[Federal Register Volume 59, Number 203 (Friday, October 21, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-26047]
[[Page Unknown]]
[Federal Register: October 21, 1994]
_______________________________________________________________________
Part II
Department of Transportation
_______________________________________________________________________
Federal Aviation Administration
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14 CFR Parts 61 and 67
Revision of Medical Standards and Certification Procedures and Duration
of Medical Certificates; Proposed Rule
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DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
14 CFR Parts 61 and 67
[Docket No. 27940; Notice No. 94-31]
RIN 2120-AA70
Revision of Medical Standards and Certification Procedures and
Duration of Medical Certificates
AGENCY: Federal Aviation Administration (FAA), DOT.
ACTION: Notice of proposed rulemaking (NPRM).
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SUMMARY: This notice proposes an extensive amendment of part 67 of the
Federal Aviation Regulations (FAR) to revise airman medical standards
and medical certification procedures. This announcement, in part,
proposes to implement a number of recommendations resulting from a
comprehensive review of the medical standards announced in previous
notices. As proposed, this revision of the standards for airman medical
certification and associated administrative procedures of part 67 will
better provide for safety in the aviation system and reflect current
medical knowledge, practice, and terminology.
This notice also proposes to amend Sec. 61.23 of part 61 to revise
the duration of third-class airman medical certificates, based on the
age of the airman, for operations requiring a private, recreational, or
student pilot certificate.
DATES: Comments must be submitted on or before February 21, 1995.
ADDRESSES: Comments on this notice should be mailed or delivered, in
triplicate, to: Federal Aviation Administration, Office of the Chief
Counsel, Attention: Rules Docket (AGC-10), Docket No. 27940, 800
Independence Avenue, SW., Washington, DC 20591. Comments mailed or
delivered must be marked Docket No. 27940. Comments may be examined in
Room 915G weekdays between 8:30 a.m. and 5 p.m., except on Federal
holidays.
FOR FURTHER INFORMATION CONTACT: Carol A. Thomas or Dennis McEachen,
Aeromedical Standards Branch, 800 Independence Avenue, SW., Washington,
DC 20591; telephone (202) 493-4075.
SUPPLEMENTARY INFORMATION:
Comments Invited
Interested persons are invited to participate in the making of the
proposed rule by submitting such written data, views, or arguments as
they may desire. Comments relating to the environmental, energy,
federalism, or economic impact that might result from adopting the
proposals in this notice are also invited. Substantive comments should
be accompanied by cost estimates. Comments should identify regulatory
docket or notice number and should be submitted in triplicate to the
Rules Docket address specified above. All comments received on or
before the closing date for comments specified will be considered by
the Administrator before taking action on this proposed rulemaking. The
proposals contained in this notice may be changed in light of comments
received. All comments received will be available, both before and
after the closing date for comments, in the Rules Docket for
examination by interested persons. A report summarizing each
substantive public contact with FAA personnel concerned with this
rulemaking will be filed in the docket. Commenters wishing the FAA to
acknowledge receipt of their comments submitted in response to this
notice must include a preaddressed, stamped postcard on which the
following statement is made: ``Comments to Docket No. 27940.'' The
postcard will be date stamped and mailed to the commenter.
Public Meeting
Public meetings will be held in Washington, DC, Seattle, WA, and
Orlando, FL. A notice of the meeting times and locations will be
published later in the Federal Register.
Availability of NPRM
Any person may obtain a copy of this NPRM by submitting a request
to the Federal Aviation Administration, Office of Public Affairs,
Attention: Public Inquiry Center, APA-200, 800 Independence Avenue,
S.W., Washington, D.C. 20591, or by calling (202) 267-3484.
Communications must identify the notice number of this NPRM.
Persons interested in being placed on the mailing list for future
NPRM's should request from the above office a copy of Advisory Circular
No. 11-2A, Notice of Proposed Rulemaking Distribution System, which
describes the application procedure.
Background
On April 15, 1982, the FAA announced the adoption of Amendment 67-
11 (47 FR 16298; April 15, 1982) to the FAR (14 CFR part 67). The
amendment revised, among other things, the special discretionary
procedures for issuing airman medical certificates to persons who do
not qualify for certification under Secs. 67.13, 67.15, or 67.17 of the
FAR. In the preamble to that amendment, the FAA announced that, in
compliance with Executive Order 12291, Federal Regulation (February 17,
1981), it intended to conduct an overall review of the medical
standards in part 67 of the FAR. A complete review of the regulations
was needed to bring the standards and procedures for airman medical
certification up to date with advances in medical knowledge, practice,
and technology. Therefore, Amendment 67-11 was considered interim
clarification until a comprehensive review of the medical standards
contained in part 67 could be concluded.
The FAA began the review of the medical standards for airmen and of
its certification practices and procedures (47 FR 30795; July 15, 1982)
by requesting public comment. In addition, the FAA initiated a contract
with the American Medical Association (AMA) to provide professional and
technical information. The AMA presented its report, ``Review of Part
67 of the Federal Air Regulations and the Medical Certification of
Civilian Airmen'' (AMA Report), on March 26, 1986. The public was again
invited to comment on part 67 in ``Announcement of the Availability of
a Report'' (51 FR 19040; May 23, 1986). The AMA Report detailed the
results of a comprehensive review of the standards for airman medical
certification and of their application. The AMA Report considered
pertinent advances in the field of medicine since 1959, recommended
changes in FAA medical standards and explained the rationale for such
changes.
In a separate but related issue, on May 11, 1979, the Aircraft
Owners and Pilots Association (AOPA) petitioned to amend Sec. 61.23 to
require medical examinations for private pilots at 36-month intervals
rather than at 24-month intervals. In response to the petition, the FAA
reviewed the literature, surveyed the medical practices of the
Department of Defense, and considered a preliminary analysis of its own
aeromedical certification data. The FAA then contracted with Johns
Hopkins University to prepare a detailed statistical analysis of
information collected by the FAA from annual examinations on
approximately 31,000 air traffic controllers over a 15-year period. The
study sample was demographically similar and broadly comparable to the
private pilot population, and the examinations were similar to airman
medical examinations.
The Johns Hopkins University analysis confirmed an increasing
incidence of recorded pathology with increasing age, agreeing with the
data from the AMA report, but a relatively low incidence in young
individuals. Reducing the frequency of medical examinations could be
expected to result in an increased prevalence of undetected pathology
within the system. For the younger age groups, however, this effect
would be small. The Johns Hopkins analysis did not identify exact ages
at which the frequency of examinations should be changed.
In response to the AOPA petition to amend Sec. 61.23, the FAA
issued on October 29, 1982, NPRM No. 82-15 (47 FR 54414, December 2,
1982) proposing to amend part 61 to revise the duration of validity of
third-class privileges of airman medical certificates for operations
requiring a private or student pilot certificate. As proposed by Notice
No. 82-15, the requirement for a third-class medical examination would
have been changed to every 5 years for the youngest pilots then
increasing in frequency to the existing 2-year interval for older
pilots.
On September 27, 1985, prior to the issuance of the AMA Report on
its review of the airman medical standards and certification procedures
in part 67, the notice proposing to amend part 61 to revise the
duration of third-class airman medical certificates was withdrawn (50
FR 39619). The proposal was withdrawn, in part, because of issues
raised by the medical community. In addition, a regulatory evaluation
of Notice No. 82-15 suggested a slight increase in aircraft accident
fatalities if the then proposed third-class medical certificate was set
to 5 years for young airmen. Given the then pending issuance of the AMA
Report and the possibility that the report would provide better data on
which to base an evaluation of the safety concerns raised by the
medical community, the FAA decided that any future consideration of
examination frequency would be within the context of the outcome of the
comprehensive review of part 67.
On February 26, 1986, AOPA again petitioned the FAA to revise the
duration of a third-class airman medical certificate to 36 calendar
months for noncommercial operations requiring a private, recreational,
or student pilot certificate. The petition (Docket No. 24932) was
entered in the public docket and remains open.
On September 24, 1993, AOPA once again petitioned the FAA to revise
the duration of a third-class airman medical certificate to 48 calendar
months for a specific trial period for noncommercial operations
requiring a private or student pilot certificate. The petition (Docket
No. 27473) was entered in the public docket and remains open.
Based on the FAA's review of part 67, the FAA's judgment regarding
recommendations contained in the AMA Report, and on consideration of
all public comments in response to previous notices, the FAA proposes
to revise part 67, ``Medical Standards and Certification.'' The
proposed revision of part 67 will involve the incorporation of
additions and changes to specific medical standards, the scope of
examination, and the administrative procedures pertaining to airman
medical certification. In consideration of pertinent advances in the
field of medicine since the last significant revision of part 67, the
medical standards and certification procedures that are being proposed
reflect current medical knowledge, technology, and practice.
As stated in the notice withdrawing Notice 82-15, the duration of
airman medical certificates was to be reconsidered after the AMA's
report; however, the report provided no duration recommendation. The
proposal to revise airmen standards and certifications procedures and
the duration of airmen medical certificates was also addressed in a
January 1992 agency rulemaking review. The results of these events
supported the revision of part 67 and duration of third-class airman
medical certificates. A reevaluation of all studies and data collected
since 1982 supports a revision of the duration of third-class medical
certificates outlined in this proposal. Accordingly, the FAA is
proposing revisions to part 67 and to Sec. 61.23 of part 61 of the FAR.
Summary of Proposed Amendments to Part 67
The following is a summary of the substantive changes proposed in
this rulemaking. Because the FAA is proposing a complete recodification
of part 67, this summary states both the current and proposed section/
paragraph numbers.
1. Distant visual acuity requirements for first- and second-class
certification are changed to delete the uncorrected acuity standards.
However, each eye must be corrected to 20/20 as in the current
standard. [FAR Standards: Current Secs. 67.13(b) and 67.15(b); Proposed
Secs. 67.103(a) and 67.203(a)]
2. For third-class certification, the current 20/50, uncorrected,
or 20/30, corrected, distant visual acuity standard is changed to 20/40
in each eye, with or without correction. [FAR Standard: Current
Sec. 67.17(b); Proposed Sec. 67.303(a)]
3. For first- and second-class certification, minimum near visual
acuity requirements are specified in terms of Snellen equivalents (20/
40), corrected or uncorrected, each eye, at 16 inches and, after age
50, also include an intermediate standard (20/40) at 32 inches. This
replaces the current standard of V=1.00 at 18 inches for first-class
only. [FAR Standards: Current Secs. 67.13(b) and 67.15(b); Proposed
Secs. 67.103(b) and 67.203(b)]
4. A near visual acuity standard of P20/40, corrected or
uncorrected, each eye, at 16 inches is added to the third-class visual
requirements. [FAR Standard: Current (None); Proposed Sec. 67.303(b)]
5. Color vision requirements are amended to read: ``ability to
perceive those colors necessary for safe performance of airman
duties,'' and are the same for all classes. Current standards require
``normal color vision'' for first-class and the ability to distinguish
aviation signal colors for second- and third-class applicants. [FAR
Standards: Current Secs. 67.13(b), 67.15(b), and 67.17(b); Proposed
Secs. 67.103(c), 67.203(c), and 67.303(c)]
6. The current first-class standard pertaining to pathological
conditions of the eye or adnexa that interfere or that may reasonably
be expected to interfere with proper function is substituted in both
the second- and third-class standards for the current standards which
specify, respectively, ``no pathology of the eye'' and ``no serious
pathology of the eye.'' [FAR Standards: Current Secs. 67.15(b) and
67.17(b); Proposed Secs. 67.203(e) and 67.303(d)]
7. The ``whispered voice test'' for hearing is deleted for all
classes. Substituted are a conversational voice test using both ears at
6 feet; an audiometric word (speech) discrimination test to a score of
at least 70 percent obtained in one ear or in a sound field
environment; or pure tone audiometry according to a table of acceptable
thresholds (ANSI 1969). The amended standards for hearing are the same
for all classes. [FAR Standards: Current Secs. 67.13(c), 67.15(c), and
67.17(c); Proposed Secs. 67.105(a), 67.205(a), and 67.305(a)]
8. The standards pertaining to the ear, nose, mouth, pharynx, and
larynx are revised to more general terms and related to flying and
speech communication. Specific references to the mastoid and eardrum
are deleted. The current standard, ``No disturbance in equilibrium,''
is changed to, ``No ear disease or condition manifested by, or that may
reasonably be expected to be manifested by, vertigo or a disturbance of
equilibrium.'' The amended standards are the same for all classes. [FAR
Standards: Current Secs. 67.13(c), 67.15(c), and 67.17(c); Proposed
Secs. 67.105(b), 67.205(b), and 67.305(b)]
9. ``Psychosis,'' as used in the proposed regulation, refers to ``a
mental disorder in which the individual has manifested psychotic
symptoms or to a mental disorder in which an individual may reasonably
be expected to manifest psychotic symptoms.'' This alleviates some of
the problems in interpreting the regulations created by changes in
nomenclature and classification of mental conditions found in the
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM
III). [FAR Standards: Current Secs. 67.13(d), 67.15(d), and 67.17(d);
Proposed Secs. 67.107(a), 67.207(a), and 67.307(a)]
10. Substance dependence and substance abuse are defined and
specified as disqualifying medical conditions. Substance dependence is
disqualifying unless there is clinical evidence, satisfactory to the
Federal Air Surgeon, of recovery, including sustained total abstinence
from alcohol for not less than the preceding 2 years in the case of
alcohol dependence. In the case of other substance dependence, recovery
would include sustained total abstinence from that substance for not
less than the preceding 5 years. Substance abuse, in the case of
alcohol within the preceding 2 years and in the case of other
substances within the preceding 5 years, is disqualifying. Alcohol
dependence and alcohol abuse are included in the terms ``substance
dependence'' and ``substance abuse'', respectively. [FAR Standards:
Current Secs. 67.13(d), 67.15(d), and 67.17(d); Proposed
Secs. 67.107(a) and (b), 67.207(a) and (b), and 67.307(a) and (b)]
11. ``Bipolar disorder'' is added as a specifically disqualifying
condition. This corrects a regulatory problem created by the change in
nomenclature contained in DSM III. [FAR Standards: Current (None);
Proposed Secs. 67.107(a), 67.207(a), and 67.307(a)]
12. The general mental standard is amended to add the word
``other'' before ``mental.'' The proposed revised standard reads, ``No
other personality disorder, neurosis, or other mental condition * *
*.'' [FAR Standards: Current Secs. 67.13(d), 67.15(d), and 67.17(d);
Proposed Secs. 67.107(c), 67.207(c), and 67.307(c)]
13. ``A single seizure,'' and ``A transient loss of control of
nervous system function(s) without satisfactory medical explanation of
the cause,'' are added as specifically disqualifying neurologic
conditions. [FAR Standards: Current (None); Proposed Secs. 67.109(a),
67.209(a), and 67.309(a)]
14. The word ``seizure,'' is substituted for ``convulsive.'' [FAR
Standards: Current Secs. 67.13(d), 67.15(d), and 67.17(d); Proposed
Secs. 67.109(b), 67.209(b), and 67.309(b)]
15. ``Cardiac valve replacement,'' ``permanent cardiac pacemaker
implantation,'' and ``heart replacement'' are added as specifically
disqualifying cardiovascular conditions for all classes of
certification. [FAR Standards: Current Secs. 67.13(e), 67.15(e), and
67.17(e); Proposed Secs. 67.111(a), 67.211(a), and 67.311(a)]
16. A requirement is added whereby all applicants for second-class
airman medical certificates will be required to have a routine resting
electrocardiogram (ECG) at the first application after reaching age 35
and every 2 years after reaching age 40. An ECG requirement currently
exists for first-class applicants; however, first-class applicants must
have an annual ECG after reaching age 40. There is no requirement added
for third-class. [FAR Standards: Current Sec. 67.13(e); Proposed
Secs. 67.111(d) and 67.211(d)]
17. The current table of age-related maximum blood pressure
readings for applicants for first-class certificates and the reference
to ``circulatory efficiency'' are deleted, and a requirement that
average blood pressure while sitting not exceed 150/95 millimeters of
mercury is added for applicants of all classes. A medical assessment is
specified for all applicants who need or use antihypertensive
medication to control blood pressure. [FAR Standards: Current
Sec. 67.13(e); Proposed Secs. 67.111(b), 67.211(b), and 67.311(b)]
18. For first-class applicants only, a total blood cholesterol
determination after reaching age 50 is added. A cholesterol of 300
milligrams per deciliter or more may require further evaluation
although the applicant, if otherwise eligible, is issued a medical
certificate pending the results. [FAR Standard: Current (None);
Proposed Sec. 67.111(f)]
19. The use of anticoagulant medication is made specifically
disqualifying for applicants of all classes. [FAR Standards: Current
(None); Proposed Secs. 67.111(c), 67.211(c), and 67.311(c)]
20. Current Sec. 67.19 of the FAR, Special Issue of Medical
Certificates, is rewritten [Proposed FAR Standard: Sec. 67.401(a)] to
provide for, at the discretion of the Federal Air Surgeon, an
``Authorization for Special Issuance of Medical Certificate''
(Authorization), valid for a specified period of time. An individual
who does not meet the published standards of part 67 of the FAR may be
issued a medical certificate of the appropriate class if he or she
possesses a valid Authorization. The duration of any certificate issued
in accordance with proposed Sec. 67.401 of the FAR is for the period
specified at the time of its issuance or until withdrawal of the
Authorization upon which it is based. A new Authorization is required
after its expiration, and the applicant must show again that airman
duties can be performed without endangering air commerce.
Proposed FAR Standard, Sec. 67.401(b) also provides for a Statement
of Demonstrated Ability (SODA) instead of an Authorization. The SODA
will be issued to applicants whose disqualifying conditions are static
or nonprogressive and who have been found capable of performing airman
duties without endangering air commerce. The SODA authorizes an
aviation medical examiner to issue a certificate if the applicant is
otherwise eligible.
Proposed Sec. 67.401(e) retains the language of current
Sec. 67.19(c) regarding consideration of the freedom of a private pilot
to accept reasonable risks to his or her own person or property that
are not acceptable in the exercise of commercial or airline transport
pilot privileges, and consideration at the same time of the need to
protect the safety of persons and property in other aircraft and on the
ground.
Proposed Sec. 67.401(f) adds language that explicitly provides that
the Federal Air Surgeon may withdraw the Authorization or SODA. An
Authorization or SODA may be withdrawn at any time for (1) adverse
change in medical condition, (2) failure to comply with its provisions,
(3) potential endangerment of public safety, (4) failure to provide
medical information, or (5) the making or causing to be made of a
fraudulent or intentionally false statement or an incorrect statement
in support of a request for an Authorization or SODA or in any entry in
any logbook, record or report that is kept, made, or used to show
compliance with any requirement for an Authorization or SODA.
Proposed Sec. 67.401(i) allows a person to request that the Federal
Air Surgeon review a decision to withdraw an Authorization or SODA. The
request for a review would have to be made within 60 days of the
service or mailing of the letter withdrawing the Authorization or SODA.
The proposed review procedures would be on an expedited basis and would
provide an affected holder of an Authorization or SODA a full
opportunity to respond to a withdrawal by submitting supporting medical
evidence.
21. Proposed Sec. 67.403 amends current Sec. 67.20 to provide for
denial of an airman medical certificate if the application for airman
medical certificate is falsified. Though this consequence is implied,
the current regulation specifically provides only for revocation or
suspension of certificates. Additionally, Sec. 67.403 proposes to deny
or withdraw any Authorization or SODA where information provided to
obtain it is false, whether the statement was knowingly false or
unknowingly incorrect. Finally, Sec. 67.403(c) proposes that the making
of an unknowingly incorrect statement on an application for an airman
medical certificate or on a request for an Authorization or SODA is a
basis for denial, revocation, withdrawal, or suspension of an airman
medical certificate and the denial or withdrawal of an Authorization or
SODA. The making of an unknowingly incorrect statement is not a basis
for revocation or suspension of other types of certificates or ratings
issued under the FAR.
22. A new Sec. 67.415 of the FAR is proposed to provide that the
holder of any medical certificate that is suspended or revoked shall,
upon the Administrator's request, return it to the Administrator. The
FAA practice always has been to request return of the certificate in
such circumstances.
23. Where appropriate, changes are made to eliminate gender-
specific pronouns, to replace ``applicant'' with ``person,'' to use
current position titles and addresses, to correct spelling and improve
syntax, and to adjust section and sub-section references.
Summary of Proposed Amendments to Part 61
Section 61.3(c) of the FAR provides, with some exceptions, that no
person may serve as pilot in command or in any other capacity as a
required pilot flight crewmember unless that person has in his or her
personal possession an appropriate current medical certificate issued
under part 67 of the FAR. The medical standards for issuing first-,
second-, and third-class medical certificates are set forth in current
Secs. 67.13, 67.15, and 67.17, respectively.
Section 61.23 identifies the duration of validity and privileges of
each class of medical certificate. Currently, a first-class medical
certificate is valid for 6 months for operations requiring an airline
transport pilot certificate, 12 months for operations requiring only a
commercial pilot certificate, and 24 months for operations requiring
only a private, recreational, or student pilot certificate. A second-
class medical certificate is valid for 12 months for operations
requiring a commercial pilot or an air traffic control tower operator
certificate and for 24 months for operations requiring only a private,
recreational, or student pilot certificate. A third-class medical
certificate currently is valid for 24 months for operations requiring a
private, recreational, or student pilot certificate.
Using the John Hopkins University analysis (raw data originated
from the FAA), airman certification data, and annualized pilot exposure
data, a decision model was prepared for the FAA that determined the
best age-specific duration plan for the third-class medical certificate
population. We determined that the best plan would provide for maximum
regulatory relief without public safety decrement. For further
discussion of duration analysis, see this docket's copy of the
regulatory evaluation at pages 25-26, 58-64, and 77-80.
Using the model and the decision criteria previously discussed, the
FAA proposes to lengthen the validity period of third-class airman
medical certificates for most persons under the age of 40. Persons
under age 40 would be required to undergo a physical examination every
3 years for a third-class medical certificate. Third-class medical
certificates for persons age 40 but less than age 70 would continue to
be valid for 2 years. Persons age 70 and older would be required to
undergo a physical examination every year when applying for a third-
class medical certificate.
These ages and examination periods were selected because they will
allow no significant increase in undetected pathology between required
examinations. Regulatory and economic relief can be provided without a
significant effect on aviation safety.
The FAA has determined that the frequency of routine examinations
can be reduced in the case of younger airmen who are less likely to
suffer medical disability and who have undergone an initial examination
and certification prior to first solo flight. Those individuals
manifesting conditions that represent a risk to safety will be denied
certification or, after individual evaluation, will be restricted in
their flying activities or examined more thoroughly and frequently, or
both. Those individuals who meet the published medical standards but
whose conditions require more frequent scrutiny will, under the new
amendment, be issued medical certificates with a validity of 2 years
rather than the longer period which they may otherwise be granted. With
routine medical examination frequency increasing with age as proposed,
aviation safety will be maintained.
Both the AMA report and the Hopkins' analysis confirm the greater
incidence of medical pathology in older persons. FAA analysis also
confirms that the incident of accidents generally increase with an
increase in age. It is prudent, therefore, to leave the current routine
periodic examination requirement unchanged for persons age 40 but less
than age 70 and to increase the frequency of examination for persons
age 70 and older.
All third-class airman medical certificates or third-class
privileges of a first- or second-class medical certificate issued prior
to the effective date of a final rule will remain valid for 2 years
from the date of issuance unless the validity period has been otherwise
limited by the FAA. The period of validity for all third-class airman
medical certificates or third-class privileges of a first- or second-
class medical certificate issued on or after the date of a final rule
will be calculated according to the provisions of the final rule unless
the validity period has been otherwise limited by the FAA.
Because of the increased public responsibilities associated with
commercial pilot privileges, the FAA does not plan at this time to
change the frequency of examinations for first- or second-class medical
certificates for operations requiring an airline transport pilot,
commercial pilot, or air traffic control tower operator certificate.
Similarly, the agency does not plan now to revise the validity period
of student pilot certificates, now 2 years as set forth in Sec. 61.19,
though these are usually issued in combination with the third-class
medical certificate. A student pilot whose student pilot certificate
has expired but whose third-class medical certificate remains valid,
may obtain a new student pilot certificate from an FAA operations
inspector as provided in Sec. 61.85(b).
Section 61.53 of the FAR provides that: ``No person may act as
pilot in command, or in any other capacity as a required pilot flight
crewmember while he [or she] has a known medical deficiency, or
increase of a known medical deficiency, that would make him [or her]
unable to meet the requirements for his [or her] current medical
certificate.'' This amendment does not change Sec. 61.53, and the FAA
continues to require airmen to comply with that rule. In reducing the
frequency of required periodic contacts with knowledgeable health
professionals, self-monitoring and personal attention to health become
a more important part of the individual airman's responsibility for
flight safety. This notice also proposes to amend Sec. 61.39 to require
that applicants must possess at least a third-class medical certificate
or the third-class privileges of a first- or second-class medical
certificate valid under proposed Sec. 61.23 in order to be eligible for
a flight test for a certificate, or an aircraft or instrument rating.
The proposal amends Sec. 69.39 to coincide with the duration changes in
Sec. 61.23, as discussed above.
As noted above, the FAA developed its proposal through review of
the literature, survey of the medical practices of the Department of
Defense, analysis of National Transportation Safety Board (NTSB)
accident data and its own aeromedical certification data, consideration
of the data developed by the Johns Hopkins University, and in
consideration of the part 67 proposal announced in this notice. The
proposed examination spacing represents the agency's view of an optimum
schedule in terms of estimated detectable pathology in the airman
population and of the burden of required examinations.
No change in the scope of required examinations was proposed by
Notice 82-15, Duration of Medical Certificates. Where an applicant for
medical certification demonstrates by history or by findings that
additional or more detailed medical evaluation is required, current
regulations permit the FAA to obtain it. The routine examination used
for many years has proven adequate for the identification of those
airmen who should be further evaluated yet places only minimum burden
on that majority of persons who can be immediately certificated.
Nevertheless, the FAA announced and conducted a complete review of the
standards for airman medical certification (47 FR 16298, April 15, 1982
and 47 FR 30795; July 15, 1982), and examination scope was one object
of the review. The larger part of this notice announces proposals
related to standards and administrative procedures for airman medical
certification.
History of Medical Standards
Airman medical standards have been in effect for many years. The
1938 Code of Federal Regulations (14 CFR parts 20 and 21, 1938) under
the authority of the Air Commerce Act contained minimum requirements
for the physical condition of airmen. The early rules did not provide
for the issuance of airman medical certificates. However, they did
require that an appropriate physical examination be given before a
pilot could be tested for a pilot certificate. In 1942, a system for
the issuance of medical certificates was adopted that provided for the
issuance of first-, second-, and third-class medical certificates.
Discretion in the issuance of medical certificates has always been
a feature of the FAA medical certification system. Over the years this
feature has been modified but the basic provision for special issuance
of a medical certificate to a person who does not meet the required
medical standards has remained. To be granted a special issuance, an
airman has had to demonstrate by operational experience, flight
testing, special practical evaluation, or a special medical evaluation
that he or she can carry out the appropriate airman duties without
endangering public safety during the prescribed time period of the
medical certificate.
A number of specific changes to the medical standards took effect
in 1959. Electrocardiographic examination was required of first-class
certificate applicants. The ECG is to demonstrate the absence of
myocardial infarction and to identify other cardiovascular conditions.
A second amendment provided for additional medical standards related to
a person's general physical condition and nervous system. These
revisions were based primarily on a study conducted by the Flight
Safety Foundation, Inc. (FSF). The study proposed that the existing
certification criteria be expanded to cover the following specific
medical conditions:
(1) An established diagnosis of diabetes requiring insulin or other
hypoglycemic treatment agents;
(2) A history of myocardial infarction or other evidence of
coronary artery disease; and,
(3) A history of an established diagnosis of psychosis, severe
psychoneurosis, severe personality abnormality, epilepsy, chronic
alcoholism or drug addiction.
The FSF position was that the existence of any of the above
conditions was an appropriate basis for disqualification for any class
of medical certificate. The FSF based its recommendation on the belief,
at that time, that medical prognostication for these conditions was too
imprecise to provide assurance that these conditions would not
interfere with the safe piloting of an aircraft. The FSF found that the
likelihood of an occurrence of a partially or totally incapacitating
state directly related to these conditions was so great that an airman
with one of these conditions posed a potential hazard to flight safety.
As a result of the FSF's recommendations, the procedures were amended
to prohibit the granting of special issuances to airmen with these
conditions. The Federal Aviation Act of 1958, however, provided for the
granting of exemptions by the Administrator. In 1960, the FAA specified
that the existing general exemption procedures applied to the medical
standards.
Rapid developments in medical knowledge about the disqualifying
conditions and the development of improved techniques for prediction of
their risk for incapacitation led the FAA shortly afterwards to grant
exemptions, with appropriate limitations, to many persons with these
conditions. Though exemptions were available, requests from individuals
with severe manifestations of some conditions were denied.
In 1971, the authority to grant or deny petitions for exemption
from part 67 was delegated to the Federal Air Surgeon (Amendment 11-11;
36 FR 3462; February 25, 1971). This revision was designed to reduce
administrative processing time and lower costs for the FAA in the
granting of exemptions. The FAA granted over 3,000 medical exemptions
in the ensuing years. Overall, the safety record of airmen who were
granted exemptions has been at least as good as that of the general
population of airmen who hold medical certificates issued under the
medical standards.
In 1982, the FAA amended part 67 in several areas (47 FR 16298;
April 15, 1982). First, any disqualifying condition which previously
required a formal petition for exemption was permitted to be considered
for certification through special issuance procedures. Second, the
prerequisite agency administrative review and decision process leading
to eligibility for NTSB review of denial actions was streamlined.
Third, authority was delegated to the Federal Air Surgeon to place
functional limitations on medical certificates. Fourth, Sec. 67.19 was
amended to state that the Federal Air Surgeon, in granting special
issuances to applicants for private pilot certificates, considers the
freedom of these applicants to accept reasonable risks to their person
or property that are not acceptable in the exercise of commercial or
airline transport privileges, and at the same time, considers the need
to protect the safety of persons and property in other aircraft and on
the ground. Fifth, clarifying interim cardiovascular standards were
issued. Sixth, the alcoholism standard was revised to conform to the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and
Rehabilitation Act of 1970. In addition to the amendments to part 67,
the preamble to the 1982 final rule announced that in accordance with
Executive Order 12291, Federal Regulations, the FAA would undertake an
overall review of the medical standards in part 67. This total and
comprehensive review was described as a major rulemaking effort that
would involve obtaining the views of the medical profession and all
other interested parties and result in significant revision of part 67.
Reference
Review of Part 67 of the Federal Air Regulations and the Medical
Certification of Civilian Airmen; Engelberg, A.L., Doege, T.C.;
American Medical Association, under contract to DOT (DTFA01-83-C-
20066); March 1986.
This document is available from the National Technical Information
Service, 5285 Port Royal Rd., Springfield, VA 22161 (accession numbers
AD A166 464, Volume I ($31), and AD A166 465, Volume II ($53). There is
also a handling charge of $3 for purchase by wire or mail. A synopsis
of the 750-page, 2-volume report was published in the Journal of the
American Medical Association (JAMA Vol. 255, No. 12, pp. 1589-1599) on
March 26, 1986, and is available at many libraries and has been placed
in Docket No. 23190.
Current Requirements--Medical Certification of Airmen
Part 67 of the FAR provides for the issuance of three classes of
medical certificates. A first-class medical certificate is required to
exercise the privileges of an airline transport pilot certificate.
Second- and third-class medical certificates are needed to exercise the
privileges of commercial and private pilot certificates, respectively.
An applicant who is found to meet the appropriate medical
standards, based on a medical examination and an evaluation of the
applicant's history and condition, is entitled to a medical certificate
without restrictions or limitations other than the prescribed
limitation as to its duration. These medical standards are currently
set forth in Secs. 67.13, 67.15, and 67.17 (14 CFR part 67).
An applicant for a medical certificate who is unable to meet the
standards in Secs. 67.13, 67.15, or 67.17 may, nevertheless, be issued
a medical certificate. Procedures for granting special issuances or
exemptions have always been available, and, thus, the standards have
never been ``absolutely disqualifying,'' in the sense that
certification is permanently denied all who do not meet the standards.
Under Sec. 67.19, ``Special issue of medical certificates,'' at the
discretion of the Federal Air Surgeon, acting on behalf of the
Administrator under Sec. 67.25 of the FAR, a special flight test,
practical test, or medical evaluation may be conducted to determine
that, notwithstanding the applicant's inability to meet the applicable
medical standard, airman duties can be performed, with appropriate
limitations or conditions, without endangering public safety. If this
determination can be made, a medical certificate may be issued with
appropriate limitations to ensure safety.
Discussion of the Proposal
The FAA proposes to amend part 67 to incorporate additions and
changes in the specific medical standards and scope of examination and
in the administrative procedures pertaining to airman medical
certification. The FAA also proposes to recodify and partly reorganize
part 67 to improve readers' accessibility to specific standards and
procedural requirements. Additional changes are proposed to improve
syntax and correct errors. Section and sub-section references are
adjusted as necessary to reflect additions, deletions, and
reorganization. Because the proposed medical standards are not meant to
be exhaustive in naming all medical conditions that are disqualifying,
the word ``includes'' rather than the word ``are'' is used in each
section of the medical standards. Disqualifying medical conditions are
not limited to those representative conditions listed in the proposed
standards. Medical conditions may be identified during an examination
which are related to a specific medical category of a section in the
proposed standards but are not specifically named in the standards
(e.g., respiratory malignancy). These medical conditions would be
considered under the General Medical Condition section of the medical
standards.
The proposal is based on the FAA's review of part 67, on the FAA's
judgment regarding the AMA Report recommendations, and on public
comment relevant to those recommendations and to the standards
generally. The following discussion of the proposal presents under each
subject heading a discussion of the current rule, the AMA
recommendations, and the proposed rule. Also included in this preamble
is a response to the comments received on the review of part 67 (Docket
No. 23190).
Distant Visual Acuity
The current standards for applicants for first- or second-class
airman medical certificates require that the uncorrected distant visual
acuity be not poorer than 20/100 and the corrected acuity not poorer
than 20/20 in each eye, separately. Applicants for third-class
certificates are required to meet a standard of distant visual acuity
of 20/50 or better in each eye, separately, without correction; or, if
poorer than 20/50, a corrected distant visual acuity of 20/30. For
third-class airman medical certification there is no standard for
minimum acceptable uncorrected distant visual acuity.
The FAA practice for many years has been to grant any class
certificate requested, regardless of uncorrected distant acuity, if the
required minimum vision is present or achieved through conventional
corrective lenses (spectacles or contact lenses), there is no evidence
of significant eye pathology, and the person is otherwise eligible. For
first- and second-class certification, this has been accomplished
through the special issuance process.
Thousands of airmen exercising airline transport pilot, commercial
pilot, private pilot, student pilot, and air traffic control tower
operator certificates have demonstrated their ability to safely perform
their jobs while using corrective lenses for distant visual acuity that
is poorer than 20/100 in each eye.
The AMA Report recognizes that the uncorrected distant visual
acuity standards for first- and second-class certification may be too
stringent and recommends that they be changed from 20/100 to 20/200
without offering a rationale for the specific recommendation of 20/200.
The FAA notes that this recommended standard is consistent, in part,
with the standards of the International Civil Aviation Organization
(ICAO).
In response to the AMA recommendation, in mid-1986, the agency
simplified the procedure for special issuance of certification in cases
where the applicant for a first- or second-class certificate
demonstrates uncorrected distant vision worse than 20/100 but not worse
than 20/200. AME's were given permission to evaluate applicants without
further referral to eye specialists or to the agency for decision. In
the absence of significant eye pathology, the AME may, after telephone
coordination with the agency, issue any class certificate. Individuals
whose distant vision is poorer than 20/200 can be granted certification
only by the FAA, after evaluation by an eye specialist. The FAA has
found through experience that safety is not adversely affected by
permitting medical certification at any level of uncorrected acuity.
Little, if any, disqualifying eye pathology is found through the
special evaluations of applicants whose vision corrects to acceptable
levels, and AME's are able to identify those whose findings suggest the
need for further examination by specialists. Therefore, the FAA
proposes under Secs. 67.103(a) and 67.203(a) the deletion of the
current uncorrected acuity standard for first- and second-class
certification, thereby administratively simplifying the certification
process and reducing costs to airmen and to the agency. The FAA
intends, however, to retain the current requirement for first- and
second-class certification that distant visual acuity be, or correct
to, not poorer than 20/20 in each eye separately.
For third-class certification the FAA proposes under Sec. 67.303(a)
that the standard be amended to require a distant visual acuity of not
poorer than 20/40 in each eye, separately, with or without correction.
This amendment eliminates the confusing current minimum acuity standard
(20/30 if corrective lenses are used and 20/50 if not used) and is
consistent with safety and with the standards commonly used by state
automobile driver licensing authorities. It also reflects the ICAO
standards for private pilots, and it includes the AMA Report
recommendation for minimum distant visual acuity without correction.
Near Visual Acuity
The current near visual acuity standard for first-class medical
certification is expressed as ``* * * at least v=1.00 at 18 inches with
each eye separately, with or without corrective glasses.'' The near
visual acuity standard for second-class medical certification is based
on the ability to pass a test showing that the applicant can read
official aeronautical maps. Currently the rules for third-class medical
certification have no near visual acuity requirements.
The AMA Report recommends several revisions to the near visual
acuity standards. The AMA Report points out that the current vision
terminology of first-class medical certification is antiquated and
unfamiliar to most AME's and ophthalmologists. The AMA also notes that
the Near Vision Acuity Test Card, FAA Form 8500-1, contains letters
that are to be used at 16 inches while the current standards are
established for 18 inches.
The AMA Report recommends the same near visual acuity standards for
all three classes of medical certification: a near vision of 20/40,
Snellen equivalent, at 16 inches in each eye separately, with or
without corrective lenses. In addition, the AMA Report recommends, at
age 50 or older, a near vision standard of 20/40, Snellen equivalent,
at both 16 inches and 32 inches in each eye separately, with or without
corrective lenses.
Additional requirements are imposed after age 50 because, with age,
the eye loses the ability to accommodate for close viewing distances, a
condition called ``presbyopia.'' The AMA Report states:
It is important while piloting to be able to see clearly at
close distances, as when looking at maps, and at intermediate
distances, as when viewing the instrument panel. This is especially
important in night flying. Diminished intermediate visual acuity due
to presbyopia in an individual 50 years of age or older may be
further compromised by bifocal correction. Trifocal or progressive
power lenses may be necessary for clear vision at distance,
intermediate, and near.
The AMA Report recommends that the appropriate necessary corrective
lenses must be worn while exercising the privileges of the certificate.
The proposed rule at Secs. 67.103(b) and 67.203(b) follows the AMA
Report recommendations except that a standard for intermediate visual
acuity is not proposed for third-class medical certification (see
proposed Sec. 67.303(b)). Also, the proposed rule would require only
that the corrective lenses be available while exercising the privileges
of the certificate.
The FAA is not proposing an intermediate visual acuity standard for
third-class certification in recognition of the lower level of
responsibility inherent in noncommercial flight operations.
The proposal does not require that corrective lenses for near or
intermediate visual acuity be worn during all flight operations because
this is a matter better left to the discretion of the pilot. FAA
practice and the FAR currently permit airmen to exercise their
certificates when any required corrective lenses for near vision are in
their possession. This permits, at the airman's option, use of separate
near and distance spectacles; contact lenses for distance with the
addition of spectacles for near; unifocal contact lenses that correct
for both near and distance; bifocal spectacles; or continuously
variable focus spectacles. If the airman requires correction only for
near vision, spectacles, half-spectacles, or bifocal spectacles without
power in the distance portion may be used.
From among these options, an airman should be able to choose his or
her method of visual correction while piloting an aircraft. A
requirement that all airmen wear their correction for near vision while
flying would significantly and, in the absence of demonstrated
problems, unnecessarily limit their choice of visual aids. The FAA has
no evidence that significant operational problems are occurring with
the use of corrective lenses for near vision. Therefore, the proposed
requirement for corrected intermediate vision in older airmen can be
met through possession of additional spectacles of the appropriate
power or by use of trifocal lenses or lenses of continuously variable
focus, as desired.
Color Vision
The current standards for first-class medical certification require
``normal color vision'' (Sec. 67.13(b)(3)); second- and third-class
certification require ``ability to distinguish aviation signal red,
aviation signal green, and white.'' (Secs. 67.15(b)(5) and
67.17(b)(3)).
In current practice, applicants for certification are tested by use
of standard pseudoisochromatic plates or by other approved devices. A
passing score defines the applicant as not color deficient. Failure
indicates a color deficiency and requires that any certificate issued
be limited, prohibiting flight at night or by color signal control.
This limitation can, however, be removed through the successful
completion of a practical signal light test or of a medical flight
test, as appropriate for the class certificate sought and the level of
aviation experience of the applicant.
Airmen are routinely granted second- or third-class medical
certificates without restriction if they pass the signal light test.
When they have the experience required for an airline transport pilot
certificate and pass the medical flight test, first-class certification
is granted. An experienced airman rarely fails a medical flight test
given for deficient color vision.
Safety is further enhanced by the thorough training and testing
given airmen seeking authorization to pilot new aircraft. Through use
of actual aircraft or of simulators, instructors, check airmen, and
flight inspectors have an opportunity to identify and, if necessary,
recommend restrictions for those individuals who encounter difficulty
with color.
The AMA Report states:
* * * the hazard to aviation safety of anomalous color vision is not
clear. No studies have shown that color deficiency has been a direct
cause of accidents. On the other hand, color is an important
constituent of aircraft devices such as instrument panel gauges and
warning lights, and of airport landmarks, such as beacons and runway
lights.
The AMA Report recommends that testing for color vision remain part of
the routine periodic examination of airmen. The suggested standards
include the retention of ``normal color vision for first-class
certification and ``ability to distinguish aviation signal red,
aviation signal green, and white'' for third-class certification. The
AMA Report suggests, however, that the standard for second-class
certification be changed to that for first-class. The AMA Report notes
an increasing use of color in instrument displays for advanced aircraft
but less frequent use of colored signal lights in today's flight
environment. Despite these diverging trends and the absence of accident
data, prudence dictates some continued concern for the color perception
of airmen.
The FAA, therefore, proposes at Secs. 67.103(c), 67.203(c), and
67.303(c) that testing at the time of the periodic medical examination
be continued as recommended, but that the standard for all classes of
certification be, ``Ability to perceive those colors necessary for the
safe performance of airman duties.'' The standard is consistent with
that of the ICAO and reflects the agency's experience and practice for
many years. Tests, instructions, and scoring criteria are provided to
AME's in the ``Guide for Aviation Medical Examiners.''
Certification relative to deficient color vision ultimately is
based on performance. It is appropriate, therefore, that the standard
be related to the job requirement and that it be the same for each
class of medical certificate.
Other Pathology of the Eye
The current standard is worded differently for each class of
certification but without significant difference of meaning. In
accordance with the AMA recommendations, therefore, revision is made to
correct the spelling of the plural word ``adnexa'' and to provide for
the same standard for all classes of certification, at proposed
Secs. 67.103(e), 67.203(e), and 67.303(d).
Eye Fusion
This standard, which applies only to first- and second-class
certification, is revised to correct spelling and to eliminate gender-
specific pronouns. No substantive revisions are proposed for this
standard. (See proposed Secs. 67.103(f) and 67.203(f)).
Intraocular Pressure
The AMA Report recommends for all three classes of certification
the measurement of intraocular pressure after the age of 40 to identify
glaucoma. The basis for this recommendation is that glaucoma may appear
in two forms. One, closed-angle glaucoma, is acute, painful, and
potentially impairing; the other, open-angle glaucoma, is subtle,
painless, and progressive. Either form can be destructive to vision.
Since, in many cases, open-angle glaucoma is not noticed by the
individual until after permanent changes in visual fields have
occurred, a search for it should be a part of any routine health
maintenance examination.
Current regulations have no standard for intraocular pressure,
however, and the FAA is not proposing standards at this time. While the
recommendations of the AMA Report suggest that everyone might benefit
from regular measurement of intraocular pressure, the risk to flight
safety appears minimal in comparison to the cost and difficulty of
testing.
Hearing
Current standards for hearing are as follows: (1) for first-class
medical certification the person must be able to hear the whispered
voice at 20 feet with each ear separately or demonstrate a hearing
acuity of at least 50 percent of normal in each ear as shown by a
standard audiometer; (2) for second-class certification, the person
must be able to hear the whispered voice at 8 feet in each ear
separately; and (3) for third-class certification, the person must be
able to hear the whispered voice at 3 feet in one ear. The use of the
whispered voice has raised questions of accuracy and validity in the
aviation environment. Pure tone audiometry is considered a more
scientific and accepted method for determining hearing capabilities and
for documenting changes in that capability over a period of time. The
present procedure, however, has served well in enabling AME's to
identify for referral and evaluation those individuals whose hearing
acuity is less than normal.
Testing accomplished by the AME serves as a screen to identify
those individuals who should receive more specialized initial and
periodic future evaluations. Almost all hearing-impaired applicants,
however, receive special issuance of a certificate after documentation
of their condition. Many undergo practical testing to determine their
functional aviation capabilities. In the absence of other significant
pathologic conditions, the certification decision regarding hearing
relates only to the individual's ability to safely exercise airman
privileges. Medical flight tests are used frequently for this
determination, and the subject may use hearing aids, if necessary.
Though an airman may regularly use a hearing aid for activities not
involving flight, the normal aircraft communication equipment may serve
as well, and the agency does not, in such cases, mandate the wearing of
an aid. Special issuance is possible, especially for applicants for
third-class medical certification, in the presence of total deafness.
Restrictions on the exercise of airman privileges are applied to
maintain safety in cases of total or functionally significant deafness,
and agency experience demonstrates that these practices have been
successful and appropriate.
The AMA Report recommends that speech discrimination be the basic
screening examination used for certification for all three classes. If
sound field or speech testing audiometry equipment is unavailable, pure
tone audiometry is offered as an alternative. Speech testing would be
accomplished either binaurally or monaurally, while pure tone
audiometry would apply a ``better ear'' and ``poorer ear'' standard.
The AMA Report suggests individual consideration when an applicant
fails the standard tests.
The FAA agrees with the AMA Report that the standards for hearing
and for testing should be the same for all classes of medical
certification.
However, it is unlikely that equipment appropriate for speech
discrimination testing, as proposed by the AMA Report, will be
available to all AME's. In keeping with the intention of the AMA Report
and in the interest of cost, availability, simplicity, and functional
adequacy, the FAA believes and, therefore, proposes at Secs. 67.105(a),
67.205(a), and 67.305(a) that the basic screening test administered to
all applicants be a spoken voice test. This test is included as part of
Hearing Requirement No. 1 and Hearing Requirement No. 2, Chapter 6.--
Medical Requirements, Personnel Licensing, International Standards and
Recommended Practices, Annex 1 to the Convention on International Civil
Aviation, ICAO. It has been implemented in many countries and is easily
described and administered. The conversational voice test is not
inconsistent with the AMA Report emphasis on speech discrimination. The
proposed standards would require that a person be able (1) to hear an
average conversational voice in a quiet room, using both ears, at a
distance of 6 feet; (2) understand speech by audiometric speech
discrimination testing to a score of at least 70 percent obtained in
one ear or in a sound field environment; or (3) provide acceptable
results of pure tone audiometric testing in accordance with a table
that is provided in the rule.
Audiometric speech discrimination or pure tone audiometric testing
are proposed as alternatives or for the further evaluation of
individuals who show reduced hearing acuity in the conversational voice
test. The proposed standard would apply to the examination of
applicants without use of their hearing aids. Need for these devices to
meet the standard suggests that a more detailed evaluation is
appropriate before certification, and that special issuance with
periodic reevaluation may be necessary.
Ear, Nose, Throat, and Equilibrium
In addition to hearing (discussed above), current ear, nose,
throat, and equilibrium standards specify: no acute or chronic disease
of the middle or internal ear; no disease of the mastoid; no unhealed
perforation of the eardrum; no disease or malformation that would
interfere with or be aggravated by flying; and no disturbance in
equilibrium.
The AMA Report recommends, for all three classes, a change of the
standard to specify, ``No acute or chronic disease of the middle or
internal ear that will cause acute paroxysms or unpredictable attacks
of vertigo.'' Also, the AMA Report recommends an additional standard
that specifies, ``No disease or malformation of the oral cavity,
pharynx, or larynx that would interfere with clear and effective speech
communication.'' All other standards in the current rule would be
deleted.
For the most part, the proposed rule at Secs. 67.105(b), 67.205(b),
and 67.305(b) follows the AMA Report recommendations. It requires that
there be no ``disease or condition of the middle or internal ear, nose,
oral cavity, pharynx, or larynx'' that will interfere with or be
aggravated by flying or that will interfere with clear and effective
speech communication. In addition, in the proposed rule at
Secs. 67.105(c), 67.205(c), and 67.305(c) there may be no disease or
condition that may involve vertigo or a disturbance of equilibrium.
Current standards reflect specific concerns about infections of the
ear and mastoid and the damage caused by such infections to the ear
drum and middle ear. The proposed standards more generally and properly
address diseases, or conditions of the ear, nose, or throat that may
interfere with speech communication or equilibrium, factors that are
important for safety.
Mental
Mental disorders may adversely affect judgment and behavior in ways
that create potential hazards in aviation. The current standards for
all three classes of airman medical certification, therefore, list
certain psychiatric disorders for which medical certification would be
denied. The list was derived from the recommendations made by the
Flight Safety Foundation in 1959. These disorders are considered to
constitute a definite hazard to safety in flight when determined to be
present in an airman by established medical history or by clinical
diagnosis. As listed in the current regulations, any of the following
disorders is a cause for denial: (1) a personality disorder that
manifests itself in overt acts; (2) a psychosis; (3) alcoholism; and
(4) drug dependence. In addition, the current standards provide for
denial of medical certification in the presence of any ``other
personality disorder, neurosis, or mental condition that the Federal
Air Surgeon finds makes the applicant unable to safely perform the
duties or exercise the privileges of the airman certificate that he
holds or for which he is applying; or may reasonably be expected,
within two years after the finding, to make him unable to perform those
duties or exercise those privileges.''
The mental standards have been well accepted by the public and by
the medical community as practical and effective. However, with
publication of the authoritative reference, Diagnostic and Statistical
Manual of Mental Disorders, Third Edition (DSM III), changes in the
diagnostic terminology and classification of mental disorders have
caused some confusion. Major illnesses, previously included in the
category of ``psychosis,'' are separately described in the DSM III and
are, therefore, no longer considered by some others as covered under
the term ``psychosis'' in the FAR. Since these conditions are of
concern in the context of airman medical certification and flight
safety, the agency must amend the mental standards to clarify the
position of the FAA.
The AMA Report recommends amendment of the regulations to include a
more extensive and specific list of disqualifying mental disorders:
substance abuse or dependence; schizophrenic disorders; paranoid
disorders; psychotic disorders; major affective disorders (including
bipolar disorders and depression); anxiety disorders; dissociative
disorders; impulse disorders; disorders first evident in infancy,
childhood, and adolescence; and organic brain syndrome.
The proposed rule at Secs. 67.107 (a) through (c), 67.207 (a)
through (c), and 67.307 (a) through (c) would include all of these
disorders but would not specifically list them. The current and
proposed mental standard lists a psychosis as a disqualifying disorder.
The proposed standard states that ``psychosis'' refers to ``a mental
disorder in which the individual has manifested psychotic symptoms or
to a mental disorder in which an individual may reasonably be expected
to manifest psychotic symptoms.'' In this way, two types of persons
would be disqualified under this standard: those who have manifested
psychotic symptoms; and those who have not had psychotic symptoms but
whose mental condition is one in which psychotic symptoms may
reasonably be expected to develop. Psychotic symptoms are characterized
by a failure to maintain adequate contact with reality. The failure to
maintain adequate contact with reality results in or may reasonably be
expected to result in the impairment of judgment, including bizarre,
grossly disorganized behavior; out of control behavior; delusions; or
hallucinations. ``Psychosis'' would include schizophrenic disorders,
paranoid disorders, and other disorders such as mood disorders, that
sometimes manifest psychotic symptoms. Also included would be such
conditions as schizotypal and borderline personality disorders. Other
disqualifying disorders listed in the AMA Report that are not
specifically listed in the proposed rule, such as anxiety disorders and
impulse disorders, may be disqualifying under the general mental
provisions of the regulations as they are now, depending on the
severity of the disorders. The particular circumstances of each
individual history and medical condition are considered by the FAA in
determining whether such history or condition is disqualifying.
The FAA also proposes, as recommended in the AMA Report, that
bipolar disorder be added to the list of disqualifying conditions.
Previously called manic depressive psychosis, this common, major
affective disorder now is separately classified by DSM III and may
include individuals who have manifested only mania. Bipolar disorder is
not specifically referenced in current part 67. In consideration of
potential risk to flight safety, individuals with this diagnosis are
rarely granted certification. Those few individuals who are determined
to be eligible for certification through the special issuance
provisions of the FAR must be followed closely for relapse and
recurrence of symptoms. By including the new terminology, the standards
will clearly reflect the agency's concern about this disorder.
(Discussion of how a proposed disqualifying condition may affect a
current medical certificate appears under ``Additional Standards for
Disqualification.'')
Substance Abuse/Dependence
Additional proposed changes in the mental standards for airmen are
influenced by DSM III nomenclature for conditions involving dependence
on or abuse of alcohol, drugs, or other chemical substances. Current
regulations list as disqualifying ``alcoholism'' and ``drug
dependence.'' The AMA Report points out that DSM III eliminates the
term ``alcoholism'' and substitutes the diagnosis of ``substance
dependence'' and ``substance abuse.'' As disqualifying conditions, the
AMA Report recommends ``substance abuse, substance dependence and
related substance use disorders, including but not limited to those
associated with alcohol; barbiturates; other sedative/hypnotics; muscle
relaxants; anxiolytics; opioids; central nervous system stimulants such
as cocaine and amphetamines; and hallucinogens such as phencyclidine,
cannabis, and volatile solvents and gases.''
The proposed rule differs from the AMA recommendations in that (1)
``barbiturates'' are not specified separately since they would be
included with ``sedatives and hypnotics;'' (2) the phrase ``and
similarly acting sympathomimetics'' would be added to the grouping of
``cocaine'' and ``amphetamines;'' and (3) ``phencyclidine or similarly
acting arylcyclohexylamines,'' ``cannabis,'' and ``volatile solvents
and gases'' are listed separately rather than grouped under
``hallucinogens.'' Additionally, the phrase ``related substance use
disorders,'' as proposed, but not defined in the AMA Report, is not
included in this proposal.
The proposed standard defines ``substance dependence'' and
``substance abuse.'' A medical history or clinical diagnosis of
``substance dependence'' would disqualify a person for a medical
certificate under the standards unless there is evidence of recovery
satisfactory to the Federal Air Surgeon. The proposed changes also are
intended to provide specific regulatory medical standards for excluding
from aviation a person who, though not substance dependent, has abused
alcohol within the preceding 2 years or other substances within the
preceding 5 years. These proposed standards respond to the AMA Report
as well as to national concerns about substance abuse. These standards
would enhance the agency's ability to examine and to exclude, where
medically appropriate, those airmen who have abused a substance within
the time frames stated above or who have a medical history or a
clinical diagnosis of substance dependence. The proposed mental
standard retains, however, current language that permits medical
certification under the standards upon presentation of acceptable
evidence of recovery and a specified period of abstinence in the case
of alcohol dependence. The proposed rule provides that clinical
evidence of recovery would include sustained total abstinence from
alcohol for not less than the preceding 2 years in the case of alcohol
dependence, and in the case of other substance dependence, sustained
total abstinence from the substance for not less than the preceding 5
years. The time periods for sustained total abstinence are based on the
AMA recommendations. Other factors considered in determining recovery
include the natural history and severity of the problem; the period of
satisfactory recovery since manifestation of the problem; any
treatment, as well as any continuing requirements for treatment, and
its nature; any current or recent psychiatric symptoms, aberrant
behavior, or psychiatric or other medical findings; the need for or use
of chemical agents; any personality traits or other recognized factors
involving the risk of future recurrence of the problem or the risk of
other adverse events; the period of the person's abstinence from the
substance or substances; the number of times treatment was sought and
relapse occurred; the quality of the final treatment effort; the
presence of residual medical complications, especially neurologic
manifestations; progress in marital, social, vocational, and
educational areas, as appropriate, since rehabilitation began;
commitment to rehabilitation by virtue of continuing contacts with
social or professional agencies, or both, and their opinions and
recommendations; and the findings of recent psychiatric and psychologic
evaluations, if appropriate.
The proposed definition of substance abuse includes two criteria
(the first relates to alcohol, the second to other substances) that
state a person would be disqualified if he or she demonstrated
recurrent use of a substance in situations in which that use was
physically hazardous. At least one of the uses would have to have taken
place within the preceding 2 years in the case of alcohol or 5 years in
the case of other substances. Under this criterion, use in physically
hazardous situations need not involve the same substance or substances.
A third criterion states that a person who used a prohibited drug
as that term is defined in part 121, appendix I of the FAR would be
disqualified. The prohibited drug use would have to have taken place
within the preceding 5 years. ``Prohibited drugs'' as defined in the
FAR do not include all substances; however, ``substances'' as defined
in this proposal do include all prohibited drugs. Alcohol, for example,
is a substance which may be abused but is not a prohibited drug as that
term is defined under appendix I of part 121.
A positive drug test result for a prohibited drug is one type of
evidence of use. The FAA recognizes that the probative value of a drug
test result varies depending on several factors, including the type of
test, circumstances under which the test was conducted, and other
corroborative evidence of drug use. The FAA considers a positive drug
test conducted under any rule or internal program of the Department of
Transportation (such as the FAA program required by Secs. 121.457 and
135.251 or any other Administration within DOT) to be compelling proof
of the use of a prohibited drug for which the drug test was positive.
With respect to positive drug tests other than those conducted
under rules or internal programs of the Department of Transportation,
the FAA would evaluate such test results and the surrounding
circumstances on a case-by-case basis to determine the weight to be
accorded them. If one of these tests is positive for substance use, the
individual could be disqualified under the criteria used in the
definition of substance abuse or substance dependence.
A fourth substance abuse criterion states that an individual is
medically disqualified if he or she misused a substance that is found
by the Federal Air Surgeon to make the person unable to safely perform
the duties or exercise the privileges of the airman certificate applied
for or held; or may reasonably be expected, within 2 years after the
finding, to make the person unable to perform those duties or exercise
those privileges. The finding of the Federal Air Surgeon is based on
the case history and appropriate, qualified medical judgment. Again, as
in the two previous criteria the misuse must have taken place within
the preceding 2 years in the case of alcohol or 5 years in the case of
other substances.
As with the current regulation, certification before completion of
the 2- or 5-year abstinence/recovery period is possible under the
special issuance provisions of the FAR if an individual evaluation
demonstrates that the applicant is able to perform airman duties
without endangering public safety.
Neurological Conditions
Current regulations on neurological conditions list as
disqualifying for all three classes anyone with a history or clinical
diagnosis of epilepsy or disturbance of consciousness without
satisfactory medical explanation of cause. Nor may a person have any
other convulsive disorder, disturbance of consciousness, or
neurological condition that the Federal Air Surgeon finds makes the
person unable to perform airman privileges safely, or may reasonably be
expected, within 2 years after the finding to make the airman unable to
perform airman privileges.
A detailed discussion of neurological conditions, their evaluation,
and prognosis is provided within the AMA Report. Additional information
and recommendations are contained in ``Neurological and Neurosurgical
Conditions Associated with Aviation Safety,'' a major report prepared
in 1979 by representatives of the American Academy of Neurology and the
American Association of Neurological Surgeons through an earlier
contract between the FAA and the AMA. Neither report proposes detailed,
objective criteria and tests that could be included in the standards
and by which medical certification could be determined. They discuss
the medical techniques now available for evaluation of individual
airmen and the significance of the results obtained from their use.
Both reports emphasize the significance of seizure disorders. The
few changes to the standards suggested by the AMA Report are proposed
by the FAA at Secs. 67.109, 67.209, and 67.309, for all three classes
of airman medical certificates and include the addition of ``a single
seizure'' to the list of disqualifying conditions; the use of
``seizure'' rather than ``convulsive'' to describe disorders that may
be found disqualifying by the Federal Air Surgeon; and the addition of
a ``transient loss of control of nervous system function(s) without
satisfactory explanation of the cause'' as a specific basis for
disqualification. This last proposed addition clarifies the agency's
aeromedical concern about such events whether or not they are
characterized as disturbances of consciousness. (Discussion of how a
proposed disqualifying condition may affect a current medical
certificate appears under ``Additional Standards for
Disqualification.'')
Other neurological conditions described in the AMA Report, though
of significance in questions of aeromedical certification, are not
proposed as separate standards. The proposed regulatory provisions
provide an adequate medical basis for assuring safety.
The AMA Report recommended that an abbreviated mental examination
of four questions be included in each airman medical certification
examination. If one or more responses are incorrect, the Mini-Mental
Status Examination of Folstein, Folstein and McHugh (Folstein) would be
given. The FAA studied the feasibility of the AMA Report's
recommendation. It found that neither the AMA-recommended test nor the
test by Folstein provides a useful screening device, alone or in
combination, for airman neurological status. There was an unacceptable
incidence of false negatives. Additionally, neither test, alone or in
combination, provides predictors of any skills known to be relevant to
piloting.
Cardiovascular Conditions
To meet its statutory responsibility to ensure public safety, on
May 17, 1982 (47 FR 16298; April 15, 1982), the FAA amended part 67 of
the FAR in part to clarify the cardiovascular standards. This change
codified FAA policy that individuals with a history of coronary heart
disease not be medically certificated for the exercise of airman
privileges under Secs. 67.13, 67.15, or 67.17. These individuals would
continue to be certificated through the discretionary special issuance
procedures after a separate determination that their disease no longer
represents a risk to aviation safety. During that rulemaking procedure,
a number of commenters expressed the belief that the cardiovascular
standards for medical certification should be relaxed. Commenters also
suggested that those standards be revised to set forth more detailed,
objective criteria and tests by which medical certification could be
determined, and a group of concerned pilots submitted a petition for
rulemaking (to be discussed later in this document) that was intended
to accomplish such a revision. Many commenters contended that the
standards failed to take into account the advances in medicine that had
occurred since part 67 was issued. The FAA announced that these issues
would be addressed in its review of part 67.
Accordingly, the FAA specifically asked the committee of
consultants assembled by the AMA to review the cardiovascular standards
in light of recent advances and current concepts in cardiovascular
medicine. Further, the FAA asked the physicians to develop suggestions
for inclusion of diagnostic and prognostic techniques in the standards,
if appropriate and feasible. The final AMA Report, however, indicates
that the group could not establish, in the standards, qualifications
for medical certification. Instead, the AMA Report suggests general
retention of the current cardiovascular standards and format with
additions to further improve their utility for ensuring aviation
safety. In the presence of known cardiovascular disease, certification
decisions still would require professional evaluation of multiple
medical factors rather than verification of the results of a test
specified in the published standards. The individual airman who fails
to meet the published standards would continue to be considered in
accordance with the discretionary special issuance provisions.
The AMA Report does recommend a number of changes. Additional
cardiac conditions are suggested for inclusion in the standards as
rendering an airman unqualified for certification; revised standards
for acceptable blood pressure are given; maximum levels of blood
cholesterol are proposed for some commercial airmen; and routine
periodic electrocardiography for all airmen is recommended. Rather than
changes to the standards, the AMA Report emphasizes the need for
careful evaluation of all applicants prior to certification. Where
individuals are found either to have cardiovascular disease or to have
factors or findings indicative of increased risk, more exhaustive
evaluations are suggested before certification can be granted and
before periodic renewal of certification. Recommendations for these
evaluations are included in the AMA Report and are generally consistent
with long-standing FAA practice.
Coronary Heart Disease
The FAA proposes that the present standards pertaining to coronary
heart disease and its manifestations remain unchanged. As amended in
1982, these standards are clear and have provided a firm medical basis
for denying airman privileges to individuals with significant, active
coronary heart disease who might endanger public safety. This condition
precludes routine airman medical certification because it is a
documented cause of in-flight pilot incapacitation, and it is
progressive in nature.
The FAA will continue to evaluate airmen who fail to meet this
standard to determine their eligibility for a discretionary special
issuance of medical certification. Certification will be based upon
acceptable evidence that the individual has recovered and that his or
her anatomic and physiologic cardiac status would justify the
subsequent exercise of airman privileges. Appropriate functional
limitations of airman privileges may be applied, and periodic follow-up
medical reevaluations may be required to detect any relapse or
progression of disease. This procedure protects the public while
providing a means of relief for those individuals whose heart disease
has stabilized sufficiently to pose an acceptable risk. Since adoption
of the amendments in 1982, an increasing number of airmen have been
found eligible and granted certification.
Additional Standards for Disqualification
The FAA also proposes additions to the standards in proposed
paragraphs (a) (4), (5), and (6) of Secs. 67.111, 67.211, and 67.311,
providing that a history or clinical diagnosis of cardiac valve
replacement, implantation of a permanent cardiac pacemaker, or heart
replacement would make the subject person unqualified for certification
under the standards. These amendments are consistent with the AMA
Report and the opinions of agency consultants and reflect the serious
nature of each of the conditions. Among the agency's concerns are
failure of prosthetic heart valves, pacemaker malfunction or
progression of underlying disease that has required artificial cardiac
pacing, organ rejection, or the complications of immunosuppression.
While the FAA may determine that an airman with a history or clinical
diagnosis of any of these conditions may be granted a discretionary
special issuance of certification, such history would preclude
certification until specialized medical evaluation confirms adequate
recovery and function and the absence of significant risk in terms of
the aviation environment. Where special issuance of certification is
granted, the regulations will provide for periodic medical
reevaluations, if appropriate, for subsequent certification.
Under the proposed medical standards, a small number of airmen, who
currently hold certificates as a result of an order of the NTSB, would
become disqualified from further medical certification because of the
addition of specifically disqualifying medical conditions. These airmen
had been denied medical certification by the FAA under a current
general medical standard. Under the general medical standards, an
individual is denied certification by the FAA when he or she has a
condition which the Federal Air Surgeon finds may reasonably be
expected to make the individual unable to safely perform pilot duties.
For example, the FAA has denied certification to airmen who have had
cardiac valve replacement and the NTSB has ordered certification in
some of these cases. Under the proposed standards a medical history of
cardiac valve replacement would be specifically disqualifying and those
airmen would no longer be entitled to certification. It is expected,
however, that the possible certification of such individuals would be
reviewed under the Federal Air Surgeon's special issuance authority
once the FAA evaluates the case and is satisfied with the airman's
condition since the NTSB ordered certification. Such a disposition of
these cases would be consistent with the FAA's practice after the 1982
amendment of the cardiovascular standards rendered several airmen
disqualified whose certification under the old medical standards had
been ordered by the NTSB.
Other AMA Recommendations
The AMA Report also suggests that certain other cardiac diagnoses
be added to the standards as specific disqualifications. FAA
certification experience, however, has not indicated a need for
regulatory change in cases of cardiomyopathy, congenital heart disease,
valvular heart disease or murmurs, pericarditis, or disturbances of
heart rhythm or conduction. The agency agrees with the AMA Report that
these conditions pose a potential risk but has found that the existing
standards and procedures provide adequate opportunity for
identification and evaluation of the affected airmen and a regulatory
basis for denial of airman privileges, if appropriate.
Electrocardiography
Current standards require that applicants for first-class medical
certificates submit a resting, 12-lead ECG at the time of their first
examination after reaching age 35 and, annually, after reaching age 40.
They must show by these ECG's, ``an absence of myocardial infarction.''
An ECG made within the 90 days before an examination for a first-class
medical certificate is accepted as meeting the requirement. There now
is no routine requirement for submission of ECG's by applicants for
second- or third-class medical certificates.
The AMA Report notes that it is well established that up to 20
percent of myocardial infarctions (``heart attacks'') fail to produce
symptoms that bring a person to a physician. The resting ECG often
shows evidence of a prior myocardial infarction and patterns of
anatomic change and other abnormalities that are also associated with
an increased risk of coronary artery disease. The AMA Report adds that
many of the most common alterations of cardiac conduction seen on the
routine ECG are not associated with symptoms or with easily discerned
physical findings. Yet, each of these electrocardiographic findings
causes special concerns regarding medical certification and may result
in recommendations for additional assessment.
The AMA Cardiovascular Committee, in recognition of these facts,
recommended that the requirement for electrocardiography be modified in
an effort to increase the assurance that significant cardiac disease in
pilots will be detected. The committee suggested that, in addition to
the current requirement for first-class certificates, an ECG be made on
all applicants for medical certification at the time they first apply.
These ECG's would serve as a valuable medical baseline for future
comparison. Further, the committee recommended that an ECG be made on
applicants for second-class medical certificates at ages 35 and 40
years and every 2 years thereafter, and on applicants for third-class
certificates at age 40 years and every 6 years thereafter. The
committee also suggested that the standard be modified to include the
agency's concern for any clinically significant electrocardiographic
abnormality rather than the current limited specification of myocardial
infarction alone.
In proposed Sec. 67.211(d), all applicants for second-class airman
medical certification would be required to submit ECG's at the first
examination after reaching age 35 and, biennially, after reaching age
40. There is reciprocity between the first- and second-class
cardiovascular standards in satisfying the ``after reaching the 35th
birthday'' and the ``after reaching the 40th birthday'' ECG
requirements. For example, an application with an ECG that satisfies
the ``age 35'' ECG requirement for first-class medical certification
also satisfies the ``age 35'' ECG requirement of an application for
second-class medical certification and vice versa. In the case of the
``after reaching the 40th birthday'' ECG requirement, however, the time
provisions of Secs. 67.111(d)(3) and 67.211(d)(3), as discussed below,
are also required for reciprocity.
The proposed time provision for the ``after reaching the 40th
birthday'' periodic ECG for first-class medical certification requires
that an applicant submit an ECG with the application unless, within the
preceding 9 months, an ECG was provided as part of an application for
medical certification. That is, if an applicant has submitted an ECG as
part of an application for airman medical certification within 9 months
of the current application, the applicant does not have to submit
another ECG for the current application. Thus, after reaching the 40th
birthday, a person who maintains a first-class medical certificate
would be required to have an ECG at alternate applications or
approximately every year. In a few cases, it could be 1 year and 3
months between first-class ECG's. The time provision for the ``after
reaching the 40th birthday'' periodic ECG for second-class medical
certification is the preceding 15 months. An applicant maintaining a
second-class medical certificate would be required to have an ECG at
alternate applications or approximately every 2 years. In a few cases,
it could be 2 years and 3 months between ECG's. The proposed
requirement for first-class medical certification allows more leeway
than the current rule. An applicant with a first-class medical
certificate could wait up to 9 months and the ECG of the previous
application for a first-class medical certificate would meet the
requirement for the succeeding application for a first-class medical
certificate. An applicant with a second-class medical certificate could
wait up to 15 months and the ECG of the second-class medical
certificate would meet the requirement for the succeeding application
for second-class medical certification. No ECG requirement is being
proposed for third-class medical certification.
To ensure the currency of an ECG, the FAA proposes in
Secs. 67.111(e) and 67.211(e) that if a person is required to submit an
ECG as part of an application for medical certification, it must be
dated no earlier than 60 days before the date of the application it is
to accompany and must be performed and transmitted according to
acceptable standards and techniques. Of course, there is no requirement
to submit an ECG with a current application for medical certification
if a previous ECG submitted as a part of an application for medical
certification can satisfy any current ECG requirement. Sixty days is a
longer period than the 30 days recommended by the AMA Report but
represents a reduction from the 90 days now permitted. The agency
recognizes that many ECG's are provided by employers or through private
physicians other than the AME, and a reasonable period, such as that
proposed, is appropriate for the airman's convenience. Finally, the FAA
did not propose a baseline ECG be performed for either first- or
second-class medical certificate applicants because it had a negative
cost analysis and the FAA considers the ECG after age 35 to serve as an
adequate baseline ECG.
The FAA also proposes to amend the wording of the standard to
require that the affected person ``demonstrate an absence of myocardial
infarction and other clinically significant abnormality on
electrocardiographic examination.'' The FAA will continue to require
electrocardiography or other appropriate evaluations for any airman
whose medical history or findings suggest it.
Blood Pressure
The current medical standard pertaining to blood pressure applies
only for first-class medical certificates. Depending on the person's
age and the scope of the examination accomplished, blood pressures from
140 to 170 mm Hg pressure, systolic, and 88 to 100 mm Hg pressure,
diastolic, are permitted. In practice, 170 mm Hg systolic and 100 mm Hg
diastolic have been considered the maximum allowable pressures for all
applicants for second- and third-class certificates. The ICAO standard
provides only that the blood pressure of all airmen be ``within normal
limits.''
In addition, Sec. 67.13(e)(5) of the FAR provides that, ``if an
applicant is at least 40 years of age, he must show a degree of
circulatory efficiency that is compatible with the safe operation of
aircraft at high altitudes.''
It is rare for an applicant for certification to manifest
hypertension (high blood pressure) at the level of the current standard
or above. Current and accepted medical practice for several years has
reflected knowledge of the adverse effects of even mild elevations of
blood pressure and treatment is prescribed for most individuals at
levels of blood pressure much lower than the FAA standard for medical
certification. If any person is taking medication for hypertension, FAA
practice is to consider the condition as coming under the provisions of
present Sec. 67.13(f)(2), General medical condition, of the FAR. This
section directs that the applicant have ``no other organic, functional,
or structural disease, defect, or limitation that the Federal Air
Surgeon finds makes the applicant unable to safely perform the duties
or exercise the privileges of the airman certificate that he holds or
for which he is applying; or may be reasonably expected, within 2 years
after the finding, to make him unable to perform those duties or
exercise those privileges; * * *'' Certification is conditioned on the
findings of a more detailed medical evaluation, including an assessment
of cardiovascular risk factors, the presence or absence of disease of
``target'' organs, the degree of blood pressure control, and of the
medication itself.
The AMA Report recommends that the existing, outmoded standard for
blood pressure be replaced. It suggests a sitting blood pressure
standard of 150 mm Hg pressure, systolic, and 95 mm Hg pressure,
diastolic, for all pilots. It further recommends that the systolic
level never exceed 160 mm Hg, regardless of the diastolic blood
pressure. The AMA Report notes that its recommendations represent a
somewhat less rigid standard for younger airmen and a more rigid
standard for older airmen. Less rigid standards for the younger airmen
are appropriate in terms of safety. For older airmen the more rigid
standards respond to data demonstrating the adverse medical
significance of the high level of blood pressure permitted by the
current standard.
The FAA agrees that the existing standard relating to blood
pressure is outmoded and does not reflect current medical knowledge or
practice. It also finds that current Sec. 67.13(e)(5) is medically
vague and does not serve a useful purpose. Accordingly, it proposes
that the provisions of Sec. 67.13(e) (4) and (5) of the FAR, including
the table, be deleted and replaced by new standards (proposed
Secs. 67.111(b), 67.211(b), and 67.311(b)) applicable to all classes of
medical certificates. It proposes that average blood pressure while
seated not exceed 150 mm Hg, systolic, or 95 mm Hg, diastolic. For ease
of application, the agency will not introduce into the standard the
additional suggestion that the systolic pressure never exceed 160 mm
Hg.
The proposed standard would require more extensive assessment of
airmen who require or use antihypertensive medication. To maintain
first-class certification, the assessment will be required at least at
annual intervals, usually with every other application. For second- and
third-class certification, valid for 1 year and 2 years, respectively,
the assessment will be required with each application. Unless otherwise
determined by the FAA under the special issuance provisions of the FAR,
certificates will be valid for the normal periods and, in most cases,
issued by the designated AME if there are no adverse findings. These
procedures are included in current FAA guidelines.
This proposed amendment would clarify the FAA's concern for the
cardiovascular risk represented by hypertension and the agency's
position that persons who are undergoing therapy for hypertension
should be evaluated to assess the degree of risk. Though these
standards are being codified for the first time, this evaluation does
not represent a new practice.
Cholesterol
Currently no cholesterol standards exist in the regulations. In
consideration of the responsibility for public safety held by airmen
exercising pilot privileges in air transport operations, the FAA has
partially accepted the recommendations of the AMA Report that the level
of blood cholesterol be determined as part of the examination for
medical certification. The Risk Factor Committee of the AMA that
considered risk factors and qualifications for flying suggested that
serum cholesterol and triglyceride levels be determined for all
applicants initially and at 50 years of age. The Cardiovascular
Committee of the AMA, however, recommended that a determination of
serum cholesterol be made only for 50-year old applicants for first-
and second-class medical certificates who exercise airman duties in
single-pilot commercial operations. Both committees recommended further
evaluation if a level greater than 300 milligrams per deciliter (mg/dl)
of total cholesterol is found.
The FAA proposes (proposed Sec. 67.111(f)) that total serum
cholesterol be tested annually as part of the examination of all
applicants for first-class medical certification who have reached their
50th birthday. Unlike a single determination, an annual requirement
will assist the FAA in the identification of adverse trends in
cardiovascular risk factors as airmen age. Applicants whose cholesterol
level is determined to exceed 300 mg/dl would be required to undergo an
additional cardiovascular evaluation to determine if significant
disease is present, but issuance of a medical certificate would not be
withheld solely on the basis of the cholesterol level.
The FAA agrees with the AMA Report and with the National Institutes
of Health regarding the importance of this risk factor for disease and
believes that the additional cost to the holders of first-class airman
medical certificates is justified by the more effective identification
of disease. By limiting this requirement to first-class certificate
holders 50 years of age and older, public benefits are enhanced with
minimum costs by targeting the population having the greatest risk and
greatest public responsibility.
The FAA does not consider feasible the AMA Report recommendation
that the serum cholesterol level requirement be limited to persons who
exercise airman duties in single-pilot commercial operations.
Individual airmen frequently perform in a variety of commercial
operations or change from one type of operation to another. There are
no regulatory controls for limiting applicability of such a requirement
to single-pilot commercial operations.
Hematocrit
Currently no standard exists in the FAA regulations for blood
hematocrit. The AMA Report recommends that all applicants at age 40,
and periodically thereafter, demonstrate a hematocrit within the range
of 32 to 55 percent. The requirement is recommended because the ability
of blood to transport oxygen effectively to tissues is dependent on
adequate hemoglobin concentration and on the ability of blood to
perfuse organs. Abnormalities of this function can result in
incapacitating organ infarcts. Also, a number of significant medical
conditions are often reflected in abnormalities of the blood. Anemias
of various etiology, organ malignancies, polycythemia, lung disease,
hemoglobinopathies, coagulation and thrombotic disorders, hematologic
neoplasia, lymphomas, immunodeficiency syndromes, and other disorders
are included in the conditions that may be discovered through
examination of the blood.
The FAA is not proposing to add new standards for blood hematocrit
testing at this time. Hematocrit testing would impose incremental costs
on applicants for a first-class airman medical certificate and
additional administrative costs on the FAA. While the recommendations
of the AMA Report suggest that hematocrit testing would result in
detection of certain adverse or potentially incapacitating medical
conditions, the risk to flight safety appears minimal in comparison to
the cost of testing. The list of specific conditions that would
disqualify a person is not proposed for inclusion in the FAR because
the conditions are already covered in the general medical standards.
Anticoagulation
Current regulations do not contain specific standards for
anticoagulation. Under the general rules of current paragraphs (f)(2)
(i) and (ii) of Secs. 67.13, 67.15, and 67.17, the FAA has denied
routine certification of persons who require medication for
anticoagulation. The FAA does, however, grant special issuance to a
limited number of airmen who use this type of medication after
extensive evaluations of the conditions requiring anticoagulation, the
stability of the airmen's treatment regimens, and the presence or
absence of adverse side-effects. Periodic reevaluation always is
required for subsequent certification.
The AMA Report recommends denial of routine medical certification
for any person who uses an anticoagulant medication. This
recommendation is consistent with earlier medical reports such as the
report of the Eighth Bethesda Conference of the American College of
Cardiology in 1975, the Report of a Working Party of the Cardiology
Committee of the Royal College of Physicians of London in 1978, The
First United Kingdom Workshop in Aviation Cardiology in 1982, and The
Second United Kingdom Workshop in Aviation Cardiology in 1987, and with
recommendations of some FAA medical consultants. Based on its
experience with airmen who are taking anticoagulant medication, the FAA
believes that some individuals who receive anticoagulant medications
may be granted airman medical certification after careful evaluation of
their specific condition. Such certification represents an exception,
however, and must be accomplished under the special issuance provisions
of the FAR, subject to appropriate, periodic medical reevaluation and
possible restrictions. To clarify this position and to meet the FAA's
statutory responsibility to ensure public safety, the FAA proposes
(proposed Sec. 67.111(c)) to add the use of anticoagulant medication to
those conditions specified in the FAR as disqualifying an individual
for certification. (Discussion of how a proposed disqualifying
condition may affect a current medical certificate appears under
``Additional Standards for Disqualification.'')
Respiratory System
Current regulations do not contain specific standards pertaining to
the respiratory system. The Respiratory System Committee, in its
section of the AMA Report, recommended that all airmen older than 40
years periodically demonstrate the absence of severe lung disease
through spirometry, a simple, non-invasive test available in the
physician's office. The committee stated its concerns for the danger to
public safety represented by airmen with serious pulmonary disease such
as chronic obstructive pulmonary disease (COPD), asthma, pulmonary
fibrosis, infectious diseases of the lung, hypoventilation syndromes,
chronic interstitial lung disease, and disorders of the respiratory
muscles and bony thorax. Both judgment and the ability to perform
complex tasks may be affected adversely by a reduction of oxygen
available to the brain (hypoxia) because of poor pulmonary function,
and acute lung disease can cause hypoxia without warning. Altitude
itself affects pulmonary function, so careful assessment of pulmonary
status is required to prevent incapacitation during flight, according
to the committee's report.
Tests that measure the actual levels of oxygen and carbon dioxide
in the arterial blood are costly and not generally available in the
aviation medical examiner's office. Careful clinical assessment of
respiratory function, including medical history and physical
examination ordinarily are used to separate those applicants requiring
further evaluation of their pulmonary status from those who do not.
The FAA is not proposing to add a new requirement for routine
spirometric testing at this time. Spirometric testing would impose
incremental costs on applicants for all classes of airman medical
certificate and additional administrative costs on the FAA. AME's would
be required to purchase the equipment necessary to perform the
examination. Under current practice, individuals with potentially
serious pulmonary disease are identified through existing procedures
and referred for further evaluation, including spirometric testing, of
their pulmonary status to determine their eligibility for medical
certification.
The AMA Report also recommends specifically disqualifying diseases
and conditions of the respiratory system. These would include severe
lung disease, poorly controlled asthma, sleep disorders, pulmonary
hypertension, pneumothorax, pulmonary emboli, and carcinoma of the
lung. The list of specific conditions that would disqualify a person is
not proposed for inclusion in the FAR because the conditions are
already covered in the general medical standards.
Diabetes
In its discussion of diabetes in the preamble to Amendment 67-11,
the FAA stated that the Federal Air Surgeon would continue to deny
certification to individuals who have an established medical history or
clinical diagnosis of diabetes that is controlled by the use of insulin
or another hypoglycemic drug (47 FR 16298, April 15, 1982). The
preamble further stated, ``If, in the future, information demonstrating
that medical technology has advanced to the point that diabetes can be
controlled without significant risk of incapacitation from hypoglycemia
or other complications becomes available to the FAA, consideration for
special issuance of a medical certificate under Sec. 67.19 will be
possible.''
As part of the review of part 67, the AMA Report made
recommendations concerning individuals seeking medical certification
who have an established history or clinical diagnosis of diabetes that
is controlled by insulin or another hypoglycemic drug. The AMA Report
recommended that persons whose diabetes is adequately controlled with
oral hypoglycemic drugs and who show evidence of stability and freedom
from adverse effects be considered for medical certification with
proper medical monitoring. The Endocrine Committee assembled by the AMA
believes that the likelihood of incapacitation from the effects of
diabetes or its treatment with current oral hypoglycemic drugs, in
those persons medically selected and monitored, is very remote. The AMA
Endocrine Committee recommends that absolute prohibitions of
certification of individuals requiring insulin for control of diabetes
be continued. Informal surveys of agency medical consultants, comments
by interested medical practitioners, and review by the FAA medical
staff indicate general agreement with these findings and
recommendations of the AMA Report. The more widespread use of
technically advanced equipment and procedures has made it possible for
physicians to better select those persons who should be allowed to use,
or continue to use, oral drugs to control their disease. The increased
use of simple equipment and tests for self-monitoring gives the
diabetic and the physician a more accurate and timely picture of a
person's immediate condition as well as his or her ability to control
blood sugar over time.
In view of the current consensus of the medical community, the FAA
has determined that many individuals whose diabetes is without
complications and acceptably controlled by diet and oral drugs, with
appropriate monitoring and other conditions, can perform the duties
authorized by their class of medical certificate without endangering
public safety. Accordingly, though no substantive rule change is
proposed to current requirements in paragraph (f)(1) of Secs. 67.13,
67.15, and 67.17, the Federal Air Surgeon has determined that those
persons who do not meet the medical standard of the FAR because their
diabetes requires oral hypoglycemic drugs will no longer be
categorically denied special issuance of airman medical certification.
In determining eligibility for medical certification under the
special issuance provisions of the FAR, the Federal Air Surgeon
considers the natural history and severity of the problem, the period
of satisfactory recovery since manifestation of the problem, and any
treatment, as well as any continuing requirements for treatment, and
the nature of treatment. For diabetics whose disease is controlled with
oral hypoglycemic agents, additional factors that may be considered
include: the age of onset of diabetes; the documented degree and means
of past and present diabetes control; the presence or absence of
adverse effects, including hypoglycemic episodes; the presence or
absence of other known risk factors; and the individual's willingness
and ability to maintain strict control of his or her condition and
treatment and to cooperate with any monitoring plan required by the
FAA.
Four physicians who served on the AMA Report's Endocrinology
Committee subsequently submitted a letter stating that they
reconsidered their Committee's recommendation on diabetes. The
recommendation of the Endocrine Committee was to continue to disqualify
diabetics who use insulin to control their disease. In their letter,
the four physicians stated that persons on insulin therapy should be
allowed consideration for special issuance certification. Several other
physicians who commented on the AMA Report also supported certification
of persons on insulin therapy.
The issues raised by these commenters pertain to current FAA policy
of not permitting special issuance consideration for persons on insulin
therapy. As recommended by the full AMA Committee, the FAA proposes to
retain this policy but remains open to a change in its policy should
there be any new medical developments. The issue was thoroughly covered
by the full AMA Committee and its recommendation was made after
deliberation and thorough discussion. The contra recommendation of the
four physicians who submitted a letter to the FAA was not subjected to
the same process, nor did their recommendation contain any acceptable
procedure for identifying persons on insulin therapy who could be
safely, reliably, and practically certified through the special
issuance process.
In a related matter, a summary of an American Diabetes Association
(ADA) petition for rulemaking to review FAA rules and policies
regarding individuals with diabetes was recently published in the
Federal Register (56 FR 10383, March 12, 1991). Specifically, the ADA
petitioned the FAA to amend FAR Secs. 67.13, 67.15, 67.17, and 67.19 to
allow individuals with insulin-treated diabetes mellitus to be issued
medical certificates on a case-by-case basis. The ADA further requested
the creation of an FAA-appointed medical task force to develop a
medical protocol capable of permitting meaningful case-by-case review.
Docket No. 26493 was established to receive comments on the ADA
petition. Since the comment period on the ADA petition has closed but
the subject of that petition is directly related to the part 67 review,
additional comments on the diabetes-related issues raised in the ADA
petition may be submitted to the docket of this rulemaking. The FAA may
dispose of the issues raised in the ADA petition through this action at
the final rule stage, or through the issuance of a separate disposition
of the ADA petition.
Musculoskeletal
The Musculoskeletal System Committee of the AMA recommends
standards that would disqualify an applicant for medical certification
because of conditions such as quadriplegia, hemiplegia, hemiparesis,
collagen disease, and vascular disease. The FAA does not propose
specifying these conditions as disqualifying since they are already
covered by current general medical standards (proposed Secs. 67.115,
67.215, and 67.315).
Special Issuance of Medical Certificates
The FAA has used special issuance (waiver) provisions of Sec. 67.19
(proposed Sec. 67.401) for many years to grant airman medical
certification to acceptable applicants who do not meet the published
standards. Prior to 1982, except for applicants for air traffic control
tower operator certificates, this authority was not available for
airmen with histories of certain psychiatric, neurological, cardiac, or
endocrine conditions, and exemptions from the regulations were
required. Beginning in May 1982, however, airmen with a history or
clinical diagnosis of any medical condition could be granted
discretionary medical certification through the special issuance
provisions if it could be determined that, notwithstanding the person's
failure to meet the applicable medical standard, airman duties could be
performed, with appropriate limitations or conditions, without
endangering public safety. Through special issuance provisions, many
airmen have returned to productive aviation careers and others to
private flying after recovery and rehabilitation from serious medical
conditions without adverse impact on public safety.
Consideration for the granting of a special issuance can be
initiated in different ways. Currently, the FAA will often consider an
individual for a special issuance who does not meet the medical
standards under part 67 without a formal request to the agency from the
individual. In some cases an individual who does not meet the medical
standards under part 67 will make a written request to the Federal Air
Surgeon or to his or her authorized representative to be considered for
a grant of a special issuance.
Under current practice, a special issuance letter is issued
advising an airman of the FAA's decision to grant the special issuance
of a medical certificate. The letter describes the provisions and
conditions of a special issuance of medical certification. Based on the
letter and on the individual being otherwise eligible, the agency or
examiner issues a medical certificate to the individual. These
procedures apply for a new application and for an application for
recertification.
Current Sec. 67.19 provides that the Federal Air Surgeon may limit
the duration of a medical certificate issued under that section,
condition the continued effect of a medical certificate on the results
of subsequent medical tests, examinations, or evaluations, impose any
operational limitation needed for safety, or condition the continued
effect of a second- or third-class medical certificate on compliance
with a statement of functional limitations issued to the person in
coordination with the Director of Flight Standards or the Director's
designee. It is implicit in this section that in the interests of
public safety a finding of adverse change in the medical condition of
the holder would result in termination of the validity of the medical
certificate.
The validity of the special issuance letter, however, does not
lapse until the FAA takes some affirmative action to modify or
terminate it. Similarly, once a medical certificate is issued pursuant
to the special issuance provisions, even if the FAA terminates the
special issuance letter, it may be considered that the medical
certificate itself does not lapse until the original date of
expiration, unless it is sooner suspended or revoked under the
provisions of section 609 of the Federal Aviation Act. Long-standing
agency practice in the case of adverse medical change has been to send
the holder a letter terminating the validity of the special issuance of
medical certification and requesting the return of any medical
certificates held.
To ensure that the medical justification for the special issuance
remains valid and the holder of the special issuance undergoes the same
type of periodic reevaluation as the holder of any medical certificate
does, it is proposed that the duration of an Authorization for Special
Issuance of a Medical Certificate (Authorization) will be limited, and
a new request for that Authorization will be required upon expiration.
In addition, when the FAA determines that an Authorization should be
withdrawn, the medical certificate issued pursuant to that
Authorization will also expire, in accordance with proposed
Sec. 67.401(a).
An Authorization is one of two types of special issuances and
covers those medical conditions, such as coronary heart disease, where
the disease is progressive in nature. A Statement of Demonstrated
Ability (SODA) is the second type of special issuance. If a medical
condition, such as the accidental loss of a limb or deficient color
vision is static and nonprogressive, the FAA issues a SODA to those
applicants found able to perform airman duties without endangering
public safety. This document remains valid indefinitely and permits a
designated AME to issue a medical certificate of the specified class if
the holder remains otherwise eligible. In the event of adverse change,
certification is withheld and the person referred to the FAA for a new
determination of eligibility.
Current Sec. 67.19 (proposed Sec. 67.401) refers only to the
special issuance of medical certificates. The FAA proposes to add
specific reference to the two types of special issuance documents: An
Authorization and a SODA. The first document codifies the special
issuance letter currently used to grant and describe the provisions of
a special issuance of medical certification, and the second codifies a
document that has been in use for many years. The proposed change
explicitly connects the duration of any medical certificate issued to
the validity of the document upon which it is based and requires
periodic requests for reissuance.
The FAA also proposes to add language (proposed Sec. 67.401(f))
that explicitly provides that the Federal Air Surgeon may withdraw an
Authorization or SODA when: There is adverse change in the holder's
medical condition; the holder fails to comply with a statement of
functional limitations or operational limitations issued as a condition
of medical certification; the public safety would be endangered by the
holder's exercise of airman privileges; the holder fails to provide
medical information reasonably needed by the Federal Air Surgeon to
determine continued eligibility for certification under the special
issuance provisions; or the holder makes or causes to be made a
fraudulent or false statement or an incorrect statement in support of
his or her request or in any entry in any logbook, record, or report
that is kept, made, or used, to show compliance with any requirement
for an Authorization or SODA.
Proposed Sec. 67.401(i) would allow a person to request a review of
a decision to withdraw an Authorization or SODA. The holder of an
Authorization or SODA that is withdrawn may request, within 60 days
after the service or mailing of a letter of withdrawal, that the
Federal Air Surgeon provide for a review of the decision to withdraw.
The review procedures would provide the holder an opportunity to submit
supporting evidence in his or her behalf, and to otherwise respond to
the decision to withdraw. The proposed procedures and timeframes in
Sec. 67.401(i) are intended to provide an expeditious administrative
review for the benefit of those persons affected by a decision to
withdraw an Authorization or SODA. The public is invited to comment on
the proposed procedures for withdrawal of an Authorization or SODA.
Proposed Sec. 67.401(j) implements the procedure by which the FAA
will convert current special issuances to either Authorizations or
SODA's. All Authorizations will have an expiration date. The date will
coincide with the expiration date of the airman's medical certificate
or a date as stipulated by the Federal Air Surgeon or his or her
authorized representative that relates to any medical test, report, or
examination required as a condition of the special issuance.
Applications, Certificates, Logbooks, Reports, and Records:
Falsification, Reproduction, or Alteration
Section 67.20(a) (proposed Sec. 67.403(a)) of the FAR provides the
regulatory basis for enforcement action when an applicant or airman
falsifies a medical certification document. In current Sec. 67.20(b),
consequences for violating paragraph (a) include suspension or
revocation of all airman, ground instructor, and medical certificates
and ratings held by that person.
Although present paragraph (a)(1) provides explicitly only for
suspension or revocation for fraudulent or intentionally false
statements on any application for a medical certificate, the FAA has
denied the medical certificate applied for in such cases. If the FAA
interpreted the current regulation narrowly, it would have to issue a
medical certificate and then revoke it in cases where the person has
falsified the application. The proposed revision of these requirements
(proposed Sec. 67.403) provides explicitly for denial of an application
for medical certification, as well as for suspension or revocation of
all airman, ground instructor, and medical certificates and ratings
held by that person, if the person makes a fraudulent or intentionally
false statement or entry on the application or other document required
to be kept, made, or used to show compliance with any requirement for
any medical certificate under part 67.
A new paragraph (c) has been added to proposed Sec. 67.403 to allow
the FAA the option of denying, suspending, or revoking an airman
medical certificate if any incorrect statement or entry has been made,
even if the person did not knowingly make the incorrect statement or
entry. Medical certification based on incorrect medical data may be
inappropriate in the light of the true data.
Proposed Sec. 67.403 also prohibits fraudulent or intentionally
false statements or incorrect statements or entries in connection with
any Authorization or SODA. In addition, proposed Sec. 67.401, which
sets out the procedures for Authorizations and SODA's, specifically
lists the making of a fraudulent or intentionally false statement or an
incorrect statement as grounds for withdrawal of an Authorization or
SODA.
Certification Procedures, Applicability, and Medical Examinations
No substantive changes are proposed for present Sec. 67.23 of the
FAR (proposed Sec. 67.405). Current Sec. 67.21 is deleted because it is
unnecessary under the new reorganization.
Delegation of Authority
This section (current Sec. 67.25; proposed Sec. 67.407) would be
amended to substitute the current term ``Manager'' for ``Chief'' in the
delegation of authority to the Manager, Aeromedical Certification
Division, Civil Aeromedical Institute. It also would be amended to add
issuance, renewal, denial, and withdrawal of Authorizations and SODA's
to the authority delegated by the Administrator to the Federal Air
Surgeon.
Denial of Medical Certificate
Current Sec. 67.27 of the FAR (proposed Sec. 67.409), Denial of
Medical Certificate, is proposed for amendment only to substitute
current terminology and the address for the Manager, Aeromedical
Certification Division, and to remove gender-specific pronouns.
Medical Records
The FAA proposes to amend Sec. 67.31 of the FAR (proposed
Sec. 67.413(a)) to change the word ``refuses'' to ``fails'' to make it
clear that there need not be an actual refusal by an applicant or
holder of a medical certificate to furnish requested information to
trigger a suspension, modification, or revocation of a medical
certificate. Failure to provide the requested information is sufficient
cause for the Administrator to act. A new sentence would be added to
this section (Sec. 67.413(b)) to make it clear that submission of
requested information does not automatically lead to issuance of a
medical certificate. A determination by the Federal Air Surgeon that
the person meets applicable medical standards is needed before a
certificate will be issued. The FAA also proposes to remove gender-
specific pronouns and to substitute the more appropriate word,
``physician'' for the word ``doctor.''
Return of Medical Certificates After Suspension or Revocation
Current Sec. 67.27(g) of the FAR provides that the holder of a
medical certificate shall surrender it, upon request of the FAA, if its
issuance is wholly or partly reversed upon reconsideration. Part 61
(Sec. 61.19(f)) provides that the holder of any certificate issued
under that part that is suspended or revoked shall, upon the
Administrator's request, return it to the Administrator. Except for
Sec. 67.27(g), part 67 is silent regarding return of medical
certificates that have been suspended or revoked under the FAR or under
Section 609 of the Federal Aviation Act of 1958 (49 U.S.C. 1422).
Because the retention by an airman of an invalid medical certificate is
not consistent with proper and efficient enforcement of safety
regulations, new Sec. 67.415 is proposed. This amendment would codify
existing practice, and clarify that any airman medical certificate
revoked or suspended under existing authority must be returned on
request of the Administrator.
Related Petition
On July 7, 1981, the Civil Pilots for Regulatory Reform (CPRR)
filed a petition with the FAA Administrator (Docket No. 22054; AVS-81-
520-P). The petition took issue with two aspects of the airman medical
certification process. First, that the cardiovascular standards for
first-, second-, and third-class medical certificates (paragraph (e)(1)
in Secs. 67.13, 67.15, and 67.17; 1981), automatically disqualify an
airman who has an established history or clinical diagnosis of a
myocardial infarction regardless of degree or recency. Second, that the
only means to regain medical certification is dependent on the sole
discretion of the Federal Air Surgeon via an exemption under part 11 of
the FAR.
The CPRR petition proposes to modify a subparagraph of the 1981
cardiovascular standard which reads, ``No established medical history
or clinical diagnosis of myocardial infarction . . .,'' to read, ``No
coronary artery disease that makes the applicant unable to safely
perform the duties or exercise the privileges of the airman certificate
that he holds or for which he is applying; or may reasonably be
expected, within 2 years after the finding, to make him unable to
perform those duties or exercise those privileges; and the findings are
based on the case history and appropriate, qualified, medical judgment
relating to the condition involved.'' The effect of the proposed change
is that a history of coronary artery disease would not, per se,
disqualify an airman.
The CPRR petition also proposes that the standards and tests used
by the Federal Air Surgeon to recertificate pilots who have sustained
infarcts be published in regulatory form in an appendix to part 67, and
that a pilot be granted appeal rights to the NTSB in the event that an
exemption is denied. Furthermore, the CPRR petition proposes that the
medical exemption procedures under part 11 be revised to provide a
``due process'' format for the exemption deliberation under part 11.
The format would include: (a) if the airman petitioner requests
exemption under part 11 because of disqualification under the
cardiovascular standard, the airman is given a complete file, prior to
the exemption panel meeting, of all records, reports and other
documents which the agency plans to consider in the ruling; (b) the
airman may attend and present evidence at the exemption panel meeting;
(c) panel members must record their individual position in the official
record of the meeting; and (d) the agency must construct a record
sufficient to form a basis for review by the courts of appeal under the
arbitrary and capricious standard of review.
FAA Response: The medical standards were revised in 1982 (47 FR
16298; April 15, 1982). The revision eliminated the need for the time
consuming and cumbersome exemption pathway under part 11 for part 67
medical disqualification cases and opened up part 67 medical
disqualification cases (including cardiovascular cases) to special
issuance procedures under Sec. 67.19. Additionally, the 1982 rule
change stated, in the preamble, general and specific criteria that
would be considered in the determination of a cardiovascular special
issuance. The 1982 change considerably reduces the administrative costs
and processing time for special issuance cases.
In regard to the CPRR proposals to change the disqualifying
statement on myocardial infarction and to allow for ``due process'' and
appeal, FAA review of part 67 has not led to such proposals. The
disqualification for myocardial infarction remains in the proposed
rules. However, it is, and would continue to be, possible for an
applicant with a history or diagnosis of myocardial infarction to
receive a medical certificate through the special issuance procedures
if further medical evaluation of the applicant shows that he or she is
able to perform the privileges of an airman certificate without
endangering public safety. Any applicant who has been denied
certification because he or she is unqualified under the cardiovascular
standards is notified of the procedures, standards, and tests required
for special issuance determination. Test results are reviewed and
evaluated by medical specialists. Generally, in difficult cases or
those involving commercial pilots, a panel of cardiovascular
specialists reviews the medical reports and other required
documentation, assesses the risks involved in accordance with its best
medical judgment and advises if it believes a special issuance is
warranted. The procedures provide for a reasoned, objective
determination based on medical facts and judgment. The determination is
not based on a hearing-type procedure in which subjective facts are
weighed. In any case, the proposed rule would allow for the same ``due
process'' as under the present rule.
Discussion of Public Comments
The FAA requested public comments on the review of part 67 in two
separate notices. On July 15, 1982, the FAA announced the review of the
regulations and invited public comment (47 FR 30795). On May 23, 1986,
the FAA announced the availability of the AMA Report and invited public
comment on recommendations in the report (51 FR 19040). A total of 211
comments were received. Comments were submitted by pilots, pilot
organizations, and physicians, including several AME's. Most of the
comments refer to the AMA Report recommendations, only some of which
are proposed in this document for adoption.
The following discussion of comments addresses only the main
medical issues raised by commenters that are relevant to this
rulemaking document. It does not address comments on AMA
recommendations that the FAA did not choose to adopt. Some commenters
recommended changes similar to those recommended in the CPRR petition
and, since the FAA's position on these issues has already been stated,
it is not repeated below. While the following discussion addresses the
main medical issues raised by commenters, it is not intended to be an
exhaustive discussion of all of the comments received and considered by
the FAA.
Comments Received on the Review of Part 67
In response to the first notice, the FAA received 52 comments
providing suggestions for the FAA to consider during its review of part
67.
Twenty commenters, including four physicians, comment on persons
with diabetes. In general, the commenters argue that diabetes is a
disease that is well understood and easily monitored by a personal
physician. Advances in treating diabetes, such as home glucose
monitoring and other tests, provide full control to a pilot of his/her
illness. Several pilots suggest that diabetes is readily containable
with the appropriate medical care, and no significant physical strain
is placed on a diabetic pilot in providing continuous treatment of the
illness.
Four commenters discuss the possible benefits of an
electrocardiogram (ECG) in evaluating a person's medical situation. One
doctor who is also an AME recommends a chest X-ray as a preventive
test.
Another physician explains that there are currently no standards
for risk factors such as cholesterol, cigarette smoking, and blood
pressure. These all have links to heart disease and, as a result,
should be closely examined. Three people, including two physicians,
support closer testing of pilots for signs and effects of alcoholism.
They point out that alcohol abuse is a major cause of aviation
accidents and should, therefore, be tested.
Nineteen people objected to the stringent medical standards for
persons obtaining a third-class medical certificate under Sec. 67.17.
They argue that these strict standards are too rigid for this class of
flyers, who are generally leisure and sports pilots and can not easily
obtain a medical examination.
The Aircraft Owners and Pilots Association (AOPA) submitted a
detailed section by section recommendation for revising part 67 that
was based on recommendations of a medical advisory panel of
distinguished physicians that was convened by AOPA.
FAA Response: The FAA considered all of these comments, including
AOPA's section by section recommendations, during its review of part
67. The FAA's proposed standards and policy on diabetes are discussed
under the proposed rule portions of this preamble. New ECG requirements
are proposed in this notice. Assessment of risk factors such as
cholesterol and blood pressure is included and standards pertaining to
alcoholism have been updated in the proposal.
The proposed rule amends the standards for third-class medical
certificates in light of recent technology and medical knowledge. As
noted in the discussion of the proposed rule, the standards for third-
class medical certificates are less stringent than those for first- and
second-class certificates in recognition of the lower level of
responsibility inherent in noncommercial flight operations.
Comments Received on AMA Report Recommendations
Most commenters were generally opposed to any AMA recommendations
that involved a perceived strengthening of the standards for airman
medical certification. Only eight commenters generally favored the AMA
recommendations, some with suggestions for improving them.
Many of the opposing comments from pilots were based on their
reading of an editorial about the AMA Report which appeared in Flying
magazine (Volume 113, November 1986, page 24) entitled ``What's Up,
Doc?'' While the editorial was factually accurate, it briefly
summarized some of the recommendations and was primarily a subjective
editorial opinion opposing certain recommendations in the AMA Report.
Cost and Safety
The most frequent comment from those who objected to the AMA Report
recommendations is that the recommended changes will result in a
substantial increase in the cost of obtaining a medical certificate and
that there are no accident data to indicate a need for increasing
medical standards and thereby medical certification costs.
FAA Response: The review of part 67 was necessary to ensure that
the standards reflect current medical technology and evolving knowledge
about conditions that could affect a pilot's ability to perform safely.
For the most part, the proposed revisions to part 67 are not a
strengthening of the standards over current regulations and policy.
They represent clarification, codification of policy, and an updating
of the current standards and practices. The proposed rule would make
some standards less stringent, such as the deletion of uncorrected
distant visual acuity requirements and the revised wording of those
requirements pertaining to the eye, ear, nose, pharynx, and larynx. In
other instances, additions to the medical examination requirements such
as the proposed new standards for blood pressure for second- and third-
class medical certification are clearly warranted. The FAA would be
remiss in its responsibility for safety if it ignored medical findings
and advances that can better identify those individuals subject to
incapacitation or deterioration of performance. The estimated costs and
benefits of this proposal are addressed in a Regulatory Evaluation
Summary later in this preamble and more fully in a full regulatory
evaluation which is in the public docket.
Prevention vs. Safety
Several commenters object to statements in the AMA Report that
certain recommendations are based on concepts of preventive medicine.
These commenters say that the FAA's responsibility is to safety rather
than to a system of healthier pilots. According to these commenters,
the purpose of the agency's medical examination is to determine if a
pilot is able to perform safely the privileges of the airman
certificate, not whether the pilot is generally healthy.
FAA Response: The FAA is not proposing to change the primary safety
objective of the medical certification examination. Rather, the
proposed revisions to the standards embody what has been learned in the
last 25 years about medical risk factors. FAA's interest in risk
assessment is directly related to its need to determine at the time of
a medical examination as much objective information as possible on the
medical condition of the person being examined. This information is
directly relevant to FAA's need to determine the likelihood that the
person being examined will remain medically fit for the next 6 months,
or 1 or 2 years, as applicable.
The AMA report is fully consistent with helping the FAA meet its
statutory safety responsibilities. The AMA Report notes that some of
its recommendations include ``risk factor identification items.'' It
further notes:
These items add to the safety factor for which the examination
is designed; they also increase the likelihood that pilots who pay
attention to these risk factors will be able to enjoy flying
aircraft for more years.
The fact that the AMA Report mentions potential long term
preventive health benefits that may accrue to the person being examined
in no way diminishes the importance of the short term health evaluation
benefits that are of primary concern to the FAA.
AMA Contract
Several commenters object to the AMA Report because they believe
the recommendations are in the AMA's self interest. According to these
commenters, any proposed increase in requirements would serve to
increase the cost of the medical examination and thereby the income of
doctors.
FAA Response: In its consideration of the AMA Report, the FAA found
no indication of self-serving motives. The AMA committees which worked
on developing the recommendations were made up of experienced and
respected specialists in each area of medical interest. Each committee
did an in-depth and thorough analysis of the current standards in
relation to advances in medical knowledge and examination techniques
and recommended, as appropriate, optimum standards for safety. The FAA
reviewed and considered these recommendations along with public
comments (many from professionals in the field) and advice from its own
staff. Factors such as pilot performance, aircraft technology, and
cost, in addition to general safety were considered by the FAA in
assessing each AMA recommendation. (A cost benefit analysis appears in
the Regulatory Evaluation portion of this preamble.) The FAA believes
the proposed standards will benefit all airmen as well as the general
public.
FAA Workload
Several commenters express concern that the AMA Report
recommendations, if adopted, would lead to an increase of denials and,
therefore, an increase in requests for certification under the special
issuance provisions of the FAR. This in turn would lead to
certification processing delays.
FAA Response: The FAA does not anticipate that the proposed
standards will significantly increase the internal FAA workload. The
potential for such an increase and the FAA's plans to meet the increase
are discussed more fully in the regulatory evaluation.
Industry Disincentive
Several commenters state that general aviation is presently in
economic trouble and that more stringent medical standards would
discourage more people from becoming general aviation pilots.
FAA Response: The FAA does not agree. The safer the system, the
greater the number of participants and the lower the cost. The FAA
believes that these proposals encourage and support aviation.
Alleged Discrimination Against Older Pilots
Several commenters allege that the AMA recommendations discriminate
against older pilots in favor of younger ones, since many of the tests
recommended become critical for pilots after the age of 40 or 50. Air
transport pilots who commented argue that, if adopted, the
recommendations might prohibit some older and more experienced pilots
from flying. According to these commenters, older pilots represent a
high percentage of the highly competent and seasoned professional
pilots.
FAA Response: Any medical standards necessarily have a greater
effect on older persons since many disorders occur more frequently with
advancing age, especially after age 40. The FAA contracted with Johns
Hopkins University to prepare a detailed statistical analysis of
computerized medical information collected by the FAA from examination
of approximately 31,000 air traffic controllers over a 15-year period.
The study sample was demographically comparable to the private pilot
population and the examinations were similar to airman medical
examinations. The analysis shows that the incidence of pathology
recorded at periodic examinations increases with age; the prevalence of
pathology in individuals over the age of 50 was greater than in those
under the age of 40. The AMA recommendations and the FAA proposed rule
focus on those disorders most likely to result in reduced performance
or to incapacitate a pilot. They provide for more relevant, more
thorough, and more predictive evaluations after age 40 or 50,
particularly for those persons seeking first-class medical
certification. Proposed changes in this category relate to vision;
electrocardiograms; and blood cholesterol determinations. The proposed
standards will permit the identification of risk factors and encourage
pilots to maintain better control over those conditions which
eventually could lead to disqualification. Those AMA recommendations
included in the FAA proposal should serve, in the long term, to
increase the pool of experienced, professional, and medically eligible
pilots.
AME's or Private Physicians
Several commenters raise issues about the role of AME's and the
role of private physicians in the maintenance of a pilot's health. Two
flight instructor pilots state that mistrust exists between pilots and
medical examiners caused by pilots' fear of losing their medical
certification and their careers as pilots. More stringent rules, as
recommended by the AMA, will increase pilots' concerns and mistrust.
Commenters also believe that some of the recommendations concerning
family history, for example, should be the domain of a pilot's personal
physician and that in some instances personal physicians could supply
the information required by the recommended standards.
FAA Response: Both current and proposed standards permit the use of
test results provided by personal physicians, such as ECG's and X-rays.
However, the historical and legal role of the AME as a designee of the
FAA is to conduct a medical examination to determine the fitness of the
pilot to exercise the privileges of his or her certificate without
endangering public safety. The proposed standards in no way are
intended to interfere with or replace a pilot's use of a personal
physician. Experience, however, indicates that the FAA's statutory
responsibility to ensure that an airman is medically fit to perform his
or her duties cannot be delegated to any personal physician. The
proposed changes, however, should not affect the relationship between
pilots and AME's.
Specific Standards
Several commenters object to one or more specific recommendations
in the AMA Report. Objections to cardiovascular and vision standards
are the most frequent. Some of these commenters express concern that
the recommended standards will serve to discourage good health
practices through fear of denial. For example, commenters who objected
to the AMA recommendation for a blood pressure standard particularly
object to the AMA recommendation that an applicant shall have no
established medical history of use of antihypertensive medication
within the last year. Commenters who use antihypertensive medication
said they would either stop taking the medication (which they need) or
be denied.
FAA Response: The proposed standards do not specify that
individuals using antihypertensive medication shall be denied
certification. If antihypertensive medication is used or is needed to
meet the blood pressure requirement, a person may be issued a
certificate only after a current, satisfactory medical assessment,
prescribed by the Federal Air Surgeon. In this case as in some others,
the FAA has not followed the AMA recommendation. However, the comments
indicate a misunderstanding. A medical history of a disqualifying
condition, whatever that condition is, does not necessarily mean that a
person will be denied certification absolutely. It may mean that
additional evaluation may be required before the FAA can determine if
certification is appropriate. This may require additional time and some
expense for additional tests, but, for most of the proposed standards,
the added inconvenience is minimal compared to the improvement in
safety.
Regulatory Evaluation Summary
Introduction
Three requirements pertain to economic impacts of regulatory
changes to the FAR. First, Executive Order 12291 directs Federal
agencies to promulgate new regulations or modify existing regulations
only if the potential benefits to society outweigh the potential costs.
Second, the Regulatory Flexibility Act of 1980 requires agencies to
analyze the economic impact of regulatory changes on small entities.
Finally, the Office of Management and Budget (OMB) directs agencies to
assess the effects of regulatory changes on international trade. In
conducting these analyses, the FAA has determined that this rule:
(1) would generate benefits exceeding costs, and, thus, is not a
major rule as defined by the Executive Order; (2) is significant as
defined in DOT's Policies and Procedures; and (3) would not have a
significant impact on a substantial number of small entities; and (4)
would not have an impact on international trade. These analyses,
available in the docket, are summarized below.
Regulatory Evaluation Summary
The majority of the proposed amendments would have insignificant
attributable costs with respect to the benefits received. This
evaluation does not address the minor proposed amendments such as
changes in syntax, technical corrections, reorganization, updating
medical terminology, or adjustments to cross-references for conformance
purposes.
Furthermore, the evaluation attributes no significant costs or
benefits to several other proposed amendments that would add a specific
disease or medical condition to the list of medical standards. Such
additions do not necessarily constitute a change in the standards.
Current regulations include two open-ended (general) medical standards
that cover:
(1) any other personality disorder, neurosis, or mental condition *
* *, or (2) any other organic, functional, or structural disease,
defect, or limitation * * * that the Federal Air Surgeon finds would
make, or may reasonably be expected to make, the applicant unable to
perform the duties associated with the certificate. Thus, the
applicable medical standards are not limited to those actually listed
in the regulation. As medical knowledge and experience progress, the
Federal Air Surgeon may find a previously unlisted disease or condition
to be grounds for withholding or restricting a medical certificate, so
long as that finding is based on qualified medical judgment.
Under the proposed standards, a small number of airmen who
currently hold certificates as a result of an order of the NTSB would
become disqualified from further medical certification because of the
addition of specifically disqualifying medical conditions. These airmen
were denied medical certification by the FAA under the current general
medical standards. For example, the FAA has denied certification to
airmen who have had cardiac valve replacement and the NTSB has ordered
certification in some of these cases. Under the proposed standards, a
medical history of cardiac valve replacement would be specifically
disqualifying and those airmen would no longer be entitled to
certification. It is expected, however, that certification of the
affected individuals would continue under the Federal Air Surgeon's
special issuance authority once the FAA evaluates the case and is
satisfied that the airman's condition has not worsened since the NTSB
ordered certification. As such, the expected economic impact of the
specifically disqualifying medical conditions would be minor.
Costs and Benefits That Are Not Quantified
Prior to summarizing the evaluation of the substantive proposals,
it is important to note one category of costs and one category of
benefits that have not been quantified in this analysis. The evaluation
does not explicitly quantify the economic consequences to those
individuals who would lose their pilot certificate privileges as a
result of the proposed additional medical tests or standards. Where
such consequences are expected, the evaluation estimates the numbers of
persons who would be denied but does not attribute a cost to those
actions.
It is recognized that the denial of pilot privileges would mean the
loss of a highly valued avocation for some individuals. For others, it
would actually result in the loss of primary livelihood. An accurate
assessment of the economic valuation of the denials that are projected
under this proposed rule is beyond the scope of the evaluation.
At the same time, the evaluation also does not quantify the
overwhelming personal health benefits, external to flight safety, that
would be afforded to those individuals whose medical conditions would
be detected and whose treatment would be enabled by the proposed tests
and standards. On average, third-class medical certificate holders
spend only 0.7 percent of their time flying. The evaluation only
quantifies the direct benefits of the proposed rule to reduced aviation
accidents.
Under existing regulations, the Federal Air Surgeon is charged to
deny a certificate in those cases where a disease or other physical or
mental condition would make, or may be reasonably be expected to make,
the applicant unable to perform the duties associated with the
certificate. Such findings are not capricious, but instead, are based
on the case history of the individual and on appropriate, qualified
medical judgment.
Summary of Quantified Costs and Benefits
Vision Proposals, All Classes
The proposed rule would institute additional vision tests and
standards for all three classes. For first- and second-class applicants
age 50 and older, it would add a new standard (20/40 Snellen) and a new
test for intermediate vision (32 inches). Applicants for third-class
medical certificates would be subject to a new standard (20/40 Snellen)
and a new test for near vision (16 inches).
The projected 10-year (1994-2003) costs of the intermediate vision
proposal for first-class applicants are $1.1 million in primary testing
costs, $1.7 million in follow-up compliance costs (examinations and
glasses) for those persons not meeting the standard, $5,641 in direct
processing costs for the expected 14 additional persons who would be
denied under the provision, totalling $2.8 million, with a 1993 present
value of $2.0 million.
The projected 10-year costs of the intermediate vision proposal for
second-class applicants are $462,887 in primary testing costs, $2.2
million in follow-up compliance costs (examinations and glasses) for
those persons not meeting the standard, and $6,529 in direct processing
costs for the expected 17 additional persons who would be denied under
the provision, totalling $2.7 million, with a 1993 present value of
$1.8 million.
The projected 10-year costs of the near vision proposal for third-
class applicants are $2.8 million in primary testing costs, $1.3
million in follow-up compliance costs (examinations and glasses) for
those persons not meeting the standard, and $131,340 in direct
processing costs for the expected 339 additional persons who would be
denied under the provision, totalling $4.2 million, with a 1993 present
value of $2.9 million. It is emphasized that the denials and costs
associated with the near vision proposal are not wholly attributable to
the proposed amendment. Although this requirement does not exist in
current regulations, it has been in place administratively for some
time. Thus, the associated costs are being, and would continue to be,
incurred without this proposed amendment.
NTSB accident records were investigated for the periods from 1962
through 1989 for commercial flights and from 1982 through 1989 for
general aviation (GA). For these periods, no accident was found where
intermediate or near vision deficiency was specifically determined to
be the cause. As such, the FAA is not able to quantitatively ascribe
the benefits of the three proposed vision amendments based on
historical accident analysis.
Notwithstanding the absence of documented accidents related to
these three proposals, the FAA maintains that such accidents may well
have occurred and could continue to occur in the absence of the
proposed amendments. The NTSB accident analysis system may not document
those cases where a near or intermediate vision problem caused or
contributed to accidents. Examples would include deviations from course
or altitude, inaccurate monitoring of gauges and other avionic
displays, and incorrect setting of aeronautical parameters such as
headings or radio frequencies.
While the extent to which intermediate or near vision problems have
caused such accidents is unknown, it is the FAA's position that: (1)
general aviation pilots require adequate near vision to read charts and
checklists, and (2) commercial pilots require adequate intermediate
vision to properly monitor aircraft instruments. Although this
evaluation is not able to quantify the benefits of the proposed vision
amendments, the FAA holds that the benefits would be significant and
would exceed the expected costs.
Electrocardiogram (ECG), Second-Class
The proposal would add a new requirement whereby applicants for
second-class medical certificates would be required to have a routine
resting ECG at the first application after reaching age 35 and every 2
years after reaching age 40. The projected ten-year costs of the
provision are $25.5 million in primary testing costs, and $1.7 million
of additional testing and processing costs for those persons who would
not meet the standard, including 178 persons who would be denied,
totalling $27.2 million, with a 1993 present value of $19.2 million.
The projected benefits of this provision were based on a review of
the related NTSB accident records. In the absence of this proposal,
commercial pilot, heart-related accidents over the 1994-2003 period are
projected to consist of: 2.64 deaths per year valued at $6.60 million,
.14 serious injuries per year valued at $89,600, .14 minor injuries per
year valued at $322, and 2.06 damaged or destroyed (GA and commercial)
airplanes per year valued at $169,360, totalling $6,859,282 per year.
The projected benefits of this provision over the ten-year study period
are $68.6 million, with a present value of $48.2 million. The FAA holds
that the proposed amendment would meet or exceed the 40 percent
effectiveness level ($19.2 million cost / $48.2 million potential
benefit) necessary to be cost beneficial.
Blood Pressure, Second-Class
The proposal would add a new requirement that the sitting blood
pressure second-class medical certificate applicants not exceed 150/95
millimeters of mercury. The projected ten-year costs of the provision
are $1.8 million in primary testing costs and $0.7 million of
additional testing and processing costs for those persons who would not
meet the standard, including 32 persons who would be denied, totalling
$2.5 million, with a 1993 present value of $1.7 million.
The projected benefits of this provision were based on the review
of the related NTSB accident records. For second-class (commercial
pilots), only one general aviation accident was found where
hypertension or stroke was specifically listed as the cause. That
accident caused one death and destroyed one aircraft. Based on that
accident, commercial pilot accidents related to hypertension or stroke
are projected over the forecast period to equal: (1) .14 deaths per
year valued at $350,000 and (2) .14 destroyed airplanes per year valued
at $10,920, totalling $360,920 annually.
In addition to the directly attributable pathologies, high blood
pressure is also an associated risk factor for other pathologies
including cardiovascular disease and kidney failure. The exact impact
of the proposed rule on preventing accidents from these related
diseases is not known but the FAA estimates that the magnitude of
associated-disease accident costs that would be averted by the proposed
amendment is at least equal to 5 percent of the projected costs
attributable to second-class cardiovascular accidents. Such potential
benefits would total $342,964 per year. The combined (direct and
associated risk disease) potential benefits of the proposed second-
class blood pressure amendment over the ten-year study period are
expected to total $7.0 million, with a 1993 present value of $4.9
million. The FAA holds that the proposed amendment would meet or exceed
the 35 percent effectiveness level ($1.7 million cost / $4.9 million
potential benefit) necessary to be cost beneficial.
Blood Pressure, Third-Class
The proposal would add a new requirement that the sitting blood
pressure of all applicants for third-class medical certificates not
exceed 150/95 millimeters of mercury. The projected ten-year costs of
the provision are $2.8 million in primary testing costs and $1.0
million of additional testing and processing costs for those persons
who would not meet the standard, including 48 persons who would be
denied, totalling $3.8 million, with 1993 present value of $2.7
million.
The projected benefits of this provision were based on a review of
the related NTSB accident records for the period 1982 through 1989. For
third-class certificate holders, 6 general aviation accidents were
found where hypertension or stroke was specifically listed as the
cause. In the absence of this proposal, third-class accidents related
to hypertension or stroke are projected to equal .75 deaths per year
valued at $1,875,000, .5 serious injuries per year valued at $320,000,
.13 minor injuries per year valued at $299, and .75 destroyed airplanes
per year valued at $58,500, totalling $2.3 million per year. Over the
ten-year study period, the potential benefits would equal $22.5
million, with a 1993 present value of $15.8 million.
Similar to the proposal for second-class, the proposed third-class
blood pressure standard would also reduce those accidents caused by the
secondary pathologies where high blood pressure is an associated risk
factor. However, the magnitude of accidents directly caused by
hypertension and stroke in third-class pilots is so large that an
estimate of these secondary benefits is unnecessary. The FAA holds that
the proposed amendment would meet or exceed the 17 percent
effectiveness level ($2.7 million cost / $15.8 million potential
benefit) necessary to be cost beneficial.
Cholesterol, First-Class
The proposal would add a new requirement whereby applicants for
first-class medical certificates age 50 and over would be tested and
would be subject to a standard of 300 milligrams per deciliter. The
projected ten-year costs of the provision are $3.4 million in primary
testing costs and $2.0 million of additional testing and processing
costs for those persons who would not meet the standard, including 81
persons who would be denied, totalling $5.4 million, with a 1993
present value of $3.7 million.
A review of general aviation accidents from 1982 through 1989 found
six accidents caused by heart attacks in air transport pilots. These
accidents resulted in seven deaths, one serious injury, and six
destroyed airplanes. Parallel statistics for commercial accidents (from
1962 through 1989) revealed 4 accidents with 95 deaths, 15 major
injuries, 2 destroyed commuter airplanes and 2 destroyed air transport
planes.
These statistics project an annual, cardiovascular-related accident
cost of $2.0 million in damaged airplanes, and $27.2 million in lost
life and injury costs. Multiplying the total $29.2 million projected
cost by 5 percent, to estimate the likely proportion of these costs
that would be averted by the proposed cholesterol test and standard,
results in a potential annual benefit estimate of $1.46 million.
Accordingly, the ten-year benefits are projected to be $14.6 million,
with a 1993 present value of $10.3 million. The FAA projects that the
expected minimum potential benefits of the proposal ($10.3 million)
would exceed the estimated cost ($3.7 million).
Part 61, Certificate Validity Period, Third-Class
Under the proposal, persons under age 40 would generally only be
required to undergo a physical examination every 3 years. Medical
certificates for persons age 40 through 69 would continue to be valid
for 2 years. Persons age 70 and older would be required to undergo a
physical examination every year.
The amendment would reduce: (1) the projected years of pilot
pathology exposure by an estimated 0.2 percent, (2) the projected
flight hours of pilot pathology exposure by some 4.1 percent, and (3)
the projected number of third-class medical examinations by 14.5
percent. Accordingly, it is expected that the proposed amendment would
not induce any costs to third-class applicants considered as a whole.
The evaluation does not specifically quantify the potential
benefits from the expected minor reductions in pathology exposure. The
expected ten-year savings that would derive from the 14.5 percent
reduction in examinations is projected to total $23.7 million in direct
testing and time costs (a 1993 present value of $16.5 million). With a
projected benefit of $16.5 million and no expected net costs, the FAA
finds that this provision would be cost beneficial.
It is noted that the provision would transfer costs and benefits
across age groups. Third-class applicants younger than 40 would take
fewer examinations and would be expected to manifest a higher incident
of undetected pathologies. Conversely, the group of applicants age 70
and older would take more examinations and would exhibit fewer
undetected pathologies. However, the net effect would be a reduction in
both examinations and pathologies, consistent with Executive Order
12291 which requires that regulatory objectives be chosen to maximize
the net benefits to society.
Regulatory Flexibility Determination
The Regulatory Flexibility Act of 1980 (RFA) was enacted by
Congress to ensure that small entities are not unnecessarily or
disproportionately burdened by Government regulations. The RFA requires
a Regulatory Flexibility Analysis if a rule would have a significant
economic impact, either detrimental or beneficial, on a substantial
number of small entities. FAA Order 2100.14A, Regulatory Flexibility
Criteria and Guidance, provides threshold cost and small entity size
standards for complying with RFA review requirements in FAA rulemaking
actions. After reviewing the projected effects of the proposed rule in
light of these standards, the FAA finds that the proposal would not
have significant economic impact on a substantial number of small
entities.
International Trade Impact Statement
The proposed rule would have little or no impact on trade for both
U.S. firms doing business in foreign countries and foreign firms doing
business in the United States.
Paperwork Reduction Act
The paperwork burden associated with part 67 is currently approved
under OMB number 2120-0034. Any increase or decreases associated with
this NPRM will be submitted to OMB for approval.
Federalism Implications
The regulations proposed herein would not have substantial direct
effects on the states, on the relationship between the national
government and the states, or on the distribution of power and
responsibilities among the various levels of government. Therefore, in
accordance with Executive Order 12866, it is determined that this
proposal would not have sufficient federalism implications to warrant
the preparation of a Federalism Assessment.
Conclusion
For the reasons discussed in the preamble, and based on the
findings in the Regulatory Evaluation and the International Trade
Impact Analysis, the FAA has determined that this proposed regulation
is not major under Executive Order 12866. In addition, the FAA
certifies that this proposal, if adopted, will not have a significant
economic impact, positive or negative, on a substantial number of small
entities under the criteria of the Regulatory Flexibility Act. This
proposal is considered significant under DOT Regulatory Policies and
Procedures (44 FR 11034; February 26, 1979). An initial regulatory
evaluation of the proposal, including a Regulatory Flexibility
Determination and Trade Impact Analysis, has been placed in the docket.
A copy may be obtained by contacting the person identified under FOR
FURTHER INFORMATION CONTACT.
Derivation and Distribution Tables
The Derivation Table below shows the source in current part 67 on
which each paragraph of each section of proposed revised part 67 is
based. The Distribution Table below shows where each current part 67
section and paragraph can be found in the proposed revised part 67.
Derivation Table
------------------------------------------------------------------------
Proposed section Based on
------------------------------------------------------------------------
Subpart A
Section:
67.01........... Current Secs. 67.1 and 67.21.
67.03........... Current Sec. 67.11.
67.05........... Current Sec. 67.12.
67.07........... Current Sec. 67.3.
Subpart B
Section:
67.101.......... Current Sec. 67.13(a) and new language.
67.103(a)....... Current Sec. 67.13(b)(1).
67.103(b)....... Current Sec. 67.13(b)(2) and new language.
67.103(c)....... Current Sec. 67.13(b)(3) and new language.
67.103(d)....... Current Sec. 67.13(b)(4).
67.103(e)....... Current Sec. 67.13(b)(5).
67.103(f)....... Current Sec. 67.13(b)(6) and flush paragraph.
67.105(a)....... Current Sec. 67.13(c)(1) and new language.
67.105(b)....... Current Sec. 67.13(c)(2), (c)(3), (c)(4), (c)(5),
and new language.
67.105(c)....... Current Sec. 67.13(c)(6) and new language.
67.107(a)....... Current Sec. 67.13(d)(1)(i) and new language.
67.107(b)....... New language.
67.107(c)....... Current Sec. 67.13(d)(1)(ii) reordered.
67.109(a)....... Current Sec. 67.13(d)(2)(i) and new language.
67.109(b)....... Current Sec. 67.13(d)(2)(ii).
67.111(a)....... Current Sec. 67.13(e)(1) and new language.
67.111(b)....... New language.
67.111(c)....... New language.
67.111(d)....... Current Sec. 67.13(e) (2) and (3) and new language.
67.111(e)....... Flush paragraph after current Sec. 67.13(e)(5) as
modified.
67.111(f)....... New language.
67.113(a)....... Current Sec. 67.13(f)(1).
67.113(b)....... Current Sec. 67.13(f)(2).
67.115.......... Current Sec. 67.13(g).
Subpart C
Section:
67.201.......... Current Sec. 67.15(a) and new language.
67.203(a)....... Current Sec. 67.15(b)(1).
67.203(b)....... Current Sec. 67.15(b)(2) and new language.
67.203(c)....... Current Sec. 67.15(b)(5) and new language.
67.203(d)....... Current Sec. 67.15(b)(3).
67.203(e)....... Current Sec. 67.15(b)(4) and new language.
67.203(f)....... Current Sec. 67.15(b)(6) and flush paragraph.
67.205(a)....... Current Sec. 67.15(c)(1) and new language.
67.205(b)....... Current Sec. 67.15(c)(2), (c)(3), (c)(4), (c)(5),
and new language.
67.205(c)....... Current Sec. 67.15(c)(6) and new language.
67.207(a)....... Current Sec. 67.15(d)(1)(i) and new language.
67.207(b)....... New language.
67.207(c)....... Current Sec. 67.15(d)(1)(ii) reordered.
67.209(a)....... Current Sec. 67.15(d)(2)(i) and new language.
67.209(b)....... Current Sec. 67.15(d)(2)(ii) and new language.
67.211(a)....... Current Sec. 67.15(e)(1) and new language.
67.211(b)....... New language.
67.311(c)....... New language.
67.211(d)....... New language.
67.211(e)....... New language.
67.213(a)....... Current Sec. 67.15(f)(1).
67.215(b)....... Current Sec. 67.15(f)(2).
67.217.......... Current Sec. 67.15(g).
Subpart D
Section:
67.301.......... Current Sec. 67.17(a) and new language.
67.303(a)....... Current Sec. 67.17(b)(1) and new language.
67.303(b)....... New language.
67.303(c)....... Current Sec. 67.17(b)(3) and new language.
67.303(d)....... Current Sec. 67.17(b)(2) and new language.
67.305(a)....... Current Sec. 67.17(c)(1) and new language.
67.305(b)....... Current Sec. 67.17(c) (2) and (3), and new language.
67.305(c)....... Current Sec. 67.17(c)(4) and new language.
67.307(a)....... Current Sec. 67.17(d)(1)(i) and new language.
67.307(b)....... New language.
67.307(c)....... Current Sec. 67.17(d)(1)(ii) reordered.
67.309(a)....... Current Sec. 67.17(d)(2)(i) and new language.
67.309(b)....... Current Sec. 67.17(d)(2)(ii) and new language.
67.311(a)....... Current Sec. 67.17(e)(1) and new language.
67.311(b)....... New language.
67.311(c)....... New language.
67.313(a)....... Current Sec. 67.17(f)(1).
67.313(b)....... Current Sec. 67.17(f)(2).
67.315.......... Current Sec. 67.17(g).
Subpart E
Section:
67.401(a)....... Current Sec. 67.19(a) and new language.
67.401(b)....... New language.
67.401(c)....... Current Sec. 67.19(b).
67.401(d)....... Current Sec. 67.19(d) and new language.
67.401(e)....... Current Sec. 67.19(c)
67.401(f)....... New language.
67.401(g)....... Current Sec. 67.19(e) and new language.
67.401(h)....... Current Sec. 67.19(f) and new language.
67.401(i)....... New language.
67.401(j)....... New language.
67.403(a)....... Current Sec. 67.20(a) and new language.
67.403(b)....... Current Sec. 67.20(b) and new language.
67.403(c)....... New language.
67.405(a)....... Current Sec. 67.23(a).
67.405(b)....... Current Sec. 67.23(b).
67.407(a)....... Current Sec. 67.25(a) and new language.
67.407(b)....... Current Sec. 67.25(a) flush paragraph and new
language.
67.407(c)....... Current Sec. 67.25(b) and new language.
67.407(d)....... Current Sec. 67.25(c).
67.409(a)....... Current Sec. 67.27(a).
67.409(b)....... Current Sec. 67.27(b).
67.409(c)....... Current Sec. 67.27(c).
67.409(d)....... Current Sec. 67.27(d).
67.411(a)....... Current Sec. 67.29(a).
67.411(b)....... Current Sec. 67.29(b).
67.411(c)....... Current Sec. 67.29(c).
67.413(a)....... Current Sec. 67.31.
67.413(b)....... New language.
67.415.......... New language.
------------------------------------------------------------------------
Distribution Table
------------------------------------------------------------------------
Current section Proposed section
------------------------------------------------------------------------
Subpart A
Section:
67.1.......... Sec. 67.01.
67.3.......... Sec. 67.07.
67.11......... Sec. 67.03.
67.12......... Sec. 67.05.
67.13(a)...... Sec. 67.101.
67.13(b)...... Sec. 67.103.
67.13(c)...... Sec. 67.105.
67.13(d)...... Sec. 67.107 and Sec. 67.109.
67.13(e)...... Sec. 67.111.
67.13(f)...... Sec. 67.113.
67.13(g)...... Sec. 67.115.
67.15(a)...... Sec. 67.201.
67.15(b)...... Sec. 67.203.
67.15(c)...... Sec. 67.205.
67.15(d)...... Sec. 67.207 and Sec. 67.209.
67.15(e)...... Sec. 67.211.
67.15(f)...... Sec. 67.213.
67.15(g)...... Sec. 67.215.
67.17(a)...... Sec. 67.301.
67.17(b)...... Sec. 67.303.
67.17(c)...... Sec. 67.305.
67.17(d)...... Sec. 67.307 and Sec. 67.209.
67.17(e)...... Sec. 67.311.
67.17(f)...... Sec. 67.313.
67.17(g)...... Sec. 67.315.
67.19......... Sec. 67.401.
67.20......... Sec. 67.403.
Subpart B
Section:
67.21......... Sec. 67.401.
67.23......... Sec. 67.405.
67.25......... Sec. 67.407.
67.27......... Sec. 67.409.
67.29......... Sec. 67.411.
67.31......... Sec. 67.413.
------------------------------------------------------------------------
List of Subjects
14 CFR Part 67
Airman medical certification, Airman medical standards, Air safety,
Air transportation, Aviation safety, Falsification, Special issuance
procedures.
14 CFR Part 61
Airline transport pilots, Air safety, Aircraft ratings, Air
transportation, Aviation safety, Commercial pilots, Flight instructors,
Private pilots, Special certificates, Student and recreational pilots.
1. The authority citation for part 61 is revised to read as
follows:
Authority: 49 U.S.C. 106(g), 1354(a), and 1422.
2. Section 61.23 is amended by revising paragraphs (a)(3), (b)(2),
and (c) to read as follows:
Sec. 61.23 Duration of medical certificate.
(a) * * *
(3) The period specified in paragraph (c) of this section for
operations requiring only a private, recreational, or student pilot
certificate.
(b) * * *
(2) The period specified in paragraph (c) of this section for
operations requiring only a private, recreational, or student pilot
certificate.
(c) A third-class medical certificate for operations requiring a
private, recreational, or student pilot certificate issued on or after
[effective date of the final rule] expires at the end of the last day
of the:
(1) 36th month after the month of the date of the examination shown
on the certificate if the person has not reached his or her 40th
birthday on or before the date of the examination;
(2) 24th month after the month of the date of the examination shown
on the certificate if the person has reached his or her 40th birthday
but has not reached his or her 70th birthday on or before the date of
the examination; or
(3) 12th month after the month of the date of the examination shown
on the certificate if the person has reached his or her 70th birthday
on or before the date of the examination.
3. Section 61.39 is amended by revising paragraph (a)(3) to read as
follows:
Sec. 61.39 Prerequisites for flight tests.
(a) * * *
* * * * *
(3) Hold a current medical certificate appropriate to the
certificate the applicant seeks or, in the case of a rating to be added
to the applicant's pilot certificate, at least a valid third-class
medical certificate issued under Sec. 61.23;
* * * * *
4. Part 67 is revised to read as follows:
PART 67--MEDICAL STANDARDS AND CERTIFICATION
Subpart A--General
Sec.
67.01 Applicability.
67.03 Issue.
67.05 Certification of foreign airmen.
67.07 Access to the National Driver Register.
Subpart B--First-Class Airman Medical Certificate
67.101 Eligibility.
67.103 Eye.
67.105 Ear, nose, throat, and equilibrium.
67.107 Mental.
67.109 Neurologic.
67.111 Cardiovascular.
67.113 General medical condition.
67.115 Discretionary issuance.
Subpart C--Second-Class Airman Medical Certificate
67.201 Eligibility.
67.203 Eye.
67.205 Ear, nose, throat, and equilibrium.
67.207 Mental.
67.209 Neurologic.
67.211 Cardiovascular.
67.213 General medical condition.
67.215 Discretionary issuance.
Subpart D--Third-Class Airman Medical Certificate
67.301 Eligibility.
67.303 Eye.
67.305 Ear, nose, throat, and equilibrium.
67.307 Mental.
67.309 Neurologic.
67.311 Cardiovascular.
67.313 General medical condition.
67.315 Discretionary issuance.
Subpart E--Certification Procedures
67.401 Special issuance of medical certificates.
67.403 Applications, certificates, logbooks, reports, and records:
falsification, reproduction, or alteration.
67.405 Medical examinations: Who may give.
67.407 Delegation of authority.
67.409 Denial of medical certificate.
67.411 Medical certificates by flight surgeons of Armed Forces.
67.413 Medical records.
67.415 Return of medical certificate after suspension or
revocation.
Authority: 49 U.S.C. App. 1354, 1355, 1421, 1422, and 1427; 49
U.S.C. 106(g).
Subpart A--General
Sec. 67.01 Applicability.
This part prescribes the medical standards and certification
procedures for issuing medical certificates for airmen and for
remaining eligible for a medical certificate.
Sec. 67.03 Issue.
Except as provided in Sec. 67.05, an applicant who meets the
medical standards prescribed in this part, based on medical examination
and evaluation of the applicant's history and condition, is entitled to
an appropriate medical certificate.
Sec. 67.05 Certification of foreign airmen.
A person who is neither a United States citizen nor a resident
alien is issued a certificate under this part, outside the United
States, only when the Administrator finds that the certificate is
needed for operation of a U.S.-registered aircraft.
Sec. 67.07 Access to the National Driver Register.
At the time of application for a certificate issued under this
part, each person who applies for a medical certificate shall execute
an express consent form authorizing the Administrator to request the
chief driver licensing official of any state designated by the
Administrator to transmit information contained in the National Driver
Register about the person to the Administrator. The Administrator shall
make information received from the National Driver Register, if any,
available on request to the person for review and written comment.
Subpart B--First-Class Airman Medical Certificate
Sec. 67.101 Eligibility.
To be eligible for a first-class airman medical certificate, and to
remain eligible for a first-class airman medical certificate, a person
must meet the requirements of this subpart.
Sec. 67.103 Eye.
Eye standards for a first-class airman medical certificate include,
but are not limited to:
(a) Distant visual acuity of 20/20 or better in each eye separately
with or without corrective lenses. If corrective lenses (spectacles or
contact lenses) are necessary for 20/20 vision, the person may be
eligible only on the condition that corrective lenses are worn while
exercising the privileges of an airman certificate.
(b) Near vision of 20/40, Snellen equivalent, at 16 inches in each
eye separately, with or without corrective lenses. If age 50 or older,
near vision of 20/40, Snellen equivalent, at both 16 inches and 32
inches in each eye separately, with or without corrective lenses.
(c) Ability to perceive those colors necessary for the safe
performance of airman duties.
(d) Normal fields of vision.
(e) No acute or chronic pathological condition of either eye or
adnexa that interferes with the proper function of an eye, that may
reasonably be expected to progress to that degree, or that may
reasonably be expected to be aggravated by flying.
(f) Bifoveal fixation and vergence-phoria relationship sufficient
to prevent a break in fusion under conditions that may reasonably be
expected to occur in performing airman duties. Tests for the factors
named in this paragraph are not required except for persons found to
have more than 1 prism diopter of hyperphoria, 6 prism diopters of
esophoria, or 6 prism diopters of exophoria. If any of these values are
exceeded, the Federal Air Surgeon may require the person to be examined
by a qualified eye specialist to determine if there is bifoveal
fixation and an adequate vergence-phoria relationship. However, if
otherwise eligible, the person is issued a medical certificate pending
the results of the examination.
Sec. 67.105 Ear, nose, throat, and equilibrium.
Ear, nose, throat, and equilibrium standards for a first-class
airman medical certificate include, but are not limited to:
(a) The person shall--
(1) Demonstrate an ability to hear an average conversational voice
in a quiet room, using both ears, at a distance of 6 feet from the
examiner, with the back turned to the examiner;
(2) Demonstrate an acceptable understanding of speech as determined
by audiometric speech discrimination testing to a score of at least 70
percent obtained in one ear or in a sound field environment; or
(3) Provide acceptable results of pure tone audiometric testing of
unaided hearing acuity according to the following table of worst
acceptable thresholds, using the calibration standards of the American
National Standards Institute, 1969:
----------------------------------------------------------------------------------------------------------------
Frequency (Hz) 500 Hz 1000 Hz 2000 Hz 3000 Hz
----------------------------------------------------------------------------------------------------------------
Better ear (Db)............................................. 35 30 30 40
Poorer ear (Db)............................................. 35 50 50 60
----------------------------------------------------------------------------------------------------------------
(b) No disease or condition of the middle or internal ear, nose,
oral cavity, pharynx, or larynx that--
(1) Interferes with, or is aggravated by, flying or may reasonably
be expected to do so or
(2) Interferes with, or may reasonably be expected to interfere
with, clear and effective speech communication.
(c) No disease or condition manifested by, or may reasonably be
expected to be manifested by, vertigo or a disturbance of equilibrium.
Sec. 67.107 Mental.
Mental standards for a first-class airman medical certificate
include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) A personality disorder that is severe enough to have repeatedly
manifested itself by overt acts;
(2) A psychosis. As used in this section, ``psychosis'' refers to a
mental disorder in which the individual has manifested psychotic
symptoms or to a mental disorder in which an individual may reasonably
be expected to manifest psychotic symptoms;
(3) A bipolar disorder; or
(4) Substance dependence, except where there is established
clinical evidence, satisfactory to the Federal Air Surgeon, of
recovery, including sustained total abstinence from alcohol for not
less than the preceding 2 years in the case of alcohol dependence. In
the case of other substance dependence, recovery must include sustained
total abstinence from that substance for not less than the preceding 5
years. As used in this section--
(i) ``Substance'' includes: alcohol; other sedatives and hypnotics;
muscle relaxants; anxiolytics; opioids; central nervous system
stimulants such as cocaine, amphetamines, and similarly acting
sympathomimetics; hallucinogens; phencyclidine or similarly acting
arylcyclohexylamines; cannabis; volatile solvents and gases; and other
psychoactive drugs and chemicals and
(ii) ``Substance dependence'' means a condition in which a person
is dependent on a substance, other than tobacco or ordinary xanthine-
containing (e.g., caffeine) beverages, as evidenced by--
(A) Increased tolerance;
(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment
of social, personal, or occupational functioning.
(b) No substance abuse defined as:
(1) Use of alcohol within the preceding 2 years in a situation in
which that use is physically hazardous, if there has been at any other
time an instance of the use of alcohol or another substance also in a
situation in which that use was physically hazardous;
(2) Use of a substance other than alcohol within the preceding 5
years in a situation in which that use is physically hazardous, if
there has been at any other time an instance of the use of that
substance, alcohol, or another substance also in a situation in which
that use was physically hazardous;
(3) Use of a prohibited drug defined in appendix I of part 121 of
this chapter within the preceding 5 years; or
(4) Misuse of a substance, within the preceding 2 years if alcohol
or within the preceding 5 years if another substance, that the Federal
Air Surgeon, based on case history and appropriate, qualified medical
judgment, finds--
(i) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(ii) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
(c) No other personality disorder, neurosis, or other mental
condition that the Federal Air Surgeon, based on the case history and
appropriate, qualified medical judgment relating to the condition
involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.109 Neurologic.
Neurologic standards for a first-class airman medical certificate
include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) Epilepsy;
(2) A single seizure;
(3) A disturbance of consciousness without satisfactory medical
explanation of the cause; or
(4) A transient loss of control of nervous system function(s)
without satisfactory medical explanation of the cause.
(b) No other seizure disorder, disturbance of consciousness, or
neurologic condition that the Federal Air Surgeon, based on the case
history and appropriate, qualified medical judgment relating to the
condition involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.111 Cardiovascular.
Cardiovascular standards for a first-class airman medical
certificate include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) Myocardial infarction;
(2) Angina pectoris;
(3) Coronary heart disease that has required treatment or, if
untreated, that has been symptomatic or clinically significant;
(4) Cardiac valve replacement;
(5) Permanent cardiac pacemaker implantation; or
(6) Heart replacement;
(b) The person's average systolic blood pressure while sitting must
not exceed 150 millimeters of mercury, and the person's average
diastolic blood pressure while sitting must not exceed 95 millimeters
of mercury. If antihypertensive medication is used or is needed to meet
the requirement of this section, a person may be issued a certificate
only after a current (within the preceding 6 months) satisfactory
medical assessment, prescribed by the Federal Air Surgeon. This medical
assessment may include, but is not limited to, blood pressure control;
the medication used; the presence or absence of cardiovascular risk
factors other than hypertension; other vascular disease; and the
presence or absence of disease of ``target'' organs (e.g., heart,
brain, kidneys, eyes).
(c) The person must not use anticoagulant medication.
(d) A person applying for first-class medical certification must
demonstrate an absence of myocardial infarction and other clinically
significant abnormality on electrocardiographic examination:
(1) At the first application after reaching the 35th birthday,
unless the person has satisfied Sec. 67.211(d)(1) and
(2) On an annual basis after reaching the 40th birthday, unless
within the preceding 9 months an electrocardiogram (ECG) has been
provided as part of an application for medical certification.
(e) An ECG will satisfy a requirement of paragraph (d) of this
section if it is dated no earlier than 60 days before the date of the
application it is to accompany, and was performed and transmitted
according to acceptable standards and techniques.
(f) At the first examination after reaching the 50th birthday and
annually thereafter, the level of total blood cholesterol must be
determined. If the person's total blood cholesterol is determined to be
300 milligrams per deciliter or more, the Federal Air Surgeon may
require the person to submit reports of additional examinations to
determine if disease exists. However, if otherwise eligible, the person
is issued a medical certificate pending the results of those additional
examinations.
Sec. 67.113 General medical condition.
The general medical standards for a first-class airman medical
certificate are:
(a) No established medical history or clinical diagnosis of
diabetes mellitus that requires insulin or any other hypoglycemic drug
for control.
(b) No other organic, functional, or structural disease, defect, or
limitation that the Federal Air Surgeon, based on the case history and
appropriate, qualified medical judgment relating to the condition
involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.115 Discretionary issuance.
A person who does not meet the provisions of Secs. 67.103 through
67.113 of this subpart may apply for the discretionary issuance of a
certificate under Sec. 67.401.
Subpart C--Second-Class Airman Medical Certificate
Sec. 67.201 Eligibility.
To be eligible for a second-class airman medical certificate, and
to remain eligible for a second-class airman medical certificate, a
person must meet the requirements of this subpart.
Sec. 67.203 Eye.
Eye standards for a second-class airman medical certificate
include, but are not limited to:
(a) Distant visual acuity of 20/20 or better in each eye separately
with or without corrective lenses. If corrective lenses (spectacles or
contact lenses) are necessary for 20/20 vision, the person may be
eligible only on the condition that corrective lenses are worn while
exercising the privileges of an airman certificate.
(b) Near vision of 20/40, Snellen equivalent, at 16 inches in each
eye separately, with or without corrective lenses. If age 50 or older,
near vision of 20/40, Snellen equivalent, at both 16 inches and 32
inches in each eye separately, with or without corrective lenses.
(c) Ability to perceive those colors necessary for the safe
performance of airman duties.
(d) Normal fields of vision.
(e) No acute or chronic pathological condition of either eye or
adnexa that interferes with the proper function of an eye, that may
reasonably be expected to progress to that degree, or that may
reasonably be expected to be aggravated by flying.
(f) Bifoveal fixation and vergence-phoria relationship sufficient
to prevent a break in fusion under conditions that may reasonably be
expected to occur in performing airman duties. Tests for the factors
named in this paragraph are not required except for persons found to
have more than 1 prism diopter of hyperphoria, 6 prism diopters of
esophoria, or 6 prism diopters of exophoria. If any of these values are
exceeded, the Federal Air Surgeon may require the person to be examined
by a qualified eye specialist to determine if there is bifoveal
fixation and an adequate vergence-phoria relationship. However, if
otherwise eligible, the person is issued a medical certificate pending
the results of the examination.
Sec. 67.205 Ear, nose, throat, and equilibrium.
Ear, nose, throat, and equilibrium standards for a second-class
airman medical certificate include, but are not limited to:
(a) The person shall--
(1) Demonstrate an ability to hear an average conversational voice
in a quiet room, using both ears, at a distance of 6 feet from the
examiner, with the back turned to the examiner;
(2) Demonstrate an acceptable understanding of speech as determined
by audiometric speech discrimination testing to a score of at least 70
percent obtained in one ear or in a sound field environment; or
(3) Provide acceptable results of pure tone audiometric testing of
unaided hearing acuity according to the following table of worst
acceptable thresholds, using the calibration standards of the American
National Standards Institute, 1969:
----------------------------------------------------------------------------------------------------------------
Frequency (Hz) 500 Hz 1000 Hz 2000 Hz 3000 Hz
----------------------------------------------------------------------------------------------------------------
Better ear (Db)............................................. 35 30 30 40
Poorer ear (Db)............................................. 35 50 30 60
----------------------------------------------------------------------------------------------------------------
(b) No disease or condition of the middle or internal ear, nose,
oral cavity, pharynx, or larynx that--
(1) Interferes with, or is aggravated by, flying or may reasonably
be expected to do so or
(2) Interferes with, or may reasonably be expected to interfere
with, clear and effective speech communication.
(c) No disease or condition manifested by, or may reasonably be
expected to be manifested by, vertigo or a disturbance of equilibrium.
Sec. 67.207 Mental.
Mental standards for a second-class airman medical certificate
include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) A personality disorder that is severe enough to have repeatedly
manifested itself by overt acts;
(2) A psychosis. As used in this section, ``psychosis'' refers to a
mental disorder in which the individual has manifested psychotic
symptoms or to a mental disorder in which an individual may reasonably
be expected to manifest psychotic symptoms;
(3) A bipolar disorder; or
(4) Substance dependence, except where there is established
clinical evidence, satisfactory to the Federal Air Surgeon, of
recovery, including sustained total abstinence from alcohol for not
less than the preceding 2 years in the case of alcohol dependence. In
the case of other substance dependence, recovery must include sustained
total abstinence from that substance for not less than the preceding 5
years. As used in this section--
(i) ``Substance'' includes: alcohol; other sedatives and hypnotics;
muscle relaxants; anxiolytics; opioids; central nervous system
stimulants such as cocaine, amphetamines, and similarly acting
sympathomimetics; hallucinogens; phencyclidine or similarly acting
arylcyclohexylamines; cannabis; volatile solvents and gases; and other
psychoactive drugs and chemicals; and
(ii) ``Substance dependence'' means a condition in which a person
is dependent on a substance, other than tobacco or ordinary xanthine-
containing (e.g., caffeine) beverages, as evidenced by--
(A) Increased tolerance;
(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment
of social, personal, or occupational functioning.
(b) No substance abuse defined as:
(1) Use of alcohol within the preceding 2 years in a situation in
which that use is physically hazardous, if there has been at any other
time an instance of the use of alcohol or another substance also in a
situation in which that use was physically hazardous;
(2) Use of a substance other than alcohol within the preceding 5
years in a situation in which that use is physically hazardous, if
there has been at any other time an instance of the use of that
substance, alcohol, or another substance also in a situation in which
that use was physically hazardous;
(3) Use of a prohibited drug defined in Appendix I of part 121 of
this chapter within the preceding 5 years; and
(4) Misuse of a substance, within the preceding 2 years if alcohol
or within the preceding 5 years if another substance, that the Federal
Air Surgeon, based on case history and appropriate, qualified medical
judgment, finds--
(i) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(ii) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
(c) No other personality disorder, neurosis, or other mental
condition that the Federal Air Surgeon, based on the case history and
appropriate, qualified medical judgment relating to the condition
involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.209 Neurologic.
Neurologic standards for a second-class airman medical certificate
include, but is not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) Epilepsy;
(2) A single seizure;
(3) A disturbance of consciousness without satisfactory medical
explanation of the cause; or
(4) A transient loss of control of nervous system function(s)
without satisfactory medical explanation of the cause;
(b) No other seizure disorder, disturbance of consciousness, or
neurologic condition that the Federal Air Surgeon, based on the case
history and appropriate, qualified medical judgment relating to the
condition involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.211 Cardiovascular.
Cardiovascular standards for a second-class medical certificate
include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) Myocardial infarction;
(2) Angina pectoris;
(3) Coronary heart disease that has required treatment or, if
untreated, that has been symptomatic or clinically significant;
(4) Cardiac valve replacement;
(5) Permanent cardiac pacemaker implantation; or
(6) Heart replacement;
(b) The person's average systolic blood pressure while sitting must
not exceed 150 millimeters of mercury, and the person's average
diastolic blood pressure while sitting must not exceed 95 millimeters
of mercury. If antihypertensive medication is used or is needed to meet
the requirement of this section, a person may be issued a certificate
only after a current (within the preceding 6 months) satisfactory
medical assessment, prescribed by the Federal Air Surgeon, of blood
pressure control; of the medication used; of the presence or absence of
cardiovascular risk factors other than hypertension; of other vascular
disease; and of the presence or absence of disease of ``target'' organs
(e.g., heart, brain, kidneys, or eyes).
(c) The person must not use anticoagulant medication.
(d) A person applying for second-class medical certification must
demonstrate an absence of myocardial infarction and other clinically
significant abnormality on electrocardiographic examination:
(1) At the first application after reaching the 35th birthday,
unless the person has satisfied Sec. 67.111(d)(1) and
(2) On a biennial basis after reaching the 40th birthday, unless
within the preceding 15 months an electrocardiogram (ECG) has been
provided as part of an application for medical certification.
(e) An ECG will satisfy a requirement of paragraph (d) of this
section if it is dated no earlier than 60 days before the date of the
application it is to accompany, and was performed and transmitted
according to acceptable standards and techniques.
Sec. 67.213 General medical condition.
The general medical standards for a second-class airman medical
certificate are:
(a) No established medical history or clinical diagnosis of
diabetes mellitus that requires insulin or any other hypoglycemic drug
for control.
(b) No other organic, functional, or structural disease, defect, or
limitation that the Federal Air Surgeon, based on the case history and
appropriate, qualified medical judgment relating to the condition
involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.215 Discretionary issuance.
A person who does not meet the provisions of Secs. 67.203 through
67.213 of this subpart may apply for the discretionary issuance of a
certificate under Sec. 67.401.
Subpart D--Third-Class Airman Medical Certificate
Sec. 67.301 Eligibility.
To be eligible for a third-class airman medical certificate, or to
remain eligible for a third-class airman medical certificate, a person
must meet the requirements of this subpart.
Sec. 67.303 Eye.
Eye standards for a third-class airman medical certificate include,
but are not limited to:
(a) Distant visual acuity of 20/40 or better in each eye separately
with or without corrective lenses. If corrective lenses (spectacles or
contact lenses) are necessary for 20/40 vision, the person may be
eligible only on the condition that corrective lenses are worn while
exercising the privileges of an airman certificate.
(b) Near vision of 20/40, Snellen equivalent, at 16 inches in each
eye separately, with or without corrective lenses.
(c) Ability to perceive those colors necessary for the safe
performance of airman duties.
(d) No acute or chronic pathological condition of either eye or
adnexa that interferes with the proper function of an eye, that may
reasonably be expected to progress to that degree, or that may
reasonably be expected to be aggravated by flying.
Sec. 67.305 Ear, nose, throat, and equilibrium.
Ear, nose, throat, and equilibrium standards for a third-class
airman medical certificate include, but are not limited to:
(a) The person shall--
(1) Demonstrate an ability to hear an average conversational voice
in a quiet room, using both ears, at a distance of 6 feet from the
examiner, with the back turned to the examiner;
(2) Demonstrate an acceptable understanding of speech as determined
by audiometric speech discrimination testing to a score of at least 70
percent obtained in one ear or in a sound field environment; or
(3) Provide acceptable results of pure tone audiometric testing of
unaided hearing acuity according to the following table of worst
acceptable thresholds, using the calibration standards of the American
National Standards Institute, 1969:
----------------------------------------------------------------------------------------------------------------
Frequency (Hz) 500 Hz 1000 Hz 2000 Hz 3000 Hz
----------------------------------------------------------------------------------------------------------------
Better ear (Db)............................................. 35 30 30 40
Poorer ear (Db)............................................. 35 50 50 60
----------------------------------------------------------------------------------------------------------------
(b) No disease or condition of the middle or internal ear, nose,
oral cavity, pharynx, or larynx that--
(1) Interferes with, or is aggravated by, flying or may reasonably
be expected to do so or
(2) Interferes with clear and effective speech communication.
(c) No disease or condition manifested by, or may reasonably be
expected to be manifested by, vertigo or a disturbance of equilibrium.
Sec. 67.307 Mental.
Mental standards for a third-class airman medical certificate
include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) A personality disorder that is severe enough to have repeatedly
manifested itself by overt acts;
(2) A psychosis. As used in this section, ``psychosis'' refers to a
mental disorder in which the individual has manifested psychotic
symptoms or to a mental disorder in which an individual may reasonably
be expected to manifest psychotic symptoms;
(3) A bipolar disorder; or
(4) Substance dependence, except where there is established
clinical evidence, satisfactory to the Federal Air Surgeon, of
recovery, including sustained total abstinence from alcohol for not
less than the preceding 2 years in the case of alcohol dependence. In
the case of other substance dependence, recovery must include sustained
total abstinence from that substance for not less than the preceding 5
years. As used in this section--
(i) ``Substance'' includes: alcohol; other sedatives and hypnotics;
muscle relaxants; anxiolytics; opioids; central nervous system
stimulants such as cocaine, amphetamines, and similarly acting
sympathomimetics; hallucinogens; phencyclidine or similarly acting
arylcyclohexylamines; cannabis; volatile solvents and gases; and other
psychoactive drugs and chemicals and
(ii) ``Substance dependence'' means a condition in which a person
is dependent on a substance, other than tobacco or ordinary xanthine-
containing (e.g., caffeine) beverages, as evidenced by--
(A) Increased tolerance;
(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment
of social, personal, or occupational functioning.
(b) No substance abuse defined as:
(1) Use of alcohol within the preceding 2 years in a situation in
which that use is physically hazardous, if there has been at any other
time an instance of the use of alcohol or another substance also in a
situation in which that use was physically hazardous;
(2) Use of a substance other than alcohol within the preceding 5
years in a situation in which that use is physically hazardous, if
there has been at any other time an instance of the use of that
substance, alcohol, or another substance also in a situation in which
that use was physically hazardous;
(3) Use of a prohibited drug defined in Appendix I of part 121 of
this chapter within the preceding 5 years; and
(4) Misuse of a substance, within the preceding 2 years if alcohol
or within the preceding 5 years if another substance, that the Federal
Air Surgeon, based on case history and appropriate, qualified medical
judgment, finds--
(i) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(ii) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
(c) No other personality disorder, neurosis, or other mental
condition that the Federal Air Surgeon, based on the case history and
appropriate, qualified medical judgment relating to the condition
involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.309 Neurologic.
Neurologic standards for a third-class airman medical certificate
include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) Epilepsy;
(2) A single seizure;
(3) A disturbance of consciousness without satisfactory medical
explanation of the cause; or
(4) A transient loss of control of nervous system function(s)
without satisfactory medical explanation of the cause; or
(b) No other seizure disorder, disturbance of consciousness, or
neurologic condition that the Federal Air Surgeon, based on the case
history and appropriate, qualified medical judgment relating to the
condition involved, finds--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.311 Cardiovascular.
Cardiovascular standards for a third-class airman medical
certificate include, but are not limited to:
(a) No established medical history or clinical diagnosis of any of
the following:
(1) Myocardial infarction;
(2) Angina pectoris;
(3) Coronary heart disease that has required treatment or, if
untreated, that has been symptomatic or clinically significant;
(4) Cardiac valve replacement;
(5) Permanent cardiac pacemaker implantation; or
(6) Heart replacement.
(b) The person's average systolic blood pressure while sitting must
not exceed 150 millimeters of mercury, and the person's average
diastolic blood pressure while sitting must not exceed 95 millimeters
of mercury. If antihypertensive medication is used or is needed to meet
the requirement of this section, a person may be issued a certificate
only after a current (within the preceding 6 months) satisfactory
medical assessment, prescribed by the Federal Air Surgeon, of blood
pressure control; of the medication used; of the presence or absence of
cardiovascular risk factors other than hypertension; of other vascular
disease; and of the presence or absence of disease of ``target'' organs
(e.g., heart, brain, kidneys, or eyes).
(c) The person must not use anticoagulant medication.
Sec. 67.313 General medical condition.
The general medical standards for a third-class airman medical
certificate are:
(a) No established medical history or clinical diagnosis of
diabetes mellitus that requires insulin or any other hypoglycemic drug
for control.
(b) No other organic, functional, or structural disease, defect, or
limitation that the Federal Air Surgeon, based on the case history and
appropriate, qualified medical judgment relating to the condition
involved, find--
(1) Makes the person unable to safely perform the duties or
exercise the privileges of the airman certificate applied for or held
or
(2) May reasonably be expected, for the maximum duration of the
airman medical certificate applied for or held, to make the person
unable to perform those duties or exercise those privileges.
Sec. 67.315 Discretionary issuance.
A person who does not meet the provisions of Secs. 67.303 through
67.313 of this subpart may apply for the discretionary issuance of a
certificate under Sec. 67.401.
Subpart E--Certification Procedures
Sec. 67.401 Special issuance of medical certificates.
(a) At the discretion of the Federal Air Surgeon, an Authorization
for Special Issuance of a Medical Certificate (Authorization), valid
for a specified period, may be granted to a person who does not meet
the provisions of subparts B, C, or D of this part if the person shows
to the satisfaction of the Federal Air Surgeon that the duties
authorized by the class of medical certificate applied for can be
performed without endangering public safety during the period in which
the Authorization would be in force. The Federal Air Surgeon may
authorize a special medical flight test, practical test, or medical
evaluation for this purpose. A medical certificate of the appropriate
class may be issued to a person who does not meet the provisions of
subparts B, C, or D of this part if that person possesses a valid
Authorization and is otherwise eligible. An airman medical certificate
issued in accordance with this section shall expire no later than the
end of the validity period or upon the withdrawal of the Authorization
upon which it is based. At the end of its specified validity period,
for grant of a new Authorization, the person must again show to the
satisfaction of the Federal Air Surgeon that the duties authorized by
the class of medical certificate applied for can be performed without
endangering public safety during the period in which the Authorization
would be in force.
(b) At the discretion of the Federal Air Surgeon, a Statement of
Demonstrated Ability (SODA) may be granted, instead of an
Authorization, to a person whose disqualifying condition is static or
nonprogressive and who has been found capable of performing airman
duties without endangering public safety. A SODA does not expire and
authorizes a designated Aviation Medical Examiner to issue a medical
certificate of a specified class if the examiner finds that the
condition described on its face has not adversely changed.
(c) In granting an Authorization or a SODA, the Federal Air Surgeon
may consider the person's operational experience and any medical facts
that may affect the ability of the person to perform airman duties
including--
(1) The combined effect on the person of failure to meet more than
one requirement of this part and
(2) The prognosis derived from professional consideration of all
available information regarding the person.
(d) In granting an Authorization under this section, the Federal
Air Surgeon specifies the class of medical certificate authorized to be
issued and may do any or all of the following:
(1) Limit the duration of the Authorization;
(2) Condition the granting of a new Authorization on the results of
subsequent medical tests, examinations, or evaluations;
(3) State on the Authorization, and any certificate based upon it,
any operational limitation needed for safety; or
(4) Condition the continued effect of an Authorization, and any
second- or third-class medical certificate based upon it, on compliance
with a statement of functional limitations issued to the person in
coordination with the Director of Flight Standards or the Director's
designee.
(e) In determining whether an Authorization or SODA should be
granted to an applicant for a third-class medical certificate, the
Federal Air Surgeon considers the freedom of an airman, exercising the
privileges of a private pilot certificate, to accept reasonable risks
to his or her person and property that are not acceptable in the
exercise of commercial or airline transport privileges, and, at the
same time, considers the need to protect the safety of persons and
property in other aircraft and on the ground.
(f) An Authorization or SODA granted under the provisions of this
section to a person who does not meet the applicable provisions of
subparts B, C, or D of this part may be withdrawn, at the discretion of
the Federal Air Surgeon, at any time if--
(1) There is adverse change in the holder's medical condition;
(2) The holder fails to comply with a statement of functional
limitations or operational limitations issued as a condition of
certification under this section;
(3) Public safety would be endangered by the holder's exercise of
airman privileges;
(4) The holder fails to provide medical information reasonably
needed by the Federal Air Surgeon for certification under this section;
or
(5) The holder makes or causes to be made a fraudulent or
intentionally false statement or an incorrect statement--
(i) In support of his or her request for an Authorization or SODA
or
(ii) In any entry in any logbook, record, or report that is kept,
made, or used, to show compliance with any requirement for an
Authorization or SODA.
(g) A person who has been granted an Authorization or SODA under
this section based on a special medical flight or practical test need
not take the test again during later physical examinations unless the
Federal Air Surgeon determines or has reason to believe that the
physical deficiency has or may have degraded to a degree to require
another special medical flight or practical test.
(h) The authority of the Federal Air Surgeon under this section is
also exercised by the Manager, Aeromedical Certification Division and
each Regional Flight Surgeon.
(i) If an Authorization or SODA is withdrawn under paragraph (f) of
this section the following procedures apply:
(1) The holder of the Authorization or SODA will be personally
served or mailed a letter of withdrawal, stating the reason for the
action;
(2) By not later than 60 days after the service or mailing of the
letter of withdrawal, the holder of the Authorization or SODA may
request, in writing, that the Federal Air Surgeon provide for review of
the decision to withdraw. The request for review may be accompanied by
supporting medical evidence;
(3) Within 60 days of receipt of a request for review, a written
final decision either affirming or reversing the decision to withdraw
will be issued; and
(4) A medical certificate rendered invalid pursuant to a
withdrawal, in accordance with paragraph (a) of this section, shall be
surrendered to the Administrator upon request.
(j) No grant of a special issuance made prior to (the effective
date of this rule) may be used to obtain a medical certificate after
the earlier of the following dates:
(1) (One year after the effective date of this rule) or
(2) The date on which the holder of such special issuance is
required to provide additional information to the FAA as a condition
for continued medical certification.
Sec. 67.403 Applications, certificates, logbooks, reports, and
records: falsification, reproduction, or alteration.
(a) No person may make or cause to be made--
(1) A fraudulent or intentionally false statement on any
application for a medical certificate or on a request for any
Authorization for Special Issuance of a Medical Certificate
(Authorization) or Statement of Demonstrated Ability (SODA) under this
part;
(2) A fraudulent or intentionally false entry in any logbook,
record, or report that is kept, made, or used, to show compliance with
any requirement for any medical certificate or for any Authorization or
SODA under this part;
(3) A reproduction, for fraudulent purposes, of any medical
certificate under this part; or
(4) An alteration of any medical certificate under this part.
(b) The commission by any person of an act prohibited under
paragraph (a) of this section is a basis for--
(1) Suspending or revoking all airman, ground instructor, and
medical certificates and ratings held by that person;
(2) Withdrawing all Authorizations or SODA's held by that person;
and
(3) Denying all applications for medical certification and requests
for Authorizations or SODA's.
(c) The making of an incorrect statement in support of any
application for a medical certificate or request for any Authorization
or SODA or the making of an incorrect entry in any logbook, record, or
report that is kept, made, or used, to show compliance with any
requirement for any medical certificate or any Authorization or SODA is
a basis for suspending or revoking the medical certificate or
withdrawing the Authorization or SODA or for denying an application for
medical certification or a request for an Authorization or SODA.
Sec. 67.405 Medical examinations: Who may give.
(a) First-class. Any aviation medical examiner who is specifically
designated for the purpose may give the examination for the first-class
certificate. Any interested person may obtain a list of these aviation
medical examiners, in any area, from the FAA Regional Flight Surgeon of
the region in which the area is located.
(b) Second- and third-class. Any aviation medical examiner may give
the examination for the second- or third-class certificate. Any
interested person may obtain a list of aviation medical examiners, in
any area, from the FAA Regional Flight Surgeon of the region in which
the area is located.
Sec. 67.407 Delegation of authority.
(a) The authority of the Administrator, under section 602 of the
Federal Aviation Act of 1958 (49 U.S.C. App. 1422), to issue or deny
medical certificates is delegated to the Federal Air Surgeon to the
extent necessary to--
(1) Examine applicants for and holders of medical certificates to
determine whether they meet applicable medical standards and
(2) Issue, renew, and deny medical certificates, and issue, renew,
deny, and withdraw Authorizations for Special Issuance of a Medical
Certificate and Statements of Demonstrated Ability to a person based
upon meeting or failing to meet applicable medical standards.
(b) Subject to limitations in this chapter, the delegated functions
of the Federal Air Surgeon to examine applicants for and holders of
medical certificates for compliance with applicable medical standards
and to issue, renew, and deny medical certificates are also delegated
to aviation medical examiners and to authorized representatives of the
Federal Air Surgeon within the FAA.
(c) The authority of the Administrator, under subsection 314(b) of
the Federal Aviation Act of 1958 (49 U.S.C. App. 1355(b)), to
reconsider the action of an aviation medical examiner is delegated to
the Federal Air Surgeon; the Manager, Aeromedical Certification
Division; and each Regional Flight Surgeon. Where the person does not
meet the standards of Secs. 67.107(c), 67.109(b), 67.113(b), 67.207(c),
67.209(b), 67.213(b), 67.307(c), 67.309(b), or 67.313(b), any action
taken under this paragraph other than by the Federal Air Surgeon is
subject to reconsideration by the Federal Air Surgeon. A certificate
issued by an aviation medical examiner is considered to be affirmed as
issued unless an FAA official named in this paragraph (authorized
official) reverses that issuance within 60 days after the date of
issuance. However, if within 60 days after the date of issuance an
authorized official requests the certificate holder to submit
additional medical information, an authorized official may reverse the
issuance within 60 days after receipt of the requested information.
(d) The authority of the Administrator, under section 609 of the
Federal Aviation Act of 1958 (49 U.S.C. App. 1429), to re-examine any
civil airman to the extent necessary to determine an airman's
qualification to continue to hold an airman medical certificate, is
delegated to the Federal Air Surgeon and his or her authorized
representatives within the FAA.
Sec. 67.409 Denial of medical certificate.
(a) Any person who is denied a medical certificate by an aviation
medical examiner may, within 30 days after the date of the denial,
apply in writing and in duplicate to the Federal Air Surgeon,
Attention: Manager, Aeromedical Certification Division, AAM-300,
Federal Aviation Administration, P.O. Box 26080, Oklahoma City,
Oklahoma 73126, for reconsideration of that denial. If the person does
not ask for reconsideration during the 30-day period after the date of
the denial, he or she is considered to have withdrawn the application
for a medical certificate.
(b) The denial of a medical certificate--
(1) By an aviation medical examiner is not a denial by the
Administrator under section 602 of the Federal Aviation Act of 1958 (49
U.S.C. App. 1422);
(2) By the Federal Air Surgeon is considered to be a denial by the
Administrator under section 602 of the Act; and
(3) By the Manager, Aeromedical Certification Division, or a
Regional Flight Surgeon is considered to be a denial by the
Administrator under section 602 of the Act except where the applicant
does not meet the standards of Secs. 67.107(c), 67.109(b), or
67.113(b); 67.207(c), 67.209(b), or 67.213(b); or 67.307(c), 67.309(b),
or 67.313(b).
(c) Any action taken under Sec. 67.407(c) that wholly or partly
reverses the issue of a medical certificate by an aviation medical
examiner is the denial of a medical certificate under paragraph (b) of
this section.
(d) If the issue of a medical certificate is wholly or partly
reversed by the Federal Air Surgeon; the Manager, Aeromedical
Certification Division; or a Regional Flight Surgeon, the person
holding that certificate shall surrender it, upon request of the FAA.
Sec. 67.411 Medical certificates by flight surgeons of Armed Forces.
(a) The FAA has designated flight surgeons of the Armed Forces on
specified military posts, stations, and facilities, as aviation medical
examiners.
(b) An aviation medical examiner described in paragraph (a) of this
section may give physical examinations for the FAA medical certificates
to applicants who are on active duty or who are, under Department of
Defense medical programs, eligible for FAA medical certifications as
civil airmen. In addition, such an examiner may issue or deny an
appropriate FAA medical certificate in accordance with the regulations
of this chapter and the policies of the FAA.
(c) Any interested person may obtain a list of the military posts,
stations, and facilities at which a flight surgeon has been designated
as an aviation medical examiner from the Surgeon General of the Armed
Force concerned or from the Manager, Aeromedical Education Division,
AAM-400, Federal Aviation Administration, P.O. Box 26082, Oklahoma
City, Oklahoma 73125.
Sec. 67.413 Medical records.
(a) Whenever the Administrator finds that additional medical
information or history is necessary to determine whether an applicant
for or the holder of a medical certificate meets the medical standards
for it, the Administrator requests that person to furnish that
information or to authorize any clinic, hospital, physician, or other
person to release to the Administrator all available information or
records concerning that history. If the applicant or holder fails to
provide the requested medical information or history or to authorize
the release so requested, the Administrator may suspend, modify, or
revoke all medical certificates the airman holds or may, in the case of
an applicant, deny the application for an airman medical certificate.
(b) If an airman medical certificate is suspended, modified, or
revoked under paragraph (a) of this section, that suspension,
modification, or revocation remains in effect until the requested
information, history, or authorization is provided to the FAA and until
the Federal Air Surgeon determines whether the person meets the medical
standards under this part.
Sec. 67.415 Return of medical certificate after suspension or
revocation.
The holder of any medical certificate issued under this part that
is suspended or revoked shall, upon the Administrator's request, return
it to the Administrator.
Issued in Washington, D.C. on October 17, 1994.
Jon L. Jordon,
Federal Air Surgeon, Federal Aviation Administration.
[FR Doc. 94-26047 Filed 10-18-94; 8:45 am]
BILLING CODE 4910-13-P
