cent) received waivers compared with the other three Services (see tables in Appendix B). A further breakdown of the lung and chest disqualifiers by International Classification of Diseases (ICD-9) coding shows that over 70 percent of those in the chest and lung area were coded as having some form of asthma. These results were obtained through the committee’s analysis of data provided from the U.S. Military Entrance Processing Command Integrated Resource System database.

DoD Instruction 6130.4 on accession health standards states:

Asthma (493), including reactive airway disease, exercise-induced bronchospasm or asthmatic bronchitis, reliably diagnosed and symptomatic after the 13th birthday is disqualifying. Reliable diagnostic criteria may include any of the following elements: Substantiated history of cough, wheeze, chest tightness and/or dyspnea which persists or recurs over a long period of time, generally more than 12 months.

Recruits can request an asthma waiver and, if granted, can move forward to basic training. Some personnel develop asthma during military service and unless disqualified can continue their duties.

A number of investigations conducted with military personnel contribute to understanding how asthma is evident in this population. For example, Young et al. (2001) sampled active and retired military service personnel (1997-1998) enrolled in TRICARE (a military health care system) and residing in region 11 (includes Washington, Oregon, and northern Idaho) of the United States. They found that being a woman, being younger, engaging in less exercise, and having a higher BMI were all associated with the presence of asthma.

Other studies have looked at participation in military life and activities for people with asthma. The AMSARA active-duty enlistee study followed 313 “existing prior to service” discharges at Fort Jackson. Findings must be considered with caution as the self-administered survey had a low return rate. Data show that 14 percent of total discharges were for asthma. Many more asthmatics (26 to 1) believed that they could not have completed basic training because of their condition. Discharges were eight times more likely to have a history of asthma. Of those with asthma, two-thirds experienced daily or continuous symptoms, and two-thirds had symptoms one night a week or more.

Clark and colleagues (2000) reviewed records of 587 disqualified recruits and found that there was no difference in their attrition compared with the general military population (Clark et al., 2000). Sims and colleagues reviewed 119 Navy disqualification packages for individuals with asthma and found that enlisted personnel and submarine recruits were significantly more likely to be discharged than other types of personnel (Sims, Tibbles, and Jackman, 1999). More blacks were disqualified, and



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