Cancer: Medical Certification and the Big C
James D Lakin, PhD, MD, FACP
CFI, CFII, MEI
Airline Transport Pilot
FAA Senior Aviation Medical Examiner
Late winter in Minnesota can be a bleak time. How much more bleak it is learning that you have a cancer.
Malignancies are increasingly common especially with advancing age, although they can occur at any time of life. Also, they are bewilderingly varied and complex. Each tumor is unique. Each one carries a unique prognosis and a unique approach to therapy.
So if you think something is not quite right. If you have been having unexplained weight loss, bleeding, swellings, coughing—things that are really out of the ordinary, get to your primary physician.
It may just be a virus, indigestion, wear and tear arthritis, but it may be something more serious. What to do if your worst fears prove to be true? You should work with your physician to obtain as complete a picture as possible of the malignancy and the options for its treatment. These can vary widely.
When you say “I have an airplane,” that can mean anything from a Piper Cub to a B777. Saying “I have a cancer” can mean anything from a localized skin cancer that can be cut out in the office and cured to a metastatic brain tumor with a not so good future.
The next thing to do is to get hooked up with the appropriate specialists. Your doc should be able to point you in the right direction. Cancer therapy is varied and highly specialized. In Minnesota we are blessed with a large and sophisticated medical community. If there is a state of the art treatment for the type of tumor you have, it’s going to be available here.
What about flying? As you might have guessed, the answer is “it depends.” Because there are so many different types of cancers, each case must be reviewed by the FAA before a certification decision can be made. With very few exceptions the FAA considers all types of cancers to be potentially disqualifying.
Therefore a Special Issuance medical certificate will be required. You will have to go to your AME for a physical. He can help in identifying the stuff you will have to send to the FAA.
In a few weeks you will get a letter from the FAA telling you what they want to review. Usually this involves gathering every medical record you can lay your hands on relating to the diagnosis and therapy of the tumor.
Also you will need a current status report from your treating physician. The FAA will want him or her to comment on your condition, what medications you’re taking, what the plan for ongoing treatment is and what’s the outlook.
Make darn sure you give the FAA every jot and iota of the information they ask for. Otherwise, they’ll ask for it again and you’ll be waiting for an additional month or two for answers.
What they are looking for is reassurance that your tumor or the treatment for it does not pose a significant risk for sudden or subtle incapacitation in the cockpit. If they get squared away on that concern, they will mail you a fresh medical certificate and you’ll be good to go.
What happens when your medical is up for renewal will depend on the nature of the tumor. You will receive a “Letter of Authorization” along with your initial medical certificate. It will spell out exactly what has to be done and when to keep your medical current. In many instances the authorization will also include provisions for an AME Assisted Special Issuance (AASI). This allows your own AME to recertify you annually in the office. Of course this can only be done if you bring the AME the records and statements specified by the Letter of Authorization and that they all look OK.
Chronic illness of this type can be really tough both for the airman and for his family. The important thing is to stick with your docs, stick with your treatment and stick with your AME. Also, make sure you jump through all the hoops the FAA sets up for you.
Do that and odds are very good that you will be sitting left seat in no time!
Fly wisely. See you next month!
As always, comments, questions and suggestions are welcome: firstname.lastname@example.org.