Basic Med Rules

A

Anonymous

Guest
I’m under Basic Med for the last 2 years. Both of my shoulders joints are worn out and replacement was recommended. Also having sleep issues and I believe the 2 issues are related. My PCP wanted me to test for OSA and possible anxiety. When I said I would like
Physical Therapy he berated me with “ What am I trying to accomplish with that?”
Being 79 years old I do not want a lengthy recuperation period and daily PT allows me to
function fairly well. I have decided to change PCPs.
Do I have to do anything or than renew when current Basic Med expires in 2 years?
Would OSA test and diagnosis require actions before the renewal?
I understand I do not have the “ shortness of breath” symptom of OSA.
 
It's not a 14 CFR 68.9 disqualifying condition for BasicMed, but you must disclose everything on section 2 of your next comprehensive medical examination checklist and your doc completing the exam must be okay with how you are presently being treated for those conditions.
 
Is your OSA actually a diagnosis, or just something the doc suspects and wanted to test for?
 
Not a diagnosis. I prefer not to open that door though.

Shoulders make sleep difficult.
 
It sounds like you’re still thinking like it’s a 3rd class.

OSA is not grounding under BasicMed, if you have it. You do not have to report anything other than the “big three” to anyone about your medical conditions, that is between you and your doctor. The only thing the FAA will ever see is the affirmation of your medical exam when you renew in 2 years.

the “big three” are the ones that require a SI and a third class with them - mental health, nervous system disorder or cardiac. If it isn’t one of those, you’re still just working. With your doctor.

BTW, I agree about PT. Keeping moving and active is the #1 thing for longer life, assuming disease doesn’t do it. As soon as you start sitting all the time, it’s about 5 years before it all starts to fall apart.
 
Of course, if you do get one of the disqualifying things that make you go through the SI note that you have to fully pass the third class again, so OSA (AMEs are now obliged to at least pretend to screen for it) will need to be dealt with.
 
Yes, that's the hidden danger of BasicMed. If you do wind up going back for a SI, you have to catch up everything that you probably haven't been taking careful notes on.
 
bflynn said:
Yes, that's the hidden danger of BasicMed. If you do wind up going back for a SI, you have to catch up everything that you probably haven't been taking careful notes on.
Click to expand...
You should be keeping notes...you're still required to disclose your medical history (question 18a-x) and visits to health professionals in the last 3 years (question 20). You may not have as much supporting data, but it depends on what the signing physician wants to see.
 
The OP is near 80 years old and flying - Should take advantage of everything Basic Med offers.

Great post that mentioned Basic Med is not 3rd class. This is now between you and your doctors.

Suggestion to OP. No reason not to “open that window” on a possible diagnosis. If you have apnea or whatever, get it taken care of. No ding against your basic med. Not getting it looked at doesn’t mean you don’t have it.
 
Brad Z said:
You should be keeping notes...you're still required to disclose your medical history (question 18a-x) and visits to health professionals in the last 3 years (question 20). You may not have as much supporting data, but it depends on what the signing physician wants to see.
Click to expand...

I don't disagree. But if (like me), everything you do is already with your doctor, you just need to keep notes on what is done outside his practice. My doctor is 100% up to date on everything thats going on, so I don't keep detailed notes on that stuff.
 
bflynn said:
I don't disagree. But if (like me), everything you do is already with your doctor, you just need to keep notes on what is done outside his practice. My doctor is 100% up to date on everything thats going on, so I don't keep detailed notes on that stuff.
Click to expand...
It's a federal form. You have to complete it completely, even if your doc has your records. If the FAA ever asked for a copy of your CMEC, and you omitted your medical visits, you could potentially be cited for falsification. Either way, add an addendum to your CMEC with your medical records if that's how you plan to respond to those questions.
 
Basic med is between a pilot and his/her doctor. If one wants the fear of god should a federal form not be notarized and medical documents back to age 1 then just do 3rd class medical.
 
Brad Z said:
It's a federal form. You have to complete it completely, even if your doc has your records. If the FAA ever asked for a copy of your CMEC, and you omitted your medical visits, you could potentially be cited for falsification. Either way, add an addendum to your CMEC with your medical records if that's how you plan to respond to those questions.
Click to expand...

Yes, of course it's complete. But I don't have details on the form, nor in my records because that's a verbal discussion with my doctor.
 
It’s fortunate that Basic Med exams are good for 4 years, but the medical history only looks back 3 years. So every cycle has a 1 year records gap. That year is a great time to do your sleep apnea study, see your shrink, have a kidney transplant, ......

:devil:
 
Half Fast said:
It’s fortunate that Basic Med exams are good for 4 years, but the medical history only looks back 3 years. So every cycle has a 1 year records gap. That year is a great time to do your sleep apnea study, see your shrink, have a kidney transplant, ......

:devil:
Click to expand...
:p:p:p
Not quite but funny.

Just in case someone doesn't know, just like the application for an FAA medical, the BasicMed app only goes back 3 years for medical visits but "any time in your life" for diagnoses, conditions.

But yeah...I knew people who took advantage of that difference way before BasicMed. Concerned about the possibility of something. Never admitted to a hospital (one of those "any time" questions). Underwent several tests all of which were negative. Then flew under sport rules when the current medical expired until passing the three year visit period. Had nothing to disclose next time applied for an FAA medical.
 
Sleeping with joint pain is difficult and it may lead you to wonder if breathing issues contribute to the sleep problems. I was right there in the same spot post-hip replacement. Get relief from the joint pain and see if better sleep follows. Best wishes!
 
OP here.
Thanks for all the good wishes and suggestions. Tomorrow is last visit to PT and I will ask about shoulder rehab. The twice a day routines have increased range of motion and flexibility. This allows much better sleep. Hockey and skiing will be in the past but I’m still
active with other pursuits. It would be great if I could learn to sleep on my back.

Today I meet new PCP and will discuss conditions. Still have nearly 2 years left on current BM. I’m not sure if the new folks do BM physicals or if still another doc will be involved.

btw- I still buy green bananas; but not too big of a bunch!
 
Well done on the PT.

The way things sound - buy a pallet of green bananas!
 
OP here.
Several related issues I would like to share. Should I keep this as one thread or have
Individual topics?
I’ve been around long enough that while regs can change some the interpretation of regs
can change more often. That’s why I want to keep my options open.

Met with the PA part of my new PA/MD team. The meeting lasted over 1 hour and I believe
they have a good understanding of my conditions and priorities.
Besides the “ FAA Door” hear are some of the reasons I declined the Sleep Study.
I do not believe I have OSA even though I do snore. Wife says I never wake up gasping for breath nor do I get morning headaches.My belief is these are common symptoms of OSA.
When Covid came around we discontinued twice per week workouts at the Y.
At that time Shoulder Condition worsened as did the sleep pattern.

I had always slept on my side. With bone-on-bone joints I have to position myself to avoid
pulling the shoulder forward or backward. If the position changed while sleeping the discomfort would wake me but would the cease. If I were to roll onto my stomachs the
result was having my arms underneath me. Full body weight on forearms caused them to become numb and also wake me. I wish I could go to “ How to sleep on your Back School” as that would be a great solution.
That twice a-day shoulder routines have increased range-of-motion and flexibility. This in turn allowed for less instructions in the sleep pattern.

My wife had the Sleep Apnea test as did several friends. Sensors are stuck to your chest to monitor conditions.
Those that slept on their back said it no problem. Those that could not do so said it was horrible and resulted in
erratic test results and diagnostic issues.
 
What kind of mattress do you have? I have a foam mattress that is 13” thick custom made. It has four layers from the top: soft, medium, firm, extra firm. It was incredibly expensive but does seem to minimize joint and back pain during sleep, while it’s not a cure.

Thanks for explaining more what’s going on. I was confused why you’re having trouble but at the same time you said PT was helping. You’ve not been getting the PT or rather, exercise at the Y because covid. I’m assuming these aren’t formal PT sessions but rather you continuing movements they taught you, to do on your own. You were trying to tell the first doctor that you don’t feel the exercise has been given a fair chance recently and that your poor sleep and anxiety are the direct result of night pain (in your judgement).

You didn’t want to jump to chasing after other causes for poor sleep and anxiety without first treating the joint pain better and you didn’t want to jump to the last resort treatment (surgery) either. The issue is that the doctor didn’t seem to be listening to you. He seemed impatient with your desire to take the conservative approach. He may end up being right, but he wasn’t willing to let you get there on your own.

It’s possible your condition is worsening anyway but I sure would try a more conservative approach before jumping to the surgery. Maybe going back to the exercises won’t help. Have you seen a rheumatologist? There might be other options. If it were me I’d exhaust all other options before having such a drastic surgery. You’re right to be wary of a long painful recovery. On the other hand, the longer you put it off, the older you get and worse the recovery.

If it were me I’d sure look at it from all angles and learn as much as I can about it. The surgery today might be simpler, less invasive with better outcomes than in the past. I’d get more than one opinion. I’d try both prescription and alternative medications/supplements (krill oil plus hyaluronic acid has reduced my hip pain), but I would keep an open mind about the surgery meanwhile.

The OSA study? Personally only if my BMI were high or I had other signs and symptoms like daytime sleepiness.

If the first doctor wanted to test or treat for anxiety, I’d say, if you’ve never had an anxiety disorder in 79 years then odds are probably 100% your anxiety is directly related to chronic pain.
 
If you snore on your side, you likely have at a minimum intermittent brief periods of total airway obstruction lasting for a few breaths when supine. This is likely as snoring is a sign of partial obstruction and airway obstruction always gets worse when supine (especially when the head is flexed by say the use of a thick pillow). You may not have any spo2 desaturation during those events; desaturation would be the reason some with OSA would have the morning headaches you mention. Ask your wife if your snoring is interrupted occasionally by no snoring while your belly and chest still move in a rocking fashion; that is OSA.

Agree with Rushie (again) regarding the suggestion of adding padding to the mattress. Amazon offers numerous options for thick memory foam that may be placed on top of your mattress to increase comfort. We use a couple on our airbnb beds and they get great reviews. Shoulder pain can be terrible at night especially. Throbbing can keep one from being able to sleep. If I weren't going to get a total shoulder replacement (I would by the way), I would start with adding memory foam to the mattress or going to a waterbed like the Strobel Hydro-support 1800.
 
When you do your BasicMed exam, make sure it is a MD/DO conducting the exam, and not an PA or NP.
 
FWIW, my sister did a sleep study. These days they just put a finger tip sensor on and you’re good to go.

BTW - the breathing machines provide for very restful / deep sleep.
 
So I have sleep apnea and use a CPAP. Having said that I don't ever have breathing or snoring issues when sleeping on my side and I am a side sleeper in general. The problem is like you my shoulders are beat up and sleeping on them can be painful so I end up on my back and that is where the apnea really gets you.

I pray I will still be alive let alone still flying when I am 79 good for you OP. Having said that my current plan is to never involve the FAA in a medical again. My plan is to fly Basic Med going forward and if I have one of the big three and am still healthy enough to fly I will go LSA. I really hope we eventually just get drivers license med like Basic Med was supposed to be before the politicians got involved.
 
Can't speak for the OP and won't give medical advice (not being an MD, that seems like a prudent idea). But if my doc thought I needed joint replacement therapy I'd not decline it so I could go fly. Health always comes first.

That said, it sounds like the PT might do the OP, for now at least. Keep in mind that things only keep going south as you get older. PT works for now. Might not in a year or two.
 
Why would any adult be afraid of taking a simple test to find out their sleep may not be as good as it could be? Snoring or not doesn’t tell the whole story. Sleep medicine is a big thing.

Just woke up from my first sleep on our newest Sleep Number bed. This one replaces a Tempurpedic. I’ve had a Sleep Number at the other house for several years. Liked it enough to replace this one. Some models have sensors to track your sleep. This one does. Very interesting. The best part? If something’s hurting I can adjust the bed to relieve it.
 
Last edited:
Sleep medicine is a big thing.
Click to expand...
It's a very profitable thing for the CPAP industry and the sleep specialists. How big of a contribution to public health remains to be seen.
 
flyingron said:
It's a very profitable thing for the CPAP industry and the sleep specialists. How big of a contribution to public health remains to be seen.
Click to expand...
Not doubting the profitability piece however, as a CPAP user it has drastically improved my sleep quality. I thought it was normal to sleep like crap each night, wake up with headaches, sore throats and GERD. Since getting a sleep study done, and using CPAP for about 5 months, all my symptoms have disappeared. Perhaps I'm an isolated case however, I've had to sleep without it a couple times and all I can say is it makes a huge difference. I'll also finish with the fact that I was diagnosed with mild OSA, it was also positional so in my case it wasn't like some of the severe cases I've read about and it still had an impact.

My only complaint thus far is the price and that a certain manufacturer can't seem to handle a recall for a poorly designed product.
 
I'm very uncomfortable sleeping on my back. Weird dreams, too. Even I broke both my arms, I couldn't comfortably sleep on either side. For a while I slept on a recliner with my arms on pillows. It wasn't fabulous sleep, but it beat the alternative.
 
One other symptom of OSA, is frequent need to urinate at night. That is waking up and having that feeling. What causes this is an increase of the Adrenalin shot into your body when you stop breathing from OSA. That Adrenalin shot also stimulates the need to urinate. If you are waking up and needing to urinate more than 1-2 times a night, and you have other symptoms, you probably need to have the sleep study done. One other thing, do you recall dreams after waking up. Dreams are a sign that you are getting and staying in REM sleep. If not, it is another potential sign of OSA. There are about half a dozen signs of possible OSA.
 
Last edited:
OP here
When I took my first Flight Physical the term Sleep Apnea was unknown. Now it’s a big item. Since regs and interpretation can change is it possible that OSA could become #4 of
no-no’s for BM?

I tell people that when I was a teenager that model airplanes kept me out of jail.
Too busy to get in trouble. Now my world revolves around grandkids and aviation. Family tradition is we do not watch the kids play; we play with them .That involves throwing a ball or shooting the puck.
I wear; or have worn, several “hats” in aviation. My PT guy says about 8 months to recover
from double shoulder joint replacement. To me that’s like not breathing for 30 minutes.
You are not going to just resume normal activity: you are done. I enjoy what I do and it seems the people do also.

This may clarify the sequence Rushie referred to.
About 6 years ago my right shoulder started acting up. My PCP moved my arm and said
“Arthritis”. No “do this, don’t do that or you should see ?? “ I later visited 2 ortho organizations. They took X-rays and showed me the metal replacement joint.
No other options.
I was having some back issues and a pilot/neurologist/ sent me for some tests.
This resulted in twice a week visits to the Y to “strengthen the core”. Activities included
TRX, yoga and “machines”. While these activities produced the desired effect it was tough
on the shoulder joints.
When Covid came along activities were curtailed and the Y was discontinued.
I believe “ motion is lotion” and now the reduced activities were detrimental.
A friend was having similar issues and PT was helpful. After 4 visits and twice daily stretching routines my range of motion and flexibility has dramatically increased.
Today I graduated. I hope.
We do have a fairly good mattress with some type of 2 inch foam pad on the top.
As the shoulders have gotten better so has the sleep.

More to come
 
Anonymous said:
OP here
When I took my first Flight Physical the term Sleep Apnea was unknown. Now it’s a big item. Since regs and interpretation can change is it possible that OSA could become #4 of
no-no’s for BM?
Click to expand...
Since BasicMed was created by Congress, I think it would take an act of Congress to do that. Sleep apnea was already a known issue when BasicMed was created, so it seems unlikely that Congress would add it to the list now.

Caveat: Other than knowing the history, I'm not an expert of any kind.
 
Sleep apnea is not and will not be the fourth no no of basic med - not in my or your life time.
 
WDD said:
Sleep apnea is not and will not be the fourth no no of basic med - not in my or your life time.
Click to expand...
There are a lot more potentially incapacitating things that would end up on the list before you get to sleep apnea. Given the FAA's absolutely daft treatment of mental health issues, you'd probably see that expanded first if the FAA had their choice. There are lots more indicators for things like cardiac problems than are currently on the block list as well. Still even with all the FAA scrutiny, people with first-class medicals keel over and die with heart attacks. Far more end up having a survivable MI at some point in their careers.

As with a lot of issues in trying to regulate aviation safety, the sleep apnea thing is rooted in a couple of low occurrence but high visibility incidents. Then the FAA goes way overboard on the thing which ends up being counterproductive as demonstrated by this thread. The fear of the oppressive initial and maintenance of the SI drives people from contemplating things that could result in such a diagnosis even if the quality of their health would be greatly improved with treatment.
 
flyingron said:
There are a lot more potentially incapacitating things that would end up on the list before you get to sleep apnea. Given the FAA's absolutely daft treatment of mental health issues, you'd probably see that expanded first if the FAA had their choice. There are lots more indicators for things like cardiac problems than are currently on the block list as well. Still even with all the FAA scrutiny, people with first-class medicals keel over and die with heart attacks. Far more end up having a survivable MI at some point in their careers.

As with a lot of issues in trying to regulate aviation safety, the sleep apnea thing is rooted in a couple of low occurrence but high visibility incidents. Then the FAA goes way overboard on the thing which ends up being counterproductive as demonstrated by this thread. The fear of the oppressive initial and maintenance of the SI drives people from contemplating things that could result in such a diagnosis even if the quality of their health would be greatly improved with treatment.
Click to expand...

Like everything government wise, they see a thing and attempt to regulate it, on the premise that the very fact they are contemplating it has no impact on the start point, thereby assuming their actions will have predictable results. But in reality, the very act of scrutinizing and regulating something changes the initial set of conditions. This was proved on the subatomic level. The mere act of observing a particle affects its behavior.
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top