Medical - Special Issuance ---HELP---

[Tumper]

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,

[RV7A Flyer]

Originally Posted by Tumper

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?

[ColoCardinal]

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?

[RV7A Flyer]

Originally Posted by ColoCardinal

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?

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.

[Bob'sRV6A]

Check this out: https://www.aopa.org/advocacy/pilots...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.

[gyoung]

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.

[gyoung]

Originally Posted by Bob'sRV6A

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.

[terrykohler]

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

[Auburntsts]

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.

[mturnerb]

Originally Posted by terrykohler

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.