APPENDIX B

Statistical Appraisal of Mortality Experience
Among Panel Grants as Compared To The White
Male Population of the United States

Person-Years (Lx) in age intervals as reflected
in Table XII were computed by use of the
formula:

Lx=1x+Yohx-Yh (axt+dx t+ wx) + Ybx
Where:

Lx=Person-years in the interval.

lx=Individuals under observation (issued
grants) at the beginning of the interval.

hx= Individuals entering observation (issued
grants) during the interval.

ax= Individuals leaving observation (termina-
tion of grant) during the interval due to
adverse change in medical condition.

dy= Individuals leaving observation during the
interval because of death.

ws = Individuals withdrawing from observation
alive during the interval for all other
reasons including termination of the study.

bx= Individuals both entering and leaving ob-
servation in the same interval.

Individuals entering observation are counted as
being present one-half year each in the entering
interval. Individuals leaving observation for

i

whatever reason are counted as being present
for one-half year each. Individuals entering and
leaving during the same interval are counted as
being present for one-quarter year each,

This technique of evaluating mortality experi-
ence following entry into the observation group
is discussed in Chapter 10 of “Practical Statistics
in Health and Medical Work” by Ruth R. Puffer,
Dr. P.H., and involves the comparison of the
number of deaths that occurred in a group under
observation with the number that would be ex-
pected in such a population if mortality experi-
ence were similar to that of some other compari-
son group; in this case, that of the white male
population of the United States during 1965.

The death rate for the comparison group is
multiplied by the person-years of life experience
in a given age interval of the group under ob-
servation to obtain expected deaths in the ob-
served group if mortality experience were similar
to that of the comparison group. Expected deaths
are then compared with observed deaths, by age
interval, to indicate mortality experience in the
observation group (See Table XII).



thus assure reasonable certainty that the final
action taken was a denial of medical certification
as of the date of computer extraction in May
1967.2

A total of 5,727 airmen were identified by
automated means as having been denied medical
certification during the time period of May 1964
through June 1966. Elements of data from these
airmen’s medical records were then classified by
the computer into various frequency tables to
reflect the medical and general descriptive char-
acteristics mentioned in the introductory remarks
and presented later in the study.

It should be observed that medical certification
criteria changed dramatically in favor of the
airman during the time period May 1964 through
June 1966.3 The initial denial data presented
should, therefore, be viewed as a pessimistic ap-
proximation in any proportional extrapolation to
future airman populations.

Data pertaining to appellate actions by the
Federal Air Surgeon or the Administrator were
extracted from summary reports published
periodically by the Aeromedical Standards
Division and the Administrator’s Medical Ad-
visory Panel. Data were also obtained from ap-
pellate case monitoring activities conducted by
Aeromedical Certification personnel in Oklahoma
City, Oklahoma.

Some problems are recognized with respect to
individuals appealing on more than one occasion.
This would appear to produce some bias in the
data as concerns dual accounting. This is not,
however, a serious limitation; to the contrary, it
presents no limitation when it is realized that
actions taken are based on medical circumstances
at the time of the appeal. Presumably, a change
in medical condition is the only reason for an
airman to appeal on more than one occasion.

IIL. Findings and Discussion.
A. Initial Denials.

1. General comments. Between May 1964 and

?The appeal procedure would not normally involve a time
span from July 1, 1966 to May 1967. The June 30, 1966
“cut-off” was arbitrarily chosen to minimize the chance of in-
cluding an airman in the study who was still appealing the
denial action (e.g., cases where numerous medical consultations
or follow-ups were required for a final decision). Additionally,
some time lag is realized between the time of appellate decision
and the time the computer is updated to reflect the decision.

‘Reference Change 2 (Special Medical Flight or Practical
‘Test or Medical Evaluation for Special Issue of Medical Certifi-
cate) October 21, 1965, and Change 3 (Distant Visual Acuity:
First and Second Class Medica! Certificates) November 23, 1965,
to Federal Aviation Regulations, Part 67—Medical Standards
and Certification.

June 1966, 726,112 applications for medical certi-
fication were received by the Aeromedical Certifi-
cation Branch in Oklahoma City, Oklahoma.
Denials for a similar period totaled 5,727 or
0.79% of application receipts. The 726,112 ap-
plication receipts must be viewed as representing
approximately 500,000 active airmen since four
applications would have been received from some
first-class airmen during this time period; two
applications would have been received from some
second-class airmen; and _ third-class airmen
would have submitted application only once. As-
suming approximately 500,000 airmen were in-
volved, the denial rate is only slightly increased
to 1.14% when the number of denials is applied
to individuals versus applications. As noted in
Table V, the vast majority of denials are ac-
counted for by student airmen (2,862 or 49.97%)
and private airmen (1,526 or 26.65%).

The Office of Aviation Medicine recognizes that
many airmen, in effect, deny themselves medical
certification because of a known medical condi-
tion and subsequent attrition from an active air-
man status. This occurrence is less likely, how-
ever, among airmen occupationally connected to
aviation since more is obviously at stake and
since this group is probably more aware of the
appeal channels,

Taste I, Denials by Age and Class of Medical
Certificate Applied for by the Airman
May 1964 — June 1966
Percent
First Second Third of
Age* Class Class Class Unknown** Total Total
Less than 20 11 36 232 1 280 4.89
20-24 48 102. «1,014 3 1,167 20.38
25-29 33. o1 412 2 538 (9.39
30-34 15 80 401 1 497 = 8.68
85-39 22 108 488 4 622 10.86
40-44 53-202 512 5 712 13.48
45-49 60 «152 430 6 648 11.31
50-54 56 98 410 1 565 (9.87
55-59 31 66 255 1 853 «6.16
60-64 3 23 142 2 1700 (2.97
65-69 3 10 63 - 7 1.33
70 and over - - 38 1 39 (0.68
TOTAL 335 968 4,397 27 5,727
PERCENT
OF TOTAL 5.85 16.90 76.78 0.47 100.00

*Age at the time of examination recorded to the nearest year.

**Class applied’ for was unknown and therefore was treated
as an unknown in the table.

Source: Civil Aeromedical Institute, Aeromedical Certification
Branch, Medical Statistical Section.


Taste X. Reconsideration Actions by
the Federal Air Surgeon
January 1963 - December 1967

First Second Third
Pathology Class Class Class Total
Issued
Bye 43 108 117-268
Ear, Nose, Throat 3 1 9 18
Respiratory 2 5 12 19
Cardiovascular 352 108 195
Abdominal 1 9 18 28
Nervous/Mental 22 20 OTisS.
Bone/Joint 2 4 7 13
Muscles - 1 3 4
Miscellaneous* 3 35 49
TOTAL Ti (2 426 152
Denied
Eye 6t 207124 802
Ear, Nose, Throat 4 4 7 15
Respiratory 6 9 42 BT
Cardiovascular 107-201 707 1,015
Abdominal 1 52 7
Nervous/Mental 7 186 874 580
Bone/Joint - 5 14 19
Muscles 1 3 8 12
Miscellaneous* 210 58S 25m
TOTAL 230 «633-1509 (2,492

*Miscellaneous includes alcohol and drugs, endocrinopathies
and general systemic conditions.

Source: Office of Aviation Medicine, Aeromedical Standards
Division.

During the time period 1961 through 1967, the
Administrator considered 1,945 petitions from

airmen denied medical certification by the Fed-
eral Air Surgeon. These 1,945 petitions indicate
that approximately 65% of the airmen denied by
the Federal Air Surgeon petitioned the Adminis-
trator for exemption from the regulations,

Table XI summarizes the pathology repre-
sented in petitions to the Administrator, as well
as decisions rendered. As before, cardiovascular,
nervous and mental, and deficient vision were the
most frequent pathological conditions considered.
Cardiovascular problems represented 60% of the
petitions to the Administrator. Approximately
one out of four petitions based on cardiovascular
problems was favorably considered. About one
out of five of the petitions based on nervous and
mental problems was favorably considered, and
approximately one out of three petitions based
on deficient vision problems was favorably con-
sidered. Overall, approximately 25% of all pe-
titions to the Administrator received favorable
action.

Since cardiovascular problems accounted for
60% of the petitions to the Administrator and
67% of the total favorable actions, in terms of
grants of exemption to existing regulations,
further analysis seems appropriate with respect
to observed mortality experience among these
individuals as compared to the total United
States population.

During the time period January 1961 through
December 1967, 325 petitions based on cardio-

‘Taste XI. Petitions Granted or Denied by
the Administrator*
1961-1967
Granted Denied

First Second Third Pirst Second Third Percent

Pathology Class Class Class Subtotal Class Class Class Subtotat Total of Total
Bye 10 19 25 54 8 59 22 80 143 TA
War, Nose, Throat ~ 1 - 1 - 1 - 1 2 o1
Respiratory - - 4 4 8 1 10 14 18 09
Cardiovascular 6 32 287 325 120 204 52d 848 1,178 60.8
Abdominal 2 - 6 8 3 5 14 22 30 16
Nervous/Mental - 12 70 82 49 91 214 354 436 224
Bone/Joint - - 1 1 1 4 4 9 10 05
‘Muscles - - - - - - 2 2 2 O14
Miscellaneous - 2 8 10 11 15 95 121 181 6.7
TOTAL 7 6 fr “485 195 = 380 88 = 1,460 1935 = 100.0

*Counts are based on number of petitions considered rather than number of airmen petitioning.
Source: Office of Aviation Medicine, Aeromedical Standards Division.

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‘Taprx II. Age Distribution of Active Airmen by Class of Medical Certificate
January 1, 1968

First Second Third Percent

Age Clase Class Class Totat of Total
Less than 20 2,182 8,400 24,989 30,571 4.89
20-24 10,868 24,316 59,213 94,397 15.10
25-29 17,596 30,127 55,676 103,399 16.54
30-84 14,118 28,813 49,029 91,960 14.71
35-39 8,794 28,843 52,657 90,294 14,44
40-44 7,067 25,866 49,369 82,302 13.16
45-49 8,544 27,594 34,632 70,770 11.32
50-54 3,394 11,482 20,828 35,704 5.7
55-59 1,230 4,248 10,473 15,951 2.55,
60-64 312 1,812 4,621 6,745 1.08
65-69 41 572 1,657 2,270 0.36
70 and over 8 153, 708 869 0.14

TOTAL 74,154 187,226 363,852 625,232.

PERCENT OF

TOTAL 11.86 29.95 58.19 100,00

Source : Civil Aeromedical Institute, Aeromedical Certification Branch, Medical Statistical Section.

2, Age distribution of denied airmen. Tables
I, II, and III consider the age distribution of
denied airmen, the age distribution of active air-
men as of January 1, 1968, and a proportional
comparison of the denied versus certified airmen,
respectively. The mean age of the active airman
population as of January 1, 1968, was 35.0 years:
whereas, the mean age of denied airmen included
in this study is 37.5 years. Statistically speaking,
this is a significant difference in age when com-
pared via conventional statistical methodology.
The probability of a difference this large (2.5
years) due to chance is considerably less than
0001. The alternate hypothesis that the mean
age of denied airmen is greater than the mean
age of the active population would seem to be
supported, See Appendix A for further details
concerning the statistical methodology.

Reference to Tables I and III indicates that
the largest proportion of denied airmen come
from the age group 20-24 years. It may also
be observed from Table I that the largest group
of denied airmen (1,014 or 17.7%) are third-class
airmen between the ages of 20-24 years. The
proportional distribution of denied airmen is,
however, higher in the older age groups, thus
raising the mean age of denied airmen.

3. Denials by sex and previous application
status. Table IV reflects data concerning the sex
of denied applicants and whether a previous
FAA examination was recorded for the indi-

‘Active airmen are defined as having been medically certified
within the previous 25 months.

Taste III, Age Distribution Comparison—Active Air-
men Versus Denied Airmen
Active
Denied Certificated

Age Airmen* Percent Airment Percent
Less than 20 280 489 30,571 4.89
20-24 1,167 20.38 94,397 15.10
25-29 588 9.39 103,399 16.54
30-34 497 8.68 91,960 14.71
35-39 622 10.86 90,294 14.44
40-44 772 13,48 82,302 13.16
45-49 648. 11.31 10,770 11.32
50-54 565 9.87 35,704 5.71
55-59 353 6.16 15,951 2.55,
60-64 170 2.97 6,745, 1.08
65-69 6 1.33 2,270 0.36
70 and over 39 0.68 869 0.14

TOTAL 5,27 100.00 625,282 100.00

*May 1964 through June 1966.
November 1965 through December 1967.

Source : Civil Aeromedical Institute, Aeromedical Certification
Branch, Medical Statistical Section.

Tasts IV. Denials by Sex and Whether a Previous
Examination was Recorded* May 1964-June 1966

Previous Reamination Percent
Sew Yes Wo Total of Total
Male 2,387 3,109 5,406 96.0
Female 48 183 231 4.0
TOTAL 2435 «3,202 45,727
PERCENT OF TOTAL 42.5 BTS 100.0

*The indication of previous examination was taken from
Item 20 of the FAA Form 1004 (since replaced by FAA Form
8500-8). This item requests the airman to indicate the date
of his previous FAA examination, if any. As such, it is not
known whether the previous application (examination) was also
denied.

Source: Civil Aeromedical Institute, Aeromedical Certifica-
tion Branch, Medical Statistical Section.



6, Medical characteristics of‘ denied airmen.
Table VII reflects pathology associated with the
zause for denial as recorded on the medical
records of the 5,727 denied airmen. The most.
significant pathologies reflected in Table VII are
respectively (a) cardiovascular, (b) miscellaneous
defects, which include alcohol and drugs, en-
docrinopathies, general systemic conditions, and
administrative denials for failure to provide
further requested medical information concerning
conditions reflected on the application, (¢) nerv-
ous and mental pathologies, (d) eye pathology
and deficient vision, and (e) abdominal patholo-
gies.

B. Federal Air

Actions.

During the time period 1961 through 1967 the
Federal Air Surgeon considered and took action
on 4,009 appeals of initial denial. Of this total,
the Federal Air Surgeon certified 1,011 (25.2%)
airmen and denied certification in 2,998 (74.8%)
cases. Table VIII provides information concern-
ing the appeals considered by the Federal Air
Surgeon by year.

Tapie VIII, Appeals Considered by the Federal
Air Surgeon

Surgeon Reconsideration

1961-1967
Year Certified Denied Total
1961* 70 204 274
1962 189 372 561
1963 147 472 619
1964 149 Tl 860
1965, 242 661 903
1966 119 344 463
1967** 95 234 329

TOTAL Tor 2998 “F009

*Incomplete figures for January through March 1961.

**These figures Include reconsideration actions only. They
do not include opinions rendered or other decisions.

Source: Office of Aviation Medicine, Aeromedical Standards
Division.

Appeal cases and actions taken have been re-
eorded by gross pathological classification since
January 1963. Table IX summarizes appeals to
the Federal Air Surgeon from January 1963
through December 1967 by pathological area rep-
resenting the reason for appeal. Table X reflects
certification action taken by the Federal Air
Surgeon on these appeals.

Table IX clearly indicates that the most im-
portant pathological conditions among appeals
are cardiovascular, nervous and mental, and de-
ficient vision, respectively. Historically, 82.3%

Tapte IX. Pathology Representing the Basis for Appeal
to the Federal Air Surgeon
January 1963 - December 1967

Percent

Pathology Frequency of Total
Eye 655 20.6
Ear, Nose, Throat 28 0.9
Respiratory 76 24
Cardiovascular 1,210 38.1
Abdominal 105 33
Nervous/Mental 748 23.6
Bone/Joint. 82 1.0
Muscles 16 0.5
Miscellaneous* 304 9.6
TOTAL 3,174 100.0

*Miscellaneous includes aleohol and drugs, endocrinopathies
and general systemic conditions.

Source: Office of Aviation Medicine, Aeromedical Standards
Division,
of appeal cases considered by the Federal Air
Surgeon are concerned with problems in one of
these three pathological areas.

Actions by the Federal Air Surgeon, as shown
in Table X, also reflect the significance of these
three pathological areas. With respect to favor-
able action in these areas, it is observed from
Tables IX and X that approximately one out
of six airmen appealing on the basis of a cardio-
vascular problem is finally issued medical certifi-
cation. About one out of five airmen appealing
with nervous or mental problems is issued medi-
cal certification, and approximately two out of
five airmen with vision problems are issued medi-
cal certification. It should be noted that issuances
are not always for the same class appealed for
by the airman and limitations on certificate usage
are not uncommon. In many cases, these airmen
must also present follow-up evidence of medical
condition more frequently than is normally re-
quired by regulation in order to more closely
monitor those airmen whose condition is subject
to change.

C. Petitions to the Administrator.

Petitions to the Administrator of the FAA
represent the next higher level of appeal avail-
able to airmen denied certification at lower levels.
The Administrator may, on the basis of medical
evidence presented, exempt the airman from dis-
qualifying regulations in recognition of the fact
that the airman does have the specified medical
problem but is considered to be a “good risk”.
The Administrator is advised in these decisions
by a panel of consultant medical specialists.


AM 68-9

A RETROSPECTIVE ANALYSIS OF AEROMEDICAL
CERTIFICATION DENIAL ACTIONS

January 1961 - December 1967

P. V. Siegel, M. D.
and
Charles F. Booze, Jr., M. A.

Approved by Released by

Bld ile (PU Sbge€ m0
P. V. Srecen, M.D.

J. Rosert Ditie, M.
Cuter, cut ea at Feperat Arr Surceon
Insrirure

May 1968

DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION
Office of Aviation Medicine



applicants is in the age group 20-24 years. Data
contained in Table V further indicates that the
majority of these denied third-class applicants
are student airmen. About 60% of the active
population are third-class airmen and approxi-
mately one-third of the total active population
falls in the age interval 20-30 years. It is not,
therefore, surprising that the greatest frequency
of denials should come from this interval. Ad-
ditionally, it is recognized that the majority of
the denials in the 20-30 age range are initial ap-
plicants. Reference to Table IV indicates that
more than half of total denials are among new
applicants.

Data presented in Table V indicates that 91.1%
of the denied airmen in the study group were

not occupationally connected to aviation. Air
Traffic Controllers have the highest denial rate
among applicants involved in an aeronautical oc-
cupation and the majority of these individuals
were not pilots in addition to their air traffic con-
troller duties.

As expected, the study has indicated rather
conclusively that the most important medical
problems among denied airmen are cardiovascu-
lar, nervous and mental, and deficient vision. The
important consideration in this respect has been
to define the prevalence of these problems and
to appraise the success of appeal actions and pro-
cedures.



vascular problems received favorable considera-
tion. These 325 petitions represent 320 airmen
granted exemptions from medical standards.
During the same time period, 12 of the 820 air-
men have died; 11 due to cardiovascular disease.
Adverse change in medical condition has required
that grants be terminated for an additional 23
of the airmen.

A statistical technique, which considers age at.
entry into the observed group, person-years of
observation in age intervals, and subsequent
mortality, has indicated that airmen granted ex-
emptions for cardiovascular problems experi-
enced a higher mortality rate than would be ex-
pected in the white male population of the United
States.7 Table XII summarizes the comparison
of mortality experience among panel grants with
expected mortality based on death rates in the
white male population of the United States.

IV. Summary.

The study has served to quantify several im-
portant factors concerning airmen denied medical
certification. As mentioned previously, some of
the conclusions to be drawn from the foregoing
analysis were empirically observed some time ago
by Office of Aviation Medicine personnel. In

"Reference Chapter 10, Practical Statistics in Health and
Medical Work, by Ruth R. Puffer, Dr. P.H., MeGraw-Hill, 1950,
and the Appendix B for further details regarding the statistical
technique.

these instances, however, validation and quantifi-
cation of a premise has been achieved.

It has been noted that denial data accumulated
to date is partially reflective of an era much more
restrictive with respect to medical criteria.
Medical standards are constantly under review,
and if the past few years are indicative of a
trend, it appears likely that denial data to date
would provide pessimistic projections to future
airman populations.

Retrospectively, denials have amounted to less
than 1% of application receipts (0.79%). This
represents a 1.14% denial rate when applied to
active airmen. Females make up 4.0% of the
active population and the denial rate among
females is virtually the same as-among males.
Voluntary attrition resulting from known medi-
cal condition and the regulatory certification
process is unmeasurable but probably contributes
very little to the total denial rate since most air-
men use the frequency of airman medical certifi-
cation to satisfy their desires for periodic medical
examination.

The average age of denied airmen (37.5 years)
exceeds the average age of the active airman
population (35.0 years). This would be expected,
however, since most disqualifying pathology is
associated with age. Table I indicates that the
majority of denied airmen are third-class appli-
cants and that the greatest frequency of these

Taste XII. Observed and Expected* Deaths from
Cardiovascular Disease Among Panel Grants
1961-1967

Death Rates
Person Per 100,000,

Excess Deaths
Expected Observed Among

Age Group Years United States** Deaths Deaths Grants (% )
TOTAL 909.75 4.64 n 1371
15-24 years 0.50 0.6 7 - -
25-34 8.50 10.1 + - -
35-44 191.00 86.6 0.16 2 1,150.0
45-54 412.75 346.0 143 6 319.6
55-64 270.25 905.8 2.45 3 22.4
65-74 22.75 1,972.9 0.45 - -
15-84 4.00 3,812.8 0.15 - -

*Expected deaths were obtained by applying age specific death rates for arteriosclerotie heart
disease, including coronary disease, in the white male population of the United States for 1965 to

person-year observations.

**Vital Statistics of the United States, 1965, Volume II, Part A, Section I, Table 1-10.

+Less than 0.05.

Source : Civil Aeromedical Institute, Aeromedical Certification Branch, Medical Statistical Section.


vidual. It is pointed out in the footnote to Table
IV that it is not absolutely known whether those
individuals who had previous examinations re-
corded were also denied on the previous applica-
tion, However, assuming all to have been previ-
ously certified, the 2,435 denied airmen with pre-
vious FAA examinations represent less than one-
half of all applications denied (42.5%) during
the 2-year period, The remaining 57.5% of de-
nials were from new applicants. To assume that
all who had a previous examination were, in fact,
certified on the previous examination is obviously
an exaggeration; however, recognizing this exag-
geration further emphasizes the fact that less of
the total denials came from the “hard core”
aviation population.

Statistical summaries as of July 1965 defined
an active airman population consisting of 450,936
(96.2%) active male airmen and 17,969 (3.8%)
active female airmen, as recorded on the medical
certification tape files. Proportionally, therefore,
denials by sex were consistent with their respec-
tive representation in the active population
(5,496 of 5,727 or 96.0% denied males and 231 of
5,727 or 4.0% denied females).

4, Recorded occupation of denied airmen.® It
is immediately apparent from Table V that the
vast majority of denied airmen are not connected
occupationally to civil aviation. A total of 5,216
of 5,727 (91.1%) denied airmen indicated in-

5As recorded by the airman applicant in Block 10 of the
FAA Form 1004 (now FAA Form 8500-8).

volvement in non-aeronautical occupations. The
next largest group of denied airmen (2.5%) in-
dicated that their primary occupation was air
traffic control; 98 of 143 airmen in this category
were air traffic controllers only and the remaining
45 were pilots in addition to being air traffic con-
trollers. One hundred and twenty-eight denied
airmen indicated that their primary occupation
was “airline pilot.” These airmen comprise the
third largest group of denied airmen and rep-
resent 2.2% of all denials.

5. Total flying time as recorded by denied air-
men.6 Data presented in Table VI further sup-
ports what has previously been said with respect
to the primary source of denied airmen. A total
of 3,219 denied airmen had recorded total flying
time of less than the 40 hours required for a
private airman rating.

‘As recorded in Block 16 of the FAA Form 1004 (now FAA
Form 8500-8).

Taste VI. Denials by Total Flying Time
May 1964 ~ June 1966

Percent

Total Flying Time Frequency of Total
0-10 2,896 50.57
11 - 39 823 5.64
40 - 99 304 5.31
100 — 299 530 9.25,
More than 300 1,674 29.23
TOTAL 5,727 100.00

Source : Civil Aeromedical Institute, Aeromedical Certification
Branch, Medical Statistical Section.

Tasre VII. Presence of Denial Pathology by Pathology Series and Class of Medical
Certificate Applied for by the Airman*
May 1964~June 1966
Percent
Pathology First Second Third of
Series Class Class Class Unknown** Total Total
Eye 26 49 183 5 263 7.86
Ear, Nose, Throat 6 18 56 - 80 2.39
Respiratory System 5 6 Bl - 62 1.85
Cardiovascular System 110 240 930 9 1,289 38.50
Abdominal 13 31 148 3 195 5.83
Nervous and Mental 49 155 454 8 661 19.74
Bones and Joints 4 6 38 - 48 1.48
Muscles 38 2 13 - 18 0.54
Miscellaneous Defects 36 108 582 6 732 21.86
TOTAL Be ahs 2,455 36 3348 100.00

*The table above was based on the presence of a denial prefix in conjunction with a specific

pathology code,
automated system until February 1965.

expected given the 5,727 denials during the time period covered by the study.

‘The prefix to indicate denial for specific pathology was not incorporated into the
The summary total is thus lower than what might be

‘The significance of

particular groups of pathology is quite obvious however.
#*Class applied for was unknown and therefore was treated as an unknown in the table.
Source : Civil Aeromedical Institute, Aeromedical Certification Branch, Medical Statistical Section.

5



A RETROSPECTIVE ANALYSIS OF AEROMEDICAL
CERTIFICATION DENIAL ACTIONS
January 1961 - December 1967

I. Introduction.

Prior to this time relatively little has been
known about the collective characteristics of air-
men denied medical certification. Empirically,
certain factors, or characteristics, have been
recognized by professional personnel associated
with the medical certification of airman appli-
cants but these known factors have been limited
to the obvious derivatives of workload, such as
the percentage of denied airmen from total ap-
plication receipts, what class of medical appli-
cants are most frequently denied, and generally
what pathological conditions represent the ma-
jority of denials.

This study is an effort to quantify some of the
unknowns or uncertainties with respect to the
medical and general descriptive attributes of
those airmen denied medical certification. The
most obvious reason for the study was to il-
luminate areas deserving of further consideration
with respect to the amendment of medical certi-
fication program objectives as concerns standards
and appellate procedures. Secondly, the data are
important in connection with aeromedical re-
search, particularly as it may provide insight
into the early recognition of disqualifying
pathology, and the subsequent likelihood of suc-
cessful rehabilitation.

The study presents descriptive data concerning
age, sex, occupation, and total flying time of
initially denied airmen, i.e., those denied by the
AME, Regional Flight Surgeon, or FAA phy-
sicians of the Aeromedical Certification facility
at Oklahoma City, Oklahoma. Certification
actions at the appellate level are considered to in-

Much is already being done in the area of rehabilitation of
Individuals who have suffered cardiac accidents. Reference
AM 66-17, Problems in Aeromedical Certification: Cardio-
vaseular Responses to Exercise Following Myocardial Infarction
by J. Naughton, K. Shanbour, A. Armstrong and M. T. Lategola;
AM 66-21, Clinical Aviation Medicine: A Physical Conditioning
Program for Cardiac Patients—A Progress Report by J.
Naughton, M. T. Lategola and K. Shanbour.

clude Federal Air Surgeon reconsideration
actions and the FAA Administrator’s actions.

II. Methods and Source Material.

The Aeromedical Certification magnetic tape
files maintained in Oklahoma City, Oklahoma
provided the source of initial denial data as
presented in this study. This “Active Master
Tape File” contains the most recent record of
an airman’s medical application for certification.
The tape includes applications issued, pending,
denied, and abbreviated records of significant
pathology cases retained for future medical ref-
erence in the event an airman decides to again
exercise his flying privileges. The latter being
the only instance when a record is maintained on
the active master tape file for a period of time
greater than 3 years from the date of application.
After 3 years, providing that a record has not
been superceded by a more current examination
from the airman, the record is either converted
to a shorter record (if significant pathology is
present or if the airman was denied), or it is
transferred to a history tape file.

The initial denial data was accumulated during
May 1967 in connection with a separate research
effort. At that time, records were selected for
enclosure in the study if they reflected a date of
examination within the time period of May 1964
through June 1966. The earlier cut-off of May
1964 was mandatory because this was the maxi-
mum length of time a complete record could be
maintained on the active master tape file, ie. 36
months prior to the date of computer extraction
in May 1967. Timing of the computer extraction
was accomplished so that May 1964 would be the
cut-off since numerous automatic data processing
system revisions were initiated in May 1964. The
May 1964 cut-off date thus provided for maxi-
mum consistency of coded medical data input.
The latter date, June 30, 1966, was chosen to
allow sufficient appeal time for the airman and



CONTENTS

I. INTRODUCTION
Il. METHODS AND SOURCE MATERIAL --
III. FINDINGS AND DISCUSSION

A. Initial Denials
1. General comments -

. Age distribution of denied airmen --------
. Denials by sex and previous application status -
. Recorded occupation of denied airmen —_.
. Total flying time as recorded by denied airmen
. Medical characteristics of denied airmen
B. Federal Air Surgeon Reconsideration Actions
C. Petitions to the Administrator
IV. SUMMARY ----
APPENDIX A -
APPENDIX B

a op & bo

TABLES

Table
I. Denials by Age and Class of Medical Certificate
Applied for by the Airman -------------------------------
II. Age Distribution of Active Airmen by Class of Medical

Certificate

III. Age Distribution Comparison—Active Airmen Versus Denied
Airmen

IV. Denials by Sex and Whether a Previous Examination Was

Recorded ~---.~------------------------------------------

V. Denials by Occupation and Class of Certificate Applied for by
the Airman Applicant

VI. Denials by Total Flying Time ----
VII. Presence of Denial Pathology by Pathology Series and Class of
Medical Certificate Applied for by the Airman ~------------

VIII. Appeals Considered by the Federal Air Surgeon --------------
IX. Pathology Representing the Basis for Appeal to the Federal
Air Surgeon -

X. Reconsideration Actions by the Federal Air Surgeon
XI. Petitions Granted or Denied by the Administrator

XII. Observed and Expected Deaths from Cardiovascular Disease
among Panel Grants ~------------------------------------

Page



ACKNOWLEDGMENT

The authors wish to express their appreciation to Mrs. Margaret Shackel-
ford, M.S., of the University of Oklahoma Medical School, Biostatistical Unit,
for her most valuable comments and suggestions during the preparation of
this study. Appreciation is also extended to Mrs. Rachel Graham and Miss
Shirley Dark, of the Aeromedical Certification Branch, for their assistance in
the data accumulation and preparation of this manuscript.

Qualified requestors may obtain Aviation Medical Reports from Defense Documentation
Center. The general public may purchase from Clearinghouse for Federal Scientific and
Technical Information, U.S. Dept. of Commerce, Springfield, Va. 22151.


APPENDIX A

Test For Significance Between The Mean Age of
Denied Airmen and the Mean Age of Active Airmen

. Hypothesis Tested:
A. Null Hypothesis: Xp=Xs

No difference between the mean age of
active airmen (Xp) and the mean age
of denied airmen (Xs).

B. Alternate Hypothesis: Xs;>Xp
Mean age of denied airmen is greater
than the mean age of active airmen.

Significance Level: 0.05
Standard Error of the Mean:

IL
TI.

¢ (Population Standard Deviation) 10.91
VN BD
10.91
5.68

4

10

IV. x _ Xs—Xp _ 37.5 — 35.0
oc exe CAE
_ 25
~ “O14
17.36

V. P<.0001 that a difference this great could be
due to chance.

VI. Inference: The mean age of denied airmen
is significantly greater than the
mean age of the active airman
population.