Should we Test for Asthma or Wait ?

MissouriFam said:
We just received the letter last week stating that he does not meet DoD medical standards and that his file will require a review by the medical Waiver Authority. He also just received a nomination to West Point. The 76% was FEV1. So I suppose that West Point will now start the Waiver process, if they deem the rest of his application worthy of continuing?
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I recommend following in the steps of Ex.BT.USN and working with a pulmonologist (former military sure couldn't hurt) and send a favorable letter from the physician to DODMERB along with a spirometry that hits the numbers. Target for FEV1/FVC is 75 or more (for this value, DODMERB appears to use an outdated standard proposed back in 1987 -- yes, 1987 -- that has long since been abandoned). Targets for FVC and FEV1 are anything above 80% of predicted for each.

There is a great deal of variability in how these tests are conducted, and in the reference data sets that each office uses. Numbers can change if done sitting or standing, if the subject blows 3 times, 5 times or 8 times, etc. Even having shoes on when height is measured can skew results in the wrong direction. So working with a physician and technician who are patient and diligent in making sure best possible results are obtained can be key.

If you don't mind sharing, what code did DODMERB use for the DQ and what was the actual text for its conclusion (example "FEV1 < 80% predicted at baseline" or something similar)?
 
FairPlay is reqmt FEV1/FVC of 75% or a ratio of 75 ? Also, is that pre or post ratio? AST website implies it is post.. Thx
 
USMA Mom said:
FairPlay is reqmt FEV1/FVC of 75% or a ratio of 75 ? Also, is that pre or post ratio? AST website implies it is post.. Thx
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It's pre-bronchodilator (a/k/a baseline). [some modern clinical guidelines call for use of post-bronchodilator]

And it's not a percentage of any reference value. Rather, it's the ratio of the liters of air exhaled in one second (FEV1) divided by the total liters exhaled during the maneuver (FVC) [though when calculating this it is common to use the highest FEV1 from all attempts and the highest FVC from all attempts - they do not have to be from the same forced exhalation]

Spoke with another pulmonologist today who also practiced for some 15 years while in the Navy. Told him that DODMERB is requiring FEV1/FVC of 75 or more. He said there is no such standard, and that the standard is 70 or more.
 
FairPlay - thanks for posting that info. my son is in a similar position, and trying to understand how DoDMERB and/or waiver authorities define what is acceptable. the 6130.03 simply states "normal spirometry in accordance with American Thoracic Society (ATS) guidelines and as defined by current National Heart, Lung, and Blood Institute (NHLBI) standards. "

the big numbers seem to be FEV1, FVC, FEV1/FVC pre and post dilator.
I know that any increase in FEV1 >or = to 12% indicates a significant response, and reversible obstruction (ie. asthma)
What i don't know is, what is the minimum acceptable pre-drug FEV1/FVC? i've seen 70% as the minimum acceptable. also seen LLN (lower limit of normal), which for 18-19 year olds is 73 or 74. also seen some % of predicted, like 80%.

were you told directly by DODMERB that the standard is 75?

i've also seen that a slightly low FEV1/FVC with a normal or high FEV1 and FVC is considered a normal variant

i'm sure there are plenty of folks who would love to understand this better

thanks
 
A6E Dad said:
FairPlay - thanks for posting that info. my son is in a similar position, and trying to understand how DoDMERB and/or waiver authorities define what is acceptable. the 6130.03 simply states "normal spirometry in accordance with American Thoracic Society (ATS) guidelines and as defined by current National Heart, Lung, and Blood Institute (NHLBI) standards. "

the big numbers seem to be FEV1, FVC, FEV1/FVC pre and post dilator.
I know that any increase in FEV1 >or = to 12% indicates a significant response, and reversible obstruction (ie. asthma)
What i don't know is, what is the minimum acceptable pre-drug FEV1/FVC? i've seen 70% as the minimum acceptable. also seen LLN (lower limit of normal), which for 18-19 year olds is 73 or 74. also seen some % of predicted, like 80%.

were you told directly by DODMERB that the standard is 75?

i've also seen that a slightly low FEV1/FVC with a normal or high FEV1 and FVC is considered a normal variant

i'm sure there are plenty of folks who would love to understand this better

thanks
Click to expand...
 
Based on our interactions with DODMERB, its minimum acceptable pre-drug FEV1/FVC is 75. Didn't back down even in face of two letters from board certified pulmonologists, one of whom was previously responsible for screening recruits while serving 15 years in the Navy. They both said standard is 70.

My recommendation is to work with a private pulmonologist (perhaps a veteran) and explain numbers that DODMERB is looking for and ensure technician conducts tests accordingly. Spirometry is wildly subjective and can vary dramatically based on how it is administered, number of forced breaths, done sitting or standing, lingering effects of a head cold, etc.

Good luck. Though DQ'd, DS did receive waivers from USMA, USAFA and AROTC.
 
thanks for that info,
so, sounds like DODMEB will DQ with anything less than FEV1 of 75? but you were able to get waivers from USMA USAFA and AFROTC? it's easy to be >80% predicted but less than 75 actual, was your actual close to 75?

did your son pursue a waiver from USNA or NROTC?
 
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