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Military pilots and aircrew have long suspected that a link exists between a variety of medical issues and their years of valiant service. The River Rats have long been involved in this discussion. John "Deedle" Reed led the charge for many years in seeking recognition of these issues within the leadership of the Air Force. The USAF conducted a study in 2019 and many River Rats were troubled by its design and findings. The Executive Committee of the RRVA determined that the issues had risen to a level that required a committee and position on the Board of Directors to adequately address the effort required to serve the membership. In November 2019, the Aviator Medical Issues Committee was formed under its first Director, Col Vince "Aztec" Alcazar. Initially, the AMIC’s ten members are working in two areas: cancers and repetitive strain injury (RSI). Half of the AMIC are doctors of various training and experience. These doctors range from flight surgeons to medical teaching professors. The others on the committee bring planning, organizing, and production skills.


Committee Cancers Work
Cancers in military flyers is a wide range of diseases that include multiple myeloma, leukemia, esophageal, lymphoma, prostate, testicular and various brain cancers.  Relatedly, we are convinced those are not all the cancers we may see reported in the recent RRVA Cancer Survey (Fall 2019 MIG SWEEP).  With regard to cancers, where will the work of the AMIC begin?  For now, it’s not on research or treatment.  Instead, we will focus our initial efforts on advocating for large-scale studies that quantify and contrast the incidence rates of cancers among military aviators.

An initial Air Force 2019 study suggested cancer rates among Air Force pilots does not exceed rates in other groups of AF officers, hence there is no cause for concern.  We do not agree. Many Rats know military flyers fighting cancer now or who have succumbed to it. However, what is not known by the Veterans’ Administration or the Department of Defense is, do military flyers get diagnosed with cancers at rates that exceed rates seen in the mainstream U.S. population? Obtaining answers is not as straightforward as one might think.

While aviator cancer concerns initially focused on pilots of aircraft with modern high-power radars and jammers, fighter aviators are not the only flyers who spent most of their aviation careers in close proximity to high power energy sources. Illustrative of what the AMIC faces, there are piles of medical evidence that document the harmful effects of ionizing radiation (gamma rays, x-rays, etc. [think nuclear weapons effects]).  In contrast, there is very little research that focuses on the effects of high power emitters (non-ionizing radiation) on body tissues.

RSI In Military Aviators
Next, RSI is a condition with many forms. The committee is not seeking to help people with carpal tunnel syndrome, tendonitis, or bursitis. Those are common over-use injuries that affect millions of Americans. What the committee cares about is RSI related to physiological conditions that result from high-G flight in fighter/attack aircraft. What am I talking about?

Beginning in the mid-1980s, Air Force and Navy doctors began studying the potential effects of constant high-G flight on neck and spinal health. Then, the Air Force, Navy, and Marine Corps were transitioning their fighter fleets from 7.33G aircraft to 9.0G aircraft capable of maintaining that peak G-load for minutes, not moments. Today’s fighter aircraft can maintain 9Gs for as long as fuel remains in the aircraft. That is hard on the body. Now, neck and spine injuries are more common than ever in tactical military aviation.  Four decades later, two generations of high-G aircraft aircrews are living with chronic pain and range of motion limitations. Still, there is no VA recognition of high-G RSI. The AMIC aims to change that.

Briefly, About Studies
The AMIC believes multiple studies of military pilot health must be conducted by the VA and DOD.  We know that studies of cancers in military aviators should not be confined to a single service; i.e., Air Force or Navy. We also believe that to get to underlying risk factors in aviation environments, initial studies ought to avoid the risk of focusing on a single population of aviators; for example, air dominance or ground attack aircrews.  

Next, we are aware that RRVA lacks the competencies and resources to conduct large-scale multi-year studies of military aviator health. That’s okay. The VA/DOD have the resources and competencies to undertake large studies. So, any effort to advocate for the study of military aviators over any number of years is a case made first to federal lawmakers who can mandate through public law that the VA and DOD study the issues and ultimately, provide treatment paths.  

However, to successfully argue for studies and the money to fund them, the AMIC sees several planning considerations. First, proposed VA/DOD studies must be designed in ways that faithfully analyze military aviators without bias and distorted assumptions.  Second, the case for performing VA/DOD studies is rooted in the trends we obtain from small pathfinder study results (like RRVA Pilot Cancer Survey) that could suggest that there is not just smoke (complaint), there is fire (cancers). Third, even if all military flyers since 1980 (for example) are studied for cancers, an effective analytic agenda likely means the VA and DOD conduct multiple studies of military aviators to determine what links exist between emitters, environment, and cancers.

The 2019 RRVA Pilot Cancer Survey was responded to by nearly 700 of our members. The results of the survey were compiled, analyzed and shared with our membership. The results have also been shared with various members of military administration as well as lawmakers. We are making an impact. Recently Tara Copp, an award-winning journalist with McClatchy Papers interviewed the AMIC for a national story. That story is available here.

AMIC member Maj Gen George Harrison makes excellent points: first, the AMIC’s work is, contrary to critics, not about disability & compensation cash. It’s about linking our aviation service to timely diagnosis and treatment. Second, aviators’ desire to serve will not change despite any new cancer information. Bottomline: aviators want to know they are being screened, tracked, and cared for.