final certification action in the majority of cases, The active airline pilot population as of
December 31, 1987 (the mid-period date), was used for rate computation and comparison.

Five-year age groupings. beginning with age 25 and ending with age 59, were utilized since
they are closest to the age limits set by FARs 61.151’ and 121.383(c) for holding an air
transport pilot rating and engaging in air carrier operations, : ‘ “
data regarding pathology represent conditions cited as cause for denial =- not
number of airline pilots. Annual rates were computed to provide data more useful, for
answering the many questions Tecetved concerning airmen dented, medical certification.
Observations’ of the airline pilot group probably’ come closest to a true reflection ‘of
_ prevalence of disqualifying disease as is possible to observe. Prescreening by airline
before employment and FAA Tequirements for issuance of a first-class medical
Tesuit in this group being essentially purged of disease prevalence that contributes
: to higher rates for other non-pilot groups. Lo . . ‘
Denials may occur at several different levels within the FAA and/or by ihe AME (see
Figure 1). Fae oriant was denied by the AME and did not request further reconsideration ,
from the FAA, the AME denial was considered final. The final Jevel of denial is, however,
the one recorded on a pilot's medical record. ° : , ' bos
FIGURE 1. LEVEL. OF DENIAL so , \ ‘ .
Percent of Total Denials
AME Denial ve: Midied
__.- AMCD General Denia!
Regional Flight Surgeon Denial:
Federal Air Surgeon Denial
Special issuance/Final Denial
Mandatory Denial/Final Denial
Administrative or Legal Denial
_ Failure to Provide Additional Info.

t " T “Hoe T
. 0.0% 10.0%, 20.0% . 30.0% 40.0%

As of December 31, 1967, there were $8,680 airmen between the ages of 25 to 59 who listed
their occupation as airline pilot. Of this group, 537 were issued a denial during calendar
years 1987 and 1988. Of those denied, 57 (10.6% of total denials} were subsequently issued a

certificate and were excluded from this study. Of the remaining 480 denials, 4 were
gutside the 25 to 59 age range, and they were also excluded.

‘an further references in this study are based on 476 total denials, with a total of 76
disqualifying conditions. ‘Therefore, the annual denial rate for airline pilots is 4.3 per 1,000
active airline pilots, increasing from a rate of 1.0 per 1,000 in the 25-29 age interval to 16.2



These causes are somewhat different from those in the previous study. At that time. the
highest causes for denial by spécific pathology were: 1) and 2).were equal; failure to provide
additional information and use of disqualifying medications; 3) coronary artery disease: 4)
hypertension with medication: and 5) psychoneurotic disorders (1).

Sixty-two airline pilots were denied for coronary artery disease: 19 had also suffered a
prior myocardial infarction, 13 had also undergone coronary artery bypass surgery. and an
additional 3 had suffered a prior myocardial infarction and’ undergone coronary artery

Two hundred and eighty-seven airline pilots were denied for a single cause, 139 pilots for
2 causes, 39 pilots for 3 causes, 9 pilots for 4 causes, 1 pilot for 5 causes, and 1 pilot for 6
causes. : ‘ ‘ .

The annual denial rate for airline pilots ts 4:3 per 1.000 active airline pilots, increasing
from a rate of 1.0 per 1,000.in the 25-29 age interval to 16.2 per 1,000'in the 55-59 age
interval. ‘ ' . :

Cardiovascular, neuropsychiatric, andthe miscellaneous pathology category comprise
78% of .the causes for medical disqualification. These problems ‘rarely result in
disqualification before the age of 45 years, while above this age. the rate increases rapidly,
primarily: because of cardiovascular disease. The mean age of active airline pilots is °
| decreasing, while'the mean age of denied airline pilots is increasing. : ns

‘The overall highest causes for denial by pathology series are: 1) cardiovascular: 2)

+ Reuropsychiatric; and 3) the. miscellaneous pathology category, with annual denial rates per

. 1,000 active airline pilots of 2.2, 1.8, and 1.1 respectively. The highest causes for. denjal by
specific pathology are:"1) coronary artery’ disease; 2) use of disqualifying medications; 3)
psychoneurotic disorders; 4) myocardial infarction; and 5) disturbance of consciousness. '

disease is the major cause for dental in the 30-34, 35-39, 40-44, and 45-

Neuropeychiatric
49 age intervals. Cardiovascular disease is the most prevalent cause for denial in the 50-54

REFERENCES.

1. Dark 8. Medically Disqualified Atrime Pilots. Washington, DC: Federal Aviation,
Administration, Office of Aviation Medicine,.No. FAA-AM-86-7,.1986.|

[US GOVEROMENT PRINTING OFFICE 1990.781.020/01182



. FIGURE 4. DENIALS BY EMPLOYER

' FiuRE $. AIRLINE PILOT DENIALS BY AGE

Percent of Total Denials
' 31.5% °

25-29 30-34 35-39 40-44 45-49' 50-54 55-59
' AGE (Years):

“Annual Rate per 1,000 Active Airline Pilots

American Airlines

Branift Airlines

Continental Airlines

"Deka Airlines

Eastern Airlines

Fed ExFtying Tigers
Northwest Airlines 3B

Pan American Airways .

_ » Southwest Airlines

TransWorld Airlines

United Airlines

U.S. Air

Other Airlines.

TOTAL

0.0 50 ©6100. «150-200

. Data on denials by airline employers provide some interesting insight, even though

limitations that make comparison difficult, 1.e., small numbers substantially
affect comparison (see Figure 4). Of the 476 denials included in this study, 141 were airline
pilots employed by Eastern Airlines. It ts possible that some of these denials were associated
with financial and management/untion difficulties being experienced by Eastern Airlines
during the study period. The majority of these dentals were for 1) use of disqualifying

4



Per 1,000 in the 55-59 age interval (see Table I and Figures 2 and 3). Of the 476 airline pilot
denials, almost half were either general denials issued by the AMCD or AME denials. In a
Previous study (1) concerning calendar years 1983 and 1984, the annual denial rate was 4.7
Per 1,000 active airline pilots: thus, the rate has decreased slightly since then.

TABLE I. AGE DISTRIBUTION OF. AIRLINE PILoTs

Percent . Annual
of Percent Age-

Active Active Denied of Specific
Airline’ | Airline | Airline Total Denial

orvepe muse? , Pitts Pilots Denials Rates ,
35-09

8,808 15.8 16 KX 16
[10,008 18.0} 35 a3 10]

a a
[FOTAL 155.600 [100.0] 478 — se} ee

. _, *Annpal ‘rates per 1,000 active airline Pilots.
FIGURE 2. AGE-SPECIFIC DENIAL RATE .

Annual Rate per 1,000 Active Airline Pilots. |

200-7]
4 : 16.2,

25-29 30-34 35-39 40-44 45-49 50.54 55-59
AGE (Years) Ot



FIGURE S. CAUSE FOR DENIAL/BODY SYSTEM

Percent of Total Causes

. T T T T r T T T
"0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

The highest causes for denial by specific pathology are: 1) coronary artery disease; 2) use
of disqualifying medications: 3) psychoneurotic disorders; 4) myocardial infarction; and 5)
disturbance of consciousness. These five specific causes account for 30% of all causes for |
dental (see Figure 6). . :

FIGURE 6. MOST FREQUENT CAUSES OF DENIAL

Percent of Total Causes*

” Coronary Artery Dissase

Use of Disqualifying Medications
Psychoneurotic Disorders
"Myocardial Infarction
Disturbance ot Consciousness
Other Ear Pathology
Hypertension with Medication
Failure to Provide Additional Info.
Coronary Artery Bypass Surgery
Spinal Cord Disease



PAA ; 7 oe 7 oe, 4

20 DIC FILE copy te é

a vormumses Medically Disqualified —
Airline Pilots in Calendar
Office of Aviation Medicine

waagnbcws” Years 1987 and 1988

mt, ; .
¢ Lelie Downey
N ShidleyJ.Dask
< a,
L: -, Rederal Aviation Administration,’

Okdshoma City, OK 73125
1 Teme 1990

DTIC. |

Final Report @e ELECTE we
- 7 . S JUL 2 6 1990 }

This document is available eo the public
through the National Technical Information
Service, Springfield, Virginia 22161.

@
U.S. Departnent
of Tranaportation
Adminiatration

90 07 25 098




medications {about 65% of the disqualifying medications are directly related to

cardiovascular diseases); 2) spinal cord disease (ruptured disc, spinal fusion, etc.); 3) other

ear pathology (vertigo, labyrinthitis, inner ear pathology); 4): hypertension with medication;

and 5) psychoneurotic disorders (anxiety, depression, obsessive compulsive behavior,

phobias, ete.). Of the 141 denied Eastern ‘Airlines pilots, 18 (12.8%) were less than age 45; 37

(26.2%) were in the 45-49 age range; 47 (33.3%) were in the 50-54 age range; and 39 (27:7%)

4 . were in the 55-59 age range. Flying Tiger Lines, purchased by Federal Express near the end

of the study period, was attributed with 20 denials. The majority of denials’ were in the

. {atric and cardiovascular patholegy categories and within tne age range of 40-54.

v It is also possible that some of these denials were associated with financial difficulties
before the merger with Federal Express. . .

Annual age-cause-specific denial rates increase to the highest rate at age interval 55-59’.
(16.2 per 1,000 active airline pilots) (see Table 1). The rate of medical disqualification is ©
minimal before the age of 45 years but increases rapidly thereafter (see Table 1). The mean,
age of active (issued) airline pilots ts. 41.0, compared to a mean age of 49.4 for denied airline
pilots. In the previous study, the mean age of active (issued) airline pilots was. 41.8,
compared to a mean age of 48.6 for denied airline pilots (1). Therefore, it is observed that the
mean age of active airline pilote is decreasing, while the mean age of denied airline pilots ts

‘ Observed in the age-cause-specific annual denial rates is an increase of cardiovascular .

denials after age 50. Neuropsychiatric disease ia the major cause for denial in the 30-34. 35-
99, 40-44, and 45-49 age intervals, Cardiovascular disease is the most prevalent cause for '
denial in the 50-54 and 55-59 age intervals. Dental rates begin to increase rapidly in the 45- to
49 age interval with neuropsychiatric disease highest, followed closely by cardiovascular
disease, with the miscellaneous pathology category third (see Table 1). ‘

PARLE Il, DENIAL RATES OF AIRLINE PILOTS BY, CAUSE/MAJOR BODY
SYSTEM AND AGE* en :

Sea AKA tA

rears}
Rater* | Rate** | Rate** | Raters | Rate** | Rate* | Rate**

:

erald

jatric diseases (convulsive reactions, disturbance of consciousness, neuroses,
alcoholism, ete.); and 3) the miscellaneous pathology category
systemic conditions, use of disqualifying medications, and denials for failure to provide
‘medical information), with annual rates per 1,000 active atriine pilots of 2.2, 2.0,
and 1.9 respectively (see Figure 5). These causes are unchanged from the previous study (1).

overall highest causes for denial by pathology series are: 1) cardiovascular; 2)-
|
| 5



MEDICALLY DISQUALIFIED AIRLINE PILOTS
IN CALENDAR YEARS 1987 AND 1988

‘ INTRODUCTION
Federal Aviation Regulations (FARs) require that pilots for scheduled and nonscheduled
airlines possess a first-class medical certificate to validate their air transport pilot
certificate. Airline pilots are required to obtain a‘ Federal Aviation Administration (FAA)
medical examination at six-month intervals and must meet specific requirements for a
first-class medical certificate as set forth in FAR 67.13 {b) through (f).. If the medical
lards are not met, the application for first-class certification is denied. This denial can

Tesult from any of several levels of certification review within the FAA, from, the aviation
medical examiner (AME) to the Federal Air Surgeon. moe :

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

1. A personality disorder that is severe enough to have repeatedly manifested itself
2. Apsychosis.  —s, , So, fos, eo,
3. Alcoholism, unless there ts established clinical evidence, satisfactory to the

. Federal Air Surgeon, of recovery, including sustained total abstinence :from
akohol 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. 7

Drug'dependence. ©

A disturbance of consciousness without satisfactory medical explanation of the
cause. .

Myocardial infarction. - : . :

Angina pectoris.

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.

Advances in aviation medicine and changes in FAA policies and procedures during recent

' years have. resulted in the medical certification of pilots, who in earlier times, would have

been denied. Persons diagnosed as having alcoholism, coronary heart disease, and various

other diseases are, in many instances, now certified as a special issuance. For exampic,

pilots with hypertension maintain their certificates while taking medication to control

'. thetr blood pressure, and the time lapse has been reduced between myocardial infarction,

bypass surgery, etc., and re-application for certification. This study presents compre-

henstve data that reflects pertinent denial rates regarding the medical and general attributes
of those airline pilots denied medical certification in calendar years 1987 and 1988.

PON BAe

The Aeromedical Certification Division (AMCD)} of the Civil Aeromedical Institute (CAMI)

fs the nee screening facility and Feposttory within the FAA for the oe a

+ processing, judication, investigation, and analysis of medical data generate: the
aeromedical certification and related programs. s

The atrline pilot denial data were obtatned from the computer file as of July 1, 1989.for
_ calendar years 1987 and 1988 applicants, The six-month time lapse was allowed to ensure



ACKNOWLEDGMENT

The authors extend their appreciation to Dr. Audie W. Davis, Manager,
Aeromedical Certification Division, and acknowledge the assistance of the late
Dr. Chasles F. Booze, Jr., Manager, Statistics and Records Branch. They provided
\ valuable guidance, comments, and support prior to and during the preparation of

this study. ; .

Appreciation is also extended to Ms. Bridger Stephenson and Mr. Mike Wayda
for their assistance in the preparation and:review ‘of this study. ‘

Accession For a

NTIS | GRARI A
_ | DTTC TAB .
_| Unannounced ia}
‘Justification.__.4

By.
Distribution/

' VF pvattability Codes
oT. Avail and/or =. 3 .
Dist ‘Special



Technical Report Documentation Page

T. Report No. 2. Government Acces:

DOT/FAA/AM-90/5

J. Recipient's Catelag No.

[Ta Title end Sabine

MEDICALLY DISQUALIFIED AIRLINE PILOTS IN
CALENDAR YEARS 1987 AND 1988

3. Report Deve
June_1990

©. Performing Orpanvzajion Code

@. Performing Orgenizotion Report No.

7. Author! s)
Leslie E. Downey and Shirley J. Dark

9. Perlorming Organization Nome end Address

FAA Civil Aeromedical Institute
P.O. Box’ 25082
Oklahoma City, OK 73125

10. Work Unit No. (TRAIS)

Th. Contract or Grant No.

V3. Type of Report and Period Covered

12, Sponsoring Agency Nome ond Address

Office of Aviation Medicine’

Federal Aviation Administration FINAL REPORT
860 Independence Avenue, SW. Ta, - Tod
Washington, D.c. 20591 oe

15. Supplementary Notes

16, Aberrect

certification in calendar years 1987 and

(1) cardiovascular; (2) neuropsychiatric

airline pilot group.

artery disease; (2) use of disqualifying

ante study presents comprehensive. data reflecting pertinent denial rates regarding
the medical and general attributes of those airline pilots denied medicai

The overall annual denial rate of this group 1s 4.3 per 1,000 active airline pilots.
Age-specific denial rates for airline pilots increase to the highest rate at age
interval 55-59. The most significant causes for denial by pathology series are:

Denials for cardiovascular reasons account for 34% of all denials in this

The most significant causes for denial by specific pathology are: (1) coronary

disorders; (4) myocardial infarction; and (5) disturbance of. consciousness.
These 5 specific causes account for 30% of all causes for denial. |

1988.

3 and (3) the miscellaneous category.

medications; (3) psychoneurotic

17. Key Words

“Medical Certification Denials
Airline Pilots / |, "

18. Distribution Statement

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through the National Technical

ny Information Service, Springfield,
: Virginia 22161.
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