AFEB Spring 2002 Day 2 Dr Corcoran 1

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					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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