Air Force Flying Physical
Medical Examination Standards
Neurological Disorders.
Flying Classes II and III.
Infections of the CNS.
Seizure of any type (grand mal, petit mal, focal, etc.).
Disturbances of consciousness (not due to head injury).
An isolated episode of neurocardiogenic syncope associated with venipunture or prolonged standing in the sun (or similar benign precipitating event) which is less than 1 minute in duration, without loss of continence, and followed by rapid and complete recovery without sequelae does not require waiver if thorough neurological and cardiovascular evalua tion by a flight surgeon reveals no abnormalities.
Physiological loss of consciousness (LOC) caused by reduced oxygen tension, general anesthesia, or other medically induced LOC (excluding vasovagal syncope) does not require waiver provided there is full recovery without sequelae.
High G loss of consciousness (G-LOC) during a centrifuge run does not require waiver for continued flying duty unless there are neurologic sequelae or evidence that the G-LOC occurrence is associated with coexistant disease or anatomic abnormality. Inflight G-LOC caused by an improperly performed anti-G straining maneuver or a disconnect of the anti-G protective gear is not disqualifying and is managed as a physiological incident. The local flight surgeon completes appropriate post-incident medical evaluation and reports the incident according to applicable directives.
All other loss or disturbance of consciousness. For rated personnel, waivers are considered by AFMOAISGOA only after evaluation at ACS. For non-rated personnel, waiver is at MAJCOM discretion.
NOTE:Flying training applicants and students with a history of syncope evaluated according to table 16.1 and certified acceptable for Flying Class I or IA by HQ AETC/SG do not require a waiver for flying Class II for the same history of syncope.
History of any of the following types of headaches:
1. Recurrent headaches of the vascular, migraine, or cluster (Horton's cephalgia or histamine headache) type.
2. A single incapacitating headache of any type (e.g.,loss of consciousness, apha sia, ataxia, vertigo or mental confusion).
3. Headache of any type which are of sufficient severity to likely interfere with fly ing duties.
4. Acephalgic migraines.
NOTE:A waiver for migraines may be considered following one year of symptom free observation. Migrainous strokes and migraines complicated by neurological deficits other than transient visual changes are not waiverable.
Electroencephalographic abnormalities.
Truly epileptiform abnormalities to include generalized, lateralized, or focal
spikes, sharp waves, spike-wave complexes, and sharp and slow wave complexes
during alert ness, drowsiness, or sleep are disqualifying. Benign transients
such as Small Sharp Spikes (SSS) or Benign Epileptiform Transients of Sleep
(BETS), wicket spikes, 6 Hertz (Hz) (phan tom) spike and wave, rhythmic temporal
theta of drowsiness (psychomotor variant), and 14 and 6Hz positive spikes are
not disqualifying.
Generalized, lateralized, or focal continuous polymorphic delta activity or
inter mittent rhythmic delta activity (FIRDA or OIRDA) during the alert state
is disqualifying unless the etiology of the abnormality has been identified
and determined not to be a disqual ifying disorder.
History of head injury.
Head injury associated with any of the following are not waiverable:
1. Post-traumatic seizures. (Exception: seizures at the time of injury)
2. Persistent neurological deficits indicative of significant parenchymal CNS
injury, such as hemiparesis or hemianopsia.
3. Evidence of impairment of higher intellectual functions or alterations of
personality as a result of injury.
4. Cerebrospinal fluid shunts.
Severe head injury. Head trauma associated with any of the complications listed
below may be considered for Flying Class II and III waiver in 5 years:
1. Unconsciousness or amnesia or the combination of the two equal to or
exceeding 24 hours duration.
NOTE: In cases which are defined as severe only due to the duration of
loss of consciousness or amnesia and are otherwise minimal, mild, or moderate,
a waiver at 2 years may be considered.
2. Radiographic evidence of retained metallic or bony fragments. A7.23.l.6.2.3.
Leptomeningeal cysts, aerocele, brain abscess, or arteriovenous fistula.
3. Depressed skull fracture (the inner table indented by more than the thick
ness of the skull) with or without dural penetration.
4. Traumatic or surgical laceration or contusion of the dura mater or the brain,
or a history of penetrating brain injury.
5. Focal neurological signs.
6. Epidural, subdural, subarachnoid, or intracerebral hematoma.
NOTE: A small epidural collection of blood found only on CT-scan or magnetic
resonance imaging (MRI) and without evidence of parenchymal injury either on
the imaging study or on neurological examination, fol lowed to resolution without
surgery, may be considered for flying class II or III waiver at two years as
in the moderate head injury group.
7. CNS infection such as abscess or meningitis within 6 months of head injury.
8. Cerebrospinal fluid rhinorrhea or otorrhea persisting more than 7 calendar days.
Moderate head injury. Head trauma associated with the below criteria may be considered for Flying Class II or III waiver in 2 years.
1. Unconsciousness for a period of 30 minutes or greater, but less than 24 hours.
2. Amnesia for a period of 1 hour or greater but less than 24 hours. (Waiver contingent on a completely normal neurological and neuropsychological evaluation to include computerized tomography (CT) scan.)
Exception: Waiver may be considered after 6 months of observation if a normal CT-scan was obtained within 2 calendar days of injury.
NOTE:In cases which are defined as moderate only due to the duration of loss of consciousness or amnesia and are otherwise minimal, mild, a waiver at 6 months may be considered.
Mild head injury. Head trauma which does not meet criteria for more severe injury may be considered for waiver after 1 month.
Head trauma with no loss of consciousness, amnesia, or abnormal findings on examination, does not require waiver.
Persistent post-traumatic sequelae, as manifested by headache, vomiting, disorienta tion, spatial disequilibruim, personality changes, impaired memory, poor mental concentration, shortened attention span, dizziness, altered sleep patterns, or any findings consistent with organic brain syndrome are disqualifying, but may be considered for waiver when full recovery has been confn-med by complete neurological and neuropsychological evaluation.
Craniotomy and skull defects.
Neurosyphilis in any form (meningovascular, tabes dorsalis, or general paresis).
Narcolepsy, cataplexy, and similar states.
Injury of one or more peripheral nerves unless it is not expected to interfere with nor mal function in any practical manner.
History of subarachnoid hemorrhage, embolism, vascular insufficiency, thrombosis, hemorrhage, arteriosclerosis, arteriovenous malformation, or aneurysm involving the CNS.
History of tumor involving the brain or its coverings.
Personal or family history of hereditary disturbances such as multiple neurofibroma tosis, Huntington's chorea, hepatolenticular degeneration, acute intermittent porphyria, spinocere bellar ataxia, peroneal muscular atrophy, muscular dystrophy, and familial periodic paralysis.
Probable evidence or history of degenerative or demyelinating process
such as mul tiple sclerosis, dementia, basal ganglia disease, or Friedreich's
ataxia.
History or evidence of such defects as basilar invagination, hydrocephalus,
prema ture closure of the cranial sutures, menmgocele, and cerebral or cerebellar
agenesis if there is evt dence of impairment of normal functions or if the process
is expected to be progressive.
Verified history of neuritis, neuralgia, neuropathy, or radiculopathy, whatever
the etiology, unless:
The condition has completely subsided and the cause is determined to be of no
future concern.
There is no residual which could be deemed detrimental to normal function in
any practical manner.
Polyneuritis, whatever the etiology, unless:
Limited toa single episode.
The acute state subsided at least 1 year before examination.
There is no residual which could be expected to interfere with normal function
in any practical manner.
History or evidence of chronic or recurrent diseases, such as myasthenia gravis,
p01- ymyositis, or myotonia disorder.
Evidence or history of involvement of the nervous system by a toxic, metabolic
or disease process if there is any indication such involvement is likely to
interfere with prolonged normal function in any practical manner or is progressive
or recurrent, or if there is a significant neurological residual which would
interfere with aviation duties.
Tremors, chorea, dystonia or other movement disorders which could interfere
with aviation or normal function.
Flying Classes I and IA. In addition to the above, paroxysmal convulsive disorders.
Sei zures associated with febrile illness before 5 years of age may be acceptable
with waiver if recent neu rological evaluation, MRI, and electroencephalogram
(EEG) including awake and sleep samples are normal.
AHistory of severe head injury is usually not waiverable and may not be considered
until at least 10 years post injury.
Information derived from Air Force Instruction 48-23, Current as of Dec 2000.
