# Coronary Artery Disease and Jump Status Waiver



## HotelYankee22 (Jan 10, 2015)

BLUF:
2 weeks ago I had a stent put in one of my coronary arteries to open up a 90% blockage. I'm having a difficult time finding any waiver criteria that specifically relates to parachutist duty and re-vascularization of a coronary artery. I'm attempting to find a precedent that has already been set by another operator who has had the same procedure, and is still on jump status post MEB/ Waiver.

Does anyone here have, or know anyone who has gone through this process before?

Thanks.


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## Johca (Jan 10, 2015)

Static line, MFF, or both?  I suggest also look into what the waiver would be to retain the infantry MOS with a waiver.  After all the military parachutist is actually airborne "infantry" as mush as a military parachutist.


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## DA SWO (Jan 10, 2015)

Johca said:


> Static line, MFF, or both?  I suggest also look into what the waiver would be to retain the infantry MOS with a waiver.  After all the military parachutist is actually airborne "infantry" as mush as a military parachutist.


His first post said he was  a PJ with the 102nd Res Sqdn, so I assume both.


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## HotelYankee22 (Jan 10, 2015)

I'm a PJ... just on an AD team now. So yes... MFF.


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## Johca (Jan 11, 2015)

There is no waiver criteria specific to cardiac maladies that specifically relates to parachutist duty.   I have awareness of PJs in the past getting waivers for heart murmurs and some harmless ECG pattern oddities, but not for coronary artery blockages.  Generally for AF Class III/Special Operations Duty medical criteria any cardiac blood vessel stent or bypass surgery will not be eligible for waiver consideration.   With a 90% block I suggest looking at AFI 48-123 and looking at the retention in Air Force standards.


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## HotelYankee22 (Jan 11, 2015)

Jocha-
Are you a physician or still in the military?  I'm looking for as much help as possible to prepare for this upcoming MEB.  My case is unique, let me know if you'd like me to fill you in on the details.

I've read all of the Air Force Waiver Guides; there is a chance that I'll be eligible for a waiver as I meet all of the criteria in the AFI.  The flight surgeon that I'm working with contacted the O-5 in charge of processing the MEB's... she seems to think that after my board I will  be told I'm eligible to return to duty, but not jump status. All of the criteria in the Air Force Waiver Guides specifically relate to flying though, and not parachutist duty. I'm hoping find an operator here from another service that has a stent and is still on jump status.


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## HotelYankee22 (Jan 11, 2015)

Forget my first question- just read your bio. Any knowledge you have would still help.


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## Johca (Jan 11, 2015)

Just a retired PJ for about the past 18 years.   Most of my medical waiver and personal reliability program waiver (PRP) experience is from an assignment on the HQ ACC Command Surgeons staff.  I worked beside the Docs approving/disapproving aircrew medical and PRP waivers connected to medical maladies.  Of course with 23 years as a PJ I'm aware of several waiver approvals and disapprovals for cardiac concerns.

Duane Hackney, a PJ of most renown is example of an individual unable to get a waiver for cardiac ailments needed to remain on aircrew, jump, and dive status, but obtained a waiver to remain in the service in other less physically demanding AFSCs (Security Police and subsequently Intel).   He died one morning from a cardiac arrest during PT.

AF Flight medicine waiver policy does not consider  cardiac blood vessel stent or bypass surgery waiver eligible for the flying class (I, II, III) physicals.  The Marine physical (military diving) doesn't consider consider  cardiac blood vessel stent or bypass surgery conditions that should be waivered either.  Regardless the medical waiver request must disclose what expected benefits will result if granted (approved).   The waiver request can be considered to be a risk management decision.  Being considered is the risk of further injury or death in performance of duties, any permanent duty limitations and or restrictions, and if required involuntary classification (job placement) into another less physically demanding AFSC or medical separation is required.

Cardiac blood vessel stent or bypass surgery conditions would require HQ AF surgeons approval after the request was screened through your current MAJCOM's command surgeon.   Context being is the Command Surgeon lacks the authority to approve.  The MAJCOM's screening is to ensure all the needed medical examinations, tests, lab results are present and available to the approving/disapproving authority.

The Air Force Enlisted Classification Directory clearly and distinctly states award and retention of Pararescue AFSC requires current Class III Flight Physical certification as well as the physicals requires for parachuting and combat diver duties.  The initial exam standards sort of establish what can and cannot be waivered once medically qualified to perform aircrew, parachutist (particularly MFF), and combat diver duties.

As you only mentioned parachutist medical waiver concerns I didn't consider you being a PJ or CCT in my initial response.  This is why I focused on the Army's medical waiver policies for Infantry duties (TACP, Security Forces or Army Ranger or Army Special Forces).

A review of AR 40-501 lacks me finding clear policy guidance for  medical waiver eligibility criteria after basic special qualifications identifier is obtained, primarily because to be infantry does not require the service member to be a parachutist or a combat diver.  Being a US Army Ranger is being Infantry.  Being US Army Special Forces is essentially also being Infantry as the award and retention of the 18 series MOSs does not require performing MFF or Combat diver duties.  The context being the disqualifying medical condition imposes duty limitation of prohibited from perform or accomplishing parachutist or combat duties, but not core  inherent duties of the MOS.



> AR 40-501:
> 
> Waiver authority for Special Forces training, Special Forces Assessment and Selection (SFAS), survival, evasion, resistance, escape (SERE) training, Military Freefall (MFF), and Special Forces Combat Diving Qualification Course (CDQC) is the Commandant, U.S. Army John F. Kennedy Special Warfare Center and School (USAJFKSWCS). Waiver authority for the Airborne School is the Commandant, U.S. Army Infantry School in coordination with AHRC.
> ...
> (2) Special Forces/Ranger combat divers and MOS 00B divers must have a physical examination every 5 (five) years. The physical examination for divers must be performed by or reviewed by a DMO or a FS trained in diving medicine. The physical examination for MFF parachutists must be performed or reviewed by a FS every 5 years in conjunction with physiologic training.



I suggest you read paragraph 8-26. Cardiovascular Screening Program (CVSP) and  10-24. Cardiovascular Screening Program (AGR Soldiers) found in AR 40-501.



> 10-24. _b. _Soldiers who do not obtain CVSP clearance will be medically flagged and processed through the MMRB in accordance with AR 600-60.


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## HotelYankee22 (Apr 29, 2015)

UPDATE:

After a week long visit with the Aeromedical Consult Service, I was told today that I will be granted a waiver to remain on flight/ jump status, FC III physical, even with my cardiac history.  The catch is that I will have to be off of all of my anti-platelet meds before I can I get back back up on status.  The nature of our training puts us at a high risk for head injuries, which could be fatal while taking an irreversible anti-platelet drug like Plavix.  Additionally, I will be stuck with an assignment limitation code-2 (ALC-2) which means I won't be deploying for a couple years until I can get the code reduced to a less restrictive one.  

Just wanted to throw an update out there.  If any operator from any service finds themselves in a similar situation, send me a PM and we will get in the regs and figure it out.


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## TLDR20 (Apr 29, 2015)

Awesome brother! Congrats!


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## HotelYankee22 (Apr 29, 2015)

Thanks bro... it's a pretty fucking stressful process wondering if your days hacking the mish are over... especially when the decision isn't left up to you.


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## DA SWO (Apr 29, 2015)

HotelYankee22 said:


> Thanks bro... it's a pretty fucking stressful process wondering if your days hacking the mish are over... especially when the decision isn't left up to you.


Assignment wise what happens?
Back to the Guard? or a training billet?


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## HotelYankee22 (Apr 30, 2015)

Great question. AD owns me, so I won't see the guard for a while. Hopefully instructor billet.


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## Johca (Apr 30, 2015)

C2- Deployable/assignable to CONUS installations with intrinsic fixed MTFs (TRICARE network availability assumed).  However the catch-22 of " I will have to be off of all of my anti-platelet meds before I can I get back back up on status" is being deemphasized as the catch to gaining medical qualification to perform duties of AFSC (back on mission ready or mission capable status) and medically qualified to train doing anything connected to flying, parachuting and diving is getting off all the anti-platelet medications.

Although anti- platelet medications increases risks connected to just about any blunt trauma injury, the actual risk is the clotting impairment which increases risks of significant internal and external bleeding.  Did the docs give any indication of when you may be off of all the anti-platelet medications?

Antiplatelet agents 
Antiplatelet agents inhibit platelet aggregation and prevent formation of the platelet plug. Platelet plug forms in places of vascular injury to stop bleeding, and it can also cause pathological artherosclerosis and thrombosis.

There are two classes
	
 of antiplatelet agents: glycoprotein platelet inhibitors and platelet aggregation inhibitors. These drugs work by different mechanisms to inhibit platelet function.

Antiplatelet agents are used as treatment and prophylaxis in patients who have had myocardial infarctions or are at a high risk of other thromboembolic disorders such as stroke.

Plavix ... Because Plavix keeps your blood from clotting, it can also make it easier for you to bleed, even from a minor injury. Contact your doctor or seek emergency medical attention if you have bleeding that will not stop.  ...  *You should not stop using this medicine suddenly.* Use Plavix regularly even if you feel fine or have no symptoms. Get your prescription refilled before you run out of medicine completely. ...


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## HotelYankee22 (Apr 30, 2015)

Jocha-

Standard timeline for anti-platelet therapy post cardiac re-vascularization is _minimum_ of 1 year. I'm going to be DNIF for a while, but ultimately not dq'd from the career-field, and will be back up on status at some point.

As far as the "ALC-2" goes- Deployable (only with a waiver) to locations with fixed MTF's including the necessary specialty care.  (Which is basically nowhere these days). After a while it is possible to get the C-code reduced as well, but that's a ways off.


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## HotelYankee22 (May 1, 2015)

Johca said:


> There is no waiver criteria specific to cardiac maladies that specifically relates to parachutist duty.   I have awareness of PJs in the past getting waivers for heart murmurs and some harmless ECG pattern oddities, but not for coronary artery blockages.  Generally for AF Class III/Special Operations Duty medical criteria any cardiac blood vessel stent or bypass surgery will not be eligible for waiver consideration.   With a 90% block I suggest looking at AFI 48-123 and looking at the retention in Air Force standards.



Jocha- This information is incorrect. The current Aeromedical Waiver Guide covers all USAF Parachutist under the FC III standards. In addition, it lists _very specific criteria_ that must be met for cardiac conditions, not to mention every other medical condition under the sun. There were a lot of updates that took place in 2008, and the waiver guide has continued to be upated with very detailed and specific information concerning CAD, and cardiac re-vascularization.

The ACS will make the recommendation to my MAJCOM, which under the current Aeromedical Waiver Guide has the approval authority for my waiver.

While I appreciate you presenting the vol1 standards (I could crush the PT test even with a 90% block), and the vol2 standards (most commander directed downgrades are for dip-shits), I don't believe my duty limiting condition will warrant any adverse action in the long term.  

If you'd like more details shoot me a PM.


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## amlove21 (May 1, 2015)

@Johca @HotelYankee22 , sounds like PM is the way to go!

Unless there's anything for the group, thread closed. PM me with any issues.


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## TLDR20 (May 1, 2015)

I think this might be the most boring thread I have ever read.


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