Subclinical Hypothyroidism (Waiver Questions)

[AltiusOne]

Hello all,

New to the forums here. I noticed that there was another thread on acquiring a waiver for hypothyroidism way back in 2008 (*link below), and I have a similar question. I wouldn't try to bring this up again since the question has already been asked, but I feel that it is relevant since NAMI recently revised their endocrinology waiver guidelines in August of 2014 (**link below), and becoming an SNA (rotary-wing) in the Navy or Marine Corps is something I really want to pursue.

In December of 2013 I was diagnosed with subclinical hypothyroidism. I had a bout of mono in the Summer of 2013 and after lingering fatigue and hypothyroid type symptoms, lab tests showed that I had an elevated TSH with normal levels of T3 and T4. My TSH was 4.3 in December, so it is about as mild of a form of hypothyroidism as possible (though without medication I do exhibit symptoms of hypothyroidism). The NAMI endocrinology waiver guidelines specifically cover subclinical hypothyroidism in these new guidelines, so do you think that a waiver is possible? Also, is there a way to directly email personnel at NAMI to get a quote? Finding an email or contact info on their website was difficult. I would like to have all my information in line before I try to speak with an OSO. I spoke with an enlisted USMC recruiter (even though I wanted to go officer) in December and he kind of shooed me out of the office when he heard I was on medication, but didn't have any information on waivers or any other knowledge of this sort of thing. Does anyone else here have experience getting a waiver like this?

Other information - I am on a low dose of levothyroxine (the only approved form of medication according to these new guidelines). Before going on the meds I was a college athlete (runner) and would score close to a 300 on the PFT. After going on the meds nothing changed, I would still score close to 300 on the PFT, and have zero physical limitations. I feel that I could make a compelling case. I am a double major college-graduate (age 23 now) with a 3.75 GPA. Currently I am studying for the ASTB-E. Thanks for your help, I really appreciate it.

*2008 Hypothyroid Waiver Thread:
http://www.airwarriors.com/community/index.php?threads/hypothyroid-waiver.24546/

Aeromedical Reference and Waiver Guide Overview:
http://www.med.navy.mil/sites/nmotc/nami/arwg/Pages/AeromedicalReferenceandWaiverGuide.aspx

**Endocrinology Component of the ARWG:
http://www.med.navy.mil/sites/nmotc...er Guide Aug 2014/05_Endocrinology_140825.pdf

Hypothyroidism Waiver Information taken from the Endocrinology Section (Revised Apr-Jul 2014):

 

[TimeBomb]

AltiusOne,
You won't need to get a waiver for general commissioning, provided you have two normal TSH values in the past 6 months. I'm assuming you meet that requirement, but you'll need to prove it to the examining physician. Based on the information at hand, the diagnosis of hypothyroidism is considered disqualifying (CD) for aviation applicants, with waiver recommended (WR) if you meet the requirements for a waiver. Get all the consults and lab tests required in the Waiver Guide prior to and you should be well on the way.
R/

 

[Pags]

....expialidocious!

Couldn't resist, good luck

 

[AltiusOne]

AltiusOne,
You won't need to get a waiver for general commissioning, provided you have two normal TSH values in the past 6 months. I'm assuming you meet that requirement, but you'll need to prove it to the examining physician. Based on the information at hand, the diagnosis of hypothyroidism is considered disqualifying (CD) for aviation applicants, with waiver recommended (WR) if you meet the requirements for a waiver. Get all the consults and lab tests required in the Waiver Guide prior to and you should be well on the way.
R/

Thanks for the response! Wouldn't I need a waiver for both general commissioning and an air contract since the hypothyroidism requires medication? In the endocrinology guidelines for aviation it mentions medication (levothyroxine being the only permitted med - the med that I am on), but I don't know how that applies toward general commissioning. Thanks again guys!

 

[TimeBomb]

AltiusOne,
The physical standards for aviation are more stringent than those for general commissioning. It's a tiered process. First, you have to be qualified for commissioning, or have a waiver. Secondly, you then have to pass aviation standards, or get a waiver. Many applicants don't appreciate that you can be PQ for general commissioning, but NPQ for aviation. In your case, treated hypothyroidism with two normal TSH values is NCD (no waiver required) for general commissioning. You'll still be found NPQ and will have to get the waiver if you want to do aviation.
R/

 

[AltiusOne]

TimeBomb,
Thanks so much for your help! I am pretty excited that a waiver is possible and that I fit the criteria, as Naval aviation is something I've wanted to do for quite some time. From mine and some others' experience, it sounds like finding an OSO willing to do the paperwork will be the real challenge. Thanks again for your help! I will most likely update this thread if I run into issues throughout the application/waiver process.

 

[TimeBomb]

AltiusOne,
Please let me know how it plays out.
R/

 

[AltiusOne]

AltiusOne,
Please let me know how it plays out.
R/

To update this thread:

I got into MEPS a few weeks ago on 07 January, and everything went really smoothly there. It honestly seemed like the orthopedic surgery I had for a broken scaphoid 6 years ago was a bigger deal to the docs there than was my hypothyroidism (I had all pins removed and it proved nothing to worry about either however). I left MEPS being told I was fully qualified for military service. I narrowly missed the February SNA/SNFO board, but my application is at NRC and should be reviewed at the next board. Now, my questions are aimed toward the flight physical at OCS. It would be a huge disappointment to get so far and then be NPQ'd, but according to the NAMI waiver guidelines in my first post I think I should be ok. However, I am trying to remain open to all possibilities.

This thread ( http://www.airwarriors.com/community/index.php?threads/medical-paperwork-at-ocs.42655/ ) recently cropped up, and I am concerned about bringing more paperwork to OCS. @TimeBomb, can you tell me how this works? The two recruiters posting in that thread state that applicants shouldn't be bringing paperwork to OCS that hasn't been reviewed by MEPS/N3M, but for hypothyroidism the requirements for NAMI are more stringent than for MEPS. To get a waiver to fly I'll need two recent blood tests (last 6 mo's) within normal range according to the guidelines and these wouldn't have been reviewed by MEPS. I didnt have to get an N3M letter to get PQ'd by MEPS. Thanks for the help! AW is awesome.

 

[exNavyOffRec]

To update this thread:

I got into MEPS a few weeks ago on 07 January, and everything went really smoothly there. It honestly seemed like the orthopedic surgery I had for a broken scaphoid 6 years ago was a bigger deal to the docs there than was my hypothyroidism (I had all pins removed and it proved nothing to worry about either however). I left MEPS being told I was fully qualified for military service. I narrowly missed the February SNA/SNFO board, but my application is at NRC and should be reviewed at the next board. Now, my questions are aimed toward the flight physical at OCS. It would be a huge disappointment to get so far and then be NPQ'd, but according to the NAMI waiver guidelines in my first post I think I should be ok. However, I am trying to remain open to all possibilities.

This thread ( http://www.airwarriors.com/community/index.php?threads/medical-paperwork-at-ocs.42655/ ) recently cropped up, and I am concerned about bringing more paperwork to OCS. @TimeBomb, can you tell me how this works? The two recruiters posting in that thread state that applicants shouldn't be bringing paperwork to OCS that hasn't been reviewed by MEPS/N3M, but for hypothyroidism the requirements for NAMI are more stringent than for MEPS. To get a waiver to fly I'll need two recent blood tests (last 6 mo's) within normal range according to the guidelines and these wouldn't have been reviewed by MEPS. I didnt have to get an N3M letter to get PQ'd by MEPS. Thanks for the help! AW is awesome.

MEPS doesn't PQ you, they just give you a physical, the docs at N3M could care less if the MEPS doc's think you are qualified or not, they look at the data and make their own determination, in nearly all cases when they ask for something within 6 months it is within the date of the determination.

 

[AltiusOne]

MEPS doesn't PQ you, they just give you a physical, the docs at N3M could care less if the MEPS doc's think you are qualified or not, they look at the data and make their own determination, in nearly all cases when they ask for something within 6 months it is within the date of the determination.

@NavyOffRec Got it, that makes sense. Thank you, sir. I didn't know that, I was just going off of what I was told at MEPS. As I was leaving they said that I was "fully qualified for military service" and that was inaccurate. It sounds like N3M is a different ballgame. My concern was just that the docs at MEPS didn't have me submit all of the relevent labs and documentation that the waiver guide on NAMI's website says I would need to be PQ'd with my condition. When you say date of the determination, do you mean 6 months prior to my MEPS date, or 6 months prior to NAMI's determination that I am PQ/NPQ?

If all the documentation needed by NAMI to make an NPQ/PQ determination isn't there, what happens? Would labs be requested at that time or would I just be NPQ'd and that's it?

 

[exNavyOffRec]

@NavyOffRec Got it, that makes sense. Thank you, sir. I didn't know that, I was just going off of what I was told at MEPS. As I was leaving they said that I was "fully qualified for military service" and that was inaccurate. It sounds like N3M is a different ballgame. My concern was just that the docs at MEPS didn't have me submit all of the relevent labs and documentation that the waiver guide on NAMI's website says I would need to be PQ'd with my condition. When you say date of the determination, do you mean 6 months prior to my MEPS date, or 6 months prior to NAMI's determination that I am PQ/NPQ?

If all the documentation needed by NAMI to make an NPQ/PQ determination isn't there, what happens? Would labs be requested at that time or would I just be NPQ'd and that's it?

There are two steps N3M will determine if you are qualified for USN officer, then NAMI will later determine if you are qualified for aviation programs.

 

[AltiusOne]

Great, thank you @NavyOffRec. I am assuming all documents up for review by N3M/NAMI will be pulled from my packet put together at MEPS. Does N3M ask for additional documents to what was provided by MEPS?

The issue is that everything I've read from the DoD and aviation waiver guidelines says that I need two normal lab results in the past 6 months to be cleared (even for just obtaining a commission). The CMO at my NRD requested only one lab result, and I submitted the most current one I had to him at the time. When in my interview at MEPS, the physician I was with flipped through a manual on his desk and started to say that I would need another lab test in addition to the one that was in my chart. He had the CMO come into the interview room, who was irritated because I was the last interview and wanted to get moving on the next exercise, said I was fine and had all the labs I needed and that was that. I'm just concerned that its going to come back to bite me when it comes time for N3M and NAMI if I am lucky enough to be selected. FWIW, I have been getting labs every ~3 months just to ensure I have the docs if they are requested (all within the normal range) - definitely have 2 normal labs within the last 6 months (my MEPS packet only includes one though). Thanks again, I apologize for all the questions but really appreciate the advice.

 

[exNavyOffRec]

Great, thank you @NavyOffRec. I am assuming all documents up for review by N3M/NAMI will be pulled from my packet put together at MEPS. Does N3M ask for additional documents to what was provided by MEPS?

The issue is that everything I've read from the DoD and aviation waiver guidelines says that I need two normal lab results in the past 6 months to be cleared (even for just obtaining a commission). The CMO at my NRD requested only one lab result, and I submitted the most current one I had to him at the time. When in my interview at MEPS, the physician I was with flipped through a manual on his desk and started to say that I would need another lab test in addition to the one that was in my chart. He had the CMO come into the interview room, who was irritated because I was the last interview and wanted to get moving on the next exercise, said I was fine and had all the labs I needed and that was that. I'm just concerned that its going to come back to bite me when it comes time for N3M and NAMI if I am lucky enough to be selected. FWIW, I have been getting labs every ~3 months just to ensure I have the docs if they are requested (all within the normal range) - definitely have 2 normal labs within the last 6 months (my MEPS packet only includes one though). Thanks again, I apologize for all the questions but really appreciate the advice.

MEPS goes by general military entrance requirements and those do not necessarily equal USN officer requirements, so if N3M needs additional info they will ask for it, if N3M wants you to do something before going to OCS they will also ask.

 

[TimeBomb]

AltiusOne,
Don't assume that the docs at MEPS know what the requirements are for the individual services and their programs. Best bet is to rely on the instructions, since the folks who are the decision makers in your case will be going off those documents. I know almost nothing about N3M or OCS. My experience was limited to NAMI, so by the time I got a look at the applicant, he had already cleared the MEPS/N3M hurdles. If the internist at NAMI thinks you need more testing, they'll ask for it. You'll probably be stashed somewhere until the waiver comes through if it hasn't been finalized by the time you leave OCS.
R/

 

[AltiusOne]

@TimeBomb and @NavyOffRec, thank you both for your help, its a relief being able to come here and get so much good information. I just wanted to make sure that MEPS wasn't the final say on what medical information was going to be reviewed by NAMI if I am selected for aviation, since the docs didn't request all the labs that it sounds like I will need to be PQ'd. I have gone through the waiver guide with a fine-tooth comb for my condition, and I fit the criteria for a waiver so I will make sure I have all the documentation required when it comes to N3M. Thanks again for responding!