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Getting a Medical Waiver for Asthma

navyterp67

Well-Known Member
pilot
I wish I could post this as a sub-forum or something because it applies to all commissioning paths, but I'll just put it here because I am in NROTC (at U of Maryland) Go Terps!!!

Anyway, so during my senior year of high school I was accepted for a 4-year NROTC scholarship, but shortly thereafter I receiver a notice from DODMERB (those bastards) saying that I was medically disqualified because of a history of asthma past age 13. Even though my asthma symptoms were vastly diminished, DODMERB still thought I wasn't healthy enough to serve.

When my dreams of being a Naval jet pilot seemed to be shattered, I learned that there was a way to get around this disqualification. It was called a Methacholine Challenge Test. Basically, they make you breathe out many times to test lung function, and then slowly give you increasing doses of methacholine, which is supposed to induce asthma symptoms. You keep breathing out, and if your lung funciton stays above 83% (as I remember) during the approximate 2 hour test, then you pass, and DODMERB will grant you a waiver.

Sorry for the story, but I just want people out there with medical issues to know that it IS POSSIBLE to get around this, and get a waiver so you can achieve your desired goal of being a Naval Officer.

However, I am still waiting to find out if I have to pass another breathing test and get another waiver for my flight physical.

Does anybody here know?
 

scoolbubba

Brett327 gargles ballsacks
pilot
Contributor
I had a friend in ROTC who had the same deal happen to him. He took the test and passed, and then went on to a flight physical our senior year. I don't know 100% for sure, but I think when he passed the test the first time that was the last he heard of it. No breathing test at the physical as far as he told us.
 

aviator70

New Member
Medical Test

Did you have to request for this test to be done or did you go to your own doctor get a referral and pay for it yourself? I am in the same situation so I just wanted to know how you went about this?
 

feddoc

Really old guy
Contributor
I wish I could post this as a sub-forum or something because it applies to all commissioning paths, but I'll just put it here because I am in NROTC (at U of Maryland) Go Terps!!!

Anyway, so during my senior year of high school I was accepted for a 4-year NROTC scholarship, but shortly thereafter I receiver a notice from DODMERB (those bastards) saying that I was medically disqualified because of a history of asthma past age 13. Even though my asthma symptoms were vastly diminished, DODMERB still thought I wasn't healthy enough to serve.

When my dreams of being a Naval jet pilot seemed to be shattered, I learned that there was a way to get around this disqualification. It was called a Methacholine Challenge Test. Basically, they make you breathe out many times to test lung function, and then slowly give you increasing doses of methacholine, which is supposed to induce asthma symptoms. You keep breathing out, and if your lung funciton stays above 83% (as I remember) during the approximate 2 hour test, then you pass, and DODMERB will grant you a waiver.

Sorry for the story, but I just want people out there with medical issues to know that it IS POSSIBLE to get around this, and get a waiver so you can achieve your desired goal of being a Naval Officer.

However, I am still waiting to find out if I have to pass another breathing test and get another waiver for my flight physical.

Does anybody here know?

DODMERB waived you. Unless things have changed, NOMI will have to issue their own waiver. I suspect this will be relatively easy and nothing more than a paperwork drill since you passed the test.

At the top of this sub-forum is a link to the NOMI waiver guide. It will tell you most of what you need to know.
 

aviator70

New Member
I was in the same situation as the rest of you. I had recieved a NROTC scholarship and later USNA appointment. However I was listed as disqualified, by DODMERB, for my history of asthma. However after several stressfull weeks of waiting, USNA came through and gave me a waiver.

Just remeber, it is not over. You can get a waiver without having ridiculous SAT scores etc.. I did.
 

Santi87

Member
I just endured a pretty terrible waiver experience, but everything turned out well and I'm slated for OCS in a month -- thought I'd share for the folks out there who are worried about Spirometry/Methacholine/Asthma/Inhalers.

My situation was a little bit of a special case, but in the end I learned a lot about the process and the tests, which knowing more about going in would have been nice. The way it works, as I understand it, is below:

First, you fill out MEPS pre-screening paperwork. MEPS reviews it. If they see no problems, they arrange for you to come in and take a physical. If there is a problem, they may request medical records before they agree to give you a physical. They review again and hopefully grant you the physical. If, your records indicate a history of asthma or inhaler use at any point, they will say "NO" to giving you a physical. Your recruiter/processor then sends those records to BUMED for review. BUMED reviews the records and will either tell MEPS to give you a physical or they will say "NO", you will need to get such and such tests done first. They will most likely require a Pre-Post Bronchidilator Spirometry test (PFT - Pulmonary Function Test).

- Pre-Post Bronchidilator Spirometry: You breathe in and exhale out as fast as you can several times into a machine that measures and records your lung capacity. It is compared against a control population of normal patients, and percentage values are determined based on your race, age, height, and weight. The most important measurements are FVC (Forced Vital Capacity, i.e. the total amount of air your lungs can hold) and FEV1 (Forced Expository Volume in 1 Second, i.e. the amount of air you can exhale from your lungs in the first second after taking a huge breath). You can find your predicted amounts through several online resources, they're pretty readily available. Generally speaking, if you do lots of athletics and cardio, you'll be right around your predicted values if not higher. After your first set of breaths, they give you a couple puffs of a fast acting inhaler like albuterol. You wait a few minutes, then do the test again. If you show an increase of over 12%, then there is something causing constriction in your lungs that is correctible via medication, i.e. they will diagnose asthma.

If you pass the PFT with normal results (likely on your own dime, out of pocket will cost ~$150, depending on full-pay or self-pay discounts, etc), your recruiter/processor resubmits to BUMED. They review results and instruct MEPS to give you the physical. At MEPS, you take your physical and interview with the doctor. The doctor will "PHYSICALLY DISQUALIFY" you, so do not be alarmed. It is automatic at this point. They wait until your blood test and urine test to come back and then MEPS sends the ENTIRE physical to your service's waiver processing office. They send it to BUMED, who then will issue the waiver to your processor/recruiter.

Once you get a final select and an OCS date and you report to OCS, you will be given a full flight physical by NOMI on the 2nd or 3rd day. They have more strict guidelines than MEPS, and will likely require you to get a Methacholine Challenge Test. It is a showstopper of a test.

-Methacholine Challenge Test: The doc has you breathe in increasing doses of nebulized methacholine, designed to instigate a reaction. If you have asthma, your lungs will react and begin to constrict. You first begin by doing a regular spirometry. These numbers should closely match the numbers you did before. You then breathe in about 5-6 deep breaths of the methacholine. After 2 minutes, you do a spirometry. Again, you are primarily concerned with the FVC and FEV1 measurements. If you drop 20%, the test is positive. You have to complete about 5-6 dose levels. Usually the first 3 are pretty easy (I had about 1% change in FEV1 for the first few which is negligible, and then 8% and then 14% on the last two...in the clear). 14% decrease doesn't feel like much beyond some fatigue, but you feel tired. At that point, you've basically been blowing as hard as you can for an hour, so you're tired to begin with. There's really no way to cheat the test, it does what it is supposed to do. Hints: make sure when you blow your nose is clipped and your lips are sealed around the mouthpiece to no air escapes and cheats you out of your measurements. Apparently, caffeine is a proven agent that will open your lungs, which is why they specify that you be off it before the test along with all medicines and inhalers (although it really won't make a difference if you have a cup in the morning beyond mentally making you confident, so says the technician). If you actually have major asthma problems, you can be sure that no amount of coffee or anything will help you pass the test. Asthma or not, Technique is everything. On my final dose, I hit 14% on my first blow, and on my second and third I hit 26%. The doc had me do it again, really emphasizing technique. I adjusted myself, blew again, and hit 13% and 14% on the next two blows, which basically validated the first good number and negated the bad ones. Technique can be the difference between 14% (passing) and 26% (failing), so be cognizant of it...and remember, it needs to be repeatable in order for the measurements to be accurate.

I would HIGHLY recommend getting the Methacholine test before attending OCS because a) you'll know you're in the clear and can spend your time worrying about fitness and memorization b) if by some stupid chance they want you to do it again, you know what to expect and know you've passed it once and can pass it again c) you can control the test environment and retake, get a second opinion, etc if you don't perform as well as you'd hoped d) you're taking it on your own grounds, without the stress of actually being at OCS factoring into your performance. I have not yet been to NOMI, but I will be taking my results with me to OCS to pull out in case they request the MCT. On your own, if you are insured then insurance will cover the cost of a doctor ordered test. You may have to pay a copay depending on your plan. If you are not insured, you need to shop around because I have seen pricing vary. I have seen it cost $200, $420, $850, $1200 (most common range), and $2300. Really it just comes down to the facility. As far as estimating how you will do on it, the Pre-Post Spiro is not a statistically reliable method in predicting methacholine challenge performance. But FWIW, I blew 112% on my baseline Spiro and had a 1% increase after the inhaler puffs (negligible difference). I maxed out on the methacholine challenge at 14% decrease, a negative test (hooyah). When I am around cats, I still get itchy eyes and sneezy, and used to have a lot of chest tightness after 2-3 days of being around them (that mainly included sleeping where there is dander). This is what had me scared, knowing that I have had trouble breathing around cats (and ONLY cats), but I also work out and started doing a lot of cardio so who knows. What I'm saying is that even with these past symptoms, it IS possible, so get the test done and have confidence!

Hopefully this breakdown helps someone, I know I could have used a laid out "what to expect" analysis. Good luck to all!
 

dhinkle5

New Member
pilot
Great post Santi87. That really gives me a lot of insight to my questions. I guess my only issue is what happens if you are approved by NAMI and DODMERB through this methacholine challenge, but you get bumped by another area along the way? What I'm trying to say is that NAMI and DODMERB is completed before OCS. Then after OCS you get another physical before API if I understand correctly. My concern is getting the waiver for asthma, completing OCS, then the physical before API they another test of some sort and I fail that. Then I have no job and I'm screwed! Have you hear anything about more testing of the lungs and things like that after going to OCS?

Thanks for any help you or anyone else can offer!
 

Santi87

Member
Haven't been through the whole process yet (classing up in a few days), but from my experience, I already have the DODMERB waiver which allowed me to get a final select and get an OCS class date. On Monday I will go through NAMI flight physical on my second day at OCS and because I already have the successful results from both methacholine and spiro tests, they should grant me a waiver with no problem...should just be a matter of paperwork if anything.

And from there, I should never have to take the methacholine test again and this shouldn't crop up in the future. The most they would make you do is possibly another spiro exam when you go for your long form physical every 5 years to make sure nothing has changed. But hell, if you're passing the methacholine then the spiro test is a non-issue.

As for the physical before API, it's my understanding (someone can correct me if I'm wrong) that this IS the NAMI physical. As I'll have taken that physical at OCS, they probably won't make me do the long form a few months later when I check in to API, it will probably just be a quick visit with some eye exams thrown in for good measure and nothing more.

And that should be it...passing that methacholine test apparently is the magic bullet, it can make or break you when it comes to asthma. I'm hoping that's it too, I already quit my regular job haha
 

dhinkle5

New Member
pilot
ya once you quit that job your pretty much 100% committed! thanks a lot for the info. i sent you a follow up pm also, fyi

-Dave
 

Lexie

New Member
Hey navyterp67.....I know this post was 8 years ago but if you happen to see this can you please reply when you get a chance! How long was your history of asthma after the age of 13?
 
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