The Doctor is in! Ask a Flight Surgeon!

[exNavyOffRec]

jg,
From your photo, I'm assuming you are currently enlisted, and are applying for a commissioning program. If that is indeed the case, BUMED, not N3M will review your physical and recommend (or not recommend) a waiver of standards. Acquired or congenital spondlyolysis is disqualifying for commissioning, as you know (see DODI 6130.03), so you will need a favorable waiver recommendation from BUMED to be commissioned. I don't know how those winds are blowing right now, but you might want to have a ortho evaluation as a preemptive strike. I'd recommend an evaluation at a naval hospital by an orthopod who is very familiar with the waiver process, so he'll know the right tests to get and the right words to say.
As NavyOffRec points out, retention standards are different than accession/commissioning standards.
R/

Question for you, before I left recruiting we were assisting a few AD individuals trying to answer questions and when we rec'd their medical rejection paperwork for commissioning it was on paperwork from N3M signed by the senior medical officer at N3M, does BUMED review then N3M "stamp it"? I know most of the guys on the enlisted recruiting side would always say "we need to send your stuff for a waiver from BUMED" but it was really put in MEDWAIVE for N3M.

 

[TimeBomb]

For NavyOffRec: I don't know the exact pathways involved, but my friends at BUMED informed me that N3M reviews the physicals for direct accessions and general enlistment physicals. BUMED handles the rest. I don't know if BUMED gets a second chop on N3M physicals.

For jg: I would spend the time and effort to go to Portsmouth. You want to have as much medical paperwork as possible in your initial waiver package, preferably from a military physician. If NMCP still does business like I remember, a referral was necessary to get an appointment in ortho. Your situation is a bit different as you're on recruiting duty, and have limited access to military medicine. A phone call to their front desk explaining your situation may get you in the door without a referral.

While your condition is disqualifying for aviation as well, you didn't mention if your paperwork indicated that NAMI reviewed your physical and said "no waiver recommended", or words to that effect. Without that detail, all you know is that you have a condition that is disqualifying for commissioning and for flight status. It's been mentioned a number of times on this forum, but the waiver process is a tiered system. An applicant with a disqualifying condition must first have a waiver of standards for the condition simply to be eligible for general service, and then apply for a waiver of standards for any program with more rigorous standards (flight, undersea, special operations, etc.).

R/

 

[jg54170]

It was never sent for waiver, the flight surgeon told me straight up that it was not a waiverable condition for aviation which I also read in the manual as well for verification so I stopped pursuing that path. It is only waiverable for winged individuals according to the manual. This was all during my prior escapades while trying to get in through STA-21. This will be the first time they will be looking at my medical since this condition was found.

I will try and get a hold of Portsmouth and see if I can't get a day lined up for ortho. This way if they ask for information which undoubtedly will happen, I will have everything on stand by.

One other quick question, I have been evaluated by ortho at NMCP before. Will they be able to see everything that has already been done? If that is the case then they can see the X-rays, MRIs, and all the associated reports.

 

[TimeBomb]

jg: Got it. Didn't know you had already been seen by a flight surgeon.

If you were seen by NMCP in the past decade, they'll have access to most, if not all of your information via the electronic medical records system.
R/

 

[jg54170]

jg: Got it. Didn't know you had already been seen by a flight surgeon.

If you were seen by NMCP in the past decade, they'll have access to most, if not all of your information via the electronic medical records system.
R/

TimeBomb,
In your opinion, should I send in the consult information to the processors before it is requested from BUMED? Seems to me as if I can get the papers inserted now it will be quicker turn around time as opposed to waiting for them to request them and get moved to the bottom of the stack again.

Just an FYI, they would not allow me to see military providers since my PCM is a civilian doctor so I had to go to a local orthopedic center.

 

[TimeBomb]

jg,
I would send as much information as you can along with your application package. It will definitely expedite your decision if the reviewer doesn't have to go back to you for additional information. You also want to control the narrative as much as possible.
Who are "they"? If you're AD, you're eligible to be seen in a military facility.
R/

 

[teejmc]

I am an NFO applicant with a few questions about the vision requirements. I had two separate separate civilian eye doctors perform examinations concludimg that my vision was 20/30 left eye with spherical -.25 and cylinder -3.00, right eye 20/40 spherical -.25 and cylinder -3.00. Another doctor concluded the same distance acuity and spherical correction with a cylinder of -3.25 left and -3.50 right. according to the second doctors examination I would not qualify for NFO. keep note that these examinations were performed only a couple days apart also that my vision is correctable to 20/20. It seems as though the method of determining refractive error is subjective with room for patient and doctor error.

what are the chances these numbers are wrong?

If it is found that my astigmatism puts me over the allowed limit is there any chance at all for a waiver?

when I go to MEPs are they going to test me for refraction?

if MEPs gives me the thumbs up and then I go to NAMI and my astigmatism is slightly over the limit will I be NPQd?

Is there an option of PRK with pre-op numbers like that?

Is there anyone out there with distance acuity similar to mine that has been NPQd for refractive errors?

 

[BleedGreen]

I am posting on behalf of my boyfriend who is currently in OCS. He was called in recently to take the methacholine challenge test. A little bit of background; he took the test already in December 2012 with a negative response for asthma but the flight surgeon is requesting it to be repeated. The surgeon is trying to imply that the test is too old. However, the waver guidelines do not specify how old the test can be. He had the test done at a military facility and it was completed within a year his flight physical in OCS. Is there any reason he should have to retake the test. Thank you.

 

[exNavyOffRec]

Is there any reason he should have to retake the test. Thank you.

because the Doc wants it done, I have seen a few guys that have had this happen and ended up redesignating because the Doc wouldn't clear them for aviation.

 

[jcj]

I am posting on behalf of my boyfriend who is currently in OCS. He was called in recently to take the methacholine challenge test. A little bit of background; he took the test already in December 2012 with a negative response for asthma but the flight surgeon is requesting it to be repeated. The surgeon is trying to imply that the test is too old. However, the waver guidelines do not specify how old the test can be. He had the test done at a military facility and it was completed within a year his flight physical in OCS. Is there any reason he should have to retake the test. Thank you.

(disclaimer: not a flight surgeon or a pulmonologist, but I'm a general surgeon also boarded in critical care so I know a lot of pulmonology, also a civilian commercial pilot & was an 8404 corpsman back when I was young). I also just ran through the literature quickly to refresh my memory because I have my own board recert exam coming up soon. The methacholine challenge is a pretty sensitive test for asthma and is probably more likely to produce a false positive than a false negative. It also gives a reproducible result, provided it was administered correctly the first time. So from a medical standpoint if the BF was good to go in December, he's almost certainly going to be fine now too. Why would the flight surgeon want him to repeat the test? See NavyOffRec above. But tell him it really will almost certainly be OK (and seriously if it's not he needs to find out now).

 

[BleedGreen]

(disclaimer: not a flight surgeon or a pulmonologist, but I'm a general surgeon also boarded in critical care so I know a lot of pulmonology, also a civilian commercial pilot & was an 8404 corpsman back when I was young). I also just ran through the literature quickly to refresh my memory because I have my own board recert exam coming up soon. The methacholine challenge is a pretty sensitive test for asthma and is probably more likely to produce a false positive than a false negative. It also gives a reproducible result, provided it was administered correctly the first time. So from a medical standpoint if the BF was good to go in December, he's almost certainly going to be fine now too. Why would the flight surgeon want him to repeat the test? See NavyOffRec above. But tell him it really will almost certainly be OK (and seriously if it's not he needs to find out now).

thanks for the reply! Worse case scenario, I am assuming the review board would not approve him if he had one negative MCT and one positive?
Hopefully he doesn't have any issues with it the second time and we don't have to go down that road...

 

[jcj]

thanks for the reply! Worse case scenario, I am assuming the review board would not approve him if he had one negative MCT and one positive?
Hopefully he doesn't have any issues with it the second time and we don't have to go down that road...

It's been a long time since did anything with NAMI but since the first MCT was done in a military facility if this new MCT is indicative or suggestive of asthma they will have to decide how to reconcile the discordant results of the same test done twice in the military system in the same patient - which I am guessing would result in a formal pulmonology consultation and perhaps even a third MCT. This discordance is a big deal for a major diagnostic test like the MCT. So a positive result on this new test could result in a DQ, but it likely wouldn't be permanent DQ until the whole situation has been looked into in great detail - specifically the interpretation of conflicting MCT test results.

If the first MCT was done on the outside, the military would be much more likely to ignore the outside test (as improperly performed in civ world) if the military MCT was positive, and that could result in a permanent DQ that would be hard to overcome.

But none of this is likely. If his first MCT was done correctly & he passed it, his chances of passing the second one are extremely high. Other than being as rested and relaxed as he can be when he takes it (yes, I know he's in OCS), all he can do is quit worrying & concentrate on his other stuff, take the test, have a (justified) high expectation that it won't be a problem and if it is, work the problem through the system. If that happens, the Navy will have to figure out why the same test done in two different military medical facilities in a short interval showed markedly differently results on the same patient. That's a big deal to us on the clinical side for a test like the MCT that's supposed to have reproducible results. Good luck

 

[BleedGreen]

It's been a long time since did anything with NAMI but since the first MCT was done in a military facility if this new MCT is indicative or suggestive of asthma they will have to decide how to reconcile the discordant results of the same test done twice in the military system in the same patient - which I am guessing would result in a formal pulmonology consultation and perhaps even a third MCT. This discordance is a big deal for a major diagnostic test like the MCT. So a positive result on this new test could result in a DQ, but it likely wouldn't be permanent DQ until the whole situation has been looked into in great detail - specifically the interpretation of conflicting MCT test results.

If the first MCT was done on the outside, the military would be much more likely to ignore the outside test (as improperly performed in civ world) if the military MCT was positive, and that could result in a permanent DQ that would be hard to overcome.

But none of this is likely. If his first MCT was done correctly & he passed it, his chances of passing the second one are extremely high. Other than being as rested and relaxed as he can be when he takes it (yes, I know he's in OCS), all he can do is quit worrying & concentrate on his other stuff, take the test, have a (justified) high expectation that it won't be a problem and if it is, work the problem through the system. If that happens, the Navy will have to figure out why the same test done in two different military medical facilities in a short interval showed markedly differently results on the same patient. That's a big deal to us on the clinical side for a test like the MCT that's supposed to have reproducible results. Good luck

That is a great point. Either way your right, we shouldn't be worrying about the test and focus on the test....first things first!
Thank you for your professional opinion

 

[exNavyOffRec]

lots of info

FYI, in most cases with civilian OCS candidates the MCT are done by civilians, either at the applicants expense by civilian or if the USN wants it done then it is a civilian contractor thru MEPS

 

[jcj]

FYI, in most cases with civilian OCS candidates the MCT are done by civilians, either at the applicants expense by civilian or if the USN wants it done then it is a civilian contractor thru MEPS

got it & thank you. I'm guessing the MEPS is sending them to contractors who they trust to get it right, and given the importance asthma has had on deployability these days, I am guessing that the MEPS are watching the quality of those tests very closely. I would have counted those studies in the "done by the military" bucket.

I can certainly understand that there would be more concern about accepting, without some verification, results from a civilian practitioner with no affiliation with the DOD. It's a straightforward test, but like most things it can be screwed up.