Crohn's Disease and Getting a FCI/FCII: What Are My Chances?

[Mike34]

Hello all,

I have been doing research for a few months now, and I am now adamant about joining the ANG. I would like to apply as a civilian to a fighter squadron when they have a position available. I am currently a civilian flight instructor with 400 hours flight time and I hold a First Class FAA Medical Certificate. While conducting research, I have found that the military medical standards, especially for flight, are high. Back in 2008, I was diagnosed with Crohn's Disease after suffering from mild abdominal pain. I was put on Remicade treatment, and I still receive that every 2 months to keep the disease in remission. I consider myself fortunate, as the only side effect of the disease that I've experienced was the mild abdominal pain due to inflammation in a small portion of my small intestine. I have never been hospitalized, I've never had a "flare-up," never had an operation. A recent procedure revealed that the disease is almost in complete remission. With that being said, what are my chances? Remicade is an approved USAF medication. My disease is almost in complete remission. I've never had any adverse side effects. I have yearly examinations to make sure everything is working properly. I have years worth of documents and pictures from previous procedures stating/showing that I am in good health. I have been granted a First Class Medical from the FAA. I am hoping all of this will have some weight when and if I apply for a waiver (which I am going to need). If I can't get an FCI, I would consider flying heavies, which from my research requires at minimum an FCII. What are my chances of getting the FCII? If the FAA will let me operate a massive metal tube for 15+ hours with 300 human beings in the back some day, shouldn't I be able to fly with tanks and cargo behind me or with bombs and missiles under me? Thanks for your time.

Mike34

[Guest]

Somebody correct me if any of this is wrong (if JCJ would supplement this, I'd appreciate it). I hope you expected an honest and blunt answer, because that's what you're going to get.

I have found that the military medical standards, especially for flight, are high.

Very true--that's been a major concern for many applicants for many years.

Back in 2008, I was diagnosed with Crohn's Disease after suffering from mild abdominal pain. I was put on Remicade treatment, and I still receive that every 2 months to keep the disease in remission. I consider myself fortunate, as the only side effect of the disease that I've experienced was the mild abdominal pain due to inflammation in a small portion of my small intestine. I have never been hospitalized, I've never had a "flare-up," never had an operation. A recent procedure revealed that the disease is almost in complete remission. With that being said, what are my chances?

Dismal.

Remicade is an approved USAF medication.

However you found that information, I hope you or the technician looked at the notes section where it specifically states "No initial flying class waivers."

My disease is almost in complete remission. I've never had any adverse side effects. I have yearly examinations to make sure everything is working properly. I have years worth of documents and pictures from previous procedures stating/showing that I am in good health. I have been granted a First Class Medical from the FAA.

I'm glad you've been able to manage your disease and pursue a civilian career.

I am hoping all of this will have some weight when and if I apply for a waiver (which I am going to need).

It does mean a bit, in that you demonstrated skills and have experience. That is much more important to whatever selection/application board you pursue, but matters minimally to the medical folks.

If I can't get an FCI, I would consider flying heavies, which from my research requires at minimum an FCII. What are my chances of getting the FCII?

Regardless of your civilian flying experience, you are considered an "untrained asset" to the Air Force. You must process through UPT, and you must get a FCI for any initial pilot position despite the aircraft type. FCII is only applicable to "trained," currently serving military pilots.

If the FAA will let me operate a massive metal tube for 15+ hours with 300 human beings in the back some day, shouldn't I be able to fly with tanks and cargo behind me or with bombs and missiles under me?

Unfortunately, your logic here is flawed. First and foremost, the purpose of the FAA is oversight of civilian aviation. Their policy focuses on the duration of the flying clearance, meaning somebody with a diagnosis as severe and deadly as ALS could conceivably still retain a FAA clearance for the short window they managed to get a waiver. Now, would they be flying for very long? No, at most, the waiver would be good for a few months. But that difference in ideology supports and enables the American commercial trade, tourism, and aviation model. The substantially more stringent Air Force standards support a defense model.

When you Commission, the Air Force will be buying you and your medical care. Despite Guard status vice Active Duty, you will be activated semi-regularly and the cost of your care and your eventual VA benefits/claims will be no small amount. Further than that, service in the USAF carries much more than just flying around Podunkville, Iowa. The standard stems from the expectation that you will be able to successfuly adapt to the rigors of the military lifestyle and perform in austere, deployed environments for a prolonged time without access to medical care. Whether you ever actually deploy or not doesn't matter for this waiver. The nuclear warheads in silos in Montana and Wyoming must maintain readiness and the capability to perform their mission despite the immense likelihood they will never be used. The same mentality applies to servicemembers--you are expected to be able to meet a standard (deployment), regardless of your actual future assignments. And ideally, you will remain in the Air Force for a full career--the medical potential for that career is assessed as well. Let's contrast all that with the following statements, straight from the AF waiver guide:

Crohn’s disease is incurable, progressive, and unpredictable with the very real potential for progressive systemic degradation. The uncertain nature of the disease, side effects of medication and need for surgery are obvious aeromedical concerns. [...] Flyers with infrequent symptoms not requiring long-term medical therapy may do well and it may be safe to consider a waiver for such cases, but in general, prognosis for a full career staying on flight status is guarded.

But hey, if you look at the other threads (or were those private messages?), you'll see I've made multiple mentions to waiver possibilities for supposedly "non waive-able" conditions. Despite whatever the reg says, often a waiver squeeks through due to a very talented FS writing a very good waiver, or some line support pushing for an exemption, or the waiver guide entry is simply outdated and the current policy shows a trend of approval. So looking at the waiver system, we find the following:

Since ~2001, only 2 people have ever applied for a FCI waiver with a Crohn's dx. Both of them were disqualified. Nobody has applied for a FCIA waiver for this condition in the ~15 years. Now FCII (all variants) is much more rosy. In 2014 alone, 10 FCII waivers were requested, 9 were approved and only one disqualified, and that individual had multiple diagnosis. If it were just Crohn's alone, the applicant likely would have been approved. Why is there such a massive disparity?

Well, including all the reason's above, there's one other massive hurdle you face (as well as the other 2 FCI applicants previously mentioned, which will explain why there were so few). DODI 6130.03, E4, para 13.c.(1) unsurprisingly states Crohn's disease is disqualifying for entry to the armed forces. You need a commissioning waiver before you can even attempt a FCI application. That hurdle might be possible if you were seeking a non-flying AFSC, but otherwise it is a nail in the coffin for an initial pilot applicant.

So after all this, my advice to your adament determination is that you apply for the waiver, get denied, and then pursue the very slim chance of an Exception to Policy (read the other thread here in the medical subforum about ETP's). You've got slightly better odds at getting that ETP than winning the lottery, so there's that. A final word on the number of FCII applicants that were approved above, 9 is a very small number of waivers and despite a 90% acceptance history, the sample size is very small. Very few people develop this condition once in the Air Force, and that is apparently an acceptable level to the current mission of the Air Force. And of those 9 and the multiple other folks that got a waiver before them, it is very likely some did not reach retirement in the Air Force even after developing their condition some years into their career. Many probably got separated some years after initial diagnosis. Thus extracting and extrapolating that number of approvals to an ETP package is still a hard sell.

[jcj]

short answer - I agree with @deaddebate.

slightly longer answer - the FAA is concerned primarily with a pilot being able to safely (from a medical standpoint) execute the duties of their airman's certificate for the duration their medical certificate is valid, with an additional concern of advising pilots on factors that may affect their overall health. Besides being able to safely operate military aircraft, the military is concerned with medical suitability for military duty, including deployability, ability to operate in austere environments and longevity of a potential military career. The FAA medical certification process doesn't address that. Unfortunately, it's difficult to imagine a diagnosis of Crohn's disease being consistent with a military career - particularly with the risk of exacerbations and need for immunosuppressants such as steroids. This is especially true in that Crohn's is a chronic disease that is never cured, only controlled.

I did look at the latest FAA AME guide (current version always available at https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/)- as you well know (but other readers may not) Crohn's disease is not necessarily disqualifying for FAA medical certification - depending on severity. In some cases the medical certificate can be issued by the AME, in others it requires deferral to the FAA with follow-up certification possible in many cases by an AME. But as deaddebate points out in detail, military considerations are different from the FAA.

good luck

(my background - general surgeon, civilian pilot, former Navy corpsman with aeromedical experience, in training pathway for FAA AME designation).