Transcript 2016 07 16 ANG NARSUM Brief

Narrative Summary
Basics
Major Jared Brandt, MPAS, PA-C
152 MDG NVANG
July 2016
Overview
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What is a NARSUM???
Purpose
Requirements
Where to Begin???
FORMAT
USAF Specific Deployment Standards
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What is a NARSUM (or AMS)
• It is YOUR Recommendation to the
Waiver Authority
• It is a complex SOAP note, similar to a
hospital discharge summary that may
include:
• Special studies (labs, ECG’s, xrays, MRI)
• Consultations (cardiology,
neurology, etc.)
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Purpose
• Purpose of the NARSUM:
• …..to convey to the MAJCOM
a complete picture and
recommendation to help waiver
authority make decisions
regarding the member’s ability
to perform their military duty
and make the best , safest
decision for the ANG.
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Purpose Cont…..
• Purpose of the NARSUM:
• “Stand Alone” narrative of the
disqualifying condition – must convince
the waiver authority that …*
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There is no unacceptable risk to the individual
or to safety and mission accomplishment
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Specific requirements of MSD and Waiver
Guide are met
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It is in the best interests of the USAF
* If you want waiver submission to be
considered favorably.
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Requirements
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Two different templates – Medical and Mental Health
• Must use the correct template
• For MH NARSUM- DPHs are authorized to write (depending on
their credentials)
• Will be written in paragraph format and comply with the
NARSUM template. List/Bullet format is not acceptable.
• Effective NARSUM will convey a clear picture of condition(s)
• Needs to clearly state whether or not the member is unable to
reasonably perform his/her duties***
• Needs to clearly state whether or not the member is expected
to be able to perform his/her duties within the next 12
months***
***(bullets are directly from the DAWG checklist)
• The Conditions and Restrictions should match the 469!!!!
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Requirements Cont….
• Must include all conditions in NARSUM. Use the
“whole person” concept
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Example 1: Member has an ALC code for diabetes and
recently diagnosed with OSA. NARSUM will include
information regarding OSA and diabetes.
Example 2: Member has one duty related condition and
one non duty related condition. Member will be processed
using IRILO, but NARSUM will include both duty and non
duty related conditions and will indicate which conditions
are ILOD and NILOD
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Requirements Cont…
• Will describe the condition(s), how it occurred,
how it affects his/her duty, how it will affect
deployability and prognosis
• Explain if member should be returned to duty
with (or without) an ALC code or if member
should be found unfit for military duty
• Annotate anticipated future care and treatment
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Example: Member recovering from cancer-will have
follow up with oncologist every 6 months for next
three years.
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WHERE TO BEGIN??????
• Run, don’t WALK to the •
Medical Standards Directory (MSD)
• Look up the condition and VERIFY the NARSUM is even
required!!!!
• VERIFY that you are holding the member to the correct
STANDARD!!!!!!
• Aerospace Medicine Waiver Guide (AMWG)
• “This document primarily provides guidance for waivers on
trained flying class II and III personnel, and where specifically
stated applies to flying class I/IA applicants and other special
duty personnel.”
• Simply a GUIDE and REFERENCE to know what is needed to
get a favorable outcome (NOT JUST FOR FLYERS!!!)
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NARSUM Format
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(1) Demographics:
(2) History:
(3) Current Medications:
(4) HPI - Potentially Unfitting Diagnos(es):
(5) Targeted Physical Exam:
(6) Ancillary Study Summary:
(7) Consult Summary:
(8) Current Profile Restrictions:
(9) Occupational Impact:
(10) Prognosis/Recommendation:
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Demographics
• (a) Full Name, Rank, and SS#
• (b) # years in service (TAMS and/or Total Guard
Time)
• (c) Duty AFSC (Current duty title and brief
(sentence or two) synopsis of primary duties), Unit
and state (i.e. 193 SOS-PA, 201 RHS-PA, etc.)
• (d) List whether or not member has approved
retirement or separation date and give the date.
• (e) Is this Duty Related or Non-Duty Related? Must
have a completed LOD if duty related.
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History
• (a) Pertinent Past Medical History: In “list” format:
condition, year of onset, and state whether
“resolved” or “active”. Only list major diagnos(es)
which would be a factor in determining a member’s
overall health for a “fitness for duty” decision. (Most
“resolved” conditions aren’t applicable).
• (b) Pertinent Past Surgical History: In “list” format,
give name and year of procedure.
• (c) Pertinent Family History: List ONLY genetic,
heritable disorders related to any condition for which
the patient carries a related diagnos(es).
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Current Medications
• List both medications taken, and
medications that have been prescribed
and/or recommended that patient is not
taking due to “noncompliance” or optional
nature. Include dose/freq.
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HPI
• (4) HPI - Potentially Unfitting Diagnos(es): For each
potentially unfitting diagnosis as per MSD & AFI 48123, Chapter 5 (or any other diagnosis which affects
the member’s ability to perform duties, deploy and/or
places a significant burden on the government to
either protect or maintain the member), include the
following:
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(a ) Diagnosis
(b) Month/year of initial onset
(c) What was member doing when injury or symptoms of illness
occurred for the first time?
(d) Where was the member (geographical location name) when
injury or symptoms of illness first occurred?
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HPI Cont…
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(e) Was this condition ever treated during a deployment and did
it require an early return from deployment?
(f) Month/year of any hospitalization, ER, or acute care visit, in
the last 24 months, related to this condition.
(g) Current medications and/or other treatment modalities used
to treat this or related conditions
(h) Prior medications and/or treatment modalities tried, for this
condition, and reason for discontinuation.
(i) If narcotics used, give dose, frequency, level of pain control,
and history of narcotic use.
(j) Include pertinent positive and negative ROS for this
condition/related conditions.
(k) If any condition existed prior to service, please list and tell
if/how service has aggravated the condition
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Targeted Physical Exam
• Note the table (attached) for specific exam elements.
• (a) Vital signs to include measured height and
weight, with calculated BMI.
• (b) Exam should not be lengthy—give a relevant
exam that documents the pertinent positive and
negative exam findings related to each potentially
unfitting condition.
• (c) If the member falls under a category in section
(1)e above (for example, a Basic Military Trainee),
make sure that orthopedic exams include range of
motion studies (in degrees), strength, and function.
For active duty, these studies will be conducted by
the VA if DPAMM directs a full MEB.
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Ancillary Study Summary
• Note the table (attached) for ancillary requirements.
• (a) Pertinent Labs: List pertinent positive and
negative labs ONLY. Do not cut/paste groups of
labs unless you delete those that are not directly
applicable. Provide values over a continuum of time
if they pattern a picture of decline or improvement,
or unpredictable nature of condition.
• (b) Pertinent Rads: Do not copy and paste the
entire study. Give the name of study, the date, and
a clear picture of the results (impression).
• (c) Pertinent Other: refer to attached table for
“other” requirements
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Consult Summary
• Note the attached table.
• Provide a short, succinct summary of (a)
pertinent findings, (b) diagnosis (c) prognosis
and (d) recommended frequency of specialty
follow-up for each consult. Since the consults
will be attached to this NARSUM, only provide
(a)-(d) for each consult in this NARSUM.
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Current Profile Restrictions
• Review AF 469 (must be reviewed as current during
NARSUM completion) and list any specific duty
restriction, list the diagnos(es) to which the
restriction is linked, and the release date of each
restriction. We must know when you anticipate that
the restriction will be removed, or if it is expected to
be a long term and/or permanent restriction. Note:
The AF 469 review of restrictions should not be
older than 30 days. Please reflect your review in the
“Restriction section” of the AF 469 and/or in the
NARSUM via the following statement: “Provider
reviewed restrictions and they are deemed accurate
and appropriate on (date).” Signature required after
the statement.
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Line of Duty Determination (LOD):
• Reference AFI 36-2910 for (a) whether or not
this is an Administrative LOD determination
or (b) if this requires an AF Form 348 LOD
determination. If AF Form 348 is required,
ensure it is included with Initial RILO
package.
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Occupational Impact
• For each potentially unfitting condition,
succinctly summarize: (a) whether or not
condition limits the ability to perform duties
and/or deploy, (b) the extent of the
limitation(s) and (c) Admin LOD
determination required or for injury, AF Form
348 needs to be included with IRILO?
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Occupational Impact Cont.…
USAF Specific Deployment Standards
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In addition to the general DoD deployment criteria listed in DoDI 6490.07, DeploymentLimiting Medical Conditions for Service Members and DoD Civilian Employees, the
following criteria must be met in order for USAF members to be considered deployable.
Please refer to AFI 48-123, Chapter 11 prior to reviewing the additional criteria below.
Additional requirements may be required for specific deployments; See COCOM
reporting instructions.
V1. Must be able to perform duties of AFSC for a prolonged period (at least 12 hours).
V2. Must have adequate night vision to be able to travel unassisted at night.
V3. At a minimum must be able to carry all required deployment baggage (at least 40
lbs) and additional requirements for duty or deployment AFSC.
V4. Must be able to run at least 100 yards to take cover.
V5. Must be able to subsist on field rations for up to 179 days.
V6. Must be able to perform duties in hot and cold environments, without any known
predisposition to heat or cold injury.
Note: DoDI 6490.07 E3.a.(2) states “Conditions that prohibit immunizations” is a medical
condition precluding deployment and requires a waiver.
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Prognosis/Recommendations
• For each potentially unfitting condition, state the
prognosis for:
• (a) full or partial (if partial, state to what degree)
recovery, or stabilized maintenance of chronic
condition
• (b) timeline for recovery or stabilized maintenance of
chronic condition
• (c) future treatments (surgeries, procedures, studies,
etc.) and duration of expected requirements.
• (d) list the anticipated annual frequency for each
specialty requirement, and expected duration
required.
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Prognosis/Recommendations
Example Recommendations
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1. Capt X is a talented and respected fighter pilot with 15 years
of experience and is an invaluable asset to both his squadron
and the USAF. His mitral valve prolapse is completely
asymptomatic and does not pose a risk to his personal safety,
the safety of others, or mission accomplishment. I highly
recommend that he be granted a waiver without restrictions.
2. Lt Col X is an experienced navigator but his Parkinson’s
disease has become increasingly symptomatic over the past 2
months. His hands now shake too much to operate a computer.
His neurologist has started him on immune modulating therapy
which may be incompatible with flying. Moreover, he will be
unable to deploy in the foreseeable future. Therefore, waiver
can NOT be recommended at this time.
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Summary
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What is a NARSUM???
Purpose
Requirements
Where to Begin???
FORMAT
USAF Specific Deployment Standards
Always On Mission
Resources
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48-123 Ch. 5, Ch. 10 and Ch. 11
MSD
AMWG
Flightlines: “Back to Basics: Writing AMS” by
Douglas “X” Files
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Additional Questions?
Please contact:
Major Jared Brandt
152 MDG
[email protected]
(775) 788-4514 – office
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