Bones, Joints, Muscles and Nerves

By Frank Anders, M.D.

Sport Aviation, December 1996

There is a considerable list of abnormalities which warrant denial of issuance of a medical certificate or deferral to the Aeromedical Certification Division, AAM-300 at which point special issuance will be considered. The "catch all" phrase used in describing the severity of these abnormalities is that "which may interfere with the performance of airman duties." These include:

• Amputation of any extremity or any portion thereof
• Atrophy of muscles that is progressive
• Deformities of either congenital or acquired
• Limitation of motion
• Tremors
• Curvature, ankylosis or other marked deformity of the spinal column
• Other disturbances of musculoskeletal function congenital or acquired.

All of which must be sufficient to interfere with performance of airman duties. Neuralgia or neuropathy chronic or acute, particularly sciatica, that may be likely to become incapacitating are disqualifying conditions which must be referred to AAM-300 for consideration. Amputations with or without prostheses are considered to be static defects and are best evaluated by means of a special medical flight test. Applications for certification of airmen with amputations are usually deferred for special issuance. If the applicant with an amputation is otherwise qualified, the FAA may issue a limited certificate. This certificate will permit the applicant to proceed with flight training until ready for a medical flight test. At that time, at the applicant's request, the FAA Special Issuance Branch will authorize a student pilot to make a medical flight test in conjunction with the regular flight test. The medical flight test and regular pilot flight test are conducted by an FAA Inspector. This affords the student the opportunity to demonstrate the ability to control the aircraft despite the handicap. The FAA inspector prepares a written report and indicates whether there is a safety problem. A medical certificate and Statement of Demonstrated Ability, without the student limitation, may be provided to the inspector for issuance to the applicant, or the inspector may be required to send the report to the FAA medical officer who authorized the test. When prostheses are used or additional control devices are installed in an aircraft to assist the amputee, those found qualified by special certification procedures will have their certification limited to require that the devices (and, if necessary, even the specific aircraft) must always be used when exercising the privileges of the airman certificate.

Arthritis, if it is symptomatic or requires medication (other than small doses of nonprescription anti-inflammatory agents), is disqualifying unless the applicant holds a letter from the FAA specifically authorizing the medical examiner to issue the certificate when the applicant is found otherwise qualified. Although the use of many medications on a continuing basis ordinarily prohibits the performance of pilot duties, under certain circumstances certification is possible for an applicant who is taking aspirin, ibuprofen (Motrin), Naproxen (Naprosyn), or other similar agents. Further consideration for medical certification is made by the FAA (not the medical examiner) if the applicant presents evidence documenting that the underlying condition for which the medicine is being taken is not in itself disqualifying and that the applicant has been on therapy long enough to have established that the medication is well tolerated and has not produced adverse side effects. If you request further consideration and, if certified by the FAA, limitations may be placed on your medical certificate and follow-up evaluations may be required.

A history of intervertebral disc surgery is not disqualifying if the applicant is without symptoms, has completely recovered from surgery, is taking no medication and has suffered no neurological deficit. Any class of medical certificate may be issued after intervertebral disc surgery if the applicant meets all the medical standards for that class following recovery from his surgery.

The paraplegic who's paralysis is not the result of a progressive disease process is considered in much the same manner as the amputee. His application is deferred to the FAA for consideration for special issuance. The applicant may be authorized to take a medical flight test along with the flight test for his pilot certificate. If successful, the limitation "Valid for Student Pilot Purposes Only" is removed from the medical certificate, but operational limitations may be added. A Statement of Demonstrated Ability is then issued.

Neurological disorders such as epilepsy and unexplained loss of consciousness are disqualifying as are post traumatic (i.e. head injury) neurological events, as well as a history of headaches, such as migraine or cluster headaches, which can become neurologically debilitating. Spasticity, weakness or paralysis of any extremity, is also disqualifying. These can be the result of some auto immune disease such as Lupus erythematois, Periateritis Nodosa and a host of others. Diseases causing neurological deficits which do not particularly involve the joints or muscles, such as Parkinson's disease, Alzheimer's disease and Huntington's disease are also disqualifying for medical certification. Infections of the nervous system as a result of meningitis, brain abscess, encephalitis or AIDS are disqualifying for medical certification. There are many other neurological conditions which may be disqualifying in addition to those listed, but it is my desire to get you on the right path to understand the underlying reason behind the regulations. If any of the neurological conditions subside and there is a prolonged symptom free period, the FAA can medically certify an airman through the Special Issuance Branch. It has been my observation in 15 years of experience as an Aviation Medical Examiner that the special issuance process gives the airman the benefit of the doubt in cases where the regulations leave room for discretion. Dr. Audie Davis, who has been in charge of medical certification for many years, has proven himself to me to be a staunch advocate for the pilot, both general aviation and commercial, without compromising his priority for safety. He will be sorely missed by myself, as well as many other examiners, following his retirement this year. We can only hope that his successor will be as fair in his handling of applicants as he.

Many physically disabled applicants have proven that their tenacity and skill can overcome their handicap by becoming licensed to pilot aircraft with hand controls and specially modified controls. There are hundreds of pilots with severe disabilities such as paraplegia, amputations, spina bifida and polio who are currently flying aircraft. They have formed an organization called International Wheelchair Aviators. Information concerning their organization and what it has accomplished and services offered follows.

Although IWA began in 1972 as just a monthly "fly to lunch" group of four paraplegic aviators from the southern California area, it has developed into a worldwide group of disabled and able bodied (A/B) pilots interested in aviation and flying. Members have many different disabilities including paraplegics, quadriplegics, amputees, multiple sclerosis, spinal bifida, polio and other problems. Through their hard work and persistence and with the help of a tolerant FAA medical system, hundreds have been given the opportunity to fly, many to resume flying careers and others to fly for the first time. Over the past 25 years, several hundred IWA members have flown thousands of hours all over the world and in many different types of aircraft using hand controls or whatever was necessary to operate the aircraft as pilot in command.

Some of the more newsworthy flights that have been flown by IWA members include the 1984 first round the world solo flight by paraplegic "Rode" Rodewald in his Comanche. This was a remarkable feat; he encountered all types of weather conditions and bureaucratic delays in most of the countries where he landed. In 1995, Antionio Mello became the second paraplegic person to fly around the world in his Bonanza. Para Ewald Tritscher came over from Austria, took instrument flying lessons form Mike Smith at Big Bear, CA then flew a six-month trip in a Cardinal down to the tip of South America and return with stops at most of the countries en route. Para Lee Hamilton flew his A-36 up over the magnetic north pole and back with stops in the far north. Many members have made flights across the U.S., into Mexico, up to Alaska and to the Caribbean Islands.

Although the majority of members fly primarily for enjoyment, many utilize their planes for transportation bypassing the regular pinched confines and schedules of the airlines. There are several members who are engaged in flying as a business. Para Mike Smith at Big Bear, CA operates "Aerohaven," a flight school offering instruction, charter and rental in Cessnas and Pipers. A twin engine Cessna 337 is included in the hand controlled fleet for those who wish to acquire multi-engine ratings. Para Keith Nunn operates "The Flying Nunn's" Flight School in Plattsburgh, NY, giving instruction in both Cessna and Piper aircraft. Para Richard Logan and past president A/B Mindy Desens own and operates "Lucky Mindy's" flight school in Litchfield, MN. Epps Flying Service in Atlanta, GA has hand controlled aircraft available and has been active in training disabled pilots. Para Leroy Diekman flies an A-36 as a corporate pilot in Indiana.

Several members are professional airshow performers and appear in events around the country. Para Brett Willatt owns "Sky Sailing" at Warner Springs, CA, gives flight instruction and flies a sailplane act throughout the U.S. Para Dan Buchanan flies an "Air Wave" hang glider at air shows. Para Steve Soper flew a twin engine Cessna 337 in an aerobatic act all over the U.S.

Quad Rick Amber operates "Challenge Air" flying all over the country taking hundreds of disabled kids up for free rides and getting various corporations and groups to participate. He has been so busy that he enlisted the aid of several of the members around the U.S. to help out with the flying. Denny Carney of Pennsylvania has been active for the past couple of years flying kids with spinal bifida. On the west coast, many of the able bodied and para members have flown with the annual "Eagle" flight giving thousands of disabled kids rides over Disneyland. In Oregon, A/B Dorothy Schick has formed "TakeWING, Inc." and is flying some of the disadvantaged in her Cessna 172. Sue Adler, para Andy Zavodney from Akron, OH and para Lee Hamilton from Dayton, NV belong to "Flying Samaritan" groups volunteering their planes and time to fly patients who have special needs to treatment centers where they can receive care.

Former airline captain Mike Penketh recently lost both hands and replaced them with myoelectric prosthesises. He has regained his medical and is back in the air flying a 300 HP Zlin 50 in the air show circuit! Sheri Marshall uses an artificial limb to replace an arm she lost and gives flight instruction in Kentucky. Jim Finch lost both legs and uses a hand control to fly around the Midwest. There are many other amputees who are enjoying the rewards and challenges of flight and life.

IWA helps disabled persons in their quest to fly by providing valuable information about FAA medical requirements, hand control availability and flight schools that work with the disabled. IWA also provides a current listing of over 200 handicapped pilots, their injury, type of plane flown, hand control use, telephone and address.

By joining IWA, you become a member of this elite group and can share in their enthusiastic flying experiences reading the bi-monthly newsletter and by personal contact at monthly fly-ins. You will benefit from their years of experience in flying and the work they've done over the years lifting the flight restrictions. It can be extremely helpful to new pilots to contact someone with a similar disability and see how they overcame it. To join IWA, simply call, write or e-mail: International Wheelchair Aviators, Mike Smith, Secretary, P.O. Box 2799, Big Bear, CA 92314, phone: 909-585-9663, fax: 909-585-7156, e-mail: aero.haven@bigbear.net.

1996 marks the 30th year that I have been a licensed pilot and the joy of flying burns brighter in my spirit now than it did then. My respect and admiration for those with physical disabilities who go the extra mile to leap through all the hoops necessary for medical certification cannot be overstated. As always, keep 'em flying safely.