Hypothetically speaking ... SI type event while on Basic Med?

gkainz

Final Approach
Joined
Feb 23, 2005
Messages
8,399
Location
Arvada, CO
Display Name

Display name:
Greg Kainz
Let's say an airman who's flying on Basic Med has some kind of event that would trigger needing to get a Special Issuance if said airman was on a Third Class medical.

What's the process?

So, asking for a friend of course ...
 
My impression is that as long the pilot self-certifies that he’s medically fit to fly, simply having a condition that would require an SI wouldn’t change anything, nor require any “process”.

Unless...


Here is the list of “mandatory disqualifying conditions”:
  • Angina Pectoris.
  • Bipolar Disorder.
  • Coronary artery disease that has required treatment or is symptomatic.
  • Diabetes Mellitus that requires insulin or oral medications for treatment.
  • Disturbance of Consciousness without adequate explanation.
  • Epilepsy.
  • Heart transplant.
 
My impression is that as long the pilot self-certifies that he’s medically fit to fly, simply having a condition that would require an SI wouldn’t change anything, nor require any “process”.

Unless...


Here is the list of “mandatory disqualifying conditions”:
  • Angina Pectoris.
  • Bipolar Disorder.
  • Coronary artery disease that has required treatment or is symptomatic.
  • Diabetes Mellitus that requires insulin or oral medications for treatment.
  • Disturbance of Consciousness without adequate explanation.
  • Epilepsy.
  • Heart transplant.
If you have most of those conditions you may not fly until you get a 3rd Class Medical Special Issuance. I don’t see diabetes on the list. I don’t know if Angina Pectoris falls under the heart conditions listed—but it probably does.

https://www.faa.gov/documentLibrary/media/Advisory_Circular/AC_68-1A.pdf
  1. 8.2 Special Issuance Medical Certificates Required. For certain conditions, a person wishing to operate under BasicMed must complete the process for obtaining an authorization for special issuance of a medical certificate in accordance with § 68.9. The person is required to obtain only one special issuance medical certificate for each condition, and may subsequently operate under BasicMed. Persons who have, or are newly diagnosed with, a cardiovascular, neurological, or mental health condition described in FESSA, may not use BasicMed until they have been found eligible for special issuance of a medical certificate. Once issued a medical certificate, the person may then use BasicMed if they meet all other requirements of FESSA. These conditions are listed below:
I believe that the AC lists the same conditions as those in the first-time issuance.

https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/

Medical Conditions Requiring One Special Issuance Before Operating under BasicMed
  • A mental health disorder, limited to an established medical history or clinical diagnosis of—
    • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
    • A psychosis, defined as a case in which an individual —
      • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
      • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
    • A bipolar disorder; or
    • A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations
  • A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
    • Epilepsy;
    • Disturbance of consciousness without satisfactory medical explanation of the cause; or
    • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
  • A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
    • Myocardial infarction;
    • Coronary heart disease that has required treatment;
    • Cardiac valve replacement; or
    • Heart replacement.
 
Thanks. Your list is better sourced than mine.

Regardless, there are many more minor maladies that require recurring SI’s for a medical, but are not contained in that list. For those ailments nothing is required, so long as the pilot can legitimately state: “I understand that I cannot act as pilot in command, or any other capacity as a required flightcrew member, if I know or have reason to know of any medical condition that would make me unable to operate the aircraft in a safe manner.”
 
Conditions which are disqualifying for a FAA medical are not disqualifying for BasicMed because BasicMed is not a FAA medical. The only things that require a Basicmed pilot to move back to a FAA medical for a SI are the limited conditions in post #3 by JScarry.

As pointed out above, every pilot is required to refrain from flying if they have a condition which prevents them from safely flying (FAR 61.53). Under a FAA medical, a pilot is required to self certify to the FAA medical standard. Under Basicmed or Sport, a pilot is required to self certify to a standard agreed to between the pilot and their personal physician. The FAA medical standards are not a bad guide, but they are not binding.

Directly addressing the question for the OP, if a pilot has a condition that would normally require an SI but is not one of the conditions in post #3, they are not required to get an SI to continue under Basicmed. But they should consult with their doctor to understand the condition so they can comply with 61.53.
 
...Under Basicmed or Sport, a pilot is required to self certify to a standard agreed to between the pilot and their personal physician....
While that might be a good idea, I'm not aware of any such requirement in the applicable statute or regulation other than at the time of the required medical examination (if the exam is done by the pilot's personal physician).
 
While that might be a good idea, I'm not aware of any such requirement in the applicable statute or regulation other than at the time of the required medical examination (if the exam is done by the pilot's personal physician).

I’m not aware of anything in the FARs but AC 68-1A does say:

4.5 Care and Treatment by a Physician. Pilots flying as PIC under BasicMed must be under the care and treatment of a physician5 if the pilot has been diagnosed with any medical condition that may impact their ability to fly.

and

3.3 What Do I Need to Maintain My BasicMed Privileges?
1. Be sure you have a CMEC that shows that your most recent physical examination was within the past 48 months.
2. Be sure you are being treated by a physician for medical conditions that may affect the safety of flight.

It doesn’t explicitly say that you will maintain a standard agreed to between the pilot and their physician, but it comes awfully close to those words.
 
Is like departing from an airport without weather reporting and you have a CPL. Does that look like 1000ft to you? YUP.

Sent from my SM-G975U using Tapatalk
 
I’m not aware of anything in the FARs but AC 68-1A does say:

4.5 Care and Treatment by a Physician. Pilots flying as PIC under BasicMed must be under the care and treatment of a physician5 if the pilot has been diagnosed with any medical condition that may impact their ability to fly.

and

3.3 What Do I Need to Maintain My BasicMed Privileges?
1. Be sure you have a CMEC that shows that your most recent physical examination was within the past 48 months.
2. Be sure you are being treated by a physician for medical conditions that may affect the safety of flight.

It doesn’t explicitly say that you will maintain a standard agreed to between the pilot and their physician, but it comes awfully close to those words.

The "A" in AC 68-1A stands for "advisory," not "regulatory."
 
So, when the FAA has advised you how to comply with regulations, what do you suppose happens if you don’t follow that advice?

My statement about the standard with the physician is a practical one. You have to be under the care of a physician. If he doesn’t agree about your care, he won’t sign off.
 
When it comes to prosecuting a violation, doesn't the FAA have point to an actual regulation or statute that was violated?
 
...
3.3 What Do I Need to Maintain My BasicMed Privileges?
....
2. Be sure you are being treated by a physician for medical conditions that may affect the safety of flight.
....

Does the treatment have to be successful? ... ;)
 
Thanks. Your list is better sourced than mine.

Regardless, there are many more minor maladies that require recurring SI’s for a medical, but are not contained in that list. For those ailments nothing is required, so long as the pilot can legitimately state: “I understand that I cannot act as pilot in command, or any other capacity as a required flightcrew member, if I know or have reason to know of any medical condition that would make me unable to operate the aircraft in a safe manner.”
To put a finer point on it, this language is significantly more narrow than what would get you deffered/denied/SI on a medical. Note the tense, note "condition" not "diagnosis," etc.
 
When it comes to prosecuting a violation, doesn't the FAA have point to an actual regulation or statute that was violated?

Yes. Basicmed is a regulation, 14 CFR Part 68. In the matter of legality, 68.9 lists the Special Issuance conditions and these are the only conditions for which a Basicmed pilot must move back to a 3rd class SI.

Pilots must also still abide by 61.53. There's debate in this area, but every explanation I've heard of it is that the decision to self certify still rests with the self. The certify part is not to FAA standards, it is pilot judgement.
 
Well, my friend exhibited symptoms of a TIA, according to the doc, at least that's what was on the order for the CT. 10 minutes of aphasia type symptoms on the phone with his wife - couldn't name the towns or exits on the freeway while driving, telling her where he was, with absolutely no other symptoms.

CT of head/neck ordered, nothing conclusive, no signs of narrowing or blockage in carotid bulbs/arteries or other veins/arteries revealed.

Post CT review with the doc and he says "the TIA stands" - even though the CT can neither confirm nor deny.

Review of the FAA regs indicate a 24 month grounding, followed by substantial neurological testing, EEG, etc required to apply for a 3rd class with SI, in hope to get back to BasicMed again?

Friend has pretty much decided his flying days as PIC are over.
 
Review of the FAA regs indicate a 24 month grounding, followed by substantial neurological testing, EEG, etc required to apply for a 3rd class with SI, in order by hope to get back to BasicMed again?
Why does he think he needs an SI before Basic Med?
 
not sure I follow your question, but he's on BasicMed now - the TIA event appears to require reapplying for 3rd class with SI for neurological interruption and then back to SI ... yes? No?
 
not sure I follow your question, but he's on BasicMed now - the TIA event appears to require reapplying for 3rd class with SI for neurological interruption and then back to SI ... yes? No?
I'm asking why you think that. Are you basing your conclusion on a particular reg?
 
...

https://www.faa.gov/documentLibrary/media/Advisory_Circular/AC_68-1A.pdf...
  • A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
    • Epilepsy;
    • Disturbance of consciousness without satisfactory medical explanation of the cause; or
    • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause....

not sure I follow your question, but he's on BasicMed now - the TIA event appears to require reapplying for 3rd class with SI for neurological interruption and then back to SI ... yes? No?

Based upon the earlier post of the regs quoted above, Greg, it would seem that your friend needs to decide whether the ten minutes of aphasia-like symptoms represent any of the three things above; epilepsy, disturbance of consciousness, or transient loss of control of nervous system functions. The other cardiovascular and mental health conditions don't seem to apply. If your friend was able to think clearly during the episode without panic, had no physical symptoms that would impair his ability to control the vehicle, and was in control except for being confused as to location, perhaps a case could be made that flying would not necessarily be unsafe, but prudency would seem to indicate exploring the episode further before flying. During that episode, would your friend have been able to find correct frequencies to contact ATC and accept their assistance if it had happened in an airplane?

Situations like this are always heartbreaking to read. I hope things work out for your friend and he's able to continue flying, but it's a huge world with lots of opportunities. If flying is no longer possible, lots of other new doors await.
 
I just called AOPA medical and they agree with what was posted up above by FastEddieB and JScarry regarding this stipulation:

from FastEddieB post:
  • Disturbance of Consciousness without adequate explanation.
and contained within:

JScarry post (bold mine)

https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/

Medical Conditions Requiring One Special Issuance Before Operating under BasicMed
  • A mental health disorder, limited to an established medical history or clinical diagnosis of—
    • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
    • A psychosis, defined as a case in which an individual —
      • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
      • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
    • A bipolar disorder; or
    • A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations
  • A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
    • Epilepsy;
    • Disturbance of consciousness without satisfactory medical explanation of the cause; or
    • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
  • A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
    • Myocardial infarction;
    • Coronary heart disease that has required treatment;
    • Cardiac valve replacement; or
    • Heart replacement.


AOPA Medical rep confirms what is discussed here - 24 months down, then reapply for 3rd class with the requirements for Neuroligical testing completed and hope for an SI approval. She commented on the clause that allows for application earlier than 24 months but "hasn't seen one approved early yet" and then "you have a disapproval on file"
 
A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
  • Epilepsy;
  • Disturbance of consciousness without satisfactory medical explanation of the cause; or
  • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
Edit: Greg beat me to it....
 
When it comes to prosecuting a violation, doesn't the FAA have point to an actual regulation or statute that was violated?
The violation would be 61.2(b)(2), 61.3(c)(1), and 61.23(a)(3)(1) for not holding a medical certificate. Except for balloon, glider, and light sport, you can only fly without a medical certificate (i.e under BasicMed) if you meet the requirements of 61.23(c)(3) and 61.113(i). 68.9 states that if you're operating under the provisions of 61.113(i) you have to have completed the process for obtaining a special issuance for the list of medical conditions cited earlier in the thread.

Because BasicMed is still relatively new, there is not a ton of case law related what whether a specific condition is considered disqualifying or not.
 
A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
  • Epilepsy;
  • Disturbance of consciousness without satisfactory medical explanation of the cause; or
  • A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
Edit: Greg beat me to it....

Ahem. Is the airman's physician satisfied with the medical explanation of the cause?
 
the airman's physician believes the TIA is a satisfactory explanation ... the airman is not!!!!!
 
The violation would be 61.2(b)(2), 61.3(c)(1), and 61.23(a)(3)(1) for not holding a medical certificate. Except for balloon, glider, and light sport, you can only fly without a medical certificate (i.e under BasicMed) if you meet the requirements of 61.23(c)(3) and 61.113(i). 68.9 states that if you're operating under the provisions of 61.113(i) you have to have completed the process for obtaining a special issuance for the list of medical conditions cited earlier in the thread.

Because BasicMed is still relatively new, there is not a ton of case law related what whether a specific condition is considered disqualifying or not.

Looks like the context got lost in the shuffle. I was talking about the assertion that the self-certification that occurs between BasicMed exams requires adherence to "a standard agreed to between the pilot and their personal physician." I haven't found a requirement in either statute or regulations for such a standard to have been created or agreed to. There's no dispute that the requirement to have held a medical certificate, and the SI requirements (when applicable), must be followed.

...Under Basicmed or Sport, a pilot is required to self certify to a standard agreed to between the pilot and their personal physician....

While that might be a good idea, I'm not aware of any such requirement in the applicable statute or regulation other than at the time of the required medical examination (if the exam is done by the pilot's personal physician).
 
Looks like the context got lost in the shuffle. I was talking about the assertion that the self-certification that occurs between BasicMed exams requires adherence to "a standard agreed to between the pilot and their personal physician." I haven't found a requirement in either statute or regulations for such a standard to have been created or agreed to. There's no dispute that the requirement to have held a medical certificate, and the SI requirements (when applicable), must be followed.

Nope, You are correct, there is no specific standard. The congressionally mandated standard for BasicMed is that a state licensed physician certifies that he or she is not aware of any medical condition that as presently treated would prevent the airman from safely operating an aircraft.

Some have erroneously tried to extrapolate that this means meeting part 67 standards, but that is not the case. Physicians signing the form has no obligation to use anything other than their clinical judgment to make that determination.

One note though: there is no obligation for the doc signing the form to be familiar with part 68 or enforce the provisions of 68.9. As such, an airman could have received a heart transplant, the doc could be ok with the airman flying with the new organ and sign the 8700-2, but the airman would still not be legal because he would still need a medical with a special issuance for the transplant. For that reason, an airman should discuss the 68.9 list with their doctor if they're unsure as to whether a medical condition is considered one of the disqualifying conditions.
 
the airman's physician believes the TIA is a satisfactory explanation ... the airman is not!!!!!

Second opinion? I’m leery when a doc feels a need to diagnose something when their isn’t conclusive data to support.

BL: a trip to the doc doesn’t have to result in a diagnosis.
 
Second opinion? I’m leery when a doc feels a need to diagnose something when their isn’t conclusive data to support.

BL: a trip to the doc doesn’t have to result in a diagnosis.
Aww, c'mon. The insurance code was entered for TIA and resulted in the brain scan. Totally indefensible. It's what it is. Under the enabling legislation he needs an SI.
 
Aww, c'mon. The insurance code was entered for TIA and resulted in the brain scan. Totally indefensible. It's what it is. Under the enabling legislation he needs an SI.

You’re correct. In retrospect, I can see how poorly I worded my response.

My limited understanding is that the symptoms described may present due to conditions other than TIA or stroke, which is why I asked if a second opinion had been considered.

Find the cause to address the health issue, then worry about the path to medical certification.
 
Under the enabling legislation he needs an SI.
Which section requires that? What I see had the same limitations as the reg. Otherwise he just needs to be under the care of a physician.

Code:
(B) A neurological disorder, limited to an
               established medical history or clinical diagnosis of any
               of the following:
                         (i) Epilepsy.
                         (ii) Disturbance of consciousness without
                     satisfactory medical explanation of the cause.
                         (iii) A transient loss of control of nervous
                     system functions without satisfactory medical
                     explanation of the cause.
 
Needs SI for B (iii).
Basic is NOT a license to have near stokes and “fly to failure”.
 
Last edited:
Needs SI for B (iii).
Basic is NOT a license to hand near stokes and “fly to failure”.
Except there seems to be a satisfactory medical explanation, at least according to the doc: TIA.

If that's the case, it would far under 68.9(d):

Code:
(4) Special rule for neurological conditions.--
                    (A) In general.--In the case of an individual with a
                clinically diagnosed neurological condition, the third-
                class medical certificate exemption under subsection (a)
                shall not apply if--
                          (i) in the judgment of the individual's State-
                      licensed medical specialist, the condition--
                                    (I) renders the individual unable to
                                safely perform the duties or exercise
                                the airman privileges described in
                                subsection (a)(8); or
                                    (II) may reasonably be expected to
                                make the individual unable to perform
                                the duties or exercise the privileges
                                described in subsection (a)(8); or
                          (ii) the individual's driver's license is
                      revoked by the issuing agency as a result of a
                      clinically diagnosed neurological condition.
                    (B) <<NOTE: Deadline.>>  Certification.--Subject to
                subparagraph (A), an individual clinically diagnosed
                with a neurological condition shall certify every 2
                years, in conjunction with the certification under
                subsection (c)(10)(C), that the individual is under the
                care of a State-licensed medical specialist for that
                neurological condition.

You mentioned the enabling legislation. What does say FESSA say that's different from the reg?
 
I seriously hope this doesn't turn into an argument about what could be/should be regarding BasicMed and 3rd Class SI medicals ... if there is a second avenue to pursue a resolution, I really want to find out. As my reading and research revealed, with concurrence above, as well as AOPA Medical, it looks like "24 months grounded, then follow the documentation to apply for a 3rd class medical with SI for neurological exemption".

The timeframe, duration, age of airman, cost of maintaining aircraft and all the other assorted and sundry moving parts and pieces make it financially irresponsible to pursue this option. Sadly, it all adds up to "I'm done."

Thanks to @bbchien @JScarry and @FastEddieB for confirmation on the information I discovered, and to the others in the thread tossing out other "what ifs", I do appreciate it!
 
Except there seems to be a satisfactory medical explanation, at least according to the doc: TIA....
I guess it boils down to what constitutes a satisfactory medical explanation. After reading about what a TIA is and reviewing the friend's description of symptoms, to this layman's eyes the explanation doesn't look very satisfactory, because it sounds like the possibility of a recurrence while flying has not been ruled out.
 
the airman's physician believes the TIA is a satisfactory explanation ... the airman is not!!!!!
CT is has no hope of ruling TIA in or out. Might be useful in the case of a full-blown ischemic or hemorrhagic stroke but a negative CT scan in this case won't help rule TIA out. TIA is usually a clinical diagnosis. It would be important to know what the ultrasound showed. The presence of carotid narrowing and/or an ulcerating plaque would be a significant finding that would strongly support TIA as a diagnosis. The absence of those things wouldn't necessarily be exclusionary, however.
 
I agree with you, @MacFly - the CT coming back inconclusive can not rule out a TIA and didn't show anything re: no ulcerating plaque, etc

CT HEAD - No evidence of acute intracranial process.
CTA HEAD - No central hemodynamically significant stenosis or occlusion.
CTA NECK - Scattered atherosclerosis, including carotid bifurcations, without hemodynamically significant stenosis.

didn't do an ultrasound. Started a statin (which I tried 20 years ago with horrible side effects) and a minimal dosage of blood pressure meds.
Blessed with White Northern European genetic disposition to high triglycerides and marginal white coat BP syndrome
 
I guess it boils down to what constitutes a satisfactory medical explanation.
Indeed.
After reading about what a TIA is and reviewing the friend's description of symptoms, to this layman's eyes the explanation doesn't look very satisfactory...
That certainly isn't the standard.
t sounds like the possibility of a recurrence while flying has not been ruled out.

Which is why we have 68.9(d). There are indeed hoops for the OP to jump through, just not an SI:
Code:
(1) In the case of an individual with a clinically diagnosed neurological condition, the ability to operate an aircraft under § 61.113(i) of this chapter shall not apply if -

(i) In the judgment of the individual's State-licensed medical specialist, the condition -

(A) Renders the individual unable to safely perform the duties or exercise the airman privileges required to operate an aircraft under § 61.113(i) of this chapter; or

(B) May reasonably be expected to make the individual unable to perform the duties or exercise the privileges required to operate an aircraft under § 61.113(i) of this chapter;
If the friend's state-licensed physician thinks a recurrence is likely, then the friend cannot fly on Basic Med. But that requires an affirmative finding by the friend's state-licensed physician. That's very different from saying he has to go through the 3rd-class SI process.

Again, if the explanation for friend's transient loss of CNS control is medically satisfactory to the friend's state-licensed physician, and if the friend's state-licensed physician does not believe it renders him unable to safely perform PIC duties and may not reasonably be expected to make him unable to perform those duties, the reg says that he can use Basic Med. Those are still pretty big ifs, but they are not SI ifs.

No one ever said that Basic Med was a free pass. It is just a different path. And one that doesn't require the FAA's ongoing notice and consent. Some people are into that, while some people are comforted by having the government's imprimatur on their health so won't use it even if available. Neither group is wrong.
 
That certainly isn't the standard.

According to 14 CFR 68.9(a), an SI is required in order to serve as pilot in command under BasicMed if there has been "A transient loss of control of nervous system functions without satisfactory medical explanation of the cause." What is the standard for what is to be considered "satisfactory" in that context, and where is that defined?
 
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