My Flight Surgeon
Sr. Aviation Medical Examiner
This is one of a series of posts about medical issues potentially affecting a pilot’s ability to obtain a medical certificate. In this series, we will look at common problems seen by the AME, review the requirements the FAA has to consider allowing one to fly and discuss what you need to do to expedite consideration by the FAA to allow you to fly. We plan to go through all of the medical history items in Section 18 on the front of Form 8500-8 over the next several months.
I would suggest that if you are unsure of how to answer these questions in Item 18, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.
Item 18. Medical History.l. Neurological disorders; epilepsy, seizures, stroke, paralysis, etc.
An established diagnosis of epilepsy, a transient loss of control of nervous system
function(s), or a disturbance of consciousness is a basis for denial no matter how remote the history. Like all other conditions of aeromedical concern, the history surrounding the event is crucial. Certification is possible if a satisfactory explanation can be established. A convalescence period following illness or injury may be advisable to permit adequate stabilization of an individual's condition and to reduce the risk of an adverse event. Processing such applications can be expedited by including hospital records, consultation reports, and appropriate laboratory and imaging studies, if available. Symptoms or disturbances that are secondary to the underlying condition and that may be acutely incapacitating include pain, weakness, vertigo or in coordination, seizures or a disturbance of consciousness, visual disturbance, or mental confusion. Chronic conditions may be incompatible with safety in aircraft operation because of long-term unpredictability, severe neurologic deficit, or psychological impairment.
Cerebrovascular disease including brain stem disease: Cerebral Thrombosis; Intracerebral or Subarachnoid Hemorrhage; Transient Ischemic Attack (TIA), Intracranial Aneurysm or Arteriovenous Malformation, Pseudotumor Cerebri (benign intracranial hypertension); Intracranial Tumor all require that the airman submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects. In addition, the first four conditions listed also require a Brain MRI, Bilateral carotid ultra sound, and the entire Coronary Heart Syndrome protocol discussed in the Heart and Vascular trouble thread earlier. If the airman has a intracranial tumor, they may be allowed to fly. The FAA’s position follows: A variety of intracranial tumors, both malignant and benign, are capable of causing incapacitation directly by neurologic deficit or indirectly through recurrent symptomatology. Potential neurologic deficits include weakness, loss of sensation, ataxia, visual deficit, or mental impairment. Recurrent symptomatology may interfere with flight performance through mechanisms such as seizure, headaches, vertigo, visual disturbances, or confusion. A history or diagnosis of an intracranial tumor necessitates a complete neurological evaluation with appropriate laboratory and imaging studies before a determination of eligibility for medical certification can be established. An applicant with a history of benign supratentorial tumors may be considered favorably for medical certification by the FAA and returned to flying status after a minimum satisfactory convalescence of 1 year.
Demyelinating disease: This includes a list of diseases to include Acute Optic Neuritis, Allergic Encephalomyelitis, Landry Guillain Barre Syndrome, Myasthenia Gravis, or Multiple Sclerosis. Again, the airman must submit all pertinent medical records, current neurologic report, to comment on involvement and persisting deficit, period of stability without symptoms, name and dosage of medication(s) and side effects. The decisions on certification lies with the FAA. The factors used in determining eligibility will include the medical history, neurological involvement and persisting deficit, period of stability without symptoms, type and dosage of medications used, and general health. A neurological and/or general medical consultation will be necessary in most instances.
Extrapyramidal, Hereditary, and Degenerative Diseases of the Nervous System: This group includes Huntington's Disease, Parkinson's Disease, Wilson's Disease,
Gilles de la Tourette Syndrome, Alzheimer's Disease, Dementia (unspecified),
Slow viral diseases i.e., Creutzfeldt Jakob's Disease. The airman must obtain medical records and current neurological status, complete neurological evaluation with appropriate laboratory and imaging studies, as indicated. V may be indicated. Considerable variability exists in the severity of involvement, rate of progression, and treatment of the above conditions. A complete neurological evaluation with appropriate laboratory and imaging studies, including information regarding the specific neurological condition, will be necessary for determination of eligibility for medical certification. The decisions on certification lies with the FAA.
Infections of the Nervous System:Brain Abscess, Encephalitis, Meningitis, and
Neurosyphilis. These all can cause significant neurological impairment and they require the airman to provide complete neurological evaluation with appropriate laboratory and imaging studies to the FAA. They also require a decision on issuance of the medical certificate from the FAA.
Trigeminal Neuralgia: The airman is required to submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects to the FAA for their decision regarding the medical certificate.
Presence of any neurological condition or disease that potentially may incapacitate an individual: Head trauma associated with epidural or subdural hematoma, focal neurologic deficit, depressed skull fracture, or unconsciousness or disorientation of more than 1 hour following injury. Trauma of this significance can cause long lasting neurological deficits that can interfere with thought process, memory, perception, or motor function. The airman must submit all pertinent medical records, current status report, to include pre-hospital and emergency department records, operative reports, neurosurgical evaluation, name and dosage of
medication(s) and side effects for their decision regarding the issuance of a medical certificate.
Spasticity, Weakness, or Paralysis of the Extremities: The news here is not all bad. Conditions that are stable and non-progressive may be considered for medical certification. The airman must submit all pertinent medical records, current neurologic report, to include etiology, degree of involvement, period of stability, appropriate laboratory and imaging studies to the FAA for their consideration regarding the issuance of a medical certificate.
* Italicized text is from FAA documents
I would suggest that if you are unsure of how to answer these questions in Item 18, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.
Item 18. Medical History.l. Neurological disorders; epilepsy, seizures, stroke, paralysis, etc.
An established diagnosis of epilepsy, a transient loss of control of nervous system
function(s), or a disturbance of consciousness is a basis for denial no matter how remote the history. Like all other conditions of aeromedical concern, the history surrounding the event is crucial. Certification is possible if a satisfactory explanation can be established. A convalescence period following illness or injury may be advisable to permit adequate stabilization of an individual's condition and to reduce the risk of an adverse event. Processing such applications can be expedited by including hospital records, consultation reports, and appropriate laboratory and imaging studies, if available. Symptoms or disturbances that are secondary to the underlying condition and that may be acutely incapacitating include pain, weakness, vertigo or in coordination, seizures or a disturbance of consciousness, visual disturbance, or mental confusion. Chronic conditions may be incompatible with safety in aircraft operation because of long-term unpredictability, severe neurologic deficit, or psychological impairment.
Cerebrovascular disease including brain stem disease: Cerebral Thrombosis; Intracerebral or Subarachnoid Hemorrhage; Transient Ischemic Attack (TIA), Intracranial Aneurysm or Arteriovenous Malformation, Pseudotumor Cerebri (benign intracranial hypertension); Intracranial Tumor all require that the airman submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects. In addition, the first four conditions listed also require a Brain MRI, Bilateral carotid ultra sound, and the entire Coronary Heart Syndrome protocol discussed in the Heart and Vascular trouble thread earlier. If the airman has a intracranial tumor, they may be allowed to fly. The FAA’s position follows: A variety of intracranial tumors, both malignant and benign, are capable of causing incapacitation directly by neurologic deficit or indirectly through recurrent symptomatology. Potential neurologic deficits include weakness, loss of sensation, ataxia, visual deficit, or mental impairment. Recurrent symptomatology may interfere with flight performance through mechanisms such as seizure, headaches, vertigo, visual disturbances, or confusion. A history or diagnosis of an intracranial tumor necessitates a complete neurological evaluation with appropriate laboratory and imaging studies before a determination of eligibility for medical certification can be established. An applicant with a history of benign supratentorial tumors may be considered favorably for medical certification by the FAA and returned to flying status after a minimum satisfactory convalescence of 1 year.
Demyelinating disease: This includes a list of diseases to include Acute Optic Neuritis, Allergic Encephalomyelitis, Landry Guillain Barre Syndrome, Myasthenia Gravis, or Multiple Sclerosis. Again, the airman must submit all pertinent medical records, current neurologic report, to comment on involvement and persisting deficit, period of stability without symptoms, name and dosage of medication(s) and side effects. The decisions on certification lies with the FAA. The factors used in determining eligibility will include the medical history, neurological involvement and persisting deficit, period of stability without symptoms, type and dosage of medications used, and general health. A neurological and/or general medical consultation will be necessary in most instances.
Extrapyramidal, Hereditary, and Degenerative Diseases of the Nervous System: This group includes Huntington's Disease, Parkinson's Disease, Wilson's Disease,
Gilles de la Tourette Syndrome, Alzheimer's Disease, Dementia (unspecified),
Slow viral diseases i.e., Creutzfeldt Jakob's Disease. The airman must obtain medical records and current neurological status, complete neurological evaluation with appropriate laboratory and imaging studies, as indicated. V may be indicated. Considerable variability exists in the severity of involvement, rate of progression, and treatment of the above conditions. A complete neurological evaluation with appropriate laboratory and imaging studies, including information regarding the specific neurological condition, will be necessary for determination of eligibility for medical certification. The decisions on certification lies with the FAA.
Infections of the Nervous System:Brain Abscess, Encephalitis, Meningitis, and
Neurosyphilis. These all can cause significant neurological impairment and they require the airman to provide complete neurological evaluation with appropriate laboratory and imaging studies to the FAA. They also require a decision on issuance of the medical certificate from the FAA.
Trigeminal Neuralgia: The airman is required to submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects to the FAA for their decision regarding the medical certificate.
Presence of any neurological condition or disease that potentially may incapacitate an individual: Head trauma associated with epidural or subdural hematoma, focal neurologic deficit, depressed skull fracture, or unconsciousness or disorientation of more than 1 hour following injury. Trauma of this significance can cause long lasting neurological deficits that can interfere with thought process, memory, perception, or motor function. The airman must submit all pertinent medical records, current status report, to include pre-hospital and emergency department records, operative reports, neurosurgical evaluation, name and dosage of
medication(s) and side effects for their decision regarding the issuance of a medical certificate.
Spasticity, Weakness, or Paralysis of the Extremities: The news here is not all bad. Conditions that are stable and non-progressive may be considered for medical certification. The airman must submit all pertinent medical records, current neurologic report, to include etiology, degree of involvement, period of stability, appropriate laboratory and imaging studies to the FAA for their consideration regarding the issuance of a medical certificate.
* Italicized text is from FAA documents
