Revision of Airman Medical Standards and Certification Procedures and Duration of Medical Certificates

[[Page 11238]]

DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration

14 CFR Parts 61 and 67

[Docket No. 27940; Amendment Nos. 61-99 and 67-17]

RIN 2120-AA70

Revision of Airman Medical Standards and Certification Procedures

and Duration of Medical Certificates

AGENCY: Federal Aviation Administration (FAA), DOT.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: This rule revises airman medical standards and medical

certification procedures. The amendments implement a number of

recommendations resulting from a comprehensive review of the medical

standards announced in previous notices. This revision of the standards

for airman medical certification and associated administrative

procedures is necessary for aviation safety and reflects current

medical knowledge, practice, and terminology. Also, this rule revises

procedures for the special issuance of medical certificates

(``waivers'') for those airmen who are otherwise not entitled to a

medical certificate.

This rule also changes the duration of third-class airman medical

certificates, based on the age of the airman, for operations requiring

a private, recreational, or student pilot certificate.

Also, in this document, the FAA is announcing disposition of a

number of petitions for rulemaking related to medical standards and

duration of medical certificates.

EFFECTIVE DATE: September 16, 1996.

FOR FURTHER INFORMATION CONTACT: Dennis McEachen, Manager, Aeromedical

Standards and Substance Abuse Branch, 800 Independence Avenue, SW.,

Washington, DC 20591; telephone (202) 493-4075.

SUPPLEMENTARY INFORMATION:

Background

Current Requirements--Airman Medical Certification

Section 61.3(c) of Title 14 of the Code of Federal Regulations (14

CFR part 61) provides, with some exceptions, that no person may serve

as pilot in command or in any other capacity as a required pilot flight

crewmember unless that person has in his or her personal possession an

appropriate current airman medical certificate issued under 14 CFR part

67. Part 67 provides for the issuance of three classes of medical

certificates. A first-class medical certificate is required to exercise

the privileges of an airline transport pilot certificate. Second- and

third-class medical certificates are needed to exercise the privileges

of commercial and private pilot certificates, respectively.

A person who is found to meet the appropriate medical standards,

based on a medical examination and an evaluation of the applicant's

history and condition, is entitled to a medical certificate without

restrictions or limitations other than the prescribed limitation as to

its duration. These medical standards are currently set forth in

Secs. 67.13, 67.15, and 67.17.

Special Issuance of Airman Medical Certificates

An applicant for a medical certificate who is unable to meet the

standards in Secs. 67.13, 67.15, or 67.17, and be entitled to a medical

certificate, may nevertheless, be issued a medical certificate on a

discretionary basis. Procedures for granting special issuances or

exemptions have always been available, and, thus, failure to meet the

standards has never been absolutely disqualifying. Historically,

approximately 99 percent of all applicants ultimately receive a medical

certificate.

Under Sec. 67.19, Special issue of medical certificates, at the

discretion of the Federal Air Surgeon, acting on behalf of the

Administrator under Sec. 67.25, a special flight test, practical test,

or medical evaluation may be conducted to determine that,

notwithstanding the person's inability to meet the applicable medical

standard, airman duties can be performed, with appropriate limitations

or conditions, without endangering public safety. If this determination

can be made, a medical certificate may be issued with appropriate

safety limitations.

Duration of Airman Medical Certificates

Section 61.23 identifies the duration of validity and privileges of

each class of medical certificate. Currently, a first-class medical

certificate is valid for 6 months for operations requiring an airline

transport pilot certificate, 12 months for operations requiring a

commercial pilot certificate or an air traffic control tower operator

certificate (for non-FAA controllers), and 24 months for operations

requiring only a private, recreational, or student pilot certificate. A

second-class medical certificate is valid for 12 months for operations

requiring a commercial pilot certificate or an air traffic control

tower operator certificate (for non-FAA controllers) and for 24 months

for operations requiring only a private, recreational, or student pilot

certificate. A third-class medical certificate currently is valid for

24 months for operations requiring a private, recreational, or student

pilot certificate.

History

On October 21, 1994, the FAA published a notice of proposed

rulemaking (NPRM) (Notice No. 94-31, 59 FR 53226) proposing to amend

parts 61 and 67. The proposed revisions to part 67 were based on an

agency review of part 67 which was announced in the preamble to

Amendment 67-11 (47 FR 16298; April 15, 1982) and on recommendations

from a report prepared for the FAA by the American Medical Association

(AMA). In the preamble to Amendment 67-11, the FAA announced that it

intended to conduct an overall review of the medical standards in part

67. A complete review of the regulations was needed to bring the

standards and procedures for airman medical certification up to date

with advances in medical knowledge, practice, and terminology.

Amendment 67-11 was considered interim clarification until a

comprehensive review of the medical standards contained in part 67

could be concluded.

The FAA began the review of the medical standards for airmen and of

its certification practices and procedures by requesting public comment

(47 FR 30795; July 15, 1982). In addition, the FAA initiated a contract

with the AMA to provide professional and technical information. The AMA

presented its report, ``Review of Part 67 of the Federal Air

Regulations and the Medical Certification of Civilian Airmen'' (AMA

Report), on March 26, 1986. The public was again invited to comment on

part 67 in ``Announcement of the Availability of a Report'' (51 FR

19040; May 23, 1986). The AMA Report detailed the results of a

comprehensive review of the standards for airman medical certification

and of their application. The AMA Report considered pertinent advances

in the field of medicine since 1959, recommended changes in the FAA

medical standards, and explained the rationale for such changes. The

FAA considered public comments received on the AMA Report in developing

Notice No. 94-31.

In a separate but related issue, on May 11, 1979, the Aircraft

Owners and Pilots Association (AOPA) petitioned to amend Sec. 61.23 to

require medical examinations for private pilots at 36-month intervals

rather than at 24-month

[[Page 11239]]

intervals. In response to the 1979 AOPA petition to amend Sec. 61.23,

the FAA issued on October 29, 1982, NPRM No. 82-15 (47 FR 54414,

December 2, 1982) proposing to amend part 61 to revise the duration of

validity of third-class privileges of airman medical certificates for

operations requiring a private or student pilot certificate. As

proposed by Notice No. 82-15, the requirement for a third-class medical

examination would have been changed to every 5 years for the youngest

pilots then increasing in frequency to the existing 2-year interval for

older pilots.

On September 27, 1985, prior to the issuance of the AMA Report on

its review of the airman medical standards and certification procedures

in part 67, the notice proposing to amend part 61 to revise the

duration of third-class airman medical certificates was withdrawn (50

FR 39619). The proposal was withdrawn, in part, because of issues

raised by the medical community. Given the then pending issuance of the

AMA Report and the possibility that the report would provide better

data on which to base an evaluation of the safety concerns raised by

the medical community, the FAA decided that any future consideration of

examination frequency would be within the context of the outcome of the

comprehensive review of part 67.

Petitions for Rulemaking

The FAA has received a number of other petitions for rulemaking

that relate to airman medical certification and duration. These

petitions are disposed of in this rulemaking. For each of these

petitions a public docket was established, a notice of the petition was

published in the Federal Register, and comments, if any, received on

the petition were placed in the docket for public inspection.

On July 30, 1981, the Civil Pilots for Regulatory Reform petitioned

the FAA to revise the rules so that pilots who have incurred a

myocardial infarction will not be automatically disqualified for life

for airman medical certification. (Docket No. 22054) This petition was

discussed in the preamble to the NPRM (59 FR 53243). Also, see the

discussion in this preamble under ``Cardiovascular Secs. 67.111,

67.211, and 67.311'' and the corresponding rule language. Comments

received on the petition totaled 311; all of which generally supported

the petition. After careful consideration of all the comments, both

from this petition and the current rulemaking action (Docket No.

27940), the FAA has determined that a diagnosis or medical history of

myocardial infarction will continue to be disqualifying under part 67.

On February 26, 1986, AOPA again petitioned the FAA to revise the

duration of a third-class airman medical certificate to 36 calendar

months for noncommercial operations requiring a private, recreational,

or student pilot certificate. (Docket No. 24932) See preamble

discussion under ``Discussion of Comments and Amendments to Part 61''

(Sec. 61.23) and the corresponding rule language. Comments received on

this petition totaled two; both supported the petition. After careful

consideration of all comments, both from this petition and the current

rulemaking action (Docket No. 27940), the FAA has decided to deny this

AOPA petition and adopt the proposal (Docket No. 27940) with the

modifications discussed under ``Discussion of Comments and Amendments

to Part 61.''

On January 20, 1989, a petition was submitted to the FAA by Thomas

J. Rush to provide a longer timeframe (60 or 90 days) for airmen to

schedule medical examinations when they renew their special issuances

of medical certificates. (Docket No. 25787) See the discussion in the

preamble under ``Special Issuance Sec. 67.401;'' ``Discussion of

Comments and Amendments to Part 61;'' and the corresponding rule

language. The Federal Register notice of this petition received no

comment. After careful consideration of the issues of this petition and

of comments to the current rulemaking action (Docket No. 27940), the

FAA has determined that the rule as it relates to this issue should

remain unchanged.

On February 12, 1990, AOPA petitioned the FAA to revise certain eye

and cardiovascular standards to facilitate medical certificate issuance

and better relate those standards to current medical knowledge and

technology. Changes sought included the following: (1) Change the color

vision standard for first-class medical certificates to the standard

used for second-class medical certificates; and delete the color vision

standard for third-class medical certificates; (2) Delete the

uncorrected visual acuity standards; (3) Change the pathology of the

eye standard for second-class medical certificates to the standard used

for first-class medical certificates; and (4) For second- and third-

class medical certificates, relate cardiovascular conditions to their

impact on the applicant's ability to operate safely. (Docket No. 26156)

See the discussion in the preamble under the major heading ``Vision

Secs. 67.103, 67.203, and 67.303'' (``Color Vision Secs. 67.103(c),

67.203(c), and 67.303(c)''; ``Distant Visual Acuity''; ``Near Visual

Acuity Standard''; and ``Intermediate Visual Acuity Standard''); and

``Cardiovascular Secs. 67.111, 67.211, and 67.311''. Also see the

corresponding rule language for these sections. Comments received on

the petition totaled 80; 79 generally support the petition and 1 from

the Air Line Pilots Association (now known as the Air Line Pilots

Association International) (ALPA) opposed the petition. ALPA opposed

the petition because they considered it premature in light of FAA's

active rulemaking project to revise all of part 67. After careful

consideration of all comments, both from this petition and the current

rulemaking action (Docket No. 27940), the FAA has decided to adopt the

vision and cardiovascular proposals of the current rulemaking action

(Docket No. 27940) with the modifications discussed under ``Discussion

of Comments and Final Rule for Part 67.''

On June 25, 1990, AOPA petitioned the FAA to amend frequently

waived medical standards as follows: (1) Add a provision for continued

limited pilot privileges pending FAA action on an application for

renewal of a medical certificate; (2) Permit applicants for all classes

of medical certificates to meet revised hearing standards in either or

both ears with or without a corrective device; (3) Change the 2-year

period of abstinence from alcohol to a period ``reasonable to ensure

abstinence''; and (4) Permit issuance of second- and third-class

medical certificates to diabetics using hypoglycemic drugs other than

insulin (with Federal Air Surgeon concurrence). (Docket No. 26281) See

the discussion in the preamble under ``Discussion of Comments and

Amendments to Part 61'' (Sec. 61.23); ``Hearing Secs. 67.105(a),

67.205(a), and 67.305(a)''; under the major heading ``Mental Standards

Secs. 67.107, 67.207, and 67.307'' (``Substance Dependence and

Definitions'' and ``Substance Abuse''); and ``Diabetes Secs. 67.113(a),

67.213(a), and 67.313(a)''. Also see the corresponding rule language

for these sections. Comments received on the petition totaled 29; 28

generally supported the petition, and one from ALPA opposed the

petition. ALPA opposed the AOPA petition for the same reason it opposed

the February 1990 AOPA petition; ALPA considered it premature in light

of FAA's active rulemaking project to revise all of part 67. After

careful consideration of all comments, both from this petition and the

current rulemaking action (Docket No. 27940), the FAA has decided to

adopt the duration, hearing, mental, and

[[Page 11240]]

general medical proposals with the modifications discussed under

``Discussion of Comments and Amendments to Part 61'' and ``Discussion

of Comments and Final Rule for Part 67.''

On August 27, 1990, a petition was submitted to the FAA by Frank

Goeddeke, Jr., to allow individuals with alcoholism problems to obtain

a medical certificate after abstaining from alcohol for 90 days, rather

than the 2-year time period stipulated in the rules. (Docket No. 26330)

See the discussion in the preamble under the major heading ``Mental

Standards Secs. 67.107, 67.207, and 67.307'' (``Substance Dependence

and Definitions'' and ``Substance Abuse''). Also see the corresponding

rule language for these sections. Comments received on the petition

totaled three; all three supported the petition. After careful

consideration of all comments, both from this petition and the current

rulemaking action (Docket No. 27940), the FAA has decided to retain the

2-year abstinence requirement related to alcoholism.

In February 1991, the American Diabetes Association petitioned the

FAA to amend the special issuance provisions of part 67 or,

alternatively, amend the FAA special issuance policy to permit grants

of special issuance of medical certificates to persons with insulin-

treated diabetes mellitus (ITDM) and permit grants of special issuance

of medical certificates on a case-by-case basis. The ADA also requested

the creation of an FAA-appointed medical task force to develop a

medical protocol to permit meaningful case-by-case review. (Docket No.

26493) The FAA referred to this petition in a request for comments on a

proposed policy change concerning individuals with diabetes mellitus

who require insulin that was published in the Federal Register on

December 29, 1994. (See 59 FR 67246) See also the discussion in this

preamble under ``Diabetes Secs. 67.113(a), 67.213(a), and 67.313(a)''

and the corresponding rule language. Comments received on the petition

totaled 160; there was general support for the rulemaking part of the

petition. Most commenters, however, strongly support special issuance

of medical certificates for persons with ITDM. After careful

consideration of all comments, both from this petition and the current

rulemaking action (Docket No. 27940), the FAA is denying that part of

the ADA petition that requested rulemaking; i.e., an amendment to

Sec. 67.19. The FAA will respond to the ADA request for a policy change

and to the comments received to both dockets when it publishes in a

separate notice its disposition of the December 29, 1994, notice on

that subject (Docket No. 26493).

On September 24, 1993, AOPA once again petitioned the FAA to revise

the duration of a third-class airman medical certificate to 48 calendar

months for a specific trial period for noncommercial operations

requiring a private or student pilot certificate. Docket No. 27473) See

the preamble discussion under ``Discussion of Comments and Amendments

to Part 61'' (Sec. 61.23) and the corresponding rule language. Comments

received on the petition totaled 140; 137 generally supported the

petition and 3 opposed it. After careful consideration of all comments,

both from this petition and the current rulemaking action (Docket No.

27940), the FAA has decided to deny this AOPA petition and adopt the

current rulemaking action's duration proposal (Docket No. 27940) with

the modifications discussed under ``Discussion of Comments and

Amendments to Part 61.''

The FAA considered each of these petitions for rulemaking and the

public comments on the petitions in preparing the NPRM and this final

rule. The FAA believes that the actions requested in the petitions are

addressed and resolved in this rulemaking action. Therefore, action in

each of the referenced petitions is considered completed by publication

of this final rule.

The FAA is also addressing two other petitions for rulemaking

relating to part 67. On August 14, 1991, a petition was submitted to

the FAA by Charles Webber and on June 20, 1992, a petition was

submitted to the FAA by Robert H. Monson. Both of these petitioners

request that the FAA eliminate Sec. 67.3 in its entirety. The

petitioners state that this rule allows the FAA to obtain a copy of an

applicant's automobile driving record before an airman medical

certificate can be issued and that this violates individual privacy

rights (under the Privacy Act, 5 United States Code (U.S.C.) 552a).

(Docket No. 26782 and Docket No. 26913) Section 67.3 was added to part

67 in 1990 after the National Driver Register (NDR) Act of 1982 was

amended to specifically authorize the FAA to receive information from

the NDR regarding motor vehicle actions that pertain to any individual

who has applied for an airman medical certificate. In the NPRM and in

this final rule Sec. 67.3 has been recodified as Sec. 67.7. The

substance of this section was not discussed in the NPRM for this

rulemaking because the background, issues, and public comments had been

thoroughly covered in the final rule for Sec. 67.3 (August 1, 1990; 55

FR 31300). Since Sec. 67.3 went into effect, the FAA has found access

to the NDR useful in making medical certification determinations.

Comments received to the Webber petition totaled 24; all generally

supported the petition. The Monson petition received no comment. After

careful consideration of both petitions and all the comments, both from

the petitions and the current rulemaking action (Docket No. 27940), the

FAA has determined it will take no further action on the referenced

petitions after publication of this final rule.

In accordance with the above discussion and after consideration of

comments received on the NPRM, the FAA is revising part 67 and

Secs. 61.23 and 61.39 of part 61.

Summary of Amendments to Part 67

The following is a summary of the substantive revisions made by

this rulemaking. Because this rulemaking completely recodifies part 67,

this summary states both the current and new section/paragraph numbers.

1. Distant visual acuity requirements for first- and second-class

medical certification are changed to delete the uncorrected acuity

standards. However, each eye must be corrected to 20/20 or better, as

in the current standard. [Current Secs. 67.13(b) and 67.15(b); Final

Secs. 67.103(a) and 67.203(a)]

2. For third-class medical certification, the current 20/50,

uncorrected, or 20/30, corrected, distant visual acuity standard is

changed to 20/40 or better, in each eye, with or without correction.

[Current Sec. 67.17(b); Final Sec. 67.303(a)]

3. For first- and second-class medical certification, minimum near

visual acuity requirements are specified in terms of Snellen equivalent

(20/40), corrected or uncorrected, each eye, at 16 inches. This

replaces the current standard of v=1.00 at 18 inches for first-class

only. An intermediate visual acuity standard (near vision at 32 inches)

of 20/40 or better at 32 inches Snellen equivalent, corrected or

uncorrected, is added to the first- and second-class visual

requirements for persons over age 50. [Current Secs. 67.13(b) and

67.15(b); Final Secs. 67.103(b), 67.203(b), and 67.303(b)]

4. A near visual acuity standard of 20/40 or better, Snellen

equivalent (20/40), corrected or uncorrected, each eye, at 16 inches is

added to the third-class visual requirements. [Current (None); Final

Sec. 67.303(b)]

5. Color vision requirements are amended to read: ``ability to

perceive those colors necessary for safe performance of airman

duties,'' and are the same for all classes. Current

[[Page 11241]]

standards require ``normal color vision'' for first-class and the

ability to distinguish aviation signal colors for second- and third-

class applicants. [Current Secs. 67.13(b), 67.15(b), and 67.17(b);

Final Secs. 67.103(c), 67.203(c), and 67.303(c)]

6. The current first-class standard pertaining to pathological

conditions of the eye or adnexa that interfere or that may reasonably

be expected to interfere with proper function of an eye is substituted

in both the second- and third-class standards for the current standards

which specify, respectively, ``no pathology of the eye'' and ``no

serious pathology of the eye.'' [Current Secs. 67.15(b) and 67.17(b);

Final Secs. 67.203(e) and 67.303(d)]

7. The ``whispered voice test'' for hearing is replaced for all

classes by a conversational voice test using both ears at 6 feet; an

audiometric word (speech) discrimination test to a score of at least 70

percent obtained in one ear or in a sound field environment; or pure

tone audiometry according to a table of acceptable thresholds (American

National Standards Institute (ANSI), 1969). [Current Secs. 67.13(c),

67.15(c), and 67.17(c); Final Secs. 67.105(a), 67.205(a), and

67.305(a)]

8. The standards pertaining to the ear, nose, mouth, pharynx, and

larynx are revised to more general terms and related to flying and

speech communication. Specific references to the mastoid and eardrum

are deleted. The current standard, ``No disturbance in equilibrium,''

is changed to, ``No ear disease or condition manifested by, or that may

reasonably be expected to be manifested by, vertigo or a disturbance of

equilibrium.'' The amended standards are the same for all classes.

[Current Secs. 67.13(c), 67.15(c), and 67.17(c); Final Secs. 67.105(b),

67.205(b), and 67.305(b)]

9. ``Psychosis,'' as used in the final rule, refers to a mental

disorder in which the individual has delusions, hallucinations, grossly

bizarre or disorganized behavior, or other commonly accepted symptoms

of this condition, or may reasonably be expected to manifest such

symptoms. [Current Secs. 67.13(d), 67.15(d), and 67.17(d); Final

Secs. 67.107(a), 67.207(a), and 67.307(a)]

10. Substance dependence and substance abuse are defined and

specified as disqualifying medical conditions. Substance dependence is

disqualifying unless there is clinical evidence, satisfactory to the

Federal Air Surgeon, of recovery, including sustained total abstinence

from the substance for not less than the preceding 2 years. Substance

abuse is disqualifying if use of a substance was physically hazardous

and if there has been at any other time an instance of the use of a

substance also in a situation in which that use was physically

hazardous; or if a person has received a verified positive drug test

result under an anti-drug program of the Department of Transportation

or one of its administrations within the preceding 2 years. Alcohol

dependence and alcohol abuse are included in the terms ``substance

dependence'' and ``substance abuse'', respectively. [Current

Secs. 67.13(d), 67.15(d), and 67.17(d); Final Secs. 67.107(a) and (b),

67.207(a) and (b), and 67.307(a) and (b)]

11. ``Bipolar disorder'' is added as a specifically disqualifying

condition. This addresses an issue created by a change in nomenclature

contained in the Diagnostic and Statistical Manual of Mental Disorders,

Third Edition (DSM III), and continued in the DSM IV. [Current (None);

Final Secs. 67.107(a), 67.207(a), and 67.307(a)]

12. The general mental standard is amended to add the word

``other'' before ``mental.'' The final revised standard reads, ``No

other personality disorder, neurosis, or other mental condition * *

*.'' [Current Secs. 67.13(d), 67.15(d), and 67.17(d); Final

Secs. 67.107(c), 67.207(c), and 67.307(c)]

13. ``A transient loss of control of nervous system function(s)

without satisfactory medical explanation of the cause,'' is added as a

specifically disqualifying neurologic condition. [Current (None); Final

Secs. 67.109(a), 67.209(a), and 67.309(a)]

14. The word ``seizure,'' is substituted for ``convulsive.''

[Current Secs. 67.13(d), 67.15(d), and 67.17(d); Final Secs. 67.109(b),

67.209(b), and 67.309(b)]

15. ``Cardiac valve replacement,'' ``permanent cardiac pacemaker

implantation,'' and ``heart replacement'' are added as specifically

disqualifying cardiovascular conditions for all classes of

certification. [Current Secs. 67.13(e), 67.15(e), and 67.17(e); Final

Secs. 67.111(a); 67.211 (d), (e), and (f); and 67.311 (d), (e), and

(f)]

16. The time period for which an electrocardiogram may be used to

satisfy the requirements of the first-class medical certificate is

revised to 60 days from the current 90 days. [Current Sec. 67.13(e);

Final Secs. 67.111(c)]

17. The current table of age-related maximum blood pressure

readings for applicants for first-class medical certificates and the

reference to ``circulatory efficiency'' are deleted. Blood pressure

will continue to be assessed for all three classes but will be

evaluated under the appropriate general medical standards. [Current

Sec. 67.13(e); Final Secs. 67.113(b), 67.213(b), and 67.313(b)]

18. Current Sec. 67.19, Special issue of medical certificates, is

rewritten [Final Sec. 67.401(a)] to provide for, at the discretion of

the Federal Air Surgeon, an ``Authorization for a Special Issuance of

Medical Certificate'' (Authorization), valid for a specified period of

time. An individual who does not meet the published standards of part

67 may be issued a medical certificate of the appropriate class if he

or she possesses a valid Authorization. The duration of any medical

certificate issued in accordance with proposed Sec. 67.401 is for the

period specified at the time of its issuance or until withdrawal of an

Authorization upon which the certificate is based. A new Authorization

is required after expiration, and the applicant must again apply for a

special issuance of a medical certificate.

19. Final Sec. 67.401(b) provides for a Statement of Demonstrated

Ability (SODA) instead of an Authorization. A SODA will be issued with

no expiration date to applicants whose disqualifying conditions are

static or nonprogressive and who have been found capable of performing

airman duties without endangering public safety. A SODA authorizes an

aviation medical examiner to issue a medical certificate if the

applicant is otherwise eligible.

20. Final Sec. 67.401(e) retains the language of current

Sec. 67.19(c) regarding consideration of the freedom of a private pilot

to accept reasonable risks to his or her own person or property that

are not acceptable in the exercise of commercial or airline transport

pilot privileges, and consideration at the same time of the need to

protect the safety of persons and property in other aircraft and on the

ground.

21. Final Sec. 67.401(f) adds language that explicitly provides

that the Federal Air Surgeon may withdraw the Authorization or SODA. An

Authorization or SODA may be withdrawn at any time for (1) adverse

change in medical condition, (2) failure to comply with its provisions,

(3) potential endangerment of public safety, (4) failure to provide

medical information, or (5) the making or causing to be made of a

statement that is covered by Sec. 67.403.

22. Final Sec. 67.401(i) permits a person to request that the

Federal Air Surgeon review a decision to withdraw an Authorization or

SODA. The request for a review must be made within 60 days of the

service of the letter that withdrew the Authorization or SODA. The

review procedures will be on an expedited basis and will provide the

affected

[[Page 11242]]

holder of an Authorization or SODA a full opportunity to respond to a

withdrawal by submitting supporting appropriate evidence.

23. Final Sec. 67.403 differs from current Sec. 67.20 by providing

for denial of an airman medical certificate if the application for an

airman medical certificate is falsified. Though this consequence is

implied, the current regulation specifically provides only for

revocation or suspension of certificates. Additionally, Sec. 67.403

provides for denial or withdrawal of any Authorization or SODA if the

information provided to obtain it is false, whether the statement was

knowingly false or unknowingly incorrect. Finally, Sec. 67.403(c) makes

an unknowingly incorrect statement that the FAA relied upon in making

its decisions regarding an application for an airman medical

certificate or a request for an Authorization or SODA, a basis for

denial, revocation, or suspension of an airman medical certificate and

the denial or withdrawal of an Authorization or SODA.

24. A new Sec. 67.415 provides that the holder of any medical

certificate that is suspended or revoked shall, upon the

Administrator's request, return it to the Administrator. The FAA

practice always has been to request return of the certificate in such

circumstances to avoid any misunderstanding as to the validity of the

certificate.

25. Where appropriate, changes are made to eliminate gender-

specific pronouns, to replace ``applicant'' with ``person,'' to use

current position titles and addresses, to correct spelling and improve

syntax, and to adjust section and paragraph references.

General Discussion of Public Comments

In response to the NPRM, the FAA received over 5,200 written

comments from the public. In addition, in January of 1995, the FAA held

three public meetings on the proposal, at which approximately 50

individuals and organizations participated. One was held in Washington,

D.C., one in Orlando, Florida, and one in Seattle, Washington.

Information from both the written comments to the docket and the

presentations at these public meetings was considered in the final rule

decisions along with the petitions for rulemaking and the comments

received to those dockets discussed above.

Commenters include approximately 30 trade associations, over 20 FAA

aviation medical examiners (AME's), and over 5,100 members of the

general public. Air transport pilots and other commercial pilots,

private and recreational pilots, flight schools, and flight instructors

were among the public commenters.

A substantial number of commenters oppose the proposed changes on

the basis that these changes would be a financial burden, that there is

a lack of accident data to support stricter standards, and that the

stricter standards would not produce discernible safety benefits. There

was little or no opposition, however, to proposed changes that relaxed

standards or reduced the regulatory burden.

The FAA carefully considered each comment and all presentations

made at the public meetings in determining this final rule. Comments

that address specific proposed requirements relevant to the proposed

rule are summarized and responded to in the following sections of this

preamble. To the extent possible, all comments relevant to the adopted

standards and regulatory changes are addressed; issues not relevant to

this rulemaking raised in the written comments or at the public

meetings are not addressed in this document.

The FAA has determined that several of the proposed stricter

standards are not required at this time. The withdrawal of these

proposed stricter standards are fully discussed in the relevant

sections of this document.

Overall Justification and Authority for This Rulemaking

AOPA, which represents the interests of 330,000 pilots and aircraft

owners, states in its comment that there is not sufficient

justification to warrant this rulemaking since more than 98 percent of

all general aviation accidents do not involve medical factors. AOPA

also asserts that the FAA's statutory authority for regulating medical

standards does not justify the medical certification program currently

in place, especially with respect to persons who exercise only private

or recreational flying privileges. AOPA states that it is unable to

identify a grant of authority to the Administrator to deny a medical

certificate to a pilot based, not on the pilot's present physical

ability but on the finding that a condition may reasonably be expected

within 2 years after the finding to make the pilot unable to perform

the required duties. AOPA believes that the FAA should reconsider

whether the proposal goes beyond the intent of the Federal Aviation Act

of 1958 and beyond what is necessary to safety in air commerce.

In a related comment, the Independent Pilots Association (IPA)

states that ``nowhere is the FAA or the Federal Air Surgeon charged

with the duty to practice preventive medicine.''

FAA Response: The FAA has not gone beyond the intent of its

authority in this rulemaking action. As stated previously in this

notice, the purpose of this rulemaking is to update the medical

standards to reflect current medical knowledge, practice, and

terminology. The FAA is authorized under 49 U.S.C. 44703 to find that

an applicant for an airman certificate is physically able to perform

duties pertaining to the position for which the certificate is sought.

The FAA is to issue such a certificate ``containing such terms,

conditions, and limitations as to duration thereof, periodic or special

examinations, tests of physical fitness, and other matters'' necessary

to assure aviation safety.

It is reasonable that airmen, sharing the same air space and flying

over the same populated areas, whether engaged in air transportation or

in private operations, must meet certain standards in skills and

medical fitness to assure aviation safety. That some distinction in the

degree of standards is permissible is reflected in the distinction

between types of pilot certificates and classes of medical certificates

as required by law. While the FAA is not charged with the duty to

practice preventive medicine, determining the medical fitness of airmen

requires making an assessment of the risks involved in certain medical

conditions and denying medical certification in instances in which the

person is, or may be, unable to safely perform aviation activities.

On reconsideration of the proposal and after careful consideration

of all the comments and presentations received, the FAA is withdrawing

certain proposed requirements. Among the withdrawals are (1) the

proposal to shorten the duration of third-class medical certificates

for pilots 70 and older, (2) the requirement for a test to determine

total blood cholesterol, and (3) electrocardiogram requirements for

second-class medical certificates. A more complete discussion of the

withdrawal of the requirements occurs in the following sections of the

preamble.

One of the FAA's primary concerns is the need to ensure that its

regulations maintain the proper balance between cost and benefits. The

FAA will only issue a final rule when there is clear evidence that it

will enhance safety, and that it will do so at a reasonable cost. This

is a longstanding FAA commitment, and a requirement of DOT policies and

procedures. In this context, after review of the comments, the FAA is

not persuaded that there is yet adequate evidence to show that those

costs of the proposals are justified by

[[Page 11243]]

the safety benefits that can reasonably be expected.

However, the FAA will continue to monitor accident and health data

as part of our responsibility to help ensure that adequate safety is

maintained. Consistent with the principles of the Clinton

administration's National Performance Review, the FAA will, in the

coming months, explore alternative nonregulatory means to reduce

medically-related accidents. These alternative administrative actions

will not impose the same costs on airmen as the proposals contained in

the NPRM, but will assist pilots and aviation medical examiners in

identifying and reducing potential medical risks.

National Transportation Safety Board (NTSB) and Judicial Review

Several associations and individuals comment that this rulemaking

appears to be an effort by the FAA to change decisions by the NTSB and

the courts. Several individuals at the hearings held in conjunction

with this rulemaking also expressed this opinion.

FAA Response: The FAA agrees that in some cases these comments are

accurate. The FAA promulgates rules and policies when the FAA

determines that a substantial public safety interest requires such

action. In some circumstances, the NTSB or the courts have determined

that the rule language adopted by the FAA does not achieve the FAA's

intent. The FAA views the circumstances in which review authorities

have disagreed with the FAA's interpretation of its rules as a

reflection of regulatory defects and not a reflection of policy

defects. This rule corrects the regulatory defects by clarifying or

more accurately stating in the regulatory language those policies that

the FAA believes are necessary to protect substantial public safety

interests.

Discussion of Comments and Amendments to Part 61

Proposed Sec. 61.23 lengthens the current 2-year third-class

medical certification period to a 3-tier system: a 3-year period for

pilots under age 40, a 2-year period for those age 40 to 69, and annual

certification for pilots age 70 and over.

Comments: Most individual commenters expressed support for the

increased duration (from 2 years to 3 years) for third-class medical

certificates for pilots under age 40. Several AME's comment that it is

appropriate to differentiate for age, although opinions of AME's and

other commenters vary as to the age at which the frequency of

examinations should change. Commenters suggest duration periods for

third-class medical certificates ranging from 1 to 5 years.

Several associations, several AME's, and a majority of the

individuals who commented on this issue strongly oppose the proposal to

increase the frequency of medical examinations for pilots age 70 and

over for reasons including the following: the proposal may be illegal

under federal age discrimination laws; more frequent examinations will

not predict sudden incapacitation; the benefits have not been

demonstrated; accident rates are lower for older pilots; and the

statistical analysis the FAA used to confirm that incidence of

accidents increases with age is supported by an insufficient sample

size. The Experimental Aircraft Association (EAA), AOPA, and the

Colorado Pilots Association believe all airmen should have a 3-year

standard regardless of age because, until medical technology reaches a

point where the onset of a heart attack can be accurately predicted,

there is no justification for more frequent or different examinations

for pilots age 70 or over.

Some commenters say that the requirement will be particularly

burdensome to older pilots, many of whom are on a fixed income. One

commenter suggests that the FAA pay for annual examinations if they

will be required. Several commenters note that such examinations are

generally not covered by insurance.

FAA Response: The FAA has decided to lengthen the current 2-year

third-class medical certification period to a 2-tier system. For airmen

under age 40, medical certificates must be renewed every 3 years. For

airmen age 40 and over, the current 2-year duration will remain.

As stated in the NPRM, extending the length of time between

examinations for third-class medical certificates of persons under age

40 should result in no significant increase in undetected pathology

between required examinations. The FAA, after careful consideration of

all comments and testimony received as well as the petitions and

comments received to Docket Nos. 24932, 26281, and 27473, has

determined that extending the duration between medical examinations can

be done with no detriment to safety in the case of younger airmen who

are much less likely to suffer medical incapacitation. As with all age

groups, those individuals under age 40 manifesting conditions that

represent a risk to safety will be denied certification or, if they

apply for and receive a special issuance of a medical certificate, will

be restricted in their flying activities or examined more thoroughly

and frequently, or both.

The final rule will provide for maximum regulatory relief without a

decrement to public safety.

The proposal to shorten the duration of third-class medical

certificates of airmen over the age of 70 is being withdrawn because on

reexamination insufficient data exist to support the revision at this

time. Several aviation associations, AME's, and individuals commented

that the data used in the proposal did not support the conclusion that

decreased accidents would result if the duration of third-class medical

certificates for airmen over the age of 70 was shortened. The FAA has

determined that the possible reduction of a very few known general

aviation accidents that are medically-related cannot be justified when

compared with the cost of the proposal. This is in contrast to

accidents of airline transport and commercial carriers where a single

accident may have significant loss of life and property.

All third-class medical certificates or third-class privileges of a

first- or second-class medical certificate issued prior to the

effective date of this final rule will remain valid for 2 years from

the date of issuance of the certificate unless the validity period has

been otherwise limited by the FAA. The period of validity for all

third-class airman medical certificates or third-class privileges of a

first- or second-class medical certificate issued on or after the

effective date of this final rule will be calculated according to the

provisions of the final rule unless the validity period is otherwise

limited by the FAA.

Section 61.53 provides that: ``No person may act as pilot in

command, or in any other capacity as a required pilot flight crewmember

while he [or she] has a known medical deficiency, or increase of a

known medical deficiency, that would make him [or her] unable to meet

the requirements for his [or her] current medical certificate.'' This

amendment does not change Sec. 61.53, and the FAA continues to require

airmen to comply with that rule. In reducing the frequency of required

periodic contacts with knowledgeable health professionals, self-

monitoring and personal attention to health become a more important

part of the individual airman's responsibility for flight safety.

Consistent with the changes above, the final rule amends Sec. 61.39

to coincide with the duration change in Sec. 61.23. Section 61.39

requires that applicants must possess at least a third-class medical

certificate or the third-class privileges of a first- or second-class

medical certificate valid under Sec. 61.23

[[Page 11244]]

in order to be eligible for a flight test for a certificate, or an

aircraft or instrument rating.

Discussion of Comments and Final Rule for Part 67

The following discussion generally addresses comments received and

the FAA's response to those comments on the specific standards or

requirements in the rule. As noted above, over 5,200 comments were

received concerning this rulemaking. The comments addressed by the FAA

are broadly representative of these many thousands of comments. Other

matters and issues raised by the commenters, such as additional tests

and examinations that are performed under the special issuance

procedures, are not addressed in this document. The FAA is responding

only to comments that are within the scope of this rulemaking.

Lists of Medical Standards

General

``Include, but are not limited to.'' The proposal uses the word

``includes'' rather than the word ``are'' in each section of the

medical standards because the proposed medical standards are not, and

never have been, meant to be exhaustive in naming all medical

conditions that are disqualifying.

Comments: AOPA, EAA, National Air Transportation Association

(NATA), and most individual commenters say this provision gives FAA

absolute discretion without proper promulgation of regulations; the

language is too open-ended and provides no standard at all. AOPA states

that because the disqualifying conditions are not enumerated,

applicants cannot know if they have a deficiency for which the FAA

would disqualify them. One AME says that the proposal gives the FAA too

much leeway, and should read ``are limited to.'' A majority of the

individual commenters strongly oppose use of the term ``include, but

are not limited to,'' saying that it would allow FAA too much unchecked

authority over an applicant.

FAA Response: The final rule will not contain the proposed language

``include, but are not limited to.'' 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, would continue to be

disqualifying under general medical standards. The intent of the

proposal was to alert individuals of this long-standing FAA practice

and not to expand the scope of the regulations.

Vision (Sections 67.103, 67.203, 67.303)

Distant Visual Acuity. The proposal deletes the uncorrected vision

standard for first- and second-class medical certificates and requires

a distant visual acuity of 20/20 or better, in each eye, with or

without correction. For third-class medical certificates, a distant

visual acuity of 20/40 or better with or without correction, is

required for each eye.

Comments: Comments on the proposal for distant visual acuity were

in favor of the changes; one AME notes that the proposal is less

stringent than the present standards.

FAA Response: The final rule is the same as proposed in the NPRM.

As stated in the NPRM, the FAA practice for many years has been to

grant any class medical certificate requested, regardless of

uncorrected distant acuity, if the required minimum vision is present

or achieved through conventional corrective lenses, there is no

evidence of significant eye pathology, and the person is otherwise

eligible. Thousands of airmen have demonstrated their ability to safely

perform their jobs while using corrective lenses for distant visual

acuity that is poorer than 20/100 in each eye. The FAA, after careful

consideration of the comments and presentations received as well as the

petition and comments received to Docket No. 26156, has determined that

the requirements for distant visual acuity may be relaxed. The revision

will streamline the process of medical certification by not requiring

special issuance for persons who cannot meet an uncorrected distant

acuity standard.

Near visual acuity standard. The proposed rule replaces the

outdated standards for near visual acuity by requiring for all three

classes a near visual acuity of 20/40 or better, Snellen equivalent, at

16 inches in each eye separately, with or without corrective lenses.

Comments: United States Pilots Association (USPA) states that the

FAA presented no evidence to justify the addition of a near-vision

standard. Joint Aviation Authorities (JAA) also notes the lack of

accident-supported data, but states that the European opinion is that

the pilot should have enough visual capacity to read the aircraft

instruments if his or her glasses or lenses are lost in flight. The EAA

suggests changing 16 inches to ``ability to read an instrument panel,''

which would preserve the intent of the rule, but would not require any

additional equipment or training of AME's.

Three AME's approve and one disapproves of the proposed near visual

acuity standards. One AME doubts that a pilot with 20/40 vision can

read small print (such as on instrument approach plates) in dim light,

but notes that a nearsighted person can compensate by looking around

one's spectacle lenses. Farsighted persons with 20/40 vision, however,

may not be able to read small print at 16 inches. This commenter

suggests (1) supplying AME's with specimen aeronautical charts and

plates and requiring that the items be read in normal room light with

or without correcting lenses, or (2) raising the near vision standard

to at least 20/25.

FAA Response: The FAA agrees with the AMA Report recommendation

that all three classes of medical certificates should have the same

near visual acuity standards. The final rule is the same as proposed.

It eliminates the antiquated terminology in the current standards for

first-class medical certification, corrects the inconsistency between

standards and practice for second-class medical certification, and

establishes a standard for third-class medical certificates. After

careful consideration of all comments and presentations received as

well as the petition and comments received to Docket No. 26156, the FAA

has determined that the near visual acuity standard proposed in the

NPRM establishes an objective requirement that is necessary for safety

and can be best accomplished by the final rule.

Intermediate visual acuity standard. The NPRM proposed to add a new

intermediate visual acuity standard (near vision at 32 inches) for

first- and second-class medical certificates for pilots age 50 or older

of 20/40, Snellen equivalent, at 32 inches in each eye separately, with

or without corrective lenses.

Comments: The AMA states that all pilot applicants older than 50

should have 20/40 visual acuity at 32 inches because they need this

degree for proper sight and use of instruments, switches, and other

controls.

Regarding intermediate visual acuity, AOPA says that 20/40 at 32

inches over age 50 is unjustified, and that the age criteria is

arbitrary. One AME says there are no data or operational experience to

suggest that an additional middle vision standard for older pilots is

needed. According to one AME, the 32-inch intermediate vision standard

is too strict for pilots over 50 and will add to the cost without

adding any discernible benefit. According to this commenter, those who

need trifocals already have them.

FAA Response: The final rule includes a requirement for

intermediate

[[Page 11245]]

visual acuity for first- and second-class medical certificates for

pilots age 50 or older. This standard is consistent with the

International Civil Aviation Organization (ICAO) standards. The AMA

Report recommended this intermediate vision standard in light of the

eye's diminished ability with age to accommodate intermediate viewing

distances. Also, the NTSB has recommended that an intermediate vision

standard be established. The FAA, after careful consideration of the

comments received as well as the petition and comments received to

Docket No. 26156, has determined to adopt the rule proposed in the

NPRM; airline transport and commercial pilots need adequate

intermediate vision to monitor aircraft instruments and other cockpit

equipment. This standard is also necessary to safeguard the public

safety.

Color Vision (Sections 67.103(c), 67.203(c), 67.303(c))

The proposed color vision standard for all classes is the ``ability

to perceive those colors necessary for safe performance of airman

duties.'' Current standards require ``normal color vision'' for first-

class applicants and the ability to distinguish aviation signal colors

for second- and third-class applicants.

Comments: The USPA, NATA, and National Agricultural Aviation

Association (NAAA) support the proposed simplification of the color

vision standard.

One AME states that the current system is adequate to identify the

individual with a color vision problem and should be left intact. This

commenter states that the proposed NPRM advances no new or improved

method of determining color vision abilities.

AOPA and the AMA say that the regulations as proposed leave too

much room for inconsistent interpretation; the rule should precisely

state what colors are ``necessary for the safe performance of airman

duties'' and what tests should be done. An individual suggests using

visual flight rule (VFR) charts and runway and taxi light colors as

discriminants for realistic and practical color vision tests. EAA says

that the FAA should change the wording ``safe performance of airman

duties'' to ``read and understand a sectional aeronautical chart.'' EAA

believes this would ensure the intent of the rule, give the AME a

simple inexpensive test, and better define what is necessary for safe

performance of duties.

Aerospace Medical Association (ASMA) and Air Transport Association

(ATA) oppose the proposed changes. ASMA suggests that the FAA

discontinue the color blindness test; the standard should be based on

an individual's ability to perform safely.

FAA Response: The final rule for color vision is the same as

proposed. As stated in the NPRM, in current practice applicants for

certification are tested by use of standard pseudoisochromatic plates

or by other approved devices. A passing score defines the applicant as

not color deficient. Failure indicates a color deficiency and requires

that any medical certificate issued be limited, prohibiting flight at

night or by color signal control. The limitation can be removed by

successful completion of a practical signal light test or of a medical

flight test, as appropriate for the class medical certificate sought

and the level of aviation experience of the applicant. This final rule

would allow, for all three classes of medical certificates, an

individual who fails the test using pseudoisochromatic plates or other

approved devices to still obtain a medical certificate without

obtaining a waiver as long as the individual can demonstrate an ability

to perceive those colors necessary for the safe performance of airman

duties. The FAA will provide guidance to AME's to assist in these

tests.

The FAA, after careful consideration of the comments and

presentations received as well as the petition and comments received to

Docket No. 26156, has determined that the color vision standard in the

final rule should remain as proposed.

Hearing (Sections 67.105(a), 67.205(a), 67.305(a))

In the proposed rule, the ``whispered voice test'' for hearing is

deleted for all classes and replaced with three alternatives: (1) A

conversational voice test using both ears at 6 feet; (2) an audiometric

word (speech) discrimination test to a score of at least 70 percent

obtained in one ear or in a sound field environment; or (3) pure tone

audiometry according to a table of acceptable thresholds (ANSI, 1969).

Comments: Some AME's generally support the proposed hearing

standards. ASMA states, however, that the rule language could be

interpreted to require audiograms and that the FAA should state in the

preamble that it intends for the basic screening test to be the spoken-

voice test. ASMA also says that the rule should state that audiometric

tests are only used as alternatives for further evaluation of

individuals who show reduced hearing acuity.

Many commenters support the ``conversational voice'' recognition

standard as operationally relevant. AOPA and USPA support the proposed

standard that allows both ears to be used simultaneously to hear

conversational voice spoken at 6 feet.

ATA says a pure tone audiogram followed by a speech discrimination

test based upon an audiometric standard guideline would be a far more

accurate and objective measurement of hearing than the highly

subjective conversational and whispered voice tests.

-ATA says that a 70 percent score on an audiometric word

discrimination test is too low to support speech comprehension during

critical phases of flight; the standard should be 95 percent. Another

individual suggests that 85 percent would allow for accurate

communication in more cockpit environments. ATA and one AME also

believe that the rule is vague, should be more descriptive, and should

cite a decibel reading for administering the test.

- One AME says that possibly a screening cut-off level for pure-

tone audiometry would be appropriate.

-AOPA says that the same screening test should apply for those

without ``normal hearing'' and users of hearing aids. According to

AOPA, there appears to be no clinical reason for excluding the use of

hearing aids within the medical standards.

-Several commenters question whether an ``and'' or an ``or'' is

appropriate between subparagraphs (a)(1) and (a)(2) of Secs. 67.105,

67.205, and 67.305. Most think the rule should say ``or.''

-A commenter notes that the standard for 2000 Hz in the chart in

Sec. 67.205(c) is 30 for the poorer ear, which is more stringent than

the standard of 50 for first-class medical certificate. The commenter

believes that this must be a typographical error.

FAA Response: The final rule is the same as proposed, except that

the typographical error in the chart in Sec. 67.205(c) is corrected to

50 and the lead-in for paragraph (a) in all three sections reads: ``The

person shall demonstrate acceptable hearing by at least one of the

following tests:'' and a period is placed at the end of each

subparagraph. These editorial corrections to paragraph (a) are intended

to eliminate any confusion or ambiguity. Passing any one of the tests,

as required, is acceptable for certification. The FAA anticipates that

the conversational voice test will be the most commonly used; however,

passing any one of the tests will suffice even if the applicant has

failed the other two. While there is some subjectivity to a

conversational voice test, it is the simplest and least expensive form

of testing. The FAA, after careful consideration of the

[[Page 11246]]

comments and presentations received as well as the petition and

comments received to Docket No. 26281, has determined that the hearing

standards in the final rule should remain as proposed.

-The FAA is following the AMA Report recommendations in requiring a

70 percent score in an audiometric word discrimination test. The FAA

considers a 95 percent score too restrictive.

-As with current policy, if a hearing aid is necessary to meet the

standard, an Authorization or SODA is required. In most cases, however,

a person using a hearing aid can be issued a medical certificate.

Equilibrium (Sections 67.105(c), 67.205(c), 67.305(c))

-The proposal revises the current standard, ``No disturbance in

equilibrium,'' to, ``No ear disease or condition manifested by, or that

may reasonably be expected to be manifested by, vertigo or a

disturbance of equilibrium.'' The proposed standards are the same for

all classes.

Comments: One commenter states that the ear, nose, throat, and

equilibrium revisions are appropriate and realistic for addressing

safety.

-AOPA and other commenters say that the language relating to

vertigo or disturbance of equilibrium is too broad; instead the rule

should qualify that an applicant shall have ``no disturbance of

equilibrium that is severe enough to make piloting an aircraft

unsafe.'' AOPA asserts that vertigo is a common and normal occurrence

and disqualification should not be based on a symptom. According to

AOPA an episode of in-flight vertigo is not necessarily attributable to

an underlying medical condition that is disqualifying. AOPA notes that

the FAA intentionally induces vertigo at safety seminars using a

``vertigon'' chair.

FAA Response: The final rule is the same as proposed. The final

rule is more precise than the current rule since it specifies that the

vertigo or disturbance of equilibrium be a manifestation of a condition

or disease of the ear. It appears commenters are confusing pilot

vertigo or spatial disorientation that can occur in flight with vertigo

that is a manifestation of a medical condition or disease. In-flight

pilot vertigo or spatial disorientation is not related to this medical

standard. The FAA has determined, after careful consideration of the

comments and presentations received, that the equilibrium standards in

the final rule should remain as proposed.

Mental Standards (Sections 67.107, 67.207, 67.307)

-Definition of Psychosis. The proposed rule states that

``psychosis'' refers to ``a mental disorder in which the individual has

manifested psychotic symptoms or to a mental disorder in which the

individual may reasonably be expected to manifest psychotic symptoms.''

This language change was proposed to be consistent with the diagnostic

terminology and classification of mental disorders, published in the

DSM III and its successor DSM IV.

Comments: ATA suggests identifying the underlying disorders that

FAA considers psychoses, e.g., schizophrenia, paranoid states, or

depression. ATA suggests defining psychosis as ``an alteration in

either thought content or process, or both, to such an extent that the

individual suffers from hallucinations, delusions, or other

manifestations.'' One AME states that ``psychotic reaction'' needs

further definition in the rule. IPA suggests that the FAA refrain from

referring to a specific edition of the DSM since DSM-IV is the current

psychiatric diagnostic standard, not the 15-year old DSM-III referenced

in the NPRM. JAA says its Manual of Civil Aviation Medicine gives much

more detailed interpretation of its psychiatric and psychological

requirements.

FAA Response: On reconsideration and after careful consideration of

the comments received, the FAA has changed the final rule language

regarding psychosis to be more specific. Paragraph (a)(2) of

Secs. 67.107, 67.207, and 67.307 reads as follows:

``(2) A psychosis. As used in this section, `psychosis' refers to a

mental disorder in which:

-``(i) The individual has manifested delusions, hallucinations,

grossly bizarre or disorganized behavior or other commonly accepted

symptoms of this condition; or

-``(ii) The individual may reasonably be expected to manifest

delusions, hallucinations, grossly bizarre or disorganized behavior, or

other commonly accepted symptoms of this condition.''

-At the time of the AMA Report and the FAA review of part 67, the

most current DSM was DSM III. Since then, the DSM has been revised and

the most current version is DSM IV. The FAA has determined that the

revisions between DSM III and DSM IV do not necessitate any substantive

changes between the proposed rule and the final rule.

-Bipolar disorder. The proposed rule adds bipolar disorder

(formerly ``manic depressive psychosis'') as a specifically

disqualifying mental condition because the American Psychiatric

Association's nomenclature in DSM III and DSM IV no longer includes

bipolar disorder within the category of psychoses.

Comments: One AME and a few individuals support the proposal to

make bipolar disorders disqualifying.

AOPA believes bipolar disorder should not be singled out as a

disqualifying mental condition, and that applicants should be evaluated

on a case-by-case basis. AOPA asserts that bipolar disorders vary in

severity and symptoms from one individual to another; some never

exhibit the manic symptoms which appear to be the primary concern of

the FAA.

FAA Response: The FAA, after careful consideration of the comments

and presentations received, has determined that the final rule be the

same as proposed. However, since the proposed rule was issued, DSM IV

was developed which refers to more than one bipolar disorder and to

separate criteria that apply to the different types of bipolar

disorders. Although the DSM IV contains a change in classification of

this disorder, there is no change in the rule language from the

proposed rule language because the disorder, whatever its

classification, is considered disqualifying.

The FAA believes these conditions are of concern in the context of

airman medical certification and flight safety, and that the agency

must amend the mental standards since in accordance with the DSM III

and its successor DSM IV, psychoses no longer include bipolar

disorders. In consideration of potential risk to flight safety,

individuals with this diagnosis are rarely granted certification. Those

few individuals who are determined to be eligible for certification

through the special issuance provisions must be followed closely for

relapse and recurrence of symptoms. By including the new terminology,

the standards will clearly reflect the agency's concern about this

disorder. Specifically listing bipolar disorders as disqualifying is

not a substantive change in FAA policy or practice.

-Substance Dependence and Definitions. The proposal updates the

standards for alcoholism and drug dependence to make them consistent

with DSM III (and subsequently DSM IV) nomenclature which eliminates

the term ``alcoholism'' and substitutes the diagnoses of ``substance

dependence'' and ``substance abuse.'' The proposed revision defines

``substance dependence,'' ``substance abuse,'' and ``substance.'' The

proposed revision identifies disqualifying substances or

[[Page 11247]]

groups of substances (e.g., alcohol, cocaine, opioids, hallucinogens,

cannabis, etc.) and would make dependence on or abuse of them

disqualifying. The proposal also makes substance dependence

disqualifying unless there is clinical evidence of recovery, including

sustained total abstinence for not less than the preceding 2 years in

the case of alcohol dependence, and the preceding 5 years in the case

of other substance dependence.

Comments: Two AME's generally support the proposed changes

regarding substance dependence. AOPA, National Air Traffic Controllers

Association (NATCA), EAA, and two other AME's suggest a minimum 2-year

abstinence for all substances because they believe the extended period

of decertification for substance dependency is without statistical

justification. According to these commenters, the AMA data on which the

5-year restriction is based are dated; there are many new treatments

and research that indicate a required 5-year abstinence is too strict;

and the 5-year rule may reflect some public hysteria concerning drug

use. In addition, according to these commenters, there are six times as

many alcohol-related accidents as drug-related accidents, bringing into

question why the FAA is proposing stricter standards on other

substances when alcohol is a greater problem.

Two AME's say the FAA should not broaden the substances and should

leave the regulation as is. Another AME says FAA needs to further

define ``substance'' by identifying particular drugs.

EAA says that the FAA should limit the disqualification for muscle

relaxants to users of ``muscle relaxants with habit-forming potential''

because many muscle relaxants have no habit-forming potential.

FAA Response: The FAA, after careful consideration of the comments

and presentations received as well as the petitions and comments

received to Docket Nos. 26281 and 26330, has decided to make the

minimum period of abstinence from alcohol and other substances 2 years

because longer term experience with recovery from dependence on drugs

or alcohol now suggest that 2 years is adequate for both alcohol and

drugs. In many cases, the FAA has granted special issuance to air

transport and commercial pilots and has waived the 2-year abstinence

period when it was satisfied that certain stringent criteria are met.

The criteria can be summarized as follows: (1) A full commitment and

partnership of the aviation employer and employee to ensure the

employee's continued sobriety through monitoring; (2) full commitment

and partnership of the recovering employee with a fellow employee to

ensure continued sobriety through monitoring; and (3) frequent

evaluations, testing, and attendance at professional aftercare

treatment.

Also, the FAA has decided to delete ``muscle relaxants'' from the

list of substances in Secs. 67.107(a)(4)(i), 67.207(a)(4)(i), and

67.307(a)(4)(i) in part because the FAA agrees with the EAA comment,

but also because muscle relaxants are not included as a substance in

DSM III and its successor DSM IV.

To conform with DSM IV terminology, the FAA has changed the

reference to ``volatile solvents and gases'' to ``inhalants,'' a term

the FAA considers to be equivalent.

Otherwise the final rule is the same as proposed. The standards are

consistent with the AMA Report and address the national concerns about

substance dependence.

-Substance abuse. As proposed, substance abuse is one of the

following:

(1) Use of alcohol within the preceding 2 years in a situation in

which that use is physically hazardous, if there has been at any other

time an instance of the use of alcohol or another substance also in a

situation in which that use was physically hazardous; or

(2) Use of a substance other than alcohol within the preceding 5

years in a situation in which that use is physically hazardous, if

there has been at any other time an instance of the use of that

substance, alcohol, or another substance also in a situation in which

that use was physically hazardous; -

(3) Use of a prohibited drug defined in appendix I of part 121 of

this chapter within the preceding 5 years; or -

(4) Misuse of a substance within the preceding 2 years if alcohol

or within the preceding 5 years if another substance, that the Federal

Air Surgeon based on case history and appropriate qualified medical

judgment, finds-- -

(i) Makes the person unable to safely perform the duties or

exercise the privileges of the airman certificate applied for or held

or -

(ii) May reasonably be expected, for the maximum duration of the

airman medical certificate applied for or held, to make the person

unable to perform those duties or exercise those privileges.

Comments: Two AME's and other commenters generally support the

proposed changes to the substance abuse standard. -

The JAA states that the proposed recommendations are similar to

those in the JAA proposals except that a shorter recertification period

following alcohol abuse is allowed and the JAA Manual of Civil Aviation

Medicine gives much more detailed interpretation of the psychiatric and

psychological requirements. -

EAA says the broad FAA list of ``substances,'' combined with the

definition of ``abuse'' and the extremely vague issue of ``physical

hazard'' makes it conceivable that abuse could be held as a single

misapplication of prescription medication (e.g., amphetamines,

tranquilizers, sedatives, and muscle relaxants).

FAA Response: The FAA has decided to make the time periods related

to substance abuse of alcohol or other substances 2 years to be

consistent with substance dependence abstinence time requirements of

this section and for the reasons already given. Otherwise the final

rule is the same as proposed, except that Secs. 67.107(b)(2),

67.207(b)(2), and 67.307(b)(2) are modified. Instead of prohibiting the

``use of a prohibited drug defined in Appendix I of part 121,'' the

final rule language reads ``A verified positive drug test result

acquired under any anti-drug program or internal program of the U.S.

Department of Transportation or any other Administration of the U.S.

Department of Transportation.'' The modified language clarifies the

FAA's intention in referencing Appendix I in the proposed rule. The FAA

stated in the NPRM preamble that it considers a positive drug test

conducted under any rule or internal program of the Department of

Transportation to be compelling proof of the use of a prohibited drug

for which the drug test was positive. -

The changes are intended to provide specific regulatory medical

standards and enhance the agency's ability to examine and exclude from

aviation a person who, though not substance dependent, manifests

recurrent abuse of alcohol or other legal or illegal substances, or has

a single violation of DOT drug testing programs within the preceding 2

years. These standards are consistent with the AMA Report and address

national concerns about substance abuse. -

In referring to use of a substance when ``physically hazardous,''

the standard generally refers to instances such as driving or flying

while intoxicated or under the influence of alcohol or drugs, but could

also refer to other physically hazardous situations that occurred while

a person was under the influence of alcohol or legal or illegal drugs.

This term is also used in DSM III and its successor DSM IV. The FAA,

after careful consideration of the comments and presentations

concerning

[[Page 11248]]

substance abuse as well as the petitions and comments received to

Dockets Nos. 26281 and 26330, has determined that the rule as modified

provides adequate notice to airmen of the required medical standards

and is necessary to protect the public safety.

Neurological (Sections 67.109, 67.209, and 67.309) -

The FAA proposed three changes to the neurological standards,

adding ``a single seizure'' to the list of disqualifying conditions;

using ``seizure'' rather than ``convulsive'' to describe potentially

disqualifying conditions; and adding a ``transient loss of control of

nervous system functions'' standard.

Comments: ATA, AOPA, and three AME's assert that the proposed

requirement that focuses on a single seizure is burdensome and not

necessary; a single mild seizure should not be the sole cause for

disqualification. ATA notes that a single febrile seizure during

childhood, associated with a normal electroencephalogram (EEG),

neurological examination, and imaging study, does not increase the risk

for further seizure activity over time. EAA suggests rather than

disqualifying applicants who have had seizures, AME's be given a

checklist and evaluation guide for pilots with a history of a

disturbance of consciousness or neurologic function. AOPA cites common

causes of single seizure events including low sodium in the blood, heat

exhaustion, head injury from which the applicant entirely recovers, and

eclampsia during pregnancy. -

One AME asserts that the frequency of in-flight incapacitation

following seizure episodes is so low as to render this change

unnecessary. According to the AME, febrile seizures are common, and the

amount of increased paperwork to request special issuance of a medical

certificate for individuals who have had these is simply not worth it.

-

USPA and AOPA say the neurological loss of control definition is

too broad and is open to abuse and misinterpretation. -

In response to the FAA's statement in the NPRM preamble that

neither the AMA-recommended test nor the test by Folstein provides a

``useful screening device, alone or in combination, for airman

neurological status,'' the AMA emphasizes the extreme importance of a

test of mental fitness in attempting to ensure aviation safety and

strongly recommends that the FAA designate or develop a sensitive and

more specific test of mental capacity if those proposed by the AMA

report are unsatisfactory.

FAA Response: The FAA, after careful consideration of all the

comments and presentations received, has decided to withdraw the

proposal that specifies that a single seizure is disqualifying. The

proposed standard at paragraph (a)(2) will not be added to the first-,

second-, or third-class medical certificate requirements. This part of

the proposal is being withdrawn because the FAA agrees with commenters

that a single febrile seizure in childhood should not in most instances

be disqualifying. However, any seizure that has occurred must be

reported by the applicant as part of the medical history and could be

found to be disqualifying under the general neurological standards of

Secs. 67.109(b), 67.209(b), and 67.309(b). Also, a single seizure that

constitutes a disturbance of consciousness or a transient loss of

control of nervous system function(s) without satisfactory medical

explanation of the cause would be disqualifying under

Secs. 67.109(a)(2) or (3), 67.209(a)(2) or (3), and 67.309(a)(2) or 3).

Under Sec. 61.53, Operations during medical deficiency, such an

occurrence would require an airman to cease exercising the privileges

of any airman certificate held until medically evaluated and cleared

for airman duties by the FAA. -

The proposed change from ``convulsive disorder'' to ``seizure

disorder'' at paragraph (b) remains in the final rule.-

The FAA has determined that the addition of ``transient loss of

control of nervous system functions'' should remain in the final rule.

It clarifies the agency's aeromedical concern about such events whether

or not they are characterized as disturbances of consciousness and

allows for the identification and individual evaluation of persons with

this history. -

As to mental screening tests, neither the AMA report nor the

American Academy of Neurology/American Association of Neurological

Surgeons report proposes detailed, objective criteria and tests that

could be included in the standards and by which medical certification

could be determined. Neither the AMA-recommended test nor the Folstein

test provides a useful screening device, alone or in combination, for

airman neurological status. Also, neither screening test, alone or in

combination, provides predictors of skills relevant to piloting.

Cardiovascular (Sections 67.111, 67.211, and 67.311) -

List of Disqualifying Conditions. The proposed rule adds to the

list of disqualifying cardiovascular conditions for first-, second-,

and third-class airman medical certificates an established medical

history of cardiac valve replacement, permanent cardiac pacemaker

implantation, and heart replacement.

Comments: None of the commenters specifically object to the

disqualification for heart replacement. -

Two associations, one AME, and several individuals do not support

the proposal to specifically disqualify applicants with cardiac valve

replacements or permanent cardiac pacemakers. One association states

that the current list of disqualifying conditions is adequate. Many of

these commenters say medical technology for valve replacements and

pacemakers is excellent and improving, so it would be premature for the

FAA to disqualify these heart conditions. -

EAA says that for bioprosthetic cardiac valve patients with no

signs of heart failure, arrhythmia, or atrial fibrillation, and with a

normal functional capacity on stress testing, the FAA should not

require the applicant to go through the special issuance process to

obtain a medical certificate. According to the commenter, these

individuals are at very low risk for sudden incapacitation and can

perform normal activities including piloting an aircraft without undue

risk. One AME believes that disqualifications for heart valve

replacements should be evaluated on an individual basis. -

EAA maintains that standby pacemakers or well-functioning permanent

pacemakers should be allowed with a satisfactory cardiovascular

evaluation and monitoring. Another commenter believes it is appropriate

to deny pacemaker users first- and second-class medical certificates,

but a pacemaker should not disqualify a person from a third-class

medical certificate.

FAA Response: The FAA, after careful consideration of the comments

and presentations received as well as the petitions and comments

received to Docket Nos. 22054 and 26156, has determined that

disqualifying cardiovascular conditions remain in the final rule as

proposed. Further, the FAA has determined that these are serious

conditions that give rise to safety concerns in the aviation

environment specifically with regard to valve failure, pacemaker

malfunction, progression of the underlying disease that required

[[Page 11249]]

artificial cardiac pacing, organ rejection, or the complications of

immunosuppression. As stated in the NPRM preamble, the FAA will

continue to consider special issuance of medical certification on a

case-by-case basis after specialized medical evaluations to confirm

adequate recovery and function and the absence of significant risk in

terms of the aviation environment. -

These regulations clarify long-standing FAA policy. Previously, the

FAA has denied medical certification to airmen with cardiac valve

replacement, pacemaker implantation, or heart transplant under the

current general medical standards. In the final rule, a medical history

of cardiac valve replacement, pacemaker implantation, or heart

transplant is disqualifying. A person with such a medical history,

however, may apply for and possibly receive, a special issuance of a

medical certificate. The FAA will continue to monitor medical

technology in this area and will reassess these rules as developments

warrant. -

Blood Pressure (Proposed Secs. 67.111(b), 67.211(b), and

67.311(b)). The proposed rule revises the blood pressure standards

established in 1959 applicable to first-class medical certificates. The

current table of age-related maximum blood pressure readings for

applicants for first-class medical certificates and the reference to

``circulatory efficiency'' are deleted, and a requirement that average

blood pressure while sitting not exceed 150/95 millimeters of mercury

is added for applicants of all classes. A medical assessment is

specified for all applicants who need or use antihypertensive

medication to control blood pressure.

Comments: Four AME's support the proposed blood pressure standard,

but one requests that the AME make some notation as to whether this is

achieved by approved antihypertensive medication. JAA suggests further

assessment of applicants whose blood pressure level is not

``consistently 160/95'' or lower. -

The Boeing Employees Soaring Club, ALPA, USPA, NATA, GAPA, NAAA,

three AME's, and many individual commenters do not support the proposed

blood pressure standard. They say that it would increase the cost of

medical care, would require costly cardiovascular work-ups for people

who would not otherwise require therapy, and is not supported by

medical data or accident information. Many commenters and one AME do

not support the proposal because, according to these commenters, blood

pressure naturally increases with age. -

ALPA and Boeing Employees Soaring Club say a blood pressure reading

could be affected by many factors, including time of day, daily stress,

or fear of a visit to their physician, and that the FAA should not have

a set blood pressure level in the rule. -

AOPA, EAA, and several commenters, including doctors, say that the

FAA should not disqualify persons whose blood pressure is stabilized at

a lower level with therapy. According to commenters, in the NPRM the

FAA implies that treated hypertension is more of a risk than the

condition of high blood pressure.

FAA Response: After careful consideration of all the comments and

testimony, the FAA has decided to eliminate specific blood pressure

requirements in the final rule. For all classes, the final rule makes

no specific reference to blood pressure but, rather, requires that the

appropriate general medical standard in Secs. 67.113(b), 67.213(b), and

67.313(b) be met.

The FAA has determined that a blood pressure standard is

unnecessary. Each person's medical condition and treatment regimen, if

any, will continue to be evaluated on an individual basis. While the

use of an antihypertensive medication is not made specifically

disqualifying, a person may be required to undergo further medical

assessment.

Electrocardiograms (Proposed Sec. Sec. 67.111 (c) and (d) and

67.211(d)); Final Sec. Sec. 67.111 (b) and (c)). The NPRM proposed to

add a new requirement for routine resting electrocardiograms (ECG) for

second-class medical certification. Applicants would have an ECG after

reaching age 35 and every 2 years after reaching age 40. An ECG

requirement currently exists for first-class applicants; however,

first-class applicants must have an initial ECG after the 35th birthday

and annually after reaching age 40. The NPRM did not propose to add an

ECG requirement for third-class applicants. The NPRM also proposed to

change the validity period for an ECG to meet the requirements of a

medical examination. Currently, an ECG made within 90 days before a

medical examination can be used to satisfy the first-class application

requirement. The proposal was to change to this to 60 days.

Comments: The AMA, ATA, JAA, and two AME's support the proposal.

ASMA, NATA, NAAA, EAA, GAPA, and ALPA do not support the proposal

to require ECG's for second-class applicants. National Business

Aircraft Association (NBAA), ASMA, AOPA, and EAA cite the lack of

cardiac incapacitation as a causal factor in aviation accidents. Many

commenters, including doctors, do not support the requirement to

administer ECG tests to asymptomatic persons. Six AME's say that the

ECG does not predict sudden incapacitation.

A majority of commenters stress the financial burden that ECG

testing would create on those who need second-class medical

certificates. According to commenters, the FAA's cost estimate for

ECG's does not account for the cost to AME's of purchasing the

equipment and modems to transmit the readings to the Civil Aeromedical

Institute. The ECG test would also increase the amount of time an AME

would spend on each pilot. AOPA notes that the FAA anticipates 1,800

applicants will not meet ECG standards, and would have to undergo the

cost of additional evaluation to determine eligibility for a medical

certificate. AOPA also noted that the FAA's regulatory evaluation

estimated that 90 percent of these applicants would ultimately be

granted medical certificates. AOPA believes the ECG requirement and

follow-up testing is a waste of time and money. The Soaring Society of

America suggests that an applicant's regular medical facility could

perform this test and certify it to the AME, which would prevent

redundant tests and lower the cost and complexity of obtaining the

second-class medical certificate.

FAA Response: After careful consideration of the comments and

testimony received, the FAA has decided to withdraw the proposal for an

ECG requirement for second-class medical certification. There was

limited support for the proposal within the medical community; and

several aviation associations (including an aeromedical association),

AME's, and individuals commented that the cost of implementing this

proposal cannot be justified when compared with the current, limited-

prognostic capabilities of the routine resting ECG.

The existing ECG requirement for first-class medical certification,

an initial ECG after the 35th birthday and annual ECG's after reaching

age 40, remains in the final rule. The change from 90 to 60 days for

using an ECG to satisfy the first-class medical certification

requirement also remains in the final rule. The FAA has determined that

the ECG requirement for first-class medical certification, normally

held by airline transport pilots, is consistent with the highest level

of safety and is cost effective when coupled with the semi-annual

examination required for that certificate. An airman holding a first-

class medical certificate receives the highest level of medical

scrutiny (i.e., semi-annual

[[Page 11250]]

examination) because of the nature of his or her employment; the annual

ECG is one element of this frequent, multi-factorial, medical

surveillance.

Most commercial ``commuter'' operations (e.g., passenger operations

of a turbojet airplane, passenger operations of an airplane having a

passenger seating configuration of 10 seats or more, or passenger

operations of a multiengine airplane being operated by a commuter air

carrier) require pilots to have first-class medical certificates. The

remaining population of commercial pilots (e.g., pilots of commuter

passenger operations with airplane passenger seating configuration of 9

seats or less; flight instructors; pilots of crop dusting, banner

towing, powerline, pipeline inspection operations) is required to hold

a second-class medical certificate. As previously stated, the FAA has

determined that biennial ECG's for these commercial pilots are not cost

effective and that these pilots do not require the same level of

medical scrutiny, given their employment, as pilots who are required to

have a first-class medical certificate. The FAA, however, will continue

to monitor and evaluate the medical/flying histories of those pilots

required to have a second-class medical certficate and will, if

appropriate, impose an ECG requirement in the future.

Finally, the public should be aware that the FAA uses the ECG to

evaluate the medical fitness of second-class medical certificate

applicants when sound medical judgment indicates that the test would be

reasonable and useful. The FAA routinely requests an ECG when an

individual has or may have a medical history or clinical diagnosis of a

variety of medical conditions, including cardiovascular disease,

hypertension, dysrhythmia, diabetes, peripheral vascular disease,

cerebral vascular disease, cardiomyopathy, valvular heart disease,

congenital heart disease, or a previously abnormal ECG. The FAA will

continue to use the ECG as a diagnostic tool in appropriate situations.

Anticoagulant medications (Proposed Secs. 67.111(c), 67.211(c),

and 67.311(c)). The proposed rule adds the provision that

persons applying for first-, second-, or third-class medical

certificates must not use anticoagulant medication.

Comments: EAA, AOPA, two AME's, and several individuals state that

the proposed rule is subject to interpretation and could, for example,

include aspirin. The two AME's say that the FAA needs to differentiate

between anticoagulant and antiplatelet medications regarding which are

disqualifying. AOPA says disqualification should be based on the

applicant's disease, not on the medicine taken, unless there are

specific side effects that directly affect the safety of flight.

EAA supports the prohibition of heparin. AOPA says coumadin use

should not be disqualifying, since its track record is well

established.

FAA Response: The FAA did not intend for antiplatelet medications

(e.g., aspirin) to be included as anticoagulants. After careful

consideration of the comments and testimony received, the FAA has

decided to withdraw the proposal to add anticoagulant use as a

specifically disqualifying medication since the use of these

medications could be found disqualifying in this final rule under

paragraph (c) of the general medical condition section (see

Secs. 67.113(c), 67.213(c), and 67.313(c)), of part 67.

Cholesterol Testing (Proposed Section 67.111(f))

The current rule contains no cholesterol standards. The proposed

rule adds a new total blood cholesterol testing requirement for first-

class applicants after they reach age 50, and annually thereafter. A

blood cholesterol level of 300 milligrams per deciliter or more

requires applicants to undergo further evaluation. If otherwise

eligible, the applicant would be issued a medical certificate pending

results of the evaluation.

Comments: The vast majority of individual commenters, as well as

NBAA, AOPA, ASMA, and EAA, do not support the proposed requirement for

total blood cholesterol determination for first-class medical

certification. AOPA, NATA, and ALPA say some individuals believe that

the test is invasive and a personal health matter to be discussed with

a private physician, not with the FAA. AOPA, EAA, two AME's, and

several individuals say factors other than total cholesterol contribute

to coronary artery disease. Since the AMA study, Allied Pilots

Association (APA), EAA, two AME's and several others note, high density

lipoprotein (HDL) and low density lipoprotein (LDL) have been found to

better correlate with coronary artery disease (CAD) than total

cholesterol.

Nearly half of the AME commenters state that cholesterol testing is

not needed because it does not predict an applicant's ability to

perform safely. One AME notes that 50 percent of all myocardial

infarctions occur in people with cholesterol ranging between 180 and

220, levels well below the FAA's proposed evaluation threshold of 300.

NBAA and APA say the link between incidence of high serum cholesterol

and aircraft accidents caused by pilot incapacitation is tenuous at

best. APA suggests that the FAA consider reviewing cardiovascular risk

factors every 3-5 years to develop other, more appropriate measures of

cardiovascular risk.

FAA Response: After careful consideration of the comments and

testimony received, the FAA has decided to withdraw the proposal to

measure the total cholesterol of applicants for first-class medical

certification. Several aviation associations, AME's, and individuals

commented that there is no scientific evidence that demonstrates the

relationship between a specific cholesterol value and the existence of

identifiable pathology that represents a threat to aviation safety.

Commenters pointed out that a different understanding exists today

about total cholesterol level, per se, and pathology compared to when

the data that supported the original proposal were compiled.

Cholesterol testing, as proposed, is not cost effective. The FAA

encourages airmen to have their lipid levels checked as a health

measure but is not requiring airmen to do so in the final rule.

Diabetes (Sections 67.113(a), 67.213(a), and 67.313(a))

No change is proposed to the standards concerning airmen with

diabetes, currently set forth in paragraph (f)(1) of Secs. 67.13,

67.15, and 67.17. In the preamble to the proposed rule, however, FAA

states that it has determined that persons who do not meet the medical

standard because their diabetes requires oral hypoglycemic drugs would

no longer be categorically denied special issuance of airman medical

certification. This policy would apply to individuals whose diabetes is

without complications and acceptably controlled by diet and oral drugs

with appropriate monitoring and other conditions. However, this policy

change does not affect the long-standing FAA policy and practice that a

diabetic using insulin for control is not eligible for unrestricted or

restricted medical certification.

Comments: Two AME's believe that insulin-dependent diabetics should

not be allowed any type of pilot's license.

USPA says insulin-dependent diabetics should be acceptable on a

case-by-case basis. One commenter believes that diabetic private or

recreational pilots should be certificated if their diabetes is under

good control.

EAA, two other AME's, and many individuals support permitting

[[Page 11251]]

noninsulin-dependent diabetics to obtain special issuance.

A few commenters state that it is unrealistic to exclude all users

of hypoglycemic drugs, as proposed in the NPRM. One diabetic noted that

50 percent of men over 65 have ``Diabetes II,'' which does not require

insulin or anything other than a mild drug.

FAA Response: After careful consideration of the comments and

testimony received as well as the petitions and comments received to

docket Nos. 26281 and 26493, the FAA has determined that the current

consensus of the medical community supports the FAA position. Many

individuals who are not insulin-treated diabetics can, with appropriate

monitoring and other conditions, receive a special issuance of their

medical certificates to perform the duties authorized by their class of

medical certificate without endangering public safety. The final rule

is the same as the current rule.

Also, the FAA has determined that, rather than engaging in

rulemaking concerning diabetes, it is more appropriate to reexamine its

policy on special issuance of medical certificates to persons with

insulin-treated diabetes mellitus. On December 29, 1994, subsequent to

publication of the NPRM, the Federal Air Surgeon requested comments on

a possible policy change with respect to individuals who have a

clinical diagnosis of insulin-treated diabetes mellitus (59 FR 67246,

December 29, 1994). The docket for this notice closed on March 29,

1995. The FAA will review the comments and testimony received in

dockets Nos. 26493 and 27940 concerning diabetes and will publish in a

separate notice the agency's determination concerning its policy on

special issuance of medical certificates to persons with insulin-

treated diabetes mellitus.

Special Issuance (Section 67.401)

Proposed Sec. 67.401(a) limits the duration of any medical

certificate issued under the special issuance procedures of this

section to the duration of an Authorization for special issuance. When

the Authorization expires, or if the FAA withdraws the Authorization,

the medical certificate issued pursuant to that Authorization also

expires.

Comments: AOPA and IPA say that the extra requirements for special

issuance procedures should be withdrawn because they will increase the

burden on FAA to write exceptions (especially in a time of government

budget cutting and staff reductions), and because applicants will have

to pay more and bet their livelihood with each reaffirmation request.

FAA Response: The FAA, after careful consideration of all the

comments and testimony received as well as the petitions and comments

received to Docket No. 25787, has decided to retain the requirement

limiting duration of any class medical certificate to the duration of

an Authorization. This will ensure that the medical justification for

the special issuance remains valid and the holder of the special

issuance undergoes appropriate periodic reevaluation. This change

explicitly connects the duration of any special issuance medical

certificate to the validity of the document upon which it is based and

requires periodic requests for reissuance. The FAA foresees no

significant additional administrative burden on the FAA.

The FAA has included specific requirements for an Authorization in

the rule language in order to provide procedures for legal

documentation and control of validity periods, followup requirements,

withdrawals, and functional or operational limitations.

Incorrect Statements by Applicants (Sections 67.401(f)(5) and

67.403(c))

The proposed rule broadens the regulatory basis for action when an

applicant or airman provides incorrect information when applying for

medical certification. Proposed Secs. 67.401(f)(5) and 67.403(c) would

allow the FAA the option of denying, suspending, or revoking an airman

medical certificate and denying or withdrawing an Authorization or

SODA, not only when the holder makes a fraudulent or intentionally

false statement, but also when the holder makes an incorrect statement

in support of a request for a medical certificate, an Authorization, or

SODA or in an entry in any logbook, record, or report that is kept,

made, or used to show compliance with the medical certificate,

Authorization, or SODA. A suspension, revocation, or withdrawal could

occur even if the person did not knowingly make the incorrect statement

or entry.

Comments: One AME supports the Authorization and SODA withdrawal

proposals.

EAA says the proposed Sec. 67.403(c) statement concerning

unknowingly false statements should only call for a review of the

medical certificate and possible revocation, if warranted by the

corrected information. AOPA notes that the Federal Aviation Act says

applicants denied issuance or renewal of a certificate may have an NTSB

hearing.

NATCA, IPA, APA, four AME's, and a large number of individual

commenters are concerned about what they view as the lack of due

process in the decision to withdraw the Authorization. According to

these commenters, many innocent errors are made on the applications due

to the applicant's unclear memory or misunderstanding of terms on the

application. These commenters suggest that the FAA require the AME to

contact the pilot and provide a chance to explain and correct the

incorrect statements. Commenters say that the wording creates too

ambiguous an authority for the FAA and creates the potential for action

by the FAA against almost any pilot. Some associations are concerned

that individuals whose applications or certificates are denied may

actually lose their jobs without benefit of an opportunity to clarify

unintentional discrepancies.

FAA Response: The FAA noted in the preamble to the NPRM its concern

that medical certification based on incorrect medical data may be

inappropriate in the light of the true data. The current regulations do

not explicitly provide for withdrawal of an Authorization or SODA or

suspension or revocation of a medical certificate when unknowingly

incorrect statements are relied upon in the FAA's decision to issue an

Authorization, SODA, or medical certificate. The FAA's intent in

including language on incorrect statements is to provide a basis for

appropriate action when a person provides such unknowingly incorrect

information that is relied on by the agency in its decision. The

withdrawal, suspension, or revocation in this case is not meant to be

punitive, but rather corrects the inappropriate granting of an

Authorization, SODA, or medical certificate. The final rule clarifies

the FAA's intent by including language in Sec. 67.403(c) that limits

the reference to ``incorrect statements'' to those ``upon which the FAA

relied.''

Return of Medical Certificate Sections 67.401(i)(4) and 67.415

Proposed Sec. 67.401(i)(4) requires surrender to the Administrator

of a medical certificate rendered invalid pursuant to a withdrawal in

accordance with Sec. 67.401(a). The proposal also adds a requirement in

Sec. 67.415 to specify that the holder of a medical certificate that is

suspended or revoked must return the medical certificate to the

Administrator.

Comments: EAA says that presently airmen are not required to return

their medical certificates without a hearing before the NTSB;

procedures now exist for emergency suspension or revocation of a

certificate based on false information. Therefore, EAA believes

[[Page 11252]]

there is no need for this requirement. Three AME's believe that the

added requirement for mandatory return of a medical certificate at the

request of the Administrator would open the whole process of medical

certification to potential abuse by the FAA and should be deleted.

Several individuals state that this provision is unnecessary and should

be withdrawn; the current rules are sufficient to ensure that pilots

fly only with a valid medical certificate.

FAA Response: Current Sec. 67.27(g) provides that the holder of a

medical certificate shall surrender it, upon request of the FAA, if its

issuance is wholly or partly reversed upon reconsideration. After

careful consideration of all the comments and testimony received, the

FAA has determined that the language, as proposed, codifies existing

practice, parallels the procedures with airman certificates, and

clarifies the FAA's intent to require the return of medical

certificates that have become invalid. The retention by an airman of an

invalid medical certificate is not consistent with proper and efficient

enforcement of safety regulations because of the apparent authority of

these documents. Inclusion of this requirement, however, does not in

any way affect the certificate holder's administrative review or appeal

rights.

Regulatory Evaluation Summary

Introduction

Changes to Federal regulations must undergo several economic

analyses. First, Executive Order 12866 directs Federal agencies to

promulgate new regulations or modify existing regulations only if the

potential benefits to society justify its costs. Second, the Regulatory

Flexibility Act of 1980 requires agencies to analyze the economic

impact of regulatory changes on small entities. Finally, the Office of

Management and Budget directs agencies to assess the effects of

regulatory changes on international trade. In conducting these

assessments, the FAA has determined that this rule: (1) Will generate

benefits exceeding its costs and is not ``significant'' as defined in

Executive Order 12866; (2) is not ``significant'' as defined in DOT's

Policies and Procedures; (3) will not have a significant impact on a

substantial number of small entities; and (4) will not constitute a

barrier to international trade. These analyses, available in the

docket, are summarized below.

The majority of the amendments will have insignificant attributable

costs and benefits. This evaluation does not address the minor

amendments such as changes in syntax, technical corrections,

reorganization, updating medical terminology, or adjustments to cross

references for conformance purposes.

Furthermore, the evaluation attributes no significant costs or

benefits to several other amendments that add a specific disease or

medical condition to the list of medical standards. Such additions do

not necessarily constitute a change in the standards. Existing

regulations include three open-ended (general) medical standards that

cover:

(1) any other personality disorder, neurosis, or mental

condition * * *, (2) any other organic, functional, or structural

disease, defect, or limitation * * *, and (3) no medication or other

treatment * * *.

that the Federal Air Surgeon finds would make, or may reasonably be

expected to make, the applicant unable to perform the duties associated

with the airman certificate. Thus, the applicable medical standards are

not limited to those actually listed in the regulation. As medical

knowledge and experience progress, the Federal Air Surgeon may find a

previously unlisted disease or condition to be grounds for withholding

or restricting a medical certificate, so long as that finding is based

on qualified medical judgment.

The addition of specifically disqualifying medical conditions under

the amended standards could cause a small number of airmen, who

currently hold medical certificates as a result of an order of the

National Transportation Safety Board (NTSB) to be disqualified from

further medical certification. These airmen were denied medical

certification by the FAA under the current general medical standards.

For example, the FAA has denied medical certification to airmen who

have had cardiac valve replacement and the NTSB has ordered medical

certification in some of these cases. Under the amended standards a

medical history of cardiac valve replacement is specifically

disqualifying and those airmen will no longer be entitled to medical

certification. It is expected, however, that medical certification of

the affected individuals will continue under the Federal Air Surgeon's

special issuance authority once the FAA evaluates the case and is

satisfied that the airman's condition has not worsened since the NTSB

ordered medical certification. As such, the expected economic impact of

the specifically disqualifying medical conditions will be minor.

Discussion of Comments Addressing Economic Evaluation

This section of the summary responds to comments concerning the

economic evaluation of the NPRM. The NPRM for this rule included five

significant proposals that were withdrawn after careful consideration

of the comments received. This section notes, but does not address

comments concerning the regulatory evaluation of the withdrawn

proposals, since such comments are no longer pertinent.

Comment: The U.S. Small Business Administration (SBA) states in it

comment that the FAA's regulatory flexibility analysis for the NPRM

does not conform to the Regulatory Flexibility Act (RFA), and that a

proper regulatory flexibility analysis must be performed prior to

issuing a final rule.

FAA Response: The FAA does not agree. Federal agencies are required

to prepare a regulatory flexibility analysis only if the proposed rule

would have a significant economic impact on a substantial number of

small entities.\1\ The NPRM would not have had such impact and this was

stated. The SBA also notes that no explanation was provided to support

that determination. The FAA agrees and provides the following table of

explanation.

\1\ A Guide to Federal Agency Rulemaking, 2nd edition,

Administrative Conference of the United States; 1991; p. 162.

[[Page 11253]]

----------------------------------------------------------------------------------------------------------------

Average

NPRM cost per

Medical certification category NPRM 10-year annualized Active year per

present value costs airmen active

airman

----------------------------------------------------------------------------------------------------------------

First-class........................................... $5,700,000 $811,551 147,676 $5.50

Second-class.......................................... 22,700,000 3,231,969 173,435 18.64

Third-class........................................... 5,600,000 797,314 325,996 2.45

----------------------------------------------------------------------------------------------------------------

As shown above, the average annualized cost impact of the proposed

rule would have ranged from $2.45 to $18.64 per person subject to

medical certification requirements. It would be statistically

impossible for the impact of the proposed rule to exceed these averages

to such an extent as to have a significant impact (multiple thousands

of dollars annually depending on the entity type) on a substantial

number (at least one-third) of small entities; even if the rule only

affected small entities. Similarly, since the costs of the final rule

are approximately 20 percent of the NPRM costs, it follows that the

final rule also will not have a significant economic impact on a

substantial number of small entities.

Comments: Several associations and numerous individual commenters

find it illogical to draw inferences for pilots from the air traffic

controllers who were monitored in the Johns Hopkins study. The reasons

cited by the commenters include air traffic control (ATC) work is

inherently stressful, ATC work is sedentary, controllers are exposed to

cathode ray tube monitors and indoor air, controllers have a history of

strife between labor and management, and they work on varying shifts.

FAA Response: The FAA disagrees. The Hopkins study was expressly

used to quantify the relative differences of primary pathology

incidence across age cohorts. The Hopkins results are conclusively

supported by other general medical investigation as well as the FAA's

own medical certification data for pathology incidence and application

denials.

Comments: Four national aviation associations strongly disagree

with the NPRM proposal to reduce the duration of third-class medical

certificates for persons age 70 and older. The commenters assert that

the benefits have not been demonstrated and that the statistical

analysis FAA used to confirm that the incidence of pathology related

accidents increases with age is supported by an insufficient sample

size.

FAA Response: After careful consideration of the testimony and

comments received, the FAA has withdrawn this proposed provision.

Comments: Numerous individual commenters stated that the proposed

higher standards for blood pressure would prove costly to pilots with

borderline pressure measurements and that the affected individuals

would be required to take extensive additional testing.

FAA Response: After careful consideration of the testimony and

comments received, the FAA has withdrawn this proposed provision.

Comments: Six major associations disagree with the provision for

electrocardiograms, second class and assert that the frequency of

medically related aviation accidents, the majority of which are not

predictable, does not support the administrative and economic burdens

that would be imposed on the affected applicants. Two associations

assert that the 40-percent effectiveness level that was assumed in the

evaluation is questionable and is a significant error in the cost-

benefit analysis. Five associations, two AME's, and numerous individual

commenters state that the FAA's cost estimate does not account for the

cost for AME's to purchase the necessary medical equipment and modems.

They warn that some AME's may withdraw their participation rather than

incur the additional costs.

FAA Response: After careful consideration of the testimony and

comments received, the FAA has withdrawn this proposed provision.

Comments: Several associations assert that requiring a cholesterol

test would be a significant administrative and cost burden. One

association stated that the regulatory evaluation employed an average

laboratory test cost of $10, but that costs range between $15 and $16

in the Washington, D.C. area. One individual commenter asserts that the

cost-benefit analysis is flawed because it based cost savings on a

cholesterol level lower than 300, and because the analysis assumed that

all heart attacks studied represented individuals with critically high

cholesterol.

FAA Response: After careful consideration of the testimony and

comments received, the FAA has withdrawn this proposed provision.

Comments: One major association states that the addition of the

intermediate vision, first and second class is unnecessary and

unwarranted, and that it would add costs with no significant safety

benefit.

FAA Response: The FAA does not agree. The evaluation estimated that

the direct testing costs, including applicant time, would range from

$1.30 to $3.86 per year per applicant age 50 and older. Additional

costs (for glasses and examinations) would only be incurred by those

persons whose intermediate vision was, in fact, deficient, and who

could not satisfactorily read their flight instruments. The FAA

maintains that these costs are not unreasonable, and that the benefits

of commercial pilots being able to read flight instruments are

conclusive.

Costs and Benefits That Are Not Quantified

Prior to summarizing the evaluation of the substantive provisions,

it is important to note one category of costs and one category of

benefits that have not been quantified in this analysis. The evaluation

does not explicitly quantify the economic consequences to those

individuals who could lose their pilot medical certificate privileges

as a result of the additional medical tests or standards. Where such

consequences are expected, the evaluation estimates the numbers of

persons who may be denied but does not attribute a cost to those

actions.

-It is recognized that the denial of pilot privileges could mean

the loss of a highly valued avocation for some individuals. For others,

it could actually result in the loss of primary livelihood. An accurate

assessment of the economic valuation of the denials that are projected

under the rule is beyond the scope of the evaluation.

-At the same time, the evaluation also does not quantify the

overwhelming personal health benefits, external to flight safety, that

will be afforded to those individuals whose medical conditions will be

detected and whose treatment will be enabled by the new tests and

standards. On average, third-class medical certificate holders spend

only 0.7 percent of their time flying. The evaluation only quantifies

the direct benefits of the rule to reduced aviation accidents.

[[Page 11254]]

-Under existing regulations, the Federal Air Surgeon is charged to

deny a medical certificate in those cases where a disease or other

physical or mental condition would make, or may be reasonably be

expected to make, the applicant unable to perform the duties associated

with the medical certificate. Such findings are not capricious, but

instead, are based on the case history of the individual and on

appropriate, qualified medical judgment. The FAA holds that the

severity of a disease or medical condition necessary to warrant a

denial is such that the aviation safety and personal health benefits of

that action will always exceed the costs associated with the loss of

pilot privilege.

Summary of Quantified Costs and Benefits

Vision Amendments, All Classes. The final rule institutes

additional vision tests and standards for all three classes. For first-

and second-class medical certificate applicants age 50 and older, it

adds a new standard (20/40 or better, Snellen equivalent) and a new

test for intermediate vision (near vision at 32 inches). Applicants for

third-class medical certificates will be subject to a new standard (20/

40 or better) and a new test for near vision (16 inches).

The projected 10-year costs of the intermediate vision amendment

for first-class medical certificate applicants are: (1) $1.4 million in

primary testing costs, (2) $2.1 million in follow-up compliance costs

(examinations and glasses) for those persons who would not meet the

standard, and (3) $6,147 in direct processing costs for the expected 15

additional persons who could be denied under the provision. In total,

it is expected that the intermediate vision amendment for first-class

medical certificate applicants would impose an incremental 10-year cost

of $3.5 million, with a 1995 present value of $2.5 million.

The projected 10-year costs of the intermediate vision amendment

for second-class medical certificate applicants are: (1) $442,224 in

primary testing costs, (2) $2.0 million in follow-up compliance costs

(examinations and glasses) for those persons who would not meet the

standard, and (3) $6,626 in direct processing costs for the expected 17

additional persons who would be denied under the provision. In total,

it is expected that the intermediate vision amendment for second-class

medical certificate applicants would impose an incremental 10-year cost

of $2.4 million, with a 1995 present value of $1.7 million.

The projected 10-year costs of the near vision amendment for third-

class medical certificate applicants are: (1) $2.3 million in primary

testing costs, (2) $1.1 million in follow-up compliance costs

(examinations and glasses) for those persons who would not meet the

standard, and (3) $129,690 in direct processing costs for the expected

330 additional persons who would be denied under the provision. In

total, it is expected that the near vision amendment for third-class

medical certificate applicants would impose an incremental 10-year cost

of $3.5 million, with a 1995 present value of $2.5 million. It is

emphasized that the denials and costs associated with the near vision

requirement are not wholly attributable to the amendment. Although this

requirement does not exist in current regulations, the requirement has

been in place administratively for some time. Thus, the associated

costs are being and would continue to be incurred without this

amendment. The economic evaluation of this requirement is provided as

information to assess the fact the requirement would explicitly be

added to the regulations.

In assessing the benefits of the vision amendments, NTSB accident

records were investigated for the periods from 1962 through 1989 for

commercial flights and from 1982 through 1989 for general aviation. For

these periods, no accident was found where intermediate or near vision

deficiency was specifically determined to be the cause. As such, the

FAA is not able to quantitatively ascribe the benefits of the three

vision amendments based solely on historical accident analysis.

Notwithstanding the absence of documented accidents related to

these three provisions, the FAA maintains that such accidents may well

have occurred and would continue to occur in the absence of the

amendments. The NTSB accident analysis system may not document those

cases where a near or intermediate vision problem caused or contributed

to accidents. Examples would include deviations from course or

altitude, inaccurate monitoring of gauges and other avionics displays,

and incorrect setting of aeronautical parameters such as headings or

radio frequencies.

While the extent to which intermediate or near vision problems have

caused such accidents is unknown, it is the FAA's position that: (1)

general aviation pilots require adequate near vision to read charts and

checklists, and (2) commercial pilots require adequate intermediate

vision to properly monitor aircraft instruments. Although this

evaluation is not able to quantify the benefits of the vision

amendments, the FAA holds that the benefits will be significant and

will exceed the expected costs.

Part 61, Medical Certificate Validity Period, Third-Class. Under

the final rule, persons under age 40 will generally only be required to

undergo a physical examination every 3 years. Medical certificates for

persons age 40 and older will continue to be valid for 2 years.

Other than minor administrative costs to effect the new procedure,

there will be no direct expenditures associated with the amendment. In

addition, careful consideration of all comments and testimony received,

as well as the petitions and comments received to Docket Nos. 24932,

26281, and 27473, leads the FAA to conclude that extending the duration

between medical examinations can be done with no detriment to safety in

the case of younger airmen, who are much less likely to suffer medical

incapacitation.

The FAA has investigated the relative primary pathology incidence

rates for persons under and over 40 years of age. As a group, persons

under age 40 exhibit 1/27 of the pathology incidence rate of persons 40

and older. Even weighting these rates, by the numbers of pilots by age

class, results in an ``under age 40'' incidence equal to 1/6 that of

third-class medical certificate applicants age 40 and older.

The FAA's position on this issue is further supported by a review

of the pertinent accident data. National Transportation Safety Board

(NTSB) data were reviewed for the period 1982 through 1989. During that

period, 259 pathology related, general aviation accidents occurred.

Only two of those accidents, however, involved private pilots under age

40 with a potentially detectable primary pathology. One case involved a

37-year-old pilot with a valid medical certificate who suffered a heart

attack that had not been predicted. The second accident involved a 25-

year-old with a vasovagal syncope who was flying without a medical

certificate.

As with all age groups, those individuals under age 40 manifesting

conditions that represent a risk to safety will be denied medical

certification or, if they apply for and receive a special issuance of a

medical certificate, will be restricted in their flying activities and/

or examined more thoroughly and frequently.

The primary benefits of this amended provision will derive from the

annual reduction in third-class medical certificate applications. FAA

compared the projected numbers of applications

[[Page 11255]]

under the existing 2 year duration for all ages, against the

applications that are expected under the final rule provision extending

the duration for persons under age 40 to 3 years. Applications under

the final rule were computed by reducing the projected applications for

persons under age 40 by a factor of two-thirds. Over the 10-year study

period, the part 61 provision is expected to reduce applications by

268,000.

Each avoided examination is valued at $89, consisting of $50 in

direct testing costs, and one and one-half hours of the applicant's

time valued at $29 per hour. This produces an expected 10-year savings

of $23.9 million, with a 1995 present value of $16.7 million, not

counting FAA processing costs

Regulatory Flexibility Determination

The Regulatory Flexibility Act of 1980 (RFA) was enacted by

Congress to ensure that small entities are not unnecessarily or

disproportionately burdened by Government regulations. The RFA requires

a Regulatory Flexibility Analysis if a rule would have a significant

economic impact, either detrimental or beneficial, on a substantial

number of small entities. FAA Order 2100.14A, Regulatory Flexibility

Criteria and Guidance, provides threshold cost and small entity size

standards for complying with RFA review requirements in FAA rulemaking

actions.

The rule is estimated to have a 10 year, 1995 present value cost of

$6.6 million, which equates to an annualized cost of $940,000 to the

approximately 647,100 active airmen. The average annualized effect per

airman is projected to equal $1.45. In light of this information, the

FAA finds that the amendment will not have a significant economic

impact on a substantial number of small entities.

International Trade Impact Assessment

The final rule will have little or no impact on trade for both U.S.

firms doing business in foreign countries and foreign firms doing

business in the United States.

Federalism Implications

The regulations herein would not have substantial direct effects on

the states, on the relationship between the national government and the

states, or on the distribution of power and responsibilities among the

various levels of government. Therefore, in accordance with Executive

Order 12866, it is determined that this rule does not have sufficient

federalism implications to warrant the preparation of a Federalism

Assessment.

Conclusion

For the reasons discussed in the preamble, and based on the

findings in the Regulatory Evaluation and the International Trade

Impact Analysis, the FAA has determined that this rule is not major

under Executive Order 12866. In addition, the FAA certifies that this

rule will not have a significant economic impact, positive or negative,

on a substantial number of small entities under the criteria of the

Regulatory Flexibility Act. This rule is considered significant under

DOT Regulatory Policies and Procedures (44 FR 11034; February 26,

1979). A regulatory evaluation of the rule, including a Regulatory

Flexibility Determination and Trade Impact Analysis, has been placed in

the docket. A copy may be obtained by contacting the person identified

under FOR FURTHER INFORMATION CONTACT.

Paperwork Reduction Act

The paperwork burden associated with part 67 is currently approved

under OMB number 2120-0034. There is small reduction in paperwork

associated with this final rule.

Derivation and Distribution Tables

The Derivation Table below shows the source in current part 67 on

which each paragraph of each section of revised part 67 is based. The

Distribution Table below shows where each current part 67 section and

paragraph can be found in the revised part 67.

Derivation Table

Revised section Based On

Subpart A

Section

67.1............................... Current Secs. 67.1 and 67.21.

67.3............................... Current Sec. 67.11.

67.5............................... Current Sec. 67.12.

67.7............................... Current Sec. 67.3.

Subpart B

Section

67.101............................. Current Sec. 67.13(a) and new

language.

67.103(a).......................... Current Sec. 67.13(b)(1).

67.103(b).......................... Current Sec. 67.13(b)(2) and new

language.

67.103(c).......................... Current Sec. 67.13(b)(3) and new

language.

67.103(d).......................... Current Sec. 67.13(b)(4).

67.103(e).......................... Current Sec. 67.13(b)(5).

67.103(f).......................... Current Sec. 67.13(b)(6) and

flush paragraph.

67.105(a).......................... Current Sec. 67.13(c)(1) and new

language.

67.105(b).......................... Current Sec. 67.13(c)(2),

(c)(3), (c)(4), (c)(5), and new

language.

67.105(c).......................... Current Sec. 67.13(c)(6) and new

language.

67.107(a).......................... Current Sec. 67.13(d)(1)(i) and

new language.

67.107(b).......................... New language.

67.107(c).......................... Current Sec. 67.13(d)(1)(ii)

reordered.

67.109(a).......................... Current Sec. 67.13(d)(2)(i) and

new language.

67.109(b).......................... Current Sec. 67.13(d)(2)(ii).

67.111(a).......................... Current Sec. 67.13(e)(1) and new

language.

67.111(b).......................... Current Sec. 67.13(e)(2) and (3)

and new language.

67.111(c).......................... Flush paragraph after current

Sec. 67.13(e)(5) as modified.

67.113(a).......................... Current Sec. 67.13(f)(1).

67.113(b).......................... Current Sec. 67.13(f)(2).

67.113(c).......................... Current Sec. 67.13(f)(3), added

September 9, 1994.

67.115............................. Current Sec. 67.13(g).

Subpart C

Section

67.201............................. Current Sec. 67.15(a) and new

language.

67.203(a).......................... Current Sec. 67.15(b)(1).

67.203(b).......................... Current Sec. 67.15(b)(2) and new

language.

67.203(c).......................... Current Sec. 67.15(b)(5) and new

language.

67.203(d).......................... Current Sec. 67.15(b)(3).

67.203(e).......................... Current Sec. 67.15(b)(4) and new

language.

67.203(f).......................... Current Sec. 67.15(b)(6) and

flush paragraph.

67.205(a).......................... Current Sec. 67.15(c)(1) and new

language.

67.205(b).......................... Current Sec. 67.15(c)(2),

(c)(3), (c)(4), (c)(5), and new

language.

67.205(c).......................... Current Sec. 67.15(c)(6) and new

language.

67.207(a).......................... Current Sec. 67.15(d)(1)(i) and

new language.

67.207(b).......................... New language.

67.207(c).......................... Current Sec. 67.15(d)(1)(ii)

reordered.

67.209(a).......................... Current Sec. 67.15(d)(2)(i) and

new language.

67.209(b).......................... Current Sec. 67.15(d)(2)(ii) and

new language.

67.211............................. Current Sec. 67.15(e)(1) and new

language.

67.213(a).......................... Current Sec. 67.15(f)(1).

67.213(b).......................... Current Sec. 67.15(f)(2).

67.213(c).......................... Current Sec. 67.15(f)(3), added

September 9, 1994.

67.215............................. Current Sec. 67.15(g).

Subpart D

Section

67.301............................. Current Sec. 67.17(a) and new

language.

67.303(a).......................... Current Sec. 67.17(b)(1) and new

language.

67.303(b).......................... New language.

67.303(c).......................... Current Sec. 67.17(b)(3) and new

language.

67.303(d).......................... Current Sec. 67.17(b)(2) and new

language.

67.305(a).......................... Current Sec. 67.17(c)(1) and new

language.

67.305(b).......................... Current Sec. 67.17(c)(2) and

(3), and new language.

67.305(c).......................... Current Sec. 67.17(c)(4) and new

language.

67.307(a).......................... Current Sec. 67.17(d)(1)(i) and

new language.

67.307(b).......................... New language.

67.307(c).......................... Current Sec. 67.17(d)(1)(ii)

reordered.

67.309(a).......................... Current Sec. 67.17(d)(2)(i) and

new language.

67.309(b).......................... Current Sec. 67.17(d)(2)(ii) and

new language.

[[Page 11256]]

67.311............................. Current Sec. 67.17(e)(1) and new

language.

67.313(a).......................... Current Sec. 67.17(f)(1).

67.313(b).......................... Current Sec. 67.17(f)(2).

67.313(c).......................... Current Sec. 67.17(f)(3), added

September 9, 1994.

67.315............................. Current Sec. 67.17(g).

Subpart E

Section

67.401(a).......................... Current Sec. 67.19(a) and new

language.

67.401(b).......................... New language.

67.401(c).......................... Current Sec. 67.19(b).

67.401(d).......................... Current Sec. 67.19(d) and new

language.

67.401(e).......................... Current Sec. 67.19(c).

67.401(f).......................... New language.

67.401(g).......................... Current Sec. 67.19(e) and new

language.

67.401(h).......................... Current Sec. 67.19(f) and new

language.

67.401(i).......................... New language.

67.401(j).......................... New language.

67.403(a).......................... Current Sec. 67.20(a) and new

language.

67.403(b).......................... Current Sec. 67.20(b) and new

language.

67.403(c).......................... New language.

67.405(a).......................... Current Sec. 67.23(a).

67.405(b).......................... Current Sec. 67.23(b).

67.407(a).......................... Current Sec. 67.25(a) and new

language.

67.407(b).......................... Current Sec. 67.25(a) flush

paragraph and new language.

67.407(c).......................... Current Sec. 67.25(b), as

amended September 9, 1994, and

new language.

67.407(d).......................... Current Sec. 67.25(c).

67.409(a).......................... Current Sec. 67.27(a).

67.409(b).......................... Current Sec. 67.27(b), as

amended September 9, 1994.

67.409(c).......................... Current Sec. 67.27(c).

67.409(d).......................... Current Sec. 67.27(d).

67.411(a).......................... Current Sec. 67.29(a).

67.411(b).......................... Current Sec. 67.29(b).

67.411(c).......................... Current Sec. 67.29(c).

67.413(a).......................... Current Sec. 67.31.

67.413(b).......................... New language.

67.415............................. New language.

Distribution Table

Current Section Revised Section

Subpart A

Section

67.1............................... Sec. 67.1.

67.3............................... Sec. 67.7.

67.11.............................. Sec. 67.3.

67.12.............................. Sec. 67.5.

67.13(a)........................... Sec. 67.101.

67.13(b)........................... Sec. 67.103.

67.13(c)........................... Sec. 67.105.

67.13(d)........................... Sec. 67.107 and Sec. 67.109.

67.13(e)........................... Sec. 67.111 and Sec. 67.113(b).

67.13(f)........................... Sec. 67.113.

67.13(g)........................... Sec. 67.115.

67.15(a)........................... Sec. 67.201.

67.15(b)........................... Sec. 67.203.

67.15(c)........................... Sec. 67.205.

67.15(d)........................... Sec. 67.207 and Sec. 67.209.

67.15(e)........................... Sec. 67.211.

67.15(f)........................... Sec. 67.213.

67.15(g)........................... Sec. 67.215.

67.17(a)........................... Sec. 67.301.

67.17(b)........................... Sec. 67.303.

67.17(c)........................... Sec. 67.305.

67.17(d)........................... Sec. 67.307 and Sec. 67.309.

67.17(e)........................... Sec. 67.311.

67.17(f)........................... Sec. 67.313.

67.17(g)........................... Sec. 67.315.

67.19.............................. Sec. 67.401.

67.20.............................. Sec. 67.403.

Subpart B

Section

67.21.............................. Sec. 67.1.

67.23.............................. Sec. 67.405.

67.25.............................. Sec. 67.407.

67.27.............................. Sec. 67.409.

67.29.............................. Sec. 67.411.

67.31.............................. Sec. 67.413.

List of Subjects

14 CFR Part 61

Aircraft, Airmen, Alcohol abuse, Drug abuse, Recreation and

recreation areas, Reporting and recordkeeping requirements.

14 CFR Part 67

Airmen, Delegations of authority (Government agencies), Health,

Medical standards and certification procedures, Reporting and

recordkeeping requirements.

The Amendments

In consideration of the foregoing, the Federal Aviation

Administration amends parts 61 and 67 of Title 14 Code of Federal

Regulations (14 CFR parts 61 and 67) as follows:

PART 61--CERTIFICATION: PILOTS AND FLIGHT INSTRUCTORS

1. The authority citation for part 61 continues to read as follows:

Authority: 49 U.S.C. 106(g), 40113, 44701-44703, 44707, 44709-

44711, 45102-45103, 45301-45302.

2. Section 61.23 is amended by revising paragraphs (a)(3), (b)(2),

and (c) to read as follows:

Sec. 61.23 Duration of medical certificates.

(a)-* * *

(3) The period specified in paragraph (c) of this section for

operations requiring only a private, recreational, or student pilot

certificate.

(b)-* * *

(2) The period specified in paragraph (c) of this section for

operations requiring only a private, recreational, or student pilot

certificate.

(c) A third-class medical certificate for operations requiring a

private, recreational, or student pilot certificate issued--

(1) Before September 16, 1996, expires at the end of the 24th month

after the month of the date of examination shown on the certificate.

(2) On or after September 16, 1996, expires at the end of the:

(i) 36th month after the month of the date of the examination shown

on the certificate if the person has not reached his or her 40th

birthday on or before the date of the examination; or

(ii) 24th month after the month of the date of the examination

shown on the certificate if the person has reached his or her 40th

birthday on or before the date of the examination.

3. Section 61.39 is amended by revising paragraph (a)(3) to read as

follows:

Sec. 61.39 Prerequisites for flight tests.

(a)-* * *

(3) Hold a current medical certificate appropriate to the

certificate the applicant seeks or, in the case of a rating to be added

to the applicant's pilot certificate, at least a current third-class

medical certificate issued under part 67 of this chapter;

* * * * *

4. Part 67 is revised to read as follows:

PART 67--MEDICAL STANDARDS AND CERTIFICATION

Subpart A--General

Sec.

67.1 Applicability.

67.3 Issue.

67.5 Certification of foreign airmen.

67.7 Access to the National Driver Register.

Subpart B--First-Class Airman Medical Certificate

67.101 Eligibility.

67.103 Eye.

67.105 Ear, nose, throat, and equilibrium.

67.107 Mental.

67.109 Neurologic.

67.111 Cardiovascular.

67.113 General medical condition.

67.115 Discretionary issuance.

Subpart C--Second-Class Airman Medical Certificate

67.201 Eligibility.

67.203 Eye.

67.205 Ear, nose, throat, and equilibrium.

67.207 Mental.

67.209 Neurologic.

67.211 Cardiovascular.

67.213 General medical condition.

67.215 Discretionary issuance.

Subpart D--Third-Class Airman Medical Certificate

67.301 Eligibility.

67.303 Eye.

67.305 Ear, nose, throat, and equilibrium.

67.307 Mental.

67.309 Neurologic.

67.311 Cardiovascular.

67.313 General medical condition.

67.315 Discretionary issuance.

[[Page 11257]]

Subpart E--Certification Procedures

67.401 Special issuance of medical certificates.

67.403 Applications, certificates, logbooks, reports, and -

records: Falsification, reproduction, or alteration; incorrect

statements.

67.405 Medical examinations: Who may give.

67.407 Delegation of authority.

67.409 Denial of medical certificate.

67.411 Medical certificates by flight surgeons of Armed Forces.

67.413 Medical records.

67.415 Return of medical certificate after suspension or

revocation.

Authority: 49 U.S.C. 106(g), 40113, 44701-44703, 44707, 44709-

44711, 45102-45103, 45301-45303.

Subpart A--General

Sec. 67.1 Applicability. -

This part prescribes the medical standards and certification

procedures for issuing medical certificates for airmen and for

remaining eligible for a medical certificate.

Sec. 67.3 Issue. -

Except as provided in Sec. 67.5, a person who meets the medical

standards prescribed in this part, based on medical examination and

evaluation of the person's history and condition, is entitled to an

appropriate medical certificate.

Sec. 67.5 Certification of foreign airmen. -

A person who is neither a United States citizen nor a resident

alien is issued a certificate under this part, outside the United

States, only when the Administrator finds that the certificate is

needed for operation of a U.S.-registered aircraft.

Sec. 67.7 Access to the National Driver Register. -

At the time of application for a certificate issued under this

part, each person who applies for a medical certificate shall execute

an express consent form authorizing the Administrator to request the

chief driver licensing official of any state designated by the

Administrator to transmit information contained in the National Driver

Register about the person to the Administrator. The Administrator shall

make information received from the National Driver Register, if any,

available on request to the person for review and written comment.

Subpart B -- First-Class Airman Medical Certificate

Sec. 67.101 Eligibility. -

To be eligible for a first-class airman medical certificate, and to

remain eligible for a first-class airman medical certificate, a person

must meet the requirements of this subpart.

Sec. 67.103 Eye. -

Eye standards for a first-class airman medical certificate are: -

(a) Distant visual acuity of 20/20 or better in each eye

separately, with or without corrective lenses. If corrective lenses

(spectacles or contact lenses) are necessary for 20/20 vision, the

person may be eligible only on the condition that corrective lenses are

worn while exercising the privileges of an airman certificate. -

(b) Near vision of 20/40 or better, Snellen equivalent, at 16

inches in each eye separately, with or without corrective lenses. If

age 50 or older, near vision of 20/40 or better, Snellen equivalent, at

both 16 inches and 32 inches in each eye separately, with or without

corrective lenses. -

(c) Ability to perceive those colors necessary for the safe

performance of airman duties. -

(d) Normal fields of vision. -

(e) No acute or chronic pathological condition of either eye or

adnexa that interferes with the proper function of an eye, that may

reasonably be expected to progress to that degree, or that may

reasonably be expected to be aggravated by flying. -

(f) Bifoveal fixation and vergence-phoria relationship sufficient

to prevent a break in fusion under conditions that may reasonably be

expected to occur in performing airman duties. Tests for the factors

named in this paragraph are not required except for persons found to

have more than 1 prism diopter of hyperphoria, 6 prism diopters of

esophoria, or 6 prism diopters of exophoria. If any of these values are

exceeded, the Federal Air Surgeon may require the person to be examined

by a qualified eye specialist to determine if there is bifoveal

fixation and an adequate vergence-phoria relationship. However, if

otherwise eligible, the person is issued a medical certificate pending

the results of the examination.

67.105 Ear, nose, throat, and equilibrium. -

Ear, nose, throat, and equilibrium standards for a first-class

airman medical certificate are:

(a) The person shall demonstrate acceptable hearing by at least one

of the following tests:

(1) Demonstrate an ability to hear an average conversational voice

in a quiet room, using both ears, at a distance of 6 feet from the

examiner, with the back turned to the examiner.

(2) Demonstrate an acceptable understanding of speech as determined

by audiometric speech discrimination testing to a score of at least 70

percent obtained in one ear or in a sound field environment.

(3) Provide acceptable results of pure tone audiometric testing of

unaided hearing acuity according to the following table of worst

acceptable thresholds, using the calibration standards of the American

National Standards Institute, 1969 (11 West 42d Street, New York, NY

10036):

------------------------------------------------------------------------

500 1000 2000 3000

Frequency (Hz) Hz Hz Hz Hz

------------------------------------------------------------------------

Better ear (Db)............................... 35 30 30 40

Poorer ear (Db)............................... 35 50 50 60

------------------------------------------------------------------------

(b) No disease or condition of the middle or internal ear, nose,

oral cavity, pharynx, or larynx that--

(1) Interferes with, or is aggravated by, flying or may reasonably

be expected to do so; or

(2) Interferes with, or may reasonably be expected to interfere

with, clear and effective speech communication.

(c) No disease or condition manifested by, or that may reasonably

be expected to be manifested by, vertigo or a disturbance of

equilibrium.

Sec. 67.107 Mental.

Mental standards for a first-class airman medical certificate are:

(a) No established medical history or clinical diagnosis of any of

the following:

(1) A personality disorder that is severe enough to have repeatedly

manifested itself by overt acts.

(2) A psychosis. As used in this section, ``psychosis'' refers to a

mental disorder in which:

(i) The individual has manifested delusions, hallucinations,

grossly bizarre or disorganized behavior, or other commonly accepted

symptoms of this condition; or

(ii) The individual may reasonably be expected to manifest

delusions, hallucinations, grossly bizarre or disorganized behavior, or

other commonly accepted symptoms of this condition.

(3) A bipolar disorder.

(4) Substance dependence, except where 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. As used in this section-- --

(i) ``Substance'' includes: Alcohol; other sedatives and hypnotics;

anxiolytics; opioids; central nervous system stimulants such as

cocaine, amphetamines, and similarly acting sympathomimetics;

hallucinogens;

[[Page 11258]]

phencyclidine or similarly acting arylcyclohexylamines; cannabis;

inhalants; and other psychoactive drugs and chemicals; and

(ii) ``Substance dependence'' means a condition in which a person

is dependent on a substance, other than tobacco or ordinary xanthine-

containing (e.g., caffeine) beverages, as evidenced by--

(A) Increased tolerance;

(B) Manifestation of withdrawal symptoms;

(C) Impaired control of use; or

(D) Continued use despite damage to physical health or impairment

of social, personal, or occupational functioning.

(b) No substance abuse within the preceding 2 years defined as:

(1) Use of a substance in a situation in which that use was

physically hazardous, if there has been at any other time an instance

of the use of a substance also in a situation in which that use was

physically hazardous;

(2) A verified positive drug test result acquired under an anti-

drug program or internal program of the U.S. Department of

Transportation or any other Administration within the U.S. Department

of Transportation; or

(3) Misuse of a substance that the Federal Air Surgeon, based on

case history and appropriate, qualified medical judgment relating to

the substance involved, finds--

(i) Makes the person unable to safely perform the duties or

exercise the privileges of the airman certificate applied for or held;

or

(ii) May reasonably be expected, for the maximum duration of the

airman medical certificate applied for or held, to make the person

unable to perform those duties or exercise those privileges.

(c) No other personality disorder, neurosis, or other mental

condition that the Federal Air Surgeon, based on the case history and

appropriate, qualified medical judgment relating to the condition

involved, finds--

(1) Makes the person unable to safely perform the duties or

exercise the privileges of the airman certificate applied for or held;

or

(2) May reasonably be expected, for the maximum duration of the

airman medical certificate applied for or held, to make the person

unable to perform those duties or exercise those privileges.

Sec. 67.109 Neurologic.

Neurologic standards for a first-class airman medical certificate

are:

(a) No established medical history or clinical diagnosis of any of

the following:

(1) Epilepsy;

(2) A disturbance of consciousness without satisfactory medical

explanation of the cause; or

(3) A transient loss of control of nervous system function(s)

without satisfactory medical explanation of the cause.

(b) No other seizure disorder, disturbance of consciousness, or

neurologic condition that the Federal Air Surgeon, based on the case

history and appropriate, qualified medical judgment relating to the

condition involved, finds--

(1) Makes the person unable to safely perform the duties or

exercise the privileges of the airman certificate applied for or held;

or

(2) May reasonably be expected, for the maximum duration of the

airman medical certificate applied for or held, to make the person

unable to perform those duties or exercise those privileges.

Sec. 67.111 Cardiovascular.

Cardiovascular standards for a first-class airman medical

certificate are:

(a) No established medical history or clinical diagnosis of any of

the following:

(1) Myocardial infarction;

(2) Angina pectoris;

(3) Coronary heart disease that has required treatment or, if

untreated, that has been symptomatic or clinically significant;

(4) Cardiac valve replacement;

(5) Permanent cardiac pacemaker implantation; or

(6) Heart replacement;

(b) A person applying for first-class medical certification must

demonstrate an absence of myocardial infarction and other clinically

significant abnormality on electrocardiographic examination:

(1) At the first application after reaching the 35th birthday; and

(2) On an annual basis after reaching the 40th birthday.

(c) An electrocardiogram will satisfy a requirement of paragraph

(b) of this section if it is dated no earlier than 60 days before the

date of the application it is to accompany and was performed and

transmitted according to acceptable standards and techniques.

Sec. 67.113 General medical condition.

The general medical standards for a first-class airman medical

certificate are:

(a) No established medical history or clinical diagnosis of

diabetes mellitus that requires insulin or any other hypoglycemic drug

for control.

(b) No other organic, functional, or structural disease, defect, or

limitation that the Federal Air Surgeon, based on the case history and

appropriate, qualified medical judgment relating to the condition

involved, finds--

(1) Makes the person unable to safely perform the duties or

exercise the privileges of the airman certificate applied for or held;

or

(2) May reasonably be expected, for the maximum duration of the

airman medical certificate applied for or held, to make the person

unable to perform those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon,

based on the case history and appropriate, qualified medical judgment

relating to the medication or other treatment involved, finds--

(1) Makes the person unable to safely perform the duties or

exercise the privileges of the airman certificate applied for or held;

or

(2) May reasonably be expected, for the maximum duration of the

airman medical certificate applied for or held, to make the person

unable to perform those duties or exercise those privileges.

Sec. 67.115 Discretionary issuance.

A person who does not meet the provisions of Secs. 67.103 through

67.113 may apply for the discretionary issuance of a certificate under

Sec. 67.401.

Subpart C--Second-Class Airman Medical Certificate

Sec. 67.201 Eligibility.

To be eligible for a second-class airman medical certificate, and

to remain eligible for a second-class airman medical certificate, a

person must meet the requirements of this subpart.

Sec. 67.203 Eye.

Eye standards for a second-class airman medical certificate are:

(a) Distant visual acuity of 20/20 or better in each eye

separately, with or without corrective lenses. If corrective lenses

(spectacles or contact lenses) are necessary for 20/20 vision, the

person may be eligible only on the condition that corrective lenses are

worn while exercising the privileges of an airman certificate.

(b) Near vision of 20/40 or better, Snellen equivalent, at 16

inches in each eye separately, with or without corrective lenses. If

age 50 or older, near vision of 20/40 or better, Snellen equivalent, at

both 16 inches and 32 inches in each eye separately, with or without

corrective lenses.

(c) Ability to perceive those colors necessary for the safe

performance of airman duties.

(d) Normal fields of vision.

(e) No acute or chronic pathological condition of either eye or

adnexa that

[[Page 11259]]

interferes with the proper function of an eye, that may reasonably be

expected to progress to that degree, or that may reasonably be expected

to be aggravated by flying.

(f) Bifoveal fixation and vergence-phoria relationship sufficient

to prevent a break in fusion under conditions that may reasonably be

expected to occur in performing airman duties. Tests for the factors

named in this paragraph are not required except for persons found to

have more than 1 prism diopter of hyperphoria, 6 prism diopters of

esophoria, or 6 prism diopters of exophoria. If any of these values are

exceeded, the Federal Air Surgeon may require the person to be examined

by a qualified eye specialist to determine if there is bifoveal

fixation and an adequate vergence-phoria relationship. However, if

otherwise eligible, the person is issued a medical certificate pending

the results of the examination.

Sec. 67.205 Ear, nose, throat, and equilibrium.

Ear, nose, throat, and equilibrium standards for a second-class

airman medical certificate are:

(a) The person shall demonstrate acceptable hearing by at least one

of the following tests:

(1) Demonstrate an ability to hear an average conversational voice

in a quiet room, using both ears, at a distance of 6 feet from the

examiner, with the back turned to the examiner.

(2) Demonstrate an acceptable understanding of speech as determined

by audiometric speech discrimination testing to a score of at least 70

percent obtained in one ear or in a sound field environment.

(3) Provide acceptable results of pure tone audiometric testing of

unaided hearing acuity according to the following table of worst

acceptable thresholds, using the calibration standards of the American

National Standards Institute, 1969:

------------------------------------------------------------------------

500 1000 2000 3000

Frequency (Hz) Hz Hz Hz Hz

---

This text is long and has been trimmed here. Open the source document for the complete record.