Q: If I have to take blood pressure medications, will I lose my medical?

A: Of course not! This is one of the most common medical problems pilots face, and is one of the easiest to handle with the FAA. All the usually prescribed anti-hypertension medications in current use are approved by the FAA. The AME may issue a certificate if the treating physician provides a brief hypertension evaluation report which documents the medications used, their dosages, whether there are any adverse effects or any complications of the hypertension itself. This report must contain a recent blood pressure reading (no higher than 155/95) and also whether there are other medical condition being treated.

Lab tests and electrocardiogram (ECG) are not required unless the treating physician believes it is important to do so. A follow-up current status report is required at the time of renewal of the next medical for Class III pilots, and annually for Class I and II pilots. In reality, these reports are no more than what a good doctor should be doing anyway! Of course, it is best if the pilot presents these reports to the AME at the time of the examination to avoid any delay in issuing the certificate.

To make it easier, we have created a hypertension worksheet that the treating physician can fill out instead of a typed report, Hypertension Evaluation Worksheet to download.

Q: What is the difference between a Class I, II, and III physical examination?

A: For Class I and III, it depends on the age of the applicant at the time of the exam. If the applicant is under the age of 40 at the time of the exam, the Class I certificate is valid for one year and Class III for five years; if over the age of 40, it is two years and 6 months respectively. Class II exams are good for one year no matter what the age of the applicant.

For pilots over 35, an ECG is required for Class I, and then annually after the age of 40; these must be performed at the AME’s office and transmitted to the FAA electronically. Vision standards are also different between private and commercial categories. For example, a Class I or Class II pilot needs to be able to see 20/20 in each eye (corrected if needed) for distant vision, while a private pilot can get by with 20/40 vision. Commercial pilots over the age of 50 are also required to demonstrate intermediate vision of at least 20/40, in addition to the near vision requirements, which are the same (20/40) for all classes. Commercial pilots also must demonstrate reasonable depth perception by measuring eye alignment.

Q: What is a SODA?

A: A Statement Of Demonstrated Ability (SODA) is a determination that a pilot can fly safely with a fixed physical deficiency, such as the loss of an eye or a limb. The pilot must demonstrate to an FAA examiner that he or she can safely fly with this handicap, and a waiver, called a SODA, will be issued for this particular physical deficiency. There may be some restrictions placed on this waiver, for example, the need for hand controls, if the pilot is paralyzed in the lower extremities.

Q: Can I fly commercially if I am color blind?

A: Yes, but the imposed limitations depend on the severity of the color vision deficiency. If the applicant fails the color vision screening test in the AME’s office, the certificate will state “Not valid for night flight or by color signal”. This give the pilot the opportunity to at least fly daylight with intact radio communications (when required) until such time the applicant opts to take – and passes – the Operational Color Vision Test (OCVT). Recently there have been further differentiations made between Class III and the commercial ratings (Class I and II). Please see the Color Vision Flowchart to better explain.

Most color deficient pilots can pass the OCVT, and when they do, the FAA sends a letter to that effect, which means the pilot does not have to take a color vision screening tests at future flight physicals. The FAA also sends a corrected medical certificate with the color vision restriction removed. However, if the pilot cannot pass, the color vision limitation remains on the medical certificate. Under such circumstances, it is doubtful that an airline would hire such a pilot for commercial flying.

Q: How does the FAA handle DUI’s?

A: The FAA takes any form of substance abuse or dependence very seriously. If a pilot is arrested for a DUI, he or she must report this to the security division of the FAA within 60 days of a conviction. Any ARREST (even without conviction) must also be reported on the next flight physical application. The AME is then required to assess whether the pilot might have a problem with alcohol. This includes obtaining the arrest and court records, and a copy of the plots DMV records from every state in which the applicant has had a driver’s license. The AME may then issue the medical certificate if evidence supports this to have been an episode of alcohol misuse only, unless the following is true:

1. Blood alcohol concentration (BAC) of 0.15 or higher
2. History of two DUI arrests within 10 years
3. Lifetime history of three or more DUI arrests

It therefore makes sense that any pilot or student pilot applicant should contact their AME well in advance of their flight physical to minimize delays in certification. If any of the above three criteria are met, then FAA will require the applicant to undergo a high quality Substance Abuse Evaluation, before further consideration can be undertaken. If the pilot is determined to have an alcohol abuse or dependence diagnosis, further assistance from a HIMS – designated AME will be necessary to facilitate Special Issuance consideration.

Q: I have been diagnosed with Adult Onset Diabetes. How does this affect my medical?

A: If it can be determined that your diabetes is well controlled by diet and exercise alone, then only a report from your physician is required and the airman can receive an unlimited medical certificate from the AME. However, if medications are necessary, the pilot must be considered under Special Issuance, as diabetes requiring medications is a disqualifying medical condition. Class I and II pilots are not allowed to use insulin. Class III requirements for insulin-dependent diabetics are quite stringent, emphasizing the absense of any hypoglycemic events. For diabetics requiring only oral medications, annual reports from the treating physician are required. These reports must show that the pilot is under adequate control with medications by virtue of a hemoglobin A1C below 10, that there are no adverse effects from the medication, and that there are no complications to other organ systems from the diabetes itself. Under this circumstance, the medical certificate would be limited to one year, with further certificates contingent upon favorable reports from the treating physician. If a pilot is diagnosed with diabetes on his or her FAA examination, a minimum waiting period of 60 days is required to determine effectiveness of oral medication.

Q: If I had a childhood illness or surgery, do I have to continue reporting it on the application?

A: Technically, yes. Section 18 of the application requires disclosure of your entire life’s medical history. However, anything previously reported does not need to be re-explained each time. It is alright to mark the question “yes” and state “previously reported, no change” in the explanations box.

Q: I see my physician several times per year for my medical condition. Do I have to report each and every visit?

A: In box 19 of the application, it asks about visits to health professionals in the last 3 years, the date, name and address of the physician, and the reason for the visit. If there are several visits for the same type of medical condition, it is not necessary to list each episode. Aggregating them, for example, to the last visit, is perfectly acceptable. It is also not necessary to remember the exact dates of the visits. These questions have more to do with prompting the AME to understand your medical situation and to perhaps request medical records, than to exercise your detailed memory of your medical appointments. Routine preventive health check-ups are not included, unless these examinations result in treatment of an illness. Your FAA flight physical examinations are also not required to be listed here. Please note that “previously reported” is not an option for this category!

Q: Is there an approved medication list published by the FAA?

A: The FAA has recently posted very helpful guidance to pharmaceuticals in the AME Guide: http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/

Q: Can I fly if I have been diagnosed with ADD?

A: If this was a “soft” diagnosis in childhood, and it can be determined that no medications are needed and the applicant has no current evidence of Attention Deficit Disorder, then the answer is yes, possibly with not much more documentation than a thorough explanation by the applicant’s treating physician, as long as ADD medications have not been used for a long time. However, if the diagnosis is solid, the applicant will need to be off all ADD medications and undergo a rigorous cognitive evaluation by a board-certified clinical neuropsychologist. The FAA has recently released new testing guidelines for this type of evaluation, and the applicant should consult with an AME before undergoing such testing to make sure it is done correctly.

Q: What about a diagnosis of depression?

A: There are basically two different kinds of depression. Situational depression occurs to normal and mentally healthy people, when they find themselves in depressing situations. As long as the individual has resolved their depression and is no longer requiring medications after a “reasonable” period of time, the FAA will likely certify, based on a favorable current psychiatric evaluation. (Although this evaluation may come from a non-psychiatrist if the applicant has been treated by his or her own health practitioner – as long as the report is thorough.)

The other kind of depression (recurrent or chronic) may require ongoing medication for the person to feel well, along with regular or periodic counseling therapy. In the past, the FAA has considered this diagnosis to be disqualifying, whether or not the applicant was using prescription anti-depressant medications. Fortunately, in 2010, the FAA began allowing pilots to use one of four allowable antidepressants, called SSRI’s, and become medical certified after an in depth evaluation. The current criteria are quite strict http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/ssri/, and it is hoped that with the passage of time demonstrating that this is safe, these criteria may be loosened in the future.

Q: What about sleeping pills?

A: All over-the-counter (OTC) sleeping aides are actually antihistamines, have a very long half-life, and should be avoided for at least 24-48 hours after ingestion. In some people, cognitive effects can last even longer. The FAA has approved two short-acting prescription sleep aides, but with two important restrictions. First, they should not be used more than 1-2 times per week, as habituation can easily occur. Secondly, there are required waiting periods between ingestion and flight. Ambien has a 24 hour waiting period, and Lunesta has a 30 hour waiting period. Of course, individual variations can occur, and pilots should “ground test” them before using them prior to a planned flight.

For further details about other sleep medications, please see: http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/sleepaids/

Q: Do I have to disclose medications I occasionally take, if not currently taking at the time of the examination?

A: This depends on the type of medication and the reason. For example, if an individual took an antibiotic some time ago for a few days for an infection that is not a chronic condition, then that does not need to be reported. However, if a medication, even an OTC drug, is periodically used for a chronic medical condition, this should be reported, even if not being taken at the time of examination. Anti-inflammatories such as Advil come to mind, for example, for an individual with arthritis who takes it only when needed. If not sure, this is a good question to ask of the AME at the time of the examination.

Q: Can I fly if I have had a kidney stone?

A: Yes, if it can be domonstrated by an imaging technique (X ray, CT scan) that the stone has passed. The question becomes more complicated for pilots who have recurrent stone formation, as these can be unpredictable and the pain quite incapacitating when new stones form in the urinary tract. These individuals should be carefully evaluated by a specialist for determining the cause of the recurrent stone formation, so that preventive techniques, if any, can be utilized.

Q: I was recently treated for prostate cancer. how long do I have to wait before I can fly again?

A: As soon as it can be determined that you are cancer free and your treatment is concluded, you can be eligible again under Special Issuance. Because prostate cancer can often be eradicated before the cancer has spread beyond the prostate capsule, pilots with successful treatment of this form of cancer can frequently return to flying immediately after their therapy is finished. This is not necessarily the case of other cancers, such as breast cancer, which can spread to other body areas, by virtue of only a single cancer cell escaping and lodging elsewhere in the body. Many other cancers require waiting periods to determine a cancer-free state.

Q: I am worried that I might not pass my next medical due to a heart condition. I would be satisified to fly an airplane that qualifies under Sport Pilot rule. Should I try to get my medical anyway?

A: You should discuss this with your AME, but it may be best for you not to apply for a medical certificate as a denial will prevent you from flying under Sport Pilot licensure unless you go through the trouble of first getting certified under Special Issuance. Although the FAA requires only a valid driver’s license as proof of medical suitability for the Sport Pilot category, it does exclude individuals who have had a previous denial of their medical certificate. To me, this makes no sense, as it creates a double standard. Having said that, if you knowingly have a medical condition that is a risk to flight safety, you should not fly under the Sport Pilot rule, even if you do hold a drivers’ license!

Q: What is Special Issuance?

A: Special Issuance is a category of medical certification for pilots with certain disqualifying medical conditions. Many pilots fly with conditions that are technically disqualifying, but are stable enough that they can be issued a time-limited certificate under careful medical monitoring. Medical conditions such as well-controlled diabetes or slowly developing neurological conditions such as Parkinson’s come to mind. Even people with coronary artery disease often can return to flying, as long as their disease is well managed and they are not at significant risk for having an adverse medical event due to their condition. These Special Issuance certificates are time limited, often to a year, requiring status reports from the treating physician to be forwarded to the FAA before a new medical certificate can be issued. The requirements for future consideration are spelled out in the Special Issuance Authorization Letter. Often the tests that the FAA requires are more than what the treating physician feels is necessary to monitor the condition or disease. It can therefore be challenging for the pilot to convince their doctor, much less their insurance company, of the need for this additional testing. For pilots facing Special Issuance, it is highly recommended that they consult with their AME before making the appointment for the FAA physical examination. This will allow the pilot to have all the required medical records in hand, so that their medical certification process is not held up by waiting for the required documentation.

Q: The FAA sent me a letter requirng more medical information within 30 days, otherwise I might have my medical certificate revoked. I am not able to obtain these records within that period of time. What should I do?

A: It is important that you at least respond to the FAA in writing within 30 days, and let them know that you are attempting to gather the necessary documents. They will give you a 30 -day extension if you request this, but be prepared to give them everything they need as soon as possible.

Q: I had surgery a couple weeks ago, and during this time, I did not fly. Do I need to forward a report from my surgeon to the FAA to indicate that I am fully recovered?

A: Unless the surgery was for a disqualifying condition, you do not need to report anything to the FAA until your next FAA medical examination. As long as you did not fly during your incapacitation, you did not violate any FAA regulations. As soon as you have recovered and are no longer taking disqualifying medications, you are good to get back into the airplane. If you are not sure whether or not the reason for the surgery is diqualifying, please check with your AME or Regional Flight Surgeon.

Q: Should my AME also be my personal physician?

A: There is a difference of opinion on that. Some pilots prefer their AME and their personal doctor to be one and the same, with the idea tha their doctor will more easily catch medical conditions that are potentially problematic for the FAA. Others feel they can be more honest about their health concerns if their personal physician is not also their AME. Interestingly enough, the FAA takes the latter position, even though they have no regulations on this matter.