The Doctor is in! Ask a Flight Surgeon!

[jcj]

Question for the Docs/Experienced out there:
About a year and ago, I was having some mild heartburn problems, and I saw a gastroenterologist. On my medical documents from my EGD, it says moderately severe localized reflux esophagitis, but does not say GERD. I had a follow up at the gastro doc’s office about a year ago in which I saw the nurse practitioner there. On that report, it says Impressions: GERD with prior esophagitis. Since then, I have long discontinued use of the medicine (dexilant) that was prescribed to me, and the symptoms have completely disappeared. No tests were ran when I saw the nurse practitioner, but I believe she (and the gasto Doc beforehand) may have just put GERD because I told them I thought I had acid reflux. As I now live in a new city, I saw a new gastroenterologist today to do complete testing, and he told me that all issues have been resolved, and I am in perfect condition. He even mentioned he found me exceptionally qualified for military service and is writing a personalized letter for when I send my package to MEPS. He did not perform an EGD because he stated he found it uneeded since his testing thus far has revealed that all issues are resolved, but he did say he would schedule an EGD if it was absolutely needed for me to be found physically qualified.
My main question is:
Since this new doctor's testing indeed reports that all issues have been resolved with lifestyle changes and that I have been off of PPIs for a few months, and I do not have GERD or esophagitis, will I be disqualified from Navy officer service when I send my documents to MEPS pre-enlistment/pre-commission? Should I have the EGD performed first and also send that in my report to MEPS? I really hope not as this issue was only minor heartburn in the first place, and now it has completely gone away without the need for any medicine, OTC or presciption. Thanks in advance.
–Trey

(civilian pilot and general surgeon, former corpsman, not a flight surgeon) - GERD is a correct term for the findings identified on your EGD done (moderately severe localized reflux esophagitis) - and the fact that your symptoms resolved with a brief treatment with dexilant supports the GERD diagnosis and is in your favor, If there are no other factors, I think you are looking at a fairly straightforward waiver or perhaps NCD at all. The important thing is that the diagnosis was easily identified, promptly treated, promptly went away and (hopefully) isn't going to come back when you are deployed with your bro's on the South Pole protecting us from rouge missile attack from terrorists in south africa. So probably you're OK. Probably you won't need another EGD but do listen to the docs on the board with closer military connections & DO NOT LIE on your SF 88's, 93's or other med documents, If you've had recurrent episodes it's more complicated, but all hope is not lost, Still ALWAYS TELL THE TRUTH. good luck,

The NAMI waiver guide is here :http://www.med.navy.mil/sites/nmotc/nami/arwg/Pages/AeromedicalReferenceandWaiverGuide.aspx - go to the gastroenterology waiver guide section 7.10

 

[Trey4383]

jcj,
This is great news! I have no intentions on concealing anything as I find the truth is always the best route, and the repercussions for lying are obviously much worse than the truth. Thank you for your professional opinion. Any docs with closer military connections out there with an opinion?
My biggest fear is that MEPS and N3M will disqualify me just by looking at a sheet of paper, and not actually examining me themselves. Are there any other options such as a private doctors that are contracted with the Navy or a Naval hospital? Thanks.

--Trey

 

[feddoc]

Im active duty and was finishing the medical side of my package, then it came up that I was ADHD back in elementary school. I went through high school and college without symtoms or medication. Now I'm worried and not sure how much this will affect my chances of selection. It's out of my hands now, aside me retrieving the paper work medical asked me to round up. Does anyone know of people getting selected for SNA with this in their history?

Have you researched the waiver guide?

 

[Robert Allen]

Hey Doc,
My Doc submitted a waiver to NAMI 2weeks ago, because I had ADHD back in grade school. I was told it can take 3-6 months to get that waiver. What is the normal turnaround time for me to be PQ'd? Also, told it may be much sooner than that.

Also, does it count for anything (regards to receiving a Final Select for SNA) that my Doc sent a CLEARANCE NOTICE (Aeromedical) Recommend subject indivdual be found physically qualified and aeronautically adapted for duty involving flight as: SNA Waiver has been (recommended) for: ADHD
Dated to expire 2014 06 29?

Thank you for your time.

 

[jakesnake1220]

Hi, my question has to do with my final select. Since my vision distance is 20/100 I knew I had to go SNFO. But when my final select letter came in they had me designated SNA. My OR called Millington and they said that they wanted me to be designated SNA with my scores.

Won't the flight physical done at OCS change this anyway? Or is there something I don't know?

 

[Kchsload]

I may have minor eczema on my hand. I am aware that this could be disqualifying due to the fear that the smallpox vaccine could cause a potential adverse reaction, but what if I've already had a smallpox vaccine alongside a history of military aviation as an enlisted crew member? Would that change the calculus for an eczema waiver?

 

[MJT]

Hey I posted this in a different forum, and it was suggested that I post it here:

Hi, I just heard back from the July boards and I've been pro req'd for Pilot and NFO. I still have to do the medical, and I have four medical issues which I am a bit concerned about. The first two there is nothing I can do about, but I'd like your advice on what might come of them. The second two, I have actually never been diagnosed by a doctor for, hence there is nothing on my medical history about them. What do you think?

If you're curious, I'm 25 years old and I have a BS in Computer Engineering from UVA. My GPA was 3.1. I got good scores on the ASTB (I don't remember what they were, but at least one was in the 99th percentile).

Medical issues:

Vision. I wear glasses. One of my eyes is -1, the other is -1.5. I don't know what this translates to on the 20/XX scale. I know that some pilot programs do not allow natural vision worse that 20/40. Should I be concerned? If I am right on the line will they deny me entrance to those programs? Is there anything I can do to improve my score when I get my vision tested at the medical?

Shoulder. I had major reconstructive surgery on my left shoulder in May 2010. My shoulder feels fine now, and I haven't had any pain in two years. My left shoulder is visibly different from my right shoulder with my shirt off, and if you are looking for it. There is a slight bump. I can BP 225 and do 50 push-ups in a row (I know that's not that high - I'm working on stamina). I have all of the documentation. Is there any chance this will preclude me from certain programs?

Acid Reflux. I have chronic acid reflux. If I take Omeprazole (Prilosec) every day, and smack it down with Famotidine (PEPCID) whenever it flares up, it gives me no problems. Neither of these drugs have ANY side effect. If I DON'T medicate it, it can be quite painful. Both of these medications are OTC. I have never been diagnosed by a doctor with this problem, and have never been prescribed medication for it. What should I say about this on my medical? Is it possible this would be a problem? Will I have access to this medication at OCS?

Gluten Intolerance. I am allergic to gluten, the primary protein found in wheat and barley. Not badly allergic, but enough that if I eat a piece of bread or have a glass of beer I'll get a slight headache and possibly abdominal pain. If I eat a big plate of pasta, I'll have get a severe headache and diarrhea. Mixing my food with gluteny food is not that big of a deal, but I do need to avoid foods with large quantities of gluten in them. Again, I have never been diagnosed by a doctor. I was gene-tested for susceptibility by a private lab and I confirmed it by taking it out of my diet then adding it back in. How should I include this in my medical? Will I be able to eat food without gluten (i.e. no breads, pastas, etc) at OCS?

Thanks for your help in advance! Any insight would be appreciated.

 

[RiseR 25]

Hey I posted this in a different forum, and it was suggested that I post it here:

Hi, I just heard back from the July boards and I've been pro req'd for Pilot and NFO. I still have to do the medical, and I have four medical issues which I am a bit concerned about. The first two there is nothing I can do about, but I'd like your advice on what might come of them. The second two, I have actually never been diagnosed by a doctor for, hence there is nothing on my medical history about them. What do you think?

If you're curious, I'm 25 years old and I have a BS in Computer Engineering from UVA. My GPA was 3.1. I got good scores on the ASTB (I don't remember what they were, but at least one was in the 99th percentile).

Medical issues:

Vision. I wear glasses. One of my eyes is -1, the other is -1.5. I don't know what this translates to on the 20/XX scale. I know that some pilot programs do not allow natural vision worse that 20/40. Should I be concerned? If I am right on the line will they deny me entrance to those programs? Is there anything I can do to improve my score when I get my vision tested at the medical?

Shoulder. I had major reconstructive surgery on my left shoulder in May 2010. My shoulder feels fine now, and I haven't had any pain in two years. My left shoulder is visibly different from my right shoulder with my shirt off, and if you are looking for it. There is a slight bump. I can BP 225 and do 50 push-ups in a row (I know that's not that high - I'm working on stamina). I have all of the documentation. Is there any chance this will preclude me from certain programs?

Acid Reflux. I have chronic acid reflux. If I take Omeprazole (Prilosec) every day, and smack it down with Famotidine (PEPCID) whenever it flares up, it gives me no problems. Neither of these drugs have ANY side effect. If I DON'T medicate it, it can be quite painful. Both of these medications are OTC. I have never been diagnosed by a doctor with this problem, and have never been prescribed medication for it. What should I say about this on my medical? Is it possible this would be a problem? Will I have access to this medication at OCS?

Gluten Intolerance. I am allergic to gluten, the primary protein found in wheat and barley. Not badly allergic, but enough that if I eat a piece of bread or have a glass of beer I'll get a slight headache and possibly abdominal pain. If I eat a big plate of pasta, I'll have get a severe headache and diarrhea. Mixing my food with gluteny food is not that big of a deal, but I do need to avoid foods with large quantities of gluten in them. Again, I have never been diagnosed by a doctor. I was gene-tested for susceptibility by a private lab and I confirmed it by taking it out of my diet then adding it back in. How should I include this in my medical? Will I be able to eat food without gluten (i.e. no breads, pastas, etc) at OCS?

Thanks for your help in advance! Any insight would be appreciated.

Judging by your -1 and -1.5. You should be around the range of 20/100 and 20/150 in your eyes. I'm basing that roughly off my own which were 20/300 and 20/400 with -2.75 and -4.00 respectively, before I got PRK and am since seeing 20/15 in both. By where you stand now you could make the NFO medical requirements. As far as the Acid Reflux and Gluten Intol goes, I honestly don't know Navy-Med wise and you'd have to get a doc's opinion. Good luck

 

[bcort]

Hey I posted this in a different forum, and it was suggested that I post it here:

Hi, I just heard back from the July boards and I've been pro req'd for Pilot and NFO. I still have to do the medical, and I have four medical issues which I am a bit concerned about. The first two there is nothing I can do about, but I'd like your advice on what might come of them. The second two, I have actually never been diagnosed by a doctor for, hence there is nothing on my medical history about them. What do you think?

If you're curious, I'm 25 years old and I have a BS in Computer Engineering from UVA. My GPA was 3.1. I got good scores on the ASTB (I don't remember what they were, but at least one was in the 99th percentile).

Medical issues:

Vision. I wear glasses. One of my eyes is -1, the other is -1.5. I don't know what this translates to on the 20/XX scale. I know that some pilot programs do not allow natural vision worse that 20/40. Should I be concerned? If I am right on the line will they deny me entrance to those programs? Is there anything I can do to improve my score when I get my vision tested at the medical?

Shoulder. I had major reconstructive surgery on my left shoulder in May 2010. My shoulder feels fine now, and I haven't had any pain in two years. My left shoulder is visibly different from my right shoulder with my shirt off, and if you are looking for it. There is a slight bump. I can BP 225 and do 50 push-ups in a row (I know that's not that high - I'm working on stamina). I have all of the documentation. Is there any chance this will preclude me from certain programs?

Acid Reflux. I have chronic acid reflux. If I take Omeprazole (Prilosec) every day, and smack it down with Famotidine (PEPCID) whenever it flares up, it gives me no problems. Neither of these drugs have ANY side effect. If I DON'T medicate it, it can be quite painful. Both of these medications are OTC. I have never been diagnosed by a doctor with this problem, and have never been prescribed medication for it. What should I say about this on my medical? Is it possible this would be a problem? Will I have access to this medication at OCS?

Gluten Intolerance. I am allergic to gluten, the primary protein found in wheat and barley. Not badly allergic, but enough that if I eat a piece of bread or have a glass of beer I'll get a slight headache and possibly abdominal pain. If I eat a big plate of pasta, I'll have get a severe headache and diarrhea. Mixing my food with gluteny food is not that big of a deal, but I do need to avoid foods with large quantities of gluten in them. Again, I have never been diagnosed by a doctor. I was gene-tested for susceptibility by a private lab and I confirmed it by taking it out of my diet then adding it back in. How should I include this in my medical? Will I be able to eat food without gluten (i.e. no breads, pastas, etc) at OCS?

Thanks for your help in advance! Any insight would be appreciated.

I'm -1 and -1.75. I usually get 20/40 and 20/50 or 20/60. That's all I can help you with.

 

[vladivostok391]

Hi all... so here's my deal. I had LASIK surgery in May of this year to correct my vision. I am currently pursuing an Intel commission. For those who've had LASIK or PRK, vision standards (for RL commissions) are determined by NAVMED P-117 article 15-36(3)(b), which states the following:

"Current refractive error [hyperopia (367.0), myopia (36.1), astigmatism (367.2)] or history of refractive error prior to any refractive surgery manifest by any refractive error in spherical equivalent of worse than +/-8.00 diopters is disqualifying."

I know that the +/-8.00 standard is waiverable up to a spherical equivalent of +/-10.00 diopters (not a guarantee, but certainly a possibility). My question is, in order to determine the "spherical equivalent," which pre-op refraction is used? Would it be my pre-LASIK glasses prescription, or my pre-LASIK cycloplegic refraction (where they dilated my pupils)? That is not clear from the NAVMED manual, at least as far as I could tell. I ask because the numbers are different, and I'm near enough to the waiverable limits that I'd like to at least know the standard. Thank you very much in advance.

 

[jg54170]

Just curious, I was pro recd SWO after having been found NPQ for flight duty due to an L4 and L5 bilateral spondylolysis. Do you docs on here see any way that this could impact being found PQ for comissioning? I haven't been seen for it for years and have no issues with it. I am in great shape and cleared special programs screening for recruiting...tough, i know ... haven't had any LIMDU since it was initally found. Basically an assymptomatic condition but not sure how it is viewed other than being a no go for flight duty.

 

[exNavyOffRec]

Just curious, I was pro recd SWO after having been found NPQ for flight duty due to an L4 and L5 bilateral spondylolysis. Do you docs on here see any way that this could impact being found PQ for comissioning? I haven't been seen for it for years and have no issues with it. I am in great shape and cleared special programs screening for recruiting...tough, i know ... haven't had any LIMDU since it was initally found. Basically an assymptomatic condition but not sure how it is viewed other than being a no go for flight duty.

The biggest thing is how N3M views this, more specifically how the doc that is currently at N3M views this, they look at commissioning standards, there are many conditions that allow for continuation of service but not for commissioning, I know of a few people in the fleet that are enlisted because they were not fit for commissioning.

 

[jg54170]

The biggest thing is how N3M views this, more specifically how the doc that is currently at N3M views this, they look at commissioning standards, there are many conditions that allow for continuation of service but not for commissioning, I know of a few people in the fleet that are enlisted because they were not fit for commissioning.

That is my biggest concern, just have to cross my fingers and hope they don't can me for it. I imagine they are going to ask for an ortho evaluation and have to waive the problem from what I am seeing. Just wish they would get to my papers and let me know.

 

[TimeBomb]

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/

 

[jg54170]

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/

Thanks and yes, I am currently active duty. I looked at the medical manuals this morning and also saw that it was a physically disqualifying condition. Hopefully they will approve me, I am in excellent shape and run upwards of 30 miles a week. Any idea if I will I have to obtain a referral to see ortho or should I just call and explain the situation to them? My PCM is a civilian doctor since I am out recruiting and my closest base medical would be Ft Lee. I reckon I could drive the 4 hours to Portsmouth, it would be worth it to get it right the first time by the right folks.

Thanks again!