AINsight: When Can’t I Fly?

 - August 8, 2019, 6:04 PM

As I previously noted, U.S. FAR 61.53 outlines basic medical responsibilities that a pilot must adhere to at all times between FAA medical exams with an aviation medical examiner (AME). Pilots have both leeway and ethics in self-assessing whether they are fit-to-fly on any given day.

Are there circumstances, however, when it is certain that a pilot cannot fly? Quite clearly there are, and these provisions are outlined in Part 67 “Medical Standards and Certification.”

Per FAR 67.3 “Issue,” a pilot who meets the medical standards (based both on medical history and the FAA exam findings) “is entitled to an appropriate medical certificate.” At least this regulation has the courtesy to state that a qualified pilot should indeed receive a medical certificate.

That was the fun part. As we know in life, and especially when dealing with the FAA, with the good comes the bad.

However, the disqualifying conditions outlined in Part 67 in reality do compromise the safety of flight. Grounding, therefore, is appropriate (at least temporarily).

Rest assured, once again, that for the majority of disqualifying conditions, a pilot may ultimately return to flight status when that condition is deemed resolved and/or stable enough that the FAA might grant a “special issuance” medical certificate. This procedure includes an exhaustive discussion that is found in FAR 67.401. (I will address the special issuance process more in future discussions.)

The medical standards and certification considerations are found in Part 67, Subpart B “First-Class Airman Medical Certificate” (provisions are similar for second- and third-class medical certificates, with the exception of some “slack” in the third-class vision requirements).

FAR 67.101, “Eligibility,” states that for a pilot to be eligible for a first-class medical certificate, “and to remain eligible,” the pilot must meet the provisions of the FAR. The key here is the phrase “to remain eligible.”

There is an important distinction between the provisions discussed in this FAR and the separate “general medical conditions” that the FAA has the authority to act on in any way that seems appropriate under the circumstances. In other words, for all of the other circumstances for which a pilot must figure out when and how to comply with FAR 61.53. 

The provisions herein, however, are rather cut and dried. Under the provisions of this FAR (in conjunction with the general responsibilities under FAR 61.53), the take home message is that a pilot will be unable to continue to exercise the privileges of the medical certificate from the moment that either any of the standards presented in FAR 67 are no longer met, or if any of the disqualifying medical conditions are diagnosed.

Therefore, even if a medical certificate would be theoretically valid for an additional period of time (based on the usual time periods assigned to medical certificates), in essence it no longer can be used for flight privileges from that moment forward if the requirements are no longer met.

Part 67 also addresses vision and hearing standards (these are worthy of separate and detailed discussions in a future blog). However, the “standards” addressed in these regulations are important, and should be known by all pilots and AMEs. A pilot must meet these standards to be eligible to exercise the privileges of the medical certificate.

As for the medical conditions that are immediately disqualifying, in reality there are just about 15 of them. These are referred to as “specifically disqualifying.” All other medical conditions fall into the “generally disqualifying” review protocols and policies.

While the conditions noted in Part 67 are immediately grounding, they also are often approvable through the special issuance process. The primary goal is to first ensure that all conditions that could cause “sudden incapacitation” are stabilized before then permitting a pilot to return to the cockpit. This is all part of the FAA’s mandate to “protect the national airspace.”

They include diabetes, cardiovascular issues, mental issues, and neurological conditions.

Diabetes involves impaired glucose metabolism. Very high or low blood glucose levels can affect cognition and might cause tremulousness, loss of consciousness, or even seizures. Once diagnosed with diabetes that requires medication to control, the pilot may not fly until receiving a special issuance.

For diabetes controlled with oral medications, any class of medical certificate is obtainable. If insulin is required, only a third-class medical certificate is available. For now, the Federal Air Surgeon has not permitted first- or second-class medical certificates for insulin-dependent diabetics, but this situation remains actively in discussion at the FAA (I am hopeful that, in the future, well-controlled insulin-dependent diabetics might be able to obtain classes of medical certificates higher than just third).

As for neurological issues, epilepsy is disqualifying (as is any ongoing need for seizure-control medications). I don’t think someone needs to stretch their imagination too far to understand that seizures in flight might potentially cause fatal events. There are some cases whereby pilots who have had seizures in the past might ultimately qualify again for a medical certificate.

Other disqualifying neurological conditions include “disturbance of consciousness” or “transient loss of nervous system function.” These can be simple fainting events or a full-blown stroke. Yes, even a one-time fainting event must be “explained” to the FAA, permitting the “opportunity” to review and grant a medical certificate. If a pilot has recovered fully from a stroke or other cerebrovascular event, a special issuance is often obtainable.

On the cardiovascular side, myocardial infarction (heart attack), angina pectoris (chest pain likely due to coronary artery disease), coronary heart disease treatment (bypass surgery, stent placements, etc.), heart valve replacement, heart “replacement” (transplant), and cardiac pacemaker implantation all are disqualifying.

The majority of these disqualifying heart conditions (once stabilized and various FAA protocols are met) do not lead to permanent grounding. Most pilots return to the cockpit in a reasonable period of time after such treatments.

Other than heart transplant, these are relatively common procedures that the FAA has been approving under special issuance for many years. Believe it or not, there have indeed been a few heart transplant pilots who have returned to flying.

Mental issues such as substance abuse and/or dependence are disqualifying (whether the substance is alcohol or drugs). As I’ve discussed in previous blogs, a pilot in remission from substance usage problems can obtain a special issuance. It is a comprehensive and strict protocol, but it is also fabulously successful. The FAA, to its credit, has embraced this program since the mid-1970s.

The other mental health conditions discussed in this section are more challenging, as it is difficult to predict whether they will manifest again in the future (even after an episode that may have improved or resolved). And, to be frank, all of these pose significant risks to aviation safety.

These conditions include psychosis (delusions, hallucinations, loss of connection to reality), bipolar disorder, and personality disorders that can manifest with “overt acts.” To coin expert witness phraseology, it is “more likely than not” that a pilot with any of these diagnoses won’t fly again.

The FAA reviews all mental health conditions on a case-by-case basis, but the conditions in this paragraph are usually excluded from special issuance approvals.  

Although not germane to today’s discussion, the FAA does now have a successful program to grant special issuances to pilots on several antidepressant medications for routine depression treatment (so long as none of the specifically disqualifying mental health conditions are also diagnosed).

While I don’t claim to be a legal expert, nor am I an aviation attorney, through my many years of experience as an AME I discuss the interpretations of conditions that I’ve been involved with both first-hand and through discussions at FAA conferences. For formal legal advice, of course, a pilot should seek consultation from competent counsel.

For most generally disqualifying medical conditions, once stabilized, a pilot may return to the cockpit via a self-assessment per FAR 61.53 (usually with the assistance of the AME or other aviation medicine consultants). In my next blog, I’ll begin discussing how we actually make that process work, and how we interact at the time of the pilot’s next formal medical exam.

The specifically disqualifying conditions discussed in Part 67 are those that are immediately grounding (regardless of any theoretical remaining period of validity for the medical certificate). Fortunately, for many of these conditions, once stabilized, a special issuance may ultimately return the pilot to the cockpit.

No different than for operational FARs, please read and understand the provisions of Part 67 to augment your understanding of FAR 61.53.