FAA adds another hoop for medicals

This is getting funny. Fat pilots are more dangerous then pilots with ADD or a history of DUIs.:lol: Or maybe not, who knows. Doesn't matter no one cries when the regulators come after those guys so why should we(not in any of the mentioned categories) care if they go after fatties?
 
Isn't that required testing for commercial drivers?

I only know based on what the lab tech told me (from his experience administering the tests), but I think that probably is the case. Things may have changed since then (about 7-8 years). Before anyone extrapolates this to compare commercial OTR truck drivers to commercial/non-commercial pilots, all our certificates are from the feds. Where your normal, everyday non-commercial auotmobile driver is certified by the state.
 
I have a friend that collects WWII memorabilia. He's got complete uniforms on display in his study. It's incredible how much smaller people were in the 1930s than they are today.
 
This is getting funny. Fat pilots are more dangerous then pilots with ADD or a history of DUIs.:lol: Or maybe not, who knows. Doesn't matter no one cries when the regulators come after those guys so why should we(not in any of the mentioned categories) care if they go after fatties?

Where do you come up with that? ADD is way harder and more expensive to get an SI on and a history of DUIs (multiple) is straight up disqualifying, even one gets you some nifty hoops.

So, someone with OSA already has oxygen depravation problems at sea level, what do you think happens when you add altitude to the mix?
 
I have a friend that collects WWII memorabilia. He's got complete uniforms on display in his study. It's incredible how much smaller people were in the 1930s than they are today.

Type II diabetes was a medical curiosity.
 
Is it:

(BMI > 40 AND NECK > 17") must be evaluated - i.e., a candidate must meet BOTH conditions to be captured

OR:

(BMI > 40) AND THOSE WITH (NECK > 17") must be evaluated - captures TWO sets of conditions (i.e., neck size over 17 but BMI < 40 still must be tested)
It is the first one. Greater than 40 BMI AND 17" neck.

I suspect that there aren't too many out there with a BMI of 40 and less than a 17" neck.
 
I only know based on what the lab tech told me (from his experience administering the tests), but I think that probably is the case. Things may have changed since then (about 7-8 years). Before anyone extrapolates this to compare commercial OTR truck drivers to commercial/non-commercial pilots, all our certificates are from the feds. Where your normal, everyday non-commercial auotmobile driver is certified by the state.

I suspect that it also has a lot to do with problems that would be faced with instituting testing of the many millions of noncommercial drivers, both politically, and in terms of practicality.
 
How many accidents have been attributed to SA ? Have they looked into there inspectors ,and checked there BMI ? I guess they have to go after something.
 
This is screening for the cause of a condition that can cause incapacitation at any time. I worked with a car salesman that had the glass walled cube next to mine, he used to regularly nod off in the middle of a sale, I got more than one sale from that effect when they would walk over to my cube. He also crashed two of the dealership's cars falling asleep behind the wheel, once on the way to picking up lunch.

You seem to like anecdotes, which reminds me of this old saw: The plural of ‘anecdote’ is not ‘data.’ :no:
 
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My problem with this is the Federal Government entering into the realm of predictive medicine. Where will it end? I have twice made the comment that soon enough, it will not surprise me to know that surgeons require knowledge of how often sexual intercourse occurs. Ridiculous you say? OK so be it.

Where will it end? What will you have to prove to the faceless bureaucrats who always have your best—and the children's—at heart before he allows you access to a "privilege"?

Bend now, bend forever.
 
My problem with this is the Federal Government entering into the realm of predictive medicine. Where will it end?
That's almost exactly the EAA's statement.
"The FAA has not presented nor have we seen any evidence of aeronautical hazards or threats based on sleep apnea in general aviation," said Sean Elliott, EAA's vice president of advocacy and safety. "To enter into the realm of predictive medicine based on no safety threat or symptoms - at a significant cost to individual aviators and the GA community - is not only a reach beyond FAA's mission but a serious hurdle to those who enjoy recreational aviation...."

Elliott also notes that while this newly announced FAA policy is clearly unjustified, a greater threat looms in subsequent plans outlined by Dr. Tilton, that "once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA."

The Pilot's Bill of Rights passed by Congress and signed by the president in 2012 required that the FAA thoroughly evaluate the medical certification process and supply medical science and justification to support its policies. Any sleep apnea requirements or policy should also meet this requirement. To date, the FAA has not undertaken such an evaluation.
 
My problem with this is the Federal Government entering into the realm of predictive medicine. Where will it end?

Entering?, they've been doing plenty of predictive medicine for a while.
I admit I was a little shocked by this at first, but thinking it through and comparing with other situations in which they ask for further studies, I don't see much of a difference.
 
Agreed....they say they believe "..up to 30% of individuals with a BMI less than 30 have OSA."

and

"Once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA."

Clearly we all will have to do this if the bureaucrats continue unchecked. I'm in the 20's so I guess I have a while but it's coming for all of us it seems.

The worst part is they appear to be doing this by bureaucratic fiat rather then following the rules and amending the regs. If they tried to do it right there would be a comment period so the more stupid parts of this would get cleaned up. I agree 40 is a risk factor and could be reasonable for a class 1 but they are not demonstrating any boundaries here.....
...and this from the guy who maintains that the 3rd class is going away.....ROTFCMAO. ("C" is for crying).

...and Matthew is correct. CSA is a denial.
 
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The contention of the Federal Air Surgeon is that no such proof as demanded by Pilot Alan is necessary. The danger of narcolepsy associated with untreated sleep apnea is "self evident".

The aviation standard is, "normal natural health or the equivalent as determined by the Federal Air Surgeon based on best expert advice". Well, it IS the federal air surgeon, and it is on best expert (external and internal) advice.

I would rather the AOPA spend it's energy on educating airmen on how to get this dealt with economically. On how to relate to the sleep guy and in getting him to order the home oximetry recording and that this is an adequate basis for this assessment, "no sleep apnea present", on a simple, at home study that is reimbursable by just about every plan.

AOPA is just so very out of it. The energy should have been spent, for example on that crazy a__ed Piper Yoke-falls off" AD.
 

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They're screwed. They sell a "Medical defense" product. They let the lawyers drive the bus at AOPA, now they have to fight everything "medical" to give that broken program legitimacy, IMNSHO.
 
First they came for the morbidly obese and I did nothing. Then they came for the merely overweight and I did nothing. Then they came for svelte, athletic me. But by then, only Doctor Bruce was remaining and he got me an SI. :lol:
 
Getting back to this issue of unethical conduct, is there anything the patient can watch out for, to determine if the place he is going to is on the up-and-up or not?

Stay away from any place where the door-handles are made from gold ;) .

The 'sleep center' industry is another outgrowth of the DME racket, the same people that advertise for scooters or bladder catheters on TV. I think your best bet of getting an unbiased evaluation is at a university medical center or large non-profit hospital with a sleep lab. Yes, it is not as convenient as having the sleep study done at the place at the mall, but you are going to deal with salaried staff that gets paid for their evaluation, not off of the the $300 machine they sell you for $2500.
 
I think your best bet of getting an unbiased evaluation is at a university medical center or large non-profit hospital with a sleep lab. Yes, it is not as convenient as having the sleep study done at the place at the mall, but you are going to deal with salaried staff that gets paid for their evaluation, not off of the the $300 machine they sell you for $2500.

I suppose Stanford Hospital ought to do. :D

I was just at Stanford's new Bing Concert Hall for an orchestra and chorus rehearsal tonight. Very nice.
 
I suppose Stanford Hospital ought to do. :D

I was just at Stanford's new Bing Concert Hall for an orchestra and chorus rehearsal tonight. Very nice.

Oh, they will certainly charge what they think they are worth ;-) . What I don't like about the commercial places is the direct link between a diagnosis and sale of DME and supplies. If you need the test done, get it done and then shop for equipment, supplies and ongoing treatment locally.
 
The aviation standard is, "normal natural health or the equivalent as determined by the Federal Air Surgeon based on best expert advice". Well, it IS the federal air surgeon, and it is on best expert (external and internal) advice.

This does not give the FAS the right to arbitrarily discriminate in the screening process for such conditions. A person with undiagnosed OSA who has BMI<40 and 16" neck poses the same "risk" as someone with OSA with BMI>40 and neck >17" who would be caught by this change. One will be have to go through hoops or be denied, the other will go along unnoticed. The cutoff, while supposedly based on some statistics, is arbitrary, and that results in a discriminated class.
 
This does not give the FAS the right to arbitrarily discriminate in the screening process for such conditions. A person with undiagnosed OSA who has BMI<40 and 16" neck poses the same "risk" as someone with OSA with BMI>40 and neck >17" who would be caught by this change. One will be have to go through hoops or be denied, the other will go along unnoticed. The cutoff, while supposedly based on some statistics, is arbitrary, and that results in a discriminated class.
It sure does.

For the past 20 years, safety critical functions have been allowed great latitude. Example: An airline company can discriminate against a man who applies who has had a DUI. Your argument carries NO water.

Besides:
bbchien said:
The aviation standard is, "normal natural health or the equivalent as determined by the Federal Air Surgeon based on best expert advice". Well, it IS the federal air surgeon, and it is on best expert (external and internal) advice
Yes, Jeff, it means you have to get in shape, after avoiding it for all these years. The FAS can demand that you get in shape, and BMI <40 is not too big an ask, or alternatively, he can as that the material issue, your alertness, be adequately proven.

There is no true discrimination because you have the ability to vet, your ability to operate safely. He is not saying, "BMI >40-->no medical". That would be somewhat different (though he CAN say that, too...he won't and that's ANOTHER conversation). See the above "in quote".
Denverpilot said:
They're screwed. They sell a "Medical defense" product. They let the lawyers drive the bus at AOPA, now they have to fight everything "medical" to give that broken program legitimacy, IMNSHO.
THIS.
 
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I just don't get why the AOPA doesn't fight to get rid of the SI and just make it a check box on the form that the AME can handle. If I have OSA and I show the AME that I am compliant check the box and move on. At least from what I have heard that the SI is not hard to get but if you are universally going to approve it let the AME do it.

I will also tell you this it is possible to have OSA and not have significant day time sleepiness. Not that there are not other good reasons to get it treated if you have it.
 
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The FAS can demand that you get in shape, and BMI <40 is not too big an ask, or alternatively, he can as that the material issue, your alertness, be adequately proven.

First of all, I have no issue with encouraging people to get in better shape--and if the carrot they choose to use is "you get to keep flying", and that encourages you to get into better shape and exercise more and eat and sleep healthier, then bravo.

And secondly, thank you to Dr. Bruce and wielke and any other doctors for their participation on this thread.

Finally, to Dr. Bruce' comment quoted above: shouldn't the "material issue, your alertness", be tested in a simulator, connected to sensors, after a normal night's sleep (or lack thereof)? I don't fly when I'm sleeping, and a test in bed of OSA or lack thereof doesn't guarantee I will or will not nod off in the air.

Or is the premise that if you have OSA, you will also have alertness issues in the cockpit? Can you point us to a clinical study that shows a correlation between OSA at night and performance/alertness issues during the day? I'm sure one must exist, and seeing those numbers / charts / graphs may convince some of the naysayers here.
 
Can somebody please let us know how many aviation accidents are the result of undiagnosed sleep apnea? It would also be nice to know that same statistic for violation or at least stretching of crew rest requirements to compare the two.
 
I just don't get why the AOPA doesn't fight to get rid of the SI and just make it a check box on the form that the AME can handle. If I have OSA and I show the AME that I am compliant check the box and move on. At least from what I have heard that the SI is not hard to get but if you are universally going to approve it let the AME do it.

I will also tell you this it is possible to have OSA and not have significant day time sleepiness. Not that there are not other good reasons to get it treated if you have it.

Exactly, they do the spoiled brat "NO NO NO" act on too many issues where it is the wrong approach to take.
 
Can somebody please let us know how many aviation accidents are the result of undiagnosed sleep apnea? It would also be nice to know that same statistic for violation or at least stretching of crew rest requirements to compare the two.

How do we know the reason for for so many accidents, especially the CFIT ones and the ones that leave threads where everyone asks, "What the Hell was he thinking?" Sleep Apnea leaves people falling asleep and with cognitive impairment.
 
Can somebody please let us know how many aviation accidents are the result of undiagnosed sleep apnea? It would also be nice to know that same statistic for violation or at least stretching of crew rest requirements to compare the two.

Doesn't matter if we can prevent one crash it is worth it/sarcasm. That is what you are up against, fatties are just the next easiest target. Give it time and getting a third class medical will be harder then astronaut selection. I find it kind of funny fat shaming has been gone for so long heavies are surprised they are being picked on.
 
How do we know the reason for for so many accidents, especially the CFIT ones and the ones that leave threads where everyone asks, "What the Hell was he thinking?" Sleep Apnea leaves people falling asleep and with cognitive impairment.
So you are asking for the proof of a negative? That is a logic fail and if it is what the FAA is doing shame on them. Bruce has posted some data that shows a correlation between BMI/neck size and sleep apena. But I have yet to see how any of this is fixing a problem that is affecting aviation safety. That is the question to ask, how much of a problem is sleeping in the cockpit, how many accidents has been caused by it and then we ask what causes the sleep problem. It may be something else other than this undiagnosed sleep apena thing. This is a simple science process.
Instead what it is looking like is someone who has a solution but has not yet defined what it is fixing.
 
So you are asking for the proof of a negative? That is a logic fail and if it is what the FAA is doing shame on them. Bruce has posted some data that shows a correlation between BMI/neck size and sleep apena. But I have yet to see how any of this is fixing a problem that is affecting aviation safety. That is the question to ask, how much of a problem is sleeping in the cockpit, how many accidents has been caused by it and then we ask what causes the sleep problem. It may be something else other than this undiagnosed sleep apena thing. This is a simple science process.
Instead what it is looking like is someone who has a solution but has not yet defined what it is fixing.

Well, since the DOT also has this program already in effect for truck drivers, I'd say to answer your question of evidence I would suggest you look and see what they came up with as I'm sure the Teamsters likely challenged this matter as well and I doubt DOT overcame the challenge without some evidence of fact.
 
It's interesting for me to watch this - I already had an OSA diagnosis prior to training. Since I'm already in the system, this doesn't apply to me. But I do know the ramifications for others.

FAA already screens for a lot of diseases at our medicals. Unless you have high blood pressure, diabetes, poor eyesight, poor hearing, colorblindness, or some other things and for some reason don't already know about it, then you've probably paid for a diagnosis at some point.

The difference here is that FAA is going to start telling us we will need an OSA evaluation, and that may be the only thing I'm aware of that works this way. In other diseases, we either already know or there is a cheap, quick way for the AME to discover it. This is different, this is FAA saying, "There's a chance you have something, we won't issue until you come back with more info. Here's my bill, and your tests may run $xxxx and cost you 4 months in deferral purgatory."

I really don't think FAA medical wants this headache any more than the rest of us. I'm hoping that's the case and they allow some low cost screening test and revamp the OSA SI process to allow the AME the latitude to issue in-office the first time. I'm also waiting to find out how they deal with negative test results. What if you meet the criteria for a screening and it comes up negative? Will you have to repeat it at each medical?
 
So here's a question:

Let's say a pilot fits both of these criteria (BMI > 40 and neck > 17"). Do they have to self ground, get a study done for OSA, and then the SI?
 
So here's a question:

Let's say a pilot fits both of these criteria (BMI > 40 and neck > 17"). Do they have to self ground, get a study done for OSA, and then the SI?

I think we are still waiting for the details. The only thing we know is the requirements are on the way.
 
I really don't think FAA medical wants this headache any more than the rest of us. I'm hoping that's the case and they allow some low cost screening test and revamp the OSA SI process to allow the AME the latitude to issue in-office the first time.

That would sure make the whole thing a lot more palatable.
 
It's interesting for me to watch this - I already had an OSA diagnosis prior to training. Since I'm already in the system, this doesn't apply to me. But I do know the ramifications for others.

FAA already screens for a lot of diseases at our medicals. Unless you have high blood pressure, diabetes, poor eyesight, poor hearing, colorblindness, or some other things and for some reason don't already know about it, then you've probably paid for a diagnosis at some point.

The difference here is that FAA is going to start telling us we will need an OSA evaluation, and that may be the only thing I'm aware of that works this way. In other diseases, we either already know or there is a cheap, quick way for the AME to discover it. This is different, this is FAA saying, "There's a chance you have something, we won't issue until you come back with more info. Here's my bill, and your tests may run $xxxx and cost you 4 months in deferral purgatory."

I really don't think FAA medical wants this headache any more than the rest of us. I'm hoping that's the case and they allow some low cost screening test and revamp the OSA SI process to allow the AME the latitude to issue in-office the first time. I'm also waiting to find out how they deal with negative test results. What if you meet the criteria for a screening and it comes up negative? Will you have to repeat it at each medical?

The FAA is now recognizing the diagnosis of morbid obesity (ICD-9-CM 278.01) and requiring a specific test prior to approval just as it may require periodic stress tests for coronary artery disease (414.01)

Gary F
 
The FAA is now recognizing the diagnosis of morbid obesity (ICD-9-CM 278.01) and requiring a specific test prior to approval just as it may require periodic stress tests for coronary artery disease (414.01)

Gary F

But in the case of morbid obesity or CAD, isn't that an 'already known' diagnosis when you go to the AME?

In the case of OSA, the FAA is saying, "Maybe you have it and maybe you don't, but we won't issue until you find out for us."

I don't know - it does seem to me there's a difference between knowing ahead of time you have a diagnosis or failing the medical because of something the AME is already supposed to look for, and FAA telling airmen (with no diagnosis or failed test) to come back later after a test to find out if there is something wrong.

It just seems different from the way it normally works.

I'm still leaning toward thinking that FAA medical is doing this to answer to its government overlords and that FAA medical doesn't really want to do this.
 
I'm also 5'8"...

From looking at that table my "normal" weight range should be between 125 and 158lbs. That's ridiculous... I probably fit in there around the time I was a high school freshman and was one of the scrawniest kids around.

The BMI assumes you're sedentary and have an "average" frame. It's not a measurement of body fat, it's overall mass so that excess could very well be muscle. Most pro-athletes are overweight or obese by the standard of that chart.

I've been thinking about the formula used to construct that table. One problem is that it is a linear function of weight, and says that you could only have zero fat percentage by reducing weight to zero. That would only be true if the weight of bone, muscle, and other non-fat material were zero, so it looks like the formula would be wildly inaccurate for very lean individuals, or very muscular individuals.

By the way, since normal is a statistical concept, I suspect that what is normal has increased a lot. Normal is not synonymous with optimal.
 
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But in the case of morbid obesity or CAD, isn't that an 'already known' diagnosis when you go to the AME?

In the case of OSA, the FAA is saying, "Maybe you have it and maybe you don't, but we won't issue until you find out for us."

I don't know - it does seem to me there's a difference between knowing ahead of time you have a diagnosis or failing the medical because of something the AME is already supposed to look for, and FAA telling airmen (with no diagnosis or failed test) to come back later after a test to find out if there is something wrong.

It just seems different from the way it normally works.

I'm still leaning toward thinking that FAA medical is doing this to answer to its government overlords and that FAA medical doesn't really want to do this.

Not really different IMO. The >40 +17" is already the diagnosis for morbid obesity, same as a diagnosis for CAD. If you have CAD, you now have to prove that you don't have debilitating effects from CAD. In the same way, this is requiring you to show that you don't have debilitating effects from morbid obesity, eg Sleep Apnea.
 
Not really different IMO. The >40 +17" is already the diagnosis for morbid obesity, same as a diagnosis for CAD. If you have CAD, you now have to prove that you don't have debilitating effects from CAD. In the same way, this is requiring you to show that you don't have debilitating effects from morbid obesity, eg Sleep Apnea.
Exactly. If you have coronary artery disease you may or may not have cardiac ischemia at a given workload.

Gary F
 
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