Area of Focus

Military Flight
Aptitude Tests

Officer Candidate
Tests

Flying Class I/II Physical Exams
When Needed?
Term of Validity

Flying Class I/II Physical Exams
How do I get one?
Where do I get one?

Flying Class I/II Physical Exams
Dental Factors

Flying Class I/II Physical Exams
Blood/Urine Tests
Hemorrhoids

Flying Class I/II Physical Exams
FCII Standards

Flying Class I/II Physical Exams
Blood Test-
Loss of consciousness

Flying Class I/II Physical Exams
ECG Anomaly

Flying Class I/II Physical Exams
Wait for Results

Flying Class I/II Physical Exams
Hearing Test

Flying Class III Physical Exams
What is involved?

Flying Class I/II Physical Exams
Waiting for Package to return

Vision
Standards-
Optic Nerve Coupling

Vision
Correction-
PRK procedures

Vision
Waivers for
PRK procedures

Vision
Refraction Test

Vision
Refractive Errors

Vision
Refractive Error

Vision
Accommodation

Vision
Acommodation

Vision
Optic Cup

Vision
Vision Waiver

Vision
Depth Perception
+Waiver process

Vision
Depth Perception

Vision
Color Vision
+Waivers

Vision
Keratoconus
+Waivers

Vision
Sphere/Cylinder
Refraction

Physiological Conditions
Spine/Scoliosis

Physiological Conditions
Spine/Scoliosis

Physiological Conditions
Spine/Surgery
+Waivers

Physiological Conditions
Head Injury
Evaluation

Physiological Conditions
STDs

Physiological Conditions
Herpes
+DNIF Status

Physiological Conditions
Knee range of motion standards

Areas of Focus:
1. Flying Class I / II Physical Exams
When do I need it? Term of validity.  Where do I get one.  Dental factors.  Blood tests, Urine tests.  ECG anomaly.  Exam results.
2. Vision Questions
Waivers for PRK procedures.  Refraction Test.  Refractive Errors.  Accommodation.  Depth Perception +Waiver process.  Color Vision +Waivers. Keratoconus +Waivers.
3. Physiological Conditions
Spine/Scoliosis.  Spine/Surgery +Waivers.  Head Injury Evaluation.  STDs.  Knee range of motion standards.

1.  Flying Class I/II Physical Exams

Q1.  I am planning on getting a Class I physical before I apply to some ANG units. Can anyone tell me how long one is good for? Thanks!

A.  Depends on the circumstances. The simple answer (with some caveats) is the FC I exam must be current within 36 months of entry into UPT. You need to take and pass a long FC II before beginning UPT. Here’s the AFI on the subject:

To obtain a military flying exam, you have to have whatever agency you’re applying to arrange for it.  You can’t just call a flight surgeon’s office and say, “I want to schedule a Flying Class I exam.”

If you’re applying to a Service Academy or ROTC the Department of Defense Medical Examination Review Board (DoDMERB) will arrange for your exam. If you’re going for AD AF via OTS or you’re trying to get an ANG slot, your recruiter is the one who arranges the exam. They’ll send you a letter that authorizes you to get on base (bring ID such as driver’s license) and to have the exam done, as well as instructions for the exam, “nothing to eat or drink after midnight the night before except you can drink plain water in the morning.”

The exam can be done by any military flight surgeon’s office that has the capability. That is, if you’re applying to be an AF pilot, you can get the exam done by a Naval flight surgeon’s office or vice versa.  Once you get the authorization to have the exam and appointment (usually on the same letter), there is no charge to you for the exam.

Q2.  Doc, I've heard that cavities can downgrade your flying class I to a class II. Is this true? Thanks for all your help!

A.  Cavities don’t downgrade your Flying Class I to a Class II; they simply make you disqualified for Flying Class I. Get the cavities fixed. See A7.5.2.1 below. ($10 word for cavity is caries).

Here’s what’s disqualifying in the dental arena:

Q3.  I had my FC1 about two weeks ago. I did everything but see the flight surgeon. I guess they said he was too booked and now I am going back on This week. Well a couple questions for ya. One I was never informed we had to fast or not drink before we went for blood and urine. Well the test was on Monday and I ate breakfast that morning. Also that Friday before I was at a function and too say the least got a little boozed up. Will I have some problems that I should bring up to the FS. And secondly, I get hemorrhoids sometimes because I have a rather grueling workout program, is this something that will DQ me, should I bring it up. They really don't bother me , its just something I thought the doc may find in his little rear end search. What should my approach be.

A.  1. You'll probably have to repeat the blood and urine tests.

2. Unless your hemorrhoids meet the following description, you should be OK:

Q4.  Provided you have a valid FCI and passed MFS, how threatening is the FCII at class start?

A.  Not at all. My opinion, for what it’s worth.

These same FCII standards must be met by all the older pilots, navs, and flight surgeons. If they aren’t a problem for the usual colonel, they shouldn’t be an issue for you unless your physical standards have gone downhill in a hurry.  In the old days, you had one last FCI or FCIA at the start of UPT or UNT. In more than a few cases the would be pilot or nav got a no-go at the last minute. Now you only have to pass FCII. Count your blessings.

Q5.  I am going for my Flying Class I Physical soon, but there is something that concerns me. I have come close to passing out the last 3 times I have given blood. I don't know what the heck it is, but I get dizzy and everything gets dark. No one has told me that it is a problem, but will this keep me from getting into pilot training? Is their anything I can do to prevent this?

A.  Passing out, or almost passing out, while having blood drawn is not disqualifying, provided it is momentary (and some other requirements) and evaluation shows there is nothing else wrong.  Also, giving blood grounds you for at least 72 hours. In the old days, AF flyers weren’t allowed to give blood. Now they may with a 72 hour minimum grounding period.

There are two parts of the autonomic (involuntary) nervous system, sympathetic and parasympathetic. They generally have opposite functions. The sympathetic is involved in “fight or flight” responses. It can cause your blood vessels to constrict and your heart to beat faster. The parasympathetic system slows your heart. It also increases blood flow to and activity in your digestive system.

The size of a lot of blood vessels in your body can vary. If a lot of them get bigger at the same time, this lowers your blood pressure by two mechanisms, one is that more blood is pooling in your blood vessels instead of returning to the heart to be pumped around and the second is there is less resistance in the arterial system because the “pipes” are wider.

For those who have the problem with feeling dizzy when having blood drawn, their parasympathetic nervous system tells the heart to slow, the blood vessels in the body get bigger, pooling more blood, intestinal activity and sweating increase and your blood pressure goes low enough for you to become transiently unconscious.

If you give blood (or are having a blood sample drawn) and know you are likely to get light headed the best position to be in is lying down with your feet higher than your body. Most blood donation sites and some labs have furniture to accommodate this. Lying flat is next best, then reclining. Sitting can be a problem for some people and standing invites passing out.

Q6.  I just finished my FCI and everything was AOK except for my ECG. It said (don't remember letter for letter):
"Normal Sinus Rythm with Sinus Arythmia"
"Right Axis"
"Borderline"

When I talked to the flight doc he said it was normal because I'm a pretty skinny dude and my chest wall is thin.  But according to AFI: A7.17.1.7. Resting ECG findings considered to be "borderline," or known to be serial changes  from previous records unless a cardiac evaluation as directed by the ECG Library reveals no  underlying disease. Refer to ACS “Disposition for ECG findings.”

He wrote "Normal" on the ECG and didn't seem to think it would cause any problem at all.  What's your take?

A.  Modern ECG machines include software that “reads” them. The printed reading is the computer's reading on most automated ECG machines. It tends to “overcall” a bit. If the computer says “Normal,” you can pretty much count on it. If it says something other than normal, it may or may not be exactly correct.

At some bases, all ECGs for flying exams are reviewed by cardiologists for an “official” reading. Some bases don’t have the luxury of a cardiologist on staff. An experienced cardiologist's reading is correct more often than the machine if they differ. There are also explicit instructions for various borderline ECG situations. It may be the case that the electrical axis on your ECG fits within the allowed range and requires no further action. Since your flight surgeon read it as normal, that is a good start, but it will be further reviewed by the AETC Command Surgeon’s office and by the ACS at Brooks. (ALL ECGs on flyers, whether done for exams or possible problems are sent to ACS even if they are stone cold normal; this is not particular to your situation). If they agree with your ECG being actually normal/acceptable normal variant, you are good to go. If not, you'll need further evaluation.

Q7.  I completed a Flying Class I Phyiscal back in early November (2001), and still haven't received my results back. Is this typical? I heard from the medical personnel that administered my physical (at the local Guard unit) that the processing in general (wherever it takes place) is backed up quite a bit. Is there anyway I can check up on the status of my physical? If so, who can I contact? Also, where is the physical processed? My sense of urgency is brought upon by an interested Guard unit that would like to know the status of my physical. Any information would be appreciated.

A.  Physical examinations for persons applying for pilot training commission, etc. are accomplished by a Physical Exams and Standards (PES) office. The doctor portion must be done by a flight surgeon for flying and special operational duty qualification. Sometimes, the portion done by the technicians will be done on one day and the physician portion a different day. This is sometimes the case for someone already in the military. If the person is not in the military, they try to do it all in one day. If the person requires specialty consultations, this adds more visits and time to the process.

Once all the data are gathered, the exam must be typed and checked. It must be signed off by relevant persons: the dentist, the technician, the flight surgeon, and the approval authority (hospital commander or equivalent). Getting the exam all processed and out the door of the PES office has a goal of 30 days. The PES section keeps copies of exams for a couple of years in case the exam is lost in transit. In a busy or undermanned (or both) PES (they do a lot more than initial FCIs), they may have trouble meeting the 30 day goal.

It is then mailed to the Command Surgeon’s office at Air Education and Training Command at Randolph AFB, TX. Even if the local PES thought everything was good to go, they carefully inspect each and every exam for completeness and whether, based on the findings of the exam, the individual is qualified. How long this takes depends on how long the line of exams awaiting disposition is.

The exam is certified with either the black stamp (Medically Qualified for FCI, FCIA, or whatever) or the dreaded red stamp (Medically Disqualified for Flying Duties). It is returned to the PES so the individual can attach it to the application for training.  The whole process usually takes at least a couple of months.

All initial FCI (pilot), initial FCIA (nav), and initial FCII (flight surgeon) exams must be certified by the AETC Command Surgeon's office. If it doesn't have the magic black stamp from AETC saying medically qualified for flying class I (or IA or II as appropriate) it doesn’t count. (Exception: AFRC/SG or ANG/SG certify would-be flight surgeons from the Reserve and Guard).

Q8.  Just took my FCII to start UPT (march class date) and ran into a problem. All my hearing scores were fine except I busted the 6000hz level by 5 dB. I'm told I can still start UPT, but will require 'further audiological workup' Kinda scary. No one would really talk to me about it. What can I expect/ Should I be looking at other AFSC's? (please say NO)

A.  First, don't sweat it. The fact that you've been allowed to start UPT before the evaluation is done should tell you all you need to know.

You should expect an in-depth audiological evaluation. You will get a full audiogram and possibly other tests, such as a brainstem auditory evoked response (BAER) or CT. The BAER looks at brain electrical activity associated with sound. In the vast majority of cases of a hearing loss at a single frequency, the evaluation shows nothing other than a hearing loss at a given frequency and that's the end of it.

Q9.  I'm goin in for an intial FC III -Air Weapons Physical. What all is involved? Chest X-ray, EKG/ECG, vision stuff?

A.  The Flying Class III will be like your enlistment exam, except with a few added tests and higher standards.  ECG, chest X-ray, color vision testing will be done. The vision requirements are not as strict as for pilot or nav and a lot more people can meet them (but they are stricter than enlistment requirements).  If you are applying for certain fields (Pararescue, Combat Controller, Paraweather, Diving, etc) there are additional requirements on top of the usual FCIII.

Q10.  My physical was originally sent in October 01. It has since been sent back to my medical squadron twice because information was left out of the package. The last time it was sent off was Jan 23 and I have yet to hear back. Is this normal? Is there anybody I can contact to check on the status? I have talked to the sgt in charge of the medical files at my squadron and she told me that AETC does not like you to contact them. She said that all I can do is wait, but my completed application package including my physical must be sent to Guard Bureau by May to get a slot for FY 03 (from what Ive been told). Any information would be helpful.

A.  Unfortunately, sometimes the exam packages “bounce” and need more done or corrections made. In defense of the PES people, they are an example of a group that has had increased workload combined with manpower shortages (AF wide issue). Not that that helps your situation.

How fast AETC reviews them depends on how many exams they have in line. They have to approve most initial flying exams (all FCI, FCIA, initial FCII), FCIII requiring waiver, AD commissioning exams (except those going through DoDMERB), and even enlistment exams needing waiver.

There’s a fine line between conveying your concern and pestering (and it won’t help you to cross it). I would not recommend calling AETC. If you can have the NCIOC of the Physical Exams and Standards section check on it for you, this is the way to go, in my opinion. If you haven’t already, be sure you make them aware of the deadline.

2.  Vision

Q1.  I have a Class I coming up for an ANG unit and had a concern with my vision. I meet the current visual acuity standards and refraction errors. My concern is with optic nerve cupping. I have had a few optometrists give me an exam and one guy found the right at .5 and the left at .4, the other guy saw them both at .4. I know this is kind of a subjective exam (fundus exam), but how concerned should I be. BTW, my interocular pressures were normal and field of view was also normal. Thanks in advance.

A.  Excessive cupping of the optic nerve is a possible sign of optic nerve atrophy. Glaucoma (with or without high eye pressure) is one possible cause of atrophy. There is a certain amount of normal variation in the size of the optic nerve cup from person to person and eye to eye. The AF standards are cup size of no more than 0.4 and a difference between the two eyes of no more than 0.2. It sounds like you are right on the border with your measurements.

The measurement can be done in ways to minimize the subjectivity of the result.  What I can’t give you a good answer for is if your measurement exceeds 0.4 but all other findings such as field of vision, eye pressure, etc, are normal, what your chances of getting a waiver on the cup size are.

Q2.  I am currently a cadet in ROTC trying to get a pilot slot on the next board. Only one problem: My vision is HORRIBLE! 20/200 in both eyes. I meet all of the pre-op requirements for PRK, but how difficult is it to get a waiver for this? No one at my Detachment can give me any info. Is there somthing I can do to start the process now? A website I can visit?

A.  The AF website on this subject has been down for a couple of months. I can see by your e mail you're at LSU. I think your medical support is through Keesler. I recommend having your Det call the Keesler Flight Surgeon's Office to get a hard copy of the waiver guidance. (It was a USAF/SG policy letter with attachment). If you meet the preop criteria, it takes a year minimum from procedure to start of UPT.

A.  I'm Active Duty and just had PRK at WHMC in San Antonio. I'm 8 weeks post op and doing well. The active duty waiver is a laborious process. Check out the PRK website under special flying programs on the afpc web site. This has specific info on the post op requirements for waiver approval. Also there is a limit to the number of applicants that can be accepted who have had PRK. This number is limited to 10% across the board! To me it's worth the risk, but carefully consider the benefits vs. the side effects.

Check out the Official USAF PRK Website (link updated 5Aug07).

Q3.  I'm Active Duty and had Air Force approved PRK at WHMC. I'm pursuing pilot training and need to complete my Flying Class I physical. The physical is complete with the exception of the updated vision portion. I read the PRK policy letter thoroughly for FCI waivers and am a little confused by all the different time restrictions mentioned. The way I interpret the policy is that three months post PRK I can apply for the waiver assuming I have no other complications pertaining to the surgery. I would appreciate your interpretation or the AETC/SG interpretation of this policy.

A.  Here’s my understanding of the rules for those who have had PRK and are applying for pilot training:  You may begin the waiver process no earlier than three months after having PRK done (this includes a full examination including your “new” visual acuity, with and without corrective lenses). You’ll need a second visual examination at least three months after the first post PRK evaluation (i.e., at or after six months post PRK). You’ll need a full ACS PRK evaluation in any case thereafter. You will be able to begin UPT no sooner than twelve months post PRK.

Q4.  A few years ago I took an Army flight physical; failing the eye refraction test. Shortly after I went to a civilian doc with my physical paperwork and was told that the Army doctor had made a mistake in his calculations. During this period my window to branch aviation had passed. Now I have the ability to branch transfer to aviation.  I was wondering what refraction is? Could a mistake be made in diagnosing it?  How is it tested for?  Does refraction change under certain conditions ie dehydration, fatigue, time of day, age?  Can it be fixed?  Can a waiver be obtained for it?

I am planning on scheduling an appiontment with another Army doctor. I would just like a little education on the topic. Thanks for the help.

A.  Refractive error is expressed in diopters, sphere (correction for far or nearsightedness) and cylinder (correction for astigmatism).

Q: I was wondering what refraction is?  A: As used here, it’s the refractive error, if any. Put another way, how many diopters of correction do you need to meet standards?

Q: Could a mistake be made in diagnosing it?  A: Yes. In addition to clerical/math errors, there is some subjectivity in the test, but mostly on your part. (Which looks clearer, A or B?)

Q: How is it tested for?  A: There are several ways. One is for the optometrist/ophthalmologist to focus on your retina and see what lens setting is needed to make it clear. Another is to put lenses in front of your eye and have you see which makes your eye focus better. For flying class I, this is done with the lens unable to move (so it can’t play). This is done by putting in eyedrops that temporarily stop the muscle that changes the lens shape from working.

Q: Does refraction change under certain conditions ie dehydration, fatigue, time of day, age?  A: It should not change except slowly with age. If done with the lens able to change shape, fatigue of the muscle that changes lens shape can be a factor. (If you have out of control diabetes, your vision can change with blood sugar level.) As you age, the lens becomes less elastic and less able to change for near versus far vision. This is why people start needing reading glasses in their 40s.

Q: Can it be fixed?  A: Yes, that’s what RK, PRK, LASIK, LASEK, etc do. Remember, only PRK is approved (under very limited conditions) for flyers!!!

Q: Can a waiver be obtained for it?  A: No, but you can apply for an exception to policy (not commonly granted).

Q5.  I was curious about refractive errors. I know that you need to have 20/20 uncorrected reading vision so I was wondering where the +2.00 and -1.5 come from. If you have a plus correction I thought that meant that you couldn't read 20/20 and minus was for distant vision but I seem to be confused by these numbers. Thanks for your help.

A.  The question had to do with the plus/minus numbers in the refractive error standards.  Short answer, in the case of the standards for FCI, the allowed correction (plus or minus) applies to distant vision because you can meet standards while requiring correction for distant, but not near, vision. For other classes, it is the maximum you need, whether to correct near or distant visual acuity.

The numbers are the strength of the lenses used to correct your vision in diopters. The plus or minus does not have to do with near or distant vision. The plus indicates a convex lens equivalent and the minus a concave lens. The easy way to think of the sign of the number of the lens strength is whether it is for correcting “nearsightedness” or “farsightedness.” This is not to be confused with near visual acuity (tested at 16”) and distant visual acuity (tested at 20 feet).

The numbers referred to as sphere are lenses that correct equally in every visual plane (up/down, right/left, diagonally). Cylindrical lenses correct along a given axis and are used for astigmatism. This is when the person’s lens has different strengths in different visual planes. Without correction, an “X” or “+” would have one limb blurred and one in focus.

In a simple prescription, you have one (spherical) lens strength per eye. Add astigmatism and you get a second lens strength (cylindrical) as well as the axis along which it is oriented. Add bifocals, you get yet another spherical lens strength for the reading portion.

In the case of FCI standards, the correction is only applicable for distant vision (near vision must be 20/20, uncorrected).

Q6.  During my FC1 my vision was 20/50 but my refractive error was -1.75. I was wondering first if this will DQ me and second if waivers are ever granted for refractive error if you meet acuity standards but not refractive standards and if they are how hard is it to get an ETP.

A.  Refractive error is out of standards, but only by 0.25 diopters. This is DQ, however. It would require an exception to policy and not a waiver. It is really hard to predict ETP likelihood, but with it so close and the acuity within standards, you might get lucky.

Q7.  I took a Flight Class I Physical a month ago and I was just informed that my "accommodation" was out of standards and I would need to go back and have the test done again.  Can you tell me what this means and what test was used to determine this?

A.  The accommodation test measures how close to your eye you can focus. As you age, the lens becomes less flexible and the minimum distance you must have something from your eye to see it in focus increases. (This is why kids can hold an object really close to their eyes to get a magnified view and if an adult tries this, it only looks blurry).

The test involves a card that is moved slowly away from your eye along a ruler. Each eye is tested separately. The result is determined by the distance at which you can read type that is 1mm high. The passing score is a function of age (as you get older, the minimum distance at which you can focus tends to increase). The results are expressed in diopters, but the easiest way to look at it is the minimum distance at which your lens can bring an object into focus.

Q8.  On the Accommodation standards for Flying Class I, is being less than or more than the diopters for your age disqualifying? Example: The diopters for a 25 year old person is 6.9. Do you have to have less or more than that.

A.  You want to have that much or more accommodative power. Having less than required for age is disqualifying. In this measurement, bigger is better. It represents the eye being able to focus even at very short distances. Or another way of looking at it is you are closer to needing reading glasses than you should be at your age if your accommodation power is less than standard.  The way to think of accommodation is you can get a “bigger” view of an object by holding it closer to your eyes. This works until you get it so close that you can no longer get it in focus. When you are young, your lens is very pliable and can change shape to be a fairly strong magnifying lens. Kids can get a magnified view of an object by putting it a few inches in front of their eye. They can still focus on it and it does not look blurry. It would look big but blurred to an adult. As you get into your 40s, you will probably need glasses (or longer arms) to read. And note how low the accommodative power standard is at 45.

Q9.  I am a Junior in ROTC. I go for my AF Flying Physical on the 24th and i have a question regarding my eyes. I have deep Optic Cups, so I have been asked many times if there is a history of glaucoma in my family (NO), and i had a visual periphery check and pressure test and all that, which all came back normal. So what can I expect the Flight Surgeon to say about this?

A.  There are standards for the width of the optic cup (an indentation in the optic nerve head as seen looking in the eye). There are no standards for the depth. As long as the width is within standards and there are no other abnormalities, I think you should be OK.

Q10.  In the AFI148-123 14Nov2000 it states that for UPT flying class I one must have 20/70 Uncorrected distance vision and no more than -1.5 refraction. As I understand it one must meet Class I standards to get into UPT. Currently my right eye needs -2.75 and left -2.5 correction. As far as the 20/70 line I can get about 50% of the letters right. On the civilian side I have about 800hrs flight time along with my single/multi engine commercial instrument ratings along with CFI, CFII, and MEI, which means I can teach others to fly. Looking at class II requirements the max refraction is -4.0 and 20/400. I definitely meet class II requirements. My question is it possible/likely that I might get some sort of waver to the class I requirements to gain eligibility to UPT? I should also mention that I have 5 years in the Army reserves at E-5 and am currently 24 years old.

A.  I hate to have to be the bearer of bad news, but this is outside the medical waiver process.  You do not meet standards for FCI and need to apply for an exception to policy, not a medical waiver.  The approval authority for exception to policy for vision and refraction standards for UFT is the Chief of Staff of the Air Force. (AFI 48-123 A7.7, Note 10).

Q11.  I recently took my Flying Physical for UPT and I can't pass the depth perception test (even with correction to 20/20). I have been told that I don't have "perfect" 20/20 vision, it is a weak one and just barely get it. I have read the AFI 48-123 on stereopsis and some of it is greek to me? Can I still go to pilot training? The waiver process sounds really intimidating. Do you know of anyone that has received this waiver before? Or anybody in Microtropia Study/ Management Group? Thank you for your time...greatly appreciated.

A.  The bottom line (FCI, FCIA, FCII): You need to either pass the depth perception test or get a waiver for substandard depth perception if you don't.  A brief simplified explanation of the depth perception test:

Depth perception screening tests the ability to tell which object is closer/further by the angle between your eyes. For this to work, both eyes must simultaneously focus on the object (visual fusion). In some people, one eye is sufficiently "dominant" that the information from the other eye cannot be used simultaneously. You can see OK with both eyes (tested individually), but when using both eyes together the "weak" eye gets semi-ignored so you don't get the angular information processed by the brain to tell depth. In other people, the brain switches rapidly from one eye to the other and never actually sees with both at precisely the same time. In either case, depth perception may be substandard.

If you fail the screening depth perception tests (including testing with corrective lenses), you need an extensive evaluation of your depth perception using a battery of tests. (See A7.11.2 below).

The tests can show
Normal depth perception
Substandard depth perception (of various degrees)
Lack of depth perception

If you have normal depth perception by the more extensive testing, you're pretty much good to go (with extra paperwork, of course). If you have substandard depth perception of a mild degree, you are a reasonable waiver candidate. If you have absent depth perception or substandard depth perception worse than mild, you are not likely to get a waiver.  I do know people who failed the screening depth perception test and went on to be approved for FCI.  Here's the waiver guide info:

Q12.  I failed the OVT depth perception test, however just recently took an alternative test, the Verhoeff test, at a local Navy Base for my UPT physical. Is this good enough? Or do I need to still be evaluated? I hope I'm in the clear on this issue and can get my physical off to the National Guard Bureau asap. Thank you once again for your time and your interpretation of the Regs.

A.  The bad news: You still need a bunch of eye tests.
The good news: If you pass, you should be OK.

The quote from the reg (note: you need ALL the tests mentioned performed, except they may do either the Randot or Titmus stereopsis test).  Failure of the Vision Test Apparatus (VTA-DP) or its newer replacement, the Optec Vision Tester (OVT), screening depth perception test with uncorrected refractive errors should be retested with refraction correction in place, regardless of level of unaided visual acuity. Failure even with correction is disqualifying, but may be considered for waiver consideration by higher waiver authorities, only after completion of a full evaluation by an ophthalmologist or optometrist, to include all of the following: ductions, versions, cover test and alternate cover test in primary and 6 cardinal positions of gaze, AO Vectograph Stereopsis Test at 6 meters (4 line version), AO Suppression Test at 6 meters, Randot or Titmus Stereopsis Test, Red Lens Test, and 4 Diopter Base out Prism Test at 6 meters. These tests are designed to identify and characterize motility/alignment disorders, especially microtropias and monofixation syndrome. The results of these tests done locally are considered to be preliminary, but will be used by waiver authorities to determine whether a candidate should be permanently disqualified without any waiver consideration, to identify if there are potentially correctable causes, and to determine whether further evaluation is required.  Good luck.

Q13.  I am sweating the color vision thing again and had a couple more questions:

A.  1) Any chance of getting a waiver from the Air Force, or an exemption from the requirement to pass the color vision (plates) exam (i.e. already commissioned, status as a naval aviator, can pass the FALANT, etc.?)

A: The AF has become very reluctant to waive substandard color vision. The AFI specifies that the AF no longer accepts the FALANT. The fact that you're commissioned won't help, but the fact that you demonstrated success as a naval aviator may help. What will happen in your case - only time will tell.

2) I assume the reserves fall under the same standards as the rest of the USAF. Do you think I have any chance of heading to UPT if I can't pass anything other than the FALANT?

A: FCI/FCIA/FCII are the same standards AD, ANG, and AFRC. You'll need a waiver for UPT if you can't pass the pseudoisochromatic plates.

3) Any suggestion of who I should contact if I get medically disqualified?

A: Request a waiver. This involves extensive color vision testing and submission of the results with an aeromedical summary.

4) Are Navy flight surgeons able to give the Flying Class I/IA exams.... or do I really have to have another long form exam done (latest longform/ekg/eye exam was 2 February 2002).

A: Yes, USN flight surgeons can do FCIs that the USAF will accept. If you had your "long" flying exam in your USN capacity, this is probably the FCII (remain qualified as pilot/nav) exam, not the FCI (become a pilot). The FCII leaves a few tests out, so you may have to add to the exam already done or do the whole thing over.

Q14.  I am in the USAF, flying for many years with glasses. Recently diagnosed with Keratoconus. I can still see 20/20 with glasses, but the next physical could be a problem. I have researched this problem, and I think I now know more than my eye doc on base about it. I looked into it on the web, and the Brooks AFB site says there are 85 of us (AF pilots) out there that wear RGP's to correct their vision. I have a feeling my doc has no idea about this, or how to treat it, and I have just gone with the flow, as he scratches his head in confusion over my eyes. Any advice? Ever hear of anyone out there with my prob? I still see very well with my glasses and am very confident when flying, but I have tried on RGPs, and my vision is far superior.

A.  First, the (probably) good news. In many people with keratoconus, the disease progresses slowly and you can probably continue to fly (with a waiver) as long as you can be corrected to standard. Yes, I've seen people with this condition. The fact that you can be corrected with just glasses is a helpful sign, but there are other considerations.

Now the bad news: The diagnosis alone (even if mild) is disqualifying and you will need a waiver.  RGP contact lenses are not authorized in the "usual" contact lens program. They may be authorized for a person with keratoconus, if that's what it takes.

If you have been no-kidding diagnosed with keratoconus, you should have been grounded and plugged into the waiver process already from how I see it. If you have a "topical pattern suggestive of keratoconus" as opposed to actual keratoconus, this makes a difference. (It may or may not ever progress to actual keratoconus but still needs to be followed).

Keratoconus is a disease of the cornea that results in it weakening and changing from a shape that is like a tangential cut from a sphere (to a first approximation) to a more protuberant cone shape (hence the name). In severe cases it can be so pronounced as to be visible when looking at the cornea from the side. It is thought to have genetic predisposition, but may affect the one eye and not the other or to different degrees. The amount of progression is variable. It might not progress at all (reasonable waiver candidate). In slowly progressive cases, you may just need a new prescription every couple of years (also reasonable waiver candidate). In more quickly progressive cases, you may need a new prescription every few months (this is a circumstance in which you would almost certainly not get a waiver approved). In severe cases, you're looking at a cornea transplant (which would not be waived).

Q15.  On the FCI physical, how does your normal eyeglass prescription (sphere/cylinder) differ from what goes on SF 88 under cycloplegic refraction. I notice it reads BY___ S.___ Cx___. What exactly are these values? Also, I had heard that the opthalmologist is supposed to record the prescripiton in positive cylinder. Could you explain this?

Q: On the IFC1 physical, how does your normal eyeglass prescription (sphere/cylinder) differ from what goes on SF 88 under cycloplegic refraction.

A: First of all, on any given day, if you have your eyes checked, you might get slightly different results. Secondly, when your lens can't play (the muscle that changes its shape is temporarily not active due to the eyedrops they put in for a FCI or FCIA), you might get a different result. Thirdly, there are two ways of expressing the correction for astigmatism and your glasses prescription uses one convention and the exam uses the other.

Here's what "BY___ S.___ Cx___." means:
The S is sphere (near or farsightedness) correction, the Cx is cylinder (astigmatism) correction with the axis of the cylinder in degrees.
Example:
By S. Cx
+0.25 +0.25 090

In the example, the individual had the best vision in this eye with a + 0.25 sphere correction and a +0.25 cylinder along an axis of 90 degrees (which could also be expressed as +0.50 -0.25 0 degrees).

Q: Also, I had heard that the ophthalmologist is supposed to record the prescription in positive cylinder. Could you explain this.

If you have astigmatism, there will be two correction numbers for lens strength and an axis for the second number.
- Sphere (S), for a spherical lens equivalent, which is equal correction in all axes.
- Cylinder (Cx), for a cylindrical lens equivalent, which corrects along one axis and has no strength at 90 degrees to that axis.

The Cx correction can be expressed as added to or subtracted from the S correction. These are two different ways of expressing the same information. Traditionally glasses are ordered in minus sphere and the exams are reported in in plus sphere. Here's an explanation:

3.  Physiological Conditions

Q1.  I have an active duty OTS/UPT slot and will be going for my class I physical soon. My question has to do with the regulations regarding the spine. I was told I have scoliosis in jr. high, so I recently went to a spine doctor to get the exact degrees and so forth. I was found to 18 degrees right lumbar idiopathic scoliosis measured by the Cobb method. I have read the regulation and I believe I am within limits. The thing that was concerning is the doctor said I also had an old compresion fracture at L1. I told her I never remember injuring my back and she said it probably happened when I was very young. Anyway, the diagnosis she gave me is this: Old healed L1 compression fracture with a 20.5% compression anteriorly that is completely asymptomatic. I have read the regulation on this and I'm not sure if a waiver is required or not. Any feedback on this matter would be greatly appreciated. Thank you sir.

A.  1. Your scoliosis is within standards.

2. A compression fracture of the spine does require a waiver. In the case of a single, healed, asymptomatic, <25% compression fracture, unrestricted waiver is possible.

A waiver request associated with an FCI, FCIA, or Initial FCII exam has to be approved by the AETC Command Surgeon's office. This is the same office that must approve all FCI, FCIA, and Initial FCII exams.  You and your local flight doc and staff can do the leg work to make sure the waiver request is complete.

Q2.  Based on the medical questions, it looks like there's a lot of scoliosis out there. I have it too, but I was lucky to get my waiver back in 1987; and I've been flying fighters since then.
But what about the airlines? I want to finish 20 years and then (hopefully) get hired by a major airline. Do they use the same standards as the air force? I have 23 degrees, asymptomatic, mid-thoracic scoliosis, with a permanent waiver. It's never been a problem so far - - but will it raise any questions for employment in the commercial airlines?

A.  I wouldn’t worry about your degree of scoliosis as far as the FAA medical certificate is concerned. On the civil aviation medical side, if scoliosis is not severe enough to interfere with function, it’s not disqualifying.

Quote from Guide for AMEs:

Now, some airlines are known for having their own physical standards that exceed FAA First Class requirements. While I can't speak for them, in general, if it's good enough for the AF, it's good enough for the airlines.

Q3.  I've got a flight physical coming up and have been out of the Air Force for a few years. I had surgery to remove a disc in my neck and it was replaced with a piece of my hip. Is this going to be a problem? I play golf, run marathons, and work in an environment where I am lifting heavy loads and I do this with no problems. Any information you can provide would be appreciated.

A.  The history of fusion is disqualifying and will require waiver. It does make a difference if you are an already qualified aviator (and thus are looking for a FCII waiver) versus want to become an aviator (and thus need a FCI or FCIA waiver). It also makes a difference if you are going for ejection seat aircraft or not.

There are 142 rated aviators in the USAF waiver file with the diagnosis of surgical fusions. Of these, 135 were waivered and 7 were disqualified. 75 aviators had cervical fusions, and 6 of these were disqualified. There were 27 flyers with lumbar fusions and 1 was disqualified. Four aviators had thoracic level fusions and none were disqualified.

Q4.  My Class 1 was just returned to my unit saying I needed a Neurological workup for a "moderate" head injury sustained 12 years ago. The injury was a brief loss of consciousness sustained playing hockey (yes, I was wearing my helmet). When I took my first physical I answered the questionnaire honestly and wrote down the details.  I can hear crewdogs laughing at me through the computer.  So, two questions: First, what will this workup entail?

Second, is this something I should worry about? I have been on flight status as a navigator for a while and have experienced no symptoms or had any adverse effects.

A.  The short version is that the head injury evaluation in your case should be the same as what you had done (or should have had done) for the same history when you first became a nav. The requirements for evaluation of head injury are the same for pilot and nav. Considering you’re over ten years out from the injury and had already been approved for FCIA, it should just be a matter of documenting the required test results and resubmitting the exam. The required tests are listed below.

There are a couple of reasons they worry about head injury. One is that you might have some points shaved off your IQ (thus the neuropsychological tests). Another is the possibility of post-traumatic seizure disorder. This is more likely with more serious injuries. That’s the reason for the 2 year observation period for moderate versus 5 or 10 years for severe head injuries. (A good predictor of not having post-traumatic seizure disorder is not having seizures over a period of time).
 

Depending on how long you were knocked out (and other factors) your injury may be classified as mild instead of moderate. This means less testing required.

If you can obtain medical records from the time of the injury, such as an ER report, hospital admission history and physical exam, doctor’s notes, or whatever that document the nature of the injury, time of loss of consciousness or amnesia, any test results, etc and the injury meets the criteria for mild head injury instead of moderate head injury, it’ll save everyone trouble.

Q5. I was wondering what the policy the Air Force has on STDs. I know about HIV, but what about the other ones. Serious question.

A.  Most STDs are disqualifying while active but not DQ once adequately treated. HIV, syphilis, and herpes warrant specific comments.  STDs in general (remember anything disqualifying for entry into the Service is automatically DQ for flying status).

Herpes is disqualifying while active. Topical acyclovir to treat herpes may be prescribed by a flight surgeon and is not by itself disqualifying.
Oral acyclovir to prevent/suppress herpes may be taken with a waiver.

Most other STDs are disqualifying while active and not disqualifying once adequately treated.

Q6.  Is it at all disqualifying if you have you Tonsils removed. And one more question regarding STDs. If a herpes outbreak is very mild and only one has occurred in three years and did not require any treatment does that still require a waiver.

A.  When you have an active herpes outbreak (with blisters, pain, etc), this is DQ. When it is not active, no problem. If you tend to get frequent outbreaks and take medication to suppress the disease, this is DQ but is waiverable as long as a ground trial on the medication (acyclovir) shows no side effects.

The short answer is that you are made DNIF because you have a condition that is (temporarily) DQ for flying duty.
People tend to think of DQ as the bad things that need a waiver for, but anything that makes you medically not legal to fly is (technically, at least) a DQ issue.

For example, if you have a cold and are taking OTC meds such as Nyquil, the fact that you are taking the medication is DQ.

You are usually made duty no to include flying (DNIF) because you have an illness that is disqualifying (DQ) for flying duty (even if only temporarily). DNIF functionally translates as “Can work but not fly.” As colloquially used it is often thought of as “temporarily off flying status.”

The AF Form 1042 has a box you can check for “Medically restricted from flying or special operational duty (DNIF)” but the two aren’t exactly the same. Something that is temporarily disqualifying may result in a duty status other than DNIF, such as hospital inpatient, quarters, convalescent leave, etc, which (technically) aren’t DNIF (i.e., when DNIF you can work but not fly). You can have a temporarily DQ condition that (technically, at least) doesn’t make you DNIF because you are not fit to work at all.


In fact, we provide additional information in certain cases. If someone has a condition that will have no effect whatsoever on alertness, thinking, judgment, etc, the flight surgeon may note “OK for SOF duties while DNIF” or whatever.

To further muddy the water, you may have a condition that makes you DQ for performing aircrew duties but OK to fly as pax. Technically speaking, this is not DNIF, either.

Q7.  Can anyone tell me what the requirement (AFI) for knee range of motion (extension/flexion) is for the the FC1 or entry into service? Are they different? I had knee ligament reconstruction surgery (PCL) last week and am wondering what is considered normal according to the Air Force.

A.  Knee range of motion standards.  For entry into Service:

For flying status:

BTW, a normal knee will flex well over 90 degrees, but that’s all you need to meet standards. Full extension = straight, i.e., 0 degrees.

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