1. Establish a long term relationship with an Aviation Medical Examiner (AME)
An AME who knows you and your medical history well and who is also willing to make the extra effort to help you keep your medical certificate is an invaluable resource. Many times, the convenience of scheduling an appointment for a physical on short notice will save you time or missed flying days. Medical problems that have been previously addressed will be familiar to this AME and not be a source of anxiety for you or your AME when you report them on your physical. Additionally, the AME will have a file of all correspondence to and from the FAA regarding your medical certificate. An AME who knows you well is more likely to answer questions for you over the phone about your use of medications, medical conditions and flying. Of course, pilots and AME's are always welcome to contact the Aerospace Medicine physicians of Virtual Flight Surgeons through the secure and anonymous Confidential Questionnaire or by contacting our offices at 1-866-AEROMED. ALPA pilots are entitled to free services by calling the ALPA Aeromedical office at 303-341-4435.
2. Select an AME that you and other pilots are comfortable using.
The AME should be knowledgeable about aviation medicine and willing to work with the pilot, the pilot's treating physicians, and the FAA Regional and national offices if necessary, to help you retain your medical certificate. Many AME's do relatively few examinations each year and have a very busy office practice. The pace of their practice may not allow them to take the time to make a phone call to the Regional Flight Surgeon or the Aeromedical Certification Division at Oklahoma City if a question arises about your medical qualifications. Those AME's who do make the time for a phone call may save you weeks of administrative time versus those who do not take the time, but instead defer a medical certificate to the Regional Office or Oklahoma City for a decision. Some AME's do hundreds or even thousands of FAA physicals each year and are extremely familiar with the nuances of the FAA administrative process. They are very comfortable working within the system, knowledgeable about the regulations and capable of assisting the pilot with rapid determinations of eligibility. We recommend using these AMEs, many who are members of the Civil Aviation Medicine Association.
3. Understand the three possible outcomes of an FAA medical examination
First, the expected outcome for a physical examination is that the medical certificate will be ISSUED. In this circumstance, the pilot completes the FAA Form 8500-8, Application For Medical Certification, at the time of the physical examination and assuming he or she meets all of the standards, walks out of the AME's office with a new medical certificate in hand. The overwhelming majority of physical exams have this result.
A second result is a DENIAL of the medical certificate. If pilot's clearly do not meet FAA medical standards, particularly if they have conditions that are specifically grounding in Part 67 of the FARs or the Guide to Aviation Medical Examiners, the aviation medical examiner may issue a denial letter to the pilot revoking the pilot's current medical privileges. That information is forwarded to the FAA Aeromedical Certification Division which will then issue a formal denial letter and request return of the current Airman's Medical Certificate. Denials are not necessarily permanent. If the pilot can present information that the disqualifying medical condition has resolved or is being treated in an aeromedically safe manner, the FAA may reissue the airman's medical certificate. A denial of an application is extremely rare.
The third possible outcome is an intermediate decision termed a DEFERRAL. In this situation, the AME notes a medical condition that is questionable with regards to eligibility for medical certification. The pilot takes the physical examination, but rather than issue the medical certificate or give the pilot a denial letter, the AME defers the application and medical certificate to the Regional Flight Surgeon or the Aeromedical Certification Division in Oklahoma City. With the AME's permission, the pilot may continue to fly on their current medical certificate until it lapses.
Unfortunately, deferrals often take several months to obtain a response from the FAA. The FAA response letters frequently request the pilot provide additional medical information to support the application. A 30-day suspense from the date of the FAA letter on this reporting requirement is common. If no information is received at the end of the period, the FAA may deny the airman's medical certificate. The pilot is not eligible to use the older medical certificate. Instead, the pilot must await the arrival of the previously deferred certificate to be returned from the FAA office that to which the AME forwarded it. If additional information is required by the FAA, this process may take several additional months. Submission of complete information to the FAA is CRITICAL to timely certification decisions.
Savvy pilots can see the advantage in this situation of having the AME call the FAA Regional office or AMCD to get an answer immediately rather than using the mail to handle a deferred medical application. Also see "Documentation" section in tip #6 below.
4. Take your physical examination early in the month that it is due
Often, pilots wait until the last several days before their medical certificate lapses to schedule another physical examination. Sometimes, an examination cannot be scheduled prior to the lapse of the pilot's previous medical certificate. If a medical condition arises that requires additional information, obtaining that information may take several days. Often, the aviation medical examiner will hold the certificate for several days pending receipt of additional information in hopes of issuing a medical certificate to the pilot. The maximum time an AME may hold a medical application before electronically submitting it to the FAA is 14 days. If the physical is scheduled early in the month, the pilot has sufficient time to gather that information and take it to their AME's for subsequent issuance of a new medical certificate prior to expiration of their previous medical certificate.
5. DO NOT take a physical examination if you are not medically qualified
There are no adverse consequences with the FAA Aeromedical Certification Division of allowing your medical certificate to lapse. As long as you are not operating an aircraft without the appropriate class of medical certificate, the FAA AMCD is not concerned with the currency of your medical certificate. If you do take a physical and have a disqualifying condition, the AME is obligated to deny or defer your application. This can result in significant administrative delays even if your medical condition resolves while awaiting a letter from the FAA. If you have a disqualifying medical condition when your next physical is due, it is usually better to allow you medical certificate to lapse. When the condition has resolved, bring appropriate documentation from your treating physician to your physical and present it to your AME after noting the treatment on the front of the application. You may then expect to leave the office with a new medical certificate in hand.
6. Bring appropriate documentation
If you have had medical evaluations or treatment since your last FAA physical examination, bring documentation of the treatment and the resolution of the condition to your FAA medical examination. This may help avoid any delays in issuing a new medical certificate if all aeromedically relevant questions are answered. For example, if you have had surgery on a knee or an appendix removed or were hospitalized for an infection, the hospital discharge summary and a signed, dated follow-up note from your treating physician indicating you can return to full activity is usually sufficient. Some conditions, such as cancer, heart disease, neurologic and psychiatric conditions requiring hospitalization require additional documentation and review by the FAA. In general, the more documentation available, the easier it is to make a favorable certification decision. Again, submission of complete information to the FAA is CRITICAL to timely certification decisions.
A program instituted by the FAA in 2002, termed AME Assisted Special Issuances allows AME's to renew Special Issuance medical certificates for all classes for 25 medical conditions designated by the FAA. Two additional conditions, coronary artery disease and cardiac valve replacements/repair, are eligible for AASI for third class certification only. To be eligible, airmen must bring specific documentation from their treating physicians with a copy of their Special Issuance Authorization letter. If the documentation reflects they have had no adverse change in their medical condition, the AME may renew the Special Issuance and submit the documentation to the FAA.
7. Bring glasses, contact lenses or hearing aids, if required
An aviation medical examiner is not authorized to issue a new medical certificate if a pilot does not meet the standards listed in FAR Part 67 and the Guide to Aviation Medical Examiners. Pilots using glasses or contact lenses should bring them to the physical examination to optimize their chances of passing those respective tests. Likewise, pilot's using hearing aids (which are authorized during flying with a limitation on the medical certificate) should also bring them to the exam.
8. Prepare physically for the examination
Pilots who have a medical examination should be well rested and should avoid high sugar meals, caffeine, tobacco and stimulant type medications before their physical examination. Meals high in sugar may cause an erroneous result in the urinalysis that raises a suspicion of diabetes. Complex carbohydrates and proteins before an examination will stabilize blood sugars and decrease the risk of an abnormal urine result in helping individuals. Fasting is not necessary, however.
For those pilots requiring electrocardiograms (first physical examination after age 35 and annually after age 40 for First Class certification), being well rested, avoiding caffeine, tobacco and stimulant medications, such as decongestants, decreases the risk of abnormalities on the ECG. Although in most cases, these abnormalities are shown to be not clinically significant, the time and expense, not to mention the anxiety, associated with obtaining the required evaluation can be avoided by simple preparation.
9. Understand reporting responsibilities on your FAA medical application
The medical application requires pilots to report all medicines, prescription and non-prescription, that the pilot is using on question 17 of the FAA medical application. If this is your first time reporting the use of a medication, be sure to include a statement about the absence of any side effects, if true. Over-the-counter "nutritional supplements" do not require reporting.
Likewise, the pilot is required to report all visits to health care providers within the last three years, along with the name, address and reason for visit. If a pilot has or has ever had conditions listed on question 18, a check mark in the "yes" block is required. If this information has been previously reported to the FAA, an annotation in the remarks section, "previously reported, no change" is acceptable if there has been no significant change in the medical condition. The pilot may list a "PI#" referencing the condition if one has been assigned to the pilot by the FAA. If this is a new condition or there has been a change, bringing the appropriate documentation as mentioned above will alleviate most questions regarding certification.
The FAA has recently amended the Form 8500-8. It now includes a new question 18y that asks about receiving disability benefits. Pilots who have received Social Security, state, military, Veterans? Administration or insurance disability benefits should check YES to this question. Receiving disability benefits is not generally disqualifying, but does require submission of information as to the nature of the benefits. Often a VA form listing the benefits is adequate. Other more serious conditions require more detailed information. Many conditions should have already been reported under one of the other questions on the Form 8500-8.
The FAA is very concerned with omission and falsification of medical conditions and evaluations on Questions 18 and 19 on the medical application, Form 8500-8. Do not forget to list all visits to healthcare providers (except FAA exams and routine dental/eye exams) on your application. Failure to do so may result in revocation of both medical certificates and all pilot certificates and ratings for up to one year.
Pilots may use an electronic version of the Form 8500-8, termed MedXPress and found at https://medxpress.faa.gov/, to submit their information to the AME electronically within 30 days of or at the time of their examination. After submission of the electronic application, pilots are given a confirmation number. Access to the applications is restricted to only the AME to whom the pilot provides a confirmation number. Our office encourages the use of MedXPress.
10. Remember to check the blocks regarding drug and alcohol offenses and other legal encounters
Many applications are returned to airmen because they fail to check any answer on questions 18.v. (convictions or administrative actions related to driving under the influence of alcohol or drugs) and 18.w. (history of other convictions). This results in the medical application being returned to the pilot for completion. As above, this question not only includes events since your last FAA medical exam, but also requires a "Yes" response if you EVER have had a conviction or administrative action.
The newest version of the FAA medical application, Form 8500-8, now asks if an applicant has ever been ARRESTED for an offense involving drugs or alcohol while driving (18v). Previously, only convictions required a YES response. For pilots who are now required to respond affirmatively, an explanation of the circumstances and police/driving records may be required.
Concealing a moving violation involving the use of alcohol or illegal drugs is foolish. The pilot's signature at the bottom of the application authorizes the FAA to search the National Driver's Registry for any violations. Not only will concealment of an offense trigger a medical evaluation, but the Securities Division of the FAA may pursue enforcement action against your Pilot Certificate. Falsification of a medical application is subject to up to 5 years in prison, a $250,000 fine and revocation of a pilot certificates and ratings. Please see articles in several issues of the Virtual Flight Surgeons Aeromedical Newsletter regarding the legal implications associated with inaccurate completion of the Airman's Medical Application, FAA Form 8500-8.
11. Be prepared to send further information to the FAA upon request
Occasionally, pilots will receive a letter from the FAA after they have been issued a medical certificate by their AME. The letter states that the FAA is unable to determine their eligibility for an airman medical certificate based on incomplete information regarding some medical condition. The FAA specifically requests information and/or further studies to be submitted prior to an eligibility determination.
Usually, there is a 30-day suspense from the date of the letter on this submission requirement. Attempt to comply with this time line and submit all requested information. If it is impossible to complete this requirement prior to the 30-day extension, a call to the FAA requesting a 30-day extension is all that is needed.The FAA AMCD Customer service number to call for an extension is 405-954-4821. Do not request an extension until near the end of the original 30 days suspense as the FAA grants an extension of 30 days from the day of the request, not sequentially with the first suspense date. The pilot may continue to operate an aircraft with a current medical certificate issued by the AME pending a final determination from the FAA.
Denial letters from the FAA come via certified mail and specifically request a return of the medical certificate.
12. Contact an aviation medicine specialist early for any questions you may have
Many AME's are very knowledgeable and have assisted many pilots. Most questions can be addressed with a simple phone call, which avoids administrative delays and anxieties at a later date. If AME's are not certain about the appropriate action, they will contact the FAA Regional Flight Surgeon or the FAA Aeromedical Certification Division for advice. ALPA pilots are entitled to free consultations and assistance with FAA reporting by calling the ALPA Aeromedical office at 303-341-4435. Pilots who are not eligible for the free services of the ALPA Aeromedical Office are always welcome to contact the Aerospace Medicine physicians of Virtual Flight Surgeons through the secure and anonymous Confidential Questionnaire at www.AviationMedicine.com or by phone at 720-857-6117.
Fly Safely, Stay Healthy, Ask Questions Early.