What is the likelihood that the patient's ongoing knee pain, which began in 1981 during military service in the Marianas, where he carried heavy backpacks up high mountains, is related to his military service, given that he underwent left knee surgery recently and has been experiencing continued knee pain since his separation from service in 1982?

From the Guidelines

The patient's history of chronic knee pain, which began during his military service in 1981 and has persisted since his discharge in 1982, suggests a potential service-connected condition that warrants documentation for veterans benefits purposes. The patient reports that his bilateral knee pain started during his time in the Marianas, where he was carrying heavy backpacks up mountains, and has continued to experience knee pain since then. Recently, the patient underwent left knee surgery and is recovering well, though he continues to experience knee pain bilaterally, with the left knee having required surgical intervention.

History of Present Illness (HPI)

• The patient is a veteran who served from June 20,1979, to July 13,1982
• He reports that his bilateral knee pain began in 1981 during his military service in the Marianas
• The pain has persisted since his discharge from service in 1982
• The patient attributes his knee pain to carrying heavy backpacks up mountains during his military service
• Recently, the patient underwent left knee surgery and is recovering well, though he continues to experience knee pain bilaterally
• The patient is seeking documentation connecting his current knee condition to his military service for veterans benefits purposes

Relevant Medical History

• The patient has a history of chronic knee pain that began during his military service
• He has undergone left knee surgery recently and is recovering well
• The patient continues to experience knee pain bilaterally, with the left knee having required surgical intervention

Current Symptoms

• The patient continues to experience knee pain bilaterally
• The pain has persisted since his discharge from service in 1982
• The patient is seeking documentation connecting his current knee condition to his military service for veterans benefits purposes As noted in the 2020 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip & Knee Osteoarthritis 1, osteoarthritis (OA) is one of the most common chronic medical conditions worldwide and in the United States, and heavy work activities or work that requires frequent kneeling, heavy lifting, or repetitive use of joints are associated with the development of OA. The guideline recommends a self-management program, physical therapy, and pharmacotherapy, including topical NSAIDs and capsaicin for knee OA pain, and oral NSAIDs, acetaminophen, and duloxetine for either knee or hip OA pain 1. The patient's history and current symptoms are consistent with a diagnosis of OA, and his treatment should be guided by the recommendations outlined in the guideline.

From the Research

History of Present Illness (HPI)

The patient is a veteran who underwent left knee surgery and is currently recovering. He reports experiencing continuous knee pain since his release from the Marines in 1982. The patient's knee pain began in 1981, while he was still in service, and has persisted ever since. He mentions that carrying heavy backpacks up high mountains may have contributed to his knee pain. Both knees are affected, but he recently underwent surgery on his left knee.

Relevant Medical History

• Entered service: 6/20/79
• Separated from service: 7/13/82
• Onset of knee pain: 1981
• Recent left knee surgery

Possible Causes of Knee Pain

• Osteoarthritis (OA) 2
• Patellofemoral pain 2
• Meniscal tears 2
• Arthrofibrosis 3
• Infection 3
• Instability 3
• Nerve damage 3
• Overstuffing 3
• Patellar maltracking 3
• Polyethylene wear 3
• Psychological factors 3
• Unresurfaced patella 3

Diagnostic Considerations

• Clinical evaluation, including history and physical examination 2
• Radiographic imaging, if necessary 2
• McMurray test for meniscal tears 2
• Joint line tenderness for meniscal tears 2
• Sigma-1 receptor radioligand and PET/MRI for chronic pain localization 4

Treatment Options

• Conservative management, including exercise therapy, weight loss, and education 2
• Surgical referral for knee joint replacement, if necessary 2
• Intra-articular steroids, radiofrequency ablation, and neuromodulation for post-arthroplasty pain 5
• Patella-friendly femoral components in total knee arthroplasty to reduce anterior knee pain and patellofemoral complications 6