The Medical Certification Process

by Dr. Bill Blank, M.D.
Published in Midwest Flyer – Dec 2016/Jan 2017

In the last issue, I talked about how some pilots who will soon be permitted to fly without an FAA-issued medical certificate, while the majority of pilots will continue to fly with FAA-issued medical certificates.

Most of us don’t think much about the certification process until some health problem occurs. It is important to understand the process. This helps the airman and his physician to provide the FAA the needed information so that certification can be quickly attained in as many cases as possible.

In order to be certified, the applicant completes an online form on MedXPress and submits it electronically. The applicant should then print a copy of it to bring to his/her Aviation Medical Examiner (AME), along with the confirmation number. If the applicant does not bring the confirmation number, the exam cannot be completed. If the applicant does not receive a confirmation number, he/she has not submitted it!

In my case, I look at the form before I ever go to the computer. If I see something, which will prevent certification, I tell the airman we cannot do the exam today. We need some clarification. If I am not given the printed-out form, I need to open up the application on the FAA website using the confirmation number. Once I have done that I have essentially two choices: issue or defer. In some cases, that is pointless and a waste of time. If there are no problems with the form, I perform the exam, print and sign the medical certificate, then enter my exam information on the form and submit it. This is what the FAA calls a Regular Issuance (RI).

In most cases, that’s it until the next medical. For quality assurance, the FAA randomly reviews a small percentage of these medicals. If they find a problem, the applicant and the AME get a letter requesting further information.

What if there are medical issues? Now the question becomes what are the medical conditions and how serious are they. The answer determines how they are resolved. By regulation, there are 15 specific disqualifying conditions:
- Angina Pectoris
- Bipolar Disease
- Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant.
- Diabetes Mellitus requiring hypoglycemic medications.
- Disturbance of consciousness without satisfactory explanation of cause.
- Epilepsy
- Heart Replacement
- Myocardial Infarction
- Permanent cardiac pacemaker
- Cardiac valve replacement
- Personality Disorder
- Psychosis
- Substance Abuse
- Substance Dependence
- Transient loss of control of nervous system function(s) without satisfactory explanation of cause.

You may sometimes be certified with one or more of these conditions if you meet certain requirements. These requirements can be found online either at the FAA or AOPA websites. You or your AME need to provide this information to the FAA. I cannot emphasize enough the importance of providing the information they ask for.

The biggest problem I see is the failure of the treating physician to write a complete letter. I recommend that you print out the information requested, underline the subjects to be covered, and ask your physician to comment specifically on each item. When you get the letter, read it and make sure that everything has been covered. Otherwise, have it redone. If you do not do this, you will receive a letter from the FAA requesting further information. This can easily waste two or three months. I suggest to my airmen that they show me the letter before it is submitted. That way, if it is incomplete, we can fix the problem.

If the FAA decides that certification is appropriate, you will receive a Special Issuance authorization letter. It will specify what information you will need to provide to the FAA, usually, annually. In most cases, you can provide it to your AME who can issue the interim certificate and forward the information to the FAA. Another choice is to send the information directly to the FAA. That is free, but takes a lot longer. The authorization letter has an expiration date, usually 5 years. You need to make sure that you get a new authorization letter as needed.

Always take the authorization letter to your AME. He may not have a copy of it.

What if you have a medical condition not requiring an Special Issuance?

The FAA has made a big improvement via the CACI program. CACI stands for Conditions AMEs Can Issue.

There are worksheets available online for each of these conditions. Google: AME Guide Worksheets. Current CACI conditions:
- Arthritis
- Asthma
- Bladder Cancer
- Chronic Kidney Disease
- Colitis
- Glaucoma
- Hepatitis C – Chronic
- Hypertension
- Hypothyroidism
- Migraine and Chronic Headache
- Mitral Valve Repair
- Pre-Diabetes
- Prostate Cancer
- Renal Cancer
- Retained Kidney Stone(s)
- Testicular Cancer

Print out the one or ones that you need, write your name at the top and take it to your physician. Ask him to check the answers to the condition and sign it and date it. This can be done anytime within 60 days prior to seeing your AME. You don’t need to do it a week or two before the exam. As long as the answers are the desired ones, the AME can issue your certificate via Regular Issuance (RI). All he needs to do is write on the 8500-8, “Conditions AMEs Can Issue (CACI) Qualified for the Condition.” Interestingly, the Pilot’s Bill of Rights II contains a provision requiring the FAA to identify and implement more CACI conditions. It even requires the FAA to seek input from physicians outside the FAA on developing these worksheets!

In some situations, you will have a non-CACI condition. In that case, your AME can frequently work with the FAA to obtain certification.

In the next issue of Midwest Flyer Magazine, I plan to talk more about the CACI process. I hope that you now have a better understanding of medical certification.

EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Blank holds an Airline Transport Pilot Certificate and has 5300 hours. He is a Certified Instrument Flight Instructor (CFII), and has given over 1200 hours of aerobatic instruction. In addition, Blank was an airshow performer through the 2014 season, and held a Statement of Aerobatic Competency (SAC) since 1987.

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