What is the Purpose of the FAA Medical Certificate?

By Dr. Warren S. Silberman
Reprinted with permission from FAA Safety Briefing

Dr. Warren S. Silberman and his staff administer the aeromedical certification program for about 600,000 holders of U.S. pilot certificates and process 450,000 medical certification applications each year.

Q: I would like to know in layman’s terms the purpose of an FAA medical certificate. It seems to me the only legitimate purpose is to make it a statistically low probability that a pilot will be unable to act as pilot in command due to a medical condition.

If my assumption is true, what is the danger of a pilot flying after having a prostatectomy? What is the danger after having the seed implants? What if a pilot is diagnosed with prostate cancer and the doctor recommends monitoring only due to the slow cancer progression?

A: Under Title 14 of the Code of Federal Regulations (14 CFR) part 1, the FAA defines a medical certificate as “acceptable evidence of physical fitness on a form prescribed by the Administrator.” The primary goal of the FAA’s airmen medical certification program is to protect not only those who exercise the privileges of a pilot certificate but also air travelers and the general public. I do not mean to belabor this point, but pilots in the United States have been required to have medical certification to fly since 1926. The purpose of medical certification in the United States is to minimize the risk that the pilot will suffer a sudden incapacitating event while flying.

In the case of prostate cancer, the issues that the airman deals with are the discomfort that can occur with pressure in the bladder as a result of incomplete emptying and the potential spread of the cancer to the bones of the spine. When the cancer spreads to the bone it makes the bone prone to collapse. Sudden collapse of a vertebra will result in significant pain and the possibility of nerve damage and paralysis. The collapse can occur with only minimal stimulation.

There are also the issues of side effects from treatment. In the case of radiation therapy, these can include an inflammation of the rectum, the urge to urinate, and frequency of urination. These symptoms may not be incapacitating, but are annoying and can effect a pilot’s concentration.

In your last sentence, you mention monitoring, which is known as “watchful waiting.” Here the treating physician will closely follow the airman with medical history, examinations, serial PSA levels, and perhaps certain x-ray studies. The FAA accepts this, but may require certain testing on a regular basis because of the concerns mentioned earlier.

The FAA has accepted all forms of treatment for prostate cancer for Authorization for Special Issuance (waiver) consideration. Once an airman has one of the forms of treatment, he must consider himself grounded pending review by the Aerospace Medical Certification Division.

FAA policy requires the airman wait at least six weeks until he provides the FAA with a waiver request. Before the FAA will consider the request, the airman must provide the operative and pathology reports from the procedure, a current status report from the treating urologist that addresses any complications and treatment, and a current PSA level. If you have not yet provided this medical information, please do so.

Warren S. Silberman, D.O., M.P.H., manager of FAA’s Aerospace Medical Certification Division, joined FAA in 1997 after a career in the U.S. Army Medical Corps. Dr. Silberman is Board Certified in Internal Medical and Preventive/Aerospace Medicine. A private pilot with instrument and multiengine ratings, he holds a third-class medical certificate.