' u5 

A4 

Office of Aviation Medicine 

Washington, D.C. 20591 Medically Disqualified Airline Pilots 

Shirley J. Dark 

RY Civil Aeromedical Institute 

Office of Aviation Medicine 

Federal Aviation Administration 

Oklahoma City, Oklahoma 73125 QCT I7 9986 

June 1986 

Final Report 

This document is available to the public 

through the National Technical Information 

Service, Springfield, Virginia 22161. 

U. S. DEPARTMENT OF TRANSPORTATION 

Federal Aviation Administration 
Acknowledgment 

Appreciation is extended to Mrs. Theresa Mengers and Mrs. Leslie Downey for 

their assistance in the review and preparation of this study. 

ii 
Technical Report Documentation Page 

1. Report No. I 2. Government Accession No. 

DOT/FAA/A”I-86/ 7 1 

4. Title and Subtitle 

NEDICALLY DISQUALIFIED AIRLINE PILOTS 

7. Author‘s) 

Shirley J. Dark 

9. Performing Organization Name and Address 

FAA Civil Aeromedical Institute 

P.O. Box 25082 

Oklahoma City, Oklahoma 73125 

12. Sponsoring Agency Name and Address 

Off ice of Aviation Medicine 

Federal Aviation Administration 

800 Independence Avenue, SW. 

Washington, D.C. 20591 

15. Supplementary Notes 

3. Recipient’s Catalog No. 

5. Report Date 

JUNE 1986 

6. Performing Organizotion Code 

8. Performing Organization Report NO. 

10. Work Unit No. (TRAIS) 

11. Contract or Grant No. 

13. Type of Report and Period Covered 

FINAL REPORT 

14. Sponsoring Agency Code 

AAM-132 

16. Abstract 

This study presents comprehensive data reflecting pertinent denial rates regarding 

the medical and general attributes of those airline pilots denied medical 

certification in calendar years 1983 and 1984. 

The overall annual denial rate of this group is 4.7 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 are cardiovascular, 

neuropsychiatric, and the miscellaneous category. The importance of these causes 

for denial, particularly above age 45, is again recognized. Denials for cardiovascular reasons account for 33% of all denials in this airline pilot group. 

Reasons/causes for denial and age -specific denial rates are changing. Denial rates 

of older pilots have decreased while rates for younger pilots have increased when 

compared with previous studies’ rates. This could be attributed to changes in the 

interpretation of FAA regulations, certification policies, and pilots’ concepts and 

concerns regarding the economic status of their employer. On the basis of these 

and previous findings, pilots should be educated to report history or symptoms of 

any disease during their periodic medical certification examinations. 

17. Key Words 18. Distribution Statement 

Medical Certification Denials 

Airline Pilots through the National Technical 

Document is available to the public 

Information Service, Springfield, 

Virginia 22 16 1. 

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

Unclassified Unclassified 17 

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

I 
MEDICALLY DISQUALIFIED AIRLINE PILOTS 

INTRODUCTION 

Federal Aviation Regulations (FAR' S ) 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 6-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 standards are not 

met, the application for first- class certification is denied. This denial can 

result from any of several levels of certification review within the FAA, 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. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

A personality disorder that is severe enough to have repeatedly 

manifested itself by overt acts. 

A psychosis. 

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. 

Drug dependence. 

Epilepsy. 

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. 

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 on an individual basis. For example, pilots with 

hypertension maintain their certificates while taking medications to control 

their blood pressure and the time lapse between myocardial infarction, bypass 

surgery, etc., and re - application for certification has been reduced. This 

study presents comprehensive data reflecting pertinent denial rates regarding 

the medical and general attributes of those airline pilots denied medical 

certification in calendar years 1983 and 1984 and updates previously reported 

data with respect to medical certification denials (1,2). 

1 
METHODS 

The Aeromedical Certification Branch (AMCB) of the Civil Aeromedical 

Institute is the central screening facility and repository within the FAA for 

the collection, processing, adjudication, investigation, and analysis of 

medical data generated by the aeromedical certification and related programs. 

The airline pilot denial data were obtained from the computer file as of 

July 1, 1985, for calendar year (CY) 1983 and 1984 applicants. The 6-month 

time lapse was allowed to ensure final certification action in the majority of 

cases. The active airline pilot population as of December 31, 1983, (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 FAR'S 61.151 and 

121.383 (c) for holding an air transport pilot rating and engaging in air 

carrier operations. 

Prevalence 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 received concerning 

airmen denied medical certification. 

RESULTS AND DISCUSSION 

Observations on the airline pilot group probably come closest to a true 

reflection of incidence of disqualifying disease as is possible to observe. 

Prescreening by airline companies before employment and FAA requirements for 

issuance of a first-class medical certificate result in this group being 

essentially purged of disease prevalence that contributes to higher rates for 

other groups. Also, because of occupational/economic reasons, these individuals are less likely to voluntarily remove themselves from follow-up 

observation for known medical conditions that would preclude FAA medical 

certification. 

Denials may occur at several different levels within the FAA and/or by the 

AME. The final level of denial is, however, the one recorded on a pilot's 

medical record. Of the 377 airline pilot denials, over 65% were either 

general denials issued by the AMCB or AME denials (see Figure 1). 

As of December 31, 1983, there were 40,128 airmen between the ages of 

25-59 who listed their occupation as airline pilot. As of July 1, 1985, there 

were 377 airline pilots who had been denied first-class medical certification 

during CYs 1983 and 1984. 

The annual denial rate for airline pilots is, therefore, 4.7 per 1,000 

active airline pilots, increasing from a rate of 1.0 in the 25-29 age interval 

to 12.8 in the 55-59 age interval (see Table I and Figures 2 and 3). 

Data on denials by airline employers provide some interesting insight, 

even though fraught with limitations that make comparison difficult, i.e., 

small numbers substantially affect comparison. Of interest, however, is that 

in previous studies, the larger employers have had lower denial rates than the 

smaller employers (1,2). Part of this difference was undoubtedly due to the 

preventive medical programs of the larger employers and their assumed 

association with other organizations' prevention and rehabilitation programs. 

2 
Another part of the difference was likewise due to early recognition and 

removal from flight status of those pilots manifesting disease states 

(pathology) likely to result in denial and the fact that the major airlines 

have a larger, more select group of pilots from which to choose when initially 

employed. However, data for this group reflect an unusually high denial rate 

for some of the larger airlines. This appears to be due to the pilots' 

concepts and concerns about the economic status of their employer. It could 

also, at least in part, be attributed to the closing of several of the major 

airlines' medical departments (see Figure 4). 

Annual age- cause-specific denial rates increase to the highest rate at age 

interval 55-59 (17.8 per 1,000 active airline pilots). The rate of medical 

disqualification is minimal before the age of 45 years but increases rapidly 

thereafter (from a rate of 4.8 at the 40-44 age interval to 8.4 at the 45-49 

age interval). The mean age of active (issued) airline pilots is 41.8 years 

of age, compared to a mean age of 48.6 for denied airline pilots. While the 

mean age of active airline pilots remains fairly stable, the mean age of 

denied airline pilots is 3 years lower than in the 1984 study (1). Denial 

rates of older pilots have decreased and rates for younger pilots have 

increased when compared with previous studies' rates (1,2). The reasons 

remain unclear but changes in the interpretation of the FAA regulations, 

changes in certification policies, and airline pilots' concepts and concerns 

about the economic status of their employer most surely contributed to these 

rate changes. 

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

cardiovascular denials after age 45. Nothing significant is found in the 

25-29, 30-34, and 35-39 age intervals; however, in the 40-44 age interval, 

neuropsychiatric and cardiovascular diseases begin to be reflected, along with 

the miscellaneous category pathologies. Denial rates begin to increase 

rapidly in the 45-49 age interval with cardiovascular highest and neuropsychiatric and the miscellaneous category equal and next highest. Cardiovascular diseases continue to increase and to represent the highest cause for 

denial in age intervals 50-54 and 55-59. 

The overall highest causes for denial by pathology series are: 

(1) cardiovascular; (2) neuropsychiatric; and (3) the miscellaneous category 

which includes endocrinopathies, general systemic conditions, use of 

disqualifying medications, and denials for failure to provide additional 

medical information, with annual rates per 1,000 active airline pilots of 2.1, 

1.6, and 1.4 respectively. Cardiovascular causes account for one -third of all 

causes for denial, with neuropsychiatric and the miscellaneous category 

approximately one-fourth each (see Table 11 and Figure 5). 

The highest causes for denial by specific pathology are: (1) and (2) are 

equal: failure to provide additional information and use of disqualifying 

medications (about 213 of the disqualifying medications are directly related 

to cardiovascular diseases); (3) coronary artery disease; (4) hypertension 

with medication; and (5) psychoneurotic disorders. These five specific causes 

account for 37% of all causes for denial. The current five highest causes for 

denial by specific pathology are quite different from the five highest causes 

in the 1984 study. The highest causes at that time were: (1) coronary artery 

disease; (2) myocardial infarction; (3) use of disqualifying medications; (4) 

hypertension with medication; and (5) coronary artery bypass surgery. Again, 

changes in the interpretation of FAA regulations and changes in certification 

policy probably contributed. Two hundred and fifty -seven pilots were denied 

for a single cause, 109 for 2 causes, and 11 for 3 causes (see Figure 6). 
SUMMARY 

Cardiovascular, neuropsychiatric, and the miscellaneous pathology category 

comprise 80% 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 due to cardiovascular disease (1-5). 

The overall highest causes for denial by pathology series are: 

(1) cardiovascular; (2) neuropsychiatric; and (3) the miscellaneous category, 

with annual rates per 1,000 active airline pilots of 2.1, 1.6, and 1.4 

respectively. The highest causes for denial by specific pathology are: 

(1) and (2) are equal: failure to provide additional information and use of 

disqualifying medications (about 213 of the disqualifying medications are 

directly related to cardiovascular diseases); (3) coronary artery disease; 

(4) hypertension with medication; and (5) psychoneurotic disorders. These 

five specific causes account for 37% of all causes for denial. 

Reasons/causes for denial and age-specific denial rates are changing. 

This could be attributed to changes in the interpretation of FAA regulations 

and certification policies and to pilots' concepts and concerns regarding the 

economic status of their employer. 

On the basis of these and previous findings, pilots should be educated to 

report history or symptoms of any disease, but particularly heart disease, 

during their periodic medical certification examinations (1-5). AMEs should 

also be especially alert for evidence of cardiovascular disease detectable by 

routine physical examination. 
REFERENCES 

1. Dark S. Medically Disqualified Airline Pilots. Washington, DC: 

Federal Aviation Administration, Office of Aviation Medicine, 

NO FAA-AM-84-9 1984 

2. Dark S. Characteristics of Medically Disqualified Airline Pilots. 

Washington, DC: Federal Aviation Administration, Office of Aviation 

Medicine, No. FAA-AM-83-5. 1983. 

3. Holt GW, Taylor WF, Carter ET. Airline Pilot Disability: The 

Continued Experience of a Major U.S. Airline. Aviat. Space Environ. 

Med. 56 : 939-44, 1985. 

4. Mohler SR. Aircrew Physical Status and Career Longevity. Human 

Factors Bulletin. January/April 1984. Vol. 31, No.1. 

5. Orford RR, Carter ET. Pre-employment and Periodic Physical Examination 

of Airline Pilots at the Mayo Clinic, 1939-1974. Aviat. Space 

Environ. Med. 47(2) : 180-184, 1976 0 

5 
TABLE I. AGE DISTRIBUTION OF AIRLINE PILOTS 

Active Percent of Denied Percent of Annual 

Age Air 1 ine Ac t ive Air 1 ine Air 1 ine Total Age-Specific 

Groups Pilots Pilots Pilots Denials Denial Rate* 

25-29 3,365 8.4 7 1.9 1.0 

30-34 5,7 16 14.2 7 1.9 0.6 

35-39 7,022 17.5 17 4.5 1.2 

40-44 7,738 19.3 56 14.8 3.6 

45-49 8,088 20.2 10 1 26.8 6.2 

50-54 5,50 1 13.7 120 31.8 10.9 

55-59 2,698 6.7 69 18.3 12.8 

TOTAL 40 , 128 100 .o 377 100.0 4.7 

*Annual rates per 1,000 active airline pilots. 

Note: The annual denial rate for all first- class medical certificate holders is 3.9; 

3.6 for second- class medical certificate holders; 8.4 for third - class medical 

certificate holders; and 6.3 for all classes of medical certificates. 

6 
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TOTAL p 4.7 

Annual Rate per 1,000 Active Airline Pilots 

FIGURE 4. DENIALS BY EMPLOYER. 

11 
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FIGURE 5. CAUSE FOR DENIAL BY MAJOR BODY SYSTEM. 

12 
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