If there is one thing on which most pilots agree, it is their disdain for the FAA’s medical requirements. Some tests required by the FAA are invasive and expensive prompting even physicians to balk at the costs of providing flight-fitness proof. Cardiovascular testing is at the forefront of this controversy. Some of the testing required for commercial privileges even have mortality rates associated with them. For most pilots obtaining FAA medical certification with a cardiovascular issue is a very inefficient process yet there is an effective and timely solution for almost every condition of the heart.
Cardiovascular issues are common and they are also the leading cause of death in the United States. Issues of the heart are also the leading cause of FAA medical certificate denial. In many ways, FAA medical standards for matters of the heart are liberal considering that few cardiovascular issues are ultimately disqualifying. The US-FAA medical system can be more permissive than other countries but that does not mean that the process for FAA medical approval is simple. Dealing with the FAA medical authorities is usually not so much a medical challenge as it is a bureaucratic one. The primary solution to gaining FAA acceptance is eloquent customized paperwork.
Simple issues such as hypertension (high blood pressure), cholesterol, heart murmurs, or an unusual EKG/ECG may ground pilots for months while they gather evidence that shows they are fit to fly. Many pilots are caught off-guard since they have passed medicals for years and the required paperwork is likely an intrusion in their private physician’s daily routine.
In 2017 there were more than 62,595 hypertensive pilots who reported taking medication, making blood pressure the foremost cardiovascular issue with pilots. When considering your blood pressure, if the systolic number is above 155 or the diastolic value is over 95, expect to be grounded until it is lowered and the FAA is satisfied that a serious heart problem is not the cause. The FAA accepts most medications to control hypertension but only on a case-by-case basis. To avoid unnecessary grounding have your blood pressure checked regularly. If you pressure has been running high, have your documents well-groomed before your date with the Aviation Medical Examiner (AME).
Hyperlipidemia which includes issues such as elevated cholesterol is usually not an overarching concern of the FAA and generally, there are no particular values which are required for FAA acceptance. If, however, your private physician prescribes medication to manage your lipids this can be a factor which will affect medical certification. If your doctor has written a prescription for a medicine to improve your cholesterol values, this is almost always acceptable to the FAA provided there is clear documentation. In fact, many cardiovascular medications are acceptable to the FAA. One prominent exception is medication to control heart-related chest pain or “angina”. A list of approved medications can be found on the Accepted Medications List HERE. The medical condition which the medication has been prescribed for usually drives the FAA’s decision.
Abnormal EKG/ECG results are another common cause of FAA medical delays. Electrocardiogram (ECG/EKG) testing is not routinely performed by AME’s unless you have had at least 35 birthdays and require a Class One physical. If certain cardiac arrhythmias are discovered, the AME will likely defer the medical certification decision to the actual FAA in Oklahoma. Regular checkups from a private doctor may prevent this. If an issue surfaces, complete whatever testing your physician recommends along with his eloquently detailed letter outlining the results. This can spell the difference between being an FAA medical certificate being issued and being delayed by several months.
There are several conditions which require the actual FAA (not an AME) to make the FAA medical certification decision. Six of the 15 disqualifying conditions in the medical FAR’s relate to the heart:
(1) Angina Pectoris (chest pain)
(2) Coronary Heart Disease that requires treatment or is clinically significant
(3) Myocardial Infarction (heart attack)
(4) Cardiac Valve Replacement
(5) Permanent Cardiac Pacemaker
(6) Heart Replacement
Of these, only persistent chest pain is absolutely disqualifying. The FAA may certify the others under FAR 67.401, known as Special Issuance. Special Issuance is the “Mother-May-I” of medical certification. Pilots willing to undergo testing may be certified despite their inability to meet the FAA’s primary medical standards. The FAA’s decision is based on the quality of documentation provided and the severity of the condition.
For favorable FAA consideration, a comprehensive cardiovascular evaluation should be performed. This should include pertinent case-specific testing. Again, an eloquent letter from the managing physician outlining the pilot’s complete history and status is essential. This “narrative” letter should read like a story-book and should include medical, family and social history. Obviously, it is advantageous if the narrative letter has a favorable tone with closing remarks such as: “I believe this pilot is at low risk for an incapacitating event” and/ or “may pilot an aircraft safely and without endangering public safety.” Nevertheless, don’t expect the FAA to take your physician’s word for it. Diagnostic-quality copies of all testing results must support his opinion and these results must be congruent with the FAA’s policies.