1. Ask the Aviation Medical Examiner
Sergio B. Seoane, M.D., Col., CAP
Chief, CAP National Health Service
FAA Senior Aviation Medical Examiner

2. AME – Aviation Medical Examiner
Aviation Medical Examiner (AME) is a physician designated by the FAA and given the authority to perform flight physical examinations and issue aviation medical certificates.
AMEs are practitioners of Aviation Medicine
Many AMEs are also qualified in other medical specialties
The International Civil Aviation Organization have established basic medical rules for determining whether a pilot is fit to act in that capacity, and they are codified in Annex 1 to the Convention on International Civil Aviation.
Must be a Physician to be an AME, cannot be ARNP or PA

3. Assisted Special Issuance Process (AASI)
A several years ago, FAA introduced the Aviation Medical Examiner Assisted Special Issuance process (AASI)
AASI permitted AMEs to issue applicants a special issuance certificate at the time of examination, provided the applicant had complied with a previously defined set of conditions.
The AASI process eliminated the wait time for a subset of airmen, but there were still a large number of pilots who had to wait for the FAA to make a decision in their case.

4. New and Improved FAA Aeromedical Certification
In , the Federal Air Surgeon, Fred Tilton MD decided to reduce the number of medical conditions requiring a special issuance.
Dr Tilton has identified 18 medical conditions that will no longer require a special issuance,
Protocols for 11 of them have been issued to AMEs
The rest will be published in
These 18 conditions account for 10 to 15 percent of the special issuances.

5. April 2013 AME Changes Conditions the AME Can Issue (CACI)
Conditions that previously required an initial FAA Special Issuance authorization before the AME could issue a medical certificate
Now, the AME is authorized to directly issue the medical certificate. The pilot does not need to wait to receive the Medical Certificate from the FAA

6. April 2013 AME Changes Conditions the AME Can Issue (CACI) Arthritis
Asthma
Glaucoma
Hepatitis C
Hypertension
Hypothyroidism
Migraine
Chronic Headaches
Pre-Diabetes (IFG)
Metabolic Syndrome
Impaired Fasting Glucose
Glucose Elevation
Renal Cancer

7. April 2013 AME Changes
The criteria and the required medical documentation has NOT changed
The only difference is that the local AME can issue the medical certificate without approval from FAA Aerospace Medical Certification Division in Oklahoma City
This should result in the Airman obtaining the FAA Medical Certificate sooner

8. April 2013 AME Changes
The recovery time after coronary artery stenting has been decreased from 6 months to 3 months

9. AME
AVIATOR
FAA

10. Legal Authority of Designated Aviation Medical Examiners
Title 49, United States Code (U.S.C.)
(Transportation), sections 109(9), 40113(a), , and (1994) formerly codified in the Federal Aviation Act of 1958, as amended, authorizes the FAA Administrator to delegate to qualified private persons; i.e. designated Examiners, matters related to the examination, testing, and inspection necessary to issue a certificate under the U.S.C. and to issue the certificate.
Designated Examiners are delegated the Administrator's authority to examine applicants for airman medical certificates and to issue or deny issuance of certificates.

11. Aviation Medical Examiner Population (3,465 as of March 31, 2012)90
countries
(Includes Guam, Marshall Islands, Saipan, Pacific Island Trust Territories, Puerto Rico and Virgin Islands)
AMEs who are pilots 47%
Female AMEs 7.5%
5/7/12

12. Distribution of AMEs by Region
5/7/12

13. Nine FAA Regions
Similar to CAP Regions

14. Distribution of AMEs by Region AMEs/Senior AMEs
100% 0%
5/7/12

15. Distribution of AMEs by Medical Specialty
Family Practice / General Practice 49%
Internal Medicine %
Aerospace Medicine %
Occupational / Industrial Med 6%
General Surgery %
Ophthalmology %
Emergency Medicine, Orthopedic Surgery,
Otorhinolaryngology, OB/GYN, Urology %
All others <1% (ea)
5/7/2012

16. AME Age Trends

17. Distribution of AMEs by Number of Medical Exams Performed Annually
39%
30%
Percent of AMEs
Number of AMEs
18%
4.3% 5% 2%
0.8%
1.4%
0.05%
2/14/11

18. AME Distribution by Length of Service
352
270
144
308
184
363
294
151
101
181 99
197 79
246 36
141 64 23 70 18 4 1
AMEs
Senior AMEs
2/14/11

20. AME Exams – CY 2011
1/26/12

21. Aeromedical Certification Requests
1095 applications per day (2011)
33,312 applications per month (2011)
1/26/12

22. Certificates Not Issued56
18,971
1616
35,421
6322
1/26/12

23. Certificates Issued by AME And Reversed by AMCD
Medical Certificates
FY 2008
FY 2009 FY
2010
2011
TOTAL CERTIFICATES REVERSED
1937
2181
2616
2204
ADMINISTRATIVE OR LEGAL DENIAL
1079
1044
1333
1102
REVERSALS DUE TO AME ERROR
858
1137
1283
REVERSAL ERROR LETTERS
206
211
204
165
1/26/12

24. Most common causes for problems with issued certificates Jan to June 2011 compared to prior period
Block
Description
Occurrences
July–Dec 2010
Jan–Jun 2011 17
Unacceptable Medication 7 13 58
ECG 15 21
18h
High or low Blood Pressure 6
18V
DUI 1
18a
Headache
18M
Mental/Depression
18X
Rheumatoid Arthritis
18 g
Heart Problem
18J
Kidney stone
18u
Admission to Hospital
18x
Prostate cancer surgery, parathyroidectomy, cataract surgery
18D
Retinopathy /DM on treatment 42
Arthritis
Please note that there can more than one error in a single case

25. Final Denials for 2011 Total Denials: 5,012
Denial for Failure to Provide or Failed to Pursue: ,646
92% of Airman Fail to Provide info!
Final Denials (When all information requested is provided):
400,000 only 366 Denied by FAA %
1/26/12

26. Final Certification Denials
2/14/11

27. Medical Certificate Timeline
FIRST CLASS:
Airline Transport Pilots
Valid for 12 months under 40, 6 months 40 and over
SECOND CLASS:
Commercial Pilots, Flight Navigators and Flight Engineers
Contract Air Traffic Control Tower Operator
Valid for 12 months
THIRD CLASS:
Private and Recreational Pilots
Valid for 60 months under 40, 24 months age 40 and over

28. FAA Authority to Disqualify
1994, Bullwinkel vs. FAA & NTSB, challenged FAA authority to disqualify medications in absence of a disqualifying medical condition
As a result, the Federal Air Surgeon was given the authority to deny any “medications or other treatment that (a) makes the applicant unable to safely perform the duties or exercise the privileges of the airman certificate that the applicant holds or for which the applicant is applying; or (b) may reasonably be expected, within 2 years after the finding, to make the applicant unable to safely perform those duties or exercise those privileges.”

29. Not everyone is Healthy
650,000 Pilots in the USA
400,000 Medicals Issued by FAA every year
They are not all healthy
The number of prescriptions for Type II Diabetes Drugs has doubled between 2002 and 2005, in children ages 5-19 years. From 0.3 per thousand to 0.6 per thousand.
There was a 106% increase in prescriptions for diabetic drugs in children ages years from

30. How Healthy do you need to be?
You do not have to be very healthy
You need to be good enough
Kind of like being a pilot….
You need to be healthy enough so you are not going to suddenly become incapacitated while operating an aircraft
Key Word…”Sudden Incapacitation”

31. FAA Concerns Aeromedical Significant Disorders
Occurs suddenly or unpredictably
Is or may be incapacitating
Progresses at an unpredictable rate
May degrade flight safety

32. The aviation environment is very complex and dynamic
Good Health is critical functioning is this environment.

33. Two key elements for safe flying Aircraft Performance Airman Performance Both need to be adequate

34. Medical Certification of Airmen Special Issuances – Cardiovascular (2005)
Problem
Class 1
Class 2
Class 3
Total
Bioprosthetic Valves 33 38
135
206
Mechanical
Valves
169
235
Pacemaker 37 53
276
355
Defibrillator 2

36. FAA Policy on Medications FAR 61
FAA Policy on Medications FAR 61.53, prohibits acting as pilot-in-command or in any other capacity as a required pilot flight crewmember if that person:
“Knows or has reason to know of any medical condition that would make the person unable to meet the requirement for the medical certificate necessary for the pilot operation, or:
“Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirement for the medical certificate necessary for the pilot operation.”

37. FAA Policy on Medications
In addition, FAR 91.17, prohibits the use of:
“any drug that affects the persons faculties in any way contrary to safety.”
“Severe Head Cold” maybe a “medical deficiency” under FAR 61.53

38. Why the FAA Denies Certain Medications
Not exclusively the Medications, but rather the underlying medical condition associated with the Medications
Potential for Sudden Incapacitation
All Medications are evaluated based on this concept

39. Generally Disallowed Medications
Anticoagulants
Antiviral Agents
Anxiolytics (anti-anxiety)
Barbiturates
Chemotherapeutic Agents
Hypoglycemic
Mood Altering
Antidepressants (exceptions, 4/2/2010: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro) 
Narcotics
Sedating Agents
Antihistamines
Decongestants
Tranquilizers
Stimulants (Diet Medications)
Experimental or Investigational Medications
Muscle Relaxants
Motion Sickness
Anticonvulsants
Steroids
Lomotil
There is no “Official FAA Medication List”
The condition is often the disqualifying issue, not the medication

40. Over The Counter Medications
Antihistamines and Decongestants
Any drug that produces drowsiness or other central nervous system effects and experimental or investigational drugs are prohibited

41. Medications NOT Authorized
Anticoagulants (Maybe Yes, Maybe No --but ASA, Plavix OK…warfarin/coumadin…it depends…often yes)
Mood Altering Medications
Sedatives
No investigational Drug Treatments
No one currently receiving Radiation Treatment
Anti-seizure Medications
Antidepressants (off smoking cessations medications for 30 days before flying is OK)
Except –need “SI”..Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro) 

42. AOPA Database
This database is compiled by the AOPA Medical Certification Department and is based upon confirmation with the FAA Aerospace Medical Certification Division in Oklahoma City. The list includes both allowed and non-allowed medications and, for the allowed medications, the conditions under which the drug is considered acceptable for flight duties. Although a medication might be listed as allowed, there are variables with each individual's situation that could render a particular medication inappropriate for flying because of case history or adverse side effects. For example, some medications are used "off label," meaning that a drug is prescribed for symptoms that do not fall within the FDA's approval guidelines for that drug. The FAA might not allow an otherwise acceptable drug in this circumstance.

43. What the FAA doesn't know will not Hurt you
In a fatal crash, the remains of the crew will be tested for Prescription and Over the Counter Medications
140,000 substances can be screened for by the FAA Civil Aerospace Medical Institute
In General Aviation, several hundred substances are routinely screened for after an accident
In Commercial Aviation, several thousand substances are screened for
DNA in the future – Genetic Markers to determine: Fatigue, Lack of Sleep

44. It’s a Crime to Lie or Mislead
Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or who makes any false, fictitious or fraudulent statements or representations, or entry, may be fined up to $250,000 or imprisoned not more than 5 years, or both" (Title 18 U.S. Code. Secs. 1001; 3571).
TWO TYPES OF FALSIFICATION
Intentional False Statement – A False Representation of a Material Fact Made with the Knowledge of Falsity
Fraudulent Statement
A False Representation of a Material Fact Made with the Knowledge of Falsity
Made with the Intent to Deceive and Relied Upon by Another

45. FAA Form 8500-8 No more paper Form 8500-8 Only online as of: 10/1/2012
If you make a false statement..60 day suspension
Revocation of your Medical
The revocation will always show up on your airman record, you will never get another Medical from the FAA

46. FAA Policy Regarding Falsification
Revocation of BOTH Medical Certificate and Airman Certificate
Revocation of Airman Certificate because you the Lack of Qualification of Hold Airman Certificate

47. Honesty Best Policy
If you are taking a prohibited Medication and you LIE, and the FAA finds out, they may press charges, but you will NEVER get another Medical under ANY circumstances.
If you are taking a prohibited Medication and you state the truth, your Medical will be denied, if you apply at a future date and are not longer taking the Medication, you will almost certainly be approved for an FAA Medical.
FAA wants to encourage honesty, punish those who are not honest

48. Follow the Rules
If you Fly with prohibited substance, you are in violation of your Medical and FAA regulations
Any Life Insurance, Accident Insurance, Aircraft Insurance, Liability Insurance will no longer be valid since you are not in compliance with FAA Regulations

49. Certification of Airman
Approximately 400,000 applicants annually
Approximately 25,000 Special Issuances per Year
400 Pilots in USA with Diabetes requiring Insulin (3rd Class Medical)
Cardiovascular conditions most common in Airmen
Final Denial are approximately 0.1%

50. Privacy of Medical Information
Within the FAA, access to an individual's medical information is strictly on a "need-to-know" basis. The safeguards of the Privacy Act apply to the application for airman medical certification and to other medical files in the FAA's possession. The FAA does not release medical information without an order from a court of competent jurisdiction, written permission from the individual to whom it applies, or, with the individual's knowledge, during litigation of matters related to certification. The FAA does, however, on request, disclose the fact that an individual holds an airman medical certificate and its class, and it may provide medical information regarding a pilot involved in an accident to the National Transportation Safety Board (NTSB) (or to a physician of the appropriate medical discipline who is retained by the NTSB for use in aircraft accident investigation.
FAA Aviation Medical Examiner Guide, Version IV, July 31, 2005

51. Disqualifying Medical Conditions
Angina pectoris
Bipolar disorder
Cardiac valve replacement
Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant;
Diabetes mellitus requiring insulin or other hypoglycemic medication
Disturbance of consciousness without satisfactory medical explanation of the cause
Epilepsy
Heart replacement
Myocardial infarction
Permanent cardiac pacemaker
Personality disorder that is severe enough to have repeatedly manifested itself by overt acts
Psychosis
Substance abuse and dependence;
Transient loss of control of nervous system function(s) without satisfactory medical explanation of cause

52. Did not pass your Medical?
SODA
Statement Of Demonstrated Ability (SODA) may be granted in lieu of an Authorization
Medical condition or defect that is static and nonprogressive
One time test, usually not repeated
Assisted Special Issuance
For Disease Protocols
Special Issuance
An airman who is medically disqualified for any reason may be considered by the FAA for an Authorization for Special Issuance of a Medical Certificate

53. One Eyed Pilot One Arm Pilot
Can you get a Medical with only one Eye or with one Arm?
Can you get a Medical with Skeletal Deformities or after a Stroke?
What about a Prosthesis?
Deafness?
For medical defects, which are static or nonprogressive in nature, a Statement of Demonstrated Ability (SODA) may be granted in lieu of an Authorization.

54. SODA Statement Of Demonstrated Ability
At the discretion of the Federal Air Surgeon, a Statement of Demonstrated Ability (SODA) may be granted, instead of an Authorization, to a person whose disqualifying condition is static or nonprogressive and who has been found capable of performing airman duties without endangering public safety. A SODA does not expire and authorizes a designated Examiner to issue a medical certificate of a specified class if the Examiner finds that the condition described on the SODA has not adversely changed
In granting a SODA, the Federal Air Surgeon may consider the person's operational experience and any medical facts that may affect the ability of the person to perform airman duties including
Essentially a Flight Test performed by FAA Examiner

55. Cardiovascular Disease in Pilots
Disease 1st 2nd 3rd
Class Class Class MI
CABG
PTCA
PTCA with Stent

56. Cardiovascular Disease I
10,000 Pilots Flying in USA with Heart Disease with Special Issuance
Pacemaker, most pilots certified with Special Issuance (wait 2 mo & stress test)
Heart Murmurs usually OK if evaluation negative
Most Valvular Heart Disease OK (Mitral Insufficiency, Mitral Regurgitation, MVP, Aortic Insufficiency, Aortic Stenosis)
Atrial Fibrillation OK
Hypertension OK (30,000 Pilots fly with HTN on Medications)
Coronary Artery Disease OK (if < 50% Lesion, LV ok, Stress Test normal)

57. Cardiovascular Disease II
Heart Attacks (MI), OK but need to wait 6 months, need cath and nuclear imaging – no ischemia
Heart Valve Replacement OK (wait 6 mo)

58. Medical Certification of Airmen Special Issuances – Substance Abuse (2005)
Problem
Class 1
Class 2
Class 3
Total
Alcoholism
979
354
542
1,875
Drug Dependence 43 13 17 73

59. Medical Certification of Airmen Special Issuances – Monocularity (2005)
Condition
Class 1
Class 2
Class 3
Total
Monocularity
209
476
1,912
2,597

60. Medical Certification of Airmen Special Issuances – Diabetes (2005)
Condition
Class 1
Class 2
Class 3
Total
Non-Insulin
493
988
3,819
5,300
Insulin
425

61. Epilepsy - Seizures Generally Speaking - No Way
Sometimes possible, but this rare

62. Diabetes Usually Possible If no medications and Diet controlled – OK
If on medications, need Special Issuance

63. Commercial Space Flight
Orbital Crew
Crew: To Be Determined
Passengers: Medical Questionnaire with physical examination and laboratory studies
Suborbital Flight
Crew: Second Class Medical Certification with endorsement
Passengers: Medical questionnaire without routine physical or laboratory studies

64. Authorization for Special Issuance of a Medical Certificate
Granted by the Federal Air Surgeon
Valid for a specified period
Granted to a person who does not meet the established medical standards
Federal Air Surgeon may consider the person's operational experience
Individual must satisfy of the Federal Air Surgeon that the duties authorized by the class of medical certificate applied for can be performed without endangering public safety during the period in which the Authorization would be in force.
The Federal Air Surgeon may authorize a special medical flight test, practical test, or medical evaluation for this purpose. A medical certificate of the appropriate class may be issued to a person who fails to meet one or more of the established medical standards if that person possesses a valid agency issued Authorization and is otherwise eligible. An airman medical certificate issued in accordance with the special issuance section of part 67 (14 CFR § ), shall expire no later than the end of the validity period or upon the withdrawal of the Authorization upon which it is based.

65. Aeromedical Certification 2004
442,498 Applications Processed
12,076 Special Issuances (waivers) for significant medical conditions

66. Airman Certification and Hypertension
American Heart Association
Normal BP < 120/80
Pre-Hypertension /80-89
Hypertension > 140/90
FAA- should not exceed, seated
155/95

67. Initial Protocol for Hypertension Guide for Aviation Medical Examiners
AME-- conduct an evaluation OR review report by the attending physician.
Personal and family medical history
Assessment of risk factors CHD
A clinical exam and 3 BP readings separated by 24 hours !
Resting EKG

68. Initial HTN (Continued)
Glucose, Lipid Profile, K+ and Creatinine
Medications used, dosage and adverse effects
Airman to wait 2 weeks upon initiation of medication or change in dosage
Summarize results of evaluation in box # 60

69. Can You Fly Without a Medical?
Glider and Free Balloon Pilots are not required to hold a medical certificate of any class. To be issued Glider or Free Balloon Airman Certificates, applicants must certify that they do not know, or have reason to know, of any medical condition that would make them unable to operate a glider or free balloon in a safe manner.

70. Sport Pilot Operational Limits - Max. Gross Weight 1,320 Lbs.
- Max. Stall Speed 45 Knots
- Max. Speed 120 Knots
- Max. Two-Place
- Day VFR Only
- Single, Non-Turbine Engine
- Fixed Landing Gear
January 21, 2011

71. Sport Pilot (Continued)
Medical Requirements
- FAA medical certificate or a valid U.S. driver’s
license
- An individual may not use a driver’s license if:
- A certificate was not issued with the individual’s most recent application;
- The individual’s most recent application has been denied, suspended, or revoked;
- The individual’s most recent Authorization for a special issuance medical certificate has been withdrawn

72. Sport Pilot - Medical
Hold valid airman medical certificate or a current and valid U.S. driver’s license
Must comply with each restriction and limitation on their U.S. driver’s license and any judicial or administrative order applying to the operation of a motor vehicle.
Cannot have been denied the issuance of at least a third-class airman medical certificate (if they have applied for an airman medical certificate)
Must not have airman medical certificate revoked or suspended
Must not have had an Authorization withdrawn (if they have ever been granted an Authorization)
May not use a current and valid U.S. driver’s license in lieu of a valid airman medical certificate if they know or have reason to know of any medical condition that would make them unable to operate a light-sport aircraft in a safe manner.
Sport pilot medical provisions are found under 14 CFR §§ 61.3, , 61.53, and ). For more information about the sport pilot final rule, see: LAST UPDATE: July 31, 2005

73. Antidepressants
Mild to moderate depression only - no history of psychosis or suicidal thoughts
4 authorized medications: Fluoxetine, Sertraline, Citalopram, Escitalopram
Special Issuance
- Single medication only
- Stable on medication for minimum of 1 year
- Close monitoring
Applications
- 17 in certification review process
- 3 denied

74. Which type of pilots do not need an FAA Medical Certificate?
Free Balloon Pilots
Glider Pilots
Ultralight Pilots
Sport Pilots

75. Tips for your AME Medical Examination
Establish long term relationship with an AME
Take your flight physical 4-6 weeks prior to the expiration of your medical certificate
Bring all your medical documentation
Do not drink coffee or soda prior to exam…only water
Bring eyeglasses, hearing aids, seeing eye dog
Bring a list of all medications and dosage (the prescription bottle)

76. Tips for your AME Medical Examination
Make sure your vision is good, have your vision checked few weeks prior to flight physical, minimum is 20/40 for 3rd class, 20/20 for 1st /2nd class
If you do not feel well or are ill….do not take the flight physical, reschedule it
Check your blood pressure 4-6 weeks prior to your flight physical, must be < 155/95!
Once you start the flight physical exam never leave

77. Tips for your AME Medical Examination
Chose an AME that will be your advocate
Bring any doctors notes, MRI, CT and x-ray report, all recent ER Visits
Bring all recent lab reports and Hospital Records
Do not get your FAA Physical if you are ill or do not feel well
Be Patient…if you have a medical problem it will take time to collect and review the information

78. Tips for your AME Medical Examination
The vast majority of physicians do not understand anything about flying an aircraft and even less about the FAA Aeromedical Certification process
If you acquire a medical condition, call you AME 8-10 weeks prior to your medical. It is ok to make an appointment with an AME to review your medical status prior to obtaining your Flight Physical.
If possible, go to an AME that is a pilot, he/she will be sympathetic to your desire to keep on flying (my personal opinion)

79. Office of Aerospace Medicine (AAM) Aviation Safety (AVS)
New England Region
Headquarters
Regional Flight Surgeon
Paul H. Clark, M.D.
Deputy Regional Flight Surgeon
Joseph H. Ray, M. D.
Susan E. Northrup, M.D.
Federal Air Surgeon
Frederick E. Tilton, M.D.
Deputy Federal Air Surgeon
James R. Fraser, M.D.
Civil Aeronautical Medical Institute (CAMI) Melchor J. Antunano, M.D.
Medical Specialties Division
Michael Berry, MD
Southern Region

80. Medications Authorized by FAA
New Medications - Will authorize any medication if it has been out for ONE year
All Antihypertensive Medications OK
All Asthma Medications OK, including steroids (prednisone) if dose < 20mg qd
All anti-cholesterol Medications OK

81. Future Changes to FAA Aeromedical Certification Special Issuance List (2014?)
Kidney stones
Carotid artery stenosis
Colitis
Irritable bowel syndrome,
Colon cancer
Bladder cancer
Leukemia
Hodgkin’s disease
Lymphoma

82. Airman Medical Certification Review and Appeals Process
AME
REGIONAL
FLIGHT SURGEON
AEROMEDICAL CERTIFICATION
DIVISION, CAMI
FEDERAL AIR SURGEON
NATIONAL TRANSPORTATION
SAFETY BOARD
ADMINISTRATIVE LAW JUDGE
FULL BOARD
U.S COURT OF APPEALS
SUPREME COURT

84. Ask the Aviation Medical Examiner
Sergio B. Seoane, M.D., Col., CAP
Chief, CAP National Health Service
FAA Senior Aviation Medical Examiner