Naval operational medicine institute

Aviation Waivers

 

In Aviation:

Waivers are usually not granted to SNA's or SNFO's unless defects are minor and as of such nature as to not jeopardize flight performance now or in the future.

Designated aircrew are frequently waived in order to preserve trained assests.

The waiver is recommended by the flight surgeon.

Requests for waiver are initiated by the member or the flight surgeon and submitted to BUPERS/CMC/COMNAVCRUITCOM, via NOMI Code 42. The member's commanding officer is no longer required to request the waiver.

BUPERS or CMC grants the waiver request, usually based on input from NOMI/BUMED.

No flight surgeon can grant waivers.

 

Practical Issues

Does the Aviator need a waiver?

• 
  Anticipate problems before they develop.
  
• 
  If it looks like a waiver will be required and you feel that you can recommend it, encourage action by the member and his C.O.
  
• 
  Keep the member and the C.O. informed of the status of the condition and the waiver process.
  

• 
  Remember, the member submits the waiver request, you only recommend.
  
• 
  You may not grant a waiver. Neither can NOMI. Only BUPERS or CMC.
  
• 
  There is no such thing as a "temporary waiver."
  

When doubt exists about the process or what current thinking is, the Physical Qualifications Department at NOMI (Code 42) can provide help. They will consider all requests for waiver, but will only recommend one if all medical questions have been answered completely and logically, and there is no reason to believe that continued flight would be detrimental or dangerous to the individual or others.

 

The Final Package

1. 
   The member's letter of request for waiver and C.O.’s endorsement.
   

2. 
   Typed SF-88 and SF-93 with your recommendation for waiver.
   

3. 
   Consults obtained (they must be legible).
   

4. 
   All appropriate lab data.
   

5. 
   Aeromedical summary or LBFS proceedings if warranted to support your recommendation.
   

All too often the waiver package may be lost if the medical and aviation commander's components are mailed separately. It is probably a good idea to mail the entire package from medical to avoid this loss.

FNAEB - Field Naval Aviator Evaluation Board

FNFOEB - Field Naval Flight Officer Evaluation Board

FFPB - Field Flight Performance Board (for USMC Aviator and NFO's)

 

Purpose:

Flight performance boards are purely administrative in nature, and are designed to ensure that only those officers who can safely and competently perform their aviation duties are so assigned. These boards are not to be considered as either a forum for disciplinary or punitive action.

 

Aviation Designations:

The Chief, Bureau of Naval Personnel (BUPERS) confers aviation designations through the Chief of Naval Education and Training (CNATRA) to Aviators and NFO's, and NOMI, for Flight Surgeons, SNAP's and SNAEPS's. The right to wear the aviation designation insignia may be revoked by BUPERS, if such is recommended by the Board. Aviation personnel assigned to flight billets are required to maintain all physical exam, water survival, physiology training and minimum flight time requirements and in addition, perform their aviation duties safely and competently.

 

Flight disqualifications, Medical:

2. 
   NPQ because of illness or injury. May require temporary grounding, restriction to certain service groups if an aviator and may necessitate waiver.
   
3. 
   NAA in the Aeromedical sense, where the individual's ability to adjust to stressors in the aviation environment has been unsuccessful or maladaptive.
   

 

Drug Abuse

Flight status and the right to wear the insignia are permanently revoked and the member processed in accordance with SECNAVINST 1920.6.

 

Voluntary termination of Flight Status:

Any designated aviation personnel who voluntarily request termination from flight status must be:

• 
  Immediately grounded
  
• 
  Counselled that this will be considered permanent.
  
• 
  Evaluated by a Flight Surgeon.
  

 

Evaluation Boards:

After ruling out all the above issues that may remove an individual from flight status, one other remains, the Evaluation Board.

This board is convened to evaluate the performance, motivation and behavior of an individual to determine whether he can safely and competently continue in a flight status.

 

Convening Authority - immediate superior in command

Reasons to convene:

• 
  faulty judgement
  
• 
  violation of flight discipline
  
• 
  mishaps
  
• 
  minor incidents
  
• 
  failure to maintain currency requirements
  
• 
  lack of motivation
  
• 
  poor character traits
  

 

Board membership:

    FNAEB & FFPB's

• 
  Three Pilots - Senior member is senior to the aviator
  
• 
  One flight surgeon.
  

• 
  Three NFO's (or one NFO, two NA's)
  
• 
  One flight surgeon
  

Examinee is told of the reasons for the board.

Examinee is allowed to be present at all open sessions of the board, and present information, witnesses and rebuttal.

Board members may not act as witnesses.

Medical evaluations of the examinee must be provided by a different flight surgeon from the one on the board, unless there are no other Flight Surgeons in the area. In that case, the Flight Surgeon board member may do both duties as long as the examinee waives this right in writing.

All of these principles are for the purpose of providing customary standards of fairness in administrative proceedings.

 

Findings of the Board:

Type A. Continuation of Flight Status

1. 
   At present duty assignment.
   
2. 
   Transfer to another activity within the same administrative command.
   
3. 
   Transfer to another activity.
   
4. 
   Probationary status for a definite period with consequences for failure to meet the requirements of probation.
   

1. 
   Right to wear the insignia
   
2. 
   Revocation of the right to wear the insignia. This is considered appropriate board action as a result of acts which dishonor naval aviation or there has been willful and flagrant violation of established rules, regulations and directives.
   

The Flight Surgeon member of the board will be expected to attend all meetings of the board, provide interpretation of all aeromedical aspects of the case, participate in all deliberations of the board and provide any other assistance as required.

 

Reporting:

A formal report of the Boards findings is due to the first endorser in the chain of command within 20 days of issuance of the convening order. There is little time to waste preparing the medical evaluation.

A number of documents are required in preparation of the report as outlined in PERSMAN and the ACTS Manuals, but the Flight Surgeon member shall see to presenting to the board the typed findings of the examining Flight Surgeon, with any SF88's, SF93, consultations etc. Additionally, the Flight Surgeon member's findings and opinions should include:

• 
  age, family constellation and marital status,
  
• 
  aviation background, study habits,
  
• 
  past illnesses, social problems, failures, medications,
  
• 
  life style, alcohol or drug use,
  
• 
  major life changes (stressors), especially in the last year,
  
• 
  coping mechanisms and effectiveness under stress,
  
• 
  attitudes and motivation,
  
• 
  continuity of training (delays, groundings, etc.),
  
• 
  peer relationships,
  
• 
  interests, hobbies,
  
• 
  medical qualifications as per MANMED,
  
• 
  your overall impression of the aviator as a person.
  

If the opinion of the board is not unanimous, a dissenting opinion may be submitted. There certainly have been recommendations made which were less than completely fair due to domination of the proceedings by the senior member, or the prevailing attitudes of the command at the time of the board. If you strongly disagree with the results of the board, by all means write a dissenting opinion. Please recognize that this does not give license to impune the integrity of the board, the command, the Navy or anything else. It is your opportunity to bring to bear your special understanding of human behaviors and logic applied to the aviation environment.

For most competence for duty examinations, (properly documented) clinical observation is sufficient. Drawing samples of body fluids for such purposes is discouraged. Samples drawn for medical purposes may be used as evidence.

A service member may be ordered to provide body fluids for legal purposes, if a valid search warrant, or Command authorization has been issued. It is the responsibility of the Command, not the Medical Officer, to ensure the validity of the authorization. Refusal by the member to comply constitutes disobedience of a lawful order. Use of force to obtain such samples may be determined unreasonable by a court martial, and may expose the person giving the order, and the Medical Officer who carries it out, to criminal charges.

Observations should be documented on NAVMED 6120/1, Competence for Duty Examination form.

 

Pre-confinement Medical Examinations

References:

• 
  SECNAVINST 1640.9B (Art. 7205)
  
• 
  BUMEDINST 6320.11
  

The examining official shall certify the prisoner "fit for confinement" on the confinement order (NAVPERS 1640/4).

The member is unfit for confinement if he has:

"... a serious physical injury or problem which requires immediate treatment, psychiatric disorders which make the individual a threat to himself/herself or others, requires drugs or other intervention to control his/her behavior, or is suspected to have suicidal ideation or behavior as specified in BUMEDINST 6520.1. If persons ordered into confinement display irrational or inappropriate behavior which is symptomatic of mental disturbance or of the effects of hallucinatory substances, they shall be admitted to a hospital and be certified as ‘unfit for confinement’ until such time as they are capable of participating in their legal defense..."

• 
  Note any cuts, bruises, scars, unusual marks, or other physical injuries; any unusual behavior traits, gestures, or actions; and any physical limitations that would restrict participation in the rigorous brig program.
  
• 
  Be meticulous; you may have to testify about your findings later.
  
• 
  Females require documentation of pregnancy test results on the confinement order.
  

In 1984, subdivision (d)(2) in the original Rule, the provision permitting delegation of a commander's search powers, was deleted in light of United States v. Kalscheuer, 11 M.J. 373 (C.M.A. 1981) (annotated infra). The remaining provisions were then renumbered. The court impliedly invalidated 315(d)(2) when it ruled that delegations to persons other than magistrates or judges do not meet Fourth Amendment standards. Although there are now no provisions in the Rules of Evidence for delegating search authority, the court's "admittedly imperfect" solution in Kalscheuer should normally suffice where the commander is absent: the authority to search devolves to the subordinate who exercises command in the commander's absence. Commanders may still delegate their authority to a military judge or magistrate.

The CDO is authorized to order a competency for duty exam including a urine for drug screen. He can no longer authorize blood drawing or searches. E-4 shore patrol may not authorize searches.

Aircraft Mishap Planning

 
The Changing Role of the Armed Forces Institute of Pathology

Due to budget and manpower constraints, the Armed Forces Institute of Pathology (AFIP) will no longer be able to dispatch a team of investigators to every fatal mishap. AFIP will continue to provide consultation and laboratory support to medical investigators. They will also review Flight Surgeons' Reports (FSR), Mishap Investigation Reports (MIR), and autopsy protocols. However, the collection and preservation of medical evidence will fall to the on-scene investigators.

Historically, few Flight Surgeons investigate more than one fatal mishap in their careers. The vast majority leave Flight Surgery at the end of their first tour for clinical specialties. These factors impair the development of a "corporate memory" in the community. Aerospace Physiologists (AP), especially the Aerospace Medical Safety Officers (AMSO) remain in the field for several tours and are likely to investigate many mishaps. Their assistance and experience can be extremely helpful to the junior FS as he approaches his first smoking hole.

 

The Flight Surgeon's Role in Aircraft Mishap Investigation

Although this section will focus on the responsibilities of the Flight Surgeon in mishap investigations, and the resources available to assist him in meeting these responsibilities, several pre-mishap planning issues will be addressed. Each Service has its own guidance regarding investigation of aircraft mishaps. These are:

• 
  OPNAVINST 3750.6Q The Naval Aviation Safety Program
  
• 
  DA Pam 385-95 Aircraft Accident Investigation and Reporting
  
• 
  AFP 127-1V1 US Air Force Guide to Mishap Investigations
  
• 
  AFI 91-204 Safety Investigations and Reports
  

Additionally, each facility is well advised to have a copy of the other Services procedures handy; you never know when a stranger may "drop in" on you. As a Naval Flight Surgeon, the author was extremely impressed and grateful when upon arrival to an AFB to investigate a USMC mishap, all required medical evaluations, interviews, and biological sample required by the Navy instruction were presented in one neat packet. The USAF Senior Flight Surgeon had provided his subordinate with excerpts from the Navy instruction, outlining these requirements (which were subtly different from USAF procedures). Could your facility do as well?

Reprinted from:

"The Role of the Flight Surgeon in Aircraft Mishap Investigation"; WRC Stewart; Navy Physiology Supplement; 2nd - 3rd Qtr, 1988, Naval Air Systems Command, Washington, DC; presented to 1988 FAILSAFE Meeting, Yuma AZ.

 

Flight Surgeon participation in pre-mishap planning

Upon arriving at a new duty station, the FS should meet the persons with whom he will be working. The "old hands" should aid him in this endeavor whenever possible. He should study the local mishap plans with special attention to Medical Department responsibilities and participate in local mishap planning meetings. This is where many "what if's" should be addressed.

SAR response and FS responsibilities must be clear to all involved. The FS must be familiar with the emergency equipment he will have available, and the qualifications of support personnel to assist him.

Agreements with MTF's for care of casualties, and collection of biological samples must be addressed. Very specific, brief instructions should be provided to those facilities, especially ER's and labs, where the person on duty at the time of the mishap may be unfamiliar with the requirements. These must be readily available to the duty personnel; a special folder for the duty desk with a covering checklist may be helpful. Appendix 2 is an example of such an instruction for USN mishaps. These "go-by" notes must be reviewed and updated, especially when Service instructions are modified.

Especially important is settling who has jurisdiction over remains of anyone killed in a mishap in your operating area. Letters of agreement should be executed if possible so that all parties concerned know what is expected of them. Many Medical Examiners will welcome assistance from the Aerospace Pathologists from the Armed Forces Institute of Pathology (AFIP). Some may be happy to relinquish jurisdiction outright, while others will permit varying degrees of participation by AFIP or other military pathologists. The Medical Examiner may wish to retain certain "sensitive" cases. However, liaison and establishment of rapport before a mishap is more likely to produce co-operation than unprofessional haggling over the remains at the mishap site. The local Judge Advocate General Officer can assist you in researching this issue and drafting any agreement. Most states take a dim view of "body snatching", so prior resolution of this issue is very important.

Identification of fatalities and notification of next of kin will require the efforts of many persons. Avoidance of errors is critical for obvious reasons, but so is prompt resolution of the question. Dentists and law enforcement agencies such as Naval Investigative Service or the Provost Martial Office may have useful expertise in identification. The Decedent Affairs Officer can assist with notification of next of kin. Clear delineation of the responsibilities and authority of those involved can prevent confusion during such an event.

Since you will want to make photographs of the mishap site, liaison with the base photo activity is recommended. These professionals can probably provide better quality photos than you can take on your own. However, they will need to be shown what you want photographed, and what the picture is supposed to demonstrate. Also, remember that the photographer will likely be unaccustomed to the proximity of dead bodies, so be sensitive to his reaction.

Pictures should also be taken during the autopsy. If no medical photographer is available, ask the photographer to shoot color strips for each roll, and bracket the exposure for each shot. Begin with the remains before removing the flight gear, then the exposed body. Ask the pathologist conducting the autopsy to point out all significant findings, and make pictures whenever possible. If no photographer is available, shoot your own. Use prudence, but don't be stingy with the film - it's the cheapest part of the investigation! Take any shots you might reasonably need and extras of critical items. Contact sheets of each roll can be made quickly and can help you decide which shots you want printed.

Aerial views of the mishap site can usually be obtained from a helo. An extra circle of the site on the way in or out will allow the photographer to get the shots you need. Additional aerial photos with infra-red film thru a #12 yellow filter can often provide information not visible on standard photos. The photo facility can obtain and store this film for you until needed. AFIP can assist with interpretation of the infra-red photos.

 

Post-mishap considerations:

Care of casualties takes priority over collection of evidence. However, proper prior planning can maximize efficiency of both. Although the injured require prompt evacuation for treatment, obvious fatalities (eg, decapitated, incinerated, etc.) need not be removed from the wreckage immediately, unless additional fire, explosions or other damage is likely.

Accident reconstruction will be easier if the position of the fatally injured is documented. Pictures can be valuable, but notes can be of great help in interpreting them, especially if the quality is less than ideal. Engineers can help survey the crash site and make accurate drawings of the location of wreckage and bodies.

Flight gear should be left on the bodies until the postmortem. This permits corelation of injuries, damage to flight gear, and trace evidence from the aircraft to reconstruct the crash. Explosive devices (flares, ejection seats, etc.) should be "safed" before removing the fatalities. If there will be a delay before autopsy, the remains should be refrigerated, not frozen.

AFIP assistance must be requested; it is not automatic for all fatal mishaps. Check OPNAVINST 3750.6 to determine how to get them launched to you. Remember they will be limited to working with the physical evidence that you collect and protect. Avoid disturbing such evidence to the greatest degree possible.

Inform the CO of the severity of the injuries ASAP. As soon as fatalities are identified, execute previously agreed upon responsibilities to allow notification of next of kin. Allow survivors to speak with family as soon as practical, but caution them to avoid discussing injuries of other crewmembers or starting rumors.

Histories of the events preceeding a mishap are routinely collected by the FS examining survivors. Statements should be obtained from aircrew, support personnel, and witnesses as soon as possible. Tape recording is preferred, but a written outline should be made if a recorder is not available. In the case of fatalities, family, friends, and co-workers are interviewed. The art of such interviews is beyond the scope of this paper. However, a FS who gains the respect of the interviewees prior to the mishap is more likely to receive co-operation from surviving aircrew, squadron mates, or next of kin.

Although most Flight Surgeons receive little to no formal training in ergonomics, dynamic cockpit workload evaluation, or system safety engineering, they are expected to be the human factors expert for the AMB. Even the "medical" factors in a mishap may require specialist knowledge of such esoterica as the effect of presbyopia on accomodation time of the night myope in low illumination conditions. Each Service has its own experts in aviation life support systems (ALSS), who can compliment the FS medical knowledge. In the Navy, Aerospace Physiologist AMSO's are far more experienced in this area than most FS. Their assistance can enhance the quality of the investigation and report. USAF Safety and Inspection Center and the Army Safety Center also have ALSS experts. Additionally, these experts know experts in related fields such as ejection seats, parachutes, etc. If you have a question whether any such factors might have contributed to the accident or injuries, timely contact may be able to resolve the issue. The FS should ensure that design flaws that aggravate injury or impede safe egress are appropriately addressed.

Perhaps the most under utilized resources are the Aerospace Medical Specialist Senior FS who can assist the new guy by helping him organize the available information, focus his investigation, and request other "specialists" to assist as necessary. Collecting and analyzing all this data, and evaluating the effect on the Aviator's cockpit performance at the time of the mishap is a bit much to expect of a first tour Flight Surgeon who may also be grieving the loss of a friend and squadron mate. Several recent MIR's reflect the inexperience of the AMB Flight Surgeon. Providing him with a more experienced colleague, who has participated in several investigations can produce a better investigation and report.

Two questions frequently asked about a fatal mishap are, "what killed him ?" and "was it potentially survivable ?" Mishap survivability is a complex subject, but can be approached systematically. Survival depends on several factors for which the acronym "CREEP" has been coined: