Knee injury resulting in acute meniscal tear or permanent ligamentous instability

An injury to the knee resulting in damage to a meniscus most often occurs when the knee is severely twisted, for example, as happens when playing sports such as football or tennis.  Symptoms may include feeling a 'click' and a sudden agonising pain in the joint, which may give way.  Then follows restriction of movement, pain and swelling of the knee.

Permanent ligamentous instability

Ligaments bind the joint, so that if ligaments are over stretched and become loose as a result of trauma, the joint becomes abnormally mobile, and unstable.  Because of this the joint will periodically give way, giving rise to acute symptoms of pain and/or swelling which subside until the next episode.  Permanent ligamentous instability is indicated by regular recurrences of such episodes.  The frequency of episodes depends on the nature and level of physical activity, so medical advice may be needed to determine the presence of permanent ligamentous instability.

Establishing a history of an injury that resulted in acute meniscal tear or permanent ligamentous instability

If the person had an injury to the knee resulting in the symptoms described above, it is very likely he or she would have sought some type of medical attention at that time, unless circumstances such as being in combat, or the unavailability of medical facilities prevented the seeking of treatment.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, these records may have been destroyed or can no longer be obtained.  Therefore, if there is a reliable history of appropriate medical treatment at a particular time, this generally will be accepted, unless there is contradictory evidence.

Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to acute meniscal tear or permanent ligamentous instability of the knee joint rather than to some other condition.

• If the injury resulted in an acute meniscal tear then this is covered by the SOP for acute meniscal tear you must apply that SOP when investigating if the injury satisfies the causal factors.
• If the injury is a permanent ligamentous instability then this is covered by the SOP for joint instability you must apply that SOP when investigating if the injury satisfies the causal factors.

Last reviewed for CCPS 16 June 2014.

Investigative Documents

Preliminary questions [12924]

12986 the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability at some time.

12987  the veteran has established the causal connection between the injury resulting in acute meniscal tear or permanent ligamentous instability and VEA service for chondromalacia patella.

12990   the veteran has established the causal connection between the injury resulting in acute meniscal tear or permanent ligamentous instability and VEA service for the clinical onset of chondromalacia patella.

12992  the veteran has established the causal connection between the injury resulting in acute meniscal tear or permanent ligamentous instability and operational service for the clinical onset of chondromalacia patella.

or

12993  the veteran has established the causal connection between the injury resulting in acute meniscal tear or permanent ligamentous instability and eligible service for the clinical onset of chondromalacia patella.

or

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

12991   the veteran has established the causal connection between the injury resulting in acute meniscal tear or permanent ligamentous instability and VEA service for the clinical worsening of chondromalacia patella.

12994  the veteran has established the causal connection between the injury resulting in acute meniscal tear or permanent ligamentous instability and operational service for the clinical worsening of chondromalacia patella.

or

12995  the veteran has established the causal connection between the injury resulting in meniscal damage or permanent ligamentous instability and eligible service for the clinical worsening of chondromalacia patellae.

Clinical onset and operational service [12992]

12996 on operational service, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

12998 on operational service, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the six months before the clinical onset of the chondromalacia patella.

13001 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the six months before the clinical onset of the condition under consideration, on operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

13003 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability was due to an illness or injury which is identifiable.

31125 as a consequence of the identified illness or injury, the veteran had the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the six months before the clinical onset of the condition under consideration.

13004  the identified illness or injury that caused the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability is causally related to operational service.

Clinical onset and eligible service [12993]

12999 on eligible service, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

13000 on eligible service, in the course of eligible service duties, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

31126 on eligible service, in the course of eligible service duties, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the three months before the clinical onset of the chondromalacia patella.

13002 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the three months before the clinical onset of the condition under consideration, on eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

13003 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability was due to an illness or injury which is identifiable.

31127 as a consequence of the identified illness or injury, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the three months before the clinical onset of the chondromalacia patella.

13005  the identified illness or injury that caused the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability is causally related to eligible service.

Clinical worsening and operational service [12994]

12996 on operational service, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

12997 on operational service, in the course of operational service duties, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

13007 on operational service, in the course of operational service duties, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the six months before the clinical worsening of the chondromalacia patella.

13010 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the six months before the clinical worsening of the condition under consideration, on operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

13003 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability was due to an illness or injury which is identifiable.

31128 as a consequence of the identified illness or injury, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the six months before the clinical worsening of the condition under consideration.

13004  the identified illness or injury that caused the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability is causally related to operational service.

13012 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that caused the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability is causally related.

Clinical worsening and eligible service [12995]

12999 on eligible service, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

13000 on eligible service, in the course of eligible service duties, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability.

31129 on eligible service, in the course of eligible service duties, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the three months before the clinical worsening of the condition under consideration.

13011 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the three months before the clinical worsening of the condition under consideration, on eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

13003 the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability was due to an illness or injury which is identifiable.

31130 as a consequence of the identified illness or injury, the veteran had an injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability within the three months before the clinical worsening of the condition under consideration.

13005  the identified illness or injury that caused the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability is causally related to eligible service.

13013 the clinical onset of the chondromalacia patella occurred prior to that part of eligible service to which the identified illness or injury that caused the injury to side and site of the body resulting in acute meniscal tear or permanent ligamentous instability is causally related.