Ask the Flight Surgeon / MAJ Theresa M. Long: Q: I am a senior UH-60 pilot who was recently permanently grounded for chronic lower back pain after having lumbar disc fusion.
I still have some recurrent numbness, tingling and pain in my legs that requires treatment with a drug called Gabapentin. I currently have a P2 for no sit-ups and an alternate aerobic event. I have a friend in the Infantry who was sent to the medical evaluation board (MEB) and medically retired for almost the exact same thing. Why doesn’t my flight surgeon submit me for an MEB too?
Photo Credit: U.S. Army
FS: This is an excellent and common question. It is important to understand that Soldiers are referred for an MEB when 1.) they have a P3 profile that indicates they are unable to perform one or more of the functional Soldiers tasks, such as wearing body armor, and 2.) their medical condition has reached the medical retention determination point (MRDP). MRDP is reached if the medical condition has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. This is in accordance with AR 40-502 Medical Readiness.
The Army compensates Soldiers only for the conditions that ended their career, and the Department of Veterans Affairs compensates Soldiers for the conditions that impact their life. The percent disability is awarded according to the Veterans Affair Schedule Rating of Disabilities (VASRD). There are four potential outcomes from a medical evaluation board: 1) unfit- separated from service 2) unfit- medically retired and 3) retained on active duty within the limitations of their profile and 4) temporary duty retirement list (rare).
Unfortunately, some medications, like Gabapentin, are not compatible with flight status given side effects that pose a significant safety risk in flight such as cognitive impairment, sedating effects, decreased reaction times and degraded overall performance. However, that does not mean that your Army career is over. There are still numerous other non-flying positions you can be assigned to. However, if you cannot perform any of the functional Soldiers tasks, you are required to be issued a P3 profile and referred to the MEB.
I recommend that you make an appointment with your aeromedical provider and go over your profile limitations and treatment options. Meeting with your healthcare team is necessary to determine if you can perform all functional Soldier tasks and are appropriately profiled.
Background on Intervertebral Disc Disease
Intervertebral Disc Disease (ex: herniated nucleus pulposus, bulging disc, degenerative disc disease, foraminal impingement, spinal stenosis) is a frequent finding on advanced imaging in all populations regardless of presence or absence of symptoms like numbness, tingling or shooting pain. Research indicates that about half of 50-year olds who have no back-pain symptoms, will have a herniated disc on MRI. Furthermore, about 80% of all back pain completely resolves in a couple of months. Therefore, MRIs or x-rays are not generally ordered on your first visit to the healthcare provider for back pain. Back pain among aircrew members is not uncommon and research is ongoing as to possible causes and their mitigation. Degenerative changes of the neck and back have been associated with a higher number of accumulated flight hours. There have been investigations on a possible relationship between whole body vibration (WBV) induced during helicopter flights, degenerative changes and the potential synergistic effect with poor in-flight postures. I recently did a data analysis examining whether UH-60 and CH-47 pilots or back seaters were more at risk of having documented intervertebral disc disease. The results showed back seaters had a slightly increased risk. This may be related to the type of duties they perform (i.e., loading equipment or patients). The study also showed that both female pilots and back seaters were 1.2 times more likely to have a reported diagnosis of IDD than their male coworkers.
Injury Prevention in the Aviation Environment
Recognizing when we are most at risk for back injury and reinjury is key to prevention. Although sometimes it is a significant straining event like lifting weights, it is usually small repeated loads like picking up the daily newspaper that creates back injuries because we don’t prepare ourselves for the small, everyday movements like we prepare for a lift in the gym. It is found that spine injuries are most likely to occur when dehydrated, during the first 30 minutes after arising in the morning and after prolonged sitting. So to reduce the chance of injury and/or re-injury of the spine, individuals should avoid high risk activities under these conditions. This can sometimes be a difficult task for our aircrew members, so remember to stay hydrated, engage in core strengthening exercises, stretch regularly, maintain good body mechanics when lifting any objects (heavy or relatively light) and be mindful of the increased risk of injury after prolonged flights.
The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.
MAJ (Dr) Theresa M. Long is a flight surgeon at the U.S. Army School of Aviation Medicine at Fort Rucker, Alabama.