Federal Aviation Certification Updates

Federal AviationAdministration

CertificationUpdates:

Warren S. Silberman, DO

Aerospace Medical Education Division

September 2017

AME Updates2

Federal Aviation AdministrationAME Updates

Structure Changes to Guide• 3 columns (was 4)• Moved the “class” to top of page• Look for “Updated” dates• USE THE DISPO TABLES---to help a/m

collect the info we will ask for


AME Updates

Updates---how to find changes

Last Wed of themonth: AME guide“archives section”with links

www.faa.gov/go/ame

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AME Updates

Structure Changes -- AME aids• Disposition table updates• CACIs• Status Reports• AME Checklist• Certification Aids• Airman Questionnaires• Pharmaceutical sections

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AME Updates

Disposition tables• Start here• Many conditions can now be cleared by the

AME at this step• Need block 60 notes

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AME Updates

Has it been updated?• Old version • New version

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AME Updates

Disposition table changes

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AME Updates

CACIs---4/9/2013• Allows AME to issue from the office without

calling the FAA.• Start with the Disposition Table first• If CACI is needed--Follow the worksheet• If NOT CACI qualified—most likely will AASI

or SI

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AME Updates

CACIs• AME can issue if the

worksheet criteriaare met

• Worksheets Do NOTneed to besubmitted to FAA

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AME Updates

If NOT CACI qualified

• See what info tosubmit

• Middle column• Possible AASI or SI

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AME Updates

CACI vs Special IssuanceCACI Special issuance

Where to find info to submit Dispo table first, then CACI Dispo table

Initial presentation AME can issue if conditions aremet

AME must defer

Follow up AME can issue if conditions aremet

AME can issue follow up withvalid Authorization Letter

Reports are due 1st and 2nd—annually3rd class—at each exam (2 or 5years)

Per Authorization letter (mostare annual)

If not qualified May be special issuance Defer for FAA decision

Reports submitted to FAA No—keep in your records Yes

Time limited cert NO Yes

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AME Updates

CACI-- Pearls• See if CACI is even needed (dispo tables)• Review the required documents• Block 60 notes

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AME Updates

CACI block 60• Previously:

– “Airman meets certification criteria for hypothyroidism”• NOW

– CACI qualified hypothyroidism

• Working on a CACI button• If no block 60 notes—it is an AME error

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AME Updates

Status Reports• Must be signed and dated• Can take the place of clinic

notes• Must be submitted to FAA

• Current:– Diabetes– Gender Dysphoria

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AME Updates

AME Checklist• Must be signed and dated• Does NOT take the place of

clinic notes– Allows AME to issue a follow up

if criteria met

• Must be submitted to FAA

• Current:– SSRI recert– HIMS recert

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AME Updates

Certification Aids• Designed to treating

providers• Does NOT need to be

submitted• Must be submitted to

FAA• Current:

– SSRI recert– HIMS recert

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AME Updates

Airman Questionnaires• Designed to collect history

from the airman• Must be submitted to FAA• Only used for specific

conditions

• Current:– Seizure history

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AME Updates

Pharmaceutical section• Designed to identify

meds allowed/notallowed/wait time

• Only used forspecific conditions– Do Not Issue –Do

Not Fly list– Pharmaceuticals

table

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AME Updates

Pharmaceuticals• Pharmaceutical table

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Changes since 3/2015– Seizure history sheet added– SSRI and HIMS standardization– Remove ATCs (x color vision)– Student Pilot combined cert

remove 4/1/16– Mitral valve repair– Gender Dysphoria– Chronic Kidney Disease– HTN medication section expanded,

CACI updated, 7 days, new AASI,FAQ

– Kidney stones---big changes,CACI, AASI

– Renal cancer CACI– PC and TC have CACI worksheets– ED/BPH meds– Bladder cancer CACI– HIV prophylaxis meds– Hypothyroid 1 year TSH is ok– Diabetes. IDDM—3rd class send to

AMCD/RFS. 1st/2nd class decisionreview at HQ, DM form, metformin14 days

– CACI wording changes


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AME Updates

SSRI Program Changes• Initial

– 6 months on meds (was 12) to consider for initial Authorization– AME must defer– Worked at HQ

• Recerts– Can be issued by HIMS AMEs in some cases– Must now see face to face every 6 months– Checklist

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AME Updates

SSRI and HIMS—AME pearls• Current auth letter is ok to use• Will get new auth letter saying 6 months

• AME phone calls/complaints---HQ• AME questions—send to AAM-220• SEE HANDOUT (checklist and cert aid)

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AME Updates

SSRI• www.faa.gov/go/ssri

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AME Updates

HIMS• www.faa.gov/go/HIMS-DA

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AME Updates 29


Student Pilot changes 4/1/16• Removal of the COMBINED student pilot

certificate and medical certificate• AMEs—continue to perform AME medical

exams.• Student need a medical prior to solo


AME Updates

Student Pilot – AME pearls• 1) MFT needed---AME should defer• 2) Restrictions eliminated

• Valid for MFT only• VSPPO—valid for student pilot purposes only• Not valid until (mm/dd/yy) age 16

• 3) Language requirement—FSDO• 4) Transmit all w/in 14 days

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AME Updates

Student Pilot – where AMEs arehaving trouble• Think they cannot do the medical if they

are a student• Places to go for help• www.faa.gov.go/ame

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AME Updates 33


Mitral Valve Repair

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AME Updates

Mitral Valve Repair• Followed indefinitely• Previously all Special Issuance• Now 5 or more years out—possible CACI

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AME Updates

Mitral Valve Repair

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AME Updates

Mitral Valve Repair -- CACI

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AME Updates

Mitral Valve—not CACI qualified• Mitral Valve REPLACEMENT• Any other valve• Any other additional valve• Any of the Co-morbid conditions

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AME Updates

Mitral Vale Repair–AME Pearls• If 5 or more years out---- New CACI

– see if CACI qualified– What’s NOT a CACI

• Other valves• Other cardiac conditions• Co-morbid conditions

– Echo results—use the CACI worksheet• If not—may qualify for AASI (annual c/s and

echo)39


AME Updates 40


Gender Dysphoria

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AME Updates

Gender Dysphoria

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AME Updates

Gender Dysphoria• The AME may ISSUE (no further information is needed), if the

airman:• Was evaluated for or diagnosed with Gender Dysphoria and

has never undergone treatment (counseling or support groupfor GD does not require information);

• Has no history of other mental health diagnoses or treatment;and

• Is otherwise qualified

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AME Updates

Gender Dysphoria

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AME Updates

Gender Dysphoria—Status Report

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AME Updates

Gender Dysphoria–AME Pearls• 5 or more years stable on meds—AME may be able

to issue• Change in status may reset 5 year clock

• Use the AME Gender Dysphoria Status Report• If airman has shaded answers---send in addition

info

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Chronic Kidney Disease

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AME Updates


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AME Updates


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AME Updates


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AME Updates

CKD – AME Pearls• New CACI• New AASI

– New info in the guide– eGRF – if other testing was done, have the airman

submit

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AME Updates 53


AME Updates

Latest CACI: COLON Cancer

• The 17th CACI is Colon Cancer– Need Current Status Report– Note Chemo TX or XRTx would not qualify– Positive margins or Metastasis also a “no go”– No Recurrence for CACI– CEA at Dx must be < 5 ng/ml– Cannot have HgB less than 11 (done within 90 days)


AME Updates 55


Hypertension

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AME Updates

Hypertension (HTN)

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AME Updates

Hypertension (HTN)

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AME Updates

Hypertension (HTN)---- FAQs

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AME Updates

Hypertension (HTN)—Pharmaceutical Section

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AME Updates

HTN—if airman does not meet 155/95

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AME Updates

HTN- AME Pearls• CACI is based on # of component meds

– Lisinopril/HCTZ is 2

– 7 days no fly when starting meds– (was 14 day no fly)

– New AASI if 4 or more meds

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Kidney Stones

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AME Updates

Kidney Stone(s)

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AME Updates

Kidney Stones--retained

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AME Updates

Kidney Stones--retained

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AME Updates

Kidney Stones – AME Pearls• 5 or more years ago---AME may issue• If retained stones

– No complications– Possible CACI– If complications---possible AASI– Size and number no longer requirement. Urologist

needs to state if treatment is needed.

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AME Updates

Kidney Stones—when NOT CACI

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AME Updates 70


Renal Cancer

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CACI

AME Updates72


Prostate Conditions & Cancer

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AME Updates

Prostate Meds

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AME Updates

Prostate Cancer -- CACI

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AME Updates 76


Testicular Cancer

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AME Updates

Bladder Cancer

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AME Updates 79


AME Updates

HIV prophylaxis

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AME Updates

Hypothyroid• TSH within the last year for CACI (was 90 days)

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AME Updates 82


Diabetes• Up to 3 meds allowed


AME Updates

Diabetes -- DM Status Report

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AME Updates

Diabetes -- DM Status Report

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AME Updates

Diabetes – Metformin 14 days

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AME Updates

Diabetes—Acceptable Combo Meds

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AME Updates

Diabetes• B-blockers and insulin• B-blockers and sulfonylurea• ALLOWED

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AME Updates

Diabetes---IDDM• 3rd class---as before• 3rd class who wants to upgrade---ok to issue

3rd class if qualified and a/m wants in themeantime (per auth letter) while HQ workson the upgrade

• 1st/2nd – worked at HQ

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AME Updates

OSA 8/30/2017

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AME Updates

Skin Cancer updates

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AME Updates

Liver transplant

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Summary• Condition Changes• Updates

– Dispo tables– CACI– New AASIs– AME & treating physician tools

• What’s next

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AME Updates95

Documents

Federal Aviation Certification Updates