by Dr. Bill Blank, M.D.
Published in Midwest Flyer – October/November 2017 issue
In early December, I spoke at an Aviation Medical Examiner (AME) refresher course in Tucson. There, I picked up some information, which has probably escaped notice and is significant to pilots.
An AME has three options with each exam: pass, defer, or deny. We are never supposed to deny. In the past, we have always been told, “if in doubt, defer.” Recently the emphasis has changed. Now, the recommendation is to defer only if absolutely unavoidable. This is the result of a policy issued by the soon-to-retire Federal Air Surgeon James R. Fraser to cut down certification delays. He realized that a certification “speed-up” could only be attained by better utilization of AMEs. His goal is to have 95% of airmen certified on the first visit to the AME. The previous rate was 85%. The FAA has actually attained 97%!
How has this been accomplished? By empowering AMEs to initially issue for many conditions, which previously required deferral. The emphasis is now on giving more responsibility to AMEs. AMEs have been given worksheets, such as the CACI (Conditions-the-Ame-Can-Issue) worksheets for various conditions. In the past, certification requirements were almost a secret, and certification authority was closely guarded in Oklahoma City. Think about the list of “approved medications” which previously, DID NOT EXIST! Of course, it always did.
Why was this change made? It was the result of pressure from pilots, AMEs, pilot advocacy groups, and Congress to cut down certification delays. Conscientious forward-looking FAA physicians, both in Oklahoma City and Washington, were also looking for solutions. Doctors Judith Frazier and Richard Carter come to mind. There was, of course, some internal FAA resistance, which needed to be overcome.
I want to talk about CACIs. There are currently 16 CACI conditions with worksheets with more to come. The worksheets all have many things in common. The condition must be stable. If any medications are used, they must be approved. There must be no side effects. Treatment for cancer must be over. In several conditions, there may be several varieties of the condition. In this case, you must have one of the varieties approved for CACI issuance. If all of the answers on the worksheet are correct, the AME can issue the certificate on the day of the exam. He retains the worksheet in his records, but does not need to submit it to the FAA.
How will the AME know the answers to the questions on the worksheet? I recommend printing out the worksheet, writing your name on the top of it, and taking it to your treating physician. He can complete his portion, sign and date it. An alternative would be to have him write a letter covering the same questions. I recommend using the worksheet. That way you know that all of the questions have been answered. It is faster too. Your physician can complete it while you are there, rather than dictating a letter, having it typed, mailed, etc. Remember that the date on the worksheet must be within 60 days of your visit to your AME. If your condition cannot be certified via the CACI process, in many cases it may be possible via the Special Issuance process.
When you have time, Google FAA CACI Worksheets. Click on a few of them and read them. Then, I think that you will have a better understanding of the process. Hopefully, you will never need to use one.
Now, the bad news… In spite of all these changes, there is an insufficient number of FAA Medical Review Officers in Oklahoma City. As a result, uncomplicated Special Issuances are taking about two months after all of the data has arrived. This is even with some of the Medical Review Officers working 10-hour days trying to cut down the backlog. A knowledgeable AME can frequently find a way to speed up the process. As I close, here is a tidbit: what is meant by APPEER? That is FAA talk for “Alternate Pilot Physical Exam and Education Requirement!” It is the name the FAA has given to certification via the Pilot’s Bill of Rights 2. The FAA looks at it as essentially another worksheet.
I hope this article is helpful in speeding up your airman certification.
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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. Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII), and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season, and held a Statement of Aerobatic Competency (SAC) since 1987.
DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others, and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.