As I have said before, there are fifteen specifically disqualifying medical conditions listed in Part 67 of the federal aviation regulations. These are conditions that the FAA determined can only be granted certification under the special issuance process. An aviation medical examiner may not grant issuance to an airman with one of these conditions without verbal or written permission from an FAA physician. Also, the appeal process for a denial of certification for one of these conditions is directly to the NTSB.
Five of the 15 conditions are psychological/psychiatric diagnoses that include psychosis, bipolar disorder, substance dependence, substance abuse, and a personality disorder manifested by overt acts.
A psychosis is a generic term for a mental state where an individual loses contact with reality. People who have a psychosis may exhibit personality changes and thought disorders. This condition can be accompanied by unusual or bizarre behavior. The person can have difficulty with social interactions and problems carrying out daily activities. People with this condition generally have one or more of the following: catatonia, delusions, hallucinations, or a disorder of thought.
Psychosis can be caused by certain drugs and other medical conditions. If the aviation physician can demonstrate that in fact the psychosis was the result of a treatment or some nonpsychiatric medical condition, medical certification can be possible. However, the medications to treat this condition are unacceptable for FAA medical certification. Airmen who develop a true psychotic illness are usually denied medical certification.
Bipolar disorder, which is also known as manic-depressive illness, is a disorder that causes shifts in mood, energy, and activity levels. These shifts in mood are much worse than the occasional “blues” we all go through on occasion. This condition can be treated, but once again, the medications used are unacceptable to the FAA. It is rare for an individual who is diagnosed with this condition to gain medical certification. On occasion an airman is incorrectly diagnosed with bipolar disorder and then must spend much effort and money to convince the FAA that the diagnosis was incorrect.
Substance dependence for the FAA usually means alcohol dependence, but it can also be dependence on drugs, and on rare occasions both alcohol and drugs. The diagnosis of substance dependence in the FAA requires that only one of the following situations be present: increased tolerance, meaning the person requires more than an average amount to notice an effect of the substance; manifestation of withdrawal symptoms; impaired control of use; or continued use despite damage to physical health or impairment of social, personal, or occupational functioning.
Substance abuse as defined in Part 67 means that within the preceding two years the airman used a substance in a situation that was physically hazardous (for example, a DUI offense); or had a positive drug test or a refusal to submit to an alcohol or drug test required by the Department of Transportation. The individual has not yet reached the stage to meet the definition of “dependence.”
A detailed discussion of how the FAA manages substance dependence or abuse issues is beyond the scope of this article, but you know from my previous articles that airmen can gain medical certification after being diagnosed with one of these conditions.
The last of the five is a personality disorder manifested by overt acts. These folks exhibit characteristic known as an “anti-social personality disorder.” This is an individual who has multiple run-ins with the law, DUI offenses, robbery, or other serial law violations.. This is not an easy diagnosis to determine, and these cases are almost always reviewed in Washington, D.C., by the FAA psychiatrist. In most cases these individuals will not gain medical certification.