EXAMINATION TECHNIQUES AND CRITERIA FOR QUALIFICATION | CHAPTER 4, PAGE 77
Items 49-64 of FAA Form 8500-8
This chapter provides guidance for the completion of Items 49-64 of FAA Form 8500-8. The Examiner is responsible for conducting the examination. However, he or she may delegate to a qualified physician’s assistant, nurse, aide, or laboratory assistant the testing required for Items 49-58. Regardless of who performs the tests, the Examiner is responsible for the accuracy of the findings, and this responsibility may not be delegated.
After all routine evaluations and tests are completed, the Examiner should make a complete review of FAA Form 8500-8. If the form is complete and accurate, the Examiner should add final comments, make qualification decision statements, and sign the declaration. The medical history page of FAA Form 8500-8 must be completed in the handwriting of and signed and dated by the applicant. The reverse side of the FAA copy must be typed if it is not electronically transmitted.
ITEM 49. Hearing
I. CODE OF FEDERAL REGULATIONS
All Classes: 14 CFR 67.105
67.205, and 67.305
***The person shall demonstrate acceptable hearing by at least one of the following tests:
Demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the examiner, with the back turned to the examiner.
or
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Demonstrate an acceptable understanding of speech as determined by audiometric speech discrimination testing to a score of at least 70 percent obtained in one ear or in a sound field environment.
or
Provide acceptable results of pure tone audiometric testing of unaided hearing acuity according to the following table of worst acceptable thresholds, using the calibration standards of the American National Standards Institute, 1969 (11 West 42nd Street, New York, NY 10036):
(Hz) 500 1000 2000 3000
Frequency
Better ear (Db) 35 30 30 40
Poorer ear(Db) 35 50 50 60
***No disease or condition of the middle or internal ear, nose, oral cavity, pharynx, or larynx that—
Interferes with, or is aggravated by, flying or may reasonably be expected to do so; or
Interferes with, or may reasonably be expected to interfere with, clear and effective speech communication.
***No disease or condition manifested by, or that may reasonably be expected to be manifested by, vertigo or a disturbance of equilibrium.
II. EXAMINATION PROCEDURES
A. Order of Examinations
1. The applicant must demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the Examiner, with the back turned to the Examiner.
2. If an applicant fails the conversational voice test, the Examiner may administer pure tone audiometric testing of unaided hearing acuity according to the following table of worst acceptable thresholds, using the calibration standards of the American National Standards Institute, 1969:
If the applicant fails an audiometric test and the conversational voice test had not been administered, the conversational voice test should be performed to determine if the standard applicable to that test can be met.
3. If an applicant is unable to pass either the conversational voice test or the pure tone audiometric test, then an audiometric speech discrimination test should be
administered. A passing score is at
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least 70 percent obtained in one ear at an intensity of no greater than 65 Db.
B. Discussion
1. Conversational voice test. For all classes of certification, the applicant must demonstrate hearing of an average conversational voice in a quiet room, using both ears, at 6 feet, with the back turned to the Examiner. The Examiner should not use only sibilants (S-sounding test materials). If the applicant is able to repeat correctly the test numbers or words, “pass” should be noted and recorded on FAA Form 8500-8, item 49. If the applicant is unable to hear a normal conversational voice then “fail” should be marked and one of the following tests may be administered:
2. Standard. For all classes of certification the applicant may be examined by pure tone audiometry as an alternative to conversational voice testing or upon failing the conversational voice test. If the applicant fails the pure tone audiometric test and has not been tested by conversational voice, that test may be administered. The requirements expressed as audiometric standards according to a table of acceptable thresholds (American National Standards Institute [ANSI], 1969, calibration) are as follows:
TABLE
3. Audiometric Speech Discrimination. Upon failing both conversational voice and pure tone audiometric test, an audiometric speech discrimination test should be administered (usually by an otologist or audiologist). The applicant must score at least 70 percent at an intensity no greater than 65 Db in either ear.
C. Equipment
1. Approval. The FAA does not approve or designate specific audiometric equipment for use in medical certification. Equipment used for FAA testing must accurately and reliably cover the required frequencies and have adequate threshold step features. Because every audiometer manufactured in the United States for screening and diagnostic purposes is built to meet appropriate standards, most audiometers should be acceptable if they are maintained in proper calibration and are used in an adequately quiet place.
2. Calibration. It is critical that any audiometer be periodically
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an occasional audiogram on a “known” subject or staff member between calibrations, especially at any time that a test result unexpectedly varies significantly from the hearing levels clinically expected. This testing provides an approximate “at threshold” calibration. The Examiner should ensure that the audiometer is calibrated to ANSI standards or if calibrated to the older ASA/USASI standards, the appropriate correction is applied (see paragraph 3 below).
3. ASA/ANSI. Older audiometers were often calibrated to meet the standards specified by the USA Standards Institute (USASI), formerly the American Standards Association (ASA). These standards were based upon a U.S. Public Health Service survey. Newer audiometers are calibrated so that the zero hearing threshold level is now based on laboratory measurements rather than on the survey. In 1969, the American National Standards Institute (ANSI) incorporated these new measurements. Audiometers built to this standard have instruments or dials that read in ANSI values. For these reasons, it is very important that every audiogram submitted (for values reported in Item 49 on FAA Form 8500-8) include a note indicating whether it is ASA or ANSI. Only then can the FAA standards be appropriately applied. ASA or USASI values can be converted to ANSI by adding corrections as follows:
Frequency (Hz) 500 1,000 2,000 3,000
Decibels Added* 14 10 8.5 8.5
*The decibels added figure is the amount added to ASA or USASI at each specific frequency to convert to ANSI or older equivalent ISO values.
III. DISPOSITION
1. Special Issuance of Medical Certificates
Applicants who do not meet the auditory standards may be found eligible for a Statement of Demonstrated Ability (SODA). An applicant seeking a SODA must make the request in writing to the Aeromedical Certification Division, AAM-300. A determination of qualifications will be made on the basis of a special medical examination by an ENT consultant, a medical flight test, or operational experience.
2. Unilateral Deafness
An applicant with unilateral cogenital or acquired deafness should not be denied medical certification if able to pass any of the tests of hearing acuity.
3. Bilateral Deafness
It is possible for a totally deaf person to qualify for a private pilot certificate. When such an applicant initially applies for medical certification, if otherwise qualified, the Aeromedical Certification Division may issue a
combination medical/student pilot certificate with the limitation VALID FOR STUDENT PILOT PURPOSES
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ONLY as well as the limitation NOT VALID FOR CONTROL ZONES OR AREAS WHERE RADIO COMMUNICATION IS REQUIRED. This will enable the applicant to proceed with training to the point of a private pilot checkride.
When the student pilot’s instructor confirms the student’s eligibility for a private pilot checkride, the applicant should submit a written request to the Aeromedical Certification Division, AAM-300, for an authorization for a medical flight test. This test will be given by an FAA inspector in conjunction with the checkride. If the applicant successfully completes the test, the FAA will issue a third-class medical certificate and SODA. Pilot activities will be restricted to areas in which radio communication is not required.
4. Hearing Aids
Under some circumstances, the use of hearing aids may be acceptable. If the applicant is unable to pass any of the above tests without the use of hearing aids, he or she may be tested using hearing aids. If the applicant meets the standard with the use of hearing aids, the certificate may be issued with the following restriction:
VALID ONLY WITH USE OF HEARING AMPLIFICATION.
Some pilots who normally wear hearing aids to assist in communicating while on the ground report that they elect not to wear them while flying. They prefer to use the volume amplification of the radio headphone. Some use the headphone on one ear for radio communication and the hearing aid in the other for cockpit communications.
5. Otologic Surgery
A history of otologic surgery is not necessarily disqualifying for medical certification. The FAA evaluates each case on an individual basis following review of the otologist’s report of surgery. The type of prosthesis used, the person’s adaptability and progress following surgery, and the extent of hearing acuity attained are all major factors to be considered. Examiners should defer issuance to an applicant presenting a history of otologic surgery for the first time, sending the completed Report of Medical Examination, with all available supplementary information, to the Aeromedical Certification Division, AAM-300.
ITEM 50. Distant Vision
50. Distant Vision
Right 20/ Corrected to 20/
Left 20/ Corrected to 20/
Both 20/ Corrected to 20/
I. CODE OF FEDERAL REGULATIONS
A. First- and Second-Class;
14 CFR 67.103(a) and 67.203(a)
***Distant visual acuity of 20/20 or better in each eye separately, with or without corrective lenses. If
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corrective lenses (spectacles or contact lenses) are necessary for 20/20 vision, the person may be eligible only on the condition that corrective lenses are worn while exercising the privileges of an airman certificate.
B. Third-Class;
14 CFR 67.303(a)
***Distant visual acuity of 20/40 or better in each eye separately, with or without corrective lenses. If corrective lenses (spectacles or contact lenses) are necessary for 20/40 vision, the person may be eligible only on the condition that corrective lenses are worn while exercising the privileges of an airman certificate.
II. EXAMINATION PROCEDURES
A. Equipment
1. Snellen 20-foot eye chart.
2. Acceptable substitutes for distant vision testing: Projector with screen; Keystone Orthoscope; Bausch & Lomb Orthorator; AOC Site-Screener; Titmus Vision Tester; Keystone Telebinocular; OPTEC 2000 Vision Tester.
B. Examination Techniques
1. Each eye will be tested separately, and both eyes together.
2. Snellen eye charts may be used as follows:
a. The Snellen chart should be illuminated by a 100-watt incandescent lamp placed 4 feet in front of and slightly above the chart.
b. The chart or screen should be placed 20 feet from the applicant’s eyes and the 20/20 line should be placed 5 feet 4 inches above the floor.
c. A metal, opaque plastic, or cardboard occluder should be used to cover the eye not being examined.
d. The examining room should be darkened with the exception of the illuminated chart or screen.
e. If the applicant wears corrective lenses, the uncorrected acuity should be determined first, then corrected acuity. If the applicant wears contact lenses, see the recommendations in paragraph III.F. of this item.
f. Common errors:
• Failure to shield the applicant’s eyes from extraneous light.
• Permitting the applicant to view the chart with both eyes.
• Failure to observe the applicant’s face to detect squinting.
• Incorrect sizing of projected chart letters for a 20-foot distance.
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• Failure to focus the projector sharply.
• Failure to obtain the corrected acuity when the applicant wears glasses.
• Failure to note and to require the removal of contactlenses.
3. Directions furnished by the manufacturer or distributor should be followed when using substitute devices for the above testing.
III. DISPOSITION
A. When corrective lenses are required to meet the standards, an appropriate limitation will be placed on the medical certificate. For example, when lenses are needed for distant vision only:
Holder shall wear corrective lenses
For multiple vision defects involving distant and/or intermediate and/or near vision when one set of monofocal lenses corrects for all, the limitation is:
Holder shall wear corrective lenses
For combined defective distant and near visual acuity where multifocal lenses are required, the appropriate limitation is:
Holder shall wear lenses that correct for distant vision and possess glasses that correct for near vision
For multiple vision defects involving distant, near, and intermediate visual acuity when more than one set of lenses is required to correct for all vision defects, the appropriate limitation is:
Holder shall wear lenses that correct for distant VISION and possess glasses that correct for near and intermediate VISION
(For limitations as they appear on medical certificates, see Appendix B).
B. An applicant who fails to meet vision standards and has no SODA that covers the extent of the visual acuity defect found on examination may obtain further FAA consideration for grant of an Authorization under the special issuance section of Part 67 (14 CFR 67.401) for medical certification by submitting a report of an eye evaluation. The Examiner can help to expedite the review procedure by forwarding a copy of FAA Form 8500-7, Report of Eye Evaluation, that has been completed by an eye specialist.
C. Applicants who do not meet the visual standards should be referred to a specialist for evaluation. Applicants with visual acuity or ocular muscle balance problems may be referred to either an optometrist or an ophthalmologist of the applicant’s choice. Applicants with eye disease (e.g., glaucoma) should be referred only to an ophthalmologist. The FAA
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Form 8500-7, Report of Eye Evaluation, should be provided to the specialist by the Examiner.
D. Amblyopia.
In amblyopia ex anopsia, the visual acuity of one eye is decreased without the presence of organic eye disease, usually because of strabismus or anisometropia in childhood. In amblyopia ex anopsia, the visual acuity loss is simply recorded in Item 50 of FAA Form 8500-8, and visual standards are applied as usual. If the standards are not met, a Report of Eye Evaluation, FAA Form 8500-7, should be submitted for consideration.
E. Aphakia/Lens Implant(s)
The Examiner may issue a medical certificate to an aphakic applicant if:
1. The applicant has fully recovered and is stable,
2. There is no other pathology of the eye, and
3. The visual standard of 20/20 for first- or second-class or 20/40 for third-class is achieved in the aphakic eye(s) with use of corrective lens(es) and/or lens implant(s), for near, distant, and, if appropriate, intermediate vision.
F. Contact Lenses
Experience has indicated no significant risk to aviation safety in the use of contact lenses for distant vision correction. As a consequence, no special evaluation is routinely required before the use of contact lenses is authorized, and no SODA is required or issued to a contact lens wearer who meets the standards and has no complications. Contact lenses that correct near visual acuity only or that are bifocal or monofocal are not considered acceptable for aviation duties. Similarly, the use of a contact lens in one eye for distant visual acuity and a lens in the other eye for near visual acuity (monovision) is not acceptable.
The Examiner’s careful evaluation of the eye is of major importance. Issuance should be deferred if the Examiner finds evidence of lens irritation or a tinted lens that causes significant diminution of transmitted light.
G. Monocularity
An individual with one eye, or effective visual acuity equivalent to monocular, may be considered for medical certification, any class, through the special issuance section of Part 67 (14 CFR 67.401).
An airman will be considered monocular when there is only one eye or when the best corrected distant visual acuity in the poorer eye is no better than 20/200.
An applicant with acquired monocularity may be considered for certification by the FAA after completion of a 6-month period of adaptation.
H. Nystagmus
Nystagmus of recent onset is cause to deny or defer certificate issuance. Any recent neurological or other
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evaluations available to the Examiner should be submitted to the Aeromedical Certification Division, AAM-300. If nystagmus has been present for a number of years and has not recently worsened, it is usually necessary to consider only the impact that the nystagmus has upon visual acuity. The Examiner should be aware of how nystagmus may be aggravated by the forces of acceleration commonly encountered in aviation and by poor illumination.
I. Sunglasses
Airmen should be encouraged to use sunglasses in bright daylight but must be cautioned that, under conditions of low illumination, they may compromise vision. Mention should be made that sunglasses do not protect the eyes from the effects of ultra violet radiation without special glass or coatings and that photosensitive lenses are unsuitable for aviation purposes because they respond to changes in light intensity too slowly. The so-called “blue blockers” may not be suitable since they block the blue light used in many current panel displays. Polarized sunglasses are unacceptable if the windscreen is also polarized.
Sunglasses are not acceptable as the only means of correction to meet visual standards, but may be used for backup purposes if they provide the necessary correction.
J. Refractive Surgery
An applicant who has been treated with refractive surgery may be issued a medical certificate by the Examiner if the applicant meets the visual acuity standards and the Report of Eye Evaluation indicates that healing is complete, visual acuity remains stable, and the applicant does not suffer from significant glare intolerance. This state of recovery is usually reached within 6- to 12-weeks after surgery. The Examiner may, of course, defer issuance and forward the ophthalmology report to the Aeromedical Certification Division, AAM-300.
ITEM 51.a. NEAR VISION
51.a. Near Vision
Right 20/ Corrected to 20/
Left 20/ Corrected to 20/
Both 20/ Corrected to 20/
ITEM 51.b. INTERMEDIATE VISION
51.b. Intermediate Vision
Right 20/ Corrected to 20/
Left 20/ Corrected to 20/
Both 20/ Corrected to 20/
I. CODE OF FEDERAL REGULATIONS
A. First- and Second-Class:
14 CFR 67.103(b) and 67.203(b)
***Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye separately, with or without corrective lenses. If age 50 or older, near vision of 20/40 or better, Snellen equivalent, at both 16 inches and 32 inches in each eye
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separately, with or without corrective lenses.
B. Third-Class:
14 CFR 67.303(b)
***Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye separately, with or without corrective lenses.
II. EXAMINATION PROCEDURES
A. Equipment – Near Vision (16 inches)
1. FAA Form 8500-1, Near Vision Acuity Test Chart, (16 inches) dated April 1993.
2. Acceptable substitutes:
• AOC Site-Screener.
• Bausch & Lomb Orthorator.
• Keystone Orthoscope.
• Keystone Telebinocular.
• OPTEC 2000 Vision Tester.
• Titmus Vision Tester.
B. Equipment – Intermediate Vision (32 inches)
1. FAA Form 8500-1, Near Vision Acuity Chart, (32 inches) dated April 1993.
2. Acceptable substitutes:
· OPEC 2000 Vision Tester.
· Titmus Vision Tester.
· Titmus II Vision Tester (Model Nos. TII and TIIS).
· Titmus 2 Vision Tester, (Model Nos. T2A and T2S).
· Others as approved.
C. Examination Techniques
1. Near visual acuity and intermediate visual acuity, if the latter is required, are determined for each eye separately and for both eyes together. Test values are recorded both with and without corrective glasses/lenses when either are worn or required to meet the standards. If the applicant is unable to meet the intermediate acuity standard unaided, he or she then is tested using each of the corrective lenses or glasses otherwise needed by that person to meet distant and/or near visual acuity standards. If the aided acuity meets the standard using any of the lenses or glasses, the findings are recorded, and the certificate appropriately limited (see Appendix B). If an applicant has no lenses that bring intermediate and/or near visual acuity to the required standards, or better, in each eye, no certificate may be issued, and the applicant is referred to an eye specialist for appropriate visual evaluation and correction.
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2. Bifocal contact lenses or contact lenses that correct for near and/or intermediate vision only are not considered acceptable. Similarly, the use of a contact lens in one eye for distant visual acuity and a lens in the other eye for near visual acuity (monovision) is not acceptable.
3. FAA Form 8500-1, Near Vision Acuity Test Chart, dated April 1993, should be used as follows:
a. The examination is conducted in a well-lighted room with the source of light behind the applicant.
b. The applicant holds the chart 16 inches (near) and 32 inches (intermediate) from the eyes in a position that will provide uniform illumination. To ensure that the chart is held at exactly 16 inches or 32 inches from the eyes, a string of that length may be attached to the chart.
c. Each eye is tested separately, with the other eye covered. Both eyes are then tested together.
d. The smallest type correctly read with each eye separately and both eyes together is recorded in linear value. In performing the test using FAA Form 8500-1, the level of visual acuity will be recorded as the line of smallest type the applicant reads accurately. The applicant should be allowed no more than two misread letters on any line.
e. Common errors:
(1) Inadequate illumination of the test chart.
(2) Failure to hold the chart the specified distance from the eye.
(3) Failure to ensure that the untested eye is covered.
(4) Failure to determine uncorrected and corrected acuity when the applicant wears glasses.
f. Practical Test. At the bottom of FAA Form 8500-1 is a section for Aeronautical Chart Reading. Letter types and charts are reproduced from aeronautical charts in their actual size.
This may be used when a borderline condition exists at the certifiable limits of an applicant’s vision. If successfully completed, a favorable certification action may be taken.
3. Acceptable substitute instruments may be used, following the directions accompanying the instruments.
III. DISPOSITION
When correcting glasses are required to meet the near and intermediate vision standards, an appropriate limitation will be placed on the medical certificate. Contact lenses that correct only for near or intermediate visual acuity are not considered acceptable for aviation duties.
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If the applicant meets the uncorrected near or intermediate vision standard of 20/40, but already uses spectacles that correct the vision better than 20/40, it is recommended that the Examiner enter the limitation for near or intermediate vision corrective glasses on the certificate.
The use of a contact lens in one eye for distant visual acuity (monovision) and another in the other eye for near or intermediate visual acuity is not acceptable.
For all classes, the appropriate wording for the near vision limitation is:
Holder shall possess glasses THAT CORRECT for near vision
Possession only is required, because it may be hazardous to have distant vision obscured by the continuous wearing of reading glasses.
For first- and second-class, the appropriate wording for combined near and intermediate vision limitation is:
Holder shall possess glasses THAT CORRECT for near and intermediate vision
For multiple defective distant, near, and intermediate visual acuity when unifocal glasses or contact lenses are used and correct all, the appropriate limitation is:
Holder shall wear corrective lenses
For multiple vision defects involving distance and/or near and/or intermediate visual acuity when more than one set of lenses is required to correct for all vision defects, the appropriate limitation is:
Holder shall wear lenses that correct for distanT VISION and possess glasses that correct for near and intermediate vision
ITEM 52. Color Vision
I. CODE OF FEDERAL REGULATION
All Classes: 14 CFR 67.103(c), 67.203(c), and 67.303(c)
***Ability to perceive those colors necessary for the safe performance of airman duties.
*THE FAA RECENTLY CHANGED TESTING FOR COLOR VISION- CALL 405-787-0303 to discuss these changes.
II. EXAMINATION PROCEDURES
A. Equipment
1. Pseudoisochromatic plates. (American Optical Company [AOC], 1965 edition; AOC-HRR, 2nd edition; Dvorine, 2nd edition; Ishihara, 14-, 24- or 38-plate editions; or Richmond, 1983 edition, 15-plates).
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2. Acceptable substitutes:
• Farnsworth Lantern.
• Keystone Orthoscope.
• Keystone Telebinocular.
• LKC Technologies, Inc., APT-5 Color Vision Tester.
• OPTEC 2000 Vision Tester (Model Nos. 2000PM, 2000PAME, and 2000PI).
• Titmus Vision Tester.
• Titmus II Vision Tester (Model Nos. TII and TIIS).
• Titmus 2 Vision Tester (Model Nos. T2A and T2S).
*
B. Techniques
1. The test plates to be used for each of the approved pseudoisochromatic tests are:
Test Edition Plates
AOC 1965 1-15
AOC-HRR 2nd 1-11
Dvorine 2nd 1-15
Ishihara 14-Plate 1-11
Ishihara 24-Plate 1-15
Ishihara 38-Plate 1-21
Richmond 1983 1-15
*THE FAA RECENTLY CHANGED TESTING FOR COLOR VISION- CALL 405-787-0303 to discuss these changes.
2. The following conditions should be ensured when testing with pseudoisochromatic plates:
a. The test book should be held 30 inches from the applicant.
b. Plates should be illuminated by at least 20 foot candles, preferably by a Macbeth Easel Lamp or a Verilux True Color Light (F15T8VLX).
c. Three seconds should be allowed for the applicant to interpret and respond to a given plate.
3. Testing procedures for the Farnsworth Lantern; Keystone; LKC Technologies, Inc.; OPTEC 2000, Titmus, Titmus II, and Titmus 2 Vision Testers accompany the instruments.
4. The results (pass or fail) should be recorded.
III. DISPOSITION
An applicant does not meet the color vision standard if testing reveals:
A. All Classes
1. Seven or more errors on plates 1-15 of the AOC (1965 edition) pseudoisochromatic plates.
2. AOC-HRR (second edition): Any error in test plates 7-11. Because the first 4 plates in the test book are for demonstration only, test plate 7 is actually the eleventh plate in the book. (See instruction booklet).
3. Seven or more errors on plates 1-15 of Dvorine pseudoisochromatic plates (second edition, 15 plates).
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4. Six or more errors on plates 1-11 of the concise 14-plate edition of the Ishihara pseudoisochromatic plates. Seven or more errors on plates 1-15 of the 24-plate edition of Ishihara pseudoisochromatic plates. Nine or more errors on plates 1-21 of the 38-plate edition of Ishihara pseudoisochromatic plates.
5. Seven or more errors on plates 1-15 of the Richmond (1983 edition) pseudoisochromatic plates.
6. Farnsworth Lantern test: An average of more than one error per series of nine color pairs in series 2 and 3. (See instruction booklet).
7. Any errors in the six plates of the Titmus Vision Tester, the Titmus II Vision Tester, the Titmus 2 Vision Tester, the OPTEC 2000 Vision Tester, the Keystone Orthoscope, or Keystone Telebinocular.
8. LKC Technologies, Inc., APT-5 Color Vision Tester. The letter must be correctly identified in at least two of the three presentations of each test condition. (See APT-5 screening chart for FAA-related testing in instruction booklet).
B. Certificate Limitation
If an applicant fails to meet the color vision standard as interpreted above but is otherwise qualified, the Examiner may issue a medical certificate bearing the limitation:
Not valid for night flying or by color signal control
C. Special Issuance of Medical Certificates
An applicant who holds a medical certificate bearing a color vision limitation may request reevaluation or a SODA under the special issuance section of Part 67 (14 CFR 67.401). This request should be in writing and should be directed to the Aeromedical Certification Division, AAM-300. If the applicant can perform the color vision tasks, the FAA will issue a medical certificate without limitation with a SODA.
Demonstrating the ability to perform color vision tasks appropriate to the certificate applied for may entail a medical flight test or a signal light test. If a signal light test or medical flight test is required, the FAA will authorize the test. The signal light test may be given at any time during flight training.
The medical flight test is most often required when an airman with borderline color vision wishes to upgrade a medical certificate.
D. “Color Vision Correcting” Lens (e.g. X-Chrom)
Such lens are unacceptable to the FAA as a means for correcting a pilot’s color vision deficiencies.
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E. Yarn Test
Yarn tests are not acceptable methods of testing for the FAA medical certificate.
ITEM 53. Field of Vision
I. CODE OF FEDERAL REGULATIONS
A. First- and Second-Class:
14 CFR 67.103(d) and 67.203(d)
***Normal fields of vision.
B. Third-Class: 14 CFR 303(d)
***No acute or chronic pathological condition of either eye or adnexa that interferes with the proper function of an eye, that may reasonably be expected to progress to that degree, or that may reasonably be expected to be aggravated by flying.
II. EXAMINATION PROCEDURES
A. Equipment
1. Fifty-inch square black matte surface wall target with center white fixation point; 2 millimeter white test object on black-handled holder.
2. Acceptable substitute: Standard perimeter.
B. Techniques
1. Wall target.
a. The applicant should be seated 40 inches from the target.
b. An occluder should be placed over the applicant’s right eye.
c. The applicant should be instructed to keep the left eye focused on the fixation point.
d. The white test object should be moved from the outside border of the wall target toward the point of fixation on each of the eight 4-degree radials.
e. The result should be recorded on a worksheet as the number of inches from the fixation point at which the applicant first identifies the white target on each radial.
f. The test should be repeated with the applicant’s left eye occluded and the right eye focusing on the fixation point.
2. Alternative Procedures.
a. A standard perimeter may be used in place of the above procedure. With this method, any significant deviation from normal field configuration will require evaluation by an ophthalmologist.
b. Direct confrontation. This is the least acceptable alternative since this tests for peripheral vision and only grossly for field size and visual defects. The Examiner, standing in front of the applicant, has the applicant look at
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the Examiner’s nose while advancing two moving fingers from slightly behind and to the side of the applicant in each of the four quadrants. Any significant deviation from normal requires ophthalmological evaluation.
III. DISPOSITION
A. Ophthalmological Consultations
If an applicant fails to identify the target in any presentation at a distance of less than 23 inches from the fixation point, an ophthalmologist’s evaluation must be requested. This is a requirement for all classes of certification. The Examiner should provide FAA Form 8500-14, Ophthalmological Evaluation for Glaucoma, for use by the ophthalmologist if glaucoma is suspected
B. Glaucoma
The Examiner should deny or defer issuance of a medical certificate to an applicant if there is a loss of visual fields, a significant change in visual acuity, a diagnosis of or treatment for glaucoma, or intraocular hypertension.
The FAA may grant an Authorization under the special issuance section of Part 67 (14 CFR 67.401) on an individual basis. The Examiner can facilitate FAA review by obtaining a report of Ophthalmological Evaluation for Glaucoma (FAA Form 8500-14) from a treating or evaluating ophthalmologist. Because secondary glaucoma is caused by known pathology such as uveitis or trauma, eligibility must largely depend upon that pathology. Secondary glaucoma is often unilateral, and if the cause or disease process is no longer active and the other eye remains normal certification is likely.
In primary glaucoma, applicants with closed angle, narrow angle, or angle closure are usually denied because of the possibilities of unanticipated acute rise in pressure, severe pain, nausea, transitory loss of accommodative power, blurred vision, halos, epiphora, or iridoparesis. Central venous occlusion can occur with catastrophic loss of vision. However, when surgery such as iridectomy or iridencleisis has been performed satisfactorily more than 3 months before the application, the likelihood of difficulties is considerably more remote, and applicants in that situation may be favorably considered by the FAA.
An applicant with unilateral or bilateral open angle glaucoma may be certified by the FAA (with follow-up required) when a current ophthalmological report substantiates that pressures are under adequate control, there is little or no visual field loss or other complications, and the person tolerates small to moderate doses of allowable medications. A few applicants have been certified following their demonstration of adequate control with oral medication. Neither miotics nor mydriatics are necessarily medically disqualifying.
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However, miotics such as pilocarpine cause pupillary constriction and could conceivably interfere with night vision. Although the FAA no longer routinely prohibits pilots who use such medications from flying at night, it may be worthwhile for the Examiner to discuss this aspect of the use of miotics with applicants. If considerable disturbance in night vision is documented, the FAA may limit the medical certificate:
Not Valid for Night Flying
C. Other Pathological Conditions
Applicants for all classes can have no acute or chronic pathological condition of either eye or adnexa that interferes with the proper function of an eye, that may reasonably be expected to progress to that degree, or that may reasonably be expected to be aggravated by flying.
ITEM 54. Heterophoria
I. CODE OF FEDERAL REGULATIONS
A. First- and Second-Class:
14 CFR 67.103(f) and 67.203(f)
***Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in fusion under conditions that may reasonably be expected to occur in performing airman duties. Tests for the factors named in this paragraph are not required except for persons found to have more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded, the Federal Air Surgeon may require the person to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate vergence-phoria relationship. However, if otherwise eligible, the person is issued a medical certificate pending the results of the examination.
B. Third-Class:
***No standards.
II. EXAMINATION PROCEDURES
A. Equipment
1. Red Maddox rod with handle.
2. Horizontal prism bar with graduated prisms beginning with one prism diopter and increasing in power to at least eight prism diopters.
3. Acceptable substitutes:
• AOC Site-Screener.
• Bausch & Lomb Orthorator.
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• Keystone Orthoscope.
• Keystone Telebinocular.
• Maddox rod and individual prisms.
• Maddox rod and Risley rotary prism.
• OPTEC 2000 Vision Tester
• Titmus Vision Tester
B. Techniques
Test procedures to be used accompany the instruments. If the Examiner needs specific instructions for use of the horizontal prism bar and red Maddox rod, these may be obtained from a Regional Flight Surgeon.
III. DISPOSITION
A. Third-Class
Applicants for a third-class certificate are not required to undergo heterophoria testing. However, if an applicant has strabismus or a history of diplopia, the Examiner should defer issuance of a certificate and forward the application to the Aeromedical Certification Division, AAM-300. If the applicant wishes further consideration, the Examiner can help expedite FAA review by providing the applicant with a copy of FAA Form 8500-7, Report of Eye Evaluation.
B. First- and Second-Class
If an applicant exceeds the heterophoria standards (1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria) but shows no evidence of diplopia or serious eye pathology, and all other aspects of the examination are favorable, the Examiner should not withhold or deny the medical certificate. The applicant should be advised that the FAA may require further examination by a qualified eye specialist.
C. Diplopia
Any applicant with a history of diplopia should be denied or deferred unless the applicant provides written evidence that the FAA has previously considered and determined that this condition is not adverse to flight safety.
ITEM 55. BLOOD PRESSURE
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I. CODE OF FEDERAL REGULATIONS
A. All Classes:
14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)
***No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—
Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
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.
***No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment involved finds—
Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or 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.
Measurement of blood pressure is an essential part of the FAA medical certification examination. The average blood pressure while sitting should not exceed 155 mm mercury systolic and 95 mm mercury diastolic maximum pressure for all classes. A medical assessment is specified for all applicants who need or use antihypertensive medication to control blood pressure. (See B. below).
II. EXAMINATION PROCEDURES
In accordance with accepted clinical procedures, routine blood pressure should be taken with the applicant in the seated position. However, an applicant should not be denied or deferred first-, second-, or third-class certification unless subsequent recumbent blood pressure readings exceed those specified. Any conditions that may adversely affect the validity of the blood pressure reading should be noted.
III. DISPOSITION
A. Examining Options
1. An applicant whose pressures are within the above limits, who has not used antihypertensives for 30 days, and who is otherwise
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qualified should be issued a medical certificate by the Examiner.
2. An applicant whose blood pressure is slightly elevated beyond the FAA specified limits, may, at the Examiner’s discretion, have a series of 3 morning and evening blood pressure readings over a 7-day period. If the indication of hypertension remains, even if it is mild or intermittent, the Examiner should defer certification and transmit the application to the Aeromedical Certification Division with a note of explanation.
The Examiner must defer issuance of a medical certificate to any applicant whose hypertension has not been evaluated, who uses unacceptable medications, whose medical status is unclear, whose hypertension is uncontrolled, who manifests significant adverse effects of medication, or whose certification has previously been specifically reserved to the FAA.
B. Initial Evaluation for Hypertensives Under Treatment
The Examiner may issue first-, second-, or third-class medical certificates to otherwise qualified airmen whose hypertension is adequately controlled with acceptable medications without significant adverse effects. In such cases, the Examiner shall:
1. Conduct an evaluation or, at the applicant’s option, review the report of a current (within preceding 6 months) cardiovascular evaluation by the applicant’s attending physician. This evaluation must include pertinent personal and family medical history, including an assessment of the risk factors for coronary heart disease, a clinical examination including at least three blood pressure readings, a resting ECG, and a report of fasting plasma glucose, cholesterol (LDL/HDL), triglycerides, potassium, and creatinine levels. A maximal electrocardiographic exercise stress test will be accomplished if it is indicated by history or clinical findings. Specific mention must be made of the medications used, their dosage, and the presence, absence, or history of adverse effects.
2. Summarize the results of this evaluation in item 60 of the transmitted application and forward the appropriate documents to the Aeromedical Certification Division, AAM-300.
3. Report the results of any additional tests or evaluations that have been accomplished.
4. If appropriate, state on FAA Form 8500-8 that the applicant’s blood pressure is adequately controlled with acceptable medication, there are no known significant adverse effects, and no other cardiovascular, cerebrovascular, or arteriosclerotic disease is evident.
5. Defer certification if the person declines any of the recommended evaluations.
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C. Medications
1. Medications acceptable to the FAA for treatment of hypertension in airmen include all Food and Drug Administration (FDA) approved diuretics, alpha-adrenergic blocking agents, beta-adrenergic blocking agents, calcium channel blocking agents, angiotension converting enzyme (ACE inhibitors) agents, and direct vasodilators. Centrally acting agents (such as, reserpine, guanethidine, guanadrel, guanabenz, and methyldopa) are not usually acceptable to the FAA. Dosage levels should be the minimum necessary to obtain optimal clinical control and should not be modified to influence the certification decision.
2. The Examiner may submit for the Federal Air Surgeon’s review requests for Authorization under the special issuance section of Part 67 (14 CFR 67.401) in cases in which these or other usually unacceptable medications are used. Specialty evaluations are required in such cases and must provide information on why the specific drug is required. The Examiner’s own recommendation should be included. The Examiner must defer issuance of a medical certificate to any applicant whose hypertension is being treated with unacceptable medications.
D. Follow-up Reports
Follow-up evaluations must include a current status report describing at least the medications used and their dosages, the adequacy of blood pressure control, the presence or absence of side effects, the presence or absence of end-organ complications and the results of any appropriate tests or studies. Hypertension follow-ups are required annually for first- and second-class medical certificate applicants and at the time of renewal for third-class certificate applicants.
E. Duration of Certificates
The duration of the certificate will be valid until time of normal expiration, unless otherwise specified by the FAA.
ITEM 56. Pulse
The medical standards do not specify pulse rates that, per se, are disqualifying for medical certification. These tests are used, however, to determine the status and responsiveness of the cardiovascular system. Abnormal pulse rates may be reason to conduct additional cardiovascular system evaluations.
II. EXAMINATION PROCEDURES
A. The pulse rate is determined with the individual relaxed in a sitting position.
B. Bradycardia of less than 50 beats per minute, any episode of tachycardia during the course of the examination, and any other irregularities of pulse other than an
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occasional ectopic beat or sinus arrhythmia must be noted and reported.
III. DISPOSITION
A. If there is bradycardia, tachycardia, or arrhythmia further evaluation may be warranted and deferral may be indicated.
B. A cardiac evaluation may be needed to determine the applicant’s qualifications. Temporary stresses or fever may, at times, result in abnormal results from these tests. If the Examiner believes this to be the case, the applicant should be given a few days to recover and then be retested. If this is not possible, the Examiner should defer issuance, pending further evaluation.
ITEM 57. Urinalysis
I. CODE OF FEDERAL REGULATIONS
All Classes:
***No established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control.
***No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds-
Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
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.
II. EXAMINATION PROCEDURES
Any standard laboratory procedures are acceptable for these tests.
III. DISPOSITION
A. Glycosuria or proteinuria is cause for deferral of medical certificate issuance until additional studies determine the status of the endocrine and/or urinary systems. If the glycosuria has been determined not to be due to carbohydrate intolerance, the Examiner may issue the certificate. Trace or 1+ proteinuria in the absence of a history of renal disease is not cause for denial.
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B. The Examiner may request additional urinary tests when they are indicated by history or examination. These should be reported on FAA Form 8500-8.
See Items 18, 41, and 48 for related information.
ITEM 58. ECG
I. CODE OF FEDERAL REGULATIONS
A. First-Class: 14 CFR 67.111(b)(c)
***A person applying for first-class medical certification must demonstrate an absence of myocardial infarction and other clinically significant abnormality on electrocardiographic examination:
At the first application after reaching the 35th birthday; and
On an annual basis after reaching the 40th birthday.
***An ECG will satisfy a requirement of paragraph (b) of this section if it is dated no earlier than 60 days before the date of the application it is to accompany and was performed and transmitted according to acceptable standards and techniques.
B. All Classes
All applicants for certification may be required to provide ECG’s when indicated by history or physical examination under the provisions of 14 CFR 67.413, Medical records.
II. EXAMINATION PROCEDURES
A. Date
The date of the most recent ECG shall be entered in Item 58 of FAA Form 8500-8 for all first-class applicants.
1. If a first-class applicant is due for a periodic ECG, the Examiner performs and transmits a current tracing according to established procedures. (See D. below).
However, some applicants (such as airline transport pilots who are employed by air carriers with medical departments) may have their company transmit a current ECG directly to the FAA. The Examiner need not require such an applicant to undergo another ECG examination and, if the applicant is otherwise qualified, a medical certificate may be issued. The Examiner should attach a statement to FAA Form 8500-8 to verify that a tracing has been transmitted from another source. The date of that ECG should be entered in Item 58.
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2. If a first-class applicant is not required to have a periodic ECG with the current examination, the Examiner should record the date of the preceding ECG in Item 58.
3. If a second- or third-class applicant gives a history of having had an electrocardiogram, the test and date may be entered in Item 59. More importantly, the Examiner should indicate in Item 60 of FAA Form 8500-8 the history and its significance, if any.
4. If the applicant provides no statement and refuses to have a current ECG submitted by the Examiner, the Examiner should defer issuance of the medical certificate. When an ECG is due but is not submitted, the FAA will not affirm the applicant’s eligibility for medical certification until the requested ECG has been received and interpreted as being within normal limits. Failure to respond to FAA requests for a required current ECG will result in denial of certification.
B. Currency
1. In order to meet regulatory requirements, a first-class applicant’s periodic ECG must have been performed and transmitted within 60 days prior tothe date of the first-class application (FAA Form 8500-8). The Aeromedical Certification Division, AAM-300, verifies currency of all periodic ECG’s.
2. There is no provision for issuance of a first-class medical certificate based upon a promise that an ECG will be obtained at a future date. In such circumstances, the Examiner should defer issuance and mail the completed FAA Form 8500-8 to the Aeromedical Certification Division, AAM-300.
C. Interpretation
1. All ECG’s required to establish eligibility for medical certification–whether a periodic requirement or not–are to be forwarded for interpretation to the Manager of the Aeromedical Certification Division, AAM-300. This does not preclude submission of an interpretation by or through the Examiner.
2. Interpretation is accomplished by the staff and consultant cardiologists at the Civil Aeromedical Institute in Oklahoma City. Abnormalities are investigated to determine their significance, if any.
D. Technique and Reporting Format for Required ECG’s on First-Class Applicants
The method for recording and transmitting ECG’s is by digital electronic data transfer by the Examiner to the Aeromedical Certification Division. Senior Examiners who perform first-class medical examinations are required to have access to this capability.
International Examiners who submit ECG’s should use the following format for preparation and submission:
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1. See FAA Form 8065-1, Appendix B, Instructions for Preparation and Submittal of Electrocardiogram. However, the FAA also will accept 3-channel or 12-channel strips uncut or mounted on standard mounting paper. The following steps are essential to expedite processing of these tracings:
a. All leads must be properly identified.
b. Applicant and Examiner identification must be complete and the tracing must be dated.
2. Such hard-copy ECG’s are microfilmed for permanent retention in the Aeromedical Certification Division. Only tracings that can be microfilmed are acceptable.
3. Tracings must be stapled to the ECG report form to ensure that all leads are appropriately coded and interpreted.
III. DISPOSITION
The following is a partial list of conditions that warrant denial or deferral to the Aeromedical Certification Division, AAM-300. All disqualifying defects are subject to further FAA consideration.
A. Arrhythmias, except sinus arrhythmia and occasional atrial or ventricular ectopic beats.
B. Conduction defects such as:
1. Second degree or complete heart block.
2. Left bundle branch block.
3. Acquired right bundle branch block.
4. Preexcitation, with or without a history of tachyarrhythmia.
C. Other significant findings such as unequivocal ECG evidence of:
1. Myocardial infarction.
2. Coronary heart disease.
3. Ventricular strain.
4. Ventricular hypertrophy.
ITEM 59. Other Tests Given
***Whenever the Administrator finds that additional medical information or history is necessary to determine whether an applicant for or the holder of a medical certificate meets the medical standards for it, the Administrator requests that person to furnish that
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information or to authorize any clinic, hospital, physician, or other person to release to the Administrator all available information or records concerning that history. If the applicant or holder fails to provide the requested medical information or history or to authorize the release so requested, the Administrator may suspend, modify, or revoke all medical certificates the airman holds or may, in the case of an applicant, deny the application for an airman medical certificate.
***If an airman medical certificate is suspended or modified under paragraph (a) of this section, that suspension or modification remains in effect until the requested information, history, or authorization is provided to the FAA and until the Federal Air Surgeon determines whether the person meets the medical standards under this part.
II. EXAMINATION PROCEDURES
Additional medical information may be furnished through additional history taking, further clinical examination procedures, and supplemental laboratory procedures.
On rare occasions, even surgical procedures such as biopsies may be indicated. As a designee of the FAA Administrator, the Examiner has limited authority to apply 14 CFR 67.413 in processing applications for medical certification. When an Examiner determines that there is a need for additional medical information, based upon history and findings, the Examiner is authorized to request prior hospital and outpatient records and to request supplementary examinations including laboratory testing and examinations by appropriate medical specialists. The Examiner should discuss the need with the applicant. The applicant should be advised of the types of additional examinations required and the type of medical specialist to be consulted. Responsibility for ensuring that these examinations are forwarded and that any charges or fees are paid will rest with the applicant. All reports should be forwarded to the Aeromedical Certification Division, AAM-300, unless otherwise directed (such as by a Regional Flight Surgeon).
Whenever, in the Examiner’s opinion, medical records are necessary to evaluate an applicant’s medical fitness, the Examiner should request that the applicant sign an authorization for the Release of Medical Information (FAA Form 8500-21). (See Appendix B). The Examiner should forward this authorization to the custodian of the applicant’s records so that the information contained in the record may be obtained for attachment to the report of medical examination.
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ITEM 60. Comments On History And Findings
In addition to comments on positive historical or examination findings, this item gives the Examiner an opportunity to report observations and/or findings that are not asked for in other items on the application form. Concern about the applicant’s behavior, abnormal situations arising during the conduct of tests, unusual findings, unreported history, and other information thought germane to aviation safety should be reported in Item 60. The Examiner should record dosage, the frequency, and purpose for all currently used medications.
If possible, all ancillary reports such as consultations, ECG’s, x-ray release forms, and hospital or other treatment records should be attached. If the delay for those items would exceed 14 days, the Examiner should forward all available data to the Aeromedical Certification Division, AAM-300, with a note specifying what additional information is being prepared for submission at a later date.
If there are no significant medical history items or abnormal physical findings, the Examiner should indicate this by checking the appropriate block.
ITEM 61. Applicant’s Name
ITEM 62. Has Been Issued
The Examiner must check the proper box to indicate if the Medical Certificate, FAA Form 8500-9 (white), or Medical Certificate and Student Pilot Certificate, FAA Form 8420-2 (yellow), has been issued. If neither form has been issued, the Examiner must indicate denial or deferral by checking one of the two lower boxes. If denied, a copy of the Examiner’s letter of denial, FAA Form 8500-2, should be forwarded to the Aeromedical Certification Division, AAM-300.
A. Applicant’s Refusal
When advised by an Examiner that further examination and/or medical records are needed, the applicant may elect not to proceed. The Examiner should note this on FAA Form 8500-8. No certificate should be issued, and the Examiner should forward the application form to the Aeromedical Certification Division, AAM-300, even if the application is incomplete.
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B. Anticipated Delay
When the Examiner anticipates a delay of more than 14 days in obtaining records or reports concerning additional examinations, the completed FAA Form 8500-8 should be transmitted to the Aeromedical Certification Division with a note stating that additional information will follow. No medical certificate should be issued.
C. Issuance
When the Examiner receives all the supplemental information requested and finds that the applicant meets all the FAA medical standards for the class sought, the Examiner should issue a medical certificate.
D. Deferral
If upon receipt of the information the Examiner finds there is a need for even more information or there is uncertainty about the significance of the findings, certification should be deferred. The Examiner’s concerns should be noted on FAA Form 8500-8 and the application transmitted to the Aeromedical Certification Division for further consideration.
If the applicant decides at this point to abandon the application for a medical certificate (for any class), the Examiner should also note this on
FAA Form 8500-8 before transmitting it to the FAA. (See Chapter 1, Item 3, Medical Certification Decision Making).
E. Denial
When the Examiner concludes that the applicant is clearly ineligible for certification, the applicant should be denied, using FAA Form 8500-2. (See Appendix B). Use of this form will provide the applicant with the reason for the denial and with appeal rights and procedures. (See Chapter 1, Item 3, Medical Certification Decision Making).
ITEM 63. Disqualifying Defects
Any disqualifying defects, diagnoses, or conditions must be listed by item number. Comments or discussion of specific observations or findings may be reported in Item 60 or submitted on a separate sheet of paper.
The Examiner should note in item 60 that a Letter of Denial, FAA Form 8500-2, was given to the applicant.
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ITEM 64. Medical Examiner’s Declaration
If the application is not transmitted electronically, the date of examination and the Examiner’s name and complete address must be typed. The Examiner must personally sign the completed form. The Examiner’s serial number and telephone number should be entered in the blocks provided.
The FAA designates specific individuals as Examiners, and this status may not be further delegated to a physician who may be covering the designee’s practice.
Although the FAA does not require that the Examiner sign the Examiner’s copy of FAA Form 8500-8, the Examiner should at least personally initial this form.
END OF CHAPTER 4 | AME GUIDE
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