New FAA medical policy – fixing a problem that doesn’t exist

In a recent newsletter for AMEs, Federal Air Surgeon Fred Tilton said he hoped his readers had a “really scary Halloween.” Nothing could be as scary as what he had to say next. In describing a new policy on obstructive sleep apnea (OSA) that will soon take effect, Tilton basically put pilots on notice that if you’re too fat you might lose your medical. There’s no other way to read this outrageous proposal.

Sleep apnea
Have sleep apnea? Get ready to pay up or quit flying.

Specifically, pilots who have a Body Mass Index (BMI) over 40 and a neck circumference of 17 inches or more will be required to undergo further testing with a sleep specialist–at their own expense. If they are found to have OSA, pilots will have to receive treatment before they can renew a medical certificate. Again, this would be paid for by pilots. AOPA estimates this could affect nearly 125,000 pilots–at a cost of $374 million.

Go ahead, calculate your BMI. If it’s over 40, you should be worried. But if you’re under 40, you can’t relax either. As if the basic proposal wasn’t scary enough, Tilton mentions that “we will gradually expand the testing pool by going to lower BMI measurements.” The FAA’s aeromedical branch seems intent on having a BMI on file for every pilot–a thought that should frighten us all.

The obvious question is: to what end? What safety improvement could possibly be worth the hassle and expense of this? There is none, and Tilton doesn’t really try to make an argument for one. Indeed, this seems to be a classic case of the FAA fixing a problem that simply doesn’t exist (see the ECi cylinder AD for another example). The FAA’s own study of nearly a decade of aviation accidents found zero crashes where OSA was a factor. A quick reading of the NTSB database or a survey of your pilot friends would come up with the same answer. While being overweight and living with OSA may be bad things, it’s only an issue for the FAA if it affects flight safety.

EAA’s letter sums it up best: “FAA’s charge is to protect the flying public, not to practice predictive medicine or further public health policy.” But this is the problem of the bureaucracy. The only incentive is to make more rules, close more non-existent loopholes and cover your rear end. There’s no attempt to balance costs and benefits.

At a time when most pilots are debating whether the third class medical should even exist, the FAA seems to be doubling down on it. Rarely has the FAA and the airmen it regulates been further apart on an issue.

Both AOPA and EAA were quick to respond, as were most pilots. A battle is definitely brewing, but it’s unclear what comes next. This was not released as a notice of proposed rulemaking and there seems to be no attempt to solicit input from pilots. Right now it looks like this policy will simply be enforced by AMEs, starting very soon.

We have real safety problems to address in general aviation–this is not one of them. This is a stimulus package for AMEs and a massive overreach by the nanny state. Not one life will be saved next year because of this.

It’s time for pilots to fight back. Let’s kill this ridiculous policy, but let’s not stop there. This latest stunt shows just how dangerous it is to give the FAA any say over the health of a private pilot. It’s time to get rid of the third class medical once and for all.

50 Comments

  • ” This is a stimulus package for AMEs and a massive overreach by the nanny state. Not one life will be saved next year because of this.”

    Anyone who knows the aviation industry worldwide understands that aviation demonstrates American Freedom likely more than any other endeavor. This administration seems to understand this and is determined to level the field.

    • Not a stimulus package for AMEs. Anyone who has a special issuance, which obstructive sleep apnea requires, is more work for the AME. More out of a pilot’s pocket, though.

    • You are obviously uninformed. As a senior AME, I can tell you that I make no more with this proposal. It also, obviously doesn’t make you more likely to see an AME.
      What it does do is address one of the core symptoms of obstructive sleep apnea;
      Excessive daytime somnolence. If excessively sleepy pilots doesn’t worry you, then maybe you should reevaluate your priorities.
      Now, if on the other hand you want to construct a valid cost-benefit analysis as to the cost of excessive daytime somnolence, potential health risks and the costs associated with a sleep study and treatment….
      I would put forth the proposition, that it is very difficult to measure the impact of OSA on health, safety and pilotage, but it should not be summarily dismissed. Think back to smoking and flying. Many of our legacy aircraft had built in ashtrays when built. Very few would argue that smoking while flying is a great idea now…

  • Clue me in here a little. If the third class medical is abolished, does that mean all of those pilots then would need second class medicals, or none at all? If none, then why would we need the LSA license classification? I think LS pilots only need a valid driver’s license. All of those pilots who lost medicals (who wanted to) could still fly.

    • John. The Sport Pilot regulation states that if you lose your medical, you can’t become a sport pilot. In a separate but related subject, the petition to relax the requirements for a third class medical, made by the EAA and AOPA, was just ignored by the FAA.

      • In addition, the FARs say that (regardless of whether you fly under Sport Pilot medical rules), that if you have a known disqualifying medical condition, or SHOULD have known your medical condition is disqualifying, you cannot legally fly.

        • The EAA and AOPA were not asking for just a relaxation of FAA regs. They were asking to eliminate the 3rd class medical in exchange for limiting such pilots to, essentially, Recreational Pilot standards with medical self-certification. I doubt that every such pilot, with, perhaps as many as 3-4 “disqualifying conditions,” for which the pilot has special issuances, would never carry more than one passenger and never fly a plane with more than 180 HP. Self-certification for someone with multiple disqualifying conditions is not a good idea. Also, a special issuance is rescinded if there is any change in the status of the condition for which the pilot has a special issuance.

          • This all assumes that the Third Class medical is solving some problem. I haven’t seen anything that convinces me of that. It’s purely a game to be played.

    • John, if you loose you medical, you can’t fly Light Sport either. Flunk that physical, and you are toast when it comes to flying.

    • If the third class medical goes away, there will be a lot of pilots flying around who formerly had special issuances for multiple health problems. Should a pilot with type II diabetes, high blood pressure, and two coronary artery stents be self-certifying?

    • I doubt that the 3rd class medical will disappear. What might be reasonable would be to gradually go from a 5-year medical certificate (current interval for those <age 40) to the 2-year certificate at age 40. Starting at age 40, change to a 4 year certificate, 3 year certificate at age 45, and 2 year at age 50. Would that make sense? Also, remember that for nearly all of the "disqualifying conditions" a special issuance can be obtained by jumping through the FAA hoops. Another consideration might be to require sleep studies for only class 1 and 2 medical certificates, since pilots holding those medical certificates are the ones carrying passengers for hire. Just supposing.

  • It is my opinion that the current Administration is against GA for ideological reasons. They see GA as a hobby, and business resource, of the rich and privileged. It plays well in the “class warfare” theme of the current Administration. Remember the campaign against “tax breaks for corporate jets”? (In reality the argument was about 5 vs 7 years depreciation) That, from the man who flies the most expensive corporate jet in the world, on the taxpayers’ dime. It is time to wake up and realize that Obama and Huerta are the enemies of GA, and intend to choke us out of existence with senseless regulations, just for ideological reasons. We pilots seem to be too free, and seem to have too much disposable income, for their liking.

    • Aviation in the US can’t survive without a steady pumping of money from the military or the FAA. The aviation industry has gotten like an obese person that needs a machine to keep breathing.

      How would you like to have user pays for all GA activity? Costs of flying would triple

    • Cannot agree more with you. This administration and its boss have declared that liberty, freedom and flying should not exist. As user fees have such an opposition in congress, they try to distroy aviation through another avenue. This one is too diminish the number of pilots and the influence of AOPA. When will pilots realize what is going on and decide that enough BS is enough.
      EK

      • EK, I think it’s wishful thinking to simply pin this on Obama. It’s much deeper than that. The bureaucracy hangs around no matter who is in the White House, and they are always thinking up new ways to make their jobs look important and make our lives more difficult.

        • John,
          Agree with you completely. Bureaucracy is dangerous and bad for all citizens. We are heading on a very dangerous path. The keys of liberty, freedom in various ways will be thrown away without a doubt. Some countries have lived through it and it took great sacrifices to change back.
          Indeed our lives will soon be rendered very very difficult to the profit of the Nomenclatura that is being established around the world.
          EK

  • Plain and simple, this will require Congressional action. Now that’s an interesting concept. Any Congressman who goes on record in favor of eliminating medical certificates for not-for-hire flying will be accused of imperiling the public safety.

    Each year, a LOT of collisions are caused by drivers who fall asleep at the wheel. But the FAA has NO evidence of similar incidents with pilots in aircraft.

    The only way to get John Q Public on our side (and allow their Congressmen to advocate on our behalf), will be to threaten every “fat driver” with the loss of their driver’s licenses – unless/until they submit to a multi-thousand-dollar regimen of OSA diagnosis and treatment. Yearly. What could be more reasonable – right?

    • I think that this has already been proposed for those with CDL’s (Commercial Drivers License) but that the trucker’s union stepped in and quashed it.

    • Something will happen with the BMI situation. For a couple of years, the formula for calculating BMI has been in the AME Guide, available online at faa.gov for anyone to see.

  • It will only get worse. As a truck driver I had to submit to this for my DOT medical already. And remember DOT and FAA are both under the same federal department.

  • It’s not fair that the FAA is trying to implement something of this sort to create a “safer” pilot. It’s my opinion that they [FAA] could create a safer pilot through education.
    For example, it’s probably not on their priority list at all to change the FAA written exams. Especially the private pilot one. I’m sure if there was a study done comparing accidents/incidents related to GPS and Autopilot misuses to pilots who have fallen asleep while flying, one would find that the GPS related incidents were substantially higher and possibly more fatal.
    They like to call it pilot error and teach us about controlled flight into terrain. [CFIT]

  • The FAA have no idea

    That being said ‘murica is the fattest country on the planet, I wouldn’t fly with a pilot who needed medicine or mechanical device to keep breathing.

  • I just calculated my BMI to get to 40 I would need to increase my weight by 50%. I am 174cm tall and weight 82Kg and would need to go to 122Kgs to get over 40. To put on 40Kgs I have to do some seriously unhealthy eating.

    • I think you hit the nail squarely. I’ve seen some pilots climb into their aircraft and I have to wonder how they don’t have a heart attack enroute. When 1/3 of adults in the US are reported as obese, this proposed rule makes very good sense. The message is clearly: Pilots, flying is a privilge, not a right. This is especially true if we carry passengers who depend on us to survive the landing.

      • Okay, John, but what about all the obese automobile drivers? I bet they aren’t brave enough to require this for them. The govenment only picks on the little guy because we don’t have enough clout to stop them. Even old skinny you are going to eventually be evaluated under this rule. By the way, I know a lot of skinny guys that have had heart attacks too.

      • @ John,
        Your premise is faulty, as the FAA is proposing that BMI be used as the sole metric for determination of whether a pilot could suffer from OSA. There are plenty of people who have a BMI over 40 and who are fantastically fit. Again the issue is there are no proven incidents of OSA causing an accident and the FAA is using a single metric as an indicator of OSA. The logic chain is seriously broken on this one….

        FAA = Fail

  • I am 6’4″ and 225 lbs; nowhere near a 40 BMI. But I have a 17″ neck. I would consider a 17″ neck nothing more than an average size. This is a ridiculous standard. The only people on the planet able to meet this standard will be the ones starving to death in Africa.

    • I completly agree with you Mike,i’m 6-3 260 with almost 17” neck too. FAA can not tell me that i can’t fly because of that, or that i have a BMI above 40, although i have 30. this is B.S if they allow it.

    • Both a BMI of 40 or more AND a 17 inch neck would be needed.
      The FAA does not consider decisions like this in a vacuum. Objective, controlled medical studies at medical institutions always play a role in FAA medical institutions.

      • True, but they have never heard of a cost/benefit analysis. It’s all about closing minute loopholes. Can we ask if there’s a problem before we set off on these crusades?

  • Personally, I’d be more worried if the state didn’t take away my medical if I had a BMI of over 40..
    Though I agree, the link between obesity and flight safety is tenuous. At a BMI of 40+ I’d imagine it’d be more of a weight and balance issue..

    • Hi Nick, I respectfully disagree with your statement. “Personally, I’d be more worried if the state didn’t take away my medical if I had a BMI of over 40.” Driving is an extremely dangerous activity. Should driver’s licenses have a BMI requirement also? What about enacting a McDonald’s card that requires you to have a BMI of less than 40% to eat at a fast food restaurant, or all you can eat buffet. I was in Japan, and factory workers are required to perform a manual dexterity check before clocking in for the day. Maybe we should require integrated simulators in all aircraft that makes you perform a check before you can start the engine. It is time to draw a line in the sand and say no to this intrusion by the Feds.

  • While this affects us, the root problem is the lack of reality and the proper thought process of the government bureaucrats. Where is the application of some of the most famous words of one of our founding fathers, Thomas Paine, “…Common Sense.”

    Expand your research and you will note that the FAA is increasingly saying NO more and more rather than providing a yes answer to simple requests. We have to prove them wrong before they say yes to anything (some inspectors are fortunately just the opposite, but those Professionals are sadly decreasing in numbers). That is the mentality in the beltway for everything, not just the FAA. How long does it take for a Veteran to get care at the VA?

    The following is an example of the FAA. With an aircraft that is to be operated in RVSM airspace in the NAT, WATRS, and domestic US, one needs Letters of Authorization (LOA’S). Lets see, the aircraft has been certified as RVSM capable, has a current Airworthiness certificate, has the RVSM certified equipment on board, current 91.411 and 91.413, and the crew is current and trained. Oops, takes months to get the LOA’s. If the submission has a spelling error, it gets rejected. One submits it again, but it goes to the bottom of the pile. The result, longer trip times and increased fuel use, so I guess the FET tax program benefits.

    Certainly, medical issues are critical, but how many occurrences, i.e., accidents/incidents have occurred due to medical issues? Not enough to statistically be measurable.

    If this BMI trash continues, what will be the “new limit?” Then what will be the next issue? We already have hearing, sight, blood and urine limits (and EKG’s for us 1st class med holders). What is going to be next, lifting limits, arm and force standards for flight controls? In summary, the mentality is for them to say no to everything thing we do and it will become our struggle to prove them wrong. In my case, I am 6 feet tall, 204 lbs and my BMI is 27.7, so I guess I am overweight and a threat.

    To all, be safe and have great flights.

      • A BMI of 40 is only the beginning, it will go lower and much like this rule in the first place the next lower numbers will be pulled out of some bureaucrats……..

  • No it can’t be the insane hours and work duty times why pilots are falling asleep in the cockpit. It must be something else. Lets blame it on being overweight. Leave it to the FAA to just skirt around the problem.

  • ANOTHER example of governmental over regulation. It is time to get involved, stand, and be counted. If we wait to get involved and take no action, our freedoms will be gone. This is discrimination. With no basis in fact, this is intrusion of personal privacy without cause. It is time that the liberty bell is rang loudly and we stand and fight.

  • Okay, now its REALLY time to kill the third class medical. Useless government over reach doesn’t begin to cover it. Let’s go AOPA, EAA and every other organization with an interest in general aviation. I’m in and I’ll put money into this project.

  • Pilots need to be very wary of a sleep apnea diagnosis. I consulted a neurologist two years ago who recommended a sleep study to address a chronic headache problem. I was diagnosed with very mild sleep apnea, and advised to use a CPAP machine. When I then tried to renew my 2nd class medical, I was told that to qualify I had to undergo a “meaningful wakefulness test”, to demonstrate that I was NOT going to go sleep during a normal day of flying. This involves sitting in a dimly lit room with NO stimulus whatsoever (you can’t read, listen to music, sing, or do anything other than just sit there quietly) without nodding off. Fortunately, I passed, but it cost thousands of dollars and considerable worry on my part. Of course, fatigue was not in any way a factor in my original diagnosis, nor has it been since. This proposal is to mitigate a problem that does not exist, except in the bored mind of some FAA medical professional with nothing else to do.

  • A request for the aviation attorneys out there:
    Please come up with some kind of legislation spelling out that the FAA will be responsible to pay all the testing costs for all airmen who are found not to have OSA. Do you think they will reconsider their position?

  • This was supposedly triggered by an airline crew falling asleep. If that’s the case, A) they need to fix the duty time rules, and B) why doesn’t this start with First Class medicals? I do not understand why they lumped Third Class private pilots in with airline pilots – it’s a totally different scenario.

  • I’ll just say that this is one more reason to pause before investing time and money into a medical, flight review, or aircraft purchase, especially if one has any medical issues at all or is “up-in-age.” Your investment can be taken from you at any moment by a government agency. The Nanny State is killing GA. You think Mr. Harley man or Corvette driver worries about losing his license? I think not.

  • This is just another example of bureaucrats being bureaucrats. Job security pure and simple. These people exist to write and revise new and existing laws and regulations.
    The result–more pilots flying without Medicals and/or Flight Reviews.
    If this is so important then everyone who drives a car or truck should be required to meet the same criteria. After all, there are many more cars, trucks and busses than airplanes–and many more crashes and deaths.

  • OK, this is not going to be popular. OSA is real. It causes clear impairment in function that is important to a pilot (car driver, machine operator, thinker etc.). If you have it you need to have it treated. Most folks after treatment can function normally. And yes it is more prevalent in people that are overweight, high BMI, and have large necks. Sorry this is a fact of life. The only thing you can argue about is should the testing be done drag net stile?
    Should we have similar standards for driving a car? You bet! biannual driver exams also.

    • Like most complicated issues, David, there are really a couple of different questions involved here. I agree that OSA is real and in severe cases it can be debilitating. But the beef here seems to be with the way the FAA is trying to find OSA–crude, expensive and intrusive. Then there’s the debate about how this policy was proposed.

      I think heart disease, cancer and lots of other medical issues are serious problems. But we have to be thoughtful about how we deal with them. Let’s not make the cure worse than the disease.

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