General Claim Education

Claims Principles Through the Lens of High-G RSI

The RRVA Aviator Medical Issues Committee

Overview

 It is not enough to point at the issue of high-G RSI in Gen 3-5 fighter/attack aircrews and declare an issue exists without offering some help to affected fighter/attack aircrew. The RRVA AMIC internally discussed what approaches were best to help those encountering various difficulties in assembling a fully developed claim or appealing an existing claim. This page and our ongoing education efforts are our tools to help Vets. 

Introduction

We know that not everyone who spent a tour or career flying high-G jets will develop significant neck, back, and other joint related issues attributable to “high-G RSI.” Setting that population aside for a moment, though our High-G RSI survey, we perceive that another portion of aircrews that flew high-G fighter/attack aircraft suffer from something clinically akin to Musculo-skeletal issues that fall into a familiar pattern. As we looked at the modest peer reviewed medical literature on the effects of high-G flight written by military medical experts, we realized needed to coin a term easily understood by lay Veterans and medical professionals. The term of art we settled on is high-G repetitive strain injury (High-G RSI). For those who live with high-G RSI, their symptoms most commonly include chronic pain, permanent range of motion limits, decreased use, or they face surgical interventions. 

Before proceeding, two caveats: first, this webpage does not offer legal advice. Notably, every Veteran seemingly trapped within the hamster wheel that is VA disability rating claims adjudication, retains the right to seek counsel to represent you in your rating disagreement or decision case. Second, this webpage does not dispense medical advice. That written, upon request, the active and retired medical doctors of the AMIC—all of whom were at one time military flight surgeons or physicians, may have the bandwidth to review the most egregious cases and offer insights in the development of your case. 

The Discussion

To frame the discussion of high-G RSI symptoms, what follows are experiences shared with us from former Air Force, Navy, and Marine Corps Operators. As an Operator, if you are just entering the VA disability & compensation (D&C) process for issues you perceive are more likely than not attributable to injuries you incurred during Gen 3-5 fighter/attack aircraft flying, read on. If you are entering the VBA D&C process years after your last high-G fighter/attack aircraft flight but your issues fall into the high-G RSI symptom bin we describe and you are seeking the award of an associated disability rating, read on. If you have a disability rating for general joint pain, but feel that your award inadequately speaks to your condition, especially if your condition has gradually worsened and you want the rating decision to be based on new personal medical evidence, read on.

VA Claims Process Changes

The Congress enacted the Veterans Appeals Modernization and Improvement Act better known as AMA on 23 AUG 17. A key distinction: if you began a claim or received a board/court decision prior to the AUG 17, your claim likely remains in the VBA’s legacy claims system. On the other hand, if you began a claim or received a board/court decision after NOV 17, the VA may have invited you to opt into the early phase of AMA implementation, the Rapid Appeals Modernization Program (RAMP). At that time, there were first-time advantages to taking a disability claim into RAMP. The first advantage was faster claims adjudication process—compared to the years-long process of the VA legacy claim adjudication system. The second advantage to using RAMP was the proposed ease of introducing new evidence into a supplemental claim. 

When the VA fully implemented AMA in FEB 19, it ended RAMP. Key point: if you began your claim in the legacy claims system that preceded AMA, you may continue in that structure or you may opt into the AMA structure. Whether, how, and why you make a decision to remain in the legacy claims structure instead of AMA is subject to the particulars of your case, situation, advice of a trained Veteran’s Service Organization (VSO) representative, or if applicable, a lawyer. For example, I launched my disability award claim in early 2015 in the legacy structure, years before the advent of RAMP or AMA. When RAMP reached initial operating state in late 2018, I opted into RAMP after my attorney counseled me that RAMP was in effect, a speed line contrasted to the ponderous legacy system. To determine which claims system your previous claims or appeals may be within, call the VA 24/7 at 800-698-2411 and ask to speak to a disability claims counselor.

VBA & Examination

The D&C process administered by the Veterans Benefit Administration (separate from VA healthcare) is conducted at a VA facility by a medical practitioner typically under contract to the VBA. The knowledge and experience of your D&C examiner in understanding high-G RSI will be non-existent. This is the case because VBA has no diagnosis or rating protocol pertinent to high-G RSI. More importantly, the VBA does not have a term in its claims adjudication manual termed “High-G RSI.” If high-G RSI were in the VBA’s claims adjudication manual, there would be established symptoms for the D&C examiner to identify and document at the exam. 

VBA lacks any rating award criteria for high-G RSI, has no symptom table, and does not have a mandate to do so under federal law. When you are seen for your intake D&C appointment, you will not hear the examiner ask you if you flew high-G aircraft nor will symptoms you attribute to that service enter the discussion. Instead, you will be asked routine questions pertaining to range of motion, pain threshold, use limits, and/or findings documented in your flight records. If you are like most of us, you likely did not report pain, range of motion issues, etc. while you actively flew out of concern that doing so may result in negative consequences. Whatever the specifics of your case and your experience, the D&C examiner will document disabilities considered routine in the current manual that a VBA claims adjudicator can associate with a specific disability rating. 

Outcome - My Experience

In late 2018, I got the disability rating I sought  for conditions separate from high-G RSI on an adjudication timeline of 105 days. Importantly, when it came to symptoms that I would later attribute to high-G RSI, I was granted a 10% disability award for permanent neck and back pain and range of motion limits I now attribute to repetitive injuries I sustained in high-G flying. While my neck and back pain is managed (not eliminated) by various treatments, the pain’s underlying cause is not acknowledged by the VBA. Here is another key point: without the VBA’s acknowledgment that my neck and back issues are linked to high-G RSI, I must justify my current VA hospital treatments multiple times every year. I have no leverage to obtain certain treatments if they are not available at an a VA healthcare facility I can reasonably access. Consequently, I have no service connection so I am at the mercy of what VHA providers find is acceptable treatment for general neck and back pain rather than issues appropriate to my condition connected to my service. Lack of service connection also means that the disability rating for the magnitude of pain and quality of life impact is less than what would otherwise be appropriate.

Committee Experience

In our lived experience corroborated by experiences related to us by Veteran fighter/attack aircrew, there is variation in what the D&C examiner documents and what the claims adjudicator assigns for an eventual VBA disability rating. It is our observation that low to zero disability ratings may be frequent for a set of symptoms more likely than not attributable to physical exposure to routine high-G flight. With AMA now in place since 2019, Veterans are better able to dispute the initial VBA disability rating as well as more easily new medical evidence that emerges later in point of time. Unfortunately, few VSOs and attorneys have sufficient experience with AMA to build a verifiable track record of success in disputing a disability award rating for neck and back pain which the Veteran believes is attributable to high-G flight experience.

Summary

What is the relevance of any of this information for Vets filing claims that seek to link their high-G flight experience to their physical symptoms? The Docs of the AMIC have limited capacity to review records and provide some medical insight, ideally in conjunction with your ongoing work with a VSO to build your fully developed case. In our experience, what is needed but is absent is a VBA disability award rating protocol for high-G RSI (mentioned above) and a tracking/treatment protocol within VA hospitals and clinics. Our work in RRVA is to eventually get those protocols in place. However, that study, implementation path, and service connection are likely years away. 

Closing

For assistance feel free to email us at: medical@river-rats.org. We may not know the answer to your question, nor may a readymade answer exist. But we may be able to provide limited insight based on our shared experiences. Praise for VSOs: they perform good work in assisting Veterans through an arcane and often arduous VBA process—even if it is more streamlined. A good website to understand and seek VSO assistance: https://www.vfw.org/assistance/va-claims-separation-benefits In conclusion, these are benefits you earned. If you do not see reason to seek them, think of how they can help your significant other after your death. Check the VA’s claim filing website for the latest information: https://www.va.gov/disability/how-to-file-claim/ The VA Benefits hotline is open M-F (closed fed. holidays), 0800-2100ET: 800-827-1000.