Assessment for Sleep Apnea During Your FAA Medical

  • ON Dec 29, 2022
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  • BY Anthony Ison
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  • IN Pilot Law

Did you know that your AME conducts an assessment for sleep apnea during your FAA medical examination? In 2015, the FAA made it a requirement that your Aviation Medical Examiner (“AME”) conduct a risk assessment for obstructive sleep apnea (“sleep apnea”) on every airman being examined for FAA medical certification. The FAA encourages AMEs to use their own clinical judgment in assessing an airman’s risk for sleep apnea. Nevertheless, the FAA has noted in the Guide for Aviation Medical Examiners that the following items may put an airman at a higher risk for sleep apnea: retrograde mandible, large tongue or tonsils, neuromuscular disorders, connective tissue anomalies, and airmen with a body mass index (“BMI”) of 40 or greater. The FAA also identifies that airmen with the following conditions may be at a greater risk for having sleep apnea: refractory hypertension requiring more than two medications for control, diabetes mellitus, and atrial fibrillation. Of course, there may be additional items which the AME and/or the FAA believe puts any given airman at greater risk for sleep apnea.

What happens when your AME determines that you are at risk for sleep apnea during a FAA medical examination? Generally, even if the AME thinks you are at an increased risk for sleep apnea, you can still be issued a FAA medical certificate. You may need to jump through a few hoops to satisfy the FAA in the long run, but this is usually satisfied by establishing proof of effective treatment of the underlying sleep apnea. During the FAA medical exam, however, the FAA requires that the AME make a decision as to your risk for sleep apnea. Specifically, the AME will need to identify one of six options to the FAA on your FAA medical application.

For those airmen who have previously been assessed, the AME can select one of the following:

  1. [Applicant] has [sleep apnea] diagnosis and is on Special Issuance. Reports to follow.
  2. [Applicant] has [sleep apnea] diagnosis and is currently being treated OR has previous [sleep apnea] assessment. NOT on Special Issuance. Reports to follow.

If you are an airman the falls into this category, you either already have a special issuance authorization for sleep apnea or you are reporting your diagnosis of sleep apnea to the FAA for the first time on this exam. In this context, the AME’s assessment of your sleep apnea is largely immaterial, as your treating physician would have already diagnosed the condition and (hopefully) initiated an effective treatment.

For those airmen who have previously been assessed the AME can select one of the following:

  1. [Applicant] determined to NOT be at Risk for [sleep apnea] at this examination.

If you are an airman that falls into this category, you are in the clear. Your AME will issue your medical certificate, if you are otherwise qualified.

For those airmen who may not have a prior diagnosis of sleep apnea, but the AME believes to be at risk for sleep apnea:  

  1. Discuss [sleep apnea] risks with airman and provide education material.
  2. At risk for [sleep apnea]. AASM sleep apnea assessment required. Reports to follow.

If you are an airman that falls into this category, your AME either believes you should be cautious about sleep apnea becoming a problem or the AME believes that you have sleep apnea and need to be assessed clinically. If your AME selects one of these boxes on the FAA medical application, there is still a good chance you can be issued a medical certificate by your AME, if you are otherwise qualified. Following issuance, however, you can expect to receive a letter from the FAA, requesting more information about your risk for sleep apnea. Typically, this will require you to undergo a clinic sleep study, as well as consult with a sleep specialist about the severity of your sleep apnea, if any, as well as provide the FAA with evidence of any potential treatment.

For those airmen who may not have a prior diagnosis of sleep apnea, but the AME believes to be at a high risk for severe sleep apnea:  

  1. Immediate safety risk. AASM sleep apnea assessment required. Reports to follow.

If you are an airman that falls into this category, your AME believes you are not safe to be issued an airman medical certificate. You will not leave your AME’s office with a medical certificate if your AME selects this box. You can expect to receive a letter from the FAA, requesting more information about your risk for sleep apnea. In our experience, it is rare for an AME to trigger box 6, but if you do, it is wise to consider an evaluation with a sleep specialist as soon as possible, FAA notwithstanding.

In any situation where the AME checks a box that includes “reports to follow,” the FAA will require documentation regarding the existence and severity of sleep apnea, your treatment of sleep apnea, and a status report from your treating physician regarding the severity of your sleep apnea. Typically, thereafter, the FAA will place you on a special issuance authorization, in an effort to monitor the status of your sleep apnea. It is always a good idea to have an understanding of your risk of sleep apnea before you sit for your FAA medical examination. Having a good awareness of your risk for sleep apnea can allow you to streamline the process and provide all necessary documentation to your AME at the time of exam.

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. Ensuring that your doctor is developing the proper documentation regarding your sleep apnea, as needed, can be a difficult task. 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 AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay. Also, if you have failed to report your sleep apnea on your FAA medical application, a FAA medical attorney can give you counsel on how to rectify your omission.

If you are concerned about your FAA medical and the assessment for sleep apnea during your FAA medical exam, 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 to your AME or the FAA. Aviation law is all we do. Nothing else.

FAA Medical Certificate with Sleep Apnea

  • ON Dec 27, 2022
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  • BY Anthony Ison
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  • IN Pilot Law

Is it possible to get a FAA medical certificate with sleep apnea? Yes! It is possible to be issued a FAA medical certificate with obstructive sleep apnea (“sleep apnea”), but you will also need to be granted a special issuance authorization. A special issuance authorization can be better understood as a “waiver.” When an airman has been issued a special issuance authorization, the FAA essentially wants to monitor the status of the airman’s condition and the on-going compliance with and effectiveness of treatment. Certain criteria have been identified by the FAA as prerequisites to being issued a special issuance authorization for sleep apnea. While the process may seem daunting, preparing a successful submission to the FAA, supporting your eligibility for FAA medical certification with sleep apnea, can be successful.

The National Transportation Safety Board (“NTSB”) directed the FAA to consider screening airmen for obstructive sleep apnea, as they had done in the trucking industry. In screening surveys, the NTSB found it was not infrequent that airmen were falling asleep in the cockpit, and in one rather infamous scenario both crewmembers succumbed to the effects of sleep apnea. In that case, an aircraft was flying from the Island of Oahu to Hilo, where both crew members fell asleep. One crewmember was found to have severe sleep apnea and the other crewmember had shift work fatigue. The crew overflew their destination by 22 miles before they were finally awakened and returned, with only twenty minutes of fuel left in the aircraft.

Even still, the risks of sleep apnea, if undiagnosed, include causing repeated hypoxic or low oxygen injury to the heart and brain. In turn, sleep apnea presents a four-fold increase for a heart attack or stroke, as well as a seven-fold increase of having a motor vehicle type of accident. As a result, in our experience, it has been the FAA’s position that airmen must be screened for sleep apnea and appropriately diagnosed, and if sleep apnea is present, that it be accurately treated and mitigated. In doing so, the FAA believes that risk of fatigue and/or further morbidity is being mitigated.

In order to establish your eligibility for FAA medical certification with a history of sleep apnea, you will need to provide the following documentation to the FAA: a copy of the FAA’s “OSA Status Report – Initial” or a clinical note (with ALL required information) from your physician; a copy of your most recent sleep study (used for diagnosis); and compliance data from PAP device representing 30 days if new diagnosis (may consider minimum of 2 weeks if data verifies excellent compliance, effective treatment, and resolved symptoms) OR 365 days if previously diagnosed and treated. It should also be noted that the FAA will also consider an airman for medical certification in cases where sleep apnea is being treated with a dental device, as well as other types of treatment.

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. Ensuring that your doctor is developing the proper documentation regarding your sleep apnea, as needed, can be a difficult task. 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 AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay. Also, if you have failed to report your sleep apnea on your FAA medical application, a FAA medical attorney can give you counsel on how to rectify your omission.

If you are concerned about your FAA medical and sleep apnea, 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 to your AME or the FAA. Aviation law is all we do. Nothing else.

FAA Medical with Past Anxiety       

  • ON May 05, 2022
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  • BY Anthony Ison
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  • IN Pilot Law

Obtaining your FAA medical with past anxiety is not impossible. If you are like a lot of people, you may have had anxiety at one point or another in your life. If your history of anxiety was limited to a short period of time, achieving medical certification with the FAA may be relatively straight forward. If your anxiety involved a more involved clinical presentation, medical certification is still not out of the question. Typically, whether you can obtain your FAA medical with past anxiety comes down to the level of risk for recurrence of symptoms.

If your anxiety was limited in time, you responded well to medication treatment (if any), and medication was discontinued, the required elements for treatment may be relatively simple. The FAA will likely want to review your previous treatment records, as well as a letter from your current physician regarding your status. Many times, a psychiatric evaluation can help alleviate any concerns the FAA may have regarding your current status and even facilitate a faster disposition regarding your medical certification. Be careful submitting medical records to the FAA! Always make sure you know everything that is in your records and how that information may affect the FAA’s review of your file.

A history of anxiety, when mixed with other clinical concerns, such as panic attacks, psychiatric hospitalizations, and/or other diagnoses such as major depressive disorder, will almost always warrant an evaluation by a psychiatrist. A psychiatric evaluation can give the FAA better insight as to whether the clinical picture presented in your treatment records will present a risk for recurrence of symptoms now or in the future. Ultimately, the more severe your symptoms were at the time of treatment, the more concerned the FAA will be relative to the risk for recurrence of symptoms. With a psychiatric evaluation, and in some cases, a neuropsychological evaluation, you have the ability to provide the FAA with a better perspective on the aeromedical significance of your past anxiety, as well as your current, aeromedical risk.

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. Ensuring that your doctor is developing the proper documentation regarding your past anxiety, as needed, can be a difficult task. 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 AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay. Also, if you have failed to report your past anxiety on your FAA medical application, a FAA attorney can give you counsel on how to rectify your omission.

If you are concerned about reporting your past anxiety to the FAA, 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 to your AME or the FAA. Aviation law is all we do. Nothing else.

 

FAA Medical and VA Disability Benefits

  • ON Jan 17, 2022
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  • BY Anthony Ison
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  • IN Pilot Law

Do you have questions regarding your FAA medical and VA disability benefits? A frequent question asked of our firm is whether an applicant for FAA medical certification needs to report his or her receipt of VA disability benefits to the FAA. There seems to be a good deal of confusion, somewhat caused by the Department of Veteran’s Affairs, as to whether disability benefits are reportable. Question 18y., which specifically asks whether in the applicant’s lifetime he or she has received “medical disability benefits,” can be a bit confusing. Many veterans consider their VA disability benefits to be compensation for their service, rather than a disability.  The FAA’s position, however, is that VA disability benefits are reportable on question 18y. on Form 8500-8, the application for airman medical certification.

Reporting your VA disability benefits on your FAA medical application does not have to result in the denial of your application. Some, if not most, medical conditions for which veterans receive compensation are not conditions which are aeromedically significant. Whereas some conditions, such as post-traumatic stress disorder (“PTSD”), traumatic brain injury (“TBI”), and obstructive sleep apnea (“OSA”), may warrant further evaluation by the FAA, even those conditions, in many situations, can be overcome to establish an airman’s eligibility for FAA medical certification.

If you have failed to report your VA disability benefits on your FAA medical application, you need to act immediately. In the event the FAA or the VA discovers your failure to report your VA benefits, as required, the FAA could take action to revoke your airman certificate(s), as well as your medical certificate. In rarer cases, there may be criminal action which can be pursued against you for failure to appropriately report your VA disability benefits on your FAA medical application. Fortunately, the FAA’s sanction guidelines provide an opportunity to take corrective action, which frequently avoids action for alleged “intentional falsification” and limits the FAA’s inquiry to your eligibility to hold a medical certificate.

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. Ensuring that your doctor is developing the proper documentation regarding your VA disability benefits, as needed, can be a difficult task. 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 AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay. Also, if you have failed to report your VA disability benefits on your FAA medical application, a FAA attorney can give you counsel on how to rectify your omission.

If you are concerned about your FAA medical and VA disability benefits, 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 to your AME or the FAA. Aviation law is all we do. Nothing else.

FAA Medical Certificate and Benign Prostatic Hyperplasia

Do you have questions regarding your FAA medical certificate and benign prostatic hyperplasia? Benign prostatic hyperplasia, or enlargement of the prostate, is a common condition that airmen experience. Fortunately, benign prostatic hyperplasia does not have to be a roadblock to your FAA medical certificate. Specifically, the FAA has identified a relatively straightforward process for achieving FAA medical certification following a diagnosis and treatment for benign prostatic hyperplasia.

If you are reporting benign prostatic hyperplasia on your FAA medical application, your Aviation Medical Examiner (“AME”) is authorized to issue you a medical certificate, without the need to defer your application, if you have findings consistent with uncomplicated benign prostatic hyperplasia and there is no evidence of prostate cancer. Most treatments for benign prostatic hyperplasia, such as alpha blockers, are not disqualifying and your AME should issue your certificate if you are found to be otherwise qualified. Medications for benign prostatic hyperplasia are disqualifying if you are taking them for any other condition such as pulmonary arterial hypertension. Furthermore, nitrates are disqualifying. Medications such as Cialis, Levitra, Staxyn, Stendra, and Viagra are approved by the FAA for treatment of benign prostatic hyperplasia, with certain mandatory wait times before flying.

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. Ensuring that your doctor is developing the proper documentation regarding your history of benign prostatic hyperplasia, as well as your treatment, if any, 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 AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay.

If you are concerned about your FAA medical and benign prostatic hyperplasia, 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 to your AME or the FAA. Aviation law is all we do. Nothing else.

 

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