Ask the Aviation Medical Examiner

Sergio B. Seoane, M.D., Col., CAPChief, CAP National Health Service

FAA Senior Aviation Medical Examiner

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 MedicineMany AMEs are also qualified in other medical specialtiesThe 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

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.

New and Improved FAAAeromedical Certification

In 2011-2012, 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 AMEsThe rest will be published in 2013-2014These 18 conditions account for 10 to 15 percent of the special issuances.

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 certificateNow, 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

April 2013 AME Changes

Conditions the AME Can Issue (CACI)

ArthritisAsthmaGlaucomaHepatitis CHypertensionHypothyroidismMigraine

Chronic HeadachesPre-Diabetes (IFG)Metabolic SyndromeImpaired Fasting GlucoseGlucose ElevationRenal Cancer

April 2013 AME Changes

The criteria and the required medical documentation has NOT changedThe only difference is that the local AME can issue the medical certificate without approval from FAA Aerospace Medical Certification Division in Oklahoma CityThis should result in the Airman obtaining the FAA Medical Certificate sooner

April 2013 AME Changes

The recovery time after coronary artery stenting has been decreased from 6 months to 3 months

Legal Authority of Designated Aviation Medical Examiners

Title 49, United States Code (U.S.C.)

(Transportation), sections 109(9), 40113(a), 4701-44703, and 44709 (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.

Domestic84%

Internationals9%

Military4%

Federal1%

Official2%

Chart Title

90countries

Aviation Medical Examiner Population(3,465 as of March 31, 2012)

5/7/12

(Includes Guam, Marshall Islands, Saipan, Pacific Island Trust Territories, Puerto Rico and Virgin Islands)

AMEs who are pilots 47%Female AMEs 7.5%

Distribution of AMEs by Region

Alaska2%

Southern20%Eastern

11%

New England3%

Southwest12%

Official2%

Military/Fed6%

International9%

Central5%

Great Lakes14% Western Pacific

8%

NW Mountain10%

Chart Title

5/7/12

Similar to CAP Regions13

Nine FAA Regions

5/7/12

AK CE EA GL NE NM SO SW WP Mil Intl Fed Off0

100

200

300

400

500

600

700AMEsSenior AMEs

0%

100%

60% Senior AMEs

Distribution of AMEs by RegionAMEs/Senior AMEs

Distribution of AMEs by Medical Specialty

5/7/2012

Family Practice / General Practice 49%Internal Medicine 19%Aerospace Medicine 8%Occupational / Industrial Med 6%General Surgery 3%Ophthalmology 2%Emergency Medicine, Orthopedic Surgery,

Otorhinolaryngology, OB/GYN, Urology 1%

All others <1% (ea)

AME Age Trends

2002 2003 2004 2005 2006 2007 2008 2009 2010 201154

55

56

57

58

59

60

61

Average Age

Distribution of AMEs by Number of Medical Exams Performed Annually

01-2

526

-5051

-250

251-5

00

501-7

50

751-1

000

1001

-3500

>350

00.0

500.0

1000.0

1500.0

164

1496

690

1145

18770 31 52 2

Number of Exams

AM

E Po

pula

tion

2/14/11

4.3%

39%

18%

30%

5%2% 0.8% 1.4% 0.05%

Percent of AMEs

Number of AMEs

AME Distribution by Length of Service

2/14/11

AMEs

Senior AMEs

5 or < 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 >550

100

200

300

400

500

600

700

Years of Service as AME

Num

ber o

f AM

Es

352

270

144

308

184

363 294

151

101

181

99

197

79

246

36

141 64

23

70

18

18

41

0

AME Exams – CY 2011

1/26/12

Class I Class II Class III0

20000400006000080000

100000120000140000160000180000200000

Exams PerformedAME IssuedAME Deferred

88 89 90 91 92 93 94 95 96 97 98 99 '00

'01

'02

'03

'04

'05

'06

'07

'08

'09

'10

'11

100

200

300

400

500

Class IClass IIClass IIITOTAL

Fiscal Year

# of

Req

uest

s (1

00,0

00)

Aeromedical Certification Requests

1095 applications per day (2011)33,312 applications per month (2011)

1/26/12

Certificates Not Issued

AME Denied AME Deferred Reversed by AMCD

Special Issues

Issued by Appeal

0

2000

4000

6000

8000

10000

12000

14000

16000

Class I

Class II

Class III

56 18,971 632235,4211616

1/26/12

Most common causes for problems with issued certificates Jan to June 2011 compared to prior period

Block Description OccurrencesJuly–Dec 2010

OccurrencesJan–Jun 2011

17 Unacceptable Medication 7 1358 ECG 15 2118h High or low Blood Pressure 6 618V DUI 1

18a Headache 1 1

18M Mental/Depression 1

18X Rheumatoid Arthritis 1

18 g Heart Problem 1

18J Kidney stone 1 1

18u Admission to Hospital

18x Prostate cancer surgery, parathyroidectomy, cataract surgery

1

18D Retinopathy /DM on treatment 1

42 Arthritis 1

Please note that there can more than one error in a single case

Final Denials for 2011

Total Denials: 5,012Denial for Failure to Provide or Failed to Pursue: 4,64692% of Airman Fail to Provide info!Final Denials (When all information requested is provided): 366400,000 only 366 Denied by FAA .09%

1/26/12

Final Certification Denials

'01

'02

'03

'04

'05

'06

'07

'08

'09

'10

300320340360380400420440460480

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

Total Applications Denial Ratio#

of A

pplia

tions

(Tho

usan

ds)

Denial Ratio (%

)

2/14/11

Medical CertificateTimeline

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

FAA Authority to Disqualify1994, Bullwinkel vs. FAA & NTSB, challenged FAA authority to disqualify medications in absence of a disqualifying medical conditionAs 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.”

Not everyone is Healthy650,000 Pilots in the USA400,000 Medicals Issued by FAA every yearThey are not all healthyThe 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 10-14 years from 2002-2005.

How Healthy do you need to be?

You do not have to be very healthyYou need to be good enoughKind of like being a pilot….You need to be healthy enough so you are not going to suddenly become incapacitated while operating an aircraftKey Word…”Sudden Incapacitation”

FAA Concerns Aeromedical Significant

Disorders

Occurs suddenly or unpredictablyIs or may be incapacitatingProgresses at an unpredictable rateMay degrade flight safety

The aviation environment is very complex and dynamic

Good Health is critical functioning is this environment.

Two key elements for safe flying

Aircraft PerformanceAirman Performance

Both need to be adequate

Medical Certification of AirmenSpecial Issuances – Cardiovascular (2005)

Problem Class 1 Class 2 Class 3 TotalBioprosthetic Valves 33 38 135 206

MechanicalValves

33 33 169 235

Pacemaker 37 53 276 355

Defibrillator 0 0 2 2

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.”

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

Why the FAA Denies Certain Medications

Not exclusively the Medications, but rather the underlying medical condition associated with the MedicationsPotential for Sudden IncapacitationAll Medications are evaluated based on this concept

Generally Disallowed Medications

AnticoagulantsAntiviral AgentsAnxiolytics (anti-anxiety)BarbituratesChemotherapeutic AgentsHypoglycemicMood Altering Antidepressants (exceptions, 4/2/2010: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro) NarcoticsSedating AgentsAntihistaminesDecongestantsTranquilizers

Stimulants (Diet Medications)Experimental or Investigational MedicationsMuscle RelaxantsMotion SicknessAnticonvulsantsSteroidsLomotil

There is no “Official FAA Medication List”The condition is often the disqualifying issue, not the medication

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

Medications NOT Authorized

Anticoagulants (Maybe Yes, Maybe No --but ASA, Plavix OK…warfarin/coumadin…it depends…often yes)Mood Altering MedicationsSedativesNo investigational Drug TreatmentsNo one currently receiving Radiation TreatmentAnti-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) 

AOPA DatabaseThis 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.

http://www.aopa.org/members/databases/medical/search_faa_meds.cfm

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 Medications140,000 substances can be screened for by the FAA Civil Aerospace Medical InstituteIn General Aviation, several hundred substances are routinely screened for after an accidentIn Commercial Aviation, several thousand substances are screened forDNA in the future – Genetic Markers to determine: Fatigue, Lack of Sleep

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 FALSIFICATIONIntentional False Statement – A False Representation of a Material Fact Made with the Knowledge of FalsityFraudulent 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

FAA Form 8500-8

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

FAA Policy Regarding Falsification

Revocation of BOTH Medical Certificate and Airman CertificateRevocation of Airman Certificate because you the Lack of Qualification of Hold Airman Certificate

Honesty Best PolicyIf 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

Follow the Rules

If you Fly with prohibited substance, you are in violation of your Medical and FAA regulationsAny Life Insurance, Accident Insurance, Aircraft Insurance, Liability Insurance will no longer be valid since you are not in compliance with FAA Regulations

Certification of Airman

Approximately 400,000 applicants annuallyApproximately 25,000 Special Issuances per Year400 Pilots in USA with Diabetes requiring Insulin (3rd Class Medical) Cardiovascular conditions most common in AirmenFinal Denial are approximately 0.1%

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

Disqualifying Medical Conditions

1. Angina pectoris2. Bipolar disorder3. Cardiac valve replacement4. Coronary heart disease that has required treatment or, if untreated,

that has been symptomatic or clinically significant;5. Diabetes mellitus requiring insulin or other hypoglycemic

medication6. Disturbance of consciousness without satisfactory medical

explanation of the cause7. Epilepsy8. Heart replacement 9. Myocardial infarction10. Permanent cardiac pacemaker11. Personality disorder that is severe enough to have repeatedly

manifested itself by overt acts12. Psychosis 13. Substance abuse and dependence; 14. Transient loss of control of nervous system function(s) without

satisfactory medical explanation of cause

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

One Eyed PilotOne 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.

SODA

Statement Of Demonstrated AbilityAt 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

Cardiovascular Disease in Pilots

Disease 1st 2nd 3rd

Class Class Class

MI 420 3982916

CABG 373 358 3149PTCA 385 295 1810PTCA with Stent 477 390 2460

Cardiovascular Disease I

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

Cardiovascular Disease II

Heart Attacks (MI), OK but need to wait 6 months, need cath and nuclear imaging – no ischemiaHeart Valve Replacement OK (wait 6 mo)

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

Medical Certification of Airmen

Special Issuances – Monocularity (2005)

Medical Condition

Class 1 Class 2 Class 3 Total

Monocularity 209 476 1,912 2,597

Medical Certification of Airmen

Special Issuances – Diabetes (2005)

Medical Condition

Class 1 Class 2 Class 3 Total

Non-Insulin 493 988 3,819 5,300

Insulin 0 0 425 425

Epilepsy - Seizures

Generally Speaking - No WaySometimes possible, but this rare

Diabetes

Usually PossibleIf no medications and Diet controlled – OKIf on medications, need Special Issuance

Commercial Space Flight

Orbital Crew– Crew: To Be Determined– Passengers: Medical Questionnaire with

physical examination and laboratory studiesSuborbital Flight– Crew: Second Class Medical Certification with

endorsement– Passengers: Medical questionnaire without

routine physical or laboratory studies

Authorization for Special Issuance of a

Medical CertificateGranted by the Federal Air SurgeonValid for a specified periodGranted to a person who does not meet the established medical standardsFederal Air Surgeon may consider the person's operational experienceIndividual 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 § 67.401), shall expire no later than the end of the validity period or upon the withdrawal of the Authorization upon which it is based.

Aeromedical Certification 2004

442,498 Applications Processed12,076 Special Issuances (waivers) for significant medical conditions

66

Airman Certification and Hypertension

American Heart AssociationNormal BP < 120/80

Pre-Hypertension 120-139/80-89Hypertension > 140/90

FAA- should not exceed, seated155/95

67

Initial Protocol for HypertensionGuide for Aviation Medical Examiners

AME-- conduct an evaluation OR review report by the attending physician.Personal and family medical historyAssessment of risk factors CHDA clinical exam and 3 BP readings separated by 24 hours !Resting EKG

68

Initial HTN (Continued)Glucose, Lipid Profile, K+ and CreatinineMedications used, dosage and adverse effectsAirman to wait 2 weeks upon initiation of medication or change in dosageSummarize results of evaluation in box # 60

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.

January 21, 2011

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

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

Sport Pilot - Medical

Hold valid airman medical certificate or a current and valid U.S. driver’s licenseMust 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 suspendedMust 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, 61.23 , 61.53, and 61.303). For more information about the sport pilot final rule, see: http://dmses.dot.gov/docimages/pdf89/289219_web.pdf LAST UPDATE: July 31, 2005

Antidepressants

Mild to moderate depression only - no history of psychosis or suicidal thoughts 4 authorized medications: Fluoxetine, Sertraline, Citalopram, EscitalopramSpecial Issuance- Single medication only- Stable on medication for minimum of 1 year

- Close monitoringApplications- 17 in certification review process- 3 denied

Which type of pilots do not need an

FAA Medical Certificate?

Free Balloon PilotsGlider PilotsUltralight PilotsSport Pilots

Tips for your AME Medical Examination

Establish long term relationship with an AMETake your flight physical 4-6 weeks prior to the expiration of your medical certificateBring all your medical documentationDo not drink coffee or soda prior to exam…only waterBring eyeglasses, hearing aids, seeing eye dogBring a list of all medications and dosage (the prescription bottle)

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 classIf you do not feel well or are ill….do not take the flight physical, reschedule itCheck your blood pressure 4-6 weeks prior to your flight physical, must be < 155/95!Once you start the flight physical exam never leave

Tips for your AME Medical Examination

Chose an AME that will be your advocateBring any doctors notes, MRI, CT and x-ray report, all recent ER VisitsBring all recent lab reports and Hospital RecordsDo not get your FAA Physical if you are ill or do not feel wellBe Patient…if you have a medical problem it will take time to collect and review the information

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 processIf 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)

Federal Air SurgeonFrederick E. Tilton, M.D.

Deputy Federal Air SurgeonJames R. Fraser, M.D.

Civil Aeronautical Medical Institute (CAMI) Melchor J. Antunano, M.D.

Medical Specialties DivisionMichael Berry, MD

Headquarters New England RegionRegional Flight Surgeon

Paul H. Clark, M.D.

Deputy Regional Flight SurgeonJoseph H. Ray, M. D.

Susan E. Northrup, M.D.

Southern Region

Medications Authorized by FAA

New Medications - Will authorize any medication if it has been out for ONE yearAll Antihypertensive Medications OKAll Asthma Medications OK, including steroids (prednisone) if dose < 20mg qdAll anti-cholesterol Medications OK

Future Changes to FAA Aeromedical Certification

Special Issuance List (2014?)Kidney stonesCarotid artery stenosisColitis Irritable bowel syndrome, Colon cancerBladder cancerLeukemiaHodgkin’s disease Lymphoma

AME

AEROMEDICAL CERTIFICATIONDIVISION, CAMI

FEDERAL AIR SURGEON

NATIONAL TRANSPORTATION SAFETY BOARD

ADMINISTRATIVE LAW JUDGE FULL BOARD

U.S COURT OF APPEALS

SUPREME COURT

REGIONALFLIGHT SURGEON

Airman Medical Certification Review and Appeals Process

Ask the Aviation Medical Examiner

Sergio B. Seoane, M.D., Col., CAPChief, CAP National Health Service

FAA Senior Aviation Medical Examiner