Pilot Protection Services May Medical Mailbag

QUESTION: A couple weeks back, I suffered a concussion from playing soccer the day before I happened to start Flight School. I've been trying to push through the headaches every time I fly, for fear that I may be required to sit out 6 months according to the FAA brain injury policy. I really want to do anything possible to avoid delaying my aviation career that long, so I'm hoping you can offer any advice, or provide contact information of someone who can offer advice on how to proceed. 

ANSWER: Traumatic brain injury (TBI) is a serious matter and data suggest that one can have long-lasting sequelae if things are not attended to. Seriously; “pushing through” headaches is not a good idea.  

I strongly recommend seeing a neurologist with special interest in TBI and take whatever time is necessary - or your aviation career - and life - could be negatively impacted. 

Our understanding of the sequelae of TBI has been enhanced by seeing the effects of repetitive head injuries in those playing contact sports – so-called “concussive sports injuries” that can lead to a degenerative brain disease. Also, given modern body armor, better vehicle protection and the use of improvised explosive devices, we are seeing our brave military combatants return from war zones with blast injuries that damage their brains. Different mechanisms maybe to a motor vehicle accident, fall or assault, but the end effect may be the same. 
As we have said many, many times, put your health first and then attend to the flying. 

The FAA view any type of head injury as “aeromedically significant” until proven not to be.  The six months observation period for a “mild” head injury increases with the severity of the injury, and in cases involving a severe head injury, as much as five years recovery could be required before the FAA would consider one for medical certification.   


QUESTION: I currently hold a restricted 2nd class medical due to having 2 stents inserted back to back in the right coronary (no heart attack) just blockage. I own an aerial advertising company and flying is an integral part of that business, however it does not involve passengers or cargo. Would my flying for the company require me to go through all the tests required to renew limited 2nd class (expires 8/17) or would my circumstances allow me to operate on a 3rd class medical and would I be eligible for it after 5/1/17 ? 

ANSWER: Unfortunately, your proposed flight operation would not qualify for BasicMed as the rules do not allow flying for compensation or hire, except for limited circumstances such as flight instruction or as permitted by FAR 61.113 (flights only incidental to employment, pro rata cost sharing, charitable flights, etc.).  These restrictions still apply if you are receiving compensation but not carrying persons or property.  And it sounds like your operations for the advertising company are part of your job, rather than only incidental to your employment. So, you would not be eligible for BasicMed and would need to maintain the limited second class medical.  

QUESTION: I recently read your online article “Wrapping your prostate in a bow”, and that using daily low-dose Cialis as a treatment for an enlarged prostate (BPH) was not allowed by the FAA, I was wondering what is the side-effect of daily Cialis that is not good for flying?

ANSWER: FAA guidance is regulatory, not clinical medicine and applies to populations, not individuals. As such, and knowing that Cialis can cause a range of side effects that might compromise one’s ability to discharge the required actions of pilot in charge FAA has chosen to make it a no-no. For instance, the medication can cause blurred vision or impact the ability to differentiate colors, memory issues, headache, diarrhea, symptoms akin to having flu and can interact with several other medications. This should make it very clear why the Agency has concerns when the drug is used consistently as for the management of BPH. However, it can still be used for ED but the pilot should wait the required time (36 hours) after use before flying.


QUESTION: In 2008 I had a triple coronary artery bypass. Since then I have had a special issuance medical. Every year, I take a very extensive physical & send all the results to the FAA in Oklahoma. City. My medical always expires on November 30. It always takes the FAA until sometime in January to get me my new medical, so I am grounded for a month or two every year. This year they wanted some additional information so it slowed the process up even more and I have still not heard.  I have tried to call them every week, but to no avail. I'm always told their call volume is too great, and to call back later and it is impossible to get any information from them. Where does that put me in relation to this new medical coming up in May, and what, if anything can I do about this situation?  

ANSWER: Mark, the processing backlog has plagued the FAA for decades and just never seems to get better.  90 days is about the average time a pilot waits for a special issuance reauthorization, so your situation is “normal.”  The FAA’s bureaucratic process is one reason AOPA advocated for third class medical reform for so many years.  Now that it has been papered, pilots in your situation stand to gain the most by not having to go through the special issuance renewal process every year.  If your special issuance is renewed for another year, which it most likely will be, you can let it expire next year and fly under BasicMed thereafter and will no longer have to provide the follow up reports to the FAA as long as you qualify under the new regulations. 


QUESTION: I'm on a special issuance First class medical and have been for two years due to a cardiac stent procedure. The requirement to keep my medical is that I have a nuclear stress test annually along with blood work-up. My test results have been exceptional according to my cardiologist and he feels the nuclear part of the stress test is possibly putting me at unnecessary risk. I agree. Would you happen to know if the FAA ever relieves the requirement over time not to do the nuclear portion of the stress test?  

ANSWER: Cardiovascular disease is the leading killer in the United States and the most common topic for medical questions to AOPA. If one has narrowed arteries supplying blood to the heart, untreated this can lead to angina pectoris (chest pain), myocardial infarction (heart attack) or death – no parentheses required there! 

Very often treated by coronary artery bypass, which is the cardiac surgeons version of building a bypass around a town, the minimally invasive route is now very common. Via a catheter placed into an artery in the groin or elsewhere, the narrowed area is identified, stretched with a balloon and then held open with a cardiac stent, a metal tubular cage, sometimes coated with drugs to limit further narrowing. 

One way doctors ascertain if the heart is doing okay is to “stress” it by either exercising on a treadmill or giving a drug to induce the same effect.  

The FAA requests the nuclear perfusion scan in cases where the regular treadmill stress ECG provides incomplete or inconsistent results.  However, since you have a First Class medical, that may be the reason the FAA is asking for an annual nuclear scan, but the policy did change a few years ago out of concern for the radiation exposure with repeated nuclear imaging.  We suggest you write the FAA and request that the nuclear imaging requirement be dropped and that you be required to submit only an annual exercise treadmill stress test 


QUESTION: had a triple bypass on a few months ago after failing a requested FAA Cardiac Catheterization. How long will FAA require me to wait until reissuing my 3rd Class Medical? 

ANSWER: The prior question provides some context here – the “triple” referring to how many cardiac blood vessels needed to be bypassed. The FAA requires a six-month recovery and stabilization period after coronary bypass surgery.  After six months, you can complete the required testing and request consideration for a special issuance authorization.  If you are an AOPA Plus Pilot Protection Services member, we can review your medical records before you send anything to the FAA. That way, we can make sure you have everything the FAA requires, and that the information you are sending appears favorable for the issuance of a medical certificate. 

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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