Sleep Apnea and Third Class Medical

[DocPiper2]

I am a private pilot, instrument rated, and currently hold a third class medical. The third class medical is valid until December of this year. I've been having trouble sleeping lately so my Doctor advised that I have a sleep study performed. I did and to my surprise I was diagnosed with moderate obstructive sleep apnea. I contacted AOPA Medical and they told me to send a copy of my sleep study, a letter from my Doctor describing my diagnosis and that treatment is correcting the problem and a copy of the download from the CPAP device chip indicating that I have been using the device and am complying with treatment. I also asked AOPA if I need to ground myself until I get an Ok from the FAA. They said that technically I am legal to fly since I have a current medical. Is this correct? Shouldn't I ground myself until all this is straightened out?

 

[poadeleted20]

If you read 61.53, you'll see that if you have a disqualifying condition, you must ground yourself until it is resolved or you receive a Special Issuance or other FAA approval. The fact that you have done all the things necessary to get FAA approval but don't have it yet isn't sufficient even if your medical doesn't expire for a while. That said, I don't know that what you have is in fact disqualifying -- wait for Bruce on that -- he'll be along shortly.

 

[DocPiper2]

According to the AOPA it's not a disqualifying condition. For that reason, they said I could continue to fly but....if I got into an accident... my aircraft insurance would not cover it

 

[AggieMike88]

I have OSA and the Required SI. I don't think I'd have the SI unless it was disqualifying.

Do wait for Bruce for the final word on this. Going by memory, the FAA will want to see the sleep study, a status letter from your doc saying you have OSA, you are on CPAP therapy (including the cmH2O prescription), me evidence of right heart failure on exam, no tendency to fall asleep under normal conditions (this will be the Epworth score), and the printout from your personal CPAP machine showing at least 60 days woth of compliance.

Once you get all that and get to AMCD and they have it scanned into their system, the better AME's like Bruce should be able to issue the SI in their office with a phone call. Otherwise, you wait your turn in line.

The prudent thing is to self-ground until you sort this out. Don't give them any reason to take negative action because you got impatient.

 

[poadeleted20]

According to the AOPA it's not a disqualifying condition. For that reason, they said I could continue to fly but....if I got into an accident... my aircraft insurance would not cover it

Did AOPA tell you that, or did your insurer? And if it was AOPA, did they review your policy before saying that?

In any event, I agree with AM88 -- don't fly until you're sure of the answer. One thing you can do if you're not sure is to call the Regional Flight Surgeon's office. You can tell them your situation without giving your name and get them to tell you their view on this.

 

[DocPiper2]

AOPA told me, not my insurer. But irregardless, I think it would be best to stop flying until I get the ok from the FAA

 

[poadeleted20]

AOPA told me, not my insurer. But irregardless, I think it would be best to stop flying until I get the ok from the FAA

That's a decision which cannot be wrong, but not everyone is willing to do the right thing like that. Good on ya!

 

[Jaybird180]

According to the AOPA it's not a disqualifying condition. For that reason, they said I could continue to fly but....if I got into an accident... my aircraft insurance would not cover it

What a cop out! I hope you got the name of the rep you talked to.

I will monitor this thread for the answer. Very interesting responses.

 

[AggieMike88]

I concur that the response that was obtained from the AOPA staffer is odd.

Anyhow, for the benefit of all, I found the following PDF about Obstructive Sleep Apnea on the FAA site. Might help some know what we're talking about.

 

[kontiki]

The FAA AME Handbooks are online. Just go read them.

I believe that if anyone in the process believes you are not adjusting and using a CPAP faithfully, you will be required to take Means of Wake-fullness Tests to get the SI renewed.

I'm told this involves laying down in comfortable dark places demonstrating you will remain awake by not falling asleep.

 

[bbchien]

Docpiper2, you are correct and so is AOPA, UNLESS you have accomplished certification through CFI. If that has EVER been the case, you are grounded because the agency can show you have reason to know about 67.313.

However, none of that matters. What counts is that your insuror will pay off when the s_it hits the fan. Though you do indeed possess a medical certificate, it is a nebulous gray zone when due to inattention you land ontop of a busload of nuns.

You really want Zero chance that the insuror says, "no dice, we don't have to defend you, you weren't legal". In reality that chance is small, but it's not zero if you continue to fly.

You need:
Initial sleep study
The Titration of CPAP - and if this occurred in a "split study" on the only night you were in a sleep lab, this will do.

The doc's letter has to say four separate things in plain english:
(1)Appear well rested
(2)No apparent tendancy beyond normal to fall asleep
(3)Compliant with treatment (that's what the printout is for).
(4)No overt right heart failure.

Add the CPAP printout showing more than 75% of nights with 6 hours or more of usage, and you're done.

Once you have these, and a certified return receipt for these (to AAM 331, PO Box 26200, OKC, OK. 73125) you are on adequate grounds to self certify (provided you are NOT a CFI or never have been).

It may have been a while since you saw your AME. If you have a gifted one who cares (most AMEs won't cal lif it hasn't been in the last 3 months since you were seen), give him copies and ask him to call for you about a week after you get your delivery receipt. He can get you the speical issuance on the phone.

If not, once you have all the information and the certified return receipt, you can make a pretty goood case that you were compliant and had grounds to re-self certify, because the list above is exactly what the Federal Air Surgeon requires (read 67.313 on the web) for your situation. I hesitate to say you MUST wait until you hear form FAA, because right now the wait is interminiable/unconscionable...~100 days.

I would say, once you have the items above, and the Certified return reciept, unless you ever held a CFI certificate, you can go fly.

 

[AggieMike88]

The FAA AME Handbooks are online. Just go read them.

I believe that if anyone in the process believes you are not adjusting and using a CPAP faithfully, you will be required to take Means of Wake-fullness Tests to get the SI renewed.

Close. Maintenance of Wakefulness Test.

I'm told this involves laying down in comfortable dark places demonstrating you will remain awake by not falling asleep.

Just one dark comfortable place. You are wired up similar to the original PSG And then must go through 4 trials of 15-20 minutes spaced out by 90 minutes.

What they are trying to catch is if you are able to stay away even when the conditions might cause you to take a nap.

 

[DocPiper2]

Docpiper2, you are correct and so is AOPA, UNLESS you have accomplished certification through CFI. If that has EVER been the case, you are grounded because the agency can show you have reason to know about 67.313.

However, none of that matters. What counts is that your insuror will pay off when the s_it hits the fan. Though you do indeed possess a medical certificate, it is a nebulous gray zone when due to inattention you land ontop of a busload of nuns.

You really want Zero chance that the insuror says, "no dice, we don't have to defend you, you weren't legal". In reality that chance is small, but it's not zero if you continue to fly.

You need:
Initial sleep study
The Titration of CPAP - and if this occurred in a "split study" on the only night you were in a sleep lab, this will do.

The doc's letter has to say four separate things in plain english:
(1)Appear well rested
(2)No apparent tendancy beyond normal to fall asleep
(3)Compliant with treatment (that's what the printout is for).
(4)No overt right heart failure.

Add the CPAP printout showing more than 75% of nights with 6 hours or more of usage, and you're done.

Once you have these, and a certified return receipt for these (to AAM 331, PO Box 26200, OKC, OK. 73125) you are on adequate grounds to self certify (provided you are NOT a CFI or never have been).

It may have been a while since you saw your AME. If you have a gifted one who cares (most AMEs won't cal lif it hasn't been in the last 3 months since you were seen), give him copies and ask him to call for you about a week after you get your delivery receipt. He can get you the speical issuance on the phone.

If not, once you have all the information and the certified return receipt, you can make a pretty goood case that you were compliant and had grounds to re-self certify, because the list above is exactly what the Federal Air Surgeon requires (read 67.313 on the web) for your situation. I hesitate to say you MUST wait until you hear form FAA, because right now the wait is interminiable/unconscionable...~100 days.

I would say, once you have the items above, and the Certified return reciept, unless you ever held a CFI certificate, you can go fly.

Thanks for all the help. I'll do as you suggest

 

[poadeleted20]

Docpiper2, you are correct and so is AOPA, UNLESS you have accomplished certification through CFI. If that has EVER been the case, you are grounded because the agency can show you have reason to know about 67.313.

That's not the first time you've said that about CFI's and 67.313, but I've been unable to find anything in writing that says CFI's have to self-ground when non-CFI's don't. Can you point out that regulation, interpretation, or case law?

 

[bbchien]

That's not the first time you've said that about CFI's and 67.313, but I've been unable to find anything in writing that says CFI's have to self-ground when non-CFI's don't. Can you point out that regulation, interpretation, or case law?

This is a result of an undocumented conversation with the General Counsel to AAM 1. Her commentary, was that enforcement against someone who self certified under 61.53 is difficult if they have no knowledge of 67.313 (and .213 and .113). But, if they wanted to, they could make life very hard for a former or current CFI because they have demonstrated knowledge of part 67 and therefore know where to find the 67.X13's.

I will not be asking for that in writing because that falls in the category of "Bob Miller interacts with FAA": be careful for what you wish. IN addition, AOPA's general counsel agrees with this take on the enforcement situation, and shares the aversion to asking about this in writing. I hope you and everyone who see this "gets" why we do not ask.

67.313 actually does apply to all 3rd class airmen; 67.213 for all 2nd class airmen, and 67.113 for First Class airmen. It's all about who knows about 67.313 and who has demonstrable knowledge.

Think about my situation- I'm probably the last in line to self certify.

 

[jbarrass]

This is a result of an undocumented conversation with the General Counsel to AAM 1. Her commentary, was that enforcement against someone who self certified under 61.53 is difficult if they have no knowledge of 67.313 (and .213 and .113). But, if they wanted to, they could make life very hard for a former or current CFI because they have demonstrated knowledge of part 67 and therefore know where to find the 67.X13's.

I will not be asking for that in writing because that falls in the category of "Bob Miller interacts with FAA": be careful for what you wish. IN addition, AOPA's general counsel agrees with this take on the enforcement situation, and shares the aversion to asking about this in writing. I hope you and everyone who see this "gets" why we do not ask.

67.313 actually does apply to all 3rd class airmen; 67.213 for all 2nd class airmen, and 67.113 for First Class airmen. It's all about who knows about 67.313 and who has demonstrable knowledge.

Think about my situation- I'm probably the last in line to self certify.

But absolutly nothing is 67.313 addressed OSA and it is not one of the specifically listed disqualifying conditions.

 

[bbchien]

Yes, but what is says is that you cannot proceed with a disease state or treatment that has not in accord with the Federal Air Surgeon current policy. If your contention is that because it is not specifically listed, it is permitted.....well that's 1968. The FAS stopped making rule changes for disease states because medicine moves MUCH faster than that (since ~1985), and we are done. Good luck.


******

"67.313 General Medical Condition.

The general medical standards for a thrid-class airman medical certificate are:
(b) No other organic, functional or structural disease, defect or limitation that the Federal Air Surgeon, based on the case histroy and appropriate qualified medical judgement relating to the condition involved, finds-
(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held,; or
(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or execise those privileges.
(c) No other medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate qualified medical judgement, finds-
(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges."

*****(bold added by ed.)

You WILL grant that OSA is a functional and structural disease--or are you going to dance on the head of a pin, as we do on the red board? CPAP is a treatment and Sleep Apnea is a disease state...or maybe the strategy is to deny that, too.

The prevalence of narcolepsy in the population of untreated sleep apneics certainly "Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held", until it is controlled and watchfullness can be maintained.

67.313b makes no list. It applies to ANY condition. And of course, the FAS policy on Sleep Apnea is verified CPAP control.

Now who on this planet would know what the Federal Air Surgeon's current policy is on any particular disease state? So you are pushed by 67.313, 67.213, and 67.113 to ask a designee. We get quarterly "advice" (stronger than adivce, really) on what we are to tell the pilots.

So this you see, is a sort of "cover all". The key is if the FAS can show you have knowledge of 67.313. It doesn't appear until the CFI candidate quiz as to "where to find it".

 

[Jaybird180]

Dr Bruce- a little OT and tongue in check, but would pregnancy also be subject to this 67.313? One could argue yes, by the logic proposed above.

 

[bbchien]

Pregnancy is, unfortuantely physiologic.

however, I do poke fun at it a little bit with my example of the "5 year SI for Norplant" should FAA rule that pregnancy is grounding..... a perfect example of how the agency "thinks".

 

[AggieMike88]

Pregnancy is, unfortuantely physiologic.

ROFL! If you said that at the fly in, whole buckets of popcorn would be flying in your direction from the ladies. But bravo for giving me a good laugh after a challenging day at work!

 

[comanche]

q

Add the CPAP printout showing more than 75% of nights with 6 hours or more of usage, and you're done.


(removed all of quoted message except for above)

Dr. Bruce, is this 6 hours a change? You have written in the past that 4 hours is required. All of the CPAP/BIPAP machines I have/had indicate a satisfactory night is with four hours usage.

 

[Tristar]

Make sure you stay on top of everyone to get paperwork done including yourself. I have a student with sleep apnea and it took him 4 months to get his medical.

 

[comanche]

Make sure you stay on top of everyone to get paperwork done including yourself. I have a student with sleep apnea and it took him 4 months to get his medical.

4 months is a walk in the park. It took me 7 months from being differed to jump through all of the hoops to receive the 3d class with the SI. I got the medical in March and have to be re evaluated by End of July be treating Physican to receive the year extension.

My re eval received top scores and the results have been sent to Dr. Bruce for him to work his skills.

 

[bbchien]

No. 6 hours is the spec, by they accept 4 hours. I just got your documents. They pass.

But see my comments (by email) about what your doc also included. So we need some cardiology stuff....