As sobering as that might be, advances in cancer diagnosis and treatment techniques are constantly improving. Survival rates for cancers in general have been improving steadily since the 1970s², while those for certain types of leukemia have more than doubled over the same period³.

Is Flying After a Cancer Diagnosis Safe?

For many, surviving cancer massively changes their priorities. In the wake of treatment, people often find the willpower to quit smoking, and reapplying sunscreen suddenly seems much less inconvenient. So, what should pilots know about cancer risk and flying? 

Most experts seem to think that cosmic radiation at the higher reaches of the atmosphere is responsible for a large portion of the increased cancer risk in aviation. Hormonal changes associated with disrupted sleep patterns and fatigue may also contribute to breast and prostate cancer risk. Some have even suggested the possibility that certain brain tumors could occur more frequently⁴. Those factors probably do not apply to 100-hour-per-year general aviation pilots in the same way they do to airline pilots. 

There is still a lot to be answered. What we know for sure is that the risk of melanoma and other skin cancers is about two to three times higher in all pilots, and female aviators, based mostly on data collected from flight attendants, are about 50 percent more likely to be diagnosed with breast cancer⁵. Prostate cancer in men⁶ along with Non-Hodgkin lymphoma and some brain cancers may also occur more frequently, but the association is less clear.   

Flying After Cancer Treatment

For pilots who want a medical certificate, beating cancer is just the beginning. Whether you are a professional who needs a medical certificate to sustain your livelihood or a recreational pilot who recognizes flying an airplane as an expression of truly living, maintaining your FAA medical certificate after any cancer diagnosis introduces a level of complexity to the medical certification process that you likely have not experienced before.

Describing all the nuances of that process in a single article would be impossible. To begin with, the term cancer itself applies to a wide variety of abnormal cell growth that can affect just about every kind of tissue and organ system in the body. 

Each one carries with it a different risk of recurrence and has different implications for how it might affect the safety of flight. Basal cell carcinoma is a superficial skin cancer that is most often cured with a single surgery. More aggressive malignancies often require complex surgeries along with radiation and chemotherapy. Lumping them together would defy even the most determined efforts.

Common FAA Procedures for Common Cancers

For some of the most common types of cancer that have well-established treatment guidelines, the FAA has streamlined the process. In fact, there are seven different forms of cancer that have been included in the list of Conditions AMEs Can Issue (CACI). For pilots with a history of cancer involving the bladder, breast, colon, prostate, kidney, testicles, or skin, the Aerospace Medicine Certification Division (AMCD) of the FAA has issued a detailed set of criteria that allow AMEs to issue certificates without waiting for an agency determination. 

Each condition has its own set of specific criteria, but some common considerations apply:

• You must be complete with active treatment.
• You must have no history of recurrent or metastatic disease.
• If you had surgery, you must be off all related pain medications and cleared to resume normal activity by your surgeon.
• Your doctors feel that your condition is stable and no additional treatments are planned.

You still need to make sure you meet all the criteria for your specific diagnosis and properly prepare for your appointment, but if those conditions apply to you, there is a good chance your AME can issue your certificate on the day of your exam.

General Guidelines for Less Common Conditions

For cancer that involves other organ systems, or when it has spread to more than one part of the body, the process is more involved. While the FAA has not published set guidelines, a general rule is that to be considered for a medical certificate, you must:

• Be cancer free for five years or more.
• Any radiation or chemotherapy used for treatment must have ended. 
• The doctors responsible for your cancer treatment and your primary care physician must also submit current status reports that attest to your overall health and cancer remission.

Depending on your circumstances, you will need to supply additional information unique to your own history. The five-year waiting period can also be reduced in some cases. The major point is that if you’ve had a rare malignancy, recurrence or metastatic disease, you will most likely have to wait a significant period of time before you can qualify for a medical certificate. 

What About BasicMed?

If you’re not a professional pilot, skipping your AME appointment and flying under BasicMed is another option. If you’re flying within the U.S. at less than FL 180 with fewer than six passengers aboard, BasicMed provides an alternative to traditional medical certification that may suit your mission well. You will also need to stay below 250 knots, but for recreational pilots, that’s a restriction most only fantasize about exceeding. 

Strange as it may seem, cancer does not exclude pilots from using BasicMed. FAR 61.53 still prohibits you from flying with a known “medical deficiency,” but if you feel you are safe to fly after an honest self-assessment and your doctor agrees with your position, BasicMed may provide an expedient way to continue flying. 

Getting Back in the Air When Life Is Back to Normal

The important thing to remember is that being a cancer survivor does not automatically mean the end of your flying career. For the CACI cancer conditions, it might not even delay your FAA medical certification. 

If you do not meet the criteria for a CACI, but you feel you can still fly safely after a discussion with your doctors, there is still a good chance that the FAA will grant your certificate. The agency’s medical certification policies are much more permissive than many pilots realize. The hard part is dealing with its bureaucracy. 

Once you think it is appropriate to start flying again, make sure to do your homework before scheduling an appointment with an AME. Not all AMEs will be familiar with complex certifications, and submitting the right documentation upfront can speed up the process by months or more.

References

The post Surviving Cancer as a Pilot appeared first on FLYING Magazine.

The unofficial rule of threes when it comes to survival go like this:

You can survive:

• three minutes without oxygen.
• three hours without shelter in a harsh environment.
• three days without water.
• three weeks without food.

What does this have to do with heart attacks? One of the primary purposes of blood is to carry oxygen to the rest of the body. The heart is the pump that pushes the blood around. If you have a pump failure, you don’t have long to live. Very little on earth can incite the kind of fear you will feel if your body begins starving for oxygen.

If you look at the list of FAA disqualifying medical conditions, you’ll notice that six  are specific to the heart with most of those involving a high possibility of a heart attack. This is not surprising given that the FAA is concerned with the potential loss of control of an aircraft. Having a heart attack in flight would be devastating to your ability to continue to fly, especially if it led to full cardiac arrest—which is when your heart completely stops beating. 

What Is a Heart Attack?

In a heart attack, one or more of the blood vessels supplying oxygen to the heart muscle itself gets blocked. In essence, a heart attack is what you feel when heart muscle cells begin to die from lack of oxygen. Depending on how many cells are involved, where they are, and how long the issue persists, you can end up with any number of complications, such as pain, shortness of breath, arrhythmia, or even cardiac arrest.

The underlying cause of a heart attack is almost always coronary heart disease (CHD) resulting in a buildup of arterial plaque that mostly, or completely, prevents blood from flowing through a coronary artery. CHD goes by many names, such as coronary artery disease, heart disease, etc. As you might imagine, when it comes to medical certification, the FAA is concerned about all of them—and with good reason. Forefront in the minds of many an aerophobe is the vision of their pilot clutching his chest before slumping over the controls in the aftermath of a massive heart attack.

Hysteria aside, incapacitation or death due to heart attack, or myocardial infarction (MI), is a real concern. By some estimates, sudden cardiac death is responsible for 15 percent of all fatalities in the industrialized world [1] or about 450,000 annually in the United States [2]. Heart disease is a common problem among aging pilots, and few medical conditions pose a more direct or devastating threat to aviation safety.

If you have chest pain, shortness of breath, palpitations, or any other symptoms associated with your heart, stop reading, seek medical attention, and get your health problems under control. If you have already done that, or want to know what to do if it does ever happen to you, read on.

Disqualifying Condition

As previously stated, 14 CFR Part 67 specifically lists “coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant” as a disqualifying condition. As if afraid that one phrase was not broad enough, Part 67 also lists two common consequences of untreated CHD: angina pectoris, which we have written about before, and myocardial infarction. Still, wondering if this might apply to you? In its guide for medical examiners, the FAA goes on to include any history of atherectomy, brachytherapy, coronary bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), rotablation, stent insertion, and minimally invasive procedures by incision or robot operations as de facto proof of CHD [3].

Even that list is not all-inclusive, but enough with the medical jargon. The point is, if you have a cardiac condition, chances are that the FAA wants to know about it. Even though a history of a heart attack is a disqualifying condition by law, the FAA has discretionary authority to grant special issuances to pilots with well-controlled medical conditions. The good news is that it is absolutely doable. 

The bad news is that demonstrating you are medically safe to fly will take a lot of time, effort, and coordination with your doctors. According to the American Heart Association, the average person needs two to three months before they are ready to return to work, and people with more strenuous or demanding jobs may need even longer. This is born out in the way the FAA treats returning to fly after a heart attack as well. If you have recovered from a heart attack, and your underlying CHD has been well managed by your physicians, there is a good chance that you have already accomplished most of the documentation the FAA will require.

What Are the Requirements?

In order to earn an FAA medical certificate after a heart attack, you will need to do EVERYTHING on the following list:

• Have no current symptoms of CHD such as chest pain or shortness of breath during exercise
• Pass a Graded eXercise Test (GXT), according to FAA standards
• Submit all relevant medical records related to your CHD diagnosis and treatment
• Submit a current cardiovascular evaluation and current status report from your treating physician
• For first class or unrestricted second class certificates, an acceptable cardiac catheterization and GXT must be repeated three to six months after initial treatment

This is a simplified list. The timing and quality for each of these requirements are critical and may vary somewhat based on which complications you have experienced and what procedures your doctors used to treat them.

Most importantly, you need to make sure to follow your doctor’s advice regarding medication, diet, and exercise to avoid additional complications. If you are doing all that, getting your medical certificate will depend as much on a properly submitted application as it does on your recovery. We highly recommend choosing an AME familiar with complex certification procedures and willing to put in the time to do it properly. Depending on how it happens, a process that could take a few weeks can stretch into months or years. Given the gravity of the condition, the medical documentation has to be done right or it will cause significant delays. Helping pilots with difficult certification issues is our specialty. You can always contact us to find out more about the process and help with preparing your request to the FAA.

Many people live long, full and productive lives after a heart attack or developing CHD and receiving treatment for some of its more severe complications. Whether you fly as a hobby or for a living, there is no reason to end your time in the skies.

References:

[1] Z. J. Zheng, J. B. Croft, W. H. Giles, and G. A. Mensah, “Sudden cardiac death in the United States, 1989 to 1998,” Circulation, vol. 104, no. 18, pp. 2158–2163, Oct. 2001, doi: 10.1161/hc4301.098254.

[2] Centers for Disease Control and Prevention (CDC), “State-specific mortality from sudden cardiac death–the United States, 1999,” MMWR Morb Mortal Wkly Rep, vol. 51, no. 6, pp. 123–126, Feb. 2002.

[3]“Guide for Aviation Medical Examiners.” https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/coronary/ (accessed Mar. 13, 2022).

The post Returning to Flight After a Heart Attack appeared first on FLYING Magazine.

As any experienced pilot can attest, there are times when landing safely requires every ounce of mental and physical capacity we can muster.

Aeromedical Risk

The purpose of the FAA medical certification process is to enhance aviation safety by limiting the possibility that a pilot at risk for sudden or insidious incapacitation might find themselves behind the controls of an airplane with lives at stake. Most people grasp that concept intuitively when it comes to seizure disorders and heart attacks. Few people—including pilots themselves—would argue with the notion that pilots who could become unconscious at a moment’s notice should not be allowed to fly. 

The discussion becomes more nuanced when considering conditions that cause subtle or insidious impairment. Aeromedical risk is difficult to quantify. From depression and ADHD to heart disease and diabetes, the FAA’s medical certification policies have been trending in a more permissive direction for years.

More than ever, pilots with significant medical diagnoses who can demonstrate their conditions are well managed can still qualify for a FAA medical certificate. DUI arrests and convictions are a special case.

DUIs by the Numbers

There are two key regulations that apply to rated pilots: 14 CFR Part 61.15 and 14 CFR Part 67. The first of these requires that anyone who holds a Part 61 certificate—including student, sport, and recreational pilots—must report any alcohol- or drug-related motor vehicle action to the FAA within 60 days. The second concerns the FAA’s medical certification standards and often involves much more time and effort in which to comply.

Details on reporting procedures and reportable events are somewhat beyond the scope of this article. Generally speaking, if you’ve been convicted of DUI, DWI, or OWUI, or had your driver’s license canceled, suspended, or revoked for an alcohol- or drug-related reason, 14 CFR Part 61.15 probably applies to you. It is a good idea to consult with an experienced attorney if you find yourself in that predicament.

While 14 CFR Part 67 does not specify a reporting deadline, it applies even more broadly than Part 61.15 and involves a much more complicated process. Under Part 67, any pilot who applies for a medical certificate must report “any arrest(s) and/or conviction(s) involving driving while intoxicated by, while impaired by, or while under the influence of alcohol or a drug.” 

That applies to aspiring pilots the same as it does for already certificated ones, and it applies to any event “ever in your life.”

Until you satisfy both of those regulatory requirements, you should not return to flying.

Can You Still Fly after a DUI?

The FAA rightfully takes drug and alcohol offenses seriously, especially when they involve operating a vehicle. Rated or aspiring pilots with one of these events in their background will need to satisfy a significant burden of proof to show that their substance use does not pose a risk to aviation safety. However, it is possible to be a pilot after a DUI.

The FAA is less concerned about the offense itself than what it suggests about substance use. The rest of this article will focus on medical certification standards after a DUI or alcohol arrest, but they apply the same principles when considering pilots who have run into issues with other drugs.

We all know the best course of action is never to get behind the wheel of a car if there is even the slightest chance you could be impaired by alcohol. That said, people make mistakes. Some make even bigger mistakes. The FAA considers three main questions when deciding whether or not to issue a medical certificate to a pilot with a DUI on record.

How Much Did You Drink?

When it comes to DUIs, blood alcohol content (BAC) provides a convenient way to measure how big a mistake you made. At higher values, it can also suggest there was no “mistake” at all.

The legal BAC limit for driving in most U.S. jurisdictions is 0.08. To fly an airplane, pilots must wait at least eight hours after consuming any alcohol and have a BAC less than 0.04.

Driving with any alcohol in your system probably is not a good idea, but it is still legal to a point. Drivers arrested with a BAC of 0.09 can probably explain it away as a mistake that is less concerning for alcoholism. However, at larger BAC values, such as 0.15 or higher, the list of those willing to help explain things away as a mistake decreases precipitously.

The FAA’s medical certification policies regarding BAC are surprisingly humane. If you were arrested for a DUI and your blood alcohol level was less than 0.15, you will get a chance to tell your story. The agency will consider a personal statement and may grant a certificate sooner than you would expect.   

How Many Times Has It Happened?

As the saying goes, “fool me once, shame on you; fool me twice, shame on me.” Under many circumstances, the FAA is willing to give pilots the benefit of the doubt. A single DUI arrest with a BAC less than 0.15 will earn a chance to plead your case. In some circumstances, your aviation medical examiner (AME) may even be able to receive permission to issue a certificate without waiting for the FAA to review your case in more detail.

If you have had more than two DUIs or alcohol-related arrests, it is a much different story. Especially for rated pilots, your first DUI arrest should be a huge wake-up call. Getting a second one can send a message that drinking is more important to you than flying. The FAA is not trying to punish drinking and driving. It is trying to prevent alcoholics and drug addicts from flying airplanes. Few things point toward those issues more accurately than repeated substance-related legal issues.

If you have had more than one DUI, you can still qualify for a medical certificate, but it will probably mean abstaining from alcohol for the duration of your aviation career and participating in a monitored recovery program. 

How Long Ago Was It?

Everyone gets to be young and stupid. Was your DUI arrest when you were 17 driving home your high school prom? Or did it jeopardize your family’s livelihood in your mid-30s or later? Those are two quite different events. Even if you have never had a DUI, most have a story from their high school or young adult years about some kind of poor judgment they would never repeat. As it relates to your medical certificate, it is who you are now that matters.   

The FAA considers arrests older than five years much more leniently than newer ones. Events 10 or more years in the past can be dealt with using an even softer touch. A lot of personal growth and maturity can develop in five or 10 years. The FAA takes that into account when considering medical certifications. Again, its goal is to make sure that alcohol and drug abusers do not threaten the federal airspace, not to rub pilots’ noses in their past mistakes.  

Every Case Is Different

Are you an aspiring pilot with a single DUI and BAC of 0.10 that happened seven years ago? If so, your AME can issue your certificate. You will still need to prepare a personal statement that summarizes the event and describes your past, present, and anticipated future relationship with alcohol. You will also need to provide some official record that corroborates your story—especially the part about your BAC at the time of arrest. However, if your story is similar to this example, it should not delay your medical certification. Even if your DUI was more recent, your AME may be able to negotiate issuing your certificate without prior FAA review.  

What if you are an airline pilot who had a DUI two months ago and your BAC was 0.15 or higher? Your path to obtaining a medical certificate will be a bit longer. The higher BAC will raise its own red flags, and the fact that you were arrested as a professional pilot, likely during your mature adult years with your career at stake, suggests you may well be an alcoholic. 

If you have more than one DUI arrest in your past, or other substance-related legal issues, it will require a long period of time and effort to qualify for a medical certificate. There are some situations where this may not be true, but the FAA generally considers multiple DUIs to be proof of substance dependence.   

Approaching Your AME Exam 

You should approach your medical certificate application after a DUI the same way as for any new medical condition. First, get treated and get better. If you have a problem with alcohol or drugs, use the opportunity to look in the mirror and address the problem head-on. Even if you do not have an issue with dependence, make sure you have resolved the legal, financial, and administrative aftermath of your arrest to the point that you can focus on flying again. 

Next, make an honest self assessment. If you’re safe to fly, the FAA will most likely agree with you. The time and effort it takes to prove that will depend on your unique situation and all the factors discussed earlier. Still, if you legitimately do not have an alcohol problem or are well established in recovery, you can still begin or resume life as a pilot. 

Be honest with the FAA too. Besides the fact that the FAA’s review of the National Driver Register may render lying a fruitless endeavor, few things will complicate, or end, your career as a pilot more reliably than deliberately concealing a DUI from the agency. 

Learn as much about the medical certificate application process as you can before your AME appointment. A well-prepared application can shave months off the time it takes the FAA to consider your application. Always treat your AME exam like a check ride. 

DUIs do not end flying careers, but untreated substance dependence and repeated abuse do. Any DUI arrest will trigger a serious and open conversation about your alcohol use, but the FAA takes a reasonable—if slow and bureaucratic—approach to evaluating who can return to the flight deck. If you are willing to engage in that conversation, chances are you still have a promising flying future.   

The post Flying as a Pilot after a DUI appeared first on FLYING Magazine.

The Road Map to Quick Certification

We have previously discussed how to fill out your MedXPress to reduce the number of questions your AME may want to ask. No matter how well you do that, there are many times when you will still need a note from your doctor about your medical condition(s). Because the FAA doesn’t see you in person nor have access to your entire medical history, those notes are critical. Providing a Current Detailed Clinical Progress Note that meets the agency’s rigorous quality and content standards is vital to your speedy medical certification.

You have done your due diligence. You have prepared for your FAA medical exam like the test that it is. You know what you need to get through your medical exam in an expeditious manner. You know what your doctor(s) write will play a critical role in that process. Now for the hard part. How do you get a busy doctor who is set in their practice pattern to write a note to the FAA’s standard instead of their own? If what you are asking is correct, and your doctor just won’t write it to the standard the FAA is looking for, what do you do? Similarly, what if your doctor already wrote a note and you need it updated to meet the FAA requirements, but they won’t do it? Why would this even happen?

Why Won’t Some Doctors Won’t Write the Note You Need?

Most importantly, you need to set realistic expectations. Don’t ask your doctor to write something that is factually incorrect. You can’t very well ask them to say you have passed your exercise stress test if you haven’t and your labs are in normal ranges if they aren’t.

You should also recognize you are asking a busy professional to do something they are not familiar with and may not view as being relevant or necessary. Not every patient encounter note needs the level of detail the FAA expects. Writing ones that do normally require much more time than documenting only to a standard to facilitate follow-up care, justify billing, and satisfy liability concerns. 

Are you asking them to revise a note they have already completed from a visit days or weeks ago? Some medical record systems make it hard to change notes that have already been signed. At a minimum, nobody likes being asked to repeat work they have already done once. Your doctor is no different.

If you have provided your physician with your request in advance, they may also not like you “telling them what to do.” How you approach the request and how you phrase things can be important. No physician likes it when a patient comes in with a self-diagnosis and starts demanding specific treatment protocols before they even have a chance to ask what is going on. Using good communication skills and tact can go a long way toward getting what you want. 

We briefly discussed this concern in our article about Direct Primary Care Physicians. It pretty much boils down to motivation. Most doctors are paid by insurance. Insurance has their own criteria for what is required to pay a doctor within their billing system. If your doctor has already written a note, especially one that meets the insurance payment criteria, why would they do it differently or a second time? In either scenario you are asking the doctor to do more work for no more compensation. For a busy doctor, this can be difficult to overcome.

What To Do When Your Doctor Won’t Write the Note You Need for the FAA

Sometimes pilots may hit a brick wall with their physician. That doesn’t mean it is over, but it might mean it is over between you and that particular doctor. When it comes to primary care physicians, which can cover the vast majority of issues you may be dealing with, this is where we think making the switch to a Direct Primary Care (DPC) physician may be beneficial. They work directly for you and are not beholden to the insurance companies for reimbursement.

Direct Primary Care’s goal is to bring that doctor- patient relationship back to the doctor and the patient. That is exactly what you need. You want a doctor who has time to listen to you and understand what your needs are. After all, your needs may be slightly different than the average patient. Direct Primary Care physicians tend to have a significantly smaller patient panel than insurance- paid physicians. This gives them a lot of time and flexibility in comparison. If you think this will be a good option for you, then use the Direct Primary Care Coalition’s website to find one near you.

If you aren’t ready to make a change to Direct Primary Care and you just need a one- time evaluation, or your situation requires a specialist, then you still have options. Independent Medical Examiners (IMEs) are physicians of varying specialties who conduct, well, independent medical exams. They specialize in reviewing records and writing complete notes along with giving their medical opinion based on the combination of the records and their own exam. That can be useful to a pilot facing a challenging FAA medical certification.

There is a downside though. Sometimes the FAA requires things that are not covered by insurance. While the agency wants certain tests and/or specialist evaluations, they may not be medically indicated from a treatment perspective. That generally means insurance won’t pay for them. Another thing that insurance won’t pay for is an independent medical exam. Rates will vary by specialty, location, and how long the review and exam will take. But if you need a specialist evaluation and you can’t get it done properly within your insurance system, then an IME may be your best option. If you want to find an IME, you can check SEAK’s National Directory of Independent Medical Examiners and the Independent Medical Examiners Directory.

If You Commit to the Process, You’ll Likely Succeed

Most of the time when a pilot’s medical certificate is denied, it is because the FAA never received the information requested. If you are safe to fly, then it is a matter of having the right documentation. Don’t let one physician unwilling to help be what stops you from getting back in the air. And Wingman Med can help.

The post Getting the Right Doctor’s Note for the FAA appeared first on FLYING Magazine.

To be clear, that statement applies to worst-case scenarios. About 90% of pilots leave their AME appointment with a medical certificate already in their hands. Many with significant but well- controlled medical conditions will wait less than three months for the FAA to make their decision.

Worst-case scenarios are ones with multiple conditions or ones associated with significant aviation safety concerns. Recent heart attacks, previous strokes, heart valve replacements, insulin-dependent diabetes, depression or anxiety treated with medication, other conditions of similar severity, or a combination of them will fall into that category.

Even with those conditions, the FAA will generally provide a decision in less than six to twelve months. It will not always be the decision pilots want, but with a few exceptions, those who wait longer are waiting for another reason.

What’s Behind the Horror Stories?

You do not have to look far to find a story on the internet about a pilot who waited years for a medical certificate only to give up and stop trying. Often those stories include a frustrating statement to the effect that, “I sent them everything they asked for, and they kept asking for more.”

There is truth behind those stories, but there are also misconceptions. Most of the misconceptions have to do with this: the doctors at the FAA’s Aeromedical Certification Division (AMCD) never actually see pilots in person. Instead, they rely on the notes provided by the pilots’ doctors to decide if they are safe to fly an airplane. When those notes are incomplete or contradict each other, AMCD reviewers need more information to make a decision. Similarly if one of those notes adds previously unknown, and concerning, information, they will want more information on that as well. 

From the time you start your MedXPress application and especially when providing medical records about complex medical conditions, it is up to you to make sure that your application tells a complete and consistent story. One of the best tools to do that is a good current detailed clinical progress note from your physician(s).

What is a Current Detailed Clinical Progress Note?

A clinical progress note is a note that every doctor should be trained to write. They might not immediately recognize what the FAA is asking for when you first discuss it with them. If the term “progress note” does not register, try asking for a “complete history and physical” or “SOAP note.” If that doesn’t work, RUN! Find another doctor! One who does not understand what those terms mean or is unwilling to provide a document that meets that standard can only delay your medical certificate application.

[Credit: Shutterstock]

For FAA purposes, the note must be signed by a board certified physician. There are many other highly skilled health care professionals who provide excellent care. You might see a physician associate or nurse practitioner who knows more about your healthcare than any physician. It does not matter. For FAA purposes the note must come from a physician.

The progress note should ideally exist as part of your medical record. It is different from an “After Visit Summary” or “Patient Summary” which you might also see in some online patient portals. Your doctor’s administrative staff should be able to help you locate it.

Elements of a Good Note

A progress note is what doctors use to communicate with each other about your care. Formatting varies somewhat, but in order to meet the FAA’s standard, it must include the following information:

• A history of the condition being treated
• All current medications and doses
• Whether or not you experience any medication side effects
• Physical exam findings
• Results of any tests performed to evaluate the condition
• Your specific diagnosis including something called an ICD-10 code
• A clear assessment regard the status of your condition and how it affects you
• A clear plan regarding how it is treated
• A clear statement about how your doctor plans to follow-up with you or monitor the condition

Letters from your doctor DO NOT replace progress notes. Letters that amplify information contained in your medical record may help to expedite your medical certification decision. The note your doctor provides is the only way that AMCD has to evaluate your medical issues. Missing information, inaccuracies, or ambiguity will generate questions.

Fine Print and Terminology

When it comes to FAA medical certification, the word “current” means within 90-days preceding your AME or any time after it. There are several exceptions to that rule-of-thumb that are clearly spelled out in the FAA’s Guide for Aviation Medical Examiners. Unless one of those exceptions applies to you, nothing prior to 90-days before your AME appointment will be considered in support of your medical certificate.

The term “detailed” is more subjective. Its inclusion in the FAA’s guidance mostly serves to emphasize that they actually want your doctor to document their considered opinion in a way that shows they spent some effort thinking about your particular situation. As one example, an assessment for high blood pressure that says “htn controlled with prescription medication” is not detailed.

A detailed assessment should look more like this: “43-year-old male with essential hypertension and no other modifiable risk factors for cardiovascular disease. He takes 20mg of Lisinopril per day and his average blood pressure is 125/78. No concern for undiagnosed comorbid conditions or indication for work-up at this time. He should follow-up annually for routine monitoring.”   

The difference should be obvious. While obvious, the first one may be all the doctor cares about for their own reference, but the second one is vital to your certification.

Avoiding Certification Delays 

Progress notes that do not meet these standards slow things down. Visit summaries, notes by non-physicians, notes that lack sufficient detail, old notes, and letters provided in lieu of progress notes will all delay your application.

You can probably identify most deficiencies on your own. If you want to take the guesswork out of your FAA medical certification and avoid any unnecessary delays, visit our website and schedule a free consultation to find out more.  

The post Avoid Medical Certification Delays appeared first on FLYING Magazine.

Once upon a time, the world used paper. Applying for a FAA medical certificate, meant filling out FAA form 8500-8 and presenting it to your AME at your flight physical. While the use of that paper form has fallen by the wayside,14 CFR part 68.7 still mandates its use.

MedXPress is the FAA’s online medical certificate application system. The output is still a PDF version of the 8500-8 (which you should keep), but MedXPress has eliminated the use of physical paper in the application process.

Except for printing your medical certificate, AMEs do not use paper either. Instead of requiring a physical copy of your application, your AME will need your MedXPress confirmation number. You will get that after successfully submitting your application online.

Your AME will use that confirmation number to import your medical certificate application into the Aerospace Medical Certification System (AMCS). AMCS allows AMEs to electronically complete their virtual portion of the 8500-8 and (hopefully) print your medical certificate. 

Each Section has a Purpose

The FAA’s intended goal with MedXPress is to get as much medical information about you as possible. The AME wants to make an informed decision about your health as it relates to flying.

MedXPress starts by asking some basic demographic questions. The next section asks what medications you take. Those are relatively straightforward. Most questions pilots have about the medical certificate application process concern the next section, about medical conditions.

That section is straightforward as well. Most questions that come up have to do with closing the gap between what pilots want it to say and what it actually says very clearly.

At the top of the “Medical History” section, the FAA asks, “Have you ever in your life been diagnosed with, had, or do you presently have any of the following?” They even ask the question in all caps to add emphasis.

25 specific questions follow, but question 18x deserves special mention. It asks about “Other illness, disability, or surgery.” Taken together with the introductory statement above, it should be obvious that the FAA asking, “Have you ever in your life had…[any] illness, disability, or surgery.”

That is not all. The section also has several general questions about other types of medically significant events including:  

• discharge from the military for medical reasons
• rejection for military service 
• rejection for life or health insurance
• receipt of medical disability benefits

Questions about driving history, drug and alcohol- related arrests, and criminal history follow. Finally, you will round out your application by listing each medical visit you have attended in the preceding three years and authorizing the FAA to obtain your driving record from the National Driver Register. 

Tell a Consistent Story

The FAA could simply say, “please tell us about your medical history and how you are doing,” but that wouldn’t get them much information. People tend to forget certain things. By asking for details on several different, specific items, they are more likely to jog the memory of the pilot filling out the form.

When asked about their medical history, many patients of ours neglect to mention hypertension, but they do remember they take a pill every day. Asking about medical history and current medications is more likely to get the full story. The FAA wants the full story. Your goal should be to tell a consistent one.

Here are some examples:

• If you list Allegra and Flonase as medications, then you should also mark “yes” to 18e (Hay fever or allergy). Zyrtec, by the way, is disqualifying for regular use.  
• If you mark “no” to all of the medical condition questions, but then mark “yes” to a medical rejection or disability benefits, it doesn’t add up.
• If you mark “no” to 18g (heart or vascular trouble), but have had five trips to the cardiologist in the last six months, your AME will have questions.

The AME Can Update Your Answers

Inconsistency in your answers should spark questions from your AME. If everything ends up meeting the FAA requirements, then you can still get your medical. Your AME can update your answers before submitting everything to the FAA, but it is in your best interest to make their job easy. 

Wingman Med Advice

By ensuring you tell a clear and consistent story on your MedXPress application, you can expect a smoother process with your AME. Here are some tips:

• You should have a corresponding medical condition for every medication you take and disability you have.
• If there isn’t a specific question about your medical condition, then list it under “other illness, disability, or surgery.” Along these lines, you should never think, “they didn’t ask about sleep apnea” because everything not specifically asked goes here.
• Provide a brief statement about each medical condition. As a rule of thumb, if you need more than a sentence, you should bring a current detailed clinical progress note from your treating physician that explains more. 
• List a reason for all visits to health care professionals.
• “Previously reported, no change” may not help your current AME evaluate your condition (AMEs don’t have access to your past exams)— use the above guidelines and then add “previously reported, no change.” 
• Retain copies of the generated 8500-8 for future reference, as this makes it much easier to remember what you wrote last time.

Finally, if you decide that an application you have submitted needs major rework, there is a solution. Before your AME imports your exam to AMCS, MedXPress applications will be deleted after 60 days of inactivity. If you want to toss your virtual application in the virtual trash can, just wait 60 days, and it will age out.

Once you share your confirmation number with an AME, the FAA will see it, so make sure your application says what you want it to say before you schedule your appointment.    

If you would like to do a trial run at MedXPress, we have our own MedXPress Simulator. If you want more personalized advice, you can also schedule a free consultation by clicking on the “Free Consult” button that can be found on our website.

The post How to Fill Out MedXPress: Start Your Flight Physical Right. appeared first on FLYING Magazine.

That defeatist attitude is common enough in general. For pilots with a history of mental conditions, it seems to be even more pervasive. Unfortunately, many pilots form their opinions based on information from those with no actual knowledge, training, or experience related to FAA medical policies. 

We have already written about the importance of preparing for a FAA medical certification appointment like any other pass-fail examination. We have also highlighted how we can help pilots with significant medical conditions navigate the complexities of the FAA medical certification progress. 

Mental health conditions deserve special consideration. Contrary to popular opinion, having a mental health diagnosis in your medical record is not automatically disqualifying for FAA medical qualification. In many cases even those with ongoing treatment for well controlled active conditions can still continue their flying careers. It often boils down to the right preparation for the exam.

Some Conditions Are Simple

The reality is that the FAA treats mental health conditions the same way as physical health conditions. They want to know about it and they want to know how well you are doing. 

When you are filling out a new MedXPress you have to report all medications, medical conditions and any visits to medical professionals in the last three years. 

What if you broke an ankle last week? The FAA cares a lot. But what if you broke an ankle three years ago and made a full recovery? They want to know, but if you are fully recovered, then that is what matters.

If you report your broken ankle on your MedXPress application, your AME can gather all the information they need to make a medical certification decision just by conducting a good physical exam. If you broke it last week and are still limping, using crutches, or recovering from surgery, do not schedule an AME appointment. Based on your medical condition, you should not be flying and you will not leave with a medical certificate. If you broke it three years ago and walk into your AME’s office with full pain-free strides, you will be just fine.

Some Conditions Are More Complex

If your AME needs more than their own physical exam to determine your eligibility for a medical certificate, you will need to do more preparation. Consider diabetes. Diabetes is a condition that usually does not cause any symptoms. If it is bad enough for your AME to identify during your physical exam, you almost certainly should not be flying. For pilots with diabetes, the only way to evaluate whether or not you are safe to fly is by reviewing recent lab results and reports from your treating physical. 

Determining how diabetes may affect safety of flight is more difficult than it is for a broken ankle, but at least your doctors, your AME, and the FAA can still reference objective data to help make their decisions.

Mental Health Conditions Are Even More Challenging To Evaluate 

Unlike a broken ankle, which an AME can evaluate by watching you walk in from the parking lot, or diabetes, which has objective lab results the FAA can use to determine your stability, the only way anyone can evaluate a mental health condition is by what you tell them.  

During the 15-20 minutes they might spend with an AME, most pilots with mental health conditions will not look or act any differently than anyone else. It takes time, lengthy discussion, and careful consideration to understand how the condition may affect a patient’s day-to-day life, much less aviation safety. There is no way an AME can provide a responsible evaluation in the amount of time they spend with pilots and there is no way to measure depression or anxiety with a lab test. 

Like with any other medical condition, the FAA will need to see that your condition has been properly evaluated by an appropriate specialist and that it has been treated to the point it will not affect safety of flight.  

No one wants another Germanwings or China Eastern. That is why the bar is high. On the other hand, there is growing acceptance that pilots who are forthcoming about their condition and have the courage to seek treatment are likely safer than the ones suffering in silence.

Not Everything Is Reportable

If you see a personal trainer to help prevent injury or as a continuation of your rehab from an acute musculoskeletal injury, it does not need to go on your MedXPress application. The same goes if you see a massage therapist to help relieve muscle pain that does not limit your ability to safely operate an aircraft. If your symptoms are bad enough that you have been to a doctor for help, that should be reported. 

By the same token, if you are going through a rough patch in life and turn to a non-medical counselor, pastor, or other trusted advisor for help, the FAA does not care. You do not need to report the life coach helping to improve your efficiency or the marriage and family therapist working to make your family relationships more supportive. But, if your symptoms become significant enough that you have taken medication or you are working with a psychologist or psychiatrist, that is something you should disclose. 

Showing Stability Is What Matters

Reporting mental health concerns does not necessarily mean that your medical certification will be denied or even delayed. It does mean that you will need to show you are still safe to fly an airplane. Just like with a broken ankle, if your episode of depression was years ago and you have obviously been doing better since, reporting it will be unlikely to jeopardize your medical certificate. Just like with diabetes, if you have chronic depression that is well treated by an appropriate specialist with or without medication, chances are you can continue flying. 

Do you think you are safe to fly? Would your co-pilot agree with you? If the answer is yes, the FAA will probably agree as well.  

Make no mistake, there are some mental health conditions that will always be disqualifying. Bipolar disease, psychosis, and severe personality disorders are some examples. That is true for physical conditions too. Active seizure disorders and untreated coronary heart disease will get your medical certificate application rejected just as fast as schizophrenia. 

For many pilots, including those who have suffered from depression, anxiety, and post traumatic stress disorder, FAA medical certification is becoming much more commonplace. The biggest difference between those conditions and the physical ailments we discussed above is that the documentation from those who treated you will have to tell the whole story. Making sure those records will meet the FAA’s standards and knowing which information to submit can be harder than you might guess. That is where we come in. If you’re safe to fly, we keep you in the air.

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