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WAIVERS Aeromedical Waivers

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					                       Waivers
            AeromedicalWAIVERS




Rick Mooney Lt Col, USAF, MC, SFS
               Overview
•   Philosophy of Waivers
•   Air Force Instructions
•   How to Submit a Waiver
•   Waiver Politics
•   Example of a Waiver
        Waiver Philosophy
• The waiver system provides
  flexibility to keep the aviator flying
  if at all possible
• Waivers are designed to provide
  benefit to the AF
• The decisions are based on the
  aviator’s ability to fly safely and
  effectively with his medical
  condition, and for a flying career
The USAF Medical Standard


      AIM HIGH
                 AFI 48-123
     Medical Examinations and Standards

•   Establishes procedures, requirements,
    recording, and medical standards for medical
    examinations given by the Air Force
•   Prescribes procedures and references the
    authority for retiring, discharging, or retaining
    members who, because of physical disability,
    are unfit to perform their duties
•   Applies to all applicants for military service,
    scholarship programs, United States Air Force
    Reserves (USAFR) and Air National Guard
    (ANG)
     Three Levels of Standards
Induction Standards
•   Entry into military
     • A medium standard

Continued Duty Standards
•   To stay in the military
     • A lower standard

Special Duty Standards
•   To be a pilot, boom operator, etc
     • A higher standard
                                  AFI 48-123
Medical Standards for …
•   Appointment, Enlistment, and Induction              Ch 4, Section 4A
     •   Refers to DoDI 6130.3.

•   Medical Evaluation for Continued Military Service   Ch 5

•   Flying Duty                                         6G 6.44.

•   Unmanned Aircraft System Medical Standards          6F 6.45.

•   Ground Based Aircraft Controller                    6I 6.46.

•   Space and Missile Operations Crew Duty              6J 6.47.

•   Miscellaneous Categories                            6K 6.48
      Miscellaneous Categories
•   Service Schools
•   Parachute Duty
•   Combat Control and Pararescue
•   Marine Diving Duty (CCT, PJ)
•   Physiological Training and Physiological
    Training Personnel (9W)
•   Hyperbaric Chamber Training/Duty/ Operational
    Support Flying Duty (9C)
•   SERE Specialist
•   Night Vision Devices
•   Incentive and Orientation Flights
          Types of Flying Exams
•   Section 6G Initial Examinations for Flying:
•   Flying Class I: qualifies for selection and commencement of
    undergraduate pilot training (UPT)
•   Flying Class IA: qualifies for selection and commencement of
    undergraduate navigator training (UNT)
•   Initial Flying Class II: qualifies physician applicants for flight
    surgeon training in the Aerospace Medicine Primary (AMP)
    course
•   Initial Flying Class III : qualifies individuals for officer or
    enlisted aircrew aviation duties (boom operators, flight
    engineer, flight nurse, etc.)
    Periodic Flying Examinations
• Annual Preventive Health Assessment
  (PHA) specific requirements for flyers
• Considered an Occupational Health
  Examination as well
     PHA in Flyers/Special Duty
•   General clinical preventive care
    eg, colon cancer screening
•   Military requirements – “fit for duty and
    deployment”
    eg, HIV, immunizations
•   Occupational exams – OSHA
    eg, hearing test
•   Job-specific
    eg, vision in flying, ATC
    3-Levels of Certification and
         Waiver Authority
• AFMSA – Highest, most complicated or
  serious conditions, categorical waivers
• MAJCOM – Most conditions
• Local – MAJCOM designates
    •   Specified Diagnoses – Initial and Renewal
         Local waivers are for common but otherwise
          minor disqualifying conditions
         SGP ± RAM designated
Section 6G— Medical Standards for Flying Duty
  6.44. Medical Standards. For accessions and
  enlistments the standards are in DoDI 6130.03
  apply. Chapter 5 applies to personnel already
  serving as active duty or ARC (example, AD
  SSgt applying for FC I duty must meet
  retention standards in Chapter 5, as well as FC
  I standards).

 So flyers must meet Continued Military
 Service Standards!
 Need MEB?
            The Waiver Process…




   “I’m broke and I’m all alone.”


The Local FS: The Flyer’s Advocate in
        The Waiver Process
     Results of the Waiver Process I
 Rated Aviator Given One of the Following

Unrestricted FC II: qualifies officer to fly in
  any airframe
Categorical Flying Class IIA: qualifies officers
  for duty in low-G aircraft (T-1, T-43, tanker,
  transport, bomber)
Categorical Flying Class IIB: qualifies officers
  for duty in non-ejection seat aircraft.
Categorical Flying Class IIC: qualifies officers
  for aviation duty as specified in the remarks
  section of AF Form 1042 (e.g., helicopters)
Permanent DQ: no waiver granted
         Results of the Waiver Process II
     Rated Aviator given one of the following
                     qualifiers

•   Indefinite - Once and for all time! Unless
    condition changes or new disqualifying
    diagnosis noted.
•   (Specified) - Set time interval (1 yr or 3 yrs,
    etc.)
•   Permanent Disqualification (DQ) - No waiver!
    Send to AFMSA
•   Duty Not Involving Flying (DNIF) - Specified
    period of grounding
           Results of the Waiver Process III
          FC III Aircrew Aviator given either

•   Unrestricted FC III
•   or DQ
    •   There are no categorical waivers for aircrew
    •   Although restrictions may be written in, eg,
        “no scanning duties within 600 ft of aricraft”
    •   Requires coordination with career field
        manager, usually by MAJCOM SGPA
Waiverable Conditions Must:

1) Not pose a risk of sudden incapacitation

2) Pose minimal potential for subtle performance
  decrement, particularly with regard to the
  higher senses.

3) Be resolved or be stable and be expected to
  remain so under the stresses of the aviation
  environment.
 A Waiverable Condition Must…

4) If the possibility of progression or recurrence
  exists, the first symptoms or signs must be
  easily detectable and not pose a risk to the
  individual or the safety of others.
5) Cannot require exotic tests, regular invasive
  procedures, or frequent absences to monitor
  for stability or progression.
6) Must be compatible with the performance of
  sustained flying operations in austere
  environments
            Waivers for…
Initial Entry vs. Qualified Member
•   Initial (applicant) – highest standard
    •   Return on investment (ROI)
    •   Ability to serve in career field for normal duration
        of a career (14 years)
    •   Cost of training (do not want a drop out)
    •   Must not need airframe restrictions
•   Qualified (has wings) – not as stringent
    •   Training costs already spent / keeps individual
        working
    •   Retains valued aircrew member
    •   Maintain experience base in career field
    •   May impose airframe restrictions
            How to do a waiver
•   DD Form 2807-1, 2808 for initial (FC I/IA, IFC
    II, IFC III) waivers
    •   Physical Examination Processing Program (PEPP)
•   Special studies (labs, ECG’s, x-rays, MRI) may
    be needed
•   Consultations (cardiology, neurology, etc)
    may be needed
•   Aeromedical Summary (AMS) is key
•   Consult the Waiver Guide (available online)
    Electronic version of legacy AFPAM 48-132
              NOTE:
If a Medical Examination Board (MEB) is
required for the diagnosis, don’t submit
the waiver request (AMS) until after
the MEB is accomplished!
       Aeromedical Summary

“Stand alone” document including:
  1) Identifying paragraph
  2) History of illness
  3) Pertinent physical examination (with labs,
    xrays, etc)
  4) Diagnosis
  5) Your recommendation to waiver authority
     Be specific.
The Aeromedical Summary

•   “Stand Alone” narrative of the medical
    condition at issue
•   Consult ACS Waiver Guide for assistance
•   Must convince the waiver authority that…
    •   The diagnosis is compatible with flying safety and
        mission accomplishment
    •   A waiver is IAW the six criteria previously discussed
    •   Specific requirements of Waiver Guide also met
    •   It’s in the best interests of the USAF
    •   Will not hurt the person
          Electronic AMS- AIMWTS
(Aeromedical Information Management Waiver
              Tracking System)


  • Electronic submission of waivers
  • Since 2001
  • Produces a waiver file database for the
    AF - searchable
           AMS Sections
I.   Identification
II. HPI
III. Physical Exam
IV. Diagnoses
V. Recommendation
        Section I - Identification
Patient Identification/Duty Information/Purpose of Submission
     {Name, SS# , is a XX year-old caucasian male F-16
     pilot (ASC: XX). He has xx years active service and
     a total of xx flying hours, of which XX were logged in
     the past 6 months. He is currently assigned to the
     XXX Sq/ (MAJCOM), XYZ AFB} This summary is
     submitted (reason) in support of a renewal of a
     Flying Class II waiver by (cite waiver authority) for
     (name) , who was diagnosed with ____ which is
     disqualifying IAW AFI 48-123 A7 (cite “chapter and
     verse”).
   Items between { } are written automatically in AMWITS
     based upon demographic information. Verify the
     accuracy of the data
           Identification

List all previous, current waivers –
diagnoses, authority, dates granted or
renewed and expiration dates at the
end of Section I
            Section II - HPI
• History of the disqualifying medical
  problem
• Concise, clear
• Remember case presentations in
  medical school!

•   No objective data - PE
    Section III - Physical Exam
•   Pertinent positives and negatives

•   Physical exam
•   X-rays, labs (normal ranges & units), special
    tests with)
•   Consults

•   EDIT to make readable
          Section IV - Diagnosis
• List all aeromedically significant
  diagnoses
• Selection list from ICD-9 codes
    •   Search by code or text
• Can add comments
• List other clinical findings
    •   E.g., borderline HTN, elevated cholesterol
        – not disqualifying, nicotine dependence
    Section V - Recommendation
• What do you want to do? Waiver? DQ?
• Make a recommendation and justify it
• Why should a waiver be granted?
• Do not recommend to the waiver
  authority “For review and disposition”
  Tell them what you want.
Example Recommendations
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 personal safety, safety of others, or
mission accomplishment. I highly recommend that he
be granted a waiver without restrictions.
        Pearls of Wisdom

1) Individual may need MEB/PEB
  prior to waiver application
2) First look at the Waiver Guide. If
  you have questions, contact
  MAJCOM for guidance on what
  studies, if any, they would like to
  see in order to consider a waiver
  for your patient
          Sample AMS
• See Word Documents
• AMS Example 1
• AMS Example 2
• AMS Example 3
Introducing the Aeromedical
      Consult Service

              KEEP ‘EM FLYI G
    Aeromedical Consult Service
• Provides expert advise and evaluates
  cases for AFMSA and Major Commands
• Conducts various study groups (eg,
  keratoconus, bicuspid aortic valve)
    Aeromedical Consult Service
•   New Evaluations
    •   Requested by AFMSA/MAJCOM
•   Study Groups and Follow-ups
    •   Requested by local base through MAJCOM
            When ACS?
• Per AFI
• Waiver Guide
• Previous waivers state ACS follow-up
  required (usually in management
  group)
           Our Last Topic:
           Waiver Politics?

• Although the Flight Surgeon may not
  feel a waiver is appropriate, the patient
  and the patient’s commander may
  disagree
• Chain of Command / political pressure
  may be felt by the FS
           What is your priority?
         Overview of Lecture
•   Philosophy of waivers
•   Air Force Instructions for Flight
    Surgeons
•   Types of Exams
•   How to Submit a Waiver
•   Example of a Waiver
•   Waiver Politics
Questions?




        Questions ???
       https://kx.afms.mil/kxweb/dotmil/kjPage.do?c
      id=CTB_020686&functionalArea=AerospaceM
                                             edicine




Integrity - Service - Excellence                       47

				
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