Pilots tend to fear their medicals simply because they value their ability to fly so intensely - and rightfully so. Much can be done prior to the medical to alleviate this fear and smooth the process for the AME (Aviation Medical Examiner) as well as the pilot. Over the past 35 plus years, I can truly say that most problems with FAA medicals are generated by mistakes the pilot or AME makes on the application sent to Oklahoma City.
Dr. Brent Blue is an Airline Transport rated Pilot with over 9,000 hours of flight time. He is a FAA Senior Aviation Medical Examiner and serves as the safety physician for the airshow at EAA AirVenture in Oshkosh Wisconsin each year. He was the team physician for the US Unlimited Aerobatic Team at the World Competition in Hungary and is a frequent lecturer on oxygen and carbon monoxide issues in aviation. Through his company, Aeromedix.com, he introduced pulse oximetry and digital carbon monoxide detection to general aviation in 1995.
For pilots who are young and healthy, the medical should be a breeze. However, there are a few caveats for the online MedExpress 8500 form. For instance, make sure you answer the questions correctly. That sounds simple, but I have had pilots put down that they had a “heart attack” because they had chest pain, went to the emergency room, and all tests for cardiac disease were negative. That is what is called musculoskeletal chest pain or non-cardiac chest pain—both of which are non-issues for the FAA. However, “heart attack” will create a tremendous of amount of heartburn for the pilot and the AME. As an AME, it is very frustrating to try to prove a negative. If you have a question, consider calling your AME and asking what to put down or call the AOPA’s Pilot Information Center for advice.
If a misstatement is made, it cannot be changed once submitted to the AME. However, if the confirmation number of the MedXpress application is not submitted to the AME, the application expires in 60 days. If the confirmation number is submitted to the AME, and he enters it into the system, the application becomes “active,” and any misstatement may be explained by the AME in block 60 of the exam form. It is important to emphasize to the AME (who should already know it) that a complete explanation in block 60 may save a lot of hassle with the FAA!
If the pilot has a problem, it is important to find out before the visit what category that problem falls into with the FAA. This is not as difficult as one might think, but is very important. There are now 18 conditions that qualify for the CACI program (Conditions an AME Can Issue) which range from arthritis to prostate cancer. This program allows the AME to issue the pilot a medical certificate on the spot without having to send paperwork to the FAA for prior approval. However, the pilot must bring in to the AME the necessary records required. CACI conditions are listed at https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/certification_ws/ and the details for what is required can be found just by clicking on the condition. If a pilot does not meet the CACI criteria, it does not mean the medical won’t eventually be issued, but it may need a Special Issuance authorization, a time limited certificate that requires additional periodic testing.
If you have had a medical problem since your last medical (or before your first medical), it is important to know what you need to bring with you and what tests the FAA might require. This may be difficult to navigate on your own. Your AME can help as, can AOPA’s Pilot Protection Services. Some common requirements are to gather all your medical records from any hospitalizations, treatments, imaging studies, and doctor notes. After that, it may become more complicated. The FAA requires testing that many non-aviation physicians do not think is necessary. In addition, the timing of the tests is very important. For instance, some tests cannot be done one day earlier than the FAA requires, and others cannot be done more than 60 days prior to the AME exam. Pilots can look up FAA requirements at https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/.
The Special Issuance process is easier to navigate with help from your AME and/or the AOPA. There are some important considerations. The most serious is that all records and test data should be sent in one mailing to the FAA utilizing a purveyor that documents delivery like UPS, FedEx, or USPS Certified Return Receipt. I always read everything that is being sent to make sure it includes only what is necessary and nothing that is not. I also make sure any specialist letters are properly worded. Some words can cause issues with the FAA and asking a consultant to rewrite a letter to make it more acceptable is reasonable as long as the information is accurate. Once all the data is submitted, it will usually take eight to twelve weeks for the FAA to grant a Special Issuance. Fortunately, when all the data is submitted properly, close to 99% of all applications result in issuance of a medical.
If the application indicated medical issues, but the medical was issued either as a “regular issuance” or special issuance, the FAA will send a letter to the pilot and a copy to the AME outlining what will be necessary (or not) for the next medical exam. READ THE LETTER carefully! Many times, the FAA only requires an interval report from a treating physician. Other times, they require much more. Sometimes they require annual medical exams and sometimes they do not. It is amazing to me how many pilots show up in my office for an exam that is not required. If they would only read the letter! Again, if you don’t understand what the FAA is stating in the letter, call your AME or AOPA for clarification.
The choice of an AME is also important. Although I received grief for saying it, I generally recommend AMEs who are pilots themselves. The critical issue is whether the AME is willing to help the pilot if there is a problem. Dealing with the FAA and the required paperwork is time consuming and the AME needs to be motivated. I find that pilot AMEs understand the love of flying and will work harder to help pilots obtain their medical certificate.