FAA Medical After a Heart Attack

FAA Medical After a Heart Attack

Can I get my FAA medical after a heart attack? If you are asking this question, there is hope for you, as there are many pilots who are able to reestablish eligibility for a FAA medical after a heart attack. The protocols for consideration of your medical eligibility following a heart attack are a bit nuanced, however, and they don’t always correlate to clinical practices. In other words, after a heart attack, the FAA’s risk mitigation protocol can often be different from what your treating physician may consider clinically necessary or relevant. On the other hand, the FAA’s standards and practices are designed for assessing and mitigating the risk for sudden incapacitation within the National Airspace System. As a result, there is often a disconnect between what your doctor would require from you in the normal course of treatment and what the FAA may require for mitigation of risk to aviation safety. This article will discuss some of these nuances and also, how you can get your FAA medical after a heart attack.

Having a medical history or clinical diagnosis of myocardial infarction or “heart attack” is a specifically disqualifying condition for airman medical certification pursuant to the Federal Aviation Regulations. See 14 C.F.R. §§ 67.111(a)(1), 67.211(a)(1), and 67.311(a)(1). What’s more (and significant to the process for showing the FAA that you are eligible for a medical after a heart attack) is that the regulations also identify the following, disqualifying condition: “coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant.” See 14 C.F.R. §§ 67.111(a)(3), 67.211(a)(3), and 67.311(a)(3). It is important to look at these two “conditions” together for FAA medical certification purposes. Why? Well, because these conditions are identified in the regulations as being specifically disqualifying for FAA medical certification, you will require a special issuance authorization (waiver) in order to be issued a FAA medical certificate. During the process of evaluating your medical history for purposes of special issuance authorization, the FAA will consider whether you have coronary artery disease which remains untreated following your heart attack. Typically, this is where we see a disconnect between clinical medicine and regulatory medicine. For example, we typically see cases where an airman’s treating physician may not believe that an artery occlusion may be significant enough for treatment (such as implantation of a stent); however, the FAA might believe that for purposes of risk mitigation, the very same artery occlusion should be treated with a stent or some other form of treatment. More often than not, it has been the experience of our practice that it is usually a heart attack which will cause an airman to be denied a FAA medical certificate, but rather, it is the coronary artery disease which is left untreated and exposed to the FAA as a result of the heart attack.

So, what will the FAA look for after a heart attack? At the “heart” of the issue, is whether your heart attack or remaining coronary artery disease, if any, puts you at risk for prolonged physical deficiencies or risk for repeat heart attack/sudden incapacitation. The FAA’s assessment of your application will depend on the type of treatment you received for your heart attack, as well as what class FAA medical certificate you apply for.

There are four broad categories in which the FAA triages coronary artery disease, whether you have had a heart attack, or not. These categories include the following:

Category One: open revascularization of any coronary artery(s) and left main artery stenting

  • According to the FAA, this is considered “open revascularization includes coronary artery bypass grafting (CABG; on- or off-pump), minimally invasive procedures by incision, and robot operations. Left main coronary artery stenting carries the same risk of future cardiac events as CABG, thus it is treated the same for certification or qualification purposes.”

Category Two: percutaneous intervention

  • According to the FAA, this is considered “angioplasty (PTCA) and bare metal or drug-eluting stents.”

Category Three: myocardial infarction without any open or percutaneous intervention

  • This is a situation in which there has been no treatment for your heart attack.

Category Four: myocardial infarction from non-coronary artery disease causes

  • According to the FAA, these are situations in which a heart attack may be caused by something other than coronary artery disease such as “epinephrine injection, cardiac trauma, complications of catheterization, blood clotting disorders (e.g. PT/PTT, Protein S and C, Factor V Leiden), etc.”

Once your situation has been appropriately categorized, the FAA will determine what observation period, post-heart attack/treatment, will be required and what level of testing/documentation will be required for FAA review. Both the observation/recovery period and testing will be different based on you the category of your situation (from above) and the class medical you have applied for. These requirements are as follows:

FIRST CLASS MEDICAL
6-Month Observation Period

Category One Situations

3-Month Observation Period

Categories Two, Three, and Four Situations

SECOND CLASS MEDICAL
6-Month Observation Period

Category One Situations

3-Month Observation Period

Categories Two, Three, and Four Situations

THIRD CLASS MEDICAL
Observation Not Required

Once you’ve achieved the required observation period, the FAA will require that you provide records regarding your heart attack, as well as your current function. Again, this is where there may be a disconnect between what your treating physician and the FAA may believe to be reasonable. In many cases, but not all cases, we experience treating cardiologists disagreeing with the necessity of repeat or redundant testing, as required by the FAA. Nevertheless, the FAA’s requirements, generally, are as follow:

CATEGORY ONE
First and Unlimited Second Class:

  1.  Current, detailed, clinical progress report from treating cardiologist;
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies;
  3.  6-month, post event, maximal, radionuclide, graded stress test; and,
  4.  6-month, post-event, cardiac catheterization.

Third Class:

  1.  Current, detailed, clinical progress report from treating cardiologist;
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies; and,
  3.  Maximal, plain graded stress test.

 

CATEGORY TWO
First and Unlimited Second Class:

  1.  Current, detailed, clinical progress report from treating cardiologist;
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies;
  3.  Copy of operative or post procedure report. If a stent was placed, the report must include make of stent, implant location(s), and the length and diameter of each stent(s).
  4.  3-month, post event, maximal, radionuclide, graded stress test; and,
  5.  3-month, post-event, cardiac catheterization.

Third Class:

  1.  Current, detailed, clinical progress report from treating cardiologist;
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies; and
  3.  Copy of operative or post procedure report. If a stent was placed, the report must include make of stent, implant location(s), and the length and diameter of each stent(s).
  4. Maximal, plain graded stress test.
CATEGORY THREE
First and Unlimited Second Class:

  1.  Current, detailed, clinical progress report from treating cardiologist;
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies;
  3.  3-month, post event, maximal, radionuclide, graded stress test; and,
  4.  3-month, post-event, cardiac catheterization.

Third Class:

  1.  Current, detailed, clinical progress report from treating cardiologist;
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies; and,
  3.  Maximal, plain graded stress test.

 

CATEGORY FOUR
All Classes

  1.  Current, detailed, clinical progress report from treating physician; and,
  2.  Copies of all medical records (inpatient and outpatient) relevant to the event, including all labs, tests, or studies.

We recommend that you consider the following when applying for a FAA medical certificate after a heart attack, especially when applying for the first time following an event:

  • You should always report your history of a heart attack or coronary artery disease to the FAA on your application for FAA medical certificate, Form 8500-8 (MedXPress). The responsive question to such an event is question 18g., which asks if you in your life whether you have been diagnosed with, had, or presently have “heart of vascular trouble.” A heart attack and/or treatment would qualify as a “yes” to this question. Remember, that if the FAA discovers a diagnosis or treatment which has not been appropriately reported on your application for airman medical certification, you could be at risk for enforcement action and revocation of your airman certificates.
  • There is often a struggle, especially in cases of post-event, cardiac catheterization, in convincing treating cardiologists that testing required by the FAA is necessary. Usually, explaining to your physician that the FAA’s standards are regulatory in nature and not to clinical standards can help provide context for the FAA’s requests.
  • When performing a standard, Bruce protocol stress test, the FAA will require that your heart rate achieve no less than 85% of the calculated maximum predicted heart rate and that you walk for a minimum of 9 minutes if you are under the age of 70 and a minimum of 6 minutes if you are over the age of 70.
  • Your treating cardiologist should identify in a statement to the FAA, if applicable, that you are demonstrating attempts to meet goals regarding the modifiable risk factors as recommended by the ACC or AHA guidelines, especially as it relates to lipid panels.
  • If post-event, testing reveals any level of remaining coronary artery disease or ischemia, be sure to have your treating cardiologist identify for the FAA why such disease is not clinically significant, if applicable. See 14 C.F.R. §§ 67.111(a)(3), 67.211(a)(3), and 67.311 (a)(3).
  • If you are applying for a first-class medical certificate following a heart attack and the FAA denies you, consider applying for a lower-class medical certificate (in the event your desired operations are suitable to a lower class medical certificate). The FAA may consider your situation favorably.
  • Your current status report from the treating cardiologist (cardiovascular evaluation (CVE) should include:
    • Personal and family medical history assessment; clinical cardiac and general physical examination; assessment and statement regarding the applicant’s functional capacity and prognosis for incapacitation
    • Documentation of counseling on modifiable cardiovascular risk factors
    • All medications and side-effects, if any
    • Labs (lipids, blood glucose)
  • Remember that if you also have hypertension, the FAA will likely consider you for the CACI program, but hypertension following a heart attack may be considered an aggravating factor in considering future risk mitigation. Listen to more on The Pilot Lawyer Podcast.
  • For more information, check out The Pilot Lawyer Podcast, Episode 27.

If you are facing a FAA medical after a heart attack, 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.

FAA Medical Certificate with Vertigo

FAA Medical Certificate with Vertigo

Getting a FAA medical certificate with vertigo or a history of vertigo is possible. The Guide for Aviation Medical Examiners provides guidance for airmen applying for a FAA medical certificate with vertigo. Specifically, the FAA’s guidance for benign paroxysmal positional vertigo or “BPPV” identifies three categories of the condition: 1) vertigo which is resolved and symptoms lasted 1 year or less in total; 2) vertigo which occurred in multiple episodes during which the combined time of sickness was 1 year or more; and 3) severe/persistent recurrent/refractory to treatment or which required surgery at any time.  Depending upon which category of disease your vertigo or history of vertigo can be identified will make a difference when it comes time to get your FAA medical certificate.

Vertigo Which is Resolved/Symptoms Lasting 1 Year or Less

If your history of vertigo falls within the category of disease in which your vertigo has been resolved and you only experienced symptoms, whether it was multiple episodes or a single episode, lasting 1 year or less, it is likely that your Aviation Medical Examiner (“AME”) will be able to issue your medical certificate. In order to issue your FAA medical certificate with a history of vertigo, your AME must be able to determine that your condition has fully resolved without complications. This will be verified by your AME via “favorable” notes from either your primary care physician, an emergency room physician, or an ENT. The AME must also be able to determine that you currently have no symptoms or problems which would interfere with flight duties, that you are not taking any medication(s) for vertigo, and that you have had no hearing loss as the result of the vertigo.

The AME should note that vertigo falling into this category should only have been brief, mild, not disabling, and should have responded to repositioning. History of disease falling outside of these criteria could result in your case being triaged into one of the other two categories of vertigo identified by the FAA.

Vertigo With Combined Sickness of 1 Year or More

Vertigo which resulted in a combined period of sickness for 1 year or more will result in your AME deferring your application to the FAA’s Office of Aerospace Medicine for review and consideration of your application. Disease falling within this category, for an example, would include a situation in which an airman may have been sick with vertigo for six months with symptoms having resolved and then 1 year later, the airman having vertigo symptoms again, lasting 8 months. This is an example of the combined period of symptoms occurring 1 year or more.

If your history of vertigo falls into this category, the FAA will require that you provide a current, detailed clinical progress note generated from a clinic visit with your treating otolaryngologist or primary care physician. The physician must make notes relative to the history of your condition, your current use of medication, findings upon physical exam, the results of any testing performed, the assessment and plan for your condition, and, importantly, notation relative to the underlying cause of your vertigo. The FAA will also require copies of additional tests which may have been conducted by your doctor, to include any ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle [CPA], etc.

Severe Vertigo or Vertigo Requiring Surgery

If your vertigo is severe, ongoing, and/or has required surgery, your application will get deferred by your AME to the FAA’s Office of Aerospace Medicine for further review. In these cases, the FAA will require that you provide a detailed, clinical progress note similar to the one referenced above, but the report must be from an ENT. The FAA would prefer that the ENT be a subspecialist in neurotology. The FAA will also want all records relative to your surgery, if you had surgery.

We recommend that you consider the following when applying for a FAA medical certificate with vertigo, especially when applying for the first time with this issue:

  • The FAA’s primary concerns relative to vertigo will include duration and severity of symptoms. Furthermore, the FAA will be interested in the etiology of your vertigo. Discuss with your physician whether the underlying cause of your vertigo could be something serious or otherwise aeromedically significant (i.e. coronary artery disease, side effect to medication, tumor, etc).
  • In cases where your symptoms lasted 1 year or less, consider obtaining a detailed, clinical progress note from your treating physician (although not required), as providing same could go a long way toward assuaging any concerns your AME (and the FAA) may have regarding your history.
  • If you provide your AME with a detailed clinical progress note from your treating physician, keep in mind that the AME (and FAA) will scrutinize the entirety of that record. If there is any additional information on this report which indicates an otherwise aeromedically significant concern (even if related to a different condition, symptom, or social habit), the FAA or your AME may require more information regarding that concern.
  • Your application for airman medical certification (FAA 8500-8) or MedXPress, should identify any history of vertigo or dizzy spells at question 18b., which asks if in your lifetime you have ever been diagnosed with, had, or whether you presently have a history of “dizziness or fainting spell.” This is one of the limited conditions which the FAA specifically identifies on the FAA medical application.
  • In cases of recurrent vertigo in which there is no known etiology or cause, the FAA will typically require that you remain asymptomatic for 2 years before you can be considered eligible for a FAA medical certificate.
  • Start your FAA medical certification process as soon as possible. Having your documentation and supporting evidence prepared and submitted before your AME examination can potentially save you months of processing time in some cases where a deferral is necessary.
  • If you would like to learn more about this topic, listen to our episode about FAA Medical with Vertigo on The Pilot Lawyer Podcast!

If you are trying to get your FAA medical certificate with vertigo, 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.

FAA Medical Certificate with Migraines

FAA Medical Certificate with Migraines

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.

Listen to more about this topic on The Pilot Lawyer Podcast!

FAA Medical Certificate with ADHD

FAA Medical Certificate with ADHD

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.
  • Learn more about getting your FAA medical certificate by listening to The Pilot Lawyer Podcast. Learn more about the FAA’s ADHD Fast Track, too!

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.

FAA Medical Certificate with Asthma

FAA Medical Certificate with Asthma

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.
  • Check out our episode on The Pilot Lawyer Podcast about FAA medical certification with asthma.
  • If you would like to learn more about this topic, listen to our episode about FAA medical certification with asthma!

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.