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.i. Stomach, liver, or intestinal trouble
The following lists the most common conditions of aeromedical significance. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed that may result in sudden or subtle incapacitation without consulting the AMCD or the Regional Flight Surgeon. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate. The applicant should provide history and treatment, pertinent medical records, current status report, and medication. If a surgical procedure was done, the applicant must provide operative and pathology reports.
Cholelithiasis (Gall stones): If there are no symptoms, the AME may issue the medical certificate.
Cirrhosis (Non-Alcoholic) (this is scarring of the liver): This condition requires consideration and issuance by the FAA. The airman must submit all pertinent medical records, current status report, to include history of encephalopathy; PT/PTT; albumin; liver enzymes; bilirubin; CBC; and other testing deemed necessary by the FAA. The potential problem here is upper gastrointestinal bleeding or changes in the pilot’s mental status as a result of the cirrhosis that occurs suddenly and can be incapacitating.
Hepatitis (all but Hepatitis C): The pilot must submit all pertinent medical records, current status report to include any other testing deemed necessary by the FAA. If the hepatitis is resolved, the AME may issue the medical certificate. If there are residual problems from the disease, the decision to issue a certificate comes from the FAA.
Hepatitis C: Because this disease is frequently treated with immunosuppresion therapy it requires the airman to submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects. The initial medical certificate is granted under a Special Issuance by the FAA. Subsequent medical certificates may be issued by the AME under the following guidelines:
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or the Regional Flight Surgeon or the initial determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
Any symptoms the applicant has developed;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
A current liver function profile performed within last 90 days.
The Examiner must defer to the AMCD or Region if:
The applicant has developed symptoms;
There has been a change in treatment regimen or the applicant has been placed on alpha-interferon;
Any side effects from required medication; or
An adverse change in liver function studies.
Inguinal, Ventral or Hiatal Hernia: If the hernia is symptomatic or likely to cause any degree of obstruction, the medical certificate requires a FAA decision. If there are no symptoms, the AME may issue the medical certificate.
Cirrhosis (Alcoholic): This always requires a FAA decision. The issue here is the underlying alcoholism. We have discussed the FAA’s alcohol protocol in the DUI thread previously.
Colitis (Ulcerative, Regional Enteritis or Crohn's disease): The airman is required to submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects. The initial medical certificate after diagnosis is granted by the FAA under Special Issuance guidelines. Subsequent medical certificates may be issued by the AME under the following protocol:
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement regarding the extent of disease;
A statement regarding the frequency of exacerbation (the applicant should cease flying with any exacerbation as warned in § 61.53); and
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
The Examiner must defer to the AMCD or Region if:
There is a current exacerbation of the illness;
The applicant is taking medications such as Lomotil, steroid doses equivalent to more than 20mg of Prednisone per day, antispasmodics, and anticholinergics; or
The pattern of exacerbations are increasing in frequency or severity; or applicant underwent surgical intervention.
Colon/Rectal Cancer: Again, the airman must submit all pertinent medical records, operative/pathology reports, current oncological status report; and current CEA and CBC to the FAA for their initial consideration. The AME may issue the medical certificate if the following guidelines are met:
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
An update of the status of the malignancy since the last FAA medical examination, to include the results of a current (performed within last 90 days) carcinoembryonic antigen (CEA), if a baseline value is available.
The Examiner must defer to the AMCD or Region if:
There has been any progression of the disease or an increase in CEA.
Peptic Ulcer: Peptic ulcer disease requires a FAA decision regarding the medical certificate. The medical certificate will be under a Special Issuance.
An applicant with a history of an active ulcer within the past 3-months or a bleeding ulcer within the past 6-months must provide evidence that the ulcer is healed if consideration for medical certification is desired.
Evidence of healing must be verified by a report from the attending physician that includes the following information:
Confirmation that the applicant is free of symptoms
Radiographic or endoscopic evidence that the ulcer has healed
The name and dosage medication(s) used for treatment and/or prevention, along with a statement describing side effects or removal
This information should be submitted to the AMCD. Under favorable circumstances, the FAA may issue a certificate with special requirements. For example, an applicant with a history of bleeding ulcer may be required to have the physician submit follow-up reports every 6-months for 1 year following initial certification.
The prophylactic use of medications including simple antacids, H-2 inhibitors or blockers, proton pump inhibitors, and/or sucralfates may not be disqualifying, if free from side effects.
An applicant with a history of gastric resection for ulcer may be favorably considered if free of sequela.
As I always emphasize, talk to your AME. He/She can guide you through the process, allowing you to have a medical certificate issued with minimal if any delay.
* 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.i. Stomach, liver, or intestinal trouble
The following lists the most common conditions of aeromedical significance. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed that may result in sudden or subtle incapacitation without consulting the AMCD or the Regional Flight Surgeon. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate. The applicant should provide history and treatment, pertinent medical records, current status report, and medication. If a surgical procedure was done, the applicant must provide operative and pathology reports.
Cholelithiasis (Gall stones): If there are no symptoms, the AME may issue the medical certificate.
Cirrhosis (Non-Alcoholic) (this is scarring of the liver): This condition requires consideration and issuance by the FAA. The airman must submit all pertinent medical records, current status report, to include history of encephalopathy; PT/PTT; albumin; liver enzymes; bilirubin; CBC; and other testing deemed necessary by the FAA. The potential problem here is upper gastrointestinal bleeding or changes in the pilot’s mental status as a result of the cirrhosis that occurs suddenly and can be incapacitating.
Hepatitis (all but Hepatitis C): The pilot must submit all pertinent medical records, current status report to include any other testing deemed necessary by the FAA. If the hepatitis is resolved, the AME may issue the medical certificate. If there are residual problems from the disease, the decision to issue a certificate comes from the FAA.
Hepatitis C: Because this disease is frequently treated with immunosuppresion therapy it requires the airman to submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects. The initial medical certificate is granted under a Special Issuance by the FAA. Subsequent medical certificates may be issued by the AME under the following guidelines:
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or the Regional Flight Surgeon or the initial determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
Any symptoms the applicant has developed;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
A current liver function profile performed within last 90 days.
The Examiner must defer to the AMCD or Region if:
The applicant has developed symptoms;
There has been a change in treatment regimen or the applicant has been placed on alpha-interferon;
Any side effects from required medication; or
An adverse change in liver function studies.
Inguinal, Ventral or Hiatal Hernia: If the hernia is symptomatic or likely to cause any degree of obstruction, the medical certificate requires a FAA decision. If there are no symptoms, the AME may issue the medical certificate.
Cirrhosis (Alcoholic): This always requires a FAA decision. The issue here is the underlying alcoholism. We have discussed the FAA’s alcohol protocol in the DUI thread previously.
Colitis (Ulcerative, Regional Enteritis or Crohn's disease): The airman is required to submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects. The initial medical certificate after diagnosis is granted by the FAA under Special Issuance guidelines. Subsequent medical certificates may be issued by the AME under the following protocol:
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement regarding the extent of disease;
A statement regarding the frequency of exacerbation (the applicant should cease flying with any exacerbation as warned in § 61.53); and
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
The Examiner must defer to the AMCD or Region if:
There is a current exacerbation of the illness;
The applicant is taking medications such as Lomotil, steroid doses equivalent to more than 20mg of Prednisone per day, antispasmodics, and anticholinergics; or
The pattern of exacerbations are increasing in frequency or severity; or applicant underwent surgical intervention.
Colon/Rectal Cancer: Again, the airman must submit all pertinent medical records, operative/pathology reports, current oncological status report; and current CEA and CBC to the FAA for their initial consideration. The AME may issue the medical certificate if the following guidelines are met:
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
An update of the status of the malignancy since the last FAA medical examination, to include the results of a current (performed within last 90 days) carcinoembryonic antigen (CEA), if a baseline value is available.
The Examiner must defer to the AMCD or Region if:
There has been any progression of the disease or an increase in CEA.
Peptic Ulcer: Peptic ulcer disease requires a FAA decision regarding the medical certificate. The medical certificate will be under a Special Issuance.
An applicant with a history of an active ulcer within the past 3-months or a bleeding ulcer within the past 6-months must provide evidence that the ulcer is healed if consideration for medical certification is desired.
Evidence of healing must be verified by a report from the attending physician that includes the following information:
Confirmation that the applicant is free of symptoms
Radiographic or endoscopic evidence that the ulcer has healed
The name and dosage medication(s) used for treatment and/or prevention, along with a statement describing side effects or removal
This information should be submitted to the AMCD. Under favorable circumstances, the FAA may issue a certificate with special requirements. For example, an applicant with a history of bleeding ulcer may be required to have the physician submit follow-up reports every 6-months for 1 year following initial certification.
The prophylactic use of medications including simple antacids, H-2 inhibitors or blockers, proton pump inhibitors, and/or sucralfates may not be disqualifying, if free from side effects.
An applicant with a history of gastric resection for ulcer may be favorably considered if free of sequela.
As I always emphasize, talk to your AME. He/She can guide you through the process, allowing you to have a medical certificate issued with minimal if any delay.
* Italicized text is from FAA documents
