I was not trying to undermine TimeBomb in anyway so I apologize if I came off in that manner.
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The Doctor is in! Ask a Flight Surgeon!
- Thread starter FlightMD
- Start date
I was not trying to undermine TimeBomb in anyway so I apologize if I came off in that manner.
jcj
Registered User
You know, Google's good but for authoritative medical information can anything really beat The Farmer's Almanac?
Or my other favorite medical reference:
jcj
Registered User
Dr. Google could afford itAnd perhaps save Dr. Google from an expensive malpractice lawsuit?
BzB
exNavyOffRec
Well-Known Member
I have used Dr. Google before trying to convince myself I don't need to go to the doctor.
JoeHello
New Member
Just out of curiosity I would love if a Flight Surgeon could once and for all let me know about NAMI standards.
I have a hereditary kidney disease called Alport Syndrome but I am asymptomatic. My nephrologists, after biopsy and two years of ultrasound, have decided it should not effect my Naval career, but I am pretty sure NAMI will not waive this. Am I right?
I am active duty, and have been cleared to re-enlist. I am currently waiting for a response from N3M on whether I can apply for IW/SWO/INTEL/SUPPLY but haven't gotten any word back yet.
I was told I should be able to get a waiver for those designators, but I am guessing SNA/NFO is out of the questions. Any advice would be great. I have over 96% kidney function, it is not degrading, i have moderate proteinurea and blood in urine. Thank you in advance.
I have a hereditary kidney disease called Alport Syndrome but I am asymptomatic. My nephrologists, after biopsy and two years of ultrasound, have decided it should not effect my Naval career, but I am pretty sure NAMI will not waive this. Am I right?
I am active duty, and have been cleared to re-enlist. I am currently waiting for a response from N3M on whether I can apply for IW/SWO/INTEL/SUPPLY but haven't gotten any word back yet.
I was told I should be able to get a waiver for those designators, but I am guessing SNA/NFO is out of the questions. Any advice would be great. I have over 96% kidney function, it is not degrading, i have moderate proteinurea and blood in urine. Thank you in advance.
JoeHello,
At the risk of boring everyone on the forum, any waiver discussion should start with the thought processes we go through when recommending, or not recommending, waivers of standards for chronic conditions. We have a good database on common conditions like hypertension, and how that condition and its treatment interact within the operational environment. For other conditions, like yours, there are a lot less hard data, and the senior physicians at BUMED, N3M and NAMI must use their judgment in recommending or not recommending waivers.
First and foremost, the navy is a forward deployed force. Career progression (both yours and other people's) depends on the ability for detailers to have flexibility in assignments. Any assignment limitation on your part has the potential to adversely affect your career, and the lives and careers of people you don't even know. If you can't go to Djibouti, somebody else has to. Specialty care or testing may not be easily available overseas, and even some CONUS assignments are so remote as to require medical screening of potential assignees due to the lack of medical support. Sending you back to CONUS to a tertiary care center like Bethesda, Portsmouth or Balboa would result in your unit picking up the TAD tab, and someone else filling your place on the watchbill for however long you're out of pocket.
Before recommending a waiver, we evaluate the condition, and any requirements for monitoring that condition, or treating that condition. The requirements should not exceed the capabilities of the typical operational physician, or the resources found in the typical forward deployed setting. The condition shouldn't require specialized testing or medications not routinely available to the unit.
Secondly, we look at the effect the operational environment may have on the condition. Can the condition be worsened by the typical stressors found in the operational setting like dehydration, irregular meals, or unpredictable sleep-wake cycles? Does the aviation environment pose additional risks for exacerbation of the condition, like noise, vibration, inhalation of concentrated oxygen, pressure changes or acceleration stresses? If there is no information, or if a reasonable argument can be made that the environment may worsen the condition, waivers generally aren't recommended.
Thirdly, we have to consider return on investment. In this environment of tightening fiscal constraints, can we anticipate that the natural history of the disease is likely to cause premature termination of a military career. Training, especially aviation training, is expensive, and if you go med-down shortly after winging, we've lost the opportunity to recoup our investment in you. Your note suggests that you have been diagnosed only recently with Alport syndrome. Two years of stability isn't that extensive of a track record when BUMED and NAMI have to consider the implications of commissioning you and putting you into the aviation pipeline.
I don't know if you'll be recommended for a waiver for commissioning. I probably wouldn't, mostly because of the assignment limitations your condition will probably place on you, and the adverse impact this will have on your promotability. It's been a long time since I was at NAMI, but if I were in my old chair, I wouldn't recommend a waiver for your medical condition for the reasons listed above.
R/
At the risk of boring everyone on the forum, any waiver discussion should start with the thought processes we go through when recommending, or not recommending, waivers of standards for chronic conditions. We have a good database on common conditions like hypertension, and how that condition and its treatment interact within the operational environment. For other conditions, like yours, there are a lot less hard data, and the senior physicians at BUMED, N3M and NAMI must use their judgment in recommending or not recommending waivers.
First and foremost, the navy is a forward deployed force. Career progression (both yours and other people's) depends on the ability for detailers to have flexibility in assignments. Any assignment limitation on your part has the potential to adversely affect your career, and the lives and careers of people you don't even know. If you can't go to Djibouti, somebody else has to. Specialty care or testing may not be easily available overseas, and even some CONUS assignments are so remote as to require medical screening of potential assignees due to the lack of medical support. Sending you back to CONUS to a tertiary care center like Bethesda, Portsmouth or Balboa would result in your unit picking up the TAD tab, and someone else filling your place on the watchbill for however long you're out of pocket.
Before recommending a waiver, we evaluate the condition, and any requirements for monitoring that condition, or treating that condition. The requirements should not exceed the capabilities of the typical operational physician, or the resources found in the typical forward deployed setting. The condition shouldn't require specialized testing or medications not routinely available to the unit.
Secondly, we look at the effect the operational environment may have on the condition. Can the condition be worsened by the typical stressors found in the operational setting like dehydration, irregular meals, or unpredictable sleep-wake cycles? Does the aviation environment pose additional risks for exacerbation of the condition, like noise, vibration, inhalation of concentrated oxygen, pressure changes or acceleration stresses? If there is no information, or if a reasonable argument can be made that the environment may worsen the condition, waivers generally aren't recommended.
Thirdly, we have to consider return on investment. In this environment of tightening fiscal constraints, can we anticipate that the natural history of the disease is likely to cause premature termination of a military career. Training, especially aviation training, is expensive, and if you go med-down shortly after winging, we've lost the opportunity to recoup our investment in you. Your note suggests that you have been diagnosed only recently with Alport syndrome. Two years of stability isn't that extensive of a track record when BUMED and NAMI have to consider the implications of commissioning you and putting you into the aviation pipeline.
I don't know if you'll be recommended for a waiver for commissioning. I probably wouldn't, mostly because of the assignment limitations your condition will probably place on you, and the adverse impact this will have on your promotability. It's been a long time since I was at NAMI, but if I were in my old chair, I wouldn't recommend a waiver for your medical condition for the reasons listed above.
R/
Timebomb,
Thanks for explaining the waiver process in great detail!! very helpful for anyone with an extensive medical history
Thanks for explaining the waiver process in great detail!! very helpful for anyone with an extensive medical history
JoeHello
New Member
Sir,
Thank you for the excellent response and your honest opinion. Unfortunately it is very much what I assumed. I have my fingers crossed a waiver will come through for IW and other IDC ratings, but I completely understand if the risk is too high for the Navy. For now, I am able to re-enlist and continue my service in that capacity.
Again, thank you for the great response and detailed explanation of how the process works. It must be a very difficult job, but I understand that NAMI, BUMED, and N3M must put the needs of the Navy first.
Very Respectfully,
CTI2
Thank you for the excellent response and your honest opinion. Unfortunately it is very much what I assumed. I have my fingers crossed a waiver will come through for IW and other IDC ratings, but I completely understand if the risk is too high for the Navy. For now, I am able to re-enlist and continue my service in that capacity.
Again, thank you for the great response and detailed explanation of how the process works. It must be a very difficult job, but I understand that NAMI, BUMED, and N3M must put the needs of the Navy first.
Very Respectfully,
CTI2
Waiver recommendation is always a balancing act between the wants and needs of the service member, and the wants and needs of the Navy. If it were simply "needs of the Navy", the calculus would be pretty simple, and the number of waiver recommendations gets very small.
Waiver requests for complex or uncommon medical conditions always generated a lot of discussion among the staff at NAMI, and we tried to take as many known factors into account as we could when making a recommendation. Most operational medicine physicians (flight surgeons, UMOs, GMOs) are fresh out of internship, meaning that they have one year of general training after graduating medical school. You're being monitored by nephrologists, who have at least five years of training out of medical school, two of which focused solely on one organ system. It isn't fair to you or to your GMO to expect the same level of expertise.
Sorry you had to get so familiar with medical at such a young age. You sound bright and motivated...both very desirable qualities. The Navy is fortunate to have you.
R/
Waiver requests for complex or uncommon medical conditions always generated a lot of discussion among the staff at NAMI, and we tried to take as many known factors into account as we could when making a recommendation. Most operational medicine physicians (flight surgeons, UMOs, GMOs) are fresh out of internship, meaning that they have one year of general training after graduating medical school. You're being monitored by nephrologists, who have at least five years of training out of medical school, two of which focused solely on one organ system. It isn't fair to you or to your GMO to expect the same level of expertise.
Sorry you had to get so familiar with medical at such a young age. You sound bright and motivated...both very desirable qualities. The Navy is fortunate to have you.
R/
phrogpilot73
Well-Known Member
Wow, never in my lifetime did I think this was going to happen: "It appears that the Air Force and the Marines share something in common..."
danpass
Well-Known Member
Is there some otc item, some type of eye drops perhaps, that meets the same intent? (or comes close)
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
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