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 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.

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