Pre-loading my deferral response. Guidance would be nice.

N

Name?

Guest
I'm a Diabetic. I've been reading all the resources on the Class 3 medical requirements here and elsewhere. Aiming to get that and get on BasicMed after that.

Besides just reading up, I joined AOPA for their guidance. I'm hoping you all with them will cover all questions I have.

I have contacts my PCP, and they are more than willing to do my BasicMed physical.

My Endocrinologist is more than willing to sign off on any paperwork they need to for me to get through the FAAs requirements. My A1C has been in the mid 5s for 3+ years, so I'm good there. I have Endo paperwork going back as far as 1993 over 3 different hospitals. No complications to date.

Sounds like I will need to get FAA 8500-7 eye evaluation form filled out ontop of the data from my Endo. Opticians, optometrists, and ophthalmologists. Does the FAA care who does the report of the above 3 types of eye doctor?

Going to call around and see up a Consult (not a full physical, yet) with and AME tomorrow.

Now, it all comes down to bureaucratic FAA stuff. This is where I hope you can help.

When I get the FAA letter in the mail, what happens next?

How does the FAA get all of this paper work for my SI? Does the AME do that for me (AOPA did not sound like they wanted this)? Does I collect this paperwork from the doctors and mail it in myself?

Of all the resources our there I couldn't seem to find a direct answer on this.

Thanks in advance.
 
As far as my case I gathered all the paperwork myself and mailed it to OKC on my own. My AME only provided guidance, although he did get a copy of the letter asking for additional paperwork. I’m pretty sure it’s that way with every AME. Good luck and don’t get frustrated. Follow the instructions of your AME to the letter. I am in the middle of the process, my stuff went to OKC last week.
 
Type 1 insulin controlled or Type 2 pill controlled Diabetic?

The guidance answer can have some variance depending on which.
 
TRC1969 said:
As far as my case I gathered all the paperwork myself and mailed it to OKC on my own. My AME only provided guidance, although he did get a copy of the letter asking for additional paperwork. I’m pretty sure it’s that way with every AME. Good luck and don’t get frustrated. Follow the instructions of your AME to the letter. I am in the middle of the process, my stuff went to OKC last week.
Click to expand...

Op here.

Thanks. That should actually simplify things for me. One of my fears was having a doctor just not send the paperwork I needed.

I guess I'll have to have my doctor send me all my medical record. That's going to be one huge envelop they get.

Good luck to you, too.
 
AggieMike88 said:
Type 1 insulin controlled or Type 2 pill controlled Diabetic?

The guidance answer can have some variance depending on which.
Click to expand...

Type 1 insulin pump and CGM, but it doesn't look like the FAA cares about CGMs for class 3.
 
Do a consult with the AME and have them explicitly list the tests and paperwork you need. Don’t assume you know everything needed to keep the FAA happy from reading here or other sources.
 
I had to by a stamp with my application number, ss#, name ect…. To stamp each page. My file was over 1300 pages and apparently the FAA wants that info on each page you send them.
 
murphey said:
Do a consult with the AME and have them explicitly list the tests and paperwork you need. Don’t assume you know everything needed to keep the FAA happy from reading here or other sources.
Click to expand...

Will do.

My general sources are AOPA, my AME, POA, and Google. In that order until I talk with my AME and determine their competency.

But I will keep on my toes so I can respond to any paperwork they may ask for.

Thanks
 
TRC1969 said:
I had to by a stamp with my application number, ss#, name ect…. To stamp each page. My file was over 1300 pages and apparently the FAA wants that info on each page you send them.
Click to expand...

That's wild.

It also makes complete sense. Great advice.

Where did you get a stamp with all that? Home Depot?
 
1. Never trust a doc to submit something to the FAA. Better yet, don’t even ask them. One of them may be proactive and submit something on your behalf assuming there is going to be a yearly follow up. The FAA will assume you are attempting another Class III medical and start making demands for documentation not needed for BasicMed. When you don’t answer and don’t have a medical to revoke, they will go after your pilot certificate.

2. Good work on the research. Before you go too far down the rabbit hole, see what the consulting AME advises for the necessary documentation. One of your questions to qualify the consulting AME as the expert you want should be “How many cases like mine have you consulted on and how successful were the outcomes?”

3. There are two schools of thought about deferrals. One is to wait and see what the FAA asks for, then start working in the documentation. The other is to know what the FAA will ask for and have the documentation ready to go. This will include specific things that need to be addressed in the physician’s note that many physician’s won’t assume needs to be there because they don’t work with the FAA.

4. The success of your medical is entirely dependent on what is in your medical history and supporting documentation of your current (within 90 days) status of your health re: potentially disqualifying diagnoses, medications, or conditions.

5. Good luck. It may be worthwhile to contact Dr Bruce Chien to see whom he might recommend you consult with if he doesn’t have capacity.
 
TCABM said:
1. Never trust a doc to submit something to the FAA. Better yet, don’t even ask them. One of them may be proactive and submit something on your behalf assuming there is going to be a yearly follow up. The FAA will assume you are attempting another Class III medical and start making demands for documentation not needed for BasicMed. When you don’t answer and don’t have a medical to revoke, they will go after your pilot certificate.
Click to expand...

Yeah. The advice Im getting from multiple sources is saying to do it myself.

TCABM said:
2. Good work on the research. Before you go too far down the rabbit hole, see what the consulting AME advises for the necessary documentation. One of your questions to qualify the consulting AME as the expert you want should be “How many cases like mine have you consulted on and how successful were the outcomes?”
Click to expand...

Ill be sure to ask them about "difficult" cases. Ill ask the local Flight School and see who they suggest.

TCABM said:
3. There are two schools of thought about deferrals. One is to wait and see what the FAA asks for, then start working in the documentation. The other is to know what the FAA will ask for and have the documentation ready to go. This will include specific things that need to be addressed in the physician’s note that many physician’s won’t assume needs to be there because they don’t work with the FAA.
Click to expand...

The wait and see school of thought is not my style. With the backlog of patients my doc has, I dont think its even possible. For me, its all going to come down to the scheduling of doc within the response window of the FAA letter.

TCABM said:
4. The success of your medical is entirely dependent on what is in your medical history and supporting documentation of your current (within 90 days) status of your health re: potentially disqualifying diagnoses, medications, or conditions.
Click to expand...

What I wouldn't give for that window to be 180 days or 120.

TCABM said:
5. Good luck. It may be worthwhile to contact Dr Bruce Chien to see whom he might recommend you consult with if he doesn’t have capacity.
Click to expand...

Ill give them a google and keep them in mind depending on my initial AME consult. Thanks!
 
Flyabetic said:
That's wild.

It also makes complete sense. Great advice.

Where did you get a stamp with all that? Home Depot?
Click to expand...
By putting as much identifying information on each page of the submissions, it prevents pages from getting separated and lost from the herd. Like branding cattle and horses.
 
The stamp came from Vista print for $24. I ordered it and it arrived 3 days later. 1300 pages was a lot but you know honesty and all that……
 
Hello Flyabetic,

As a long-time holder of a special issuance for type 1 DM before I switched to BasicMed, I can speak with some knowledge on this.

Everything the FAA will need is listed here: https://www.faa.gov/about/office_or...ces/aam/ame/guide/dec_cons/disease_prot/itdm/

It's not a particularly difficult SI to obtain, but they want a lot of information, and you have to be able to demonstrate good control of your diabetes. I would not suggest submitting until you have everything you need, and you know you meet the requirements. If you submit and wait for a deferral, it's just going to add time to the process.

You can certainly gather and submit the data on your own. I will note that I'm in the medical profession, I understand the nuances of everything they asked for, and I nevertheless felt it worthwhile to hire an experienced AME to work on my behalf to do this. Dr. Bruce Chien, a senior AME who posts here, and whom I used, has originated something like 15% of all the special issuance applications for type 1 DM in the US. Can't beat that record. If you're anywhere near Chicago (or even if you aren't) it would likely be well worth the minimal fee he charges to work on your behalf, assuming he's still accepting new cases for third-class. It's worth every penny to be sure everything they want is submitted correctly, and nothing more. I would NOT recommend using any local AME for this. The guy who sees all the healthy 20 year olds at the local flight school is NOT the AME for you, and you don't want to be his first "difficult" case!

And yes, they do care by whom the eye evaluation form is completed. Board certified ophthalmologist, MD or DO. Optician or optometrist won't cut it. Likewise, evaluation by a board certified cardiologist is required.

I held my SI before I started using an insulin pump and CGM, but my understanding is the FAA loves those, as unanticipated hypoglycemic events are much less likely to occur in flight.

So I recommend you review the disease-specific protocol from the AME guide linked above, and the links therein, and feel free to reach out to me here or by DM if I can answer any specific questions for you.
 
Thanks the reply BrianR.

Lots of info in here.

BrianR said:
It's not a particularly difficult SI to obtain, but they want a lot of information, and you have to be able to demonstrate good control of your diabetes. I would not suggest submitting until you have everything you need, and you know you meet the requirements. If you submit and wait for a deferral, it's just going to add time to the process.
Click to expand...

The last sentence makes it sound like there is an alterative path than waiting for the deferral. Am I reading that correct?

BrianR said:
You can certainly gather and submit the data on your own. I will note that I'm in the medical profession, I understand the nuances of everything they asked for, and I nevertheless felt it worthwhile to hire an experienced AME to work on my behalf to do this. Dr. Bruce Chien, a senior AME who posts here, and whom I used, has originated something like 15% of all the special issuance applications for type 1 DM in the US. Can't beat that record. If you're anywhere near Chicago (or even if you aren't) it would likely be well worth the minimal fee he charges to work on your behalf, assuming he's still accepting new cases for third-class. It's worth every penny to be sure everything they want is submitted correctly, and nothing more. I would NOT recommend using any local AME for this. The guy who sees all the healthy 20 year olds at the local flight school is NOT the AME for you, and you don't want to be his first "difficult" case!
Click to expand...

More signs are pointing for me to at least reaching out to Dr. Chien. There is no harm in it at worst. At best they help me get in the air.

I feel like your medical background probably did give you an edge compared to your average joe, but a good diabetic should be familiar with jumping hoops like this. I do live next to a notable retiree community with lots of old aviators. My plan was going to that smalltime flightschool out there and see what AME they use.

BrianR said:
And yes, they do care by whom the eye evaluation form is completed. Board certified ophthalmologist, MD or DO. Optician or optometrist won't cut it. Likewise, evaluation by a board certified cardiologist is required.
Click to expand...

Good to know. There was no direct mention of doctor type mentioned on the FAA 8500-7 eye evaluation form itself, but I had the suspicion that and OP wouldn't cut it. Thanks for the verification.

BrianR said:
I held my SI before I started using an insulin pump and CGM, but my understanding is the FAA loves those, as unanticipated hypoglycemic events are much less likely to occur in flight.

So I recommend you review the disease-specific protocol from the AME guide linked above, and the links therein, and feel free to reach out to me here or by DM if I can answer any specific questions for you.
Click to expand...

CGMs are amazing. It got me into the 5s with ease. Now Im working on my standard deviation and trying to eliminate the small spikes I see.

The only "wild card" I can predict coming my way is the heart exam. Im under 40, so they shouldn't ask for it, but it could still come my way. Thats my blind spot; I dont have a Cardiologist. No way I can call a set up a quick appointment. Think it would be worth it and set one up?

Thanks again!
 
Flyabetic said:
Type 1 insulin pump and CGM, but it doesn't look like the FAA cares about CGMs for class 3.
Click to expand...
that has just changed. If you have a CGM (and its' apprent in the notes), they will DEMAND the CGM data.

They have not specified what they want in CGM for third class, however for second it's:

CGM sensor weear at least 90% of the time
Time in Range 80-180 70% or greater
Overall Glucse readings 70-250 90% or greater
Gluc readings <70 mg <4%
Gluc readings < 55% less than 1%
Gluc reading > 250 less than 5%
Coef. of Var < 33%
Auto mode > 90%
CGM < 6.5%. (Added late = control of glucose measure, hemoglobinA1C)
....and for second they want 6 monhts priro TIM in Range data.
 
Last edited:
bbchien said:
that has just changed. If you have a CGM (and its' apprent in the notes), they will DEMAND the CGM data.

They have not specified what they want in CGM for third class, however for second it's:

CGM sensor weear at least 90% of the time
Time in Range 80-180 70% or greater
Overall Glucse readings 70-250 90% or greater
Gluc readings <70 mg <4%
Gluc readings < 55% less than 1%
Gluc reading > 250 less than 5%
Coef. of Var < 33%
Auto mode > 90%
CGM < 6.5%
....and for second they want 6 monhts priro TIM in Range data.
Click to expand...

Good to know. Thanks!

Do you mind clarifying a few terms?

"Coef. of Var" I assume thats another way of showing Standard Deviation in readings. CV = SD/AVG?

"Auto Mode" I assume thats Contol IQ or some other closed loop algorithm?

"CGM < 6.5%" I have no clue what this one is.

"6 Month prior TIM range data" I assume this is the same as all the above, but further back than the most recent 90 Days?

---

Judging by your user name, you are the AME Ive been suggested multiple times now. Would you prefer to make this official and have me visit your site and fill out the form there?

Wither way, thanks for the help!

EDIT: just pulled up my Tandem Connect, and read the report on the last 90 days. The ones I could quickly check without messing up my high/low settings were in your suggested range. Though, on the fence for the less than 70. I have mine set to less than 60 and its at 3% now.
 
Flyabetic said:
…

Judging by your user name, you are the AME Ive been suggested multiple times now. Would you prefer to make this official and have me visit your site and fill out the form there?
Click to expand...

He is. Doc Bruce can be contacted here: http://www.aeromedicaldoc.com/how-to-start.html

Read thru the rest of his pages before contacting, but you are probably the type of pt he will see if he’s accepting for consult or for consult and exam.

I wish every AME was as diligent as Doc Bruce.
 
Flyabetic said:
Thanks the reply BrianR.

The last sentence makes it sound like there is an alterative path than waiting for the deferral. Am I reading that correct?
Click to expand...

Yes. Don't submit until you have everything in hand they're going to ask for. If you do (and a proactive, knowledgeable AME such as Dr. Chien will assure this is the case before submitting) you'll wait...and wait...and wait...and eventually, get a letter in the mail with the details of your special issuance. No deferral needed.


Flyabetic said:
The only "wild card" I can predict coming my way is the heart exam. Im under 40, so they shouldn't ask for it, but it could still come my way. Thats my blind spot; I dont have a Cardiologist. No way I can call a set up a quick appointment. Think it would be worth it and set one up?

Thanks again!
Click to expand...

Since you're under 40 you aren't subject to the treadmill stress test requirement, but you'll need a resting EKG and a letter from the cardiologist evaluating your cardiac risk factors. As I recall, it can be as simple as, "I have evaluated Flyabetic for determination of cardiac risk factors. He is a non-smoker, has no history of hypertension or hyperlipidemia, reports regular exercise and has no family history of premature coronary artery disease. He does not report chest pain, exertional dyspnea or associated symptoms. Resting EKG is normal. Therefore, his history of type 1 diabetes mellitus represents his only risk factor for cardiac disease." Or something like that. Hopefully Dr. Chien will opine if anything more detailed than this is required.

In my case, I was fortunate enough to find a cardiologist who was also a pilot and AME (though not my AME). As such, he knew exactly what the FAA wanted to see. But, any cardiologist should be able to handle this. The trick is to get them to say exactly what the FAA wants to see, and nothing more.

I would definitely try to get an appointment set up, since depending on where you are, and the density of cardiologists in your area, making a new patient appointment may well take a while. Be sure that when you make the appointment, the office knows what you're coming in for. Perhaps your PCP could facilitate this?
 
BrianR said:
wall of text
Click to expand...

That's awesome info BrainR!

I'll go ahead a start the cardiologist appointment process. I've got my Endo next week, my PCP the next after that, and eyes in March (gunna try to upgrade that one). AME soon to the mix, too.

Can't hurt to add a Cardiologist into that mix. For prevention and FAA reasons.

Fingers crossed I can get all these ducks in a row and this is the last this part of the forum hears from me for a while.
 
Hey gang. Followup question.

I've got a poorly worded note in my FAA medical guide note book I've been keeping and it does not have a source on it, so I'm hoping you can help.

It says "only need endocrinologist to provide medical records (3 years.)."

I'm guessing my note to myself is saying I don't need my PCP to send anything because the Endo is the real important thing for me. AND I'll need their records back 3 years.

Is this correct? Am I pulling this out my butt?

Thanks!
 
Last edited:
Flyabetic said:
Hey gang. Followup question.

I've got a poorly worded note in my FAA medical guide note book I've been keeping and it does not have a source on it, so I'm hoping you can help.

It says "only need endocrinologist to provide medical records (3 years.)."

I'm guessing my note to myself is saying I don't need my PCP to send anything because the Endo is the real important thing for me. AND I'll need their records back 3 years.

Is this correct? Am I pulling this out my butt?

Thanks!
Click to expand...
Yes, that's how I would interpret it.
 
But the endo has to testify as to no further than a single Hypoglycemia (that needed to have external help) in the past 5 years.....
 
Good afternoon all-

I had a visit with my AME who looked over all my Endocrinologist paperwork. 3 years of doctor notes, all my 6mo labs, and my CGM data.

While he was not an AME with much SI experience, he did suggest I find a better presentation of my CGM data. He was also kind enough to point me in the direction of another AME who can possibly meet my needs better for SI guidance. Either way, they were confident facilitating my physical but would not guarantee any results. Not that I was looking for them yet.

My question:

For you type 1s, the software do you use to show your CGM data? I've been using Tandem Connect for a long while and suited my personal health needs, but it's a square peg for the FAA's round hole. I need to manually change the reading range and produce 2 separate reports to display all the data they require. I also use XDrip+ for my smart watch and has some awesome Data management built in. Think they would accept that OpenSource app?

Thanks!
 
Update for those keeping up with this or future readers trying to follow along from the future.

I discovered an app with help of Diabetes groups online. TidePool. It has the data set up just like BBChien above has suggested the FAA wants to see.

The catch is, it's not FDA certified like the OEM apps like Tandem Connect or whatever Libre uses. It is, however, endorsed by JDRF. Which is not nothing. For you pilots, JDRF is to diabetes what AOPA is to pilots.

It's a new and good tool to use in attempt to get medical. May not be needed, but can't hurt to have.

Note on TidePool. It does not have 90 day or custom ranges. It has 1 week, 2 week, and 4 week options. Not ideal. The software is OpenSource, so a tech savvy person may be able to edit it, but that's beyond my skill and desire.
 
Last edited:
The FAA has a history and precedent utilizing non FDA approved medical assays to “keep the public safe”.

So it may not be a deal killer. Just needs the right sell.
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top