1. Senior Board of Flight Surgeons
Informational and Decisional Brief
CDR Tim O’Hara
Director, Naval Aerospace Medicine

2. Senior Board of Flight Surgeons
Definitions, Purpose, Interpretation
Participants
The Case, The Course, The Process Timeline
COAs
Recommendation
Discussion & Decision (or need for more info)

3. Senior Board of Flight Surgeons
Definitions & Purpose:
The Special BFSs at NAMI evaluates medical cases, which, due to their complexity or uniqueness, warrant a comprehensive aeromedical evaluation. (MANMED 15-81)
The Senior BFSs at BUMED serves as the final appellate board to review aeromedical dispositions as requested by the CNPC, CNO or CMC. (MANMED 15-82)

4. Senior Board of Flight Surgeons
Interpretation (of the MANMED):
Similar to our court system, this hierarchy implies that the case was tried at a lower court (Special Board) and subsequently, there is belief that either:
A procedural error may have been made
New and significant information has come to light after the Special Board's recommendation
Unique needs of the Navy that had not been considered have since been disclosed
This scenario is somewhat unusual, in that a convening of a Special Board of Flight Surgeons was denied by the then OIC of NAMI 2 years ago, so the only disposition to review is the waiver of physical standards denied by CNPC.
In hindsight, this case probably should have had its day in court at a Special Board of Flight Surgeons. But it was denied, and there is no guidance in the MANMED stating that a Senior Board can only be conducted following a Special Board.
We will still require all of the research, consultation and recommendations normally completed as part of a Special Board, to be done for us in order to make the best evidence-based aeromedical disposition recommendation to CNPC.

5. Senior Board of Flight Surgeons
Participants:
Minimum of (5) members to include:
(3) Flight surgeons
(1) Senior Line Officer as assigned by CNO (N98)
Presiding Officer: Deputy Chief, Medical Operations assisted by the Director of Naval Aerospace Medicine
Individuals whose cases we are adjudicating shall be offered an opportunity to personally appear before the Board
MANMED says CNO (N78) but I’m not aware of such an office. I think the correct code would be N98 (Air Warfare)

6. Senior Board of Flight Surgeons
The Case:
30 yo otherwise healthy AD MH-60 Naval Aviator w/ 569 flt. hrs. at the time of grounding on 19 Nov 2010 for HIV and associated medications
The Course:
No seroconverting sxs per patient report
Responded well to medications (Labs 5/2/11):
Viral load undetectable (<48 copies/ml)
CD4 count 894/mcL ( )

7. Senior Board of Flight Surgeons
The Process Timeline
18 Mar 2011 waiver requested
06 Oct 2011 waiver not recommended by NAMI
07 Oct 2011 waiver denied by CNPC*
01 Nov st Special Board request (not answered)
26 Sep nd Special Board request
01 Aug nd Special Board request denied
28 Sep Request for Senior Board of FSs
19 Mar Third Endorsement for Senior Board by CNPC
08 Sep Senior Board of Flight Surgeons at DHHQ
Overall (3) year process. (7) Months to recommend waiver denial and nearly (2) YEARS between the request for Special Board and denial of a Board.

8. Senior Board of Flight Surgeons
Courses of Action (COAs)
Deny a Senior Board (unwarranted circumstances)
Send the case back down to NAMI for third request to do a Special Board of Flight Surgeons
Convene the Senior Board with:
Any new information from the member
Latest research, specialist risk analysis and final recommendations from NAMI

9. Senior Board of Flight Surgeons
Recommendation to the Chair:
Convene the Senior Board as was requested and endorsed by CNPC & CNO with:
Any new information from the member
Latest research, specialist risk analysis and final recommendations from NAMI -or-
Option to be evaluated at USAFSAM
Choice of evaluation site was offered to the mbr

10. Senior Board of Flight Surgeons
Pre-Board:
Member chose full C/S service eval at NAMI
No significant changes with original ailment
New diagnoses uncovered
Mild bilateral hand tremors
Multiple ARIs, unacknowledged disorder potential and sub-optimal admin. action, evaluation & treatment
Mbr initiated an immediate re-evaluation upon return to home station
Still no Dx given
Very astute consult team at NAMI which is precisely why we have these complex cases seen here!
Newly discovered and documented bilateral intention tremors
Newly discovered multiple alcohol-related incidents that had yet been acknowledged and appropriately assessed & treated

11. Senior Board of Flight Surgeons
The Board:
Member brought his treating physician
Both IM/ID-HIV as well as a FS
Very articulate and persuasive
Received a nearly unanimous favorable consideration for his original ailment
It was the unacknowledged and sub-optimally addressed ARIs that ultimately resulted in a negative recommendation to CNPC

12. Take-Away Points
The Senior BFSs at BUMED serves as the final appellate board to review aeromedical dispositions as requested by the CNPC, CNO or CMC. (MANMED 15-82)
Not a replacement for a Special Board:
A procedural error may have been made
New and significant information has come to light after the Special Board's recommendation
Unique needs of the Navy that had not been considered have since been disclosed
The difference between a Senior Board and Special Board
The Senior Board is NOT a replacement for a Special Board

13. What do we do?
Other Primary Functions of BUMED Aviation Medicine Office (Rep SG’s Interest):
Enterprise-wide Coordination and Oversight of Aeromedical Policy, Standards, and Waivers
Via the Force Surgeons (TYCOMs, MAWs)
Substantive changes to MANMED, ARWG, AACs, controversial Special Board results
Oversight/Program Management of BSO-18 FS/AVT Flight Medicine Clinic Programs & QA

14. M3B3F Initiatives Flt Pay & Other Spec Pays AsM Career Development
FS/GMO Conversion
UAS Aeromedical Policy Development
Enlisted PM Duties
Decentralized Waiver Authorities
Quad-Svc AsM Policy
FCMH / MCMH
OSS / LIMDU
Quad-Svc Vis Stds/CBVT
NATO / ASIC Interoperability
Carrier SMO & FS application and selection
Anthropometrics

15. Promotion Analysis of Aerospace Medicine Graduates 2000-2013
CDR Frederick Harris
DeputyDirector, Naval Aerospace Medicine

16. Navy Aerospace Medicine Graduates by Year 2000-2013
This is a simple graph depicting the number of RAMs coming out of residency each year. Possible Don Arthur effect. If nothing else it shows some volatility.
Total Number: 83

17. Current Status Navy Aerospace Medicine Graduates 2000-2013
appears to be Golden Era for O-6. The grads are too junior to make any inferences about promotion.
Someone had commented last year that perhaps a lot of RAMs separated from the Navy based on questionable future promotion prospects. Only 6 left the service and two of those entered the reserves.

18. Navy Aerospace Medicine Residency Graduates with Other Residencies
Total: 83

19. 2000-2013 Graduates (Promotion Status)
O-4 not yet in zone for O-5 Board 2
O-4 non selected for O-5 (active duty) 2
O-4 non selected for O-5 (resigned) 2
O-4 separated prior to O-5 Board 2
O-5 not yet in zone for O-6 Board 8
O-5 non selected for O-6 30
O-5 reservist (O-6 board status unknown) 1
O-6 selected (active component) 35
O-6 selected (Reserve-NG comp) 1
O-5s who non selected for O-6 (13 are retired, 17 still on active duty)

20. Assignment as CVN Senior Medical Officer
Single CVN SMO Tour completers 38
Multiple SMO Tours 6
Incomplete SMO Tours 7
No SMO 20
Current SMOs 12

21. PERS MATH

22. Promotion Rates
Total (This is when PERS math is debunked. In other words, once denominators for Above zone and below zone O-6 candidates are properly added.
PERS report (this is the fluff promotion data. These are the percentages that are calculated when the numerators for AZ and BZ candidates are ignored.

23. Promotion Rates (with Aerospace Medicine)
2013 promotion board (2/8 were promoted to O-6. One was in zone and one was above zone. In zone was 1/7.
2012 was 1/3
2011 was 5/7
2010 was 5/8
2009 was 2/4. May have been 3/5, but a select did not pin new rank.

24. Analysis of Aerospace Medicine Specialists who were Aircraft Carrier Senior Medical Officers prior to O-6 Promotion Board 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
MTF Assignment After non AM Residency > 1 Year
Non Aerospace Medicine Completion
This data includes RAM graduates who completed significant CVN SMO time (>1 yr prior) to O-6 board. The YG ranges for the O-6 selectees were The YG range for the non selectees was There were SMO tour non completers among the 19 who non selected for O-6. Keep in mind that some of the non selects had (legal issues, were AZ selects for O-5, did not complete the SMO job. Inclusion criteria is having at least 1 year of CVN SMO time prior to O-6 board.
Names and year groups are concealed to protect identity.
Each column represents a person. The bottom row depicts whether the individual was selected for O-6 or not (red = no, green = yes). The middle row represents residency training outside of aerospace medicine . The light rose shade = civ residency training. A total of 4/42 have completed civilian residency training. Darker rose = military residency training. 33/42 have completed military residency. Light grey = No residency outside aerospace medicine. 5/42 (all non O-6 selects) have not completed residency other than aerospace medicine. Top row depicts MTF tour (greater than 2 years). Blue= an MTF tour > in non aerospace medicine capacity lasting more than 2 years. Light grey equals no MTF (greater than 2 years) assignment outside of aerospace medicine specialty. Bottom line is than ZERO RAMs without other specialty have made O-6. And all 23 O-6 selects have BOTH 1. other specialty and 2. MTF assignment outside of Aerospace Medicine.
O-6 Selects (25)
O-6 Non Selects (19)
No non AM Residency Completion)
MTF Assignment After non AM Residency
Civilian Residency (non AM)
Military Residency (non AM)

25. Comparison of O-6 Promotion Rates Based on Order of Training
5/8 (38%) Who Started as RAMs were selected for O-6
31/47 (66%) Who started in other specialties were selected for O-6
Overall, 60% who were eligible were selected
O-6 Selects
O-6 non Selects 5 8 31 16 13
RAM Followed
By Other
Residency 47
RAM as a
Secondary
Residency
Data excludes those who have only one residency. 36 24 60

26. Comparison of O-6 Promotion Rates Based on Order of Training (Plus Aerospace Medicine Specialists without Other Residency Completion
O-6 Promotion Rate Drops to 26%
0/6 Aerospace Only Trained Docs Selected for O-6.
O-6 Selects
O-6 non Selects 5 14 31 16 19
RAM as
Initial or
Only
Residency 47
RAM as a
Secondary
Residency 36 30 66