injury/illness is the cause and reason for his knee replacement and should have been considered as part of the same occurrence permitting him to return to active duty for treatment as documented by his treating physician.

3.  The applicant provides the supporting documents listed on page 5 of his application.

CONSIDERATION OF EVIDENCE:

1.  The applicant was commissioned as a U.S. Army Reserve Judge Advocate General’s Corps first lieutenant on 6 August 1986.  He continues to serve in the U.S. Army Reserve and was promoted to the rank of lieutenant colonel on 26 January 2004.  He was issued his 20-year letter on 7 September 2006.

2.  On 24 May 2013, the applicant's civilian orthopedic surgeon performed a right knee arthroscopy on the applicant and indicated he had end-stage osteoarthritis and degenerative meniscal tearing of his right knee.

3.  On 2 June 2013, he flew to Virginia on active duty for training (ADT) orders to attend meetings and the following day he developed pain in his right knee.  He was seen in a civilian emergency department and was referred to WRNMMC for evaluation and treatment.  The following day he developed a fever.

4.  Upon arrival at WRNMMC he was diagnosed with septic arthritis of the right knee which was treated with arthroscopic irrigation/debridement and intravenous antibiotics.  He subsequently underwent additional arthroscopic irrigation/
debridement.  Cultures of the exudates (fluids) found in the knee joint confirmed a diagnosis of bacterial septic arthritis.

5.  The applicant was discharged from WRNMMC on 18 June 2013 with instructions to continue his medications and to follow up with his personal physician.

6.  Although the applicant has not provided and the records do not contain the LOD investigation conducted in his case, the memorandum from the Army Medical Command (MEDCOM), Fort Sam Houston, Texas, dated 20 October 2013, indicates an LOD determination was made that his knee infection (only) was determined to be in the LOD.

7.  The applicant submitted a request to return to active duty for treatment of his LOD injury and recovery from a knee replacement surgery scheduled for 13 November 2013 by his civilian surgeon.  On 29 August 2013, the MRB conducted at the U.S. Army Human Resources Command, Fort Knox, Kentucky, denied his request.

8.  He resubmitted his request and submitted additional documents with his request for reconsideration of ADME on 16 September 2013.

9.  On 7 October 2013, the MRB again denied his request for return to active duty (i.e., ADME) and attachment to a Warrior Transition Unit for knee replacement surgery.  The MRB opined that his LOD was for sepsis of the right knee joint and that there was no LOD for a right knee injury which would result in the need for orthopedic surgery.  He was advised to continue to seek treatment through the VA or utilize Reserve Component health care initiatives and to consider application for incapacitation pay.

10.  The applicant appealed the findings of the MRB to MEDCOM, Fort Sam Houston, Texas.  On 29 October 2013, MEDCOM denied his appeal based on the fact that the applicant had suffered from degenerative arthritis of the knees for an extended period of time and he had undergone arthroscopic intervention in that knee to treat meniscal tearing and osteoarthritis before being ordered to ADT.  The joint infection that developed was most likely secondary to that procedure and because it became manifest while he was in an active status, it was appropriate to consider it in the LOD.  However, the need for a total joint replacement is the result of longstanding degenerative processes in the joint and not the result of a single bout of joint infection.

11.  A review of his records shows he underwent a physical examination in 2003 which shows he had multiple right knee surgeries at ages 17, 24, 31, 38 and 43.

12.  The ADME Program is designed to voluntarily place Reserve Component Soldiers on temporary active duty in order to evaluate or treat their service-connected medical conditions or injuries so they can be returned to duty within his or her respective Regional Readiness Command as soon as possible.  To be eligible for ADME, a Soldier must have incurred or aggravated an LOD service-connected injury, illness, or disease while serving in an inactive duty for training or non-mobilization active duty status (i.e., annual training, ADT, etc.).  The medical condition must prevent the Soldier from performing his or her military occupational specialty/area of concentration within the confines of a physical profile issued by military medical authorities.





DISCUSSION AND CONCLUSIONS:

1.  The applicant's contention that he should be ordered to active duty (i.e., ADME) for post-right knee replacement treatment has been noted and appears to lack merit.

2.  The applicant was performing ADT for 1 day when an infection manifested itself in his right knee that was a residual effect of medical procedures performed on his knee by civilian doctors shortly before he reported for ADT.  Because he was serving on ADT at the time, his knee infection was determined to be in the LOD.

3.  However, he failed to show through the evidence of record and the evidence submitted with his application that a total right knee replacement was the residual effect of the infection in his right knee at the time he was serving on ADT.

4.  While his knee infection was determined to be in the LOD, it appears that it was caused by his previous surgery that occurred just prior to reporting for ADT, especially given the applicant's history of knee problems.

5.  Accordingly, the decision of the MRB and MEDCOM that the applicant's total right knee replacement was not caused or aggravated by his ADT and that the LOD pertained only to the infection appears to have been a sound decision.

6.  Accordingly, there appears to be no basis to grant the applicant's request for an ADME.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

____X____  ___X_____  ____X____  DENY APPLICATION







BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.




      ____________X_____________
                  CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.

ABCMR Record of Proceedings (cont)                                         AR20130021257



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ABCMR Record of Proceedings (cont)                                         AR20130021257



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