FAA Medical Denied Because You Use Gabapentin?

  • ON Jun 15, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because you use Gabapentin? Our firm has handled many cases where an airman was treated with Gabapentin (common brands include Horizant, Gralise, and Neuraptine). Typically, Gabapentin is prescribed by your treating physician to relieve various conditions in the nervous system. We typically see airmen being treated with Gabapentin for conditions like neuropathy and restless leg syndrome. Gabapentin is also identified as an anticonvulsant medication and is used to treat some forms of epilepsy. While you may not be taking Gabapentin for seizures or epilepsy, it really does not matter. The FAA does not accept the use of anti-epileptic or anti-seizure medications as treatment for any medical conditions. Outside of the concern that your use of Gabapentin could be seizure related, the FAA has found that the side effects of this medication may be incompatible with aviation safety.

What should you do if your FAA medical was denied because you use Gabapentin? If you are taking Gabapentin for a non-seizure related issue, the easiest way to achieve certification is to talk with your doctor about discontinuing the medication. If your doctor believes it is safe for you to come off of the medication, have him or her properly document your discontinuation. Following discontinuation for 60-days, your doctor should prepare a letter or progress note, indicating that you have successfully weaned off of the medication and that your underlying condition is stable with no functional impairment. This documentation can then be presented to the FAA for reconsideration.

If you are taking Gabapentin for seizure prevention or for epilepsy, the FAA’s inquiry will extend beyond your use of the medication. To that end, the FAA will likely deny your application for medical certification, as epilepsy is a specifically disqualifying condition, as found in Part 67 of the Code of Federal Regulations.

The FAA does have the regulatory discretion to deny your application for medical certification based on your use of a “disqualifying” medication. That regulation can be found at 14 C.F.R. 67.113 (c), 67.213 (c), and 67.313 (c). Nevertheless, if you are denied because you use a disqualifying medication, such as Gabapentin, there are usually solutions to discussing medication modification with your doctor or giving the FAA assurances regarding your proper use of the medication.

Why involve a FAA attorney in your FAA medical application? Despite what you may hear from your AME, the medical certification process is more so a legal process than a medical process. As with denials for the use of a disqualifying medication, ensuring that your doctor is developing the proper documentation regarding your discontinuation of the medication, as well as the status of your underlying condition, can be a delicate process. To that end, everything that is submitted to the FAA (i.e. records, statements, evaluations, etc.) goes into your airman medical file. This file is what the FAA then utilizes to evaluate whether you are eligible to hold a medical certificate. If you are later denied and wish to appeal that denial, your airman medical file becomes “Exhibit A” before the NTSB or upon reconsideration by the Federal Air Surgeon. So, a FAA attorney can evaluate your records, prepare a plan for best presentation of your case to the FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal.

Is your FAA medical denied because you use Gabapentin? Call the FAA attorneys at The Ison Law Firm. We are happy to evaluate your case and discuss with you a plan for presenting your case for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

FAA Medical Denied Because of Coronary Artery Disease?

  • ON Jun 14, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because of coronary artery disease? The Federal Aviation Regulations relevant to standards for airman medical certification are found in Part 67 of the Code of Federal Regulations. Therein, the FAA has identified 15 specific conditions which are disqualifying; other conditions not specifically stated therein may be disqualifying at the Federal Air Surgeon’s discretion. One such specifically disqualifying condition, however, is “coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant.” As you can see, there is some nuance to this regulation, such that your case may be arguable as to whether you have “required treatment” or if your case has been “symptomatic or clinically significant.” What is “treatment?” What are “symptoms?” What is “clinical significance?”

Many times, airmen are denied a medical certificate because of coronary artery disease following treatment with a stent or bypass surgery. The FAA has a protocol for certification following such surgical intervention. The tests associated with that protocol sometimes reveal a discrepancy, however, between what your treating physician feels is medically acceptable risk, versus what the FAA feels is an acceptable risk for the purposes of aviation safety. Oftentimes, in practice, our firm handles cases where a treating physician opted not to treat an occlusion with a stent, but rather treated the occlusion with medication. This less invasive approach may be medically acceptable. The FAA may look at this information, however, and suggest that the level of plaque buildup left behind presents a risk which is not sufficiently mitigated. In those circumstances, for example, the FAA will suggest that that this is “untreated” coronary artery disease which is “clinically significant.” Arguing your physician’s position of sufficiently mitigated risk may be the key to certification.

There are many ways that your arteries may get on the FAA’s radar (i.e. ischemia on a stress test, concerns on an echocardiogram, etc.). The key, however, is first understanding what the FAA’s concerns are (not always a simple task) and then pinpointing an argument as to why any disease is either not “significant” or no longer presenting with symptoms. Reversing a denial because of coronary artery disease (or being issued a special issuance authorization) means methodically going through the data and arguing to the FAA why you do not pose a risk to aviation safety and/or why any risk is appropriately mitigated with medication and observation.

Why involve a FAA attorney in your FAA medical application? Despite what you may hear from your AME, the medical certification process is more so a legal process than a medical process. As you can see with denials for coronary artery disease, presentation of medical data to the FAA for such a condition is a delicate application of fact to law (i.e. why does your situation not meet the level of “clinical significance”)? Furthermore, everything that is submitted to the FAA (i.e. records, statements, evaluations, etc.) goes into your airman medical file. This file is what the FAA then utilizes to evaluate whether you are eligible to hold a medical certificate. If you are later denied and wish to appeal that denial, your airman medical file becomes “Exhibit A” before the NTSB or upon reconsideration by the Federal Air Surgeon. So, a FAA attorney can evaluate your records, prepare a plan for best presentation of your case to the FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal.

Is your FAA medical denied because of coronary artery disease? Call the FAA attorneys at The Ison Law Firm. We are happy to evaluate your case and discuss with you a plan for presenting your case for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

Aviation Lawyer For My FAA Medical Certificate?

  • ON Jun 08, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Often, we are asked by prospective clients, “do I need an aviation lawyer for my FAA medical certificate?” This question usually comes from airmen who have spoken with an Aviation Medical Examiner (“AME”) before calling The Ison Law Firm. Without naming names, there are a handful of AMEs that constantly question why an airman would ever consider hiring a lawyer to address a medical concern with the Federal Aviation Administration (“FAA”).

The aviation attorneys at The Ison Law Firm are an invaluable resource for combating the FAA’s Aerospace Medical Division when applying for medical certification. As much as an AME would like to think that his or her medical prowess can affect the outcome of an airman’s medical application, the fact remains that an AME’s role in the FAA medical certification process is limited to a small part. And while this small part may be useful downstream in the process, an airman will likely need the representation of a seasoned aviation medical certification lawyer should the airman’s medical application be deferred by the AME or denied by the FAA.

Whether you are a seasoned airman or are just beginning your journey in aviation, most airmen understand that the privilege of operating an aircraft comes with the responsibility of understanding countless Federal Aviation Regulations (“FARs”). In fact, interoffice jokes around the watercooler sometimes will fixate on how a pilot thinks he or she is a based on the shear volume of FARs that are required to be read and comprehended in order to fly. To that end, most airmen are aware that medical certification standards for the operation of aircraft are found at 14 C.F.R. Part 67. What is often lost in the nuance of the FARs, and certainly on some AMEs, is that the certification of airmen under 14 C.F.R. Part 67 is not entirely premised on just the practice of medicine. To the contrary, the certification of airman under Part 67 is first based upon regulation which, by its very nature, suggests the eventual application of law to facts. And this is where FAA medical lawyers are needed!

In a perfect world, an airman goes to an AME and the AME immediately issues the airman a medical certificate. However, in situations where the airman has a history of certain disqualifying conditions under Part 67, the AME will have to defer the airman’s medical application to the FAA. After deferring an application to the FAA, the AME has little control over the outcome of the matter. The airman will likely be left to navigate the nebulous and vague requests made by the FAA for additional information, costly testing, and possible denial, depending upon the specific disqualifying issue. What is an airman to do at that point? If this was just a medical process, the AME would be able to assist. However, by this point, it should be evident that the airman will need a FAA medical certification lawyer to navigate the FARs precluding his or her ability to obtain a medical certificate.

The aviation medical certification lawyers at The Ison Law Firm are experienced in handling all types of medical certification matters before the FAA after an AME defers an airman’s medical application. The AMEs that belittle the use of lawyers fail to appreciate the process beyond the flight physical. If an airman’s medical application is denied, then that airman will ultimately have the option to appeal the Federal Air Surgeon’s final denial to the National Transportation Board of Safety (“NTSB”). At the NTSB level, 49 U.S. Code § 44703 requires the airman to present evidence by a preponderance of the evidence, in accordance with the Federal Rules of Evidence. To that end, the litigation process leading up to the hearing will require the airman to understand the various Federal Rules of Civil Procedure as the airman engages in the discovery process and exchanges discovery with the Administrator, as well as the volumes of governing NTSB opinions.

So, why would an airman ever consider hiring an aviation attorney for a medical application? For starters, the documentation provided to the FAA and the statements made by an airman and the airman’s medical providers will form the basis for the evidence to be presented at a hearing in support of that airman’s qualifications to hold a medical certificate. In other words, knowing what to provide, when to provide it, and how to frame it, before litigation even begins, is incredibly important in the medical certification process. These are techniques and strategies best left to competent legal professionals, and not to be trusted to AMEs that think they know the law just because they are doctors that practice within the realm of aviation regulation.

If your AME questions why you would hire a lawyer for your medical application with the FAA or if you are asking yourself “do I need an aviation lawyer for my FAA medical certificate,” first call the lawyers at The Ison Law Firm.  We are happy to evaluate your case and discuss with you a plan for presenting your case for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

FAA Medical Denied Because of a Colostomy Bag

  • ON Jun 07, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because of a colostomy bag? Having a history of ileostomy or colostomy may not necessarily mean you are ineligible for a Federal Aviation Administration medical certificate. An applicant with an ileostomy or colostomy may receive FAA consideration in some circumstances and qualify for aeromedical certification.

In situations where the airman has a history of colon cancer, the Guide for Aviation Medical Examiners specifically enumerates various situations and stages in which the disease/condition should affect the AME’s decision making process for issuance of a medical certification. For example, if the airman has non metastatic colon cancer and treatment completed five (5) or more years prior, and there has been no recurrence or ongoing treatment, the AME may issue a medical certificate. To that end, if the airman had a pedunculated cancerous polyp (adenocarcinoma) that was removed by colonoscopy less that five (5) years prior to the flight physical, the AME may issue a medical certificate if a status report shows that there was only a local lesion (TNM stage 0 or I), complete resection with no additional treatment needed, follow up is annual or less frequent, and there are no clinical concerns.

The attorneys at The Ison Law Firm are well versed in the Guide for Aviation Medical Examiners, as well as the applicable Federal Aviation Regulations under Part 67. While 14 CFR Part 67 does not specifically speak to airmen with a history of colostomy, the Guide for Aviation Medical Examiners does briefly discuss these matters. For those airmen that have successfully recovered from a history of cancer but require ileostomy or colostomy, the FAA will require a report from the airman’s physician to confirm that the applicant has fully recovered from the surgery and is completely asymptomatic.  Oftentimes, however, the FAA will require additional information on the underlying cause for the airman’s usage of a colostomy bag.

Is your FAA medical denied because of a colostomy bag or the underlying reasons thereof, call the FAA attorneys at The Ison Law Firm. We are happy to evaluate your case and discuss with you a plan for presenting your case for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

FAA Medical Denied Because of Previous Suicide Attempts

  • ON Jun 06, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because of previous suicide attempts? Having a history of suicide attempts is not one of the specifically disqualifying conditions found in 14 C.F.R. Part 67. In other words, you will not find a specific provision within the Federal Aviation Regulations which specifically states that if you have had a history of suicide attempts, that you do not qualify for an airman medical certificate (no matter whether you are applying for a first-, second-, or third-class certificate). Instead, the FAA typically relies upon a “catch all” regulation to support a potential denial for an application with a history of previous suicide attempts. That regulation is 14 C.F.R. 67.107 (for first-class certificates), 14 C.F.R. 67.207 (for second-class certificates), and 14 C.F.R. 67.307 (for third-class certificates. Across all classes of certificates, the wording of the regulation is the same: “[the applicant must not have] a personality disorder, neurosis, or other mental condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds – (1) makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) may reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.”

Typically, the analysis becomes a question of whether a history of previous suicide attempts rises to the level of a “mental health condition,” which the Federal Air Surgeon can find makes you unable to safely operate within the National Airspace System. Consequently, the task then becomes presenting an argument to the Federal Air Surgeon that based upon all of your relevant medical records, evaluation by qualified physicians, and assessment for future risk, that you are qualified to exercise the privileges of an airman.

With a history of previous suicide attempts, the presentation to the FAA may be multi-faceted, in that there will be several issues to sort through: was your suicide attempt(s) the results of an underlying medical condition (such as major recurrent depression, anxiety, bipolar disorder, etc.), were you hospitalized for the suicide attempt(s), were you treated with any medication (also, are you still taking medication), what is your current status (how long ago was your suicide attempt(s))? Ultimately, the task will be to present an appropriate argument to the FAA, if able, that your suicide attempts were the result of an underlying situation, which is now either in sufficient remission, without risk for future recurrence, or, that perhaps that your history of previous suicide attempt(s) has been exaggerated in your medical records. Each underlying condition and element will have to be appropriately addressed with the Federal Air Surgeon, however, so that you do not invite a denial for the underlying condition (such as depression).

Why involve a FAA attorney in your FAA medical application? Despite what you may hear from your AME, the medical certification process is more so a legal process than a medical process. Specifically, everything that is submitted to the FAA (i.e. records, statements, evaluations, etc.) goes into your airman medical file. This file is what the FAA then utilizes to evaluate whether you are eligible to hold a medical certificate. If you are later denied and wish to appeal that denial, your airman medical file becomes “Exhibit A” before the NTSB or upon reconsideration by the Federal Air Surgeon. So, a FAA attorney can evaluate your records, prepare a plan for best presentation of your case to the FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal.

Is your FAA medical denied because of previous suicide attempts? Call the FAA attorneys at The Ison Law Firm. We are happy to evaluate your case and discuss with you a plan for presenting your case for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

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