Medically Disqualifying, Yr 3/4

[S13D_S13D]

I recently recieved a memorandum disenrolling me for ROTC for “pulmonary embolism” as a disqualifying condition from Hughes, MG Commanding. (After only a medical review on paper.) I had a pulmonary embolism over a year ago after I contracted but after temporary anticoagulation and surgical removal the clot is gone. I was released back to the national guard, and had another medical review done since cadet command didn’t go into any further explanation of why they let me go. I have no lasting effects of the clot I got and am no longer on medication. I was top half of my ROTC class, top 25% if looking at APFT and Academics. In spite of my clot I never failed an APFT and continued to serve in a combat mos through the guard. Training while waiting on the answer from cadet command not only included over 30 miles in rucking but also (howitzer) ammunition runner on a gun line for field trainings with the national guard. I have shown nothing but dedication to improving myself, fulfilling my obligations, and health. The national guard has completely cleared me to stay and serve after reviewing my medical documents. I met with the Battalion PA in person a few days after the ROTC decision, and returning as a PFC to my national guard Battery. The BN PA compiled my packet to the brigade surgeon who agreed: “Soldier was released back to unit with no direction/recommendations. I referenced AR 40-501 Section 3-7 subsection F which states :

When to refer to MEB:

Thromboembolic disease when response to therapy is unsatisfactory, or when therapy is such as to require prolonged, intensive medical supervision.

My recommendation is that the SM is allowed full unrestricted activity as her condition has resolved and she is asymptomatic.”

Do I stand any chance appealing cadet command? If I’m fit enough to deploy with combat arms, how come I was denied? I am/was a contracted MS 3/4 and was slotted for ADV Camp in late summer. This happened so late in the game- I’m trying to act quickly in case anything can be done to fix this. There is a point of contact on the memorandum. However, I do not want to jump my chain of command when they were caught just as off guard as I was by the decision. Who do I go to? Am I just getting my hopes up?

 

[S13D_S13D]

I forgot to mention that the only reason I got a blood clot was because they changed my birth control to a higher dose estrogen when I went through basic training

 

[GoCubbies]

Just to let you know, Cadet Command probably used AR 40-501 chapter 2 standards when reviewing your condition. AR 40-501 chapter 3 are the retention and separation standards used for determination of MEB which are more lax than chapter 2 accessions standards. In other words, your unit used the more lax standards of chapter 3 when determining whether or not you stay in the ARNG. They did the right thing though. You're a bona fide ARNG Soldier so chapter 3 is the right standard to use.

Before you appeal to Cadet Command, there a few more things you should find out.

When someone has a pulmonary embolism (PE), then I start to think of a "hypercoagulable state." There are disorders that need to be looked into to make sure you don't have them. I would make sure you don't have Factor V Leiden, Prothrombin mutation, Antithrombin deficiency, Protien C deficiency, Protein S deficiency, and antiphospholipid antibodies.

There are other conditions that put anyone at risk for a thromboembolic event like a PE such as prolonged immobilization (long flight, post-surgery, etc), cancer, and pregnancy. So there you have the BCP that increased your risk for a PE. But women are put on BCPs all the time and we don't see a lot of PEs in them? What made you so different? That difference is what I'm talking about when I say you need to make sure you don't have some other hypercoagulable state. A woman with Factor V Leiden and on OCP has a relative risk of 9 times a woman who is on OCP but doesn't have Factor V Leiden.

I would say if you do have a chance a reversing this decision, you may have to wait a year after being off medicine and show documentation you don't have any those inherited disorders I mentioned earlier . Were you on Xeralto for 6 months or something like that? When was your last dose?

 

[S13D_S13D]

I tested negative for all of those directly after the clot and had all of the tests retested after one year + 2-3 months off medication. I was on Xarelto which they claim is out of your system in 24 hours. They had me do one year on the medication since it is still a new drug. I had a long flight coming home from basic training + the BC was the perfect storm. Of course the Army is saying they have nothing to do with me getting a clot but that's a battle for another day. I have a note in my file Highly Recommending me for other officer training in the future. I also spoke with an AMEDD recruiter because I was trying to go Med. Services (Specifically Baylor, PT) and they said: "While they are correct that a PE is a disqualifier, it can be waived as long as 1. The issue has resolved 2. There is no further issue 3. No permanent injury/ medical treatment is required". They've emailed the USAREC surgeon to see what the timeline for medical clearance is for me to be eligible to at least commission through AMEDD.

Their decision has me questioning my medical fitness: "Is there something I overlooked? Am I doing something wrong?" I'm going to see a specialist soon at Duke University, a research professor, who had studied clotting for over twenty years and has said there is no reason to require further intervention. Is there anything I should ask of him when I see him to assist in appealing, or applying for a waiver in the future?

 

[GoCubbies]

The further away this episode (and last dose of your Xeralto) is in terms of time the better. The issue is recurrence rather than having the Xeralto out of your system.

The reviewers need a warm and fuzzy that you haven't had a recurrence since being off Xeralto. Have you been off for a 5-6 months now? 2 years? I think they may want to wait a year or two to make sure no recurrence before deciding on a waiver.

If you want to directly access into the military as an AMEDD officer, then your chances of getting a waiver are better. There is a shortage of specialists in the AMEDD so being a direct accession helps out if waivers are needed.

As for the Duke specialist, I think the only thing holding this up is time, so not sure if s/he can do much more at this point to assist. You don't have Factor V Leiden, Protein C deficient, Lupus anticoagulant, etc... It was just like you said, a perfect storm of having 2 risk factors (BCP + immobilization due to long flight) at the same time. The only thing I can think of that might help is if the specialist quantifies your risk relative to someone who has never had a history of thromboembolism in the past and puts it into a memo.