Sickle Cell Disease & Trait Presentation to the AFEB 22 May 2002 LtCol Timothy Corcoran Office of the Assistant Secretary of Defense (Health Affairs) Policy for Accession Physical Standards DoDD 6130.3: “Physical Standards for Appointment, Enlistment, or Induction” DoDI 6130.4: “Criteria and Procedure Requirements for Physical Standards for Appointment, Enlistment, or Induction in the Armed Forces” Guiding Principles (DoDD 6130.3) Screen out unqualified candidates to reduce early attrition • Applicants can endure basic training & rigors of military life • Decrease failure due to existing medical conditions Exclude conditions leading to excessive time lost from duty • From medical treatment or hospitalization • Free of conditions that probably will result in separation from the Service for medical unfitness Medically adaptable without geographical area limitations Intent Deliver on demand a healthy, and medically ready force to the warfighting commanders without excessive cost Responsibilities (DoDD 6130.3) Assistant Secretary of Defense for Health Affairs and Assistant Secretary of Defense for Force Management Policy shall: • Eliminate inconsistencies and inequities based on race, sex, or examination location in the application of the standards in DoD Instruction 6130.4 Secretaries of the Military Departments shall: • Ensure uniformity of applications and implementation of this Directive and DoD Instruction 6130.4 Accession Medical Committee Accession Medical Standards Steering Committee (AMSSC) • Established by USD (P&R) • Co-chaired by DASD (MPP) and DASD (C&PP) Accession Medical Standards Work Group (AMSWG) • Representatives from the offices that comprise AMSSC Accession Medical Standards Analysis and Research Activity (AMSARA) • Present standards based on expert opinion- not on epidemiologic data linked to military performance • Provides evidence-based feedback on accession standards USMEPCOM U.S. Military Entrance Processing Command • Responsible for conducting all enlisted exams including Reserve Components and the Coast Guard • Conduct exams of individuals not included in the Military Entrance Processing Station (MEPS) programmed workload upon request from an Armed Service or other Federal activity DoDMERB DoD Medical Examination Review Board • Responsible for conducting medical examination of applicants for: – U.S. service academies – Reserve Officer Training Corps (ROTC) Scholarship & Non- scholarship Programs – Uniformed Services University of the Health Sciences Sickle Cell Disease Standard from DoDI 6130.4 • The causes for rejection for appointment, enlistment, or induction are: – E1.2.1. Anemia. Any hereditary (282), acquired (283), aplastic (284), or unspecified (285) anemia that has not been permanently corrected with therapy. Sickle Cell Trait DoDD 6130.3 & DoDI 6130.4 do not disqualify individuals with sickle cell trait for appointment, enlistment, or induction into the Armed Forces Assistant Secretary of Defense (HA) has stated1: “It is not appropriate to screen for a condition that is not disqualifying per the DoD Directive and Instruction.” 1ASD(HA) MEMORANDUM, Subject “Sickle Cell Disease and Sickle Cell Trait Testing and Safety Precautions for Sickle Cell Trait Positive Personnel,” dated 18 Mar 2002 Overview of Questions Is the present accession medical history and physical exam effective in identifying individuals with SCD? If not, would a more rigorous medical history and physical examination be adequate? Screening for SCD (MEPS) Enlisted – MEPS – DD Form 2807-2 (Medical Prescreen) asks about anemia: • “Have you ever had or do you now have: (51) anemia” • The recruiter is instructed to call MEPS Medical Section to discuss examinee’s medical history before sending the individual in for a physical examination – DD Form 2808 (Report of Medical Examination) has block for “H/H”, however, there is no requirement for MEPS to obtain a screening H/H. Screening for SCD (DoDMERB) Officers – DoDMERB – DD Form 2492 (Report of Medical History) does not specifically ask about anemia: • An individual with SCD would likely have had a history triggering a request for further medical records/history & examination – DD Form 2351 (Report of Medical Examination) has block for “Hematocrit”, however, there is no requirement for DoDMERB to obtain a screening hematocrit. – AFEB recommended against DoD screening with a lab H/H in Jan 2002- ASD(HA) concurred with this recommendation and discontinued screening effective April 2002 Overview of Questions Is testing for SCD at accession more appropriate than identification of individuals with SCD after they are accessed with disposition contingent on demonstrated performance, future risks, and deployability? – Existence of a few individuals with very mild SCD who have been retained in service after being found “fit for duty” Overview of Questions If a testing program is recommended at accession: – Would universal screening be indicated? – What is the ethical responsibility of DoD concerning counseling for those identified with SCD and SCT (recognizing that testing for SCD will also identify individuals with SCT)? What is the absolute risk of sudden death during training for an individual with SCT? Overview of Questions When in the basic training cycle have exertional deaths associated with SCT occurred? Have exertional deaths associated with SCT occurred after basic training?
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