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Airline Pilot

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Aircraft Mechanic / Fixed
Base Operator

Flight Navigator
Flight Instructor
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Annual Rates per 1,000

Figure 3, Denial rates by occupation. 7

12


The active airman population as of December 31, 1982, was used as the
midpoint population base for rate computation, A medically certified airman
is considered “active” for a maximum of 24 calendar months following the most
recent FAA medical examination; i.e., regardless of the class of medical
certificate issued, it is valid for third-class purposes for 24 months unless
otherwise’ limited or recalled by the FAA.

Data from the most recent medical record were selected and extracted from
the active file, Annual rates were computed to provide data more useful for
answering the many questions received concerning airmen denied medical
certification,

FINDINGS AND DISCUSSION
A. General Comments

As of December 31, 1982, there were 732,514 active airmen in our automated
system; 101,296 held first-class medical certificates, 253,509 held second-
class certificates, and 377,709 held third-class certificates, In CY 1982 and
1983, 9,100 airmen were denied medical certification, The annual denial rate
based on active airmen is, therefore, 6.2 per 1,000 (see Figure 1). During
the same 2-year period, 944,769 FAA physical examinations were performed,
giving an annual denial rate per 1,000 applications of 4.8, In the previous
study of CY 1977-78 applicants (4), the denial rate per 1,000 was 6.8 and the
rate per 1,000 applications was 5.1.

B. Age Distribution of Denied Airmen

Table I shows that airmen applying for third-class certificates account
for 71% of all denials, with second-class applicants accounting for
21% and first-class applicants only 7%. Table II reflects the age distri-
bution and age-specific denial rates (also, see Figure 2) by class-applied-for.

Denial rates by class-applied-for also indicate that the highest crude
rate for denials are applicants for third-class medical certification (general
aviation/private or student airmen) with an annual denial rate of 8.6 per
1,000 active airmen. Occupationally connected airmen require first- and
second-class medical certificates, and denial rates for these categories (3.3
and 3.8 per 1,000 active airmen respectively) are substantially lower than the
general aviation (third-class) category or the total population denial rate
(6.2 per 1,000). In the 1980 study (4), denial rates by class-applied-for
were 8.9 for third class, 4.9 for second class, 4,3 for first class, and 6.8
for the total denial population,

Airmen may apply for and obtain any class of medical certificate for which
they qualify; however, most new applicants apply for third-class medical
certification consistent with their intended use of the certificate. First-
and second-class medically certified airmen are most likely to be occu-
pationally connected airmen, on either a full-time or part-time basis. As
such, these airmen are, to some extent, medically purged, and denial rates for
these two classes are more likely to reflect incidence rather than prevalence
of disqualifying pathology among a more stable numerical group. Many
applications for third-class certificates are from new applicants whose
medical status has not been previously appraised by the FAA. Only 3% of all
first-class examinations and 14% of all second-class examinations performed


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19


Table VI
CY 1982 AND 1983 DENIED APPLICANTS BY PATHOLOGY SERIES AND SEX

Male* Female*
Annual Rate Annual Rate
Cause For per 1,000 Cause For per 1,000

Pathology Series Denial** Active Airmen Denial** Active Airmen
Eye 478 0.3 17 0.2
Ear, Nose, Throat, and Mouth 98 0.1 7 0.1
Respiratory 94 0.1 7 0.1
Cardiovascular 4,472 3.3 74 0.8
Abdominal 305 0.2 9 0.1
Neuropsychiatric 1,642 1.2 110 1.2
Bones and Joints 86 0.1 2 0.0+
Muscles 38 0.0+ - -
Miscellaneous (Disqualifying

Medication, Endocrinopathies,

etc.) 3,951 2.9 219 2.4
TOTAL 11,164 8.1 445 4.9

*Active airman population by sex (male--687,374, female--45,140) as of December 31, 1982.
**Refers to distinct pathological conditions cited as cause for denial; does not represent
airman applicants; however, most are denied for a single cause.

16


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class over second class and for second class over first class. The most
significant causes for denial (regardless of class applied for) are cardio-
vascular (with an annual denial rate of 3.1 per 1,000 active airmen); the
miscellaneous category, which includes endocrinopathies, general systemic
conditions, use of disqualifying medications, and administrative denials for
failure to provide additional medical information (with an annual denial rate
of 2.8 per 1,000 applicants); and neuropsychiatric (with an annual denial rate
of 1.2 per 1,000 applicants), Eye pathology is next in importance at a
substantially lower rate, These findings are essentially the same as the
findings in previous denial studies (1-5).

Use of disqualifying medication and administrative denials for failure to
provide additional medical information represent a large portion of the
denials in the miscellaneous pathology category. Of the 4,170 denials in this
category, 2,402, or 58%, were for failure to provide additional medical
information, and 1,169, or 28%, were for use of disqualifying medication.

The overall highest individual cause for denial was administrative denials
for failure to provide additional information (miscellaneous pathology
category); second was use of disqualifying medication (miscellaneous); third
was hypertension with medication (cardiovascular); fourth was coronary artery
bypass surgery (cardiovascular); fifth was myocardial infarction (cardio-
vascular); and, sixth was coronary artery disease (cardiovascular)(see Table
VII and Figures 5 and 6).

As shown in Table VI, cause for denial by sex indicates that males were
most frequently denied for cardiovascular reasons, second for miscellaneous
causes, and third for neuropsychiatric reasons, Females, however, were most
often denied for miscellaneous causes, The majority of denials in this cate-
gory were for failure to provide additional information (63%) and for use of
disqualifying medication (26%), followed by neuropsychiatric and then
cardiovascular reasons. For all denied applicants, three pathology categories
(cardiovascular, miscellaneous, and neuropsychiatric) account for more than
90% of all denials,

CONCLUSIONS

This study has provided comprehensive data reflecting pertinent denial
rates with respect to the medical and general attributes of those airmen
denied FAA medical certification, Future studies are planned to monitor any
changes in the epidemiologic findings concerning denied airman applicants.

As of December 31, 1982 (the midpoint for the denied applicant group),
there were 732,514 active certified airmen. In CY 1982 and 1983, 9,100 airman
applicants were denied medical certification, resulting in an overall denial
rate of 6.2 per 1,000 active airmen. By class of certificate applied for, the
denial rates were 3.3, 3.8, and 8.6 per 1,000 for first, second, and third
class respectively. .

Age-specific denial rates increase slowly for the younger age intervals
but begin a larger, steady increase at age interval 40-44, As expected, the
mean age of the denied airman group was higher (by 9% years) than the mean age
of the active airman population group. However, the mean age of the


are for new applicants. Therefore, the substantially higher denial rate for
the third-class group more likely results from a combination of prevalence and
incidence of disqualifying pathology than from any recognizable epidemiologic
factor. New applicants account for approximately 20% of the total applicants
for medical certification,

Also shown in Table I are the mean ages for the three class-applied-for
denial groups and the three class-issued population groups. Third-class
denied airmen were the oldest (denied airmen--47.0 years, active airmen--37.1
years); first-class airmen were next oldest (denied airmen--46.7 years, active
airmen--37.5 years); and second-class airmen were the youngest (denied
airmen--45.3 years, active airmen--37.3 years). The mean age for all denied
applicants was 46.6 years, compared to a mean age of 37.2 years for the active
airman population, Denied airmen's average age was 9% years older than the
active population airmen's average age.

Table II reflects similar age trends by class of medical certificate;
however, age-specific rates were higher for second class over first class and
third class over both first and second classes. Also observed are denial
rates increasing as age increases,

"C. Occupations of Denied Airmen

The majority of denied airmen are not occupationally connected to aviation
(see Table III and Figure 3), Of all denied applicants, 90% indicated
nonaeronautical occupations on their applications, These applicants yield an
annual denial rate of 7.0 per 1,000 active airmen,

Of the applicants occupationally connected to aviation, the flight engi-
Neer category experienced the highest overall annual denial rate (6.0 per
1,000). Of these occupationally connected airmen, commercial pilots, self-
employed; airline pilots; commercial pilots, not self-employed; aerial appli-
cation pilots; and aircraft mechanics had the next highest rates (5.4, 4.0,
3.8, 3.2, 3.0, respectively). Only 34% of the total denials were in the
airline pilot occupation category, These findings are consistent with
previous experience as to denial data by occupation (1-5).

D. Total Flying Time of Denied Airmen

Flying time data further emphasize the contribution of new applicants to
total denials, Table IV shows total civilian flying time as recorded by the
applicant on his/her denied application for medical certification. Over 38%
of the denied airmen indicated less than 40 hours total flying time (the
number of hours required for a private pilot's license). Of these airmen, 23%
indicated no flying time, again showing that new applicants are the major
contributor to total denials, The next largest percentage of denials occurs
at the “more than 1,000 hours” interval (24.2%), followéd by the “100-299
hours” interval (14.1%).°

E. Medical Characteristics of Denied Airmen
Tables V and VI and Figure 4 provide annual cause-specific denial data,

per 1,000 active airmen, by class of medical certificate applied for and sex.
In Table V, one can again observe an increasing overall denial rate for third


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Table I
CY 1982 AND 1983 DENIED APPLICANTS BY AGE
AND CLASS OF MEDICAL CERTIFICATE APPLIED FOR

First Second Third
Age (years) Class Class Class Total
Less than 20 ll 50 174 235
20 - 24 32 140 323 495
25 - 29 25 163 437 625
30 - 34 34 159 516 709
35 - 39 52 181 570 803
40 - 44 84 189 572 845
45 - 49 122 217 687 1,026
50 - 54 122 215 943 1,280
55 - 59 128 277 919 1,324
60 - 64 49 229 723 1,001
65 - 69 9 79 403 491
70 and over 3 50 213 266
Total Denied 671 1,949 6 ,480 9,100
Percent of Total Denied 7.4 21.4 71,2 100.0
Total Active Airmen* 101,296 253 509 377,709 732 514
Annual Denial Rate per
1,000 Active Airmen 3.3 3.8 8.6 6.2
Mean Age of Denied
Airmen** 46.7 45.3 47.0 46.6
Mean Age of Active
Population Airmen*** 37.5 37.3 37.1 37.2

*Examination Time Period Summary, RIS: AC 8065-4, December 31, 1982.

*kAge as of the date of examination to last birthday.

*kkAge at last birthday as of December 1, 1982.


Technical Report Documentation Page

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No.

DOT/FAA-AM-85- 9

4. Title and Subtitle 5. Report Date
CHARACTERISTICS OF MEDICALLY DISQUALIFIED ATRMAN 7 Septenb or 108 Code

APPLICANTS IN CALENDAR YEARS 1982 AND 1983

8. Performing Organization Report No.

7. Authors)

Shirley J. Dark DOT/FAA-AM-85-9
9. Performing Organization Name and Addr 10, Work Unit No. (TR:

FAA Civil Aeromedical Institute ork Uno TRANS)

P.O. Box 25082 TI, Contract or Grant No.

Oklahoma City, Oklahoma 73125

13. Type of Report and Period Covered

12. “Sponsoring Agency Name and Address
Office of Aviation Medicine

Federal Aviation Administration OAM Report
800 Independence Avenue, SW. 14, Sponsoring Agency Code
Washington, DC 20591

15. Supplementary Notes =
upplementary Pov pileh~ Drjeae ¥ Ly ye
Why he WS

16. Abstract
This study presents comprehensive data reflecting pertinent denial rates with respect

to the medical and general attributes of those airmen denied medical certification
in calendar years 1982 and 1983. The study updates previously reported data with
respect to medical certification denials.

The denial data were obtained from computer files as of July 1, 1983, for calendar
year (CY) 1982 applicants and July 1, 1984, for CY 1983 applicants. The data were
summed for the 2 calendar years to provide a larger group for comparison with the
December 31, 1982, active airman population, the midpoint population date for the
denied applicant group.

The annual denial rate based on airman applicants is 6.2 per 1,000 airmen. By class
of certificate applied for, the annual denial rate per 1,000 applicants is 3.3 for
first class, 3.8 for second class, and 8.6 for third class. As anticipated, general
aviation and new applicants contribute greatly to total denials. The most signifi-
cant causes for denial (regardless of class applied for) are cardiovascular, the
miscellaneous pathology category (endocrinopathies, disqualifying medications, and
administrative denials), neuropsychiatric, and, at a substantially lower level, eye
pathology.

The updated data on medically disqualified applicants are consistent with expecta-
tions and previous findings, with cardiovascular diseases still the number one cause
for denial.

17. Key Words 18. Distribution Statement
Denial Document is available to the public
Medical Certification through the National Technical

Information Service, Springfield,
Virginia 22161.

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages | 22. Price

Unclassified Unclassified 20

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized



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denied group appears to be rising by some 3 years over the previous study data
(3) while the mean age of the active group remains essentially the same.

As anticipated, general aviation (third-class) applicants contributed
greatly to total denials, reflecting again that new applicants are being
screened for the first time. Ninety percent of all denied applicants indi-
cated nonaeronautical occupations on their applications. Of the professional
categories, the flight engineer and commercial pilot (self-employed) had the
highest denial rates, with 6.0 and 5.4 per 1,000. Airline pilots were third
highest of the occupationally connected airmen with a rate of 4.0 per 1,000
active airmen,

Total flying time data also substantiate the contribution of new appli-
cants to total denials, with 39% of the denied applicants indicating less than
40 hours of total flying time and 23% indicating no flying time.

For denials by pathology, an increasing overall denial rate for third
class over second class and for second class over first class was observed,
The most significant causes for denial (regardless of class applied for) were
cardiovascular, the miscellaneous pathology, and neuropsychiatric. These
three categories are involved in 90% of all denials.

Cardiovascular diseases resulted in the highest denial rate for males,
while the miscellaneous pathology category provided the highest denial rate
for females, mainly contributed to by use of disqualifying medication and
failure to provide additional information,

Overall, the highest individual cause for denial was administrative
denials for failure to provide additional information; second was use of
disqualifying medication; third through sixth were hypertension with medi-
cation, coronary artery bypass surgery, myocardial infarction, and coronary
artery disease.

Epidemiologic findings are consistent with expectations and previous
findings on denied airmen except that “failure to provide additional infor-
mation" replaced “coronary artery disease" as the number one individual/
specific cause for denial.


REFERENCES

Dark $, Characteristics of medically disqualified airman applicants in
calendar years 1973 and 1974, Washington, DC: Federal Aviation
Administration, Office of Aviation Medicine, No, FAA-AM-76-10. 1976,

Dark S$, Characteristics of medically disqualified airman applicants in
calendar years 1975 and 1976. Washington, DC: Federal Aviation
Administration, Office of Aviation Medicine, No. FAA-AM-78-25. 1978.

Dark §, Characteristics of medically disqualified airman applicants in
calendar years 1977 and 1978, Washington, DC: Federal Aviation
Administration, Office of Aviation Medicine, No. FAA-AM-80-19, 1980,

Dark §, Characteristics of medically disqualified airline pilots.
Washington, DC: Federal Aviation Administration, Office of Aviation
Medicine, No. FAA~AM-83-5, 1983.

Dark S. Medically disqualified airline pilots. Washington, DC:

Federal Aviation Administration, Office of Aviation Medicine,
No. FAA-AM-84-9, 1984,

20 U.S. Government Printing Office : 1985 - 491-828/45261


METHODS AND SOURCE

The Aeromedical Certification Branch (AMCB) of CAMI is the central
screening facility and repository within the FAA for collection, processing,
adjudication, investigation, and analyses of medical data generated by the
aeromedical certification and related regulatory programs.

The AMCB's computerized medical records provide historical data for both
daily screening of document input and epidemiologic/research purposes. This
computer file contains the most recently submitted medical applications for
pilots, whether the certificate is issued or denied, or the case is pending.
These automated medical record files provided the source data for the study.

Physical examinations to detect medical conditions that could incapaci-
tate a pilot or otherwise adversely affect pilot performance are given by
designated AME's, most of whom are physicians in private practice. Military
applicants receive their examinations at designated military facilities.
Reports of these examinations from throughout the world are forwarded to the
AMCB in Oklahoma City for processing.

Data presented are descriptive in nature, and appropriate population com-
parisons are made via conventional statistical methodology where compatible
data exist and statistical treatment would be meaningful.

In many areas, accuracy of data is contingent on the completeness and
accuracy of information supplied by the airman applicant. Other data are
coded by AMCB personnel. Some human error is recognized but is not considered
significant enough to seriously bias the data provided in this study.

Some airmen who hold first-class certificates will have applied for
medical certification four times during the 2-year period, some airmen who
hold second-class certificates will have applied twice, and airmen with
third-class certificates will have applied once. However, rate data are pro-
vided for the number of applicants versus the number of applications. The
active file provides applicant data because it contains only the most recent
examination of an airman. Both the denial data and the population data are
maintained on the active file.

The cause for denial is determined by the presence of an alpha prefix to a
specific pathology code. The prefix and code are assigned by medical record
technicians in the AMCB, Internal computer edits ensure logical assignment of
such prefixes and pathology codes. These edits are applied when initial file
maintenance to an airman's record is made and again at the end of each quarter
to eliminate discrepancies in pathology and denial data on the active file.
Data presented regarding pathology represent conditions cited as cause for
denial, not applicants. Some airmen denied medical certification for legal or
administrative reasons or for failure to provide additional medical infor-
mation would not necessarily have a pathology code assigned, There are also
airmen who are denied for more than one cause.

The denial data were obtained from computer files as of July 1, 1983, for
calendar year (CY) 1982 applicants and July 1, 1984, for CY 1983 applicants.
The 6-month time lapse was allowed to ensure that final certification action
had been taken in the majority of cases, The data were summed for the 2
calendar years to’ provide a larger group for comparison with the active airman
population,


Table IV
CY 1982 AND 1983 DENIED APPLICANTS
BY TOTAL RECORDED FLYING TIME

Total Flying Time* Number Percent
(Hours) Denied of Total
0 2,085 22.9
1-10 780 8.6
11 - 20 382 4.2
21 - 40 268 2.9
Subtotal 3,515 38.6
41 - 99 493 5.4
100 - 299 1,278 14.1
300 - 499 671 764
500 - 1,000 940 10.3
More than 1,000 2,203 24.2
Subtotal 5,585 61.4
TOTAL 9,100 100.0

*The total civilian flying time recorded in Block 16, FAA Form 8500-8,
determines total flying time.

13



Cardiovascular

Miscellaneous
(Includes Endocrinopathies,
Disquallfying Medications,
Failure to Provide Additional
Information, etc.)

Neuropsychiatric
Eye
Abdominal

Ear, Nose, Throat
Respiratory
Bones and Joints

Muscles

Annual Rates per 1,000

Figure 4. Cause for denial by major body system - annual rates.

15


CHARACTERISTICS OF MEDICALLY DISQUALIFIED AIRMAN APPLICANTS
IN CALENDAR YEARS 1982 AND 1983

INTRODUCTION

The Federal Aviation Administration (FAA) and its predecessors have been
charged with the responsibility for medical certification of all United States
and some international civil airmen since 1927, Each airman must hold a
current medical certificate of the appropriate class to validate any pilot
certificate(s) he or she may possess, Federal Aviation Regulations require
that physical examinations be performed at 6-month intervals for air transport
pilots, annually for other commercial pilots, and at 2-year intervals for
private or student pilots, Different medical standards apply to the different
categories of medical certification, If the medical standards are not met,
the application is denied. This denial can result from any of several levels
of certification review, from the aviation medical examiner (AME) to the
Federal Air Surgeon.

Federal Aviation Regulations, Part 67, specify that a medical certificate
will be denied if an applicant has an established medical history or clinical
diagnosis of any of the following conditions:

1. A personality disorder that is severe enough to have repeatedly
manifested itself by overt acts.

2. A psychosis,

3. Alcoholism, unless there is established clinical evidence,
satisfactory to the Federal Air Surgeon, of recovery, including
sustained total abstinence from alcohol for not less than the
preceding 2 years. “Alcoholism” means a condition in which a
person's intake of alcohol is great enough to damage physical
health or personal or social functioning, or when alcohol has
become a prerequisite to normal functioning.

4. Drug dependence.

5. Epilepsy.

6. A disturbance of consciousness without satisfactory medical expla-
nation of the cause.

7. Myocardial infarction.

8. Angina pectoris.

9. Coronary heart disease that has required treatment or, if untreated,
that has been symptomatic or clinically significant.

10. Diabetes mellitus, requiring insulin or other hypoglycemic drug for
control,

Medical certification criteria have changed dramatically in favor of the
airman during recent years as a result of the evolution of aviation medicine
and increased efforts in the area of aeromedical research, A primary function
of the Civil Aeromedical Institute (CAMI) is to identify and provide
substantive data in support of current medical criteria in the furtherance of
aviation safety, as well as provide a better service to the airman. During
recent years, for example, standards have been relaxed with respect to contact
lens use and medication allowed for control of hypertension.

This study provides comprehensive data reflecting pertinent denial rates
with respect to the medical and general attributes of those airmen denied
medical certification in calendar years 1982 and 1983,


Acknowledgment

Appreciation is extended to Dr. Charles F. Booze, Jr.,
Supervisor, Medical Statistical Section, Aeromedical
Certification Branch, for his valuable guidance, comments,
and suggestions during the preparation of this study. The
author also expresses appreciation to Mrs. Leslie Downey and
Mrs. Lisa Casey for their assistance in the review and
preparation of this study.


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