AROTC Chances of Waiver

A couple weeks ago we found out my daughter was medically DQ'd in the DoDMERB process. Since she is a 4 year AROTC recipient, it automatically goes to a waiver application. The basis for her DQ is as follows:

D241.30 Asthma/reactive airway disease/exercise induced bronchospasm after age 13
D101.22 Current or history of premature atrial or ventricular contractions

Some background - she is an endurance athlete (track and cross country) and has been her school's top distance runner for her junior and senior years. She pretty much crushed the PT test for her ROTC application doing 66 pushups/min and 42 situps/min and her PR in the mile is 5:28 and will most likely improve as the track season progresses. However, what triggered the DQs were a couple things in her medical records that never amounted to anything. While in middle school, she was prescribed an inhaler as a precautionary measure after having some breathing difficulty while running that ended up just being the combination of an illness coupled with intense exercise at practice. She used the inhaler a couple times and then never again as she didn't have asthma and was never diagnosed with it.

The premature ventricular contractions (PVC) issue was something that came up at a regular physical when the doctor noted a slight blip in her heartbeat. As a followup, the doctor had her undergo a stress test with a cardiologist. They put her on a treadmill while monitoring her heart and had to prematurely stop the test because she had maxed out the speed and incline without being able to get her heartrate maxed out. They did not find anything objectionable in anything they measured during that test and she was not restricted in any way or prescribed with any treatment. When I researched this issue, I found that it is very common for endurance athletes to exhibit PVCs.

So, in reality, the two conditions that resulted in her DQ are really non-issues but of course it seems to be totally out of our control as some of the mitigating circumstances don't really show up in her records. I did write a letter to her physician asking that he send a letter to her DoDMERB file to clarify these issues but I don't know if the doctor has followed up on that as of yet. I am confident that she would submit to (and pass) any stress test the Army could dream up but thus far there have been no requests for additional testing or any information whatsoever. She did speak with the ROO at her school but that didn't yield much of anything.

The school she ultimately attends hinges upon the outcome of her waiver as does her dream to serve in the Army. So, I'm wondering what her chances are that this ends up in her favor and secondly, if there is anything else she should be doing at this time to bolster and/or expedite her case.

I’m surprised the doctor didn’t order a 24 hour holter monitor.

That’s an important study to do when you’re looking into PVCs. It tells reviewers the PVC burden on the heart (less than 1% of all beats in a 24 hour period is good). It also tells if there are “dangerous” PVCs like if your DD has a run of 2-3 consecutive PVCs.

Is she scheduled for a Holter monitor? Her thyroid should be checked too.

GoCubbies said:

I’m surprised the doctor didn’t order a 24 hour holter monitor.

That’s an important study to do when you’re looking into PVCs. It tells reviewers the PVC burden on the heart (less than 1% of all beats in a 24 hour period is good). It also tells if there are “dangerous” PVCs like if your DD has a run of 2-3 consecutive PVCs.

Is she scheduled for a Holter monitor? Her thyroid should be checked too.

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Now that you mention it, I do believe she was on some sort of monitor as well, most likely the one you describe but after all of the testing and monitoring, she was given a totally clean bill of health. Don't recall if they checked her thyroid but if they did, that and everything else came back normal.

I think your DD has a good chance for waivers.

I've seen a lot of posters on this forum who got waivers for "asthma" that wasn't really asthma. The consistent pattern though seems to be they had to submit the results of a methacholine challenge test (MCCT) to prove no asthma. I think the primary care doctor had to document no history of hospitalizations or intubations for exacerbations or history of recurrent oral steroid use. Your DD's doctor should also mention your DD is an endurance athlete and note her PRs in whatever track events she runs.

As for the PVCs, the results of the exercise stress test and 24-hour holter monitor will be needed. I think the important piece of the 24-hour holter will be to ensure the PVC "burden" is normal such as <1% PVCs of all the beats in a 24-hour period or <10% of beats per hour. Since you said the holter monitor was normal, then I'm assuming no badness was seen like couplets (2 PVCs in a row) or "R-on-T phenomenon." The cardiologist could also document your daughter has no history of palpitations, lightheadedness, or syncope.

The only other thing I can think of that would be needed is an echocardiogram, but that might be going overboard. I suspect DODMERB or Cadet Command would tell you if they want an echo. The stress test and holter monitor should suffice.

As an aside, your DD should consider not consuming any more Monster or that Red Bull stuff if she uses it. If she drinks soda, then she could consider decreasing intake too.

Thanks for the advice GoCubbies. She has never had any treatment/hospitalizations for asthma - no sterioids - just used the abuterol inhaler a couple times and that was it. She also did take a MCCT test as part of the DoDMERB phase and that went well.

When I requested the letter from her physician, I mentioned quite a few of her athletic achievements that pretty clearly show that she does not have anything that would limit her from any physical activity in Army PT.

The cardio doc was supposed to send all the results related to the testing. Not sure how much DoDMERB pours through those to interpret the end result or just sees that it's there and summarily issues a DQ. Can't imagine why they would have DQd if they did interpret them.

She never drinks any of those energy drinks and is very conscious of everything she puts in her body (she eats better than I do). She does drink a cup of coffee most mornings but that's the extent of it.

I guess DODMERB can qualify the physical at their level with the info you provided. If they don’t, then I still think your DD has a good chance for a waiver if it gets that far.

Hope it works out for your DD. Keep us posted.

OP, find a retired military cardiologist or one that specializes in asthma in your area that is now a civilian practicing Dr. Take all pertinent info to them so they can do an exam and hopefully draft a letter favorable to you DD. Using a retired military doc is important in that they know the standards and language. We did this for DS and 90 days later waiver was granted. Good luck.

UPDATE: DD's physician draft and fax a letter indicating that she was never diagnosed with asthma and that the inhaler she was prescribed was on a trial basis and that use was discontinued shortly after the trial started. This went in on Thursday but I doubt that it was included in the review as the status on that changed the following day with remedials.

On Friday we got some updates in DODMERB with some requested remedials (R241.63). This is an exercise test for asthma and what I was hoping for all along to put this waiver to rest. It is a spirometry test that checks her pulmonary function before and after exercise that brings her HR up to 80% of max for four minutes. DD just ran an 11:25 2-mile at her track meet on Saturday with no breathing difficulty (as normal) so she should pass this with flying colors. Nothing showing up in DODMETS yet but hopefully soon so we can get this scheduled.

Keep us informed please, fingers crossed.

DD took her stress test for asthma on Thursday last week. Being a runner, she was hoping it would be on a treadmill but instead, it was on a bike where they kept ramping up the resistance to get her heart rate up to 80% of max. All went well. Following the test, the results still needed to be evaluated by a doctor but according to the technicians, everything looked great and no sign of any asthmatic condition. So, now we are waiting for it to go through DODMERB and hopefully the waiver will come through.

Also, she's been having a couple great weeks in track season hitting some new PRs. She did a 5:15 in the mile on Saturday and an 11:18 in the 2-mile the week prior. Districts coming up on Friday/Saturday of this week.