Pilot Protection Services Medical Mailbag- July Q&A

QUESTION: I’ve just had my class 3 medical revoked after providing a visual field printout with the standard medical due to glaucoma. A couple of years ago my medical was delayed until I had taken a medical flight review, which I passed. This time I am not being offered that option, after having requested a review by mail. I have some deterioration in vision but nothing that makes a noticeable difference in daily life (including driving) and my vision is otherwise pretty good. I have heard of pilots with only one eye passing the medical. How can I best appeal this denial?  

ANSWER: Glaucoma is a condition whereby the pressure of the substance inside the eye is raised and causes a related visual field loss, despite best efforts to prevent it. This is one of the things an annual eye exam will look for, a slightly irritating test (to my eyes anyway) where the doctor uses a device to blow a puff of air on the eye, thereby facilitating a pressure measurement.  

In your case, the FAA would likely not be able to consider you for a waiver because the loss of vision is related to a progressive condition as opposed to a “static defect” that results in no change to visual acuity.  If the most recent visual field tests show some progression of loss of visual field, the FAA may not be able to find you qualified for a continued special issuance.  Depending upon what visual field test you did, the FAA may ask you for a more comprehensive evaluation with either the Humphrey 30-2 or the Goldmann tests.  You can request reconsideration from the FAA, or better yet, just have your ophthalmologist conduct either of these tests and you can submit the results to the FAA for reconsideration. Good luck and to other readers, make sure you have your yearly eye check-up!

QUESTION: I just recently had a heart attack, an MI with stent. What do I need to do?

ANSWER: Heart attack is where the blood supply to an area of the heart is compromised by one or more “coronary arteries” becoming clogged. These are muscular tubes and when blocked by “atheroma” an unpleasant deposit from poor diet, lack of exercise, smoking or bad genes, the downstream muscle (myocardium) is killed (infarcted), hence the name “MI” which stands for “myocardial infarction.” If one gets to a patient quickly enough, doctors aim to improve blood supply by inserting a “stent” – a metal tube – to hold the vessel open after clearing out some of the blockage. 

There is a mandatory three month wait time after having a stent, unless the stent was placed in the left main coronary artery, in which case the wait is six months.  Afterward, you will need treatment records, a maximum exercise treadmill stress test, blood work, and a thorough report from your cardiologist.  Here is the link to our online information that provides all the details.

QUESTION: I have a current third class special issuance medical valid through the end of next month. However just before receiving it, my oncologist changed my medication from Gleevec to Tasigna which works even better for me without any side effects. However, I understand the FAA accepts Gleevec for Chronic Myeloid Leukemia but does not acknowledge Tasigna. I have a checkup every 3 months and all is normal. My oncologist is pleased to send a letter to the FAA  with my current status. Will I be able to get an approval when I report this change?

ANSWER: Chronic Myeloid Leukemia or “CML” is a malignancy affecting the blood and tends to often have a very slow course, afflicts older patients and can be controlled with medications in many cases. Unfortunately the FAA has not yet reviewed this medication and placed it in the acceptable category for use while flying.  It is not uncommon for this to happen with newer medications and is not an example of arbitrary bureaucracy. When a new drug is approved, even if it is similar to something else out there, because the FDA does not specifically test for the impact a drug may have while piloting an aircraft, FAA wants to wait a while. You can request a review of the medication through the FAA Office of Aerospace Medicine in Washington, but until/unless the FAA decides the medication can be used safely, you will be denied certification if you report the change in medication to the FAA, which, of course, you must do.

QUESTION: My current medical requires that I submit a current status report from my treating physician regarding my sleep apnea with use of CPAP. For what time period do I have the doctor write a prescription for? The last CPAP compliance summary was for a 30 day period.  

ANSWER: Sleep apnea is something we have written a great deal about and discussed in webinars and videos. It is a serious condition that can have profound health effects. CPAP (Continuous Positive Airway Pressure) therapy keeps the airway open and the machines have the ability to capture data about patient usage and FAA wants to know you are getting a proper night’s sleep with some consistency – not unreasonable as we don’t want pilots falling asleep at altitude! Thirty days is the minimum time the FAA will accept.  If you have been using CPAP for some time, provide at least three months of compliance data.

QUESTION: Where can I find information regarding the latest language in the Medical Reform bill in the Senate which I've heard is now attached to the Defense Authorization Bill. My previous latest read is that it requires a doctor to certify there is no condition that would prevent me from flying. If this is the case, how do you or the FAA propose to get a doctor to accept the implied legal obligations of such an assessment?

ANSWER: The language of the PBR2 is now contained in three separate Senate bills, but there has been no change in the language.  AOPA is concerned about the physician certification declaration requirement and we are working on finding a solution.

QUESTION: Is Otezla (apreemilast) approved by the FAA for use? 

ANSWER: This medication is a “phosphodiesterase 4 inhibitor” (PDE4) – a fancy way of saying it interferes with an enzyme in the immune system and is used to treat the arthritis that may accompany psoriasis, an inflammatory skin condition. Yes, Otezla is allowed by the FAA, but it does require a fourteen day observation period to identify any side effects that might occur, and you will need a status report from your treating physician addressing your tolerance of the medication without side effects, including depression symptoms.

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