QUESTION: I have been told by a former Navy Flight Surgeon that it might be possible, but likely impossible, to get a medical back because I have three strikes against me as I am over 60, diabetic and have paralysis in my left arm (I can move my shoulder but not hand or arm). Do you know of any case with such conditions getting a medical? I’m 6 years without any problems. Private pilot, now on paper a recreational pilot, as I understand it, “don’t get denied!” I don’t fly now and wonder if it’s in my future, or even possible to try for. 

ANSWER: The conditions you noted are not necessarily disqualifying, and we would need to know more specific information about your current situation before we could give you a detailed assessment, but your age is certainly not a factor. Pilots in their 80s and 90s are often issued third-class medical certificates. And diabetes that is well controlled and managed, even if on insulin, can result in a special issuance authorization. If on insulin, however, the requirements are more stringent than for oral medication control, and require specific testing, including a cardiovascular evaluation with stress testing, complete eye examination, and a detailed report from an endocrinologist with lab work showing good control of blood glucose.

Persons with limited use of limbs can often demonstrate their ability to safely operate the aircraft through a Medical Flight Test with special accommodations such as hand controls or other appliances added to the controls.

So, the short answer is that it is possible to obtain medical certification for each of the conditions you cited. You would still need to satisfy the FAA requirements to qualify for the special issuance. And you were told correctly that if your medical application is denied by the FAA, you would not be eligible to fly as a Sport or Recreational Pilot.  

QUESTION: I had a mitral valve replacement at the end of March. I completed the required stress test and submitted the hospital records to FAA on August 10, requesting a special issue third-class certificate. My cardiologist says I have no limitations whatsoever. I have called several times to see why it is taking so long (it’s been three months). I keep getting a recording to say they are too busy to talk. AOPA has also called on my behalf and I have been told that the only response is that “it’s in the queue for review.” They are either very inefficient or very understaffed. This is an area of the FAA that seriously needs some examination. Could AOPA do an article on why it takes so long for FAA review? This would help many people in the same situation as me.

ANSWER: You are in the same situation that many airmen are facing while waiting for their medical certification to be cleared. The FAA has many challenges with respect to timely certification, and the issue isn’t new. The processing delays have haunted the FAA’s Office of Aerospace Medicine for decades and the situation isn’t improving much, if any, and likely won’t for some time. We addressed the special issuance process last year. The process is very bureaucratic, often expensive, and always time consuming. 

The FAA takes safety very seriously, and although inflight medical incapacitation is rare, the FAA establishes certification policies that require more testing and documentation than would usually be considered appropriate by your health care provider. The Aerospace Medical Certification Division at the Civil Aerospace Medical Institute in Oklahoma City is responsible for the majority of certification activity, and workload often exceeds capacity, resulting in delays that often exceed 90 days. Some cases take much longer, though, and often end up in the Office of Aerospace Medicine at FAA headquarters in Washington, DC, or with one of the many specialty consultants the FAA employs around the country. The complexity of the review process and the bureaucracy exceed the scope of what we can discuss here, but it is a significant problem that the FAA just can’t get a handle on. The chronic backlog with special issuance review is one of the main reasons AOPA fought to get medical certification reform in place with the implementation in May 2017 of BasicMed. There are more than 40,000 pilots qualified under BasicMed, but in your case, since you had a valve replacement, you must make it through the gauntlet for a one-time special issuance before you can qualify for BasicMed. Hang in there. You should be hearing something soon. 

QUESTION: I was diagnosed with a DVT and placed on warfarin and although my medical has expired I would like to get it back. Please advise!

ANSWER: A deep venous thrombosis or “DVT” is a blood clot usually deep inside the leg veins, although it can happen elsewhere. This impedes blood returning to the heart from the afflicted area, leading to swelling and possible skin breakdown. Pieces of clot can then break off and travel to the lung, a so-called pulmonary embolus which can be fatal. Treatment usually involves “thinning” or anti-coagulating the blood with a drug like the one you mention, warfarin. While on this medication, it is important to closely monitor how well anti-coagulated the blood is by measuring a blood test called the INR (International Normalized Ratio) – a higher number means the blood is “thinner.” In order to sort out the medical, you will need a status report from your treating doctor on your history of DVT, symptoms presentation, evaluation, and treatment. Also, a comment on current status and, if still on warfarin, current INRs showing a range of 2.0-3.0. You can learn more HERE

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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