Pilot Protection Services July Medical Mailbag

'Given that BasicMed is new, I suppose it was inevitable there would be some teething problems, but must admit I never expected this one'

QUESTION: I am aged 86, diabetic, well controlled with Metformin and have never needed to take insulin. I have been flying as a Private pilot since 1967 i.e. for fifty years! Can I still be pilot in command?

ANSWER: Diabetes is caused by a lack of insulin or failure of the body to respond to it. The resultant lack of control of glucose can have multiple consequences including kidney problems, heart attacks, stroke, poor blood supply to extremities leading to ulcers or loss of fingers or even legs. It is rampant in our society and has a couple of presentations, either in youth where insulin is more often required or later in life, usually associated with obesity and these cases can often be controlled by medications like Metformin. The best approach is to avoid diabetes if at all possible by keeping weight in order and avoiding a large sugar intake.

First of all, congratulations on making it to 86!  The FAA doesn’t make certification decisions on the basis of age alone, but does look at age as a “risk factor.”  If you are otherwise doing well and have your diabetes well controlled on metformin alone, a third class medical is certainly possible.  And if your hemoglobin A1c is 6.5% or less, and your fasting blood sugar is less than 126 mg/dl, the FAA allows your aviation medical examiner to issue you an unrestricted medical certificate provided you are otherwise qualified.  Even if your numbers are above that level (but less than 8.9% A1c,) you can still qualify for a special issuance authorization that would be renewable annually.


QUESTION: Any new details on Basic Med and substance abuse?

ANSWER: There are no changes to BasicMed as far as substance abuse is concerned.  A history of substance abuse is not one of the conditions that requires a one-time special issuance, but the history might be questioned by the doctor performing the BasicMed exam, and one would likely be asked to provide a report or records from your healthcare provider explaining that history and current status in more detail.  If one held a medical certificate since reporting the substance abuse, it will also most likely require a letter from the FAA indicating that the pilot was found eligible for a medical based upon that history.  The individual in question should have that available when seeing the doctor for the BasicMed exam and should then be signed off by the doctor with no problem.  

QUESTION: My wife is meeting her physician who is not an AME, per Step 2 of BasicMed’s four steps to flying with a driver’s license. She dutifully printed out the FAA 8700-2 form to show her doctor and the BasicMed Section 3: Medical Examination includes a physician attestation that he or she performed an examination that included all items on the checklist. 
 Item 9. Anus: (not including digital examination)” is one of several which struck me as outlandish and over-done, with the potential to scare off the poor physician who might otherwise be ready to “.. certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft.”

I can just imagine the poor physician asking: “What does the condition of my patient’s anus have to do with her being healthy enough to drive or fly? What does the FAA know that I don’t? Must I examine her anus before thus certifying?” I have been flying for 43 years, the last 17 under an unrestricted Class 2 Medical, and NEVER had my tailpipe examined by an AME.  During that time, I have been examined by at least 5 different AMEs. In looking at, “Item 39, Anus” I was surprised to learn that All Classes of Aviation Medical exams apparently require a rectal examination (digital at applicant’s option) or direct observation or history.Can you offer any guidance?

ANSWER: Thanks for writing and I am so sorry that your wife had a rough ride of it. I have touched base with some other folks to garner input. As far as we can ascertain, this is the first legislation with the word “anus” and given my training in colorectal surgery I find some degree of resonance in it. It would seem that the relevant notations are:

1. Digital Rectal Examination: This examination is performed only at the applicant's option unless indicated by specific history or physical findings. When performed, the following should be noted and recorded in Item 59 of FAA Form 8500-8.
2.  If the digital rectal examination is not performed, the response to 
Item 39 may be based on direct observation or history.

Given that BasicMed is new, I suppose it was inevitable there would be some teething problems, but must admit I never expected this one.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA

Gary Crump

Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.
Topics: Pilot Health and Medical Certification

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