Pilot Protection Services Medical Mailbag- September Q&A

QUESTION: Two days before my 74th birthday, I experienced a cardiac event, which was diagnosed as coronary artery disease, one vessel was 98% blocked, another 75%. Two stents were inserted, and I was put on Effient (10 mg / day), Lisinopril (2.5 mg / day), and Metropolol (12.5 mg b.i.d), plus 81 mg aspirin daily. My cardiologist also made recommendations regarding my exercise regime and diet and I have successfully lost weight, down to 138 from 152 pounds with my BMI close to 22.I wish to be pro-active and submit all paperwork necessary for the FAA to confirm I am medically fit to fly, 2nd class if possible, but at least  3rd class. What do I need to do?

ANSWER: Thanks for writing and this is a topic we have covered extensively in magazine and web articles as well as webinars and at live events because coronary artery disease, blockage of the blood vessels that supply oxygen and nutrition to the heart, is the most common cause of death in developed countries. I am glad your problem was caught in time, appropriately treated and that you are doing all you can to address the problem.For full second class privileges you will have to submit another Cardiac Catheterization at the 90 day point from your heart stents as well as a Maximal Bruce Protocol Nuclear stress test.It is important to note that you request the medical class that you need, not the one you want!For third-class you will require:* A report from the treating physician that states how he/she discovered the coronary disease* The report from the Cardiac Catheterization and Stent insertion proceduresAssuming that it was NOT the Left Main Stem artery that they stented, in 90 days you will need to provide a current status report from your treating physician that informs the FAA how you have been doing cardiac wise since the procedures and provides a current list of all your medicationsRegarding the results of a Maximal Bruce Protocol stress test, you should provide all the computer print outs and all the 12 Lead Electrocardiogram tracings from the test and you should also include the results of a current Lipid panel and Fasting Blood sugar.This is a perfect situation to proudly have Pilot Protection Services though AOPA on your side!

QUESTION: I hold a 3rd class medical certificate by special issuance.  At the last required medical examination I submitted a treadmill stress test as the required information for the special issuance.  I also submitted a completed FAA Form 8500-8 so that my AME could get the information and certificate he was to sign and give to me. This year I was required to forward to the Director of Medical Certification at FAA in Oklahoma the results of this year’s treadmill test but I was not required to see the AME.  My question is since I did not see my AME this year, am I still required to file the 8500-8 form this year?

ANSWER: The short of it is, if you hold a 3rd class and last year you had an FAA flight exam, you will not need a new examination this year.  The regulations that govern the duration of medical certificates (61.23) is different from the one that allows the FAA to issue a special issuance for a disqualifying medical condition  (67.401).  Trust this helps. 

QUESTION: I've recently had a Total Ceramic Hip Replacement and wonder what information will I be required to supply my FAA AME when I apply to renew my Pilots Medical Certificate.I am presently able to drive an automatic car but have not yet tried to get into an aircraft, but will probably try this in 4 weeks from today after I see my Surgeon again.  
Additionally, as a CFI do I need a valid Medical Certificate providing I'm not using my CFI for initial pilot training just for BFR (FR) and IPC.

ANSWER: Most airmen who have had a total joint replacement do not notify the FAA until their next FAA exam, while this is not "really" kosher, it is what is generally done. The condition will not require a waiver or SODA unless you are having persistent pain that requires regular medication and/or have some limitation in range of motion that makes it difficult for you to fly. You should provide the operative report and a letter from the treating surgeon at the time that you are going to be released that notes your status (range of motion, any pain, etc.) and that you are being released to your own care. It sounds like you are being quite cautious and that is sensible! Hip – and knee – replacements are very common and have wonderful results. 

QUESTION: I read the Fly Well articles in the AOPA magazine and am addicted to flying since starting at 55 back in 1998. I even wrote a navigation APP. In a recent article you mentioned some possible changes at the FAA, including mention of getting rid of 3rd class medical.. I am an insulin dependent diabetic(40 years, type 1).  My AME passed me for 2nd class as an experiment and the FAA shot - double entendre intended - me down. They said sorry, if you take insulin your can't get a 2nd class.  I wanted it because I would like to do some revenue generating work to feed my habit. So, my question is: if they do away with 3rd Class medicals, then does that mean:

a) I can't get a certificate at all or

b) can I get a commercial endorsement?

My flight instructor says I could easily pass the tests. 

Thanks for your time and please keep up the informative pieces.

ANSWER: Thanks for taking the time to write. I am glad you have the bug and am sorry you have had issues. I covered this topic in the magazine a couple of years back and the ONLY medical certificate an individual with diabetes mellitus on Insulin can obtain is a 3rd class and limited to flight within the borders of the USA.  If the third class medical initiative is approved by FAA, they will hold these individuals who fly the heavier aircraft to "sport pilot" rules. So, to get into this category, you might reapply for third-class with your insulin dependent diabetes and gain a special issuance that way.  Then, you would be eligible, as you would no longer be denied.  Confusing, I know. It might be worth joining the AOPA Pilot Protections Services plan as they can be helpful with such situations - I am a member. Best of luck! 

QUESTION: I had a bovine aortic valve replacement because of a decrease in cardiac function which had been asymptomatic. FAA guidelines say I have to wait 6 months before they will consider a reinstatement of my 3rd Class medical certificate. Considering it takes about 3 months to process the application, I will not be able to fly for a long time for what seems to me to be no reason at all.   I never had any cardiac symptoms before or after the operation, so it possible to get the FAA to consider an application for reinstatement sooner?

ANSWER: The FAA policy for reconsideration for special issuance after valve replacement is not flexible.  You will have to wait the full six months after the surgery, complete the follow up testing, and submit to the FAA for a special issuance medical.  There is really no way around that six month waiting period.  Unfortunately, there is additional waiting time on the end of that after your records are sent in to the FAA which will add, on average, about 90 days to the overall grounding period.  The aortic valve ensures that blood can leave the main pumping chamber of the heart in regulated fashion and not flow backwards as happens when the valve becomes “incompetent” or floppy or cannot get out in sufficient quantity when it is described as “stenotic” or tight. Although you were symptomatic, this is a serious medical condition, hence the trepidation shown by FAA. As I am sure you know, there are valves retrieved from animals, such as yours or manufactured out of synthetic materials.Hoping the time passes relatively quickly for you and that you be airborne again.

QUESTION: What are the regulations concerning cataract surgery and flying with a private pilot license?

ANSWER: If a cataract obstructs vision and does not meet vision standards for the class requested, the airman is denied. Otherwise, for surgical removal and insertion of an intraocular lens, the airman needs to have the treating Ophthalmologist complete an 8500-7 (FAA Eye Exam form). If they meet standards for the class of medical they have or require, then they can resume flying (once they meet standards) and give the AME the report at the time of their next FAA exam.  If the airman has cataracts and they do not affect vision, they should also have the physician complete the FAA Eye exam form and they can fly providing they meet vision standards.

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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