Rasfetch

Hi all,

Looking at starting a career in aviation and looking for advice about a class 1 medical as a first step. Will I for sure be dealing with a deferral? Is there anything I should be prepared to bring to the AME? Are these questions I should ask to the AME before scheduling?

My medical profile (high level of fitness and very good health other than these items):
1. Veteran. 40% disabled with the VA due to pulmonary embolism and DVT. I have had multiple DVTs but never while on anticoagulants.
2. On lifetime anticoagulation (Apixaban). From my research, this should not be an issue with first class medical. If anyone has resources/experience that says otherwise please advise.
3. Will soon be getting corrective eye surgery. I could pass the eye portion with glasses but I've been wanting this surgery for several years and doubt it will be easy to pursue once I start this path.

Questions:
1. How likely will I be dealing with a deferral?
2. Should I go ahead and do the medical with my glasses to ensure nothing else is an issue and then re-do after my eye surgery or just wait until after my eye surgery?
3. Anything I should be prepared to disclose/not disclose or bring to the exam?
4. Are these questions I should call and ask the AME before I schedule the exam?

The reasoning fro Question 2 is I'd prefer to know if this career path is not available to me within the next couple of months. Appreciate the advice and let me know if anything is unclear/more information needed.

rickair7777

40% rating isn't a big deal in and of itself, there are airlines pilots with a 100% rating. VA rating is a scale of compensation entitlement, not actual disability and the FAA doesn't care about the number.

The drug shows OK for flight on the AMAS site, so I don't think that will be an issue.

1. Looks like a deferral would be required initially, but an AME can isssue periodic renewals if the condition is under control: https://www.faa.gov/ame_guide/specia...ll_classes/dvt

2. I'd think carefully before doing any elective eye surgery if you want to be a pilot. There's a risk of complications, and you will almost certainly lose one line of BCVA on the eye chart. If you can clearly correct to 20/10 in each right now, you can expect that your best post-surgey correction would be to 20/12 or 20/15. That would probably be fine. But if your best is 20/20 right now, I wouldn't do it, you might end up needing a medical flight test and waiver for BCVA. The standard is that each eye individually must correct to 20/20 individually. If you're 20/10 in one eye, 20/25 in the other, and can see 20/15 with both you're still going to need the waiver. If you do it, find the best most experienced OPTHALMOLIGIST who has thousands of surgeries under his belt and is familiar with aviation issues. Not some podiatrist who attended a weekend clinic and does lasik as a side hustle. Not everyone is well suited for corrective surgery and a real eye doc can assess that properly.

If you get LASIK later, while flying, the recovery time is typically pretty short, assuming no complications.

3/4. Either find an AME with a very good reputation for working with professional pilots, ideally on this sort of issue, or pay an aviation medicine consultant to get all your ducks in a row. AMAS is popular (they are ALPA's go-to) and there are others. If you provide the wrong info to the wrong AME, it can delay the process.

But DO NOT try to hide anything... they are sending vets to jail as we speak for FAA medicals which don't match VA ratings.

Rasfetch

This is great info, thanks for the detailed response. Regarding the eye surgery, are you saying that if, prior to surgery, I can only read 20/20 with glasses, then after surgery, I may not be able to get to 20/20 even with glasses?

Droopy

I've had 2 PE's and DVT's. I'm on Xarelto rather than what you're on, but both should be fine with the FAA.

1. Definitely deferred, but a relatively easy SI process. Just make sure to provide all the required documentation on the first try so you don't wait through the FAA backlog more than once. Once you have your Special Issuance, you can expect to be able to have your AME issue subsequent medicals with a status note from your treating physician.
2. VA percentage doesn't matter to the FAA. They only care about the underlying condition. And the FAA Special Issuance process is MUCH easier than the Air Force waiver process. Of note, a PE with required lifetime anticoagulation is a 60% rating by itself. I had to take mine to the VA Court of Appeals to get them to do their job. But if it's service connected, the rule is black and white.

For the required documentation, google is good, AOPA Medical has a lot of great info, and a company like AMAS or several others that folks talk about here on the forums can be priceless...

rickair7777

Yes. Whatever your best possible acuity currently is, with or without glasses, there's a good chance you'll lose one line on the eye chart due to the disruption of the surgery.

A lot of folks might be fine with 20/25 if they can ditch the glasses, driving and even private pilot only requires 20/40. But pro pilots need 20/20, with or without glasses.

Many of us can read 20/10 or 20/13, if so then the risk is lower for you. I'm 20/10 corrected but I still opted not to get surgery, largely because my eye geometry indicated a higher risk of complications.

It's variable by individual, and a good doc can advise you based on your specific situation. Maybe technology has improved recently and the risk is lower now than ten years ago.

If you want to explore this, might want to get a quality eye chart on amazon, get an updated prescription, and then check your vision several times a day for a couple weeks. That way you'll have an idea of where you actually stand. Optometrists often only check to 20/20.

A wall chart is ground truth, while eye docs and AMEs use the projection gadgets which can be inconsistent, if you struggle with that the AME is authorized to let you use a wall chart.

JohnBurke

The VA disability rating is irrelevant; the FAA does not care what disability rating you have from the FAA, as the VA does not make decisions for the FAA. You can be at 100% disability, and while the FAA is concerned with the cause of hte disability, the FAA does not care in any way about the disability rating. The FAA cares very much that you report the disability rating, however, as that's a regulatory requirement. The FAA makes its own decision regarding medical fitness and does not rely on the VA rating.

That said, each condition is considered on its own merits, and in some cases, in combination with other conditions, and any medications taken are considered primarily for the condition for which the medication is taken, and secondarily, for the effects of the medication itself. The FAA is concerned about the underlying condition, and also about what the medicine does to you.

In the case of pulmonary embolus, a two-month waiting period (uneventful following the pulmonary embolus) exists after experiencing the embolism. Yours is in the past, it appears, and is being treated, but it still requires FAA deferral; the AME (aviation medical examiner) cannot issue the initial medical certificate, but can issue follow-up medicals after the inidial FAA decision. The AME will defer the medical to the FAA, which will make the decision and issue the Special Issuance medical certificate and letter. This will come with all the terms that the FAA requires, on an ongoing basis, to reapply for a medical, to be issued by your local AME. These will be AASI issuances, or AME-Assisted Special Issuance medicals, in which you'll provide ongoing documentation to the AME each time you go in for your medical. The FAA regulatory basis for the initial deferral is found in 14 CFR 67.401: https://www.ecfr.gov/current/title-1...section-67.401

You did indicate that you've had multiple deep vein thrombosis events. A complete history will be required, going back to your initial diagnosis. You'l lneed a statement from your current, treating physicial describing your underlying condition, medication tolerance, side effects, reaction to medication, a history of bleeding episodes, and a full history of any DVT or PE events. You'll also need to detail your family medical history with regard to these conditions. Any hospitalization or treatment history myst be included. You'll need additional testing and documentation (pulmonary function, INR/Prothrombin Time blood work, etc). It will be best if you work through an AME that specializes in Special Issuances and AASI, or a service that can advise you. Most commonly referenced here is AMAS, from Colorado (Aviation Medicine Advisory Service: https://www.aviationmedicine.com), largely because many here have used them, and they're contracted through several of the larger pilot groups. They don't examine you, but for a fee guide you through the paperwork process and ultimately collect and submit the paperwork to the FAA on your behalf, for the initial special issuance.

The FAA Guide for Aviation Medical Exminers addresses both initial certification (SI) and subsequent AME certification (AASI): https://www.faa.gov/ame_guide/specia...ll_classes/dvt

AMAS addresses dVT (and pulmonary embolus) in general and with respect to medical certification: https://www.aviationmedicine.com/art...us-thrombosis/

AOPA (aircraft owners and pilots association) offers a service for members that covers medical and legal counseling, which is worthwhile, though I wouldn't use that as your primary source when navigating a condition that determines your career. Regarding DVT/PE: https://www.aopa.org/go-fly/medical-...20be%20resumed.

The FAA requires that you apply for the medical first, before they will address a deferral; it has to be deferred before the FAA will consider a special issuance. I would start by going through AMAS. Pilots often try to go it on their own or go the lowest-rent path first (AOPA, etc), and and up painting themself into a corner. Know before you go. Spend the money up front for solid guidance and counseling through the process; it's worth the cost.

Regardling vision, if you can pass a medical test now (color, visual acuity, field of vision), and you are serious about your medical, I'd hold onto what you have and get yourself established, before you consider corrective surgery. It's a life decision, as you must live with your eyes, but it's also a career decision, and anything that impacts your vision coudl impact your ability to hold a medical or add ongoing compications, and not all vision correction surgeries are successful in the short or long term. It's a risk.

Boxhound

Do yourself a favor

Go see this guy, he's worth every penny.
Expert AvDoc in special issuance

Dr Stephan Kramer
Pilot Medical Center
7589 Preston Road #750
Frisco, TX. 75034

972-731-9555

You'll be glad you did.

tallpilot

LASIK with a differential between the eyes can result in both near and distant vision having better focus. Unfortunately the FAA absolutely prohibits it. So if you choose a procedure that the FAA will accept (I assume you want near vision correction due to your age) then you will be wearing glasses for the other (distance).

Hopefully they will change this obtuse stance one day but for now I think glasses are your best bet and once you retire then you can get surgery to your heart's content.

Rasfetch

Thanks, I'll reach out to him on Monday. Should I go to him for my medical exam or for a consultation prior to getting my first class medical exam?

Rasfetch

Thanks for all the info and resources. Are you recommending I contact AMAS after I've had my first class medical exam with an AME or are you recommending I use them as the AME for my first class medical exam?