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

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/fr%3A96-6358

## Record

- **Collection:** Federal Register
- **Document type:** Rule
- **Published:** March 19, 1996
- **Citation:** 61 FR 11238

## Text

[[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

[Text truncated at 120,000 characters. The full text is on the page linked above.]

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A96-6358. Public record. Not legal advice.