FAR 61.53 governs all piloting operations and requires that we medically “self-assess” that we are fit and safe to fly during the time that either a medical certificate or BasicMed qualification is in effect. However, there are several “off-ramps” for self-certification that require a detour in the way of a special issuance medical before exercising BasicMed privileges.
There are eleven specific medical conditions, taken directly from the Part 67 medical standards, that require a one-time special issuance before you can start or continue with BasicMed. One of those is a “transient loss of control of nervous system function(s) without satisfactory medical explanation of the cause.” This is one of the “closet catch-all” regulations that needs a bit of a deep dive to fully understand.
Cerebrovascular disease, a common accomplice of “heart disease,” or atherosclerosis, is the result of a buildup of arterial “plaque” that forms over time in the arterial blood supply. These nasty fatty deposits are made up of a whole collection of by- products that congregate in our circulatory system, including connective tissue, collagen, cholesterol esters - lipid molecules formed by an interaction between free cholesterol and fatty acids—and phospholipids, a class of lipids that are essential components of cell membranes that help regulate the movement of nutrients and other substances in and out of cells.
The cast of characters in the makeup of plaque is complex, but when they all get together like a crowded subway car, the result is a “dam” of sorts that obstructs the free flow of blood to the brain via the internal and external carotid arteries in the neck that are the main thoroughfares of blood from the heart to the brain.
If not diagnosed and treated early, the result often is a full-blown “stroke” or a lesser but still serious “Transient Ischemic Attack,” or TIA. This diagnosis is disqualifying for medical certification purposes, and requires a substantial “observation and recovery period” of up to 24 months. However, for the purposes of BasicMed, the recovery time may be less, depending on a key factor we talked about earlier; is the transient loss of control of nervous system function established to have a “satisfactory medical explanation” of the cause?
In most cases, a “stroke” or “TIA” that is documented as the underlying cause of the CVA (cerebrovascular accident) establishes the diagnosis and therefore is the “satisfactory explanation of the cause.” With the diagnosis, based on “signs and symptoms,” diagnostic imaging, appropriate treatment, and evolving improvement after the event, hopefully a full recovery will result. Regardless, the waiting time penalty is still in place before the FAA can evaluate for special issuance consideration, especially with a TIA that could recur down the road and present as a full-blown stroke. The two-year downtime gives the FAA a pressure relief valve to see how the patient does in recovery during that time. Also, if there was any apparent cognitive deficit resulting from the event, the recovery time gives the brain plenty of leeway to regain cognitive function, and post-event cognitive function testing could be part of the required evaluation for recertification for special issuance.
So, with respect to BasicMed, if the “satisfactory explanation of the cause” is clearly identified and mitigated, and the pilot can safely perform the duties under FAR 61.53, privileges can be resumed after the event without first having to be granted a special issuance medical under FAR part 67.
