Navy Pilot - Migraines with Aura

[ealpogi]

I would first like to thank everyone here for all the information and experience shared. Hopefully my question can help others searching in the future. Sorry if this is the wrong place to post - please move if required.

Background:
BLUF: I am a designated Naval Aviator currently on LIMDU for migraines with aura.

I started getting debilitating migraines with aura about once every week or two around OCT/NOV 2016 and the frequency started increasing to 3-4 per week in JAN 2017. They usually last 6-7 hours (often times longer) and I have to find a quiet, dark room to crawl in and lay down until it passes. I wasn't flying often during that time due to our work schedule, but I knew I didn't want to put my crew in danger by having a migraine with aura in flight so I addressed the issues with my Flight Surgeon (FS). My stress level at work and at home up to this point was low, but towards the end of JAN17 I had a close family member that took his life which increased my stress a lot. My sleep schedule was shot (getting 2-3 hours per night) and my wife noticed that I was having a hard time breathing when I did sleep. My FS and I determined that I was not safe to fly and I was grounded and referred to a psychiatrist.

A few weeks later, I followed up with my FS about my migraines and she referred me to a neurologist. I told my neurologist my symptoms and I was prescribed Topamax and Maxalt and referred me to get a sleep study (I found out later that I have obstructive sleep apnea (OSA)). The Topamax started to work for me around week 4 and the frequency started to decrease to about 1, maybe 2 migraines a week. I was hopeful that they would go away completely, but according to the Naval Aerospace Medical Institute (NAMI) waiver guide I can't fly on Topamax. My command and I were looking for an alternative so I spoke with my FS to see if there was any other meds I could take that would allow me to continue flying and she recommended magnesium. I brought it up with my neurologist who was reluctant to take me off Topamax, but she agreed to put me on magnesium and give me Botox injections to facilitate the flight waiver. Fast forward a couple months and the magnesium and botox didn't work. I was put back on Topamax and continued to use magnesium and get Botox and was put on LIMDU mid August 2017.

Questions/Concerns:
I am hoping that my I will be migraine free by February 2018 (end of my LIMDU) and can get a waiver for my migraines and OSA and get back in the cockpit, but a few things have crossed my mind..

1. I can't get back into a flying status until I am migraine free. I currently have 1 migraine about every week or two. Way better than what it was before, but still not down to zero. Should I expect a second LIMDU period hoping that the trend will eventually go to no more migraines? Will that decision be up to my neurologist?

2. If I don't get a second LIMDU period (or after my second LIMDU period and the migraines don't go away), what should I expect to happen to me - Admin sep? Medical sep? Medical retirement (pilot who can't fly anymore)?

3. I got a hold of my electronic medical record and my FS and neurologist made it seem like I had recurring migraines since high school. I told them both that I have HAD migraines before (at MOST one a year), but this is what is in my record:
- FS: "Reason for Consult: ...with increase in frequency of migrianes (went from one every year or two years to multiple migraines/week) and new auroa. Would appreciate neurology eval."
- Neurologist: "...He reports that he has had migraines since high school, occurring a couple times per year. However in November they became more frequent, occurring every 1-2 weeks, and then in January they started occurring every 3-4 days..."
Additionally, in my neurologist's notes it shows that my Mother and Uncle have migraines under "family history".

How will this affect me if I do get separated in regards to the medical board and the VA? Will they say it's not service related? I sure hope they don't - I didn't start to get these dang migraines at this magnitude and frequency until several years in!!

Please let me know if I need to clarify anything or provide amplifying information. Thanks in advance!

 

[bleacherspy]

This is a tough one to answer.... here's my two cents based on my experience in the business and my recent MEB as well:

1. I'm not sure they will let you back into a flying status. That may depending on what type of aircraft you fly to some extent. Single piloted... no way; multi-piloted... maybe. The symptoms you have are disqualifying and no waivers are considered. If they go away completely, then you may have a chance but your FS is gonna have to work some magic with NAMI and I would bet you will have to do another NAMI-whammy type process with a neurologist there. If you have to stay on Topamax then I don't see it happening at all, but stranger things have happened in the past with medication approvals. The OSA is gonna come into play too so make sure you read up on it in the NAMI waiver guide and get your paperwork to say the correct things. Hopefully you have a good FS and a good command support structure to help keep you in the cockpit if that's what you want to do.

2. You probably should get a second LIMDU period if your not better; however, if you don't get better after that then it will bring up the possibility of a MEB. I don't think you have to worry about an Admin sep, bc the Navy is going to do what it can to retain you and get you to the end of your winging commitment so as to get their money's worth out of you. The most logical route for them will be to DQ you from flying and have you change to another warfare designation similar to what happens for people who wash out of flight school or get FNAEB'ed and lose their wings. I really don't see them sending you through a MEB because the likely outcome will be FIT since the loss of specialty qualification itself is not grounds for medical disqualification from service. I'm guessing the board will say you can still continue to serve in some staff capacity unless you can show that you can't perform any of your jobs when your migraines happen. Not sure if that's the case or not based on what you related. If that's the case and your goal is a MEB, then I would get your inability to perform your other duties documented and make sure your command is ready to write a non-medical assessment (NMA) that supports all of it. In fact, I'd recommend that you basically start putting together notes and compose as shell NMA for your command to use. The MEB is a long road to go down, but it may be something that is applicable to your situation if you don't want to try and stay in the Navy.

3. YIKES!!! The neurologists indication that this existed in your younger years with a family history scares me. I'm not an expert on this piece, but my thought is that the VA may say the condition existed prior to service bc of that wording. Did you report any of that on your NAMI / entrance paperwork? If not then maybe you could use the lack of reporting to create a case that they were really not something you experienced significantly until after your service started. Hopefully some other folks on here can fill in the gaps on that piece. From what I read here, it sounds like at a minimum you fit the 50% rating for migraines. The key is really how the VA looks at it and the right up. I hate to say it, but the words really do matter so you have to make sure what you tell them and what they write down are the same bc it will make or break you in some cases.

 

[chaplaincharlie]

Unfortunately, I suspect you will remain DNIF. If your condition is improving a second period of limited duty is likely.

When a condition EPTS (existed prior to service) BUT aggravated by service, you get the difference between the two levels. Meaning what the condition rates now minus what it rated prior to service.

 

[bleacherspy]

good to know!!