An AMEs Thoughts On Gaining A Special Issuance

[WindOnHisNose]

So, you have developed a disqualifying condition for holding an FAA medical certificate and you are faced with the daunting task of dealing with the FAA. What follows are some thoughts from my perspective...as an AME who happens to be a pilot.

First, it is important to understand your mission with regards to aviation. Are you wanting to simply be able to fly relatively close to home on a VFR day, or are you wanting to do more demanding flying (IFR work, etc). Once you understand your mission you have taken a big step in understanding what your plan of action should be.

Let's assume you have had a valid 3rd Class FAA medical. Is your condition medically disqualifying for BasicMed? If so, you are committed to getting a Special Issuance.

Let's assume, for now, that it is disqualifying for an FAA certificate, and the next question is: Must I report it to the FAA? This is, in my opinion, a very gray area, but there are several Shades of Gray! Let's say, for example, that you have been diagnosed with colon cancer. That is disqualifying for any class of FAA medical, but not for BasicMed, provided that the Doc who signed off on BasicMed is OK with that. If she/he is not OK with that you are grounded.

If you are already carrying a 3rd Class FAA medical AND a BasicMed, you can fly under BasicMed PROVIDED that you have informed your BasicMed doc and she/he is OK with that. In my opinion, you do not need to notify the FAA and you may choose to simply let the FAA 3rd class medical expire and continue to fly under BasicMed, again provided that the certifying Doc is OK with this.

Let's consider the scenario in which you want/need a valid FAA medical certificate. It is my feeling that you contact your AME, or your Regional Flight Surgeon's (RFS) office and ask what you will need to provide in order to successfully gain a FAA medical. It is my suggestion, in most cases, to contact the RFS and get it right from the horse's mouth. Things/criteria change from time to time and the RFS office will provide the most recent algorithm. Document what you have been told and do EXACTLY what they suggest. Share this/confirm with your AME, so you are on the same page and provide EXACTLY that information. I would suggest that you and your AME not try to second guess the RFS, but rather Just Do It.

Do the testing/consults per the RFS, collect the results and prepare to submit to the FAA. The next question revolves around who submits this data to the FAA? The answer to this is dictated by the following consideration:

If you directly submit this information/data to the FAA you should do so by first saving a copy of all the information, then mailing/shipping the packet to the FAA, per the directions provided by the RFS. Now, here is what happens when the packet arrives at the RFS or OKC...the packet is placed in the cubicle of a poor, unsuspecting person whose job is to open the packet, walk to a scanning machine, then scanning the pages into your specific record. Does it all go in as one file? No. It is divided into sections. For example, there may be a laboratory section, a diagnostic imaging section, an opthalmologic section, an operative note section, a hospitalization section and a specific file is created for each category. It isn't all scanned into one file. Each file has your name associated with it, but they are likely all separate. Now, this step typically takes 2-3 weeks, and your case will not be reviewed until all requested information is received. Yes, a 2-3 week lag period.

Another option is to take advantage of a new process (in 2024) by which your AME can upload scanned images of the requested documents directly into your FAA account. This circumvents the 2-3 week delay, folks. Pretty nice, eh? Well, pretty nice except that this places the burden to upload the information onto your AME, and she/he may not be willing to do so. Whose responsibility is it to get the info to the FAA? Your responsibility, unless your AME is willing to take the monkey off your back and do it for you...speeding things up considerably.

No brainer, right? So, what's the catch? The AME has to be willing to take the monkey from your back, put it on hers/his. Further, the AME can load up to 20-ish files at a time, but EACH FILE MUST BE LESS THAN 3 MEGABYTES WORTH OF DATA! This is really a problem, in that it doesn't take many pages of scanned data to exceed 3 megabytes. What if you gave your AME a single file (you scanned it yourself) that is 10 megabytes? Your AME cannot upload the data unless it is broken down into smaller pieces (a hassle) or unless your AME contacts you and says "Hey, break this down into separate files (each <3 megabytes) and send them to me! Then I'll upload them!"

Here's the problem with this scenario...if your AME has a staff to whom she/he simply hands over this to...no big deal! But this does take time, and time is money. What if the AME is like me (I am the chief cook and bottle washer) and I am the one who is doing this relatively menial task? The latter AME may say "Pardner, gather up that data and send it to the RFS or OKC yourself.

If you are now tasked with getting this data in yourself, how do you do so? Can you scan it and put the data on a cheap flash drive and mail to OKC? No. I was informed by my contact at the FAA that the government is unlikely to stick a stinkin' thumb drive into any of their computers! Man, I don't blame them.

So, you need to mail/ship the packet to the FAA, and it is my opinion that you organize the data into sections (per the directions given by the FAA) so that when the poor stiff who is sitting in that cubicle in OKC opens up the packet she/he sees the organized sections and they scan the sections in one at a time. Take the packet to FedEx or UPS or USPS and have it mailed as "registered mail" with a tracking number, etc, so as to be able to track the packet! Do Not Send via regular snail mail!

Something that is frustrating to me, as a solo AME without staff, is that the pilot is left with the impression that she/he is to give the requested information to the AME so that we can upload the data. O' Contrar! The responsibility to do so is with the pilot, not with the AME. The pilot needs to understand the process and negotiate this with the AME, not just assume they will take care of it!

In another thread here, Matt Hartman MD AME, suggested it counter productive to "badger" the FAA to see what the status might be, with your application. I totally agree, but here is a tip for your consideration...

I have found that it is difficult for me, as an AME, to get a response from our RFS. I can send messages until the cows come home, with little response. There was a time when our RFS promptly and effectively responded to messages/phone calls and we had great communication. This varies from region to region, folks, and is relatively ineffective and really frustrating for me/your AME! I have found, however, that each RFS office have "technical specialists" who generally work from home and are really knowledgeable and helpful! They know the system. They know their RFS. They are generally quite knowledgeable and can be EXTREMELY helpful to me in gaining an expedient disposition, shall we say, of your medical file. Really, these people are worth their weight in gold, and I greatly value the relationship I have developed with a specific technical specialist. This has been helpful, as these people tend to be in a position to help longer than a RFS. Not all RFS or specialists are the same, but I have found that if I treat them with respect I am better able to help those who honor me as their AME!

Enough dribble. Here is the synopsis:

1. Determine your aviation mission;
2. Determine what certificate you need;
3. Do NOT "get denied"...to do so is Game Over!
4. Follow directions for SI completely!
5. Determine how you will get the data to the FAA (you vs your AME)
6. Execute data submission (you vs AME)
7. Keep your fingers crossed!
8. Do not "get denied"!

I know this was a long post, but this stuff is important to fully understand. I truly hope this helps you.

Hey, you like this post/information? Support Supercub.org in some fashion! Personally, I moderate this forum because I believe in the mission of Supercub.org. If you respond and have questions and are not a supporter....sorry, sign up and gain access to lots of what I think is good information. If not willing to support, I wish you a good day!

Doc Randy

 

[jimcrawford01]

So, you have developed a disqualifying condition for holding an FAA medical certificate and you are faced with the daunting task of dealing with the FAA. What follows are some thoughts from my perspective...as an AME who happens to be a pilot.

First, it is important to understand your mission with regards to aviation. Are you wanting to simply be able to fly relatively close to home on a VFR day, or are you wanting to do more demanding flying (IFR work, etc). Once you understand your mission you have taken a big step in understanding what your plan of action should be.

Let's assume you have had a valid 3rd Class FAA medical. Is your condition medically disqualifying for BasicMed? If so, you are committed to getting a Special Issuance.

Let's assume, for now, that it is disqualifying for an FAA certificate, and the next question is: Must I report it to the FAA? This is, in my opinion, a very gray area, but there are several Shades of Gray! Let's say, for example, that you have been diagnosed with colon cancer. That is disqualifying for any class of FAA medical, but not for BasicMed, provided that the Doc who signed off on BasicMed is OK with that. If she/he is not OK with that you are grounded.

If you are already carrying a 3rd Class FAA medical AND a BasicMed, you can fly under BasicMed PROVIDED that you have informed your BasicMed doc and she/he is OK with that. In my opinion, you do not need to notify the FAA and you may choose to simply let the FAA 3rd class medical expire and continue to fly under BasicMed, again provided that the certifying Doc is OK with this.

Let's consider the scenario in which you want/need a valid FAA medical certificate. It is my feeling that you contact your AME, or your Regional Flight Surgeon's (RFS) office and ask what you will need to provide in order to successfully gain a FAA medical. It is my suggestion, in most cases, to contact the RFS and get it right from the horse's mouth. Things/criteria change from time to time and the RFS office will provide the most recent algorithm. Document what you have been told and do EXACTLY what they suggest. Share this/confirm with your AME, so you are on the same page and provide EXACTLY that information. I would suggest that you and your AME not try to second guess the RFS, but rather Just Do It.

Do the testing/consults per the RFS, collect the results and prepare to submit to the FAA. The next question revolves around who submits this data to the FAA? The answer to this is dictated by the following consideration:

If you directly submit this information/data to the FAA you should do so by first saving a copy of all the information, then mailing/shipping the packet to the FAA, per the directions provided by the RFS. Now, here is what happens when the packet arrives at the RFS or OKC...the packet is placed in the cubicle of a poor, unsuspecting person whose job is to open the packet, walk to a scanning machine, then scanning the pages into your specific record. Does it all go in as one file? No. It is divided into sections. For example, there may be a laboratory section, a diagnostic imaging section, an opthalmologic section, an operative note section, a hospitalization section and a specific file is created for each category. It isn't all scanned into one file. Each file has your name associated with it, but they are likely all separate. Now, this step typically takes 2-3 weeks, and your case will not be reviewed until all requested information is received. Yes, a 2-3 week lag period.

Another option is to take advantage of a new process (in 2024) by which your AME can upload scanned images of the requested documents directly into your FAA account. This circumvents the 2-3 week delay, folks. Pretty nice, eh? Well, pretty nice except that this places the burden to upload the information onto your AME, and she/he may not be willing to do so. Whose responsibility is it to get the info to the FAA? Your responsibility, unless your AME is willing to take the monkey off your back and do it for you...speeding things up considerably.

No brainer, right? So, what's the catch? The AME has to be willing to take the monkey from your back, put it on hers/his. Further, the AME can load up to 20-ish files at a time, but EACH FILE MUST BE LESS THAN 3 MEGABYTES WORTH OF DATA! This is really a problem, in that it doesn't take many pages of scanned data to exceed 3 megabytes. What if you gave your AME a single file (you scanned it yourself) that is 10 megabytes? Your AME cannot upload the data unless it is broken down into smaller pieces (a hassle) or unless your AME contacts you and says "Hey, break this down into separate files (each <3 megabytes) and send them to me! Then I'll upload them!"

Here's the problem with this scenario...if your AME has a staff to whom she/he simply hands over this to...no big deal! But this does take time, and time is money. What if the AME is like me (I am the chief cook and bottle washer) and I am the one who is doing this relatively menial task? The latter AME may say "Pardner, gather up that data and send it to the RFS or OKC yourself.

If you are now tasked with getting this data in yourself, how do you do so? Can you scan it and put the data on a cheap flash drive and mail to OKC? No. I was informed by my contact at the FAA that the government is unlikely to stick a stinkin' thumb drive into any of their computers! Man, I don't blame them.

So, you need to mail/ship the packet to the FAA, and it is my opinion that you organize the data into sections (per the directions given by the FAA) so that when the poor stiff who is sitting in that cubicle in OKC opens up the packet she/he sees the organized sections and they scan the sections in one at a time. Take the packet to FedEx or UPS or USPS and have it mailed as "registered mail" with a tracking number, etc, so as to be able to track the packet! Do Not Send via regular snail mail!

Something that is frustrating to me, as a solo AME without staff, is that the pilot is left with the impression that she/he is to give the requested information to the AME so that we can upload the data. O' Contrar! The responsibility to do so is with the pilot, not with the AME. The pilot needs to understand the process and negotiate this with the AME, not just assume they will take care of it!

In another thread here, Matt Hartman MD AME, suggested it counter productive to "badger" the FAA to see what the status might be, with your application. I totally agree, but here is a tip for your consideration...

I have found that it is difficult for me, as an AME, to get a response from our RFS. I can send messages until the cows come home, with little response. There was a time when our RFS promptly and effectively responded to messages/phone calls and we had great communication. This varies from region to region, folks, and is relatively ineffective and really frustrating for me/your AME! I have found, however, that each RFS office have "technical specialists" who generally work from home and are really knowledgeable and helpful! They know the system. They know their RFS. They are generally quite knowledgeable and can be EXTREMELY helpful to me in gaining an expedient disposition, shall we say, of your medical file. Really, these people are worth their weight in gold, and I greatly value the relationship I have developed with a specific technical specialist. This has been helpful, as these people tend to be in a position to help longer than a RFS. Not all RFS or specialists are the same, but I have found that if I treat them with respect I am better able to help those who honor me as their AME!

Enough dribble. Here is the synopsis:

1. Determine your aviation mission;
2. Determine what certificate you need;
3. Do NOT "get denied"...to do so is Game Over!
4. Follow directions for SI completely!
5. Determine how you will get the data to the FAA (you vs your AME)
6. Execute data submission (you vs AME)
7. Keep your fingers crossed!
8. Do not "get denied"!

I know this was a long post, but this stuff is important to fully understand. I truly hope this helps you.

Hey, you like this post/information? Support Supercub.org in some fashion! Personally, I moderate this forum because I believe in the mission of Supercub.org. If you respond and have questions and are not a supporter....sorry, sign up and gain access to lots of what I think is good information. If not willing to support, I wish you a good day!

Doc Randy

Thank You for your continuing efforts to keep us informed.
Much appreciated!!

 

[DENNY]

I had to get a Special issuance before I took my first flying lesson. I had a MI at the age of 40 and did not start flying until I was 51. It took about 9 months, and was a great learning experience. Every year to keep my class 3 I would spend 30 or more hours getting special tests, hand carrying documents, and personally getting hard copy of everything to the FISDO. I made sure to be polite and thank the staff for all there hard work!! After a few years they knew me by first name. I did all of this while working 50 hour a week job. I had to get a second one after my Bypass surgery. By this time I was well acquainted with all the procedures and it only took 3 months once all paperwork was delivered. Total 6 mo from surgery. Most of us have seen hundreds of thousands of dollars and thousands of hours over the years to be able to fly don't throw it out the window to avoid a few hours of extra work. It is frustrating dealing with the system but with the proper attitude it can be done. My list below.
1. Read every post Randy has made on Special Issuance
2. Get help!! AOPA has a medical advice section use them
3. Get more help! Use an aviation medical service, this is just one I found online.https://www.aviationmedicine.com/about-amas/faq/
4. Get more help! Get intact with professional pilots for the best service and AME to work with.
5. Vet the AME you are going to use. Randy is a dedicated professional as are most medical types but some just don't want to deal with all the hassle and IT IS A LOT!!
6. DO NOT GO CHEAP ON TIME OR MONEY!!!! You won't be flying so take all that gas money and time to get it done. Yes it may take more time to drive the extra 3-6 hours to the right AME or consultant, but it is worth it. Every doctor I deal with is a pilot it helps a lot!! Don't expect a AME to spend two or more hours going over paperwork for 100 bucks a lot happens after you leave the room. They have a big overhead so pay them what they are worth!
7. Don't lie or cut corners. Make sure aIl the information is correct (have it reviewed by medical services/AOPA) I think Randy mentioned only 3 % or so are denied just do it right.
8. Don't let yourself get into the big man is out to get me pity game. It is going to take time so go to the cupboard and get a big glass of SUCK IT UP. Once all the paperwork is done take the wife on that trip she always wanted to do, Rebuild the engine, fix all the little things you have been putting off on the plane. Get all the other crap including annual done so when it comes through you can fly. You are not going to forget how to fly in 6 months and after a few years it will just be a distant memory.
GOOD LUCK
DENNY

 

[WindOnHisNose]

I had to get a Special issuance before I took my first flying lesson. I had a MI at the age of 40 and did not start flying until I was 51. It took about 9 months, and was a great learning experience. Every year to keep my class 3 I would spend 30 or more hours getting special tests, hand carrying documents, and personally getting hard copy of everything to the FISDO. I made sure to be polite and thank the staff for all there hard work!! After a few years they knew me by first name. I did all of this while working 50 hour a week job. I had to get a second one after my Bypass surgery. By this time I was well acquainted with all the procedures and it only took 3 months once all paperwork was delivered. Total 6 mo from surgery. Most of us have seen hundreds of thousands of dollars and thousands of hours over the years to be able to fly don't throw it out the window to avoid a few hours of extra work. It is frustrating dealing with the system but with the proper attitude it can be done. My list below.
1. Read every post Randy has made on Special Issuance
2. Get help!! AOPA has a medical advice section use them
3. Get more help! Use an aviation medical service, this is just one I found online.https://www.aviationmedicine.com/about-amas/faq/
4. Get more help! Get intact with professional pilots for the best service and AME to work with.
5. Vet the AME you are going to use. Randy is a dedicated professional as are most medical types but some just don't want to deal with all the hassle and IT IS A LOT!!
6. DO NOT GO CHEAP ON TIME OR MONEY!!!! You won't be flying so take all that gas money and time to get it done. Yes it may take more time to drive the extra 3-6 hours to the right AME or consultant, but it is worth it. Every doctor I deal with is a pilot it helps a lot!! Don't expect a AME to spend two or more hours going over paperwork for 100 bucks a lot happens after you leave the room. They have a big overhead so pay them what they are worth!
7. Don't lie or cut corners. Make sure aIl the information is correct (have it reviewed by medical services/AOPA) I think Randy mentioned only 3 % or so are denied just do it right.
8. Don't let yourself get into the big man is out to get me pity game. It is going to take time so go to the cupboard and get a big glass of SUCK IT UP. Once all the paperwork is done take the wife on that trip she always wanted to do, Rebuild the engine, fix all the little things you have been putting off on the plane. Get all the other crap including annual done so when it comes through you can fly. You are not going to forget how to fly in 6 months and after a few years it will just be a distant memory.
GOOD LUCK
DENNY

What Denny says! I am a big fan of AOPA medical services. Thanks, Denny!

rsc

 

[mhartman123]

Could not agree with Doc Randy and Denny more. I’m somewhat new in the world of doing AME work, but I have found that getting a pilot a special issuance is really an exercise in being thorough, complete, organized, PERSISTENT, and PATIENT!

What really helps AME’s and greases the wheels in OKC:
1.) bring hard copies of all letters from the FAA and doctors notes from pertinent hospital/clinic encounters. (Not “after visit summaries” which are worthless)
2.) make sure the AME knows that this is going to take 1-2 hrs so they can block out enough time and not have to rush/cut corners to stay on time in clinic.
3.) don’t let your non-AME doctor talk you into getting a study that is different than what the FAA specifically requests. For example, the FAA wants an exercise EKG stress test, don’t let your cardiologist order a nuclear medicine stress test. How do you make sure this happens correctly? Bring the letter from the FAA to the cardiologist or read it specifically to them over the phone so they know exactly what is being requested.
4.) Anytime you are submitting medical records to OKC, any diagnosis that you currently or previously have/had will likely be written somewhere in the records you are mailing in. The last thing you want is to wait six months only for the FAA to send you a letter asking for more info regarding your history of anxiety or low thyroid that you forgot to mention in your Medxpress application. If you find erroneous information in your medical record feel empowered to have your doctor (not AME) change the record.
5.) Mail all the requested info in one certified mailing yourself. Don’t put that task on your AME. If you are lost and need help, ask your AME. I have gone through the packet for pilots to make sure they are submitting everything that is required and nothing that is not.

Thank you for reading and hope this doesn’t come off as a rant. Only suggestions for getting it done right the first time.

Doc Hartman

 

[WindOnHisNose]

Could not agree with Doc Randy and Denny more. I’m somewhat new in the world of doing AME work, but I have found that getting a pilot a special issuance is really an exercise in being thorough, complete, organized, PERSISTENT, and PATIENT!

What really helps AME’s and greases the wheels in OKC:
1.) bring hard copies of all letters from the FAA and doctors notes from pertinent hospital/clinic encounters. (Not “after visit summaries” which are worthless)
2.) make sure the AME knows that this is going to take 1-2 hrs so they can block out enough time and not have to rush/cut corners to stay on time in clinic.
3.) don’t let your non-AME doctor talk you into getting a study that is different than what the FAA specifically requests. For example, the FAA wants an exercise EKG stress test, don’t let your cardiologist order a nuclear medicine stress test. How do you make sure this happens correctly? Bring the letter from the FAA to the cardiologist or read it specifically to them over the phone so they know exactly what is being requested.
4.) Anytime you are submitting medical records to OKC, any diagnosis that you currently or previously have/had will likely be written somewhere in the records you are mailing in. The last thing you want is to wait six months only for the FAA to send you a letter asking for more info regarding your history of anxiety or low thyroid that you forgot to mention in your Medxpress application. If you find erroneous information in your medical record feel empowered to have your doctor (not AME) change the record.
5.) Mail all the requested info in one certified mailing yourself. Don’t put that task on your AME. If you are lost and need help, ask your AME. I have gone through the packet for pilots to make sure they are submitting everything that is required and nothing that is not.

Thank you for reading and hope this doesn’t come off as a rant. Only suggestions for getting it done right the first time.

Doc Hartman

Excellent comments, Matt. Thank you. I am so happy that Montana folks have you as an AME! Thanks for taking the steps to become an AME!

Doc R