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Rhabdomyolysis Waiver

UCbearcat

Lawn Dart
pilot
The latest news is that my medical screen came back "Disqualified" due to "Rhabdomyolysis, a history". Has anyone had any experience with waivering this?

After searching around I saw that a lot of cases of this occurred at OCS. By the sounds of things they were still able to move on and graduate.

A little bit of info:

In February 2010 I was admitted to the hospital for several days for Exertional Rhabdomyolysis after back pain and cola colored urine. My CK levels were high but my kidney function was never reduced. They only had me on IV fluids to keep me hydrated.

I developed Rhabdo after doing CrossFit. As of today I have no permanent damage and I returned to my collegiate sport after a few days. I also have all of my hospital records stating that I am now okay.

Thanks for the help!
 

HeyJoe

Fly Navy! ...or USMC
None
Super Moderator
Contributor
Crap, if you can pronounce or even spell that, you ought to get a waiver. Best of luck regardless.
 

revan1013

Death by Snoo Snoo
pilot
You can always work with your OR to work with the system while you get a second written opinion through a civilian doctor.

I don't know the waiver process myself , but your OR should know and if he/she is good, can get the ball rolling to put in for the waiver.

I saw some friends at OCS get it... ouch.
 

Boomhower

Shoot, man, it's that dang ol' internet
None
The latest news is that my medical screen came back "Disqualified" due to "Rhabdomyolysis, a history". Has anyone had any experience with waivering this?

After searching around I saw that a lot of cases of this occurred at OCS. By the sounds of things they were still able to move on and graduate.

A little bit of info:

In February 2010 I was admitted to the hospital for several days for Exertional Rhabdomyolysis after back pain and cola colored urine. My CK levels were high but my kidney function was never reduced. They only had me on IV fluids to keep me hydrated.

I developed Rhabdo after doing CrossFit. As of today I have no permanent damage and I returned to my collegiate sport after a few days. I also have all of my hospital records stating that I am now okay.

Thanks for the help!

Quoted and sent to the Couch Thread on IGX. They're gonna love this. Rhabdo is definitely the down side of Crossfit.
 

Swanee

Cereal Killer
pilot
None
Contributor
We had 3 guys get dropped from our TBS company because of Rhabdo. One was an air guy who lost his contract because of it. Good luck.
 

D_Rob

Lead LTJG
I know of a winged helo bubba who got Rhabdo before flight school. He got it bad, was even on dialysis. He got the waiver approved but the docs were all very confused. Though this was a few years ago when they needed more pilots, so YMMV.
 

UCbearcat

Lawn Dart
pilot
Well thanks for the input. It sounds like this is going to be a hit or miss type of thing.

I'll try to get the waiver process going with my recruiter as soon as possible. Hopefully I can get it taken care of, otherwise I'll be regretting my decision to do CrossFit for the rest of my life.

Does anyone else have any suggestions or experience with Rhabdo?
 

Tom

Well-Known Member
pilot
Contributor
I have a wavier for rhabdo that I got in OCS. I got diagnosed with it, was med down for three months, then classed back up and commissioned. For my case I didn't get NPQ'ed until I showed up to NAMI in Pensacola to get an admin upchit. The flight doc in Newport didn't think rhabdo disqualifying but NAMI had the hammer. The standards for waivers being recommended and approved are dependent upon where you are at. That means the standards for someone applying for SNA are usually higher than someone who is actually commissioned and is a SNA. When you wing the standards go down as well. Some waivers are granted based on a cost benefit analysis, while some conditions are purely a safety issue.

My flight doc deferred the waiver to the head of internal medicine at NAMI, which later recommended the waiver. Three months later the waiver was approved. You can read through the NAMI waiver guide to learn more about what criteria a doc is going to look at when looking at your medical history.

I think it is going to be a tough, long road for you. What a doc is going to look for is:
1. Can the cause of rhabdo be identified clearly?
2. Did you experience any permanent renal damage as a result?
3. How were treated following being diagnosed?
4. Are you asymptotic?
5. What exactly did you experience when it comes to urine color, specific Ck and other blood levels?

To be honest with you, it is hard to say what your chances of getting a waiver are. Having gotten rhabdo once already raises your chances of getting it again significantly. The Navy or Marines haven't invested anything in you yet, but it doesn't you should give up. Be well prepared with documentation, contact info for doctors, dates, timelines, waiver criteria and the how the waiver process works. If you get a form, make three copies. Be courteous while being proactive and following up with the process.

I've had flight docs tell me I had no chance for a waiver and had no business being in the Navy. Now I fly Super Hornets. Good luck with process, keep a positive outlook and arm yourself with knowledge.

Tom
 

UCbearcat

Lawn Dart
pilot
...read through the NAMI waiver guide to learn more about what criteria a doc is going to look at when looking at your medical history.

Thanks Tom. This is what I found in the medical waiver guide. It looks like it's possibly good news, especially since it's been more than 3 months since it occurred, was from working out, and I have no permanent kidney or organ damage.

17.3A RHABDOMYOLYSIS ( December 2009)

AEROMEDICAL CONCERNS: The physiologic changes that occur in rhabdomyolysis may be precipitated by and severely compounded in the aviation environment and related duties involving flight. Symptoms may include muscular pain, muscular weakness and fatigue. Decreased situational awareness and cockpit distraction are of major concern. Additionally, unrecognized rhabdomyolysis may progress to renal failure, shock, cardiac arrhythmias, and death.
WAIVER: The history of a single episode of uncomplicated rhabdomyolysis is NCD for all aviation classes, including applicants, if the condition fully resolves within three months without sequelae. Any history of prolonged, complicated or recurrent rhabdomyolysis is CD, and a waiver will be considered on a case by case basis in DESIGNATED Aviators only. Waivers are considered under the following conditions:

a. No evidence of a congenital predisposing condition (e.g., myophosphorylase deficiency, sickle cell trait).
b. An identifiable situational stressor led to the occurrence, such as extreme physical exertion, trauma or muscle compression, dehydration, electrolyte abnormality, coexisting infectious disease, toxin exposure, medication effect, or fatigue.
c. No residual organ injury or damage is present.
d. A minimum of three months has passed since the episode of rhabdomyolysis.

INFORMATION REQUIRED:
1. Internal Medicine consultation.
2. Glomerular filtration rate (GFR)
3. Blood urea nitrogen and creatinine
4. Glomerular filtration rate
5. Complete blood count
6. Liver function tests
7. Creatinine kinase
8. Complete metabolic panel Note: Consider thyroid function testing

DISCUSSION: Rhabdomyolysis is a syndrome characterized by muscle necrosis and release of intracellular muscle constituents into the circulation. The disease process can range from mild, asymptomatic enzyme elevations to life-threatening cases involving cardiac arrhythmias, disseminated intravascular coagulation, acute renal failure, and death. The classic presentation of rhabdomyolysis includes myalgias, myoglobinuria causing reddish to brown urine, and elevated serum muscle enzymes. Diagnosis is based upon fractionated serum skeletal muscle creatine kinase levels, which may exceed 100,000 IU/L, and appropriate clinically correlated history. While no specific cutoff for creatine kinase level is used to diagnose rhabdomyolysis, a serum level 5 times greater than baseline is the generally accepted level. Germaine to the aviation environment is the fact that rhabdomyolysis affects patients in a 3:1 male to female preponderance and is exacerbated by extreme heat and load-bearing activity, both of which persist as constant environmental hazards in military aviation. Additional predisposing conditions and causal factors include prolonged unconsciousness resulting in extended dorsal muscle compression, struggling against restraints, episodes of near drowning, burns, sepsis, torture victims, high-voltage electrical injuries, compartment syndrome, hyperthermia, hypothermia, prolonged tourniquet application, seizures, sporadic extreme physical exertion (i.e., ultra-marathoners), dehydration, inappropriate nutritional supplement use, and pre-existing electrolyte abnormalities. Prognosis is generally favorable provided a correctable condition or causative action is identified in those cases that do not progress to acute renal failure. There is concern, however, that multiple sub-clinical episodes of rhabdomyolysis and acute renal insufficiency may predispose patients to early onset chronic renal insufficiency later in life. Additionally, the causal and predisposing factors listed above are synergistic and the chances of developing rhabdomyolysis increase as the number of the risk factors increase.

I'm going to keep posting throughout my waiver process so hopefully others can use this to get through it too.
 

BigRed389

Registered User
None
I've had flight docs tell me I had no chance for a waiver and had no business being in the Navy. Now I fly Super Hornets. Good luck with process, keep a positive outlook and arm yourself with knowledge.

Tom

Dicks.
 

feddoc

Really old guy
Contributor
Tom offers pretty good gouge. To that I would add that the docs would like to see you off most, if not all, related meds.
 

UCbearcat

Lawn Dart
pilot
Finally some good news, yesterday I was approved for my medical waiver!

For others that may have the same problem, the following is what I did during my waiver process:

- Faxed the medical records from the Rhabdo incident to DoDMERB
- Got my attending doctor to write a letter to DoDMERB stating that, in his medical opinion, I was fit for duty
- My excellent OSO called DoDMERB in an attempt to speed up the process

I was told a major contributing factor to my waiver was that I currently play a sport for UC. I guess this helped prove that I'm not still hurt. Take it for what it's worth because I don't know how much credence it holds.
 

usmarinemike

Solidly part of the 42%.
pilot
Contributor
Finally some good news, yesterday I was approved for my medical waiver!

For others that may have the same problem, the following is what I did during my waiver process:

- Faxed the medical records from the Rhabdo incident to DoDMERB
- Got my attending doctor to write a letter to DoDMERB stating that, in his medical opinion, I was fit for duty
- My excellent OSO called DoDMERB in an attempt to speed up the process

I was told a major contributing factor to my waiver was that I currently play a sport for UC. I guess this helped prove that I'm not still hurt. Take it for what it's worth because I don't know how much credence it holds.

Good on you. Remember though that it aint over till you walk out of NAMI in Pensacola with your upchit. Keep your paperwork and contact list handy. Huge chance they'll ride your butt about it some more once you get there. Why? That's just what they do there.
 

BACONATOR

Well-Known Member
pilot
Contributor
I have a wavier for rhabdo that I got in OCS. I got diagnosed with it, was med down for three months, then classed back up and commissioned. For my case I didn't get NPQ'ed until I showed up to NAMI in Pensacola to get an admin upchit. The flight doc in Newport didn't think rhabdo disqualifying but NAMI had the hammer. The standards for waivers being recommended and approved are dependent upon where you are at. That means the standards for someone applying for SNA are usually higher than someone who is actually commissioned and is a SNA. When you wing the standards go down as well. Some waivers are granted based on a cost benefit analysis, while some conditions are purely a safety issue.

My flight doc deferred the waiver to the head of internal medicine at NAMI, which later recommended the waiver. Three months later the waiver was approved. You can read through the NAMI waiver guide to learn more about what criteria a doc is going to look at when looking at your medical history.

I think it is going to be a tough, long road for you. What a doc is going to look for is:
1. Can the cause of rhabdo be identified clearly?
2. Did you experience any permanent renal damage as a result?
3. How were treated following being diagnosed?
4. Are you asymptotic?
5. What exactly did you experience when it comes to urine color, specific Ck and other blood levels?

To be honest with you, it is hard to say what your chances of getting a waiver are. Having gotten rhabdo once already raises your chances of getting it again significantly. The Navy or Marines haven't invested anything in you yet, but it doesn't you should give up. Be well prepared with documentation, contact info for doctors, dates, timelines, waiver criteria and the how the waiver process works. If you get a form, make three copies. Be courteous while being proactive and following up with the process.

I've had flight docs tell me I had no chance for a waiver and had no business being in the Navy. Now I fly Super Hornets. Good luck with process, keep a positive outlook and arm yourself with knowledge.

Tom

Sorry, but I read this and it completely brought me back to Calculus.... haha. Nice typo though. :D
 
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