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.li~l~tlill’~’ I’jOO I) . AVIATION SAFETY 

FAA Is Considering 

Changes to Aviation 

Medical Standards 
I I 

I ’ r 

I I 

United States ,’ 

General Accounting Otnce 

Washington, D.C. 20548 

Resources, Community, and 

Economic Development Division 

B-237646 

JanuaryQ,lQQO 

The Honorable James L. Oberstar 

Chairman, Subcommittee on Aviation 

Committee on Public Works and Transportation 

House of Representatives 

The Honorable Norman Y. Mineta 

Chairman, Subcommittee on Surface Transportation 

Committee on Public Works and Transportation 

House of Representatives 

The safety of millions of aircraft passengers depends, in 

part I on the skills and medical fitness of an aircraft's 

crew. This fact sheet responds to fo,ger...Chairmann, Mineta's 

October 11, 1988, letter requesting information and Chairman 

Oberstar's interest concerning the nature and status of the 

revisions the Federal Aviation Administration (FAA) is 

considering for aviation medical standards. As agreed with 

your offices, we did not assess the medical appropriateness 

of the changes under consideration. 

Under the Federal Aviation Act of 1958 (49 U.S.C. 1422), FAA 

is responsible for promoting flight safety by prescribing 

minimum safety standards for pilots, flight navigators, and 

flight engineers. These individuals must possess a medical 

certificate, issued after passing a required medical 

evaluation by an FAA-approved physician known as an aviation 

medical examiner. FAA issues three classes of medical 

certificates. All airline transport pilots are required to 

have a first-class medical certificate. Other commercial 

pilots, flight engineers, and flight navigators must possess 

a second-class certificate; private pilots a third-class 

certificate. A first-class certificate is valid for 6 

months, second-class for 12 months, and third-class for 24 

months. 

NATURE OF THE CHANGES 

UNDER 

Although minor revisions have been made to the medical 

@standards since they were promulgated, they had not 

undergone a comprehensive regulatory review since 1959. In 
B-237646 

,. 

, ” 

1982, FAA announced a major ruleinaking effort to revise the 

medical standards. As part of the review process, FAA 

contracted with the American Medical Association (AMA) in 

1983 to study the standards and recommend any needed 

changes. In March 1986, the AMA provided FAA with its 

report, which included numerous recommendations for changes 

in the standards. Changes under consideration by the Office 

of Aviation Medicine are based primarily on the results of 

the AMA report and are designed to bring regulatory medical 

standards up to date with advances in medical knowledge and 

technology. Since these changes are of a proposed nature, 

some of them may be altered or dropped before the rulemaking 

is finalized. 

The current medical standards for all classes cover five 

categories: visual: ear, nose, throat, and equilibrium: 

mental and neurological: cardiovascular; and a fifth general 

category. FAA is considering major revisions in some 

categories and minor revisions in others. Some of the 

revisions FAA is considering are listed below. 

Visual, 

Among the visual acuity revisions being considered are the 

following: 

-- eliminating all uncorrected distance vision standards, 

and 

-- establishing one near vision acuity standard for all 

classes of certification. 

E;ar. Nose. Throat. and Ec&librium 

Among the rrrviaions in the rar, nose, throat, and 

': equilibrium atmqory, FM is considering the following: 

-- requiring all airmen to pass a conversational voice 

hearing test, and 

-- requiring all airmen to be free of any disease or 

condition that might interfere with speech communication 

or equilibrium. 

Mental and Neurological 

In the category of mental and neurological standards, among 

b the revisions FAA is considering are the following: 

2 
B-237646 

Y 

mm 

-- 

updating the definitions of disqualifying mental 

conditions, and 

adding substance abuse, substance dependence, and related 

substance use disorders to the list of disqualifying 

conditions. 

Among others, FAA is considering the following revisions to 

the cardiovascular standards: 

-- 

-- 

we 

expanding current testing requirements, such as 

electrocardiograms (EKG), to identify individuals who 

need to undergo a cardiovascular evaluation to determine 

if significant disease is present and adding new testing 

requirements, such as blood testing, 

establishing sitting blood pressure standards for all 

airmen, and 

expanding the list of disqualifying cardiovascular 

conditions. 

General Medical Conditions 

The following change, among others, is under consideration 

in the category of general medical conditions: 

-- establishing respiratory system standards. 

STATUS OF PROPOSED CHANGES 

FAA has been considering changes to the medical standards 

since 1986 when it received the AMA's report. Although 

FAA's Office of Aviation Medicine anticipates FAA 

Administrator approval of its proposed changes to the 

medical standards by March 1990, a Notice of Proposed 

Rulemaking will not be published in the Federal Resister 

until June 1990, at the earliest. In addition, since this 

is a major rulemaking effort, FAA plans a 120-day comment 

period and estimates that the final rule will not be issued 

until 1991. It is important to note, therefore, that the 

changes currently under consideration may undergo additional 

revisions before they are finalized. Section 1 of this fact 

sheet provides additional information on changes currently 

under consideration. Section 2 of this fact sheet is a 

chronology of events in the development of the changes. 

3 
B-237646 

To determine the nature of the changes to medical standards 

FAA is considering, we rev~iewed the current medical 

standards of FAA and the International Civil Aviation 

Organization as well as documents pertaining to the changes 

FAA is considering. To determine the status of FAA's 

actions to update the medical standards, we interviewed 

Office of Aviation Medicine officials at FAA's headquarters 

in Washington, D.C., and at the Civil Aeromedical Institute 

in Oklahoma City. 

We conducted our review between March and November 1989. We 

discussed the contents of this fact sheet with cognizant FAA 

officials who generally agreed with the information 

presented. As requested, however, we did not obtain 

official agency comments on this fact sheet. 

Unless you publicly announce its contents earlier, we plan 

no further distribution of this fact sheet until 15 days 

from the date of this letter. At that time, we will make 

copies available to the Secretary of Transportation; the 

Administrator, FAA: and other interested parties. If you 

have any questions about this fact sheet, please contact me 

on (202) 275-1000. Major contributors to this fact sheet 

are listed in appendix I. 

Director, Transportation Issues 

4 
/LETTER 1 

SECTION 

i i 

i 

2 

APPENDIX 

/ 

I I 

I 

/AMA 

; APA 

; CFR 

j EKG 

/ FM 

CONTENTS 

paae' 

CHANGES UNDER CONSIDERATION 

Visual 

Ear, Nose, Throat, and 

Equilibrium 

Mental and Neurological 

Cardiovascular 

General Medical Conditions 

Administrative Changes 

CHRONOLOGY OF EVENTS IN DEVELOPMENT 

OF REVISED STANDARDS 

MAJOR CONTRIBUTORS TO THIS FACT SHEET 

ABBREVIATIONS 

American Medical Association 

American Psychiatric Association 

Code of Federal Regulations 

electrocardiogram 

Federal Aviation Administration 

5 

11 
__~~ ~~. ~~ __~~~ 

I) 7 

SECTION 1 

CHANGES UNDER CONSIDERATION 

This section summarizes some of the changes to the medical 

standards FM is considering. However, these changes may undergo 

modifications before they are finalized. The changes under 

consideration will affect both commercial and private airmen. 

According to FM, revisions are needed to bring regulatory medical 

standards and procedures for airman medical certification up to 

date with advances in medical knowledge and technology. 

Although minor revisions have been made to the medical 

standards since they were promulgated, they had not undergone a 

comprehensive regulatory review since 1959. In 1982, FAA announced 

a major rulemaking effort to revise the medical standards. This 

effort involved obtaining the views of the medical profession and 

all interested parties. As part of the review process, FAA 

contracted with the AMA in 1983 to study the standards and 

recommend any needed changes. In March 1986, the AMA provided FAA 

with its report, which included numerous recommendations for 

changes in the standards. Changes under consideration by the 

Office of Aviation Medicine are based primarily on the results of 

the AMA report. However, in drafting its proposed changes, the 

Office considered other non-medical factors such as cost and 

inconvenience to the airman and the potential impact of the 

proposed changes on safety. 

The current medical standards for all classes cover five 

categories: visual: ear, nose, throat, and equilibrium: mental and 

neurological; cardiovascular: and a fifth general category. FAA is 

considering major changes in some categories and minor revisions in 

others. 

VISUA& 

In the category of visual acuity, FAA is considering 

eliminating all uncorrected distance vision standards. According 

to FAA, it has found through experience that safety is not 

adversely affected by permitting medical certification at any level 

of uncorrected visual acuity. 

Currently, the near vision acuity standards for first- and 

second-class certification differ. There is no near vision acuity 

standard for third-class medical certification. FAA is 

considering establishing one near vision acuity standard for all 

classes of certification. 

Current regulations for first-class medical certificates 

require Wormal color vision." The current standards for secondand third-class airmen require an ability to distinguish red, 

6 
green, and white aviation signals. FM is considering establishing 

one color vision standard for all classes of cert$,fication, ,' 1 f 

, NOSE, THROAT, 

A conversational voice test for hearing may replace the 

current "whispered voice test, I1 which requires an applicant to hear 

the physician's whispered voice at specified distances for each 

class: 20 feet for first-class, 8 feet for second-class, and 3 feet 

for third-class. FM is considering standardizing the voice test 

and making it applicable to all classes. Other current standards 

in this category are very specific; the ones under consideration 

sre more general but basically require an airman to be free of any 

disease or condition of the ear, nose, or throat that may interfere 

with speech communication or equilibrium. 

MENTAL AND NEUROLOGICAL 

Current regulations in this category list certain psychiatric 

disorders and neurological conditions, such as psychosis or 

epilepsy, for which airman certification will be denied. However, 

the American Psychiatric Association (APA) has changed the 

definition of some mental disorders since the standards were 

written. FM is considering rewording the current standards to 

make its definitions of disqualifying mental conditions parallel 

with those established by APA. 

Alcoholism and drug-use standards are also included in this 

category. Current regulations list Walcoholismll and "drug 

dependency I1 as reasons for disqualification. However, the ANA 

study pointed out that although these terms have been clinically 

useful in the past, they should be replaced with "substance abuse" 

and "substance dependence." Therefore, FM is considering a 

change that would list "substance abuse, substance dependence and 

related substance use disorders, including but not limited to those 

associated with alcohol'1 as reasons for disqualification. 

CARDIOVASCULAR 

FM is considering several changes in this category. Some of 

the changes may expand testing requirements, while others would 

expand the list of disqualifying cardiovascular conditions. For 

example, FM is considering additional testing requirements to 

identify individuals that need to undergo a cardiovascular 

evaluation to determine if significant disease is present. These 

requirements may include additional EKG testing and blood testing. 

In addition, FM is considering establishing blood pressure 

standards for all classes of airmen. Currently, there is no blood 

pressure standard for second- and third-class airmen. Y 

7 
The current standards list specific cardiovascular conditions 

that preclude medical certification. FM is considering expanding 

this list to include cardiac valve replacement, pacemaker 

implantation, and a total heart replacement. It must be noted, 

however, that under both the current standards and the changes 

being considered, airmen denied certification for any 

cardiovascular condition are eligible for special consideration 

after they have undergone a cardiac evaluation and FM has 

determined that their cardiac status would not represent a 

significant risk to aviation safety. 

GENERAL MEDICAL CONDITIONS 

Presently, no aviation medical standards exist for the 

respiratory system. The ANA report recommended that all airmen 

older than 40 years periodically demonstrate the absence of severe 

lung disease, because both judgment and the ability to perform 

complex tasks may be adversely affected by the reduction of oxygen 

available to the brain, resulting from poor pulmonary function. 

Therefore, FM is considering adding standards for the respiratory 

system. 

ADMINISTRATIVE CHANGES 

Although 14 Code of Federal Regulations (CFR), part 67.20 

states that falsification of a medical application is Oa basis for 

suspending or revoking an airman, ground instructor, or medical 

certificate rating held by that person," the regulations are 

silent about the consequences of falsification by a first-time 

applicant who does not hold any type of certificate that could be 

suspended or revoked. In the past, FM has exercised an option to 

deny medical certification to those individuals. FM is 

considering stating its current practice in the standards. 

FM is also considering changing the regulation governing the 

issuance of special medical certificates to airmen who do not meet 

all the standards for their specific class. According to the 

Office of Aviation Medicine, the changes being considered would 

not alter its long-standing practice of certifying airmen who fail 

to meet the applicable medical standards after they have undergone 

additional testing requested by FM. Instead, the changes would 

clarify administrative procedures for granting special medical 

certificates, specify that these certificates have an expiration 

date, and state the basis for termination of special certificates. 

Y 
, 

I 

ON 2 

ONOI'OGY OF EVENTS IN 

nEYELX)lPMENT S 

Awril 198;: 

FM published the most recent changes to the medical standards 

in the Feder 1 Reaister. 

"interim meaEurestf 

FM considered these standards to be 

and announced that it was undertaking a 

comprehensive review of the medical standards of 14 CFR part 67 in 

order to determine whether any changes were needed. 

Julv 1982 

FM invited comments for consideration during its review of 

medical standards. 

Auaust 1983 

FM signed a contract with the AMA to comprehensively review 

the standards to determine whether any changes were needed. 

December 1983 

The Steering Committee for the AMA study met for the first 

time. 

March 1986 

FM received the completed AMA study. 

Mav 1986 

FM requested public comments on the AMA study. 

The Office of Aviation Medicine completed the initial draft of 

the proposed changes. 

Sewtember 1989 

The Office of Aviation Medicine received preliminary approval 

of the proposed changes from a review team composed of 

representatives from FM's 

-- Office of Aviation Medicine, 

-- Office of Rulemaking, 

-7 Office of General Counsel, 

-- Office of Aviation Policy and Plans, 

9 

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4:” _* “Z 

..:: /’ ;,, 
-- Office of Associate Administrator for Aviation Safety, 

-- Office of Civil Aviation Security, and 

-- Office of Flight Standards Service. 

P-ember 1989 

The economic evaluation is scheduled to be completed. 

uarv 1990 

The review team's final approval of the proposed changes is 

expected. 

Februarv 1990 

A briefing on the proposed changes is scheduled for the 

Executive Director for Regulatory Standards and Compliance and the 

Associate Administrator for Aviation Standards. Concurrence from 

the Associate Administrator is anticipated. 

Harch 1990 

Concurrence is expected from the Executive Director for 

Regulatory Standards and Compliance, General Counsel, and the 

Associate Administrator for Aviation Safety. Approval is also 

expected from the Deputy Administrator and the Administrator. 

Mav 1990 

Secretary of Transportation and Office of Management and 

Budget approval of the proposed changes is scheduled to be 

completed. 

June 1990 

A Notice of Proposed Rulemaking soliciting comments on the 

proposed changes is scheduled for publication in the Federal 

Resister. 

March 1991 

After considering comments on the proposed rule, a final rule 

is expected to be issued. 

10 
APPENDIX I 

PIAJOR CONTRIBUTORS TO THIS FACT SHEET 

P 2, CE COMMUNI 

WASHINGTON, D.C. 

Victor S. Rezendes, Associate Director 

Thomas J. Barchi, Assistant Director 

Robert W. Shideler, Assistant Director 

Patricia A. Loach, Evaluator-in-Charge 

Martha Chow, Evaluator 

' (341215) 

Y 11 

APPENDIX I