Not qualified for Basic Med

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Not qualified for Basic Med

Posted by Nat Jackson on Jun 17, 2017 11:02 am

I don't qualify for basicmed due to the fact that my one and only second class medical certificate was obtained in 09/2003 and was never renewed. I now have been diagnosed with type II diabetes. While my last three labs have my A1c at or below 7.5 I still have to obtain an initial Special Issuance from the FAA.

My question, has anyone gone through this process? How long does it take? How much did it cost you? How many doctors did you have to see to meet all the FAA requirements? Any guidance you could provide will be greatly appreciated.

Nat
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Re: Not qualified for Basic Med

Posted by William McDonald on Jun 17, 2017 12:10 pm

Nat,
I can't speak to what you should expect regarding a Special Issuance Medical Certificate due to your condition but, I can tell you that the process I went through was both expensive and over an extended time period ( more than a year ).

In my case, Special Issuance was required because I had a Mitral valve bio prosthetic replacement. Some of the required test included CT scans, X-rays, Nuclear stress testing, hospital pre-op and progress documentation, operative report ( surgeon's narrative of the procedure ), 24 hour houlter monitoring ( monitoring my heart function ) and a statement from my Cardiologist essentially certifying that he knew of no reason I could not fly. At the time of my application, a couple of years had passed since my surgery and so, some of the test were covered by insurance as medically necessary procedures. 

I hope your your requirements will not be as extensive as mine and if I can, I would suggest that you exercise your AOPA membership benefits and enlist their assistance in following your FAA application and advocating for you.  The FAA will not give you contact phone numbers for the person or persons evaluating your documentation. AOPA may be able to help you with that.  FAA will drag their feet, ask for additional document or test, accuse you of failing to provide complete information or as they did on my third renewal change your case file number without telling you. That last bit about the case number is important because you need to write your file number on every sheet of documentation you submit. I had a rubber stamp made with my original case file number and used it on my last renewal, unaware the FAA had changed the file number. The result was the FAA took nearly a year to figure out what happened and never queried me about where my renewal documents were. When they finally sorted things out, guess what. They sent me a back dated certificate with only two months of validity remaining before I would have started the documentation and testing again!

Sorry for the long reply but I hope my experience will give you some idea of what to expect. 
Best wishes,
William

Re: Not qualified for Basic Med

Posted by Lauren Mcgavran on Jun 19, 2017 12:29 pm

I don't have personal experience with a special issuance for diabetes, but from what I read, I don't think you will have a problem. Download and read the FAA AME Guidelines (sorry I don't have the URL.) It says (if I read it correctly) that if your diabetes is diet controlled, your AME can issue the medical if there is no glycosuria and the HbA1C is normal. If it is controlled with drugs other than insulin, your Dr. fills out a worksheet (there's a link in the document so you know what to expect), and if you meet the criteria, the FAA will issue the medical. Subsequent issuances do not require the FAA to get involved. If you require insulin, it is a bit more complicated and the FAA gets involved every time. Enroll in the premium AOPA membership and let them help you get your documents and application in order before you start; they are great. Also ask around and find a sympathetic AME, if you can. My special issuance was like the second case - FAA review the first time. I knew what I would need and took everything to my AME. He (a pilot himself) called the regional flight surgeon who talked to me on the phone. She authorized an immediate issuance from the AME, subject to FAA review of the documents. So I walked out of the AME's office with a medical, and the final approval arrived about a month later. (I did this at Christmas, which is a slow time, so things moved pretty fast for me.) I was never grounded; it was relatively painless. Good luck!

Re: Not qualified for Basic Med

Posted by Ronald Levy on Jun 19, 2017 12:58 pm

Lauren Mcgavran:
...if your diabetes is diet controlled, your AME can issue the medical if there is no glycosuria and the HbA1C is normal. If it is controlled with drugs other than insulin, your Dr. fills out a worksheet (there's a link in the document so you know what to expect), and if you meet the critria, the FAA will issue the medical.

I think Lauren meant to say "If it is controlled with no drug other than metformin, your Dr. fills out a worksheet (there's a link in the document so you know what to expect),..."  Here's the link to the actual worksheet for you to examine, and note the item "Medications for condition".

https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/C-CACIPre-Diabetes.pdf

If you meet the criteria on the worksheet, your AME can issue on the spot -- no need to wait for review by the folks in Oklahoma City.  You'll also want to bring to your AME a letter from your primary care physician describing your status.  Attached is a sample letter provided by the well-known special issuance expert Dr. Bruce Chien.
 
Attached files

Re: Not qualified for Basic Med

Posted by Lauren Mcgavran on Jun 19, 2017 10:45 pm

No, I meant what I said. Here's what my copy of the AME Guide says:

Disease/condition: Diabetes Mellitus II - Medication Controlled (Non Insulin)    
Class: All
Evaluation data: See Diabetes Mellitus II -Medication  Controlled (non insulin) Protocol   
                           See chart of Acceptable Combinations of Diabetes Medications 
Disposition: Initial Special Issuance - Requires FAA Decision  
                    Followup Special Issuances - See AASI Protocol  

Here's the link to the acceptable combinations of diabetes medications:
https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/diabetesmeds_acceptablecomb.pdf

Your link seems to be for the pre-diabetes worksheet?

Re: Not qualified for Basic Med

Posted by Ronald Levy on Jun 20, 2017 8:44 am

I think we're in violent agreement.  To summarize...

​If your glucose problem is controlled by diet and/or the use of metformin, you can go to the pre-diabetes/DM2 CACI worksheet I linked above and if you meet its criteria, the AME can issue on the spot without special issuance or deferral.  If you need any drug other than metformin or you don't meet the criteria in the worksheed (mainly fasting glucose 125 or less and A1c 6.5 or less), your case must be deferred to Oklahoma City.  My point is that for the many folks who meet the CACI criteria (including those needing only metformin), no special issuance (and thus no deferral to OKC) is required.  This is significant for those considering the BasicMed route.  OTOH, if you need any medication other than metformin to control your glucose, special issuance is required, and if you need insulin, the SI process and the restrictions after issuance are more complicated than if you don't need insulin.

Re: Not qualified for Basic Med

Posted by Lauren Mcgavran on Jun 20, 2017 10:58 am

Ah. Now I get it. I did not realize that control via metformin as the only drug was treated like "pre-diabetes." 

Re: Not qualified for Basic Med

Posted by Dennis Thrasher on Jun 26, 2017 7:42 am

I'm an AME. If your pre-metformin HgbA1c was in the prediabetes range then your doc is treating prediabetes and your Ame can issue under CACI. If treatment was started because your HgbA1c was in the diabetes range, you're being treated for diabetes and will require special issuance.

Re: Not qualified for Basic Med

Posted by John Leon on Jun 26, 2017 9:43 am

I'm on a Type II diabetes special issuance.  I did not have any advice before my first vist to an AME, which caused extra work.  Bring with you an A1C lab report, dated within 30 days of your visit, and the FAA Diabetes Status report (https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/Diabetes%20or%20Hyperglycemia%20on%20Oral%20Medications%20Status%20Report.pdf), completed by your regular doctor, also dated within 30 days.  My medical was delayed because not only did it have to be deferred to OKC, but I had to wait to be contacted for this information.  Bring it with you and you'll save time and perhaps some stress!

Re: Not qualified for Basic Med

Posted by Nat Jackson on Jun 27, 2017 8:33 am

Here is an update for everone. I drove over an hour to get to the AME, great guy by the way. I had everything I hope, copies of lab results, copies of doctors notes, with me. He did the exam and stated that if I had a current med certificate he would have given me my third class right there, but because it was lapsed he had to send it to the FAA. He also stated I shouldn't have a problem but if I needed any assistance he would help in any way he could.  So, now it is a waiting game. I will keep you updated if you like.

Re: Not qualified for Basic Med

Posted by Ronald Levy on Jun 27, 2017 10:25 am

Nat Jackson:
Here is an update for everone. I drove over an hour to get to the AME, great guy by the way. I had everything I hope, copies of lab results, copies of doctors notes, with me. He did the exam and stated that if I had a current med certificate he would have given me my third class right there, but because it was lapsed he had to send it to the FAA. He also stated I shouldn't have a problem but if I needed any assistance he would help in any way he could.  So, now it is a waiting game. I will keep you updated if you like.

What Nat writes is accurate for issuing a Third Class medical where Type II diabetes which doesn't meet the CACI criteria is present and there's no previous special issuance for that condition.  However, there's no such thing as deferral to the FAA for BasicMed -- either you meet the criteria in the checklist or you don't, and diabetes is not one of the problems requiring special issuance under BasicMed (mental health disorder, neurological disorder, or cardiovascular condition).  The reason Nat has to get a Third Class before going BasicMed is that he did not hold a medical certificate within the ten years before BasicMed came into effect (last one was in 2003) so he must get one now, and Type II Diabetes which doesn't meet the CACI criteria in the Pre-Diabetes worksheet requires a special issuance.  If Nat had held a certificate valid within those last ten years, his Type II Diabetes would not require FAA involvement to start flying under BasicMed even if that condition had developed since his last medical lapsed.