Waiver Question - to the AD docs

[TheGoose]

hi,

I'm wondering if any AD docs with familiarity with the waiver process can let me know if the following would be a typically waiverable condition. I may have been too candid on my previous medications portion of the DoDmerb questionnaire and this issue came up.

I just got news that i was medically disqualified on DoDmerb due to code D211.40 Recurrent headaches interfering with function or requiring prescription medication within the past 3 years (emphasis on italicized portion).

Background: Had some migraine issues and was prescribed 10mg Nortriptyline. I would say i took it for about a year but then stopped taking it probably in the 3-4 years ago range. I dont really have the migraine issues anymore but just pop some Naproxen whenever i feel it coming on and im good.

I dont think that ive taken it within 3 years but must have just written 2005 or something on the form when trying to think when i stopped taking it. Side question is: do you think that this disqualification is specifically for having takens meds within the past "3 years" - and if I can go to my old doc and get my medical records showing that the prescriptions stopped more than 3 years ago will this go away? or will DoDmerb not care?

but, as asked earlier in the post, the main question: from the background given, and current situation of almost nonexistent migraines, would this be a waiverable issue?

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[sethco]

What exactly are you asking?

Did you want to be on flying status as a flight surgeon?

It should not preclude military service unless it is incapacitating and/or causing you to miss several days of work.

For my flyers, I am able to obtain a waiver for migraine headaches that are a) not frequent (i.e. Less than 1-2 times per month), b) not incapacitating or history of incapacitating headaches (especially during flight), and c) controlled with the use of Over-the-counter meds.

In the AF, ability to get a waiver also depends on the approving authority. For example, I am much more likely to get a waiver for a patient if this is a new condition in a patient already on flying status versus coming up on an Initial Flying Class physical.

With this in mind, it is much better that this is coming up now than it would be to discover that you had withheld this info in MEPS

Hope this helps.

 

[TheGoose]

sorry i didnt clarify. this is a question regarding USUHS admission. (navy specific)....appreciate the response though

 

[IgD]

Your best bet would be to ask a Navy neurologist for information.

Do you feel blindsided by the revelation? I know when my friend got passed over for promotion to O5 he was left scratching his head.

 

[TheGoose]

bump.

....is the consensus with Sethco?

no harm in seeking a second opinion

 

[IgD]

Call a Navy neurologist at Bethesda and ask for clarification/information. Ask them if they would support you for a waiver.

 

[backrow]

try visiting this website and posting in the DODMERB section.

http://www.serviceacademyforums.com

One of the directors of DODMERB checks the site on a very regular basis and responds within a very short amount of time. Make sure to make it clear that you are applying to USUHS and not one of the service academies.

 

[TheGoose]

thanks. is it that easy to call a bethesda neurologist and have him listen to my story and ask if he would support a waiver? any other insight would be appreciated here or in a PM, IgD

 

[IgD]

thanks. is it that easy to call a bethesda neurologist and have him listen to my story and ask if he would support a waiver? any other insight would be appreciated here or in a PM, IgD

Pick up the phone and call the neurology clinic at Bethesda and ask to speak with a neurologist. You aren't asking for medical advice, you are asking for information.

 

[backrow]

Pick up the phone and call the neurology clinic at Bethesda and ask to speak with a neurologist. You aren't asking for medical advice, you are asking for information.

Please do not call any active duty physicians for advice regarding waivers. 99% of the physicians on active duty have no idea what the standards are for DODMERB or what the waiver criteria are. The best people to call will be those at DODMERB.

You can call if you want to, but even if they say they would recommend a waiver it doesn't mean jack and could be based on faulty information.

 

[IgD]

backrow, you make a good point but a Navy neurologist would be in tune with fitness for duty evals including overseas duty screenings, limited duty boards and medical boards. Headaches certainly fall under the purview of neurology. I still think there would be some utility to getting a neurologist's take on the situation.

 

[backrow]

backrow, you make a good point but a Navy neurologist would be in tune with fitness for duty evals including overseas duty screenings, limited duty boards and medical boards. Headaches certainly fall under the purview of neurology. I still think there would be some utility to getting a neurologist's take on the situation.

I completely agree with them knowing the ins and outs of FFD evals and the other screenings you mention; however, the DODMERB rules are completely different and sometimes very weird in what they will/will not grant waivers for. I think the USUHS catalog itself may give some ideas as to waivers for various conditions, but I haven't looked at it recently.

The neurologist would have a great idea as to what the OP might need to go through in the future, but if it's a non-waiverable condition per DODMERB and USUHS then it is a moot point. Unfortunately I can't give the OP much guidance on their particular question because I don't know the USUHS medical requirements very well; however, as I mentioned above if they go to the website I put in there the guy who knows the answers will get back to him in 24 hours and put all the speculation in the world to rest.

 

[TheGoose]

just as an aside, i was informed that the waiver process would entail meeting up with a DoD contracted neurologist, but then his results would be forwarded along to Dodmerb and they would make the waiver decision. So both IgD and backrow are right in their lines of thought.

its unnerving to think that a waiver would be granted to an AD pilot but declined for someone going through the DoDmerb (especially a doc!), but like backrow said, the two processes are very different.

 

[backrow]

Sorry that I didn't write this earlier, but here are some of the basic tips that we give to service academy applicants when it comes to the waiver process. As far as I can tell the process is a bit less selective when it comes to HPSP/USUHS but as I said above it can be very weird.

1) Get all documentation from whomever prescribed the medication.
2) If you can go see this physician again and have them update a note for you stating that you have had no further problems and that you have had no limitations due to the condition at all. If you can get them to write a letter stating their opinion that you are cleared to participate in all activities then that can help as well.
3) Write a letter yourself talking about the things that you have done during the past several years and how you have had no headaches causing you any problems.

Now, if you have had problems due to the headaches then that is a different story. Once you have all this stuff together mail it all in to the DODMERB waiver address and then start shaking the magic 8 ball as often as you can.

The waiver process often does not make sense. You can hear of one kid getting a waiver for what seems to be the exact same thing someone else was denied for.

Best of luck.

 

[IgD]

2) Try calling Bethesda Neurology and you'll never get past the front desk.

That statement aptly summarizes the sad state of affairs for military medicine.

[On a side-note, why in the world does anyone think you can just call up Neurology Clinic, talk to a doc, and get a waiver?]

I think you misunderstood me. I was suggesting he speak to a neurologist to get information only to see if it was an issue worth pursuing. Getting the actually waiver would require a face-to-face evaluation as described above.

 

[TheGoose]

curious about a semantic issue (in taking Tired's post into consideration)...

i called up the old doc that originally prescribed the meds (sidenote: can easily get a letter stating what backrow recommended) to find out exact dates. Last prescribed was 3.10.06. So, if the disqualification is specifically stating "prescription meds for headache within the past 3 years" and if i wouldnt start AD (ODS june '09) past the 3 year mark, could this be a loophole or am i still scrooged because i initiated the initial process when it was still within 3 years?

 

[backrow]

curious about a semantic issue (in taking Tired's post into consideration)...

i called up the old doc that originally prescribed the meds (sidenote: can easily get a letter stating what backrow recommended) to find out exact dates. Last prescribed was 3.10.06. So, if the disqualification is specifically stating "prescription meds for headache within the past 3 years" and if i wouldnt start AD (ODS june '09) past the 3 year mark, could this be a loophole or am i still scrooged because i initiated the initial process when it was still within 3 years?

Since you already received the DQ for the condition you are now in the waiver process. If you provide the details as I mentioned above and those details show that you actually do not meet the disqualifying conditions or have a waiverable condition then you will receive either a waiver or the DQ will be rescinded.

It's all in DODMERB's hands now, but get any and all supporting information to them. The more info you have the better, they can sort through what they don't need.

 

[notdeadyet]

TheGoose-

I have nothing to add to this discussion but my sympathy. I applied for the National Guard in June and have only recently received the go-ahead for a MEPS appointment. I needed to get pre-MEPS physical waivers. The big delay in my application? Heartburn.

I feel for you. Good luck with the waiver process and keep on trying. It can be frustrating, but you still have a shot. I'll keep my fingers crossed for you.

 

[TheGoose]

thanks

 

[backrow]

The big delay in my application? Heartburn.

You may not think this is a big problem, but if I remember correctly this was one of the major causes of problems during the early phases of the Iraq/Afghanistan campaigns due to people running out of medicines.

This is why some of the things that are waivered/not waivered can seem very confusing and not make sense to many/most people.

 

[notdeadyet]

You may not think this is a big problem, but if I remember correctly this was one of the major causes of problems during the early phases of the Iraq/Afghanistan campaigns due to people running out of medicines.

25% of the U.S. population gets regular heartburn. Flareups of heartburn for most are very treatable and are not that problematic anyway (By the way, I'm talking acid reflux here. If you have ulcer-caused heartburn I can see how this would be a major problem in a combat theatre).

Is it the Army's intent to immediately DQ 25% of applicants because they're had heartburn? My gripe is that if everyone were completely honest on their MEPS physical form, I would guess that at least half of the HPSP applicants would be DQ'd right off the bat. Hell, heartburn takes care of half that. This probably not what the Army is going for and the nudge-nudge, wink-wink thing doesn't really fly for me.

I get the distinct impression of MEPS *****-covering. DQing someone without looking at the full picture is very safe. You can't get in trouble for DQing someone. But approving? That's where you're vulnerable.

 

[backrow]

25% of the U.S. population gets regular heartburn. Flareups of heartburn for most are very treatable and are not that problematic anyway (By the way, I'm talking acid reflux here. If you have ulcer-caused heartburn I can see how this would be a major problem in a combat theatre).

Is it the Army's intent to immediately DQ 25% of applicants because they're had heartburn? My gripe is that if everyone were completely honest on their MEPS physical form, I would guess that at least half of the HPSP applicants would be DQ'd right off the bat. Hell, heartburn takes care of half that. This probably not what the Army is going for and the nudge-nudge, wink-wink thing doesn't really fly for me.

I get the distinct impression of MEPS *****-covering. DQing someone without looking at the full picture is very safe. You can't get in trouble for DQing someone. But approving? That's where you're vulnerable.

Your statements here show a bit of a lack of understanding how seemingly small medical problems can become a very big problem in a theater of war or on an extended deployment. These are the reasons why some "simple to treat" conditions will generate a DQ in the military processing exams.

We will take GERD for example: as Tired mentioned above he has a couple of Marines who have their training limited due to this "not that problematic anyway" condition. Now take those Marines and place them on a sensitive mission where there is no pharmacy nearby or they "forget" their medicines on an extended mission. They now have a flare and are unable to continue this mission. The mission is now compromised due to a seemingly minor medical problem and this could be the difference between success and failure for a larger group of Marines.

These thoughts usually don't cross the mind of the majority of physicians in the US because they don't deal with deploying troops. It is also usually somewhat difficult to get across to people applying to the Service Academies when someone is disqualified from attending their "dream college."

 

[IgD]

I think its an interesting discussion. There are those that claim screening actually helps but I've seen little data to suggest it does. In some cases, screening hurts the military because it pushes people with medical issues to go underground and then they prevent in crisis taxing resources.

Do you think applicants with ADHD should be allowed in the military?

Here is a study that suggests there is no difference between service members with ADHD and without:

A retrospective cohort study was conducted to evaluate the Department of Defense practice of allowing some individuals with a history of attention-deficit/hyperactivity disorder (ADHD) to enter military service (waiving for ADHD). Enlisted recruits who entered active duty with a waiver for academic problems related to ADHD were compared with control subjects who did not reveal health problems before entry, in terms of retention, promotion, and mental health-related outcomes. A total of 539 recruits with a history of ADHD were retained at the same rate as 1,617 control subjects, with no differences in promotion rates, comorbid diagnoses, or mental health-related discharges. On the basis of these findings, the Department of Defense medical accession standards have been changed to allow applicants who reveal a history of ADHD but did not require medication to finish high school or to hold a job for at least 1 year the opportunity to enter active duty without going through the current waiver process.

Wonder what these numbers would look like if headaches or reflux was substituted for ADHD? I suspect there would be no difference between control subjects.

 

[DrMetal]

I think its an interesting discussion. There are those that claim screening actually helps but I've seen little data to suggest it does. In some cases, screening hurts the military because it pushes people with medical issues to go underground and then they prevent in crisis taxing resources.

Do you think applicants with ADHD should be allowed in the military?

Here is a study that suggests there is no difference between service members with ADHD and without:

A retrospective cohort study was conducted to evaluate the Department of Defense practice of allowing some individuals with a history of attention-deficit/hyperactivity disorder (ADHD) to enter military service (waiving for ADHD). Enlisted recruits who entered active duty with a waiver for academic problems related to ADHD were compared with control subjects who did not reveal health problems before entry, in terms of retention, promotion, and mental health-related outcomes. A total of 539 recruits with a history of ADHD were retained at the same rate as 1,617 control subjects, with no differences in promotion rates, comorbid diagnoses, or mental health-related discharges. On the basis of these findings, the Department of Defense medical accession standards have been changed to allow applicants who reveal a history of ADHD but did not require medication to finish high school or to hold a job for at least 1 year the opportunity to enter active duty without going through the current waiver process.

Wonder what these numbers would look like if headaches or reflux was substituted for ADHD? I suspect there would be no difference between control subjects.

I wonder if these 539 were properly diagnosed with ADHD. In theory, if you truly had ADHD, you would be unable to perform your job tasks, your overall performance would be sub-par, you wouldn't get promoted readily, etc etc . . . in theory, right???

Also I wonder what the jobs of these 539 were? If you're a ADHD BM, it may be easy to perform mechanical duties (like painting, cleaning). On the other hand, and ADHD-stricken IT guy or AG may have considerable problems sitting in front of a computer for hours.

Do you have a reference for the above study that you mentioned?

 

[backrow]

I can't even begin to claim that I know all of the reasons for the screening process, but among many I think there may be one major factor beyond the one we speak of already. I believe one other reason for some of the DQ's is that the military does not want to take lifetime responsibility for pre-existing conditions. Now imagine someone that comes in with some "minor" problem, but after leaving the service (not retiring) they are able to connect that problem with some other more severe problem then they could potentially get VA benefits for that problem.

I know I may be a bit out of left field on this one, but it wouldn't surprise me if this was one other reason for the stringent requirements.

 

[IgD]

Do you have a reference for the above study that you mentioned?

Accession Standards for Attention-Deficit/Hyperactivity Disorder: A Survival Analysis of Military Recruits, 1995–2000

Authors: Krauss, Margot R.; Russell, Robert K.; Powers, Timothy E.; Li, Yuanzhang

Source: Military Medicine, Volume 171, Number 2, February 2006 , pp. 99-102(4)

 

[notdeadyet]

I have three Marines in my battalion (out of 1000) with severe GERD, Barrett's, and no ulcer. Their training time is significantly limited because every time they train, they vomit.

That's very valid. But the percentage of folks with heartburn that elicits vomiting upon physical activity is a small fraction of a small percent of heartburn sufferers. Automatically DQing anyone who has claimed to have suffered from heartburn is throwing the baby out with the bathwater.

All have been on light duty significant periods of time. Despite what you may have heard, not all flareups of heartburn are easily treated with PPIs, and it can have a significant impact on your ability to perform.

Again, most flareups of heartburn, even if entirely untreated, go away without meds and can be tolerated. It's annoying, not debilitating. Folks who are literally debilitated by their heartburn is small.

DQing anyone with heartburn because of a small fraction who are debilitated by their heartburn is akin to DQing anyone whose broken a bone, because, hey, they might have osteogenesis imperfecta. It's sloppy medicine.

There's a difference between Joe Schmoe college kid who self-diagnosed with heartburn and takes TUMS, vs the guy who's seen a gastroenterologist and got an EGD and Nexium.

I couldn't agree with you more here, Tired. And that's the source of my irritation. MEPS doesn't make this distinction. It automatically disqualifies all of them. Then it's up to the initiative of the recruiter and the fates as to whether or not a waiver goes through.

I'm not advocating allowing in folks who will be a liability in the field. Just to make the process a little smarter. DQing someone who chomps TUMS after too much Mexican is just bad policy. It's easy, but it's expensive and ultimatley contributes to the feeling that you're best off not disclosing when you go to MEPS. Talk to any enlisted and they'll tell you the same: keep your mouth shut about any conditions you have that they can't prove. It's a little sad that recruits are encouraged to begin lying to their military doctors before even signing up.

 

[backrow]

I'm not advocating allowing in folks who will be a liability in the field. Just to make the process a little smarter. DQing someone who chomps TUMS after too much Mexican is just bad policy. It's easy, but it's expensive and ultimatley contributes to the feeling that you're best off not disclosing when you go to MEPS. Talk to any enlisted and they'll tell you the same: keep your mouth shut about any conditions you have that they can't prove. It's a little sad that recruits are encouraged to begin lying to their military doctors before even signing up.

I would imagine the reason for this is standardization. They don't want the contract doc's making the decisions. They would rather have all the DQ's come to one place and allow that one place to make decisions. If someone puts on their record that they need Tums every once in a while they will likely not generate a DQ. The waiver process although it seems quite daunting works relatively well in the end, but I'm sure it could be improved upon.

 

[backrow]

Accession Standards for Attention-Deficit/Hyperactivity Disorder: A Survival Analysis of Military Recruits, 1995–2000

Authors: Krauss, Margot R.; Russell, Robert K.; Powers, Timothy E.; Li, Yuanzhang

Source: Military Medicine, Volume 171, Number 2, February 2006 , pp. 99-102(4)

Interesting that this study was done prior to OIF/OEF....has there been any continued study of that population given the events since 2000?