by Anthony Ison | Nov 19, 2023 | Pilot Law
Applying for a FAA medical certificate with migraines or a history of headaches can require a bit of preparation. If you have a history of migraines or other frequent or severe headaches, the FAA requires that you report that history on question 18a. on the 8500-8, application for airman medical certification. There are many different types of migraines and headaches and as a result, the FAA requires different information depending on what kind of migraine or headache you experience. Almost all types of migraines, however, can eventually lead to FAA medical certification, assuming you don’t pose a risk to aviation safety, and you are not using any disqualifying medications to treat your headaches.
The FAA breaks migraines and headaches into the following categories:
- Stress headaches/tension headaches and headaches controlled with over the counter medications: With a history of this type of headache, the FAA will allow your Aviation Medical Examiner to issue to you a medical certificate, so long as you present with 1) an average of less than two headache days per month; 2) you are using medications which are acceptable; 3) your headaches are not incapacitating; and, 4) your headaches are not associated with any neurological findings. A detailed clinical progress note from your treating physician is not required for this category of headache.
- Classic migraines, Chronic tension headaches, Chronic daily headaches, Cluster headaches, or any history of a migraine which results in changes to vision: With a history of classic migraines or more chronic headaches, the FAA will require that you be followed under the CACI program (which stands for “Conditions AMEs Can Issue). The CACI program for migraines will allow your AME to issue to you a FAA medical certificate, assuming you provide a current, detailed clinical progress note from your treating physician and you meet all of the CACI requirements. The CACI program will require your AME to assess the treating physician’s detailed clinical progress note and evaluate the frequency of your headaches, the symptoms associated with your headaches, as well as the types of medications utilized for preventing and aborting headaches and migraines.
- Complicated migraines, Post-traumatic migraines, or Retinal migraines: If you have a history of migraines which are more involved, the FAA will require that you be considered and potentially monitored via a special issuance authorization. A special issuance authorization is necessary when the FAA believes that you are not eligible for airman medical certification, but that risk to aviation safety can be mitigated through a monitoring protocol developed at the Federal Air Surgeon’s discretion. With respect to migraines, prior to being issued a special issuance authorization, the FAA will typically want to know why you are having more severe headaches and understand your level of risk for future incapacitation. In doing so, the FAA will require that you provide 1) a detailed clinical progress note from a board-certified neurologist; 2) a MRI of the brain performed no more than one year before your examination with an AME; 3) a statement identifying the number of headache days you experience throughout a month; and 4) anything else determined to be necessary by your treating physician.
Of course, one of the most disqualifying features of migraines and headaches that we see in our practice is the medication issued for preventative and abortive measures. Medications such as Tompamax are disqualifying for airman medical certification. Furthermore, other medications such as Triptans, Reglan, and Phenergan require various periods of no-flying.
If you are applying for a FAA medical certificate with migraines, keep the following information in mind before you visit your Aviation Medical Examiner for examination:
- Ensure that you obtain a detailed clinical progress note from your treating physician or specialist prior to your examination with an AME. If you fail to produce a detailed clinical progress note within the period of time your AME has to submit your examination to the FAA, you may be at risk for having your application deferred to the FAA.
- In order to be CACI qualified, the FAA will expect that an applicant experiences symptoms which are only mild. Furthermore, the FAA will require that within the last year you have had no in-patient hospitalizations, no more than 2 outpatient clinic/urgent care visits for exacerbations. You will not be eligible for the CACI program if you’ve had neurological or TIA-type symptoms; vertigo; syncope; and/or mental status change.
- The FAA expects that in order to be CACI qualified, the applicant should not have to use any preventative medications other than daily calcium channel blockers or beta blockers only for prophylaxis without side effects. The FAA only allows over the counter medications for abortive purposes (also Triptans, Reglan, and Phenergan). Injectables and narcotics are not acceptable for the CACI program.
- If you require a special issuance authorization, consider being evaluated by a neurologist which is familiar with FAA medical certification standards. Oftentimes, presenting evidence from someone the FAA believes to be more credible regarding risk to aviation safety may help your case.
- Start your FAA medical certification process as soon as possible. Most applications which are deferred must be reviewed by the FAA’s neurological division, which can be a slow process. Having your documentation and supporting evidence prepared and submitted before the FAA asks for same can save you months of processing time in some cases.
If you are facing a FAA medical with migraines, consider a consultation with a FAA medical defense attorney at The Ison Law Firm before applying for a FAA medical certificate. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
by Anthony Ison | Nov 19, 2023 | Pilot Law
Are you trying to get a FAA medical certificate with ADHD? You aren’t alone. In our experience, ADHD is one of the most common reasons why an Aviation Medical Examiner would defer a medical certificate application to the FAA for further evaluation. In our practice, it has been our concern that the threshold for being diagnosed with ADHD as a child or even as an adult has been fairly low. To underscore that point, the Centers for Disease Control and Prevention has produced data showing that an estimated number of children aged between 3 and 17 having ever been diagnosed with ADHD is 6 million! The problem with this from a FAA medical certification perspective is that even if an applicant was diagnosed with ADHD as a child, the applicant must report that diagnosis to the FAA on his or her application for airman medical certification. Fortunately, having a history of ADHD does not have to end your flying endeavors.
Currently, the process for obtaining a FAA medical certificate with ADHD can be broken down into two tracks or thought processes:
- FAA ADHD Fast Track: if you are an applicant meeting very specific criteria, you can avoid deferral to the FAA by the AME if you undertake specific preparations prior to submitting your application. These preparations would include gathering your records, undertaking an abbreviated evaluation with a psychologist or neuropsychologist, as well as preparing additional, specific documents for review by the AME. You can learn more about the FAA’s ADHD Fast Track in our previous blog on the subject.
- FAA Standard Track: if you fall outside of the FAA’s ADHD Fast Track criteria, you will require what the FAA calls the “standard track.” Most applicants that we encounter fall within this category. Most commonly, applicants fall into this category because they have either recently used or are using medication to treat ADHD or the applicant has a history of additional mental health diagnoses. Under this track, however, the FAA will require the airman to undertake a complete battery of neuropsychological testing with a HIMS-trained neuropsychologist.
Most applicants that our firm encounters can achieve FAA medical certification with ADHD if they follow one of the above-referenced tracks. But what happens if you fail to be successful with initial interview under the Fast Track or initial testing with the evaluating neuropsychologist under the standard track? In the event you perform inadequately during an examination with the neuropsychologist (in either track), you always have the option to undertake additional testing. Specifically, the FAA offers a supplemental battery of testing for individuals whose initial testing demonstrates aeromedically significant concerns. Notwithstanding, our firm has encountered airmen who have undertaken neuropsychological testing multiple times, only to ultimately demonstrate that the applicant’s cognitive abilities are not aeromedically deficient.
The takeaway? Neuropsychologist testing for FAA medical certification is not a “one and done” ordeal. There are usually multiple opportunities for further examination and investigation in order to establish eligibility for airman medical certification.
If you are trying to get a FAA medical certificate with ADHD, we recommend you consider the following:
- You must discontinue treatment with ADHD medication (such as Adderall, Ritalin, Vyvanse, Focalin) and remain stable for 90 days prior to undertaking neuropsychological evaluation. It is important that you consult with your treating physician prior to discontinuing medication and that your treating physician document the date upon which you discontinued treatment. Documentation from your treating physician stating how you are doing following discontinuation of medication can aid the neuropsychologist in formulating an opinion regarding your current function and risk to aviation safety.
- You must understand what is contained within your medical records. Time and time again, airmen will contact our firm not understanding that the FAA will want to review a complete copy of your treating physician’s records relative to your ADHD history. Even if you perform flawlessly on neuropsychological testing or if you are issued a certificate under the FAA’s ADHD Fast Track, the FAA will still want to review your medical records. Oftentimes, an applicant’s medical records contain additional information which may be significant to the FAA. For example, we frequently find that treatment records may contain information about additional diagnoses or information about social history (such as alcohol or drug use) which might be concerning to the FAA. Obtaining and reviewing a copy of your medical records before applying for an airman medical certificate can give you sufficient lead time to address any concerns which may be in your medical records.
- You must understand that just like every licensed pilot is not the best pilot, every neuropsychologist may not be the best neuropsychologist. Just because there may be a HIMS evaluator close to where you live, doesn’t always mean you should go to that HIMS neuropsychologist. We recommend that before you undertake evaluation with any psychologist or neuropsychologist that you have at least a phone call with the evaluator in order to ensure that you can develop an appropriate rapport and that you are comfortable with the evaluator’s level of experience and understanding of the FAA’s policies and procedures. Learn more about this process here.
- You must start early. Even with the FAA’s ADHD Fast Track, the process takes time. If you or your loved one is trying to obtain a FAA medical certificate by a certain date or time period, you must start on obtaining the FAA medical certificate as soon as possible.
- You should consider taking a few flight lessons before undertaking neuropsychological testing if you are a student pilot. The reason for doing this is because a letter from a Certified Flight Instructor can go a long way toward assuaging any concerns the neuropsychologist or the FAA may have regarding your performance as a pilot.
- You should always be well rested before undertaking neuropsychological testing.
If you are trying to obtain a FAA medical certificate with ADHD, consider a consultation with a FAA medical defense attorney at The Ison Law Firm before seeing an Aviation Medical Examiner. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
by Anthony Ison | Nov 18, 2023 | Pilot Law
Are you trying to obtain a FAA medical certificate with asthma? In most cases, the process of obtaining a FAA medical certificate with asthma is relatively simple. As with all medical conditions, however, the FAA will assess your history and the current status of your asthma to determine whether your asthma and lung function presents any risk to aviation safety. In other words, the FAA will want to know whether your asthma is aeromedically significant. Most cases result in an applicant being issued an airman medical certificate under the FAA’s CACI criteria (which stands for “Conditions AMEs Can Issue”). However, some applicants with a history of more frequent and severe asthma symptoms may require monitoring via a special issuance authorization.
Applicants with mild or seasonal asthma can be issued a medical certificate by the AME, assuming certain criteria is met. More specifically, if an applicant meets the CACI criteria, the AME is authorized to issue to the applicant a medical certificate, no matter the class certificate applied for, if the applicant is found to be otherwise qualified. This is welcomed news for most, as the CACI program allows the AME to avoid deferring an applicant’s examination to the FAA for further consideration.
What are the CACI criteria? In order to be qualified under the CACI program, an applicant with asthma must procure a current, detailed clinical progress note from a treating physician or specialist. In order to be current, the detailed clinical progress note must be generated no more than 90 days prior to examination by the AME. Upon review of the treating physician note, the AME must note the following:
- The applicant’s treating physician finds the condition stable on current regimen and no changes recommended;
- The applicant’s symptoms are stable and well-controlled (either on or off medication);
- The applicant is utilizing acceptable medications; and,
- The applicant’s current pulmonary function tests are in acceptable range.
In the event the AME finds that any of the above criteria are not found to be acceptable, the AME will defer the applicant’s examination to the FAA for further consideration. Nevertheless, if an applicant is found CACI-eligible, applicants for first- or second- class must provide the above-referenced clinical progress note annually; applicants for third-class must provide the information with each required exam.
Applicants with frequent, severe, and/or a history of asthma which is outside of the FAA’s CACI criteria will need to achieve a special issuance authorization. A special issuance authorization is an exercise of discretion by the Federal Air Surgeon. In cases where a special issuance authorization is required, the FAA may expect the applicant to provide clinical progress reports at a greater frequency, as well as additional, indicated diagnostics, in order to monitor the applicant’s asthma to ensure ongoing stability and satisfactory treatment.
If you are applying for a FAA medical certificate with asthma, keep the following information in mind before you visit your Aviation Medical Examiner for examination:
- Ensure that you obtain a detailed clinical progress note from your treating physician or specialist prior to your examination with an AME. If you fail to produce a detailed clinical progress note within the period of time your AME has to submit your examination to the FAA, you may be at risk for having your application deferred to the FAA.
- In order to be CACI qualified, the FAA will expect that an applicant experiences symptoms no more than 2 days per week. If you experience symptoms more frequently, consider talking with your treating physician about how to better treat your symptoms prior to applying for a FAA medical certificate.
- The FAA expects that in order to be CACI qualified, the applicant should not have to use inhaled short-acting beta agonist (rescue inhaler) more than 2 times per week and the use of oral corticosteroids for exacerbations should be no more than 2 times per year within the preceding year.
- The FAA also expects that an applicant have had no in-patient hospitalizations and no more than 2 outpatient clinic/urgent care visits for exacerbations (with symptoms fully resolved).
- If you are using medication to treat your asthma, keep in mind that the FAA only finds the following acceptable:
- Inhaled long-acting beta agonist
- Inhaled short-acting beta agonist (e.g., albuterol)
- Inhaled corticosteroid
- Leukotriene receptor antagonist, (e.g. montelukast [Singulair])
- Monoclonal antibodies are not acceptable for FAA medical certification under the CACI program.
- The FAA expects that your pulmonary function tests will produce results showing your FEV1, FVC, and FEV1/FVC are all equal to or greater than 80% predicted before bronchodilators.
If you are facing a FAA medical with asthma, consider a consultation with a FAA medical defense attorney at The Ison Law Firm before applying for a FAA medical certificate. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
by Anthony Ison | Oct 21, 2023 | Pilot Law
Getting a FAA medical with kidney stones or a history of kidney stones is possible. Depending on the circumstances of your history of kidney stones, the Federal Aviation Administration (“FAA”) may require no evaluation of your kidney function outside of discussion with your Aviation Medical Examiner. Individuals who may have experienced multiple kidney stones or have retained kidney stone(s) will need to satisfy the criteria under the FAA’s CACI program or “Conditions AMEs Can Issue” in order to be medically certified. In more complicated cases, the FAA will require your Aviation Medical Examiner (“AME”) to defer your application to the FAA for further evaluation and assessment of whether your medical history poses a risk to aviation safety.
Perhaps the simplest of circumstances when trying to achieve a FAA medical with kidney stones are those in which the most recent kidney stone event occurred more than five (5) years ago. In these cases, the FAA has authorized AMEs to issue the FAA medical certificate, so long as there are no ongoing symptoms or current problems. Likewise, if an applicant has passed a single kidney stone within the past five (5) years and there are no retained stones, the FAA has authorized AMEs to issue the FAA medical certificate.
For applicants with retained kidney stones, being issued a FAA medical certificate requires a bit more effort. Specifically, applicants applying for a FAA medical with retained kidney stones must comply with the FAA’s CACI criteria for issuance. Specifically, the CACI program requires that the applicant’s AME review a detailed, clinical progress note from the applicant’s treating physician which identifies various data. The AME must review the treating physician’s note, which should verify that the kidney stone(s) are asymptomatic, stable, unlikely to cause an incapacitating event, and discuss any surgeries or complications. The AME should also assess whether there is an underlying cause for stone recurrence and evaluate the treatment plan in place. Applicants who require a CACI for retained kidney stones must provide a detailed, clinical progress note from a treating physician every year for first- and second- class, FAA medical certificates. Applicants applying for a third-class, FAA medical certificate need only provide a note from the treating physician at the time of every application.
In more complicated cases, where an applicant has clinical complications, the condition is symptomatic, or there is an underlying cause for the recurrent kidney stones, the FAA will require a more detailed note from the applicant’s treating physician, to include copies of imaging, if available. Your application for FAA medical certification will be deferred. It is likely that in these cases, the applicant will be issued a special issuance authorization and require more detailed follow-up with the FAA for continued medical certification.
Here are some tips when considering your FAA medical with kidney stones:
- If you are applying for your first FAA medical with kidney stones, you should plan for your treating physician to provide a detailed, clinical progress note prior to seeing your AME for exam. Even in cases where your kidney stone(s) may have occurred five (5) years or more prior to your AME exam, having a document from your doctor will help your AME better understand your history and help avoid a deferral (in the case of uncertainty by your AME).
- If your AME issues to you a medical certificate, keep in mind that the FAA may still follow up with you via letter and inquire regarding your history to confirm that you meet eligibility criteria to hold your FAA medical certificate.
- If you have a history of retained kidney stones, make sure that you obtain a detailed, clinical progress note from your treating physician at the appropriate intervals, based upon which class FAA medical certificate you hold. Sometimes, providing a current “kidney, ureter, and bladder” x-ray, or “KUB,” can help give your treating physician, your AME, and the FAA more clarity on the status of your condition.
- If you have a more complex history of kidney stone(s), prepare for a deferral by your AME and anticipate the FAA requiring documentation regarding your history of kidney stone(s), as well as any underlying conditions causing your kidney stone(s). It is always important that when faced with a FAA deferral, you gather and review all of your medical records to ensure you understand what your doctors have included in your medical history. When reviewing your medical records, the FAA will look at anything and everything – their review of the records you submit will not be limited to your kidney stone(s). It is always advisable to plan ahead and address any concerns the FAA may have with respect to the entirety of your medical records.
If you are facing a FAA medical with kidney stones, consider a consultation with a FAA medical defense attorney at The Ison Law Firm before applying for a FAA medical certificate. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
by Anthony Ison | Sep 11, 2023 | Pilot Law
Since Summer 2022, there has been significant attention given to airmen trying to get a FAA medical certificate with VA disability benefits. As we have written about many times in various forums, the FAA initiated a “special project” whereby the agency started to contact airmen who had not previously reported their receipt of VA disability benefits on previous applications for airman medical certification, Form 8500-8. Specifically, question 18y. on FAA Form 8500-8, or “MedXPress” asks if in your lifetime you have received “medical disability benefits.” Time and time again, our firm is contacted by veteran airmen who believe that their receipt of benefits from the Department of Veterans Affairs (“VA”) is not a disability benefit, but rather compensation for military service. No matter the rationale, there has been a common misunderstanding by airmen that VA disability benefits do not register as a disability warranting an affirmative response to question 18y.
Contrary to this misconception, the FAA and the VA have consistently held that a history of VA disability benefits, even if the airman is receiving a 0% rating for a condition, warrants a “yes” response to question 18y. and the corresponding underlying condition. For example, if an airman is receiving disability benefits for Posttraumatic Stress Disorder (“PTSD”), the FAA would expect a “yes” response to question 18y. and question 18m., which inquires regarding the applicant’s history of mental health conditions. As of the time of this article, our firm continues to see cases where the FAA is approaching airmen identified by the “special project” as having not appropriately identified a history of receiving VA disability benefits. These airmen continue to receive “reconciliation letters” and “Letters of Investigation.”
But what about airmen attempting to apply for a FAA medical certificate with VA disability benefits who haven’t been identified by the “special project?” Perhaps you are applying for a medical certificate for the first time since receiving VA disability benefits. Are you at risk for being denied your FAA medical application purely because you receive disability benefits? Not at all. Instead, the FAA will always assess your underlying conditions to identify whether your condition(s) are aeromedically significant or progressive to a point wherein they may pose a risk to aviation safety.
The following tips should be considered when applying for a FAA medical certificate with VA disability benefits:
- Always provide complete, accurate, and truthful responses on your application for FAA medical certification. If you are receiving VA disability benefits, you should identify all condition(s) for which you receive benefits, to include conditions for which you receive a 0% rating. Furthermore, all condition(s) for which you receive benefits and for those condition(s) which have been identified as “not service connected” should be identified at the appropriate questions on the application. This means that there may be redundancy in your answers to Form 8500-8. You will need to report the condition(s) for which you receive benefits at question 18y., but also at the appropriate question corresponding to the condition itself. As referenced above, a benefit for PTSD would be identified at questions 18y. and 18m.
- You should always be consistent with your representations to both the FAA and the VA. If you represent a condition to the FAA as though you do not have that condition or have never had the condition but receive a benefit for that condition from the VA, you could be liable for fraudulent representations to one agency or the other. While you may have a condition which has improved over time, your presentation to the FAA relative to your VA disability conditions should always be approached from a standpoint of aeromedical significance, appropriate mitigation of risk to aviation safety, and level of risk for aeromedically significant, recurrent symptoms.
- If you receive VA disability benefits for traumatic brain injury, PTSD or any mental health conditions, and/or obstructive sleep apnea, you are likely going to need to provide the FAA with more information regarding your status with the condition, as well as your history of symptoms and treatment. Each of these conditions have their own protocol which should be carefully evaluated and prepared prior to engaging an Aviation Medical Examiner (“AME”).
- If you are receiving disability benefits for a CACI condition, make sure to have appropriate documentation prepared prior to your engaging an Aviation Medical Examiner.
- If you are receiving benefits for most musculoskeletal conditions, your Aviation Medical Examiner should be able to issue your certificate, if you do not present with any aeromedically significant impairment to your flexibility, strength, range of motion, or if you have aeromedically significant levels of pain. Use of a disqualifying medication for pain will likely result in a deferral by your AME and ultimate denial of your application by the FAA.
- You should know that by appropriately reporting your VA disability benefits, you may be subject to additional request(s) for information from the FAA, even if your AME issues to you a medical certificate. The FAA has such authority to ask for additional information, such as medical records and current evaluations pursuant to 14 C.F.R. § 67.407. As such, you should ensure that your medical history relevant to condition(s) for which you are not receiving VA disability benefits are also appropriately addressed on your FAA medical application.
- Preparation is key to ensuring that your FAA medical certificate is not deferred or denied if you are receiving VA disability benefits. It is always a good idea to consult with an aviation attorney prior to submitting a medical application when receiving VA disability benefits to ensure that your application is consistent, complete, and supports your eligibility for airman medical certification.
If you are applying for a FAA medical certificate with VA disability benefits, you must give specific attention to detail. Failing to appropriately report your medical history could result in a catastrophic outcome, with revocation of all certificates and potential criminal liability. Furthermore, if you are not appropriately prepared in advance of applying for a medical application, you could risk a deferral of your application by the AME.
Consider a consultation with a FAA medical defense attorney at The Ison Law Firm before applying for a FAA medical certificate with VA disability benefits. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
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