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Medical - Special Issuance ---HELP---

Tumper

Well Known Member
I have a special issuance medical question.

November 2017 I was diagnosed with Atrial Fibrillation. I am being treated with medication and I have not had an event since then.

I had all the medical work done including a stress test dated December 15, 2017.

I was remiss in getting the paperwork to the FAA in the 90 day window (didn?t realize that was a deal) and now AOPA and others recommend I get all the testing redone.

I went back to my cardiologist and got an EKG, Thyroid work up and Holter monitoring, however my doctor is hesitant to order a new stress test. He says there have not been any changes and it would be a waste of time and money. He would like to write a doctor recommendation letter describing my health to the FAA. I emailed his office last week and this is the response. ?Dr XXXXX called the FAA Friday and they said a letter had a good chance of working so he is in the process of writing one 😁?

I understand the doctor?s point however, I am concerned that this might lead to a considerable delay in getting a special issuance. The AOPA Medical Technician also says that it has been their experience that a stress test must not be older than 90 days.

Does anyone have any experience with this?

Thanks,
 
I have a special issuance medical question.

November 2017 I was diagnosed with Atrial Fibrillation. I am being treated with medication and I have not had an event since then.

I had all the medical work done including a stress test dated December 15, 2017.

I was remiss in getting the paperwork to the FAA in the 90 day window (didn’t realize that was a deal) and now AOPA and others recommend I get all the testing redone.

I went back to my cardiologist and got an EKG, Thyroid work up and Holter monitoring, however my doctor is hesitant to order a new stress test. He says there have not been any changes and it would be a waste of time and money. He would like to write a doctor recommendation letter describing my health to the FAA. I emailed his office last week and this is the response. “Dr XXXXX called the FAA Friday and they said a letter had a good chance of working so he is in the process of writing one ��”

I understand the doctor’s point however, I am concerned that this might lead to a considerable delay in getting a special issuance. The AOPA Medical Technician also says that it has been their experience that a stress test must not be older than 90 days.

Does anyone have any experience with this?

Thanks,

Is there any reason you can't go with BasicMed and avoid all this? Do you currently have an SI or have held a Class III (and not been denied one)? If so I think that qualifies, doesn't it?
 
Medical

Tumper, I too was wondering if you shouldn't fly under the Basic Med. Even if it's only until you get the rest of this sorted out.
Did you 'suggest' to your doctor that it's your time and money you would be wasting and not his? Who's the customer here? :rolleyes:
 
Tumper, I too was wondering if you shouldn't fly under the Basic Med. Even if it's only until you get the rest of this sorted out.
Did you 'suggest' to your doctor that it's your time and money you would be wasting and not his? Who's the customer here? :rolleyes:

Just remember that if you go BasicMed *and* try to "sort it out" with the FAA for a Class III (or CIII SI), if they deny you the SI, you can't use BasicMed unless and until you get a new CIII or SI. I'd think long and hard about whether I needed Class III or not before opening that can of worms, if BasicMed will meet your needs.
 
Check this out: https://www.aopa.org/advocacy/pilots/medical/third-class-airman-medical-reform
It might be that your treatment for A-fib could be considered "Coronary heart disease that has required treatment." Don't know, but if it is, then you must first get the S.I. before qualifying for the Basic Med.
Call FAA at 405-954-4821. I found them more helpful than my AME or the AOPA, even if it does take a bunch of tries to get through. My Cardiologist didn't want to use the Bruce Stress test. I did the Nuclear one, and didn't get on the tread mill but instead got the drug to race my heart--all this against my AME and AOPA advice and FAA instructions. The FAA, so far is fine with it but I am still in the process of waiting for my S.I. after almost 6 months because they asked for additional stuff that required a resubmittal a month ago.
 
I also had to go down the SI road because of Afib. It can be frustrating because common sense and good practices for you and your doctors doesn't seem to play with the FAA docs. I did not get much help from the AOPA folks. Everything they suggested was general and non-specific to my case. The very best advice I got was from a forum of AME's at Oshkosh. The suggestion was to talk to an AME who does a lot of SI's as a consultation in advance of your exam. As a consultation it is privileged and can't go to the FAA. The AME can give you the straight scoop on your specific case, what hoops you'll have to jump thru and your likelihood of success.

If you've already started the exam process you're pretty much obliged to continue with it. If you just drop it they will eventually either deny the application and/or revoke an existing medical. Then you are forever screwed for either Basic Med or LSA. I would be concerned even if all you did was send some test results or a letter without starting the MedXpress with an AME. That might be enough for them to you question your medical. It's scary as **** to get a letter that says they don't like something and to respond with xxx within 60 days or it will referred to their enforcement division, i.e. they will deny or revoke whatever you have. I got one last year and it delayed my SI renewal by 3 months. If you get one, don't ignore it. Send a response even if just to say you're trying to comply and need more time.

The SI process is navigable but as you're seeing, it helps to have a guide. I got my SI AME thru contacts in the CAF. He's an hour flight away but my initial contact and consultation was by phone. It really put my mind at ease. You should be able to find one in north Texas. Ask your contact network.

All that said, if you don't really need the FAA Medical then go BasicMed or LSA. I need the 2nd class for some things I want to do so I suffer thru the SI process each year. Mine is only good for 1 year at a time. If I ever have a doubt on renewal I'll just let it expire and go BasicMed.
 
My Cardiologist didn't want to use the Bruce Stress test. I did the Nuclear one, and didn't get on the tread mill but instead got the drug to race my heart--all this against my AME and AOPA advice and FAA instructions. The FAA, so far is fine with it but I am still in the process of waiting for my S.I. after almost 6 months because they asked for additional stuff that required a resubmittal a month ago.

I had to do a nuclear stress test with Bruce treadmill for my last SI renewal. I cramped up on the treadmill and the tech switched me to the drugs. The FAA did not like it. They made me do a separate treadmill test. Perhaps because I have a 2nd Class. I think they use the treadmill as a fitness measure which they can't state since there is no fitness criteria in the exam. The nuc test with the drugs told them everything they needed about my heart. It cost me a few months to make **** sure I wouldn't cramp again, submit the test and get the OK. The good news was the approval I got back lets my AME issue my cert for the next 5 years without getting OKC involved.

I hope yours gets resolved soon.
 
ANY cardiac event dumps you back to the FAA

I started down the S.I. trail four years ago (stent). They (FAA)require certain testing and labs within a required time frame. Requesting exceptions leads to further delays or denial. Even the letter from your cardiologist has to tick all the right boxes. My submittal each year included a Table of Contents, Lab/Blood results, EKG, Office notes(inc. BP), full tracings from a Stress Test (9minutes min.), and the Cardiologist?s letter.
AFTER the SI was issued last year (and still in effect), I was able to apply and receive Basic Med. if I experience another cardiac event, it?s back to the FAA and a SI. That?s my understanding.
The good news, I don?t keep secrets from my physician- i?m Getting regular, complete physicals. Basic Med is a godsend in that I now don?t need to go the S.I. Route every 12 months. The REALLY good news- 20 years ago pretty much any cardio event would have permanently grounded me. Today, I still have the PRIVILEGE of flying.
Terry, CFI
RV9A N323TP
 
I suggest contacting Dr. Bruce Chien, http://www.aeromedicaldoc.com/
He is a Senior AME/HIMS AME/Adv.AME and the ?medical matters? moderator on the AOPA Forum and he routinely fields these types of questions over there. He will definitely give you solid advice on how to proceed.
 
I started down the S.I. trail four years ago (stent). They (FAA)require certain testing and labs within a required time frame. Requesting exceptions leads to further delays or denial. Even the letter from your cardiologist has to tick all the right boxes. My submittal each year included a Table of Contents, Lab/Blood results, EKG, Office notes(inc. BP), full tracings from a Stress Test (9minutes min.), and the Cardiologist?s letter.
AFTER the SI was issued last year (and still in effect), I was able to apply and receive Basic Med. if I experience another cardiac event, it?s back to the FAA and a SI. That?s my understanding.
The good news, I don?t keep secrets from my physician- i?m Getting regular, complete physicals. Basic Med is a godsend in that I now don?t need to go the S.I. Route every 12 months. The REALLY good news- 20 years ago pretty much any cardio event would have permanently grounded me. Today, I still have the PRIVILEGE of flying.
Terry, CFI
RV9A N323TP

This is the best real-world description of the value of basic med I've read. Three key parts: "I don't keep secrets", "Basic Med is a godsend", " Privilege".

This time last year there were folks complaining on this and other forums about how basic med was going to be flawed, not a true "drivers license medical", etc.

As pilots educate their doctors, this will become more and more an opportunity for pilots and doctors to have a conversation, discuss the risks, and avoid the "one doctor for FAA, one for everything else" approach.
 
I know several individuals, one with heart and the other with cancer that are back flying professionally. They both used these folks. They are right there in Oklahoma and can interact with the FAA quicker on your case. Good luck!

https://www.leftseat.com
 
AFib

There are a lot of factors that go into the determination about an SI. Having accomplished a lot of them over the past 30 years, no two are the same. With AFib, the risk of embolism (stroke) and the possibility of functional impairment otherwise drive the decision process for the FAA. I would be happy to look at your information if you would like me to. As a volunteer member of the EAA Aeromedical Council, you could (but don't need to) route it through them. We have a prominent cardiologist on our four member council and we take these calls and questions all of the time as unpaid volunteers-one pilot helping another.

I have advised more than one pilot who didn't need a third class to go the BasicMed route with AFib. As long as there aren't coronary artery issues, it looks to me like it would meet the criteria for using BasicMed (***disclaimer: BasicMed is not a FAA medical so there are others better equipped to advise what is legal and not). As you are seeing, there is more to the SI process for AFib that meets the eye.

Good luck and let me know via PM if I can help.

John
 
Thanks to everyone for the responses. To answer a few questions;

1) I currently hold a Class 3 medical
2) I don?t need a Class 3 medical, I could do BasicMed if it is still available to me

It is my understanding from talking with my cardiologist I am in good health. I was only having an event about once a month and it lasted about 5 mins. Since treatment in November 2017 I have not had an event. I am taking minimum medications for the fibrillation.

I guess I am a little confused about what the requirements are to get into BasicMed. Am I still eligible? It looks like I need to make a few more phone calls prior to sending anything to the FAA.

Thanks again for the help.
 
Thanks to everyone for the responses. To answer a few questions;

1) I currently hold a Class 3 medical
2) I don’t need a Class 3 medical, I could do BasicMed if it is still available to me

It is my understanding from talking with my cardiologist I am in good health. I was only having an event about once a month and it lasted about 5 mins. Since treatment in November 2017 I have not had an event. I am taking minimum medications for the fibrillation.

I guess I am a little confused about what the requirements are to get into BasicMed. Am I still eligible? It looks like I need to make a few more phone calls prior to sending anything to the FAA.

Thanks again for the help.

It's pretty simple. First, since you currently hold a Class III medical, you ARE eligible for BasicMed.

Second, your doctor can sign off the BasicMed physical without a special issuance. Here is a direct quote from the FAA's instructions to physicians for cardiovascular conditions:

"A cardiovascular condition, limited to a one-time special issuance for each
diagnosis of the following:
• Myocardial infarction.
• Coronary heart disease that has required treatment.
• Cardiac valve replacement.
• Heart replacement. "

You have none of these, therefore you should not require any more than a sign-off by a physician of the BasicMed exam (assuming no other conditions of other types that require special issuance).

Here's the website with the specifics of BasicMed and instructions to physicians: https://basicmedicalcourse.aopa.org...s/AOPABasicMed_Pilot_and_Physicians_Guide.pdf



Hope this helps.
 
It's pretty simple. First, since you currently hold a Class III medical, you ARE eligible for BasicMed.

Second, your doctor can sign off the BasicMed physical without a special issuance.

Or *with* one, if that's what a particular pilot has (or had). But I think your point to the OP was that he need not go get an SI. Just go do BasicMed, and drop all the rest of the inquiries and phone calls (and I, for one, would certainly making calling OK City the LAST thing I'd ever do :) ).
 
Or *with* one, if that's what a particular pilot has (or had). But I think your point to the OP was that he need not go get an SI. Just go do BasicMed, and drop all the rest of the inquiries and phone calls (and I, for one, would certainly making calling OK City the LAST thing I'd ever do :) ).

I agree with not calling the FAA. However, when in doubt and you need an informed, expert medical opinion, I can't recommend Dr. Bruce Chien enough. He's helped more pilots than I can count get their medical's straightened out.

If anyone is an AOPA member you can even post to the Medical Matters Forum in the Members Forum anonymously and he'll answer questions there, within reason.
 
Please Contact John Owen or your own AME

It's pretty simple. First, since you currently hold a Class III medical, you ARE eligible for BasicMed.

Second, your doctor can sign off the BasicMed physical without a special issuance. Here is a direct quote from the FAA's instructions to physicians for cardiovascular conditions:

"A cardiovascular condition, limited to a one-time special issuance for each
diagnosis of the following:
? Myocardial infarction.
? Coronary heart disease that has required treatment.
? Cardiac valve replacement.
? Heart replacement. "

You have none of these, therefore you should not require any more than a sign-off by a physician of the BasicMed exam (assuming no other conditions of other types that require special issuance).

Here's the website with the specifics of BasicMed and instructions to physicians: https://basicmedicalcourse.aopa.org...s/AOPABasicMed_Pilot_and_Physicians_Guide.pdf



Hope this helps.

I'm not a doctor, but it seems to me that you have "a coronary heart disease that required treatment". Basic Med is not a get out of jail free card. There are a number of conditions that REQUIRE evaluation by the folks at Oklahoma City before you can fly again - even if you already have a Class III or Basic Med card. Don't take my word or the word of anyone who isn't an AME. A shout out to John (prior post) or AOPA should resolve this issue at no cost to you. Just my $.02.
Terry, CFI
RV9A N323TP
 
I'm not a doctor, but it seems to me that you have "a coronary heart disease that required treatment". Basic Med is not a get out of jail free card. There are a number of conditions that REQUIRE evaluation by the folks at Oklahoma City before you can fly again - even if you already have a Class III or Basic Med card. Don't take my word or the word of anyone who isn't an AME. A shout out to John (prior post) or AOPA should resolve this issue at no cost to you. Just my $.02.
Terry, CFI
RV9A N323TP

I am a doctor - atrial fibrillation is most emphatically NOT equivalent to coronary disease (a small minority of cases of AF are associated with coronary disease, but there are many causes, including very easy to treat ones), and I'd bet you a steak dinner that the OP's cardiologist has done a complete workup to rule out coronary disease. Moreover, I have thoroughly and repeatedly read the instructions to physicians for BasicMed and it's absolutely clear to me that the OP should have no problem getting BasicMed without having to consult anyone other than his doctor. That's the whole point and intent of BasicMed: Congress defined in good detail a very limited list of conditions that require clearance from the FAA - conditions not on the list DO NOT require involvement of the FAA or an AME - and within that list there is reasonable discretion on the part of the physician:

"I certify that I discussed all items on this checklist with the individual during my examination, discussed any medications the individual is taking
that could interfere with their ability to safely operate an aircraft or motor vehicle, and performed an examination that included all of the
items on this checklist. I certify that I am not aware of any medical condition that, as presently treated, could interfere with the
individual's ability to safely operate an aircraft"

Calling OKC to ask permission is giving them an opening to do what they do - "to a man with a hammer everything looks like a nail". BasicMed came into existence in part because there's plenty of good evidence that your doctor is in a better position than anyone else to help you make a judgement on how safe you are to fly. In addition, the association of any particular condition with in-flight incapacitation is very weak, with some obvious exceptions that are included in the BasicMed exclusion list. (and for those, there's no actual evidence since they've always prevented pilots from getting medicals - the sport pilot experience isn't showing any outbreaks of in-flight incapacitation events, even when pilots are exercising their own discretion).
 
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Or *with* one, if that's what a particular pilot has (or had). But I think your point to the OP was that he need not go get an SI. Just go do BasicMed, and drop all the rest of the inquiries and phone calls (and I, for one, would certainly making calling OK City the LAST thing I'd ever do :) ).

You're correct - a NEW special issuance is not needed. The language in the BasicMed rules states: "If they previously held a special issuance medical certificate for any condition below, it must have been valid within the ten years prior to July 15, 2016 for the pilot to be eligible for BasicMed"
 
Doc Billingsly

Good stuff. Keep posting. I'm still learning about Basic Med, and it keeps getting better.
Thanks,
Terry
 
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