| Fellow Rats, we are now 4+ years from RRVA’s initial foray into aviator medical issues. Back in that recent past, people of vision stepped up with an eye toward locating an answer to a not-so simple question: “what does it seem that more of us are diagnosed with, and ultimately are dying from cancer than Americans outside of the military?” Almost two years to the day that RRVA leaders chartered the AMIC, we have made an incredible amount of (forward) progress in aviator cancers work. Those of you who read AMIC Mig Sweep articles and our numerous RatNet Digest short bursts will recognize some of the thoughts I next offer. Like those articles, this short article will walk the reader down a path. Big picture, peer reviewed medical studies conducted at scale (big) and longitudinally (over time) are gold standards in any serious work on cancer to be used for any constructive purpose. Importantly, all studies are not equal because they are not scoped equally at the outset. Roughly, this means that different studies can (and do) say different things about the same topic. But for the reader’s benefit, let’s set aside those hard hat and lunch pail science and mathematics considerations. What the AMIC needed but lacked was a study that objectively looked at military aviator cancer incidence and mortality. So, we gratefully welcome the US Air Force School of Aerospace Medicine’s (USAFSAM) two-year long study on aviator cancers. That study is preserved in its entirety as a downloadable .pdf document on this webpage. The study was released to RRVA in late August 2021. As the AMIC Director, I will not list all of the study’s key points; the reader gets that pleasure. CLICK HERE TO READ THE FULL USAFSAM STUDY Two ideas I commend to readers: 1) The AMIC’s position is that like all studies, the USAFSAM study has limitations. For example, it is not peer-reviewed. Elsewhere, the study assessed a 34-year period of Air Force-only aviators. Next, the study did not/could not pull into its analytic model Veterans who separated/retired who did not seek care in the VA system or use Tricare and its predecessor, Champus. None of these are fatal flaws; rather, they are limitations that every reader must take into consideration when considering the study’s premises and findings. 2) This USAFSAM study is the first of its kind conducted by any armed service to objectively study cancer incidence and mortality. That is a big idea, and one that should not be overlooked. Thank you to the most recent Air Force Surgeon General (AF/SG) Lt Gen Dorothy Hogg and the present AF/SG Lt Gen Robert Miller including all of the staff at the USAFSAM Studies Division. Their leadership made this study possible. Final Thoughts: 1. This one study will likely be unable, on its own, to significantly aid you in your VA disability claim to be awarded service connection for your cancer. Why? This study does not prove nexus. The study was not designed for that purpose. To successfully gain an appropriate disability rating and percentage, you most likely need to demonstrate how your military service caused your cancer. General facts of cancer incidence and mortality do not do that, but they do set the table for what the AMIC will do next. 2. The AMIC is on a path to working with Congress to get new public law that directs the relevant US agencies to “run to ground,” that is; identify the materials, chemicals, energy sources, and/or agents in the operating environment that may (do) cause cancer. The reader may respond that science already knows what environmental elements are generally carcinogenic. I agree and disagree. 3. I disagree because the AMIC does not exist to affirm what medical science already tells us about things that cause cancer. Instead, we perceive that the things in the military environment unobserved and unexplained that could cause aviator cancers broadly bin into two hazards: ionizing and non-ionizing radiation. Ionizing is more than nuclear causation and non-ionizing takes in all the high-power emitters that surround us in the military operating environment that generally don’t exist outside of that environment. Here is how you can contact the RRVA AMIC: medical@river-rats.org vince.alcazar@river-rats.org | 
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