By Dr. Robert J. Stepp and Dr. Tom Yasuhara, Associate ALPA Aeromedical Advisors
Air Line Pilot, October 2003, p. 6

First, the diagnosis of any malignancy, regardless of stage, is disqualifying until treatment is complete, and the FAA Aeromedical Certification Division has reviewed all pertinent medical records and found the patient eligible for a special issuance airman medical certificate. Regarding prostate cancer specifically, the FAA will accept any FDA-approved treatment regimen including surgery, radiation therapy (either external beam or seed implants), and chemotherapy (including hormonal adjuvant therapy). The FAA does require that before favorable consideration (1) the treatment be fully complete, (2) the airman has fully recovered from the treatment, and (3) no evidence of residual cancer is found.

All forms of vascular headache—migraine, cluster, atypical, acephalgic, etc.—are disqualifying until the headaches are under good control with appropriate medication and the FAA Aeromedical Certification Division has approved the airman for return to flight status. If the symptoms occur less than twice per year and are not likely to interfere with the safe performance of crew duties, the FAA will approve treatment with abortive medications such as Imetrex. However, if the symptoms occur more frequently or are likely to interfere with the aviator’s inflight performance, the FAA will require that the symptoms be eliminated by the use of a preventive medication such as a beta or calcium channel blocker. In the latter case, the FAA will usually require documentation that the aviator has gone 6 continuous months without symptoms before favorable consideration.

The FAA will not grant medical certification to any pilot using any medication or appliance that is not FDA-approved. In addition, the medication or appliance must be FDA-approved for the specific condition for which it is prescribed.

Cardioscans, also known as ultrafast CAT scans, are intended to estimate an individual’s likelihood of having coronary artery disease by detecting calcium-containing plaque in the coronary arteries. Unfortunately, this technology is so relatively new that no scientific consensus has yet developed regarding interpretation of the results of these tests. The FAA position is that (1) pilots must report Cardioscan results to their aviation medical examiner not later than the FAA medical examination following the test, and (2) if the Cardioscan demonstrates "significant coronary artery calcification" (the FAA has not specifically defined "significant coronary artery calcification"), the AME is to refer the pilot to an internist or cardiologist for a radio-nuclide (nuclear) stress test. If the radionuclide stress test results are abnormal, a cardiac catheterization will be required.

The FAA will consider several factors in determining your continued eligibility for a medical certificate. First, and most importantly, the FAA will need to have a thorough assessment of the underlying condition that prompted the need for the pacemaker. Cardiac rhythm problems may often be the result of underlying conditions such as coronary artery disease. As a result, the FAA will want to see the records of your hospitalization and initial cardiac treatment.

After a minimum 2-month observation period (recently changed from a 6-month wait), the FAA will need to review a full cardiac work-up that includes a physical exam, lab studies, a 24-hour recording EKG (holter monitor), and a treadmill test. If the results of any of these studies are abnormal, your cardiologist should pursue the clinically appropriate follow-on tests.

In addition to the hospital records and the detailed current cardiac evaluation, records of monthly pacemaker checks will also need to be submitted for FAA review. You should be showing no evidence of "pacemaker dependence"—i.e., if the pacemaker is turned off, you should be able to sustain a heart rate of at least 40 beats per minute on your own and have no unusual symptoms.

Our office has helped many pilots seek a return to the cockpit following pacemaker placement and will be happy to help ensure that your request for recertification meets all FAA requirements.