QUESTION: I have some issues with my medical and have written to FAA. I am so frustrated, shocked and beside myself. They asked me to do some things and specifically said these tests were only required “if deemed necessary” by the treating physician. Well, my docs did not think further tests of my lung function were merited as I was perfectly stable and not using any medication for the underlying problem.

Lo and behold I then get a letter from FAA that states I had to provide a typed current report from my treating physician, including the very tests they told me not to bother with if he didn’t think I needed them! Well, I wrote back to them and gave them a piece of my mind; I said specifically “So now, YOU are requiring I have a test that both YOU and my DOCTOR said was NOT necessary.” I pointed out that this was an additional expense that my insurance would not cover and it was a total waste of time AND money. Finally, I told them that they should follow their own written requirements that they send to airmen. What do you think?

ANSWER: Oh dear. We have dealt with this issue many times and have pointed out that clinical medicine, the kind that doctors practice one-on-one with their individual patients, is very different from regulatory medicine, such as that imposed by FAA and other similar bodies (FDA for instance). They are looking at populations, not individuals, and the risks to health that may impact a pilot.

The way to deal with any request from FAA is:

  1. Seek the support of AOPA’s Pilot Protection Services or your AME, or both, to answer the questions they ask and only the questions they ask;
  2. Keep a copy of everything you send;
  3. Send the documents by a trackable service (Federal Express or certified United States mail with return receipt requested for instance);

And here is the MOST important. Don’t be rude. Don’t SHOUT in correspondence and don’t patronize! The person at the other end is a human being just like you, prone to error, fallible and capable of being hurt. BE NICE. You have no idea what kind of a day the person had, what bad things happened in their life. In general, if you want someone to help you, don’t push them around. Because they will push back and they have the power in this case. I suggest a well-informed, AOPA reviewed, and polite letter would have a much higher chance of a good result. 

QUESTION: I am going on a back-country flying trip with some pals in the Spring. Are there any health precautions I should take?

ANSWER: Thanks for this great question, a topic that will be the subject of a future article! As someone who learned to fly in England where grass strips – and, in fact, all strips, are vanishing, this is dear to my heart. Take this opportunity to look at your vaccination status – specifically, is your tetanus protection up to date? Take anti bug spray and use it liberally to minimize risk of a whole range of illnesses caused by bug bites and for that matter, consider clothing impregnated with anti-bug substances. At the end of the day, look for ticks and remove them carefully. Use sunscreen – pilots are much more likely to get skin cancer and being out of doors raises your risks. Finally, ensure that you have a good and appropriate first aid kit with you, and ensure you and your friends are trained in basic life-saving maneuvers such as CPR and that people back at home know where you are heading and stay in touch! Have a great trip.

QUESTION: I was recently diagnosed with atrial fibrillation and am debating my options for treatment. Can you please advise what is the best route to go and how this might affect my flying – I have a third class medical.

ANSWER: Atrial fibrillation is the most common disorder of heart rhythm and is caused by cells in the heart firing off random electrical impulses. This can cause a sense of “missed beats,” impair heart pumping and can lead to blood clots within the heart being thrown elsewhere in the body causing, among other things, stroke. However, the majority of patients have few, if any symptoms and can be treated either expectantly or with medications. If drugs do not control the aberrant beats, doctors can quell the erroneous beats by guiding a catheter into the heart with a minimally invasive procedure and zap the relevant area with some form of energy (cold, electricity and so on), returning one to normal “sinus” rhythm and abating symptoms in many. The specific needs to keep your medical will depend on whether there is any underlying heart or other issue (such as an overactive thyroid gland) so you need to work with your AME to get this sorted out. Self-ground until you are on top of the situation.

QUESTION: I just had a coronary artery bypass surgery late in 2017 and I’m confused about when I can begin the application process for a special issuance medical.  I plan to fly under BasicMed but I am aware that I have to get a special issuance from the FAA first before qualifying for BasicMed.  When can I start the process?

ANSWER: You have the basic understanding of the process down correctly.  There are eleven medical conditions that require a “one-time special issuance” from the FAA before a pilot can qualify for and fly under BasicMed, and that includes coronary artery disease that has been treated with stent or coronary artery bypass grafts.  An important change that came with the new BasicMed regulations in May, 2017 no longer requires a six-month recovery and stabilization process for THIRD CLASS special issuance consideration.  Whenever your cardiologist is comfortable putting you on the treadmill for the required exercise stress test, you can begin the process for obtaining a special issuance authorization.  Since bypass surgery usually involves a sternal incision and more wear and tear on the body that requires a longer recovery, your doctor may not really want to stress test you for at least a couple months post op. That is a discussion you and the doctor will have, but the mandatory six-month recovery period no longer applies. 
Once you have completed the process and have been granted the special issuance, you can let the authorization lapse and qualify for and fly under BasicMed regulations thereafter.

QUESTION: My medical renewal month is April so every two years I see my medical examiner for a flight physical.  Because of where I live, I also start to have allergies that require occasional use of Claritin during the spring and early summer.  Item 17 on the medXpress application asks if I am currently using any medications.  I’ve always wondered if I should be reporting the medication even though I only take if for a short time.  What does the FAA expect for that kind of situation?

ANSWER: Good question, and one that comes up fairly often, especially for applicants who are applying for their first ever medical, or for “rusty pilots” who haven’t applied for many years.  Any medications that you are taking on a regular basis, or in your case, are taking at the time you complete the medical application, (the question is asking if you are “currently” using any medication) should be reported on item 17a of the MedXpress application.  Since loratadine (Claritin) is an antihistamine, you would probably also be reporting a “yes” on item 18e, Hay fever or allergy, in the medical history section of the application.  In 17a, where the Frequency dropdown box is, the usage would be reported “as needed.”  
A frequent mistake involves declaring a medication on 17a that is no longer being taken.  It isn’t uncommon for us to receive calls from pilots who incorrectly report a medication that they haven’t taken for a long time.  Unfortunately, when the FAA reviews the application and sees a medication, especially one that is disqualifying, on the application, they will reach out to the pilot for clarification, and that almost always takes several months to sort out.  Usually, it will require a statement from the treating physician confirming that the suspect medication is no longer being prescribed. 
A good rule of thumb to keep in mind is that if you are reporting anything for the first time, as in a medical condition, medication, or a visit to a specialist health care provider, have a letter or office note from the treating or prescribing physician explaining the condition, the treatment, and/or the medication for the aviation medical examiner to review.  That short letter from your doctor could be the difference between being issued a medical on the spot or a long delay while the FAA gets the necessary information from you to determine if you are qualified for the medical issuance.  

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.

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