IBS/IBD (Irritable Bowel Syndrome/Disease)

[Spartacus]

Doc,

Is IBS (irritable bowel syndrome) a DQ condition for pilots?

[Guest doctidy]

irritable bowel syndrome is disqualifying.

[Guest Piperpilot2004]

no waivers huh? I only get it when I eat certain foods. I know IBS is common in my family, its hereditary(im sorry long day cant spell tonight). Maybe I should get some tests done or maybe just quit eating those foods. Usually any meats. Um, it could be on my record though because my mom told the doctor about my "little problem" when I was younger.

[ 25. March 2005, 22:48: Message edited by: Piperpilot2004 ]

[Spartacus]

PP2004,

That may not be what you have. I went to the doc and that is not what I have. I'm no doc but I'm sure if that's what you have either.

[Guest F16PilotMD]

Please don't waste your time worrying until you have a DIAGNOSIS. If you have been formally diagnosed with UC, you are DQ. If not, who knows....

[Guest spar91]

what's UC?

i'm fairly certain i have ibs too. the flt doc does *not* suggest i get a workup to get an official diagnosis, becuase if it is determined that i in fact have ibs, i would loose my pq. then what would i do?! i think a workup (is that what they're called?) would be beneficial, however, because wouldn't it help rule out other problems?

how many pilots fly with self-diagnosed ibs i wonder?

my question is what is the big deal with ibs - why is it dq? i mean, on any heavy jet you have a bathroom. if you need to go, you can.

[Scooter14]

Ulcerative Colitis?

Holiday Inn Express last night...let's see if it paid off.

[Guest doctidy]

IBS can be and is waived frequently.

What is the big deal? In most folks there isn't one...and they get a waiver. In some, it is way more than just going to the bathroom. Those folks don't get a waiver.

[Guest spar91]

rage - i'd sure like to know which flt docs "frequently waive" ibs. i was told by the docs at ktcm that it isn't waiverable.

please pm me if you have any more detailed info!

thanks

[Guest JoeMama]

Okay...IBS and IBD are two different things.

IBD is inflammatory bowel disease and basically includes Crohn's Disease and Ulcerative Colitis. I'm not a "flight" doc, I would imagine a waiver for either one of those would be difficult, if not impossible to get (at least for the FC1). They're also important diseases to diagnose, because of the increased risk of colon cancer among other things.

IBS, or irritable bowel syndrome, is a vague disease. The only reason you get a workup is to make sure you don't have something more serious, like IBD. If the workup comes back NORMAL, and you're still complaining of diarrhea/constipation etc, you may be labelled with the diagnosis of IBS.

The bottom line is that it's important to make sure nothing more serious is going on. If your workup is negative, and if you get labelled with IBS, probably the biggest thing determining whether you get a waiver for IBS or not is the whining factor. If your symptoms are mild, and if they can be controlled with simple diet changes and good stress management, then you're far more likely to get a waiver.

One more thing...a lot of people with IBS have worsening symptoms with stress. If you're one of those people who has bad GI symptoms with daily stresses, you probably won't be able to take the daily UPT beatings and still go out and fly.

[Guest F16PilotMD]

Thanks Jordan. I looked back at this thread and just realized we've strayed between the two. Sorry.

AFI48-123:

A7.19.1.11. Crohn’s disease (regional enteritis).

A7.19.1.12. Malabsorption syndromes (see paragraph A7.28.).

A7.19.1.13. Irritable bowel syndrome.

A7.19.1.14. Ulcerative colitis or proctitis or verified history of same.

A7.19.1.15. Chronic diarrhea, regardless of cause.

USAF Waiver Guide:

https://www.brooks.af.mil/web/consult_servi...e%20Colitis.htm

https://www.brooks.af.mil/web/consult_servi...s%20Disease.htm

https://www.brooks.af.mil/web/consult_servi...%20Syndrome.htm

[Guest Broke-College-Guy]

Hi guys! First time poster but long time viewer. I've got a question concerning IBD/IBS. I saw the thread that was started a few months back but still have a few questions...so I'll just get right to it.

About 3 years ago I had a colonoscopy done b/c there were small traces of blood in my stool. Being a young guy and not knowing a lot about medicine I wanted to know what was going on with my body. So the AF sent me down to get a scope. No big deal I thought, the doc said everything was fine, said it was about the smallest form of colitis that he had seen..if he even wanted to call it that. Fast forward 2 months to where I try to cross-train into the aerial gunner field. I'm told I can't take the flying physical b/c I have IBS/IBD..and I'm honestly not sure which one I have in my file. I never heard those words out of my Doc's mouth but apparently that's what went in my file. The flight doc said I would have to be re-scoped in a year and try then. Well, I seperated and here I am today starting ROTC in the fall. I'm going for the pilot/nav slots and I'm afraid this is going to screw me again. I say screw me again b/c here I am 3 years later and I have no problems, I didn't think I had one when I went to cross-train either. I don't go to the bathroom anymore than the next guy and I eat whatever I want. I tried reading some symptoms on the net for IBS/IBD and don't see how thats me.

I guess what I really wanted to know after all of this rambling is what should I do? I know it's in my file and will be flagged when that comes up. I do NOT know which one I was diagnosed with (that should tell you how big of a problem it is haha) IBD or IBS. I read where IBS was waiverable but IBD and or Colitis was automatic DQ. I mean I can't just say .."I'm ALRIGHT" haha. I know this can't be taken off my record but what do you guys sugest I do? Should I just hope and pray for a waiver(I guess I should hope it's IBS first ) or is there anyway to get this fixed....as in, "I'm here saying I have no problems and don't know HOW that IBD or IBS made it in to my file??"

Sorry for the rant but I was devestated when I was going to re-train and then BAM...no re-train. Just wanting to know what to expect. Any input would be appreciated

[Guest doctidy]

You have a problem we see here all the time...someone said I have this but I don't. The answer is the same...you get a gastroenterologist to give a different opinion. The key here is if there were any biopsies done. If there was, and histologically (cells under the microscope) it shows inflammatory bowel disease...it will be a hard fight.

The gastroenterologist should address...Diagnosis, Prognosis, Treatment.

[GuardBummer]

Thread revival.

A few questions for the medical bros out there.

I am a current and qualified pilot (32 years old) that is about to be diagnosed with colitis. I say "about" because i was referred to a gastroentorologist today after getting my colonoscopy results back. Those results indicated "chronic active colitis with an area of cryptitis" in the rectum. The rest of my colon was normal.

I have gathered that I will likely be DNIF until I get this figured out. I'm assuming that I'll likely need a waiver.

So:

1. How hard (sts) is the waiver to get?

2. How long (sts) will it take to get?

3. Any suggestions on how to fight this battle?

Thanks.

[Guest]

1. Waiver for trained pilots is nearly a guarantee. I pulled a report for approved or dq'd waivers from the 2010 to present, excluded retired/expired. Trained Pilots have a 95% waiver approval rate. Read the Ulcerative Colitis section of the waiver guide (linked in my signature), then read about Crohn's Disease and be glad you don't have that. There's a LOT of good info in the waiver guide.

2. Waivers are highly subjective and individualized--that's why they're waivers and not the standard. At a guess, 30 days after you complete all the required exams and follow-ups, which may be 45 days for all the primary eval's. Anticipate 75 days+.

3.a. How to fight the symptoms of UC and your long term health? Talk to your doc. (I know this isn't what you're really asking, but I wanted to clarify)

3.b. You don't fight the Flight Surgeons--you work with them to get all your consults and documentation completed quickly and proactively change your lifestyle (diet/medications/etc.) to make your case the best it can be.

[GuardBummer]

You were not kidding. This waiver guide is very informative.

Thank you for the quick reply.

[HFF]

Hey guys,

Another thread revival here. I'm a (civilian) instrument rated private pilot with a 1st class medical and I'll be applying to heavies guard units after I graduate from college. I may have been diagnosed with IBS last year by my primary care physician. I went to him complaining of occasional stomach upset more than the average person (I know, I'm an idiot). He did some tests and blood work but everything came back negative, so I guess he diagnosed me with IBS. My understanding of IBS is that it's the doctor telling you "you have stomach aches but I haven't a clue why". My guess is it's triggered by diet although I'm not really sure. The stomach aches are mild-moderate and usually don't last longer than 30 minutes, but they are somewhat unpredictable. They seldom happen (maybe 2-3/month, if that) so I don't really see it being an issue when it comes to flying, especially since heavies have bathrooms. There's no physical evidence of illness, the numbers say I'm healthy as a horse. The only reason this is an issue is because I didn't keep my mouth shut. I've had these my entire life and recognize the pain as something different than simple indigestion, so I wanted to finally go in and make sure nothing was seriously wrong with me, not thinking of course about the impact it could have on my flying career.

So, what's do you advise I do next? If I'm stuck with this diagnosis, how hard is it to get a waiver?

[Guest]

I'm presuming you're talking about an AF FCI physical/clearance, and not the FAA. If you only have FAA, you're in an entirely different situation.

The waiver guide has a specific entry for IBS (again, link in my signature block). If you were already approved for FCI previously, you'll get FCII's from now on (trained). You will not need to re-accomplish the FCI if you've maintained currency of your 1042/clearance.

Likelihood of waiver is highly dependent on severity of the condition. Read the waiver guide; I'm guessing you don't have much to worry about. Also read the waiver guide to better understand the condition. Review your medical records and verify that the diagnosis was IBS and not UC or another condition.

Additionally, history of IBS is not disqualifying, just presence of, and you might not even need a waiver if your symptoms have improved and you can get the Flight Doc/Gastroenterologist to rule it out. Chances of that though are likely low.

[GuardBummer]

Starting to figure out what I need to do to get rolling on my waiver. Couple of questions:

The diagnosis was UC present in less than 15cm, confined to rectum.

1. I have been perscribed 40mg of Prednisone, tapering over 6 weeks, as well as Lialda. I will continue the Lialda for maintenance if, in fact it produces results. Do I have to wait until I am finished with the Prednisone before waiver submission?

2. Will I have to have another colonoscopy to inspect for remission?

3. How long is the initial waiver good for?

4. Finally, if the disease presented itself while on AD over 30 days, should I expect MEDCON or INCAP until I get back on flying status?

I know these are great flight doc questions, but I have to wait until drill weekend to see one.

Thanks.

[Kenny Powers]

2. Will I have to have another colonoscopy to inspect for remission?

Not a doc but my wife has UC. All the civilian doctors we have seen wanted to do this, pretty much saying it's too difficult to determine what is going on without actually going in and taking a look. Feeling "better" is subjective, hard to determine if you are fully in remission. Based on the results of the scopes, they adjusted her treatment (more aggressive at first to help get into remission, then backed it off once in remission). Pretty sure doing another scope one year after initial diagnosis was their standard.

Also, now that you have UC, they claim you are at much higher risk statistically for colon cancer. Annual scopes starting at like year eight (since initial diagnosis) have been highly recommended by our docs.

Edited March 27, 2013 by Kenny Powers

[Guest]

1. I have been perscribed 40mg of Prednisone, tapering over 6 weeks, as well as Lialda. I will continue the Lialda for maintenance if, in fact it produces results. Do I have to wait until I am finished with the Prednisone before waiver submission?

You likely won't be submitted for waiver until you are a bit more stable. The doc could request waiver this early, but the answer would likely be to re-submit in a few more months. I only see Lialda on the "Approved Aircrew Medications" list, however Motrin would probably know more about this.

2. Will I have to have another colonoscopy to inspect for remission?

Again, I hope Motrin jumps in to this discussion--I would presume you'll need another colonoscopy once your condition is close to Optimal Medical Benefit (OMB) for your best chance at waiver.

3. How long is the initial waiver good for?

Waivers are usually annual. I've seen VERY few for less than 365. Only well-known conditions (e.g. Sleep Apnea, chronic back pain, etc.) or when the pt. has had the condition for a very long time and it is highly stable will get waivers for over 18 months.

4. Finally, if the disease presented itself while on AD over 30 days, should I expect MEDCON or INCAP until I get back on flying status?

I'm not very familiar with Reserve/Guard procedures regarding waiver/MEB processing, but know that you will almost certainly undergo MEB and have an AAC 37 for the next few months. What personnel/MPF action that triggers is beyond me. Edited March 27, 2013 by deaddebate

[cessnaguy]

Hey all,

I have a question about IBS. I'm in college and have wanted to be a guard pilot for awhile now. About a year ago my IBS got really bad, to the point where I was having 1-2 splitting stomach aches per week. I went to some doctors, seriously cleaned up my diet, and started taking a probiotic. Fortunately, I've been doing really well lately and have had ZERO symptoms in 3 and a half months.

As I understand it, IBS is disqualifying but waiverable. The definition of IBS is 3 or more stomach aches per month. Since I haven't had a stomach ache in over 3 and a half months, I fall outside the diagnosis. However, IBS is on my medical record and I was prescribed medication for it last year. I haven't taken any of it in months. Is there anything I can do now to increase the chances it will be waived?

Thanks for the help.

Edited May 12, 2014 by cessnaguy

[deaddebate]

Though you may be heavily tempted to lie about your medical history to improve your short term chances to join, you would be risking a great deal, especially if you require significant medical evaluation or care in the future. Be honest with your recruiter and all medical personnel.

According to the AF Waiver Guide, IBS is defined using the "Rome III diagnostic criteria," which states:

Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more of the following:

- Improvement with defecation

- Onset associated with a change in frequency of stool

- Onset associated with a change in form (appearance) of stool

At the most basic, it is characterized as "abdominal discomfort or pain associated with disturbed defecation." Therefore, various doctors may over- or under-diagnose IBS, or may use it as a place-holder while they continue to find the actual diagnosis. Further, doctors may diagnose IBS when they are never actually able to to find the cause of particular symptoms, but a definitive coding of IBS looks better in medical records for insurance agencies instead of something non-descriptive like "Abdominal pain unspecified site."

The first step is to gather all medical documentation of your evaluations relevant to your condition, particularly visits to any Gastroenterologists (GI). If you haven't been seen by a GI or your PCM for this condition, it wouldn't hurt to be seen again to be able to provide recent documentation. If seeing a specialist would be expensive or difficult for you, you could delay it until after you submit everything to MEPS or MTF via DODMERB (or whoever the Medical Authority will be).

Next is whether you will be eligible to join. DODI 6130.03, para. E4.13.c.6. states:

Current or history of irritable bowel syndrome (564.1) of sufficient severity to require frequent intervention or prescription medication or to interfere with normal function.

Then is the standard for flying duty in the Medical Standards Directory, which states:

[...]unless asymptomatic and controlled by diet alone.

If you don't meet that standard, unfortunately there is no waiver potential for an IFC I (meaning an applicant/untrained noob). Waivers are only possible for FC II (meaning trained personnel already in the AFSC).

In short, assuming your story is accurate, I'd guess you have a 90% chance of clearance. Of course patients often lie and some Docs are sticklers.

[moose416]

I wanted to bring this thread back up to see what the best course of action for my condition would be. I was diagnosed with IBS when I was around 10 or so. It only occurred when I ate greasy foods (sausage/bacon/etc). Around when I was 13 or so, it just went away completely, and I haven't had a single issue since. I was also diagnosed by my pediatric doctor and never went to a specialist or any real tests done, but it is on my records as IBS. I am 26 now and haven't had a single issue in over 13 years. Do I need to go and see a specialist and get tests done to show that I don't have this condition anymore?

 

Also, is this correct that a waiver isn't even possible anymore?

From: Air Force Waiver Guide 6 Mar 2019.docx

I. Waiver Consideration. IBS is disqualifying for all classes of Air Force flying to include ATC/GBC and MOD personnel, as well as for retention. Due to the chronic and unpredictable nature of the disease, it is not wise to consider aviation applicants with the history of IBS for any flying class or position. These folks do not fare well with many stressful positions and run the risk of not being available, on short notice, for many sorties. For trained aviators with mild symptoms easily treatable with diet or other non-pharmacologic therapies, waiver can be considered. There are some cases that can be controlled on approved medications; these aviators can also be considered for a waiver.