Aviation Safety: FAA Should Improve Usability of its Online Application System and Clarity of the Pilot's Medical Form
Published: 2014-04-08T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: FAA developed its medical standards and pilot's medical-certification process to identify pilot applicants with medical conditions that may pose a risk to flight safety. The Pilot's Bill of Rights (P.L. 112-153) mandated GAO to assess FAA's medical certification standards, process, and forms.
This report addresses: (1) FAA's medical standards, policies, and certification processes, along with medical experts' views on them, and (2) steps that FAA could take to promote private pilots' understanding of its medical requirements. GAO reviewed statutes, regulations, FAA documents, and interviewed officials from FAA, NTSB, pilot associations, and 20 aviation medical experts primarily identified by the National Academies' Institute of Medicine. Experts were selected based on their type and depth of experience, including recognition in the aerospace-medicine professional community. GAO also interviewed FAA's medical certification division and evaluated the usability of FAA's online application system and the clarity of its application form against federal writing guidelines and best practices in website usability.
section_title: What GAO Found
paragraphs: Aerospace medical experts GAO interviewed generally agreed that the Federal Aviation Administration's (FAA) medical standards are appropriate and supported FAA's recent data-driven efforts to improve its pilot medical-certification process. Each year, about 400,000 candidates apply for a pilot's medical certificate and complete a medical exam to determine whether they meet FAA's medical standards. From 2008 through 2012, on average, about 90 percent of applicants have been medically certified by an FAA-designated aviation medical examiner (AME) at the time of their medical exam or by a Regional Flight Surgeon. Of the remaining applicants, about 8.5 percent have received a special issuance medical certificate (special issuance) after providing additional medical information to FAA. Approximately 1.2 percent were not medically certified to fly. According to an industry association, the special issuance process adds time and costs to the application process, in part, because applicants might not understand what additional medical information they need to provide to FAA. Officials from FAA's medical certification division have said that technological problems with the aging computer systems that support the medical certification process have contributed to delays in the special issuance process. FAA's medical certification division has identified about 50 potential technological enhancements to its internal computer systems that support the medical certification process, of which about 20 have been identified as high priority, but the division has not yet implemented them or developed a timeline to do so. By developing a timeline to implement the highest-priority enhancements, FAA would take another step toward expediting the certification process for many applicants hoping to obtain a special issuance. FAA recently established a datadriven process using historic medical and accident data that authorizes AMEs to certify a greater number of applicants with medical conditions who had previously required a special issuance. Officials expect this effort to allow more applicants to be certified at the time of their AME visit and to free resources at FAA to focus on applicants with higher-risk medical conditions.
GAO's analysis and medical experts' opinions indicate that FAA could improve its communication with applicants by making its online application system--part of FAA's internal computer systems discussed above--more user-friendly and improving the clarity of the medical application form. Specifically, GAO found that the online application system requires applicants to scroll through a lengthy terms-of-service agreement and does not provide clear instructions, and that the application form contained unclear questions and terms that could be misinterpreted by the applicant. FAA could enhance its online application system by using links to improve navigability of the system and providing information that is more useful to applicants--for example, links to information about the risk that specific medical conditions pose to flight safety and any additional medical information applicants with those conditions would need to provide to FAA. FAA could also improve the clarity of its medical application form by incorporating guidelines established in FAA's Writing Standards, including shorter sentences and paragraphs, active voice, and clear terms and questions. These clarifications could not only aid an applicant's understanding of the medical standards and requirements, but also may result in more accurate and complete information provided by applicants to better inform FAA's certification decisions.
section_title: What GAO Recommends
paragraphs: GAO recommends that FAA (1) develop a timeline for implementing high-priority technological improvements to the internal computer systems that support the medical certification process, and (2) enhance the online medical-application system by clarifying instructions and questions on the form and providing useful information. The Department of Transportation agreed to consider the recommendations.

section_title: Letter
paragraphs: The primary mission of the Federal Aviation Administration (FAA) is to  ensure a safe and efficient flying environment. As part of its mission, FAA  oversees the medical certification of about 600,000 pilots to certify that  they meet FAA’s medical standards and are physically and mentally fit to  fly. According to FAA officials, most applicants for a medical certificate  meet FAA’s medical standards and are medically certified after  completing a physical exam by a FAA-designated physician. However, for  applicants with a disqualifying medical condition, FAA’s Federal Air  Surgeon may, on a case-by-case basis, authorize a special issuance  medical certificate (special issuance) for a specified period. An  authorization for a special issuance requires the applicant to show to the  satisfaction of the Federal Air Surgeon that the required operations can  be performed without endangering public safety during the period of the  special issuance. Medical conditions that generally disqualify applicants  from medical certification to fly include certain heart conditions, diabetes,  epilepsy, impaired hearing or vision, psychosis, drug and alcohol  dependence, and also generally any disease, defect, or treatment that  could prevent a pilot from safely operating an aircraft. About 10 percent  of applications—nearly 40,000 a year—may require, among other things,  further medical evaluation, medical flight testing, or submitting additional  documentation that can add time to the certification process. However,  through the special issuance process, FAA has allowed some pilots to fly  for a specified period with heart transplants, permanent cardiac  pacemakers, and insulin-treated diabetes mellitus, among other  conditions that would otherwise disqualify pilots from flying.
The Pilot’s Bill of Rights mandates that GAO assess FAA’s medical  certification process and the associated medical standards and forms.This report discusses
FAA’s medical standards and certification processes, along with  medical experts’ views on them, and  steps that could be taken to promote private pilot applicants’  understanding of FAA’s medical requirements, including potential  revisions to the medical application form.
To address our objectives, we commissioned the Institute of Medicine of  the National Academies to identify experts knowledgeable about aviation  medicine. From the list of 24 experts identified by the National Academies, seven experts were either unavailable, had concerns over  their ability to respond to the questions because of their unfamiliarity with  FAA’s medical certification program, or had a conflict of interest, and we  added three experts recommended to us, for a total of 20 aviation medical  experts. We conducted semi-structured interviews of the experts to solicit  their views on FAA’s medical standards, the medical application form, and  FAA’s communication with physicians and pilot applicants. We also  interviewed officials from FAA, and we visited the Civil Aerospace Medical  Institute (CAMI) in Oklahoma City to interview representatives of FAA’s  Aerospace Medical Certification Division (AMCD) about FAA’s medical  standards, the medical application form, and FAA’s methods for  communicating pilot medical-certification information with physicians and  pilot applicants. In addition, we interviewed officials from the National  Transportation Safety Board (NTSB), representatives from two pilot  associations, and representatives from the American Diabetes  Association. We also received written responses from three regional  airline representatives and two aviation medical associations regarding  their views on FAA’s current medical standards, the clarity of the medical  form, and FAA’s efforts to provide information to pilots and pilot  applicants. Further, we analyzed FAA’s Form 8500-8 (medical  application form) and MedXPress.faa.gov (FAA’s online application  system), against the federal government’s plain language and website  usability guidelines. (See app. I for further information on our scope and  methodology, including a list of medical experts we interviewed.)
We conducted this performance audit from January 2013 through April  2014, in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: According to FAA officials, FAA’s medical certification requirement was  established to prevent or mitigate the effect of various medical conditions  that present an undue risk to the safety of pilots, passengers, or others.  While most general aviation accidents are attributed to pilot error  involving a loss of aircraft control, according to information provided by  NTSB, medical causes were a factor in approximately 2.5 percent of the  accidents from 2008 through 2012. By ensuring that applicants meet  medical standards, FAA aims to reduce the likelihood of incapacitation of  a pilot due to a medical cause.
Federal regulations establish three classes of medical certification that  correspond to the types of operations that pilots perform. Airline transport  pilots who serve as pilots in command of scheduled air-carrier operations  must hold first-class medical certificates. Pilots who fly for compensation  or hire generally hold second-class medical certificates. Private pilots hold  third-class medical certificates. (See table 1.) Depending on their age and  the class of medical certificate sought, pilots must renew their medical  certificate periodically, from every 6 months to every 5 years (e.g.,  commercial pilots—generally those needing first- or second-class medical  certificate—must have their medical certificate updated more frequently  than private pilots). After obtaining a medical certificate, and between  renewal periods, pilots are prohibited from performing pilot operations  when they know or have reason to know of a medical deficiency that  would make them unable to fulfill their pilot operation.
In the fiscal year 2014 budget submission, FAA estimated that its Office  of Aerospace Medicine would need about $56.1 million in funding—about  4.7 percent of the total Aviation Safety budget—to carry out its mission.  To assist in the nearly 400,000 medical evaluations of pilots and new  applicants each year, FAA designates medical certification authority to  approximately 3,300 private physicians, or Aviation Medical Examiners  (AMEs). The AMEs review applicants’ medical histories and perform  physical examinations to ensure that applicants meet FAA’s medical  standards and are medically fit to operate an aircraft at the time of their  medical exam. Although AMEs are not FAA employees, they are trained  in aviation medicine by the FAA and entrusted to make medical eligibility  determinations for the majority of applicants, on behalf of the FAA. In  order to become an AME and be authorized to administer medical exams,  FAA requires AMEs to complete online courses in clinical aerospace  physiology and medical certification standards and procedures before  attending a one-week basic AME seminar. AMEs must also complete at  least 10 pilot medical exams each year and a subsequent refresher  courses every 3 years.
All applicants for medical certificates and renewals follow a similar  process. Applicants begin the medical certification process by completing  Form 8500-8, Application for Airman Medical Certificate or Airman  Medical & Student Pilot Certificate (medical application form) in  MedXPress (online application system). For applicants with disqualifying  medical conditions or for those who do not meet FAA’s medical  standards, the AME must defer the applicant to FAA to authorize a  special issuance. The special issuance process may require additional  medical information and evaluations from, for example, a primary care  physician or medical specialist. Also, a special issuance may be subject  to operational limitations for safety reasons, or may be valid for a shorter  time period than an unrestricted medical certificate. As a provision of the  special issuance, FAA may authorize AMEs to make future medical  determinations of the applicant—separate from the centralized special  issuance process—under the AME Assisted Special Issuance (AASI)  process. various outcomes.
Alternatively, if FAA determines that an applicant’s medical condition is static and non- progressive and has found the applicant capable of performing pilot duties without  endangering public safety, the FAA may grant a Statement of Demonstrated Ability  (SODA) to the applicant, which does not expire and authorizes AMEs to make future  medical determinations of the applicant, without requiring the applicant to go through the  special issuance review process.
section_title: Experts Generally Agreed with FAA’s Medical Standards and Supported FAA’s Move toward a Data- Driven Approach to Its Certification Process
subsections: section_title: FAA Uses Several Approaches to Update Its Medical Standards
paragraphs: According to FAA officials, pilot medical standards were developed to  help manage safety risk. FAA’s current medical standards have been  codified in federal regulation since March 19, 1996. The regulations set  out 15 medical conditions that are specifically disqualifying. Medical  conditions identified during an evaluation that are not specifically listed as  disqualifying but do not meet the general medical standard regarding safe  performance of duties and exercise of privileges, are also disqualifying  under general medical standards, according to FAA. (See app. II for a  summary of selected FAA medical standards.) According to FAA officials,  the standards and the medical certification process were developed to  manage the risk of an aircraft accident or incident by identifying  applicants with medical conditions that could potentially incapacitate them  in the flight environment or during critical take-off and landing periods.
FAA takes steps designed to ensure that its medical policies and  procedures are consistent with current medical and aeromedical practice,  and that these steps result in periodic updates to its medical policies. The  Federal Air Surgeon establishes medical policies and medical certification  procedures that are published in internal guidance for FAA’s Office of  Aerospace Medicine and for AMEs in the Guide for Aviation Medical  Examiners (AME Guide). The agency uses several techniques to update  policies:
First, the Aeromedical Standards and Policies Branch develops policy  recommendations for the Federal Air Surgeon, which address medical  conditions, medication use, and medical procedures. According to  FAA officials, medical policy review is a continuous process  influenced by several factors, which include (1) announcements of  significant new developments in the medical literature; (2) medical  appeals to the Federal Air Surgeon; (3) announcements and alerts by  the Food and Drug Administration; (4) inquiries by aviation  stakeholder groups and pilot advocacy groups; (5) aircraft accidents  or events; (6) inquiries by the Office of Aerospace Medicine personnel  and AMEs; and (7) communications with international aviation  authorities, and medical advocacy groups, among other things.
Second, according to FAA officials, the agency refers dozens of  individual cases annually for independent review by experts in a wide  variety of medical specialties, such as cardiology, psychology, and  neuropsychology. FAA officials stated that implicit to the process of  reviewing each case is to consider changes to current policy based on  current medical practice. FAA also periodically uses independent  medical experts to evaluate its medical policies, particularly with  regard to cardiovascular conditions, which were present in more than  one-third of the applicants who received special issuances in 2012. In  January 2013, for example, FAA hosted a cardiology roundtable to  review FAA’s policies with regard to cardiovascular conditions and to  suggest updates to the policies, if necessary. The roundtable’s  suggested policy changes were presented to the Federal Air Surgeon,  who approved several of them. However, FAA officials have said that  they do not convene such roundtables frequently due to time and cost  constraints.
Third, the results of CAMI’s aerospace medical and human factors  research have been used to inform changes to FAA guidance and  policies. In particular, CAMI’s aerospace medical research focuses on  the biomedical aspects of flight, including studies on aviation safety  associated with biomedical, pharmacological, and toxicological issues.  For example, CAMI’s research on sedating medication influenced  guidance in this area. According to FAA officials, a review of accident  investigation data showed that many pilots involved in accidents were  using over the counter and prescription sedative medications. As a  result, FAA, in coordination with the aviation industry, issued guidance  extending the length of time a pilot should wait after using these  medications and before operating an aircraft. A letter jointly signed by  the FAA and all major aviation advocacy groups was sent to all pilots  and published on the FAA website and in various public and private  publications advising pilots to comply with the new guidance.
Fourth, CAMI’s library allows research staff to collect and review  academic journals on aviation medical issues, general medical  research, engineering, management, and other general topics. CAMI  researchers have also published approximately 1200 aerospace  medicine technical reports on topics including, for example, pilot age,  alcohol and substance abuse, fatigue, psychology, and vision.  FAA’s policy branch periodically reviews this and other medical  literature, which FAA officials say can also result in a possible  revision. http://www.faa.gov/data_research/research/med_humanfacs/oamtechreports/.
In addition, FAA has recently begun analyzing aviation accident  information to develop a predictive model based on historic data of  medical conditions that have been identified as contributing factors to  aircraft accidents. The officials stated that they plan to use the model as a  data-driven guide to help inform how they determine the relative risk of  various medical conditions. FAA officials noted that the agency has begun  this work as part of a broader Safety Management Systems (SMS)  initiative that seeks to further enhance safety by shifting to a data-driven,  risk-based oversight approach.
section_title: Experts Generally Agreed FAA’s Medical Standards Are Appropriate, but Some Experts Suggested Modifying Some Policies
paragraphs: All aerospace medical experts we interviewed generally agreed that  FAA’s medical standards were appropriate, and most (16 of 20) said that   Some  the standards should be applied to commercial and private pilots.of these experts said that standards should apply equally to private pilots  because they share airspace with commercial pilots or because private  pilots typically do not fly with a copilot—an important safety feature for  commercial flight operations. In addition, although some of the experts (7  of 20) suggested no changes to FAA’s policies, many of the experts (13  of 20) identified at least one medical standard for which they considered  FAA’s policies to be either too restrictive or too permissive. A restrictive  policy might lead FAA to deny certification to an applicant who may be  sufficiently healthy to safely fly a plane, or may result in FAA requiring a  more thorough medical evaluation than the experts considered  necessary. A permissive policy, on the other hand, might lead FAA to  certify an applicant with health issues that could impair his or her ability to  safely fly a plane, or may result in FAA not completing as thorough a  medical evaluation as the experts considered necessary.
Although expert opinions varied regarding which standards were too  permissive or restrictive, neurological issues were most commonly  discussed by some (9 of 20) of the experts.noted that the FAA medical certification requirements for applicants who  use antidepressants, including selective serotonin reuptake inhibitors  (SSRI), are restrictive and onerous and may require an applicant not to fly  for an extended period of time. A medical representative from the Aircraft  Owners and Pilots Association (AOPA) said that FAA’s policies may  require a pilot using antidepressants to undergo costly cognitive studies  that were viewed as medically unnecessary for milder cases of  depression.
For example, some experts  Alternately, some medical experts said that policies regarding cognitive  functioning in aging pilots, traumatic head or brain injuries, and attention  deficit disorders may be too permissive. An FAA official stated that the  area of neurology is complex and has been somewhat difficult for AMCD  due, in part, to variation in opinion as to how to assess cognitive function  and when testing should be done. The agency hosted a neurology  summit in 2010 that convened neurology experts to review FAA policies  on neurological issues—including traumatic brain injury, migraine  headaches, and neurocognitive testing—and resulted in  recommendations that the Federal Air Surgeon adopted regarding  migraine treatments, among other neurological conditions. Also, the  Division Manager of AMCD said that they consult with neurologists, as  needed, to review the application of certification policies regarding  individual applicant cases.
To a lesser extent, some (5 of 20) experts had mixed views on the  policies for diabetes and medical conditions related to endocrine function.  Of those, three experts thought that FAA’s current policies on diabetes  might be too restrictive, for example, because the FAA has not kept pace  with medical advances and treatment options currently available to pilots.  One expert noted that some commercial pilots with insulin treated  diabetes mellitus (ITDM) may be medically fit to fly a plane with a special  issuance if they can demonstrate that their condition is stable, just as  private pilots are allowed to do. In addition, representatives from the  American Diabetes Association and a member of the Regional Airline  Association stated that FAA’s policies for commercial pilots with ITDM  have not kept current, when considering the advancements in medical  treatment of ITDM and the redundancy of having a copilot and crew in  commercial aircraft to reduce the risk associated with commercial pilots  with ITDM. Conversely, two experts thought that FAA may be too  permissive with regard to diabetes, citing, for example, concerns about  the increase in diabetes among Americans, in general, and the potential  for undiagnosed cases. FAA officials agreed that there have been  improvements in the clinical care for diabetes and the Office of Aerospace  Medicine has studied the safety and efficacy of new diabetes treatment  over the past several years, including the risks associated with new  medications and insulin formulations. However, according to FAA  officials, independent consultants—including endocrinologists and  diabetes experts—have told the FAA that the risk of incapacitation related  to hypoglycemia has not changed regardless of advancements in  treatment.
All of the experts suggested ways FAA could ensure its medical  standards are current, many of which were consistent with approaches  FAA is already taking. For example, some of the experts (9 of 20) said  FAA could review its medical standards at regular time intervals or as  medical advances occur, and some (8 of 20) of the experts said FAA  could review its medical standards based on evidence of the likelihood of  each condition causing an accident. Some experts (5 of 20) specifically  suggested FAA should convene a panel on neurology and mental health  issues. FAA convened a panel on neurological issues in 2010.
section_title: Experts Suggested FAA Should Continue Efforts to Make the Certification Process Data-Driven
paragraphs: As previously mentioned, FAA is currently undertaking an agency-wide  initiative—SMS—that seeks to further enhance safety by shifting to a  data-driven, risk-based safety oversight approach. As part of this  approach, FAA implemented the Conditions an AME Can Issue, or CACI,  program in April 2013. The CACI program authorizes AMEs to issue  medical certificates to applicants with relatively low risk medical  conditions that had previously required a special issuance from the  FAA. FAA developed the program by identifying medical conditions that,  in most cases, did not pose a safety risk, based on FAA analysis of  historic medical and accident data. Agency officials expect the program to  allow more applicants to be certified at the time of their AME visit while  freeing resources at FAA to focus on medically complex applicants with  multiple conditions or medical conditions that may pose a greater risk to  flight safety, such as applicants who have had coronary artery bypass  surgery.
Based on information provided by FAA, as of December, 31, 2011,  approximately 19 percent of all pilots reported medical conditions that  may now be evaluated by their AME as a result of the CACI program. Of  those pilots, about one-third—or nearly 39,000 pilots—reported no  additional medical conditions, making it more likely that in the future, they  may be certified at the time of their AME visit, rather than through the  special issuance process. Other medical conditions have been proposed for the CACI program but have not yet been approved by FAA officials. Most medical experts (18 of 20) we interviewed approved of the CACI  program, and some (8 of 20) believed that FAA should continue to  expand it to include additional medical conditions. Representatives of an  industry association agreed and noted that by authorizing AMEs to make  a greater number of medical certification decisions, AMCD officials could  speed up the application process for more applicants.
Medical conditions that were proposed but not yet approved for CACI, include, for  example: carotid stenosis, bladder cancer, leukemia, and lymphoma.
FAA authorization for a special issuance that they believe should be  considered under the CACI program. Their suggestions included, for  example, non-insulin-treated diabetes, which was a factor in about 17  percent of the special issuances in 2012; sleep apnea and other sleep  disorders, which were a factor in about 11 percent of the special  issuances in 2012; and various forms of cancer, which were a factor in  about 10 percent of special issuances in 2012. FAA officials have begun  to allow AMEs to make medical determinations for applicants with certain  types of cancer under the CACI program and have said that they will  evaluate other medical conditions to include in the CACI program in the  future.
Although neurological conditions (including migraines, head trauma,  stroke, and seizures) accounted for approximately 4 percent of special  issuances in 2012, some experts (5 of 20) thought, as mentioned above,  that FAA should convene an expert panel to re-evaluate its policies in this  area. Half of the experts we interviewed also said that FAA could evaluate  its medical standards based on the relative risk of incapacitation  associated with various medical conditions, assessed through greater use  of data. That is, with a better understanding of the likelihood of each  medical condition to cause a suddenly incapacitating event in flight— based on historic data of accidents and incidents—FAA could modify its  risk threshold for various medical standards and policies to manage risk.
As previously mentioned, FAA has begun to collect and analyze data that  will help it develop a proactive approach to managing aviation medical  risk; however, FAA officials told us that data from historic accidents and  incidents can be difficult to obtain and link to medical causes. The officials  also said that they would need to change how they code, or classify, the  medical information they collect—and re-code medical information they  already have—to more accurately classify medical conditions of  applicants and, therefore, improve the reliability of their predictive model.  Without more granular data collection on health conditions, officials said it  is difficult for FAA to accurately determine the level of risk, associated  with various medical conditions. In addition, officials at FAA and NTSB  noted that data on medical causes of accidents and incidents are likely to  be incomplete because not all accidents are investigated in the same way  and medical causation can be difficult to prove in light of other  contributing factors. For example, an official from NTSB explained that  there are different levels of medical investigations performed after  accidents, depending on factors like whether or not the pilot has survived,  the condition of the aircraft or severity of the crash, and the number of  people impacted. As of February 14, 2013, NTSB and FAA agreed to a  memorandum of understanding (MOU) that will facilitate NTSB’s data  sharing and record matching for aircraft accidents and incidents with  CAMI.
section_title: FAA Has Identified Technical Solutions to Improve Its Medical Certification Systems, but Has Not Set Time Frames for Implementation
paragraphs: Although most medical certification determinations are made by one of  the approximately 3,300 FAA-designated AMEs at the time of an  applicant’s medical exam, approximately 10 percent of applications—or  nearly 40,000 annually—are deferred to FAA for further medical  evaluation if the applicant does not meet FAA’s medical standards or has  a disqualifying medical condition. According to FAA officials, the 10  percent of applicants who are deferred requires a significant amount of  resources from FAA’s medical certification division, which in recent years,  has experienced a backlog of special issuance applications in need of  review. As of February 2014, an FAA official estimated this backlog at  about 17,500 applications.
FAA has not met its internal goals for responding to individuals whose  applications have been deferred. Specifically, FAA has set an internal  goal of 30 working days to make a medical determination or to respond to  an applicant with a request for further information. However, according to  FAA data, the average time it takes FAA officials to make a medical  determination or request further information from an applicant has  increased over the past 6 fiscal years, taking an average of approximately  45 working days—or about 9 weeks—in fiscal year 2013, and more than  62 working days in December 2013. If FAA makes multiple requests for  further information from an applicant, the special issuance process can  take several months or longer.
Officials from AOPA stated that some applicants for private pilot medical  certificates discontinue the application process after an initial denial from  the FAA because the applicants decide that the cost of extra medical  evaluations and added time is too great to support what the applicant  views as a recreational activity.that delays can also occur as a result of applicants who may take a long  time to respond to an FAA request for further evaluation. According to  AOPA, having information upfront would speed up the process by helping  applicants understand FAA’s additional medical requirements for a  special issuance. FAA has increasingly encouraged its Regional Flight  Surgeons to become more actively involved in making medical  determinations for applicants seeking a special issuance.
However, an official from FAA noted  FAA officials at AMCD stated that there are several reasons for the  increased processing time for applicants requiring special issuances. For  example, AMCD has faced a technical issue deploying the Document  Imaging Workflow System (DIWS), a web-based computer system used  by AMCD to process, prioritize, and track all medical certification  applications. One AMCD official noted that delays in deployment of the  system have decreased productivity of the AMCD to as low as just 25  percent of normal levels. In addition, officials cited multiple backlogs  throughout the division, such as, the electrocardiogram (ECG) unit, which  receives up to 400 ECGs each day, and the pathology-coding unit, which  may require manual coding of medical conditions to feed information into  DIWS.
Part of the challenge, identified in FAA’s National Airspace Capital  Investment Plan, is that the current medical certification systems are  based on obsolete technology from the 1990s. Accordingly, technical  working groups at AMCD have identified more than 50 problems and  potential technological solutions to enhance their systems, including the  special issuance processes, of which about 20 have been identified as  high-priority, including improvements to the online application system,  AMCS, DIWS, and the ECG transmittal and review process. For example,  officials stated that updating DIWS to import and read electronic files  would reduce the need to manually scan from paper documents, and  providing AMEs or applicants limited access to DIWS so they can check  the status of an application could reduce the number of calls AMCD  receives at its call center. As of February 2014, FAA officials stated they  received funding they requested in June 2013, to upgrade the ECG  system from analog to digital—a process which they estimate will take  about 11 months to complete. In addition, FAA has not established a  timeline for implementing its broader set of technology enhancements,  some of which may be less contingent on resource constraints. A timeline  to guide the implementation of the highest-priority enhancements would  help the agency take another step toward reducing the delays and  bottlenecks in the special issuance process related to FAA’s technology  issues.
In addition to the proposed enhancements, the Office of Aerospace  Medicine collaborated with the Volpe National Transportation Systems  Center (Volpe Center), in 2013, to define broader challenges of the  current medical certification process and develop a strategy to reengineer  the existing business processes, including the online medical-certification  system and its supporting information-technology infrastructure. Officials  from the Office of Aerospace Medicine have said that their effort with the  Volpe Center will ultimately inform their plan to replace FAA’s current  medical information systems with the Aerospace Medicine Safety  Information System (AMSIS), which the agency plans to begin developing  in fiscal year 2015. FAA officials stated that they envision several long- term positive changes that may result from AMSIS—including redesigning  the online application system and form, providing applicants with  information on actions to complete before they meet with their AME, and  a more transparent special issuance process with the capacity for  applicants to check the status of their applications. However, FAA officials  have also identified several challenges to implementing AMSIS, including  working within the confines of legal and regulatory requirements,  protecting sensitive information, and obtaining the estimated $50 million  needed to fund the system.
section_title: FAA Could Enhance its Online Application System and the Clarity of its Medical Application Form for Private Pilots
subsections: section_title: FAA Could Enhance Usability of its Online Medical Application System
paragraphs: One of FAA’s main tools to communicate its medical standards directly to  applicants, and to solicit medical information from them, is its online  medical application system. While FAA also offers training and produces  pamphlets, videos, and other educational material for AMEs and pilots,  the online medical application system is used by all applicants to apply for  a medical certificate. (See app. III for FAA’s training programs and other  communication tools for AMEs and pilots). The system includes  information such as the online medical-application form and instructions  used by applicants to submit medical information to their AME and to  FAA, and a link to the AME Guide, which contains pertinent information  and guidance regarding regulations, examination procedures, and  protocols needed to perform the duties and responsibilities of an AME.
We compared the online application system with select guidelines related  to content, navigation, and design that are considered good practices by   Based on our evaluation and discussion with experts, we  Usability.gov.identified areas in which FAA might enhance the usability of the online  application system by (1) providing useful information directly to  applicants, and (2) using links to improve how applicants navigate  through the application system.
Providing Additional Useful Information Directly to Applicants: According  to Usability.gov, a good practice in website design includes providing  useful and relevant information that is easy to access and use. Some  experts (7 of 20), including four who were also AMEs, said that applicants  may be unsure about medical requirements and documentation.
Representatives of two aviation medical associations also said a lack of  clarity can lead to delays in processing the medical certification if  applicants learn during their medical examination that they must obtain  additional test results or documentation from their primary care physician.  Some medical experts (4 of 20) said that technological improvements  would be helpful. For example, FAA could develop a Web page on its  website or within the online application system with more information for  applicants. In addition, two pilot associations stated that a specific Web  page or website for applicants with links to information on various medical  conditions, their risks to flight safety, and additional medical evaluations  that might be needed for applicants with those conditions would be  helpful. The online application system currently contains a link to the AME  Guide; however, applicants may find the 334-page AME Guide—written  for aviation medical examiners—difficult to navigate and understand and  therefore, may be unable to find information about specific documentation  and additional medical evaluations they may need.
FAA officials in the medical certification division said that providing  documentation requirements to applicants could reduce certification  delays, AME errors, and the number of phone calls to AMCD’s medical  certification call center because the applicants would know what  additional evaluations or documents they should get from their primary  care physician before they visit their AME for a medical exam. Similarly,  the FAA officials noted that applicants may not recall information they had  previously reported in prior medical certificate evaluations or may not  disclose their complete medical history when they see a new AME. NTSB  officials stated that the AME cannot see information about any previous  applications and knows only what the pilot has reported on their current  application. This means that the applicant has to recall all of his or her  past medical history each time they apply for a medical certificate.  Additionally, according to the NTSB officials, it would be useful for the  pilot to access previously reported information and update only what has  changed since their previous exam. As part of the more than 50  technological solutions discussed earlier that FAA has identified to  enhance the special issuance process, the agency has proposed  providing access to worksheets which specify required medical  documentation and providing access to previously reported medical data  to applicants and AMEs. FAA officials stated that these issues, if  addressed, would facilitate information flow between the applicant, the  AME and FAA and allow AMCD officials to more efficiently do their work.
Additionally, some experts (9 of 20) said that it would be helpful to  applicants and treating physicians if FAA posted a list of banned  medications. In a couple experts’ view, without a public list of banned  medications, applicants may not disclose their medical treatment regimen  to FAA out of fear of losing or not receiving their certification. NTSB  recommended in 2000 that DOT develop a list of approved medications  and/or classes of medications that may be safely used when operating a  vehicle; however, DOT—including FAA—did not implement the  recommendation because, in DOT’s view, a list of approved medications  would be difficult to maintain and would be a liability for the transportation  industry if the Department approved a medication that later caused an  accident. Officials from AOPA told us that the association provides an  unofficial list of approved and banned medications to its members but  believes that this information should be made public and provided by  FAA.
However, FAA states in its AME guide that maintaining a published list of  approved medications would not contribute to aviation safety because it  doesn’t address the underlying medical condition being treated. Instead,  FAA’s current policy prohibits AMEs from issuing medical certificates to  applicants using medications that have not been on the market for at least  one year after approval by the Food and Drug Administration (FDA), and  FAA has recently updated its AME Guide, to include a “Do Not Issue—Do  Not Fly” list of several general classes of medication and some specific   The “Do Not Issue” list  pharmaceuticals and therapeutic medications. names medications that are banned—meaning the AME should not issue  a medical certificate without clearance from FAA—and the “Do Not Fly”  list names medications that the pilot should not use for a specified period  of time before or during flight, including sleep aids and some allergy  medications. FAA officials said that the “Do Not Issue—Do Not Fly” list is  intended to be a “living document” that they will revisit periodically. NTSB  officials suggested that it would be helpful if medications that an applicant  discloses on the medical application form could be automatically checked  against the “Do Not Issue—Do Not Fly” list to notify their AME of the  applicant’s use of a medication on the list. http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/ph arm/dni_dnf/.
Easier Website Navigation: Navigation is the means by which users get  from page to page on a website to find and access information effectively  and efficiently. According to Usability.gov, a good practice related to  navigability is to use a clickable list of contents, thus minimizing scrolling.  The Pilot’s Bill of Rights Notification and Terms of Service Agreement— which contains a statement advising the applicant that responses may be  used as evidence against the applicant, a liability disclaimer, a statement  of privacy, and a Paperwork Reduction Act statement among other  statements—requires the user to scroll through what equates to nearly 10  pages of text (2,441 words over 417 lines of text), viewable through a  small window that shows approximately 10 to 12 words across and four  lines down at a time (see fig. 2).
FAA might enhance the visibility of this information and help applicants  better understand what they are agreeing to, if it created a larger window  with hyperlinks to help the reader navigate through various sections of the  notification and agreement. Similarly, the question and answer page for  applicants could be enhanced by including clickable links between the  questions and answers to allow readers to more easily find answers of  interest to them.
Another good practice, according to Usability.gov, is to design websites  for popular operating systems and common browsers while also  accounting for differences. According to a notification on the online  application system’s log-in screen, applicants are advised to use only  Internet Explorer to access the system. The system functions  inconsistently across other browsers such as Google Chrome, Mozilla  Firefox, and Apple Safari. For example, links to from the medical  application form to its instructions do not work for Firefox or Google  Chrome; instead, they lead the applicant back to the log-in page, causing  any unsaved information to be lost.
As described in the previous section, FAA officials at the medical  certification division identified technological problems and potential  solutions to enhance the online application system, but as of April 2014,  no changes have been made. For example, the officials observed that  some applicants enter the date in the wrong format, switching the order of  day and month (DD/MM/YYYY, as opposed to MM/DD/YYYY), which can  lead to problems when the AME imports the application. As a result, FAA  officials proposed using drop-down boxes—with the name or abbreviation  of each month, followed by the day, and the year—to collect date  information. This proposed solution is consistent with a good practice— anticipates typical user errors—highlighted by Usability.gov. Additionally,  the officials noted that it is not uncommon for an applicant to be logged  out of their session due to inactivity, resulting in a loss of data entered  during the session. To address this, FAA proposed that the online  application system incorporate an auto-save feature that would be  activated prior to the session expiring—consistent with Usability.gov  guidelines—to warn users that a Web session may be expiring after  inactivity to prevent users from losing information they entered into the  online application system.
In addition to these enhancements, FAA collects some information from  applicants and AMEs regarding their experience with the application  process. For example, FAA operates a 24-hour call center to answer  technical questions that applicants, and AMEs may have about the online  application system throughout the application process. FAA also has  surveyed AMEs and pilots to collect information about their experience  with the medical certification process.
section_title: FAA Could Enhance Clarity of Its Medical Application Form
paragraphs: The Plain Writing Act of 2010 requires federal agencies, including FAA, to  write specified types of new or substantially revised publications, forms,  and publicly distributed documents in a “clear, concise, well-organized”  manner. Several years before the Plain Writing Act of 2010—in 2003— FAA issued Writing Standards to improve the clarity of its  communication. The Writing Standards include guidance for anyone who  writes or reviews FAA documents intended for internal or external  distribution. FAA has continued to make efforts in recent years to improve  its employees’ understanding of plain language and how to incorporate it  in written documents. FAA’s Plain Language Program in the Office of  Communications trains employees and supports Plainlanguage.gov, a  website devoted to improving communication from the Federal  government to the public.
Although plain writing is only required for new or substantially changed  government documents, and is therefore not required for the current  medical application form, the goal of plain writing is to help readers find  the information they need, understand what they find, and use it to meet  their needs. In regard to the medical certification process, this would  include helping applicants understand each question and more accurately  complete the application form in the way that FAA intended. In addition,  stakeholders from two pilot associations were concerned that unclear  questions on the medical application form could lead to incomplete or  inaccurate responses, which they said could also lead to applicants’ being  accused of misrepresenting themselves or falsifying information on the  application form—an offense punishable by a fine up to $250,000 and  imprisonment up to 5 years and may also result in a suspension or  revocation or all pilot and medical certificates.
More specifically, FAA’s Writing Standards also recommend using active  voice and active verbs to emphasize the doer of the action. Our analysis  of FAA’s medical application form and instructions showed that in some  cases, FAA used passive voice although active voice would make the  statements clearer. According to FAA’s writing standards, because the  active voice emphasizes the doer of an action, it is usually briefer, clearer,  and more emphatic than the passive voice. For example, on the medical  application form the current statement, “Intentional falsification may result  in federal criminal prosecution,” may be clearer to the applicant if stated,  “If you intentionally falsify your responses, you may be prosecuted for a  federal crime,” or a similar, more direct way of notifying the applicant.  However, FAA officials noted that any re-wording of legal warnings or  disclaimers must be approved by legal counsel.
We also asked the medical experts to review the online application form.  In response, many medical experts (12 of 20) we interviewed stated that  certain questions can be confusing or too broad. For example, some  experts have said that terms like “frequent,” “abnormal,” or “medication”  aren’t clearly defined and therefore certain questions could generate  inaccurate responses. For example, many experts (15 of 20) said that  question 17a, on medication use, was unclear because, among other  reasons, the reader may not know whether supplements or herbal  medicines should be included. Some medical experts (7 of 20) also  suggested adding items to question 18, about medical history, for areas  such as cancer and sleep apnea. In 2009, NTSB recommended that FAA  modify its medical application form to elicit specific information about risk   (See app.  factors or any previous diagnosis of obstructive sleep apnea.IV for a copy of the medical application form.)
Many of the medical experts we consulted further suggested simplifying  one question on the form; this question has also been examined by FAA  officials. Specifically, the question on the form pertains to an applicant’s  arrests or convictions. For example, many experts (13 of 20) suggested  simplifying the question. FAA’s writing guidance suggests shortening  sentence length to present information clearly or using bullets or active  voice. In addition, FAA officials from the medical certification division used  a computer program to analyze the readability of the question and  discovered that an applicant would need more than 20 years of education  to understand it.
According to FAA officials, the agency can make changes to the medical  application form for various reasons, including, for example: a response to findings or a recommendation made in a report by  NTSB or by the Department of Transportation Inspector General, or a change in medical practices, for example, resulting from  advancements in medicine.
Since 1990, FAA revised the application form several times, to add or  remove questions, change time frames related to the questions, or to  clarify the questions, among other types of changes. When FAA  announced in the Federal Register that it would replace its paper  application form with an online application system, the agency said that  the online application system would allow it to make and implement any  needed or mandated changes to the application form in a timelier  manner, resulting in a more dynamic form. However, agency officials  noted that while they maintain a list of questions on the application form  that pose problems for applicants, they do not make frequent changes, in  part, because of the time and resources needed to complete a lengthy  public comment and Office of Management and Budget (OMB) approval   FAA officials also  processes which, they say, can take up to two years.said that the Office of Aerospace Medicine must balance “plain language”  with the requirements levied by FAA’s General Counsel to make sure that  the wording is legally correct and enforceable. While it will take time and  resources to improve the clarity FAA’s medical application form, if left  unchanged, the accuracy and completeness of the medical information  provided by applicants may not be improved.
section_title: Conclusions
paragraphs: Aerospace medical experts we interviewed generally agreed that FAA’s  current medical standards are appropriate and supported FAA’s recent  effort to authorize its AMEs to certify a greater number of applicants by  using a data-driven approach to assessing risk through the CACI  program. Expanding the CACI program, as some experts suggested,  could reduce the time it takes for applicants with lower risk conditions to  become medically certified and, more importantly, allow FAA to prioritize  the use of its constrained resources for medical determinations for  applicants with the highest-risk medical conditions.
FAA has identified approximately 50 potential technological  enhancements to its computer systems that support its certification  process, including adding new functionality to facilitate the process and  provide applicants with more information about medical requirements.  According to FAA officials, these enhancements would potentially reduce  the workload at the medical certification division. Although FAA intends to  eventually replace its current medical-certification computer systems with  a new Aerospace Medicine Safety Information System (AMSIS),  temporary enhancements are expected to help FAA reduce the delays  and bottlenecks currently posing challenges to the agency. FAA has not  established a timeline for implementing its broader set of 50 proposed  technological enhancements, some of which may be less expensive than  others. A timeline to guide the implementation of the highest-priority  enhancements would help the agency take another step toward reducing  the delays and bottlenecks related to FAA’s technology limitations.
The online-application system and form that FAA uses to communicate  directly to applicants contain confusing questions and instructions that do  not meet FAA’s own plain language guidance. In addition, broken links  and other navigability issues make the website difficult to follow. Efforts to  provide applicants with useful and relevant information and improve the  clarity of the questions and instructions contained in the online application  system and form could allow FAA to more clearly communicate medical  requirements to applicants. These improvements could not only aid an  applicant’s understanding of the medical standards and requirements, but  also may result in more accurate and complete information provided by  applicants to better inform FAA’s certification decisions.
section_title: Recommendations for Executive Action
paragraphs: To improve the applicants’ understanding of the medical standards and  the information required to complete FAA’s medical certification process,  the Secretary of Transportation should direct the Administrator of FAA to  1.  develop a timeline for implementing the highest-priority technological  improvements to the internal-computer systems that support the  medical-certification process, and  2.  enhance the online medical-application system by clarifying  instructions and questions on the medical application form and  providing useful information to applicants.
section_title: Agency Comments
paragraphs: We provided the Department of Transportation with a draft of this report  for review and comment. DOT provided technical comments, which we  incorporated into the report as appropriate, and DOT agreed to consider  the recommendations.
We are sending copies of this report to the Department of Transportation,  the appropriate congressional committees, and other interested parties. In  addition, the report will be available at no charge on the GAO website at  http://www.gao.gov.
If you or your staff members have any questions about this report, please  contact me at (202) 512-2834 or dillinghamg@gao.gov. Contact points for  our Offices of Congressional Relations and Public Affairs may be found  on the last page of this report. Contact information and major contributors  to this report are listed in appendix V.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: The objectives of this report are to provide information on (1) FAA’s  medical standards and policies and certification processes, along with  medical experts’ views on them, and (2) steps that could be taken to  promote private pilot applicants’ understanding of FAA’s medical  requirements, including potential revisions to the medical application  form.
To meet these objectives, we reviewed pertinent statutes, regulations,  and FAA documents regarding its pilot medical certification process,  standards and application form. We also reviewed academic, trade and  industry articles, government reports, and other relevant literature. We  interviewed officials from FAA and the National Transportation Safety  Board (NTSB), and other stakeholders in the pilot medical certification  process, including officials representing government advocacy, medical  and legal issues within the Aircraft Owners and Pilots Association (AOPA)  and the Experimental Aircraft Association (EAA), the Aeromedical Advisor  to the Air Line Pilots Association (ALPA), attorneys who assist pilots  through the medical certification process, and representatives from the  American Diabetes Association. responses from the President and representatives from three member  airlines of the Regional Airline Association, the Executive Director of the  Aerospace Medical Association (AsMA), and the President and physician  members of the Civil Aviation Medical Association (CAMA). We also  visited the Civil Aerospace Medical Institute (CAMI) in Oklahoma City to  interview representatives of FAA’s Aerospace Medical Certification  Division (AMCD), and we attended a training seminar for Aviation Medical  Examiners (AME). To obtain expert opinions on FAA’s medical standards,  we collaborated with the National Academies’ Institute of Medicine to  identify aviation medical experts. We provided the Institute of Medicine  with criteria and considerations for identifying experts, including (1) type  and depth of experience, including recognition in the aerospace medicine  professional community and relevance of any published work, (2)  employment history and professional affiliations, including any potential  conflicts of interest, and (3) other relevant experts’ recommendations.
We also contacted the American College of Cardiology and the American Academy of  Neurology to solicit their views but they did not reply for an interview.
From the list of 24 experts identified by the National Academies, we  added 3 experts recommended to us and omitted 7 due to their  unavailability, their concern that they may not have the expertise to  respond to our questions, or their stated conflicts of interest. We ended  up with a total of 20 aviation medical experts who represented private,  public, and academic institutions. Fourteen of the experts are board  certified by at least one of the American Board of Medical Specialties  member boards, including 9 who are board certified in aerospace  medicine. Eight of the 20 medical experts we interviewed are AMEs for  the FAA, and 16 are pilots or have had pilot experience in the past. Two  experts are from aviation authorities in Australia and New Zealand, and a  third expert was from the United Kingdom.
Each expert verified that they had no conflicts of interest in participating in  our study. We conducted semi-structured interviews by telephone with the  experts in August and September 2013 to solicit their views on FAA’s  medical standards and qualification policies, the medical application form,  and FAA’s communication with AMEs and pilot applicants. We also asked  general questions about aviation medical policies, followed by specific  questions about private pilots, where applicable. We provided all medical  experts with relevant background information prior to our interview, and  we provided the option to bypass questions if they believed they were  unqualified to respond in a professional capacity. Prior to conducting the  interviews, we pretested the interview questions with three aviation  medical experts (two were AMEs and one was also a pilot). We  conducted pretests to make sure that the questions were clear and  unbiased and that they did not place an undue burden on respondents.  We made appropriate revisions to the content and format of the  questionnaire after the pretests.
Each of the 20 interviews was administered by one analyst and notes  were taken by another. Those interview summaries were then evaluated  to identify similar responses among the experts and to develop our  findings. The analysis was conducted in two steps. In the first step, two  analysts developed a code book to guide how they will analyze the expert  responses. In the second step, one analyst coded each transcript of  expert responses, and then a second analyst verified those codes. Any  coding discrepancies were resolved by both analysts agreeing on what  the codes should be. We examined responses to determine if there were  systematic differences in responses between experts who were and were  not pilots and between experts who were and were not AMEs. Because  we found no significant differences between the pilot and AME groups,  we reported the results for the experts as a whole rather than by the pilot  or AME subgroups.
We used indefinite quantifiers throughout the report—”few” (2-3 experts);  “some” (4-9 experts); “half” (10); “many” (11-15 experts); and, “most” (16- 19 experts)—to inform the reader of the approximate quantity of medical  experts that agreed with a particular statement. We only reported on  issues raised by at least two experts. We interviewed individuals with  broad aerospace-medicine expertise to provide their expert opinion on  FAA’s medical standards and qualification policies. While the experts  provided their opinions on some specific standards, we do not believe  that these opinions alone provide sufficient evidence to recommend any  specific changes to FAA medical standards and policies. Rather, the  information from these interviews provides us with an overall expert  assessment of FAA’s medical standards, policies, and practices. The  results of our interviews represent opinions among the experts we  interviewed but cannot be generalized to the larger population of aviation  medical experts. See table 2, below, for a list of medical experts we  interviewed.
In addition to asking medical experts and other stakeholders about their  view of FAA’s communication of its medical certification requirements, we  reviewed MedXPress.faa.gov (online application system) used by pilots to  obtain a medical certificate. We reviewed the Pilots Bill of Rights  Notification and Terms of Service Agreement, Form 8500-8 (medical  application form) and instructions, and links within the online application  system, evaluating that information against federal government website- usability guidelines and against FAA’s plain language guidelines. We  evaluated the online application system based on the following criteria (1)  content—whether the website contained relevant and appropriate  information users need—and (2) navigation—how easily users can find  and access information on the site and move from one webpage to  another, focusing on, for example, the clickable links within a website and  limited reliance on scrolling. In addition, we reviewed various other  website usability resources and criteria, including Usability.gov, to  understand the key practices for making websites easy to use and  helpful. We evaluated the medical application form and its instructions  based on criteria established by FAA’s Office of Communications,  including its Plain Language Tool Kit and its Writing Standards. These  criteria include (1) writing principles—for example, whether the document  is appropriate for its audience, its content is well organized, and it uses  active voice, clear pronouns, and short sentences and paragraphs—and,  (2) formatting principles—for example, whether the document layout and  use of headers and blank space conform with best practices to clearly  present information to the reader.
We conducted this performance audit from January 2013 through April  2014, in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
section_title: Appendix II: Summary of Selected FAA Medical Standards
subsections: section_title: Medical Certificate Pilot Type Frequency of medical requirement
paragraphs: Second-Class  Commercial Pilot  Every year,   regardless of age.
First-Class  Airline Transport Pilot  Every 6 months if   > 40 years old.  Every year if   < 40 years old.  20/20 or better in each eye separately, with or  without correction.
Third-Class  Private Pilot  Every 2 years if   > 40 years old.  Every 5 years if   < 40 years old.  20/40 or better in each eye  separately, with or without  correction.  20/40 or better in each eye separately (Snellen equivalent), with or without correction, as measured at 16  inches.   20/40 or better in each eye separately (Snellen equivalent), with or  without correction at age 50 and over, as measured at 32 inches.
No requirement.
Ability to perceive those colors necessary for safe performance of airman duties.
Demonstrate hearing of an average conversational voice in a quiet room, using both ears at 6 feet, with  the back turned to the examiner or pass one of the audiometric tests below.   Audiometric speech discrimination test: Score at least 70% reception in one ear.  Pure tone audiometric test. Unaided, with thresholds no worse than:   No ear disease or condition manifested by, or that may reasonably be expected to be maintained by,  vertigo or a disturbance of speech or equilibrium.
Not disqualifying per se. Used to determine cardiac system status and responsiveness.
No specified values stated in the standards. The current guideline maximum value is 155/95.
Not routinely required.
No diagnosis of psychosis, or bipolar disorder, or severe personality disorders.
A diagnosis or medical history of “substance dependence” is disqualifying unless there is established  clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total  abstinence from the substance(s) for not less than the preceding 2 years. A history of “substance abuse”  within the preceding 2 years is disqualifying. “Substance” includes alcohol and other drugs (i.e., PCP,  sedatives and hynoptics, anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and  other psychoactive drugs or chemicals).
Unless otherwise directed by the FAA, the Examiner must deny or defer if the applicant has a history of  (1) diabetes mellitus requiring hypoglycemic medication; (2) Angina pectoris; (3) Coronary heart disease  that has been treated or, if untreated, that has been symptomatic or clinically significant; (4) Myocardial  infarction; (5) Cardiac valve replacement; (6) Permanent cardiac pacemaker; (7) Heart replacement; (8)  Psychosis; (9) Bipolar disorder; (10) Personality disorder that is severe enough to have repeatedly  manifested itself by overt acts; (11) Substance dependence; (12) Substance abuse; (13) Epilepsy; (14)  Disturbance of consciousness and without satisfactory explanation of cause, and (15) Transient loss of  control of nervous system function(s) without satisfactory explanation of cause.
section_title: Appendix III: Selected FAA Training Programs for AMEs and Pilots in Aerospace Medicine and Communication Tools
paragraphs: AME Training Program/ Communication tool   Description  Clinical Aerospace Physiology Review for  Aviation Medical Examiners (CAPAME) course  Medical Certification Standards and Procedures  Training (MCSPT)
Prospective AMEs must complete these online courses as a prerequisite to  becoming an AME.
Prospective AMEs generally must attend this one-week seminar to be designated  as an AME.
Practicing AMEs must complete refresher training every three years to maintain  their designation as an AME. AMEs generally fulfill this requirement by either  attending an AME Refresher Seminar;  or,  completing the online MAMERC course in lieu of attending an AME theme seminar.  This course can be used as a substitute for a theme seminar on alternate 3-year  cycles, which extends the time between theme seminar attendance to six years.
In addition to the AME training and continued professional refresher courses, AMEs  generally maintain a proficiency requirement of at least 10 exams per year.
According to the Federal Air Surgeon, FAA policies go into effect when they are  updated in the Guide for Aviation Medical Examiners, available online.
Published quarterly for aviation medical examiners and others interested in aviation  safety and aviation medicine. The Bulletin is prepared by the FAA’s Civil Aerospace  Medical Institute, with policy guidance and support from the Office of Aerospace  Medicine.
Aerospace Medical Certification Subsystem  (AMCS)
E-mail notifications are sent to AMEs and their staff through AMCS. AMCS support  is available by phone, (405) 954-3238, or e-mail, 9-amc-aam-certification@faa.gov.
subsections: section_title: Pilot Training Program/ Communication tool FAA TV and Social Media
paragraphs: FAA TV, http://www.faa.gov/tv, is a central repository for FAA videos related to pilot  medical requirements, among other topics. For example, FAA has produced two  MedXPress videos: http://www.faa.gov/tv/?mediaId=554 or  http://www.faa.gov/tv/?mediaId=634  FAA also posts videos on its YouTube page  http://www.youtube.com/user/FAAnews/videos  FAA also uses Facebook and Twitter to communicate directly with pilots and others  who choose to follow FAA through social media.
Bimonthly publications promote aviation safety by discussing current technical,  regulatory, and procedural aspects affecting the safe operation and maintenance of  aircraft.
section_title: Pilot Training Program/ Communication tool
paragraphs: FAA pilot safety brochures provide essential information to pilots regarding potential  physiological challenges of the aviation environment so pilots may manage the  challenges to ensure flight safety. Brochure topics include: Alcohol and Flying,  Medications, Spatial Disorientation, Hearing and Noise, Hypoxia, Pilot Vision, Seat  Belts and Shoulder Harnesses, Sleep Apnea, Smoke, Sunglasses for Pilots, Deep  Vein Thrombosis and Travel, and Carbon Monoxide, among other topics.
MedXPress support is available for pilots by phone, (877) 287-6731, or e-mail, 9- natl-avs-it-servicedesk@faa.gov, 24 hours each day.
section_title: Appendix IV: FAA Form 8500-8 (Medical Application Form)
paragraphs: Appendix IV: FAA Form 8500-8  (Medical Application Form)
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, the following individuals also  made important contributions to this report: Susan Zimmerman, Assistant  Director; Colin Fallon; Geoffrey Hamilton; John Healey; Linda Kohn; Jill  Lacey; Maren McAvoy; and Sara Ann Moessbauer.