Flight MD: Call your AME

Many pilots, especially if they have had a medical problem or if they are getting older, are concerned about their ability to obtain a third class medical. Those pilots usually want to keep their BasicMed option open.

Most pilots will pass their third class medical without any difficulty but for some, there may be hoops to jump through. Let’s look at some of the more common problems that cause concerns when pilots approach their medicals.

Orthopedic issues are frequent. As we get older, we pay for the abuse of our joints over the years. These problems may come from wear and tear (osteoarthritis) or a history of trauma to the joint. The FAA terminology that is crucial is whether the orthopedic problems will “interfere with the performance of airman duties.” If the AME determines that the problem could interfere with the operation of an aircraft, then detail reports from the treating physician will be required.

Many pilots have had knee, hip, or other joint replacements since their last medicals. If they have fully recovered and do not have functional limitations, pilots can have their medical signed off by the AME with proper documentation on the FAA medical form.

For pilots who have had amputations or significant neurologic paralysis of an arm or a leg, a musculoskeletal evaluation report will be required. In some cases, a medical flight test may be necessary and limitations to an aircraft with special equipment may be an FAA criterion for flying.

The AME can opine how the FAA may decide on any specific condition or malady, but the final decision is up to the federal air surgeon and her delegates.If the musculoskeletal problem is progressive, such as rheumatoid arthritis or gouty arthritis, a CACI (Condition AME Can Issue) or a special issuance might be necessary, particularly if certain medications are required.

Cataract surgery is another common procedure that pilots may have had during the interval of their medical exams. If the pilot has had a simple cataract lens replacement, once stable and the pilot has 20/40 or better distant vision (20/20 for second and first class), the AME can issue a medical. For certain kinds of implants, an eye evaluation form may be necessary, and it may require deferring to the regional flight surgeon or the FAA in Oklahoma City.

In March, the FAA released protocols for pilots who have had COVID-19 infections. For the most part, if a pilot had a positive test for COVID but did not have any hospitalization nor serious complications, the AME should be able to issue without any additional documentation. For pilots who have had complications including hospitalization, additional information may be necessary to be granted their medical.

Age itself is not disqualifying. A well-known Beechcraft Bonanza pilot was flying solo at 100. However, regardless of his or her ability to pass an FAA physical, the pilot may want to get a rigorous flight review. There are pilots who are safe to fly at 90 and others who should not be flying at 60.

Pilots must remember that the AME can only offer advice. He or she can opine how the FAA may decide on any specific condition or malady, but the final decision is up to the federal air surgeon (see “Guest Editorial: Reach Out,” p. 20) and her delegates. However, there are some important basics where your AME can assist. One is making sure you have all the necessary information that the FAA will require and that it is sent in one mailing—not piecemeal. Under the new federal air surgeon, great efforts are being made to speed medical decisions and base them on good scientific evidence. With this new leadership, AMEs are slated to have more involvement in decision making and we welcome that progress.

If they develop a condition that may be disqualifying between medicals, pilots are to report the change to the FAA and self-ground till hearing back. Pilots should call their AME to discuss whether the change is significant and/or disqualifying. Instead of waiting till the pilot’s next medical is due, once a condition stabilizes, the pilot may want to see her AME for a new medical to start the process of a CACI or special issuance if it is going to be required.

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