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Major Changes to FAA Mental Health, Cardiac, and Vision Policies

Last week the FAA released a substantial update to their Guide for Aviation Medical Examiners that includes major improvements for the agency’s protocols for mental health, coronary heart disease, and some ophthalmologic conditions. The “AME Guide” serves as the main public-facing document for medical policy published by the FAA. In the following story, we will summarize the highlights of these policy changes by diagnosis category.

Mental Health

Among the most anticipated changes are those to mental health policy. For the first time, individuals with a history of certain “uncomplicated” diagnoses that have been treated by psychotherapy (including active treatment), have not been medicated within two years, and meet other screening criteria for risk factors can be approved for a medical certificate directly by the AME without a special issuance.

Diagnoses eligible under this new policy include the following. An individual can have a history of up to two of the following diagnoses, quoting from the policy:

  • Anxiety:
    • Generalized anxiety disorder
    • Situational anxiety (aka adjustment disorder with anxiety)
    • Social anxiety disorder
    • Unspecified anxiety
  • Depression:
    • Postpartum depression
    • Situational depression* (aka adjustment disorder with depressed mood)
    • Situational anxiety and depression (adjustment disorder with mixed anxiety and depressed mood)
    • Unspecified depression
  • Other:
    • Obsessive compulsive disorder (OCD)
    • Post-traumatic stress disorder (PTSD)
    • V code^ (DSM)/Z code (ICD-10) table items

An AME can directly issue a medical certificate to individuals with these diagnoses, even under active treatment with psychotherapy, if they meet the criteria on the FAA’s decision tool.

The FAA also rolled out a “Fast Track” for individuals with a history of attention deficit and hyperactivity disorder (ADHD) last summer. This allows those with an ADHD diagnosis, no medication use in the past four years, and no current symptoms, to obtain a medical certificate from an AME after a report from a licensed mental health professional.

These new policies cover the “easiest” cases to certify. Many other individuals who do not meet the simplified criteria (i.e. current medication use, more complicated histories, other diagnoses, etc…) are still eligible for special issuance authorizations with a more thorough evaluation by the FAA.

Coronary Heart Disease

For decades, a common complaint from EAA members with coronary heart disease* was the time and expense of the annual recertification process. This often involved annual stress tests and other expensive procedures that insurance frequently refused to cover. Since 2017, many GA pilots in this situation have understandably gone to BasicMed.

Now, the FAA has rolled out a simple recertification status sheet for the treating cardiologist to fill out upon renewal for those pilots who qualify for an AME Assisted Special Issuance (AASI). Stress testing and some other procedures will still be required on initial certification, but now the FAA will accept a simple affirmation from the cardiologist that the individual’s status has remained stable in the past year and that there are no significant medical concerns for most pilots. This is a major win for anyone with coronary heart disease who requires FAA medical certification.

Lattice Degeneration

Lattice degeneration is a condition of the eye’s retina that affects 1 in 10 individuals, according to the American Academy of Ophthalmology. In a new protocol, the FAA has announced that individuals who otherwise meet the vision standards for the class sought and have no complicating symptoms can receive a normal issuance from the AME. As always, those with more complicated cases may still be eligible under a special issuance.

EAA’s Reaction

“This is a very strong, good faith effort by the FAA to address community concerns on their evaluation criteria, particularly on their mental health standards, said Tom Charpentier, EAA government relations director. “It makes progress toward the envisioned end state laid out by the Mental Health & Aviation Medical Clearances Aviation Rulemaking Committee, and with the FAA’s history of making changes in progressive steps we are confident that plenty of meaningful reforms are yet to come.”

Charpentier also noted that the coronary heart disease changes alone would be a top story without the accompanying mental health changes, and will be a great benefit to countless pilots.

*The FAA uses “Coronary Heart Disease” (CHD) and “Coronary Artery Disease” (CAD) interchangeably

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