Medical X
5 min read

One sunny afternoon in mid-June I grabbed a letter out of my mailbox. The return address sent a shiver down my spine: FAA Office of Aerospace Medicine in Oklahoma City, OK. I had no particular reason for concern, as I had a valid third class medical, which had just been renewed the previous September. Also, I have a practical joker friend who might pull off this exact stunt… I know, since I did the same thing to him before. He once got a letter from “Stephen Dickson” with a downloaded logo and everything, accusing him of environmental mayhem for spewing avgas across central Oklahoma when he had a fuel-line leak in his Mooney.

Pilot medical certificate

A precious commodity for most pilots.

But no, this one looked legit. And seemed more frightening. “Our Quality Assessment Program within the Aeromedical Certification Division had the opportunity to review your medical certification on file. Based upon our review of this information, we are unable to establish your eligibility to hold an airman medical certificate at this time.” I knew this had to be real… my friend could never string together those words in such an ominous way.

This initial letter was not a revocation of my certificate, but it did say I had 60 days to respond or face other legal action. So action I did take!

But first, some background. In 2012 I was diagnosed with a bladder condition known as interstitial cystitis. It’s a chronic condition that can have different effects on different people, but for me mostly just mild discomfort that I have managed easily with a drug called Elmiron. As time rolled around for each of my medical exams, I always made sure this medication wasn’t on the “no fly” list and my exams were not a problem.

When BasicMed became a reality, I decided that since it suits my flying perfectly, I would just go with that option and kiss the third class medical goodbye forever. This worked great until 2019, when I had the opportunity to participate in an FAA altitude training session using the PROTE system (Portable Reduced Oxygen Training Enclosure). They were offering this at our annual Mooney Summit safety seminar; the only catch was you had to have an FAA medical certificate to participate. (The logic behind this was never clear, but I’m sure a lot of lawyers were involved in the decision.) So back I went to the AME and emerged an hour later, class three docs in hand.

Fast forward now to nine months later and the letter referenced above. My first reaction was, I’m sure, similar to thousands of others who have received such a notice: “What the —-?” So I placed a call to my AME, who through coincidence also happens to be my personal physician and is well aware of my condition. He was also surprised, as there was nothing in his exam which would indicate any issues… and he had also ensured that Elmiron was not on any list.

But we went through the required repeat exam and he quickly sent in all the paperwork to his contacts to seek a resolution. And to their credit, in less than a week the FAA responded. Many folks reading this may be familiar with the language:

“The medical evidence reveals a history of [name your condition here]. You are ineligible for medical certification under Title 14 [blah blah blah lots of CFR codes that you’ll have to look up for yourself if you want to know what we’re really saying]. I have determined, however, that you may be granted Authorization for special issuance of the enclosed third-class medical…” at which point I breathed a sigh of relief and stopped reading for a moment.


Sometimes it really is worth reading the fine print.

But this is where the story takes a twist. Reading through the rest of the letter, the FAA finally explained why all this happened in the first place. Apparently, some time in 2019 evidence arose that prolonged use of Elmiron has the potential to cause macular degeneration and serious eye problems. So the Special Issuance simply requires that I complete a thorough eye exam and present the results for continuation each year.

The FAA had learned of this issue with Elmiron, and through its database of medical information was able to identify all pilots with my similar history. And if I ignored the stress-induced drinking binge this episode caused (okay, really just one double gin and tonic) I could see that the FAA was actually looking out for me. What a concept! Because I’ll be honest, I had been on the drug so long that I wasn’t paying attention to news and might never have learned of the potential new side effects of this drug.

The story ends mostly where it began. I had the eye exam with no drama, I do have a third class medical, and when that expires my Special Issuance will transfer over to BasicMed and that’s probably where I’ll stay for the rest of my flying days. And I will continue to get the regular eye exams because… you know… blindness.

Thus I can acknowledge that even though it may not always seem so, the FAA sometimes really does have our best interests in mind. The next time you get that letter from our Favorite Aviation Acronym, take a deep breath and hope for the best. But keep the bottle of gin handy just in case!

Jeff Schlueter
Latest posts by Jeff Schlueter (see all)
19 replies
  1. Rivegauche610
    Rivegauche610 says:

    Seems like an anomaly considering their motto seems to be, and is proven over and over again, “we’re not happy till you’re not happy.”

    • Jeff Schlueter
      Jeff Schlueter says:

      Hey Jud…glad you liked the story. We SHOULD do another fly out, but if we chose Jekyll again that would be all of about six minutes for me since I’m at Amelia Island now! Cheers!

  2. William Campbell
    William Campbell says:

    Sometimes I wonder who is reviewing the submissions to CAMI. I have my own story which I won’t share but left me shaking my head. Great article.

  3. Stephen Leonard
    Stephen Leonard says:

    This has been a particularly tough year for the FAA Office of Aerospace Medicine, as it has for everyone. Lots of staff were out sick, most of the rest were working remotely from home, they had more than the usual turnover of physicians and support staff in 2019. And then Amazon opened a regional fulfillment center in Oklahoma City, went on a big hiring spree offering much higher salaries than the government, and many of the experienced non-physician analysts at the medical certification division left to go work for Jeff Bezos, leaving the FAA to scramble to try to hire and train new analysts. The combined result has been delays in processing applications and some weird letters from FAA to pilots.

    The good news is that the new Federal Air Surgeon, Dr. Susan Northrup, has made it her business to clean up the whole process. She’s a star — she was an Air Force flight surgeon, retiring as a full Colonel. She was the Regional Flight Surgeon for the FAA Southern Region for years (and a pleasure to work with when I was an AME in Atlanta). She’s also a private pilot, married to a retired airline captain, they own two warbirds, and her husband and son are both long-time EAA members. So she gets it.

    Look for things to get better.

  4. Marc Harris
    Marc Harris says:

    Glad you had a good experience with FAA CAMI.

    Unfortunately, I have been communicating with them for over 5 months. After sending them initial information in complete compliance with one of their worksheets, the FAA has replied twice with demands for additional information.
    The process seems to be never-ending… every time the requested information is provided, the FAA responds with demands for additional information. One person in Oklahoma City was kind enough to grant me a 60-day extension to the date my response was required.
    This has placed a significant burden on the doctors who need to provide extremely detailed and often irrelevant information. They place very little credence on the AME who usually better knows the applicant’s condition and is in a better position than someone who has never seen the applicant but is hopefully, maybe, probably not reviewing over a hundred pages of medical records, physician’s notes, hospital records, and test results.
    When I contacted the AOPA for assistance, their answer was, “Just give them what they want.” Which is what I’ve been doing but it never seems to be enough.

  5. Larry
    Larry says:

    This blatantly underscores that no pilot should take a medical any higher than the minimum required for the type of flying they’re doing. And, pilots need to carefully pick the AME they’re working with. I had a non-pilot type who used AME exams as an extra revenue stream so he could buy things on eBay. His nurse did most of the work and paperwork and screwed something up on my last exam resulting in a letter saying that I could keep my medical THIS time but NEXT time, I was gonna have to jump thru hoops while juggling water. Fortunately, Basic Med popped up and I’ve been breathing easier while simultaneously getting better personal treatment from my regular doctor. It’s the best thing that has happened for recreational pilots in the 50 years I’ve been aviating.

    I fail to understand what the FAA is doing over-regulating pilots who fly recreationally in simple Class I airplanes. We can drive a gigantic RV at high speed but can’t fly a C150? Huh?? In like manner, they over regulate the maintenance on certificated airplanes flown the same way. I can maintain a 300mph SX300 but can’t maintain a C150. Given the description of their ‘dire’ employee circumstances described by Stephen, I don’t trust them one bit to make a logical and reasonable decision on anything. We all know that they and their lawyers will see to it that they badger us all until we give up … which IMHO is their real end goal.

    I’m glad for Jeff — THIS time — but he’d be humming a different tune if they failed to give him that special issuance. He’d be done forever had they not. I suspect they couldn’t manufacture enough gin if THAT happened ?

  6. Marc Harris
    Marc Harris says:

    “And then Amazon opened a regional fulfillment center in Oklahoma City, went on a big hiring spree….”

    Sorry, Stephen, I don’t buy this at all.
    If the FAA stopped over-regulating and second-guessing AME’s, they could do with a lot less staff. But no one wants to see their organizations and budgets decrease.
    In my case, the doctors who took the time to answer the FAA’s additional questions – and two of them were Chiefs of their departments at major medical centers – were surprised at the detail the FAA required and doubted that anyone would read it or could reach a decision based on all the historical, clinical material they wanted. Especially surprised was the doctor who had already provided previously demanded information.
    My AME was especially surprised but felt powerless to do anything about it.
    I am very skeptical that anything will improve. The more people who choose BasicMed, the more work will have to be generated by pilots applying for Medical Certificates. Bureaucracies have a very well-defined instinct for self-survival.

    • Larry
      Larry says:

      The Favorite Aviation Acronym … making simple stuff hard since 1958. We’re being over regulated by an iatrarchy as if we’re all flying A380’s ! (Google it).

    STEVEN says:


    Did you ever consider asking your doctor for an alternative medicine that wouldn’t have the potential for damaging your eyesight? It seems to me that’s even more important than keeping your flying privileges.

    • Jeff Schlueter
      Jeff Schlueter says:

      The other options right now are really just antihistamines, and they are definitely on the no-fly list. It would be great if those were possible, since Elmiron is frighteningly expensive due to a limited population that needs it. But as with flying in general, all we can do is manage risk and track progress.

  8. Gennaro Avolio
    Gennaro Avolio says:

    I take a slightly different view. Is macular degeneration a condition that is going to strike suddenly and could surprise you out of the blue while you are flying? I think not. Why not wait until the next physical and see if the applicant has impaired vision? Is the FAA concerned with safety or your health? I’m sure there is a flaw in my reasoning that several will point out. I’m looking forward to reading responses.

    • Jeff Schlueter
      Jeff Schlueter says:

      Indeed, MD doesn’t strike suddenly, but if you aren’t looking out for it every year then it can sneak up on you. And that was really the point of my article; whatever the actual intentions of the FAA, the fact is that in this instance they did me a favor and alerted me to a situation that otherwise I might now have considered.

  9. John
    John says:

    I received a letter from the FAA Office of Aerospace Medicine with that frightening statement “we are unable to establish your eligibility to hold an airman medical certificate at this time.” Was surprised since had no past issues with my third class medical certificate. Called my AME and was told I am on my own. Sent the FAA the information they requested and the reply asked for an additional test report. Sent the requested report and they again asked for additional information. It took seven months of going back and forth with the FAA to complete the process. Received a special issuance third class medical certificate that expires in five months and requires a medical status report from my doctor be sent to the FAA every year.

    • Marc Harris
      Marc Harris says:

      And you might be one of the lucky ones.
      I’m going through a similar thing. It’s not even the information they want that is annoying – they repeatedly ask for the same information.
      Good luck.

  10. Hans
    Hans says:

    The FAA actually looking out for pilots and offering Special Issuance without making you crawl through glass shards backwards. All the snark aside, great story, and for the 2nd time in my flying life, congrats FAA (I have a LOE for color blindness and the process was fast, simple and friendly)

    • Marc Harris
      Marc Harris says:

      Not sure “covering their asses” is the prime motivator of all the unnecessary, redundant paperwork as much as ensuring they continue to have large, well-paid staffs and get their increasing budget requests approved.
      Instead of letting a clinical expert like your AME determine whether you are safe or not, they issue a demand for information that probably creates 40-80 hours of work for someone at the FAA. I wonder how much a retired Doctor gets paid for going over the hundreds of pages they require to be sent to them.
      And no one can challenge their goal of “improving safety.” Of all the things that organizations like AOPA spend their time on, this is definitely not one of their priorities. Almost every month, their magazine has a column telling us how great the FAA medical division is.


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