Some months ago I covered the top five medical conditions seen at the FAA's Aerospace Medical Certification Division. Here are the next five: esophageal, stomach, and duodenal problems (22,187 airmen); skin conditions such as acne, psoriasis, basal cell carcinoma, neuroma, and some other related conditions (15,660 airmen); ruptured spinal disc, laminectomy, compression disc, and other back surgeries (15,128 airmen); hay fever (15,031 airmen); and lower extremity conditions—operations, fractures, dislocation, knee replacement, ACL reconstruction (14,769 airmen). These numbers include all classes of airmen medicals and were taken from data as of Dec. 31, 2011.
Some of the conditions require a special issuance; others do not. Many gastrointestinal problems in general will not result in a special issuance if they are mild. They all should be reported on an FAA medical application, as well as any medications taken to treat them. The most common of these conditions that I recall seeing in airmen is gastroesophageal reflux (GERD). This is a condition where the stomach contents come back up into the lower esophagus and results in inflammation. It can also lead to cancer. The precancerous version is known as Barrett's esophagitis. This condition is usually secondary to a reduction in the pressure at the lower esophagus. The majority of medications are acceptable for medical certification.
The common skin conditions seen at the FAA include psoriasis, generally considered a genetic disease triggered or influenced by environmental factors. It is characterized by scaly, reddened patches and plaques which are usually itchy. The condition and treatments are acceptable for medical certification.
Basal cell carcinoma is a very common skin cancer that is associated with sun exposure. The tumor is surgically removed and does not generally recur in the same area. You must report this to the FAA, but it does not result in a special issuance. The other skin lesions included in this pathology code are considered “benign” (noncancerous). You should report them, but they, too, do not usually result in a special issuance.
Those of you who have suffered a ruptured disc in the spine know how painful it can be. You should not fly during the acute phase. You probably would not want to nor even could fly when you are having the typical symptoms. Once the pain has resolved and you are no longer taking any pain medications, you will be able to resume your flying. Surgery to remove the protruded disc or “fuse” the spine is acceptable but you need to ground yourselves until the physician releases you to return to work and are no longer in pain and can move about normally.
Hay fever is very commonly reported by airmen. If it is mild and chronic you can continue to fly. In the rare cases when it is severe, it may result in a denial. Nasal steroids are used to prevent the attacks and are acceptable. The oral medications loratadine (Claritin) and fexofenadine (Allegra) are known as “nonsedating” antihistamines and are acceptable to the FAA. Sedating antihistamines such as diphenhydramine (Benadryl), cetirizine (Zyrtec), levocetirizine (Xyzal), and azelastine (Astelin), a nasal spray, are all “sedating” antihistamines and are unacceptable for flight.
For the “lower extremity” medical conditions, it will depend on the condition for the FAA requirements. If you fracture your leg, you will not be able to fly until the fracture has healed and you are out of the cast or splint. Obviously, you cannot take any pain medications and fly. If you have a knee replacement, you need to be at the point where your physician has released you to your own care. You should be able to manipulate the rudder pedals, or you may need to undergo what is known as a “medical flight test” and obtain a statement of demonstrated ability.