Medical Ineligible Receipt for previous intracranial shunt

[JKHDelta]

I know this is a detailed topic and is case by case but wanted to see if anyone else had this situation in the process. Our DS received a medically ineligible today because of an intracranial shunt when he was three months old. We were expected something with this as periodically a shunt is viewed as hydrocephalus when used. In this case it wasn't. It was a one year shunt to drain fluid when he was an infant and removed a year later.

We had already started gathering the previous medical records including the letter from the neurosurgeon stating it was not hydrocephalus and that he was clear. We're going to reach back out to him now to see about bringing him back into the loop to try preparing for this.

Has anyone else had this situation?

 

[THParent]

Keep gathering those records. Did DoDMERB issue a remedial code for this?

Consider posting this in, or asking a Mod to move it to, the DoDMERB forum.
I expect that Larry Mullen may be of some assistance

 

[JKHDelta]

Thank you, I'll post there. At this point DODMERB said if the Academies still consider him a potential candidate that they will trigger the waiver automatically. My main concern is that they brush past his application now based on the "surface information" from DODMERB and we may not get the chance to present what the actual situation is (there is none, he's completely clear of what they think he has). No remedial code has been issued at this point.

 

[OfficerToBe750]

Thank you, I'll post there. At this point DODMERB said if the Academies still consider him a potential candidate that they will trigger the waiver automatically. My main concern is that they brush past his application now based on the "surface information" from DODMERB and we may not get the chance to present what the actual situation is (there is none, he's completely clear of what they think he has). No remedial code has been issued at this point.

I was told (by people that know a lot more than me about this process) that the decision to request a waiver is independent of the DQ. We were informed that if the applicant is competitive and in consideration, a waiver review will be requested and to have confidence that we would have a chance to share the details if our DS's application warranted a review. I hope you get some good news soon. Hang in there.

 

[BubbaCool12]

Keep gathering those records. Did DoDMERB issue a remedial code for this?

Consider posting this in, or asking a Mod to move it to, the DoDMERB forum.
I expect that Larry Mullen may be of some assistance

Mr. Mullen has been out of the forums for a while now, not sure if/when he'll come back

 

[justme]

I was told (by people that know a lot more than me about this process) that the decision to request a waiver is independent of the DQ. We were informed that if the applicant is competitive and in consideration, a waiver review will be requested and to have confidence that we would have a chance to share the details if our DS's application warranted a review. I hope you get some good news soon. Hang in there.

This is what we were told as well.

As a parent, it is difficult to totally believe, since it just seems logical to assume (worry) its easier for SA to prefer a clean medical Q than the hassle of requesting a waiver on a DQ, regardless of what it is.

Edit to add- I do believe it is true, just doesnt feel it as a worrying parent.

 

[JKHDelta]

I was told (by people that know a lot more than me about this process) that the decision to request a waiver is independent of the DQ. We were informed that if the applicant is competitive and in consideration, a waiver review will be requested and to have confidence that we would have a chance to share the details if our DS's application warranted a review. I hope you get some good news soon. Hang in there.

Thanks so much. Praying that we get the chance for clarification. Wish I knew what they saw of this part in the admissions board to know how much it can affect their decision to request the waiver.

 

[usna1985]

The Admissions Board personnel are not medical experts. They see a medical DQ but I'm not sure they even know what it is for. If they do, they certainly aren't able to make any judgment about a situation like your DS's (as they might with colorblindness).

It IS true that USNA will not take action on a waiver unless or until they have decided a candidate is likely to or will certainly receive an appointment. It's a personnel resource issue - no use "wasting" an MD's time for a candidate who won't be offered an appointment. So, this could take awhile since decisions on most candidates aren't made until January or February. Or, if they find DS super-competitive, they might issue an LOA contingent on getting a medical waiver (and possibly a nom as well, depending on when in the process this occurs).

As for your "fear" that an initial medical DQ will influence Admissions, I've seen no evidence of it. I've had quite a few candidates over the years with LOAs who don't get the medical waiver (and many who do). That means USNA made the decision to give them an appointment conteignet on cleaning medical. So medical did not have an influence in the admissions decision but did in some cases impact whether the person ultimately was admitted. The fact is that the military is not an "equal opportunity employer" when it comes to medical issues. In the end, the medical folks decide whether a medical condition makes a member not qualified for military service or whether it will limit that person's service options upon graduation (as does, for example, colorblindness).

All you can do is gather the relevant documents and ensure DS has great alternative plans (as should every candidate!).

 

[Capt MJ]

If you haven’t already done this, as applicants or parent of, go to the DoDMERB landing page and read through every item in the left-side menu, including Contacts. No login is needed to do this. FAQs, the process, etc. See:

DoD Website Consent

If you look at past year admissions cycles threads relating to appointments - pending medical waivers, you’ll see the waiver process can go into late spring and within days of reporting dates, because the SA is willing to wait for a candidate they find admissible in every other way. If they want the candidate to be in the hunt for a seat for a particular class, they do not hesitate to initiate the waiver.

If you think about it, with the propensity for SAs to attract candidates with deep sports/athletics experience, there is potential for a lot of injury-related DQs.

 

[GoCubbies]

I know this is a detailed topic and is case by case but wanted to see if anyone else had this situation in the process. Our DS received a medically ineligible today because of an intracranial shunt when he was three months old. We were expected something with this as periodically a shunt is viewed as hydrocephalus when used. In this case it wasn't. It was a one year shunt to drain fluid when he was an infant and removed a year later.

We had already started gathering the previous medical records including the letter from the neurosurgeon stating it was not hydrocephalus and that he was clear. We're going to reach back out to him now to see about bringing him back into the loop to try preparing for this.

Has anyone else had this situation?

When you say “medically ineligible”, I am assuming your DS was DQ’ed by DODMERB?

What was the shunt for?

 

[Old Navy BGO]

My main concern is that they brush past his application now based on the "surface information" from DODMERB and we may not get the chance to present what the actual situation is (there is none, he's completely clear of what they think he has)

First, the Admissions Board determination of qualification is completely independent of medical status. In fact, I don't know if the Admissions Board even sees a Candidate's Medical Qualification. I suspect that many candidate packages go to the Admissons Board before they even do their Medical.,

Second, I don't get involved in Medical issues and don't know the in's and out of DODMERB, and certainly am not a Doctor, but the first step is to clearly understand what the basis for the DQ is. There is a document that lists the medical requirements for Officer accessions ...it has been referenced and perhaps linked on SAF many time --you should review that with a Doctor to determine whether DS condition is in fact DQ according to the standards. If not, then it really isn't a "waiver" issue, but rather a function of ensuring that DODMERB has all necessary information to determine that DS meets the applicable standard. If the DQ is accurate, then the question becomes whether the condition is actually waivable. Some things, like eyeglasses, are almost automatic (to an extent), but others are not waivable at all.

 

[JKHDelta]

When you say “medically ineligible”, I am assuming your DS was DQ’ed by DODMERB?

What was the shunt for?

The reply for USNA and USMA at this point says medically ineligible but if the Academies decide to pursue him that the waiver process will start automatically.

The shunt was placed when he was three months old for a prenatal subdural hematoma and was removed at fifteen months as all of the fluid cleared and he was no longer producing it, thus the decision from the neurosurgeon and from subsequent visits that he does not, in fact, have hydrocephalus. Also with the fact that the shunt has been out more than fifteen years.

Luckily the neurosurgeon is still in Atlanta and actually at the same hospital so we've been preemptive and waiting to hear back on a scheduled time to see him and assuming all goes well with the meeting, he'll be writing another letter clearing our DS as not having any issues relating to the original surgery and still being in 100% good health. We decided it's better to go ahead and have this done now rather than scrambling at the last minute. Also have all of his previous records from the original surgery and original letter saying he is fine.

 

[JKHDelta]

First, the Admissions Board determination of qualification is completely independent of medical status. In fact, I don't know if the Admissions Board even sees a Candidate's Medical Qualification. I suspect that many candidate packages go to the Admissons Board before they even do their Medical.,

Second, I don't get involved in Medical issues and don't know the in's and out of DODMERB, and certainly am not a Doctor, but the first step is to clearly understand what the basis for the DQ is. There is a document that lists the medical requirements for Officer accessions ...it has been referenced and perhaps linked on SAF many time --you should review that with a Doctor to determine whether DS condition is in fact DQ according to the standards. If not, then it really isn't a "waiver" issue, but rather a function of ensuring that DODMERB has all necessary information to determine that DS meets the applicable standard. If the DQ is accurate, then the question becomes whether the condition is actually waivable. Some things, like eyeglasses, are almost automatic (to an extent), but others are not waivable at all.

Thank you for this. So basically from what you're saying it ends up being more of a clarification issue than a waiver issue.

The item they listed on the Medical Ineligible did list it as basically hydrocephalus so the fact that we can show it's not the case should clear quickly given the opportunity hopefully. The good part is the doctor we're going back to is the actual same neurosurgeon from fifteen plus years ago rather than someone entirely new.

 

[justdoit19]

The reply for USNA and USMA at this point says medically ineligible but if the Academies decide to pursue him that the waiver process will start automatically.

The shunt was placed when he was three months old for a prenatal subdural hematoma and was removed at fifteen months as all of the fluid cleared and he was no longer producing it, thus the decision from the neurosurgeon and from subsequent visits that he does not, in fact, have hydrocephalus. Also with the fact that the shunt has been out more than fifteen years.

Luckily the neurosurgeon is still in Atlanta and actually at the same hospital so we've been preemptive and waiting to hear back on a scheduled time to see him and assuming all goes well with the meeting, he'll be writing another letter clearing our DS as not having any issues relating to the original surgery and still being in 100% good health. We decided it's better to go ahead and have this done now rather than scrambling at the last minute. Also have all of his previous records from the original surgery and original letter saying he is fine.

 

[GoCubbies]

The reply for USNA and USMA at this point says medically ineligible but if the Academies decide to pursue him that the waiver process will start automatically.

The shunt was placed when he was three months old for a prenatal subdural hematoma and was removed at fifteen months as all of the fluid cleared and he was no longer producing it, thus the decision from the neurosurgeon and from subsequent visits that he does not, in fact, have hydrocephalus. Also with the fact that the shunt has been out more than fifteen years.

Luckily the neurosurgeon is still in Atlanta and actually at the same hospital so we've been preemptive and waiting to hear back on a scheduled time to see him and assuming all goes well with the meeting, he'll be writing another letter clearing our DS as not having any issues relating to the original surgery and still being in 100% good health. We decided it's better to go ahead and have this done now rather than scrambling at the last minute. Also have all of his previous records from the original surgery and original letter saying he is fine.

I’m still not understanding.

Did your DS get a DoDMERB exam and was he DQ’ed by them?

Yes, the official DQ is “history of central nervous system shunts of all kinds including endoscopic ventriculocisternostomy.”

But your DS has no chance of being looked for a waiver if he hasn’t even gone through the DoDMERB process.

 

[JKHDelta]

I’m still not understanding.

Did your DS get a DoDMERB exam and was he DQ’ed by them?

Yes, the official DQ is “history of central nervous system shunts of all kinds including endoscopic ventriculocisternostomy.”

But your DS has no chance of being looked for a waiver if he hasn’t even gone through the DoDMERB process.

I'm sorry, yes, he's gone through the initial DoDMERB paperwork and process which included being seen by the doctor they assigned locally and the optometrist. Both of them gave a complete sign off on the paperwork with 100% healthy. The packet submitted included the listing for the surgery as well as the notes about the removal of the shunt.

The response to his online DoDMERB packet today stated that he wasn't disqualified but medically ineligible at this time but that it would be up to the Academies and scholarship committees as well as ROTC departments to request the start of the automatic waiver process if they were interested in him as a candidate to move forward.

There hasn't been any medical exam performed on the military side, only the ones scheduled by DoDMERB themselves with the local doctors.

I apologize for my lack of knowledge on this part as when I dealt with DoDMERB back in 1990 it was a day trip to an Army base south of Atlanta for a full medical and didn't have the process with the independent doctors we've been seeing so far.

 

[Old Navy BGO]

So basically from what you're saying it ends up being more of a clarification issue than a waiver issue.

“history of central nervous system shunts of all kinds including endoscopic ventriculocisternostomy.”

No -- If what Cubbies posted is the officer accession standard , ie. a shunt of any kind, that would be the DQ -- there is no clarification necessary. (Again, I am not a Dr but that is a layperson reading of the standard). Then is is up to USNA to evaluate whether to waive or not...and as pointed out before, some conditions are simply cannot be waived.

I apologize for my lack of knowledge on this part as when I dealt with DoDMERB back in 1990 it was a day trip to an Army base south of Atlanta for a full medical and didn't have the process with the independent doctors we've been seeing so far.

Yes, the process has changed..back in the day, Candidates went to military facilities for their exam..that is now contracted out to participating civilian doctors. (DODMETS is actually the contractor that arranges the examinations with participating doctors around the country; DODMERB is the government agency tasked with coordinating and evaluating medical for all officer accession programs). There is a good explanation of the process in the DODMERB section.

 

[JKHDelta]

Thanks for the clarification and I'll definitely go read over that part of the DoDMERB section. Our DS is very down on himself at the moment for listing the surgery but I explained he had no choice given the scar.

I guess the hopeful part is that they have said the Academies and scholarships still may request the waivers if he's considered a qualified candidate. I guess that means he's not completely out at this point.

 

[JKHDelta]

Guess it would help if I actually showed a screenshot of the actual letter. Sorry I didn't think about that.

The part that gives some hope is the "may" not be over part.

 

[GoCubbies]

Guess it would help if I actually showed a screenshot of the actual letter. Sorry I didn't think about that.

The part that gives some hope is the "may" not be over part.

View attachment 14579

Looks like DoDMERB has medically DQ'ed your DS based on the standard I previously quoted.

BUT take a look at the 2nd paragraph, it says the process "may" not be over for your DS. There's still a chance!

If your DS is applying to the USMA, then I hope he's putting in an app for AROTC. First board is in late Oct. If he is a scholarship selectee, then he will automatically be considered for a waiver.

Your DS has a chance since the shunt was removed and it was for a subdural hematoma. It is not uncommon for infants with subdural hematomas to receive a shunt in the subdural space that can be successfully removed about 12 months later once the collections resolve.

One thing the medical waiver reviewer will want is the report of an imaging study showing complete resolution of the collections. Have that report ready to submit if they consider your DS for a waiver. DO NOT get a CT scan or MRI now. A previously done imaging study that shows no collections should suffice.

To reiterate from my previous posts in this forum, DoDMERB has nothing to do with waivers. Waiver issues are the purview of the commissioning sources.

Good luck!