Navigating the FAA’s Medical Processes

Joseph LoRusso is often found flying his 1943 Stearman around Broomfield, Colorado.

Joseph LoRusso’s job as director of aviation at Ramos Law in Denver, Colorado, has changed over the past several years. The privilege of fiercely advocating for airmen remains the same, but the timing of his involvement in his aviation clients’ journeys has changed. Not only that, but the state of the current medical landscape is also very different.

“It’s important to explain from the start that I’ve been doing airman certificate defense for nearly a decade. Before that, I was a professional pilot. At this point, I have been flying for twenty years and have never seen the FAA as challenged as it is right now. The FAA aircraft registry is about eight months behind, which hasn’t happened before.”

LoRusso contends that the backlog affects not only issues about Part 47 matters but Part 67 matters as well.

“On the medical side, CAMI [Civil Aerospace Medical Institute], the office in Oklahoma City, is behind by about eight or nine months. The Federal Air Surgeon’s Washington D.C. office [FAS] has a backlog for twelve to fifteen months. So, what does that mean for the owner-operator or the typical pilot?” he asked.

“Let’s say you have a kidney stone and have been directed to produce some reports, undergo ultrasounds and provide a letter from your doctor. If you wait until your medical appointment to disclose that you have kidney stones before providing all the documentation to your AME, and they defer to Oklahoma City for review, you could be sitting without a medical certificate for eight to nine months. And you can’t fly during that time.”

As a result of the abnormally long delay, LoRusso emphasizes the necessity of pilots getting ahead of the curve. It is presently more vital for them to be proactive in addressing their medical concerns than it has ever been in the past.

“I used to say to pilots, ‘If you get in trouble with the FAA, call me.’ Nowadays, it’s much better to be proactive than reactive. The FAA has gotten so used to saying ‘no,’ that once they do say no, they tend to draw a line in the sand and dig their heels in. They can deny, deny, deny. It’s better to be proactive with them and give them everything they need for their review right from the start. That way, it’s easier to get them to say ‘yes.”

At this point in the process, LoRusso acknowledges that the FAA operates nearly identically in all cases. As a result, he can anticipate which requests the agency will ask of airmen, the consulting AME, or other parties.

“First and foremost, it is important to know that with an attorney, an airman has an advocate in the FAA medical process. Many pilots make the mistake of thinking their AME is an advocate; however, by agreement and contract, an AME is an agent and representative of the FAA tasked with performing evaluations on behalf of the government. An attorney, however, is an advocate. As an advocate, counsel can produce records and proffer arguments per regulation, policy, and agency guidance, which helps avoid the seemingly never-ending stream of FAA request letters. Moreover, an attorney can evaluate an airman’s case and develop a game plan before seeking medical certification.”

He is commonly asked whether having an attorney involved will speed up the certification process.

“The answer is more complex than a simple yes or no. First, I will answer ‘no,’ there is no ‘fast track’ for those airmen who are represented. Rather, the timeline is shortened due to the completeness of the initial submission. As many pilots can attest, the pain and suffering of the FAA’s medical review process is in the cat-and-mouse game of request letter after request letter. Eventually, the FAA either runs out of requests or the airman tires of the resulting delayed process and abandons the pursuit.”

LoRusso is an ATP-rated Citation and Learjet contract pilot who understands the desire to fly as long as possible. He is on standby if an airman faces a challenge to their medical certificate. There are several issues he frequently helps airmen work through. These range from TBIs [traumatic brain injuries], sleep apnea, substance abuse, and dozens of other conditions. Naturally, there are a few conditions that pilots seek counsel more frequently than others.

“The best option is to talk to an attorney ahead of time so that we can develop a care plan, to get the best experts to help you pass your medical evaluation,” he prefaced. “Cardiac issues are common. Interestingly, the FAA does not employ a cardiologist. They have six psychiatrists on staff but not a single cardiologist. They are trying to send airmen to cardiac panels, but the panels do not convene often. So, as a result, cardiac cases are getting backlogged. Another thing that we see a lot of, which is pretty generational, is ADHD. ADHD cases are immediate denials by the AME and must go through the Federal Air Surgeon’s office for further review.”

In recent years, he has seen some other conditions become increasingly concerning.

“There is an almost daily frustration that I am having with my pilots. Through COVID, we saw the highest number of mental health issues in the United States that we have ever seen. Pilots are no different than anyone else and are members of the same society, so we had an influx of pilots that reported seeing a therapist on their 8500-8’s [Application for Airman Medical Certificate]. You must report if you have seen a doctor, a therapist, or a counselor, within the last three years. So, these pilots reported seeing those individuals for acute depression, situational depression or anxiety, treatable mental health conditions, and were denied a medical certificate,” he advised.

“What is frustrating is that the mental health world is dynamic, and the FAA regulations are not. FAA regulations on mental health were crafted based on DSM-3 [The Diagnostic and Statistical Manual of Mental Disorders, third generation], which expired in 1987. We’re talking about greater than three decades ago. With the DSM-5 soon to drop, the FAA will be four generations behind on clinical mental health.”

LoRusso states that there are repercussions from this highlighted mismatch.

“Because FAA regulations are so antiquated, owner-operators have a warranted and justifiable fear of reporting mental health treatment. We have a justifiable fear that reporting will turn into a denial. As a result, there are two issues: Pilots either refuse to seek mental health assistance and are flying with conditions that need to be treated, or they are seeing mental health professionals and lying on their 8500’s.”

These purported issues, combined with others he has observed during his last ten years of medical defense work, make LoRusso firmly believe that something needs to change. He outlines what he feels would improve the current medical process.

“Without question, the FAA’s 2023 reauthorization bid should include a promise of medical reform. But what does that look like? I believe it begins with a new medical application. The box of death, Box 18, on the 8500 is horribly drafted – an airman must be an attorney or a doctor to answer question 18. To demonstrate how absurd it is, question 18 asks an airman if he or she has ever, in his or her entire life, suffered from ‘stomach trouble’ or ‘mental disorders of any sort.’ Box 18 also asks if an airman has ever been diagnosed with ‘alcohol dependence or abuse,’ and those terms aren’t even clinically recognized anymore!”

LoRusso added, “Once the application is revamped, the FAA needs to shift toward a system that recognizes and rewards direct clinical treatment. At present, the FAS office frequently disregards the opinions of a treating professional and defers to the opinions of its own doctors who have never personally seen or treated the airman.”

Outside of being proactive towards addressing their mental and physical issues as soon as they arise, LoRusso has a request for fellow pilots.

“The big thing is to make pilots aware of what is happening in the medical world. Because it’s never an issue until it’s an issue. And it’s never a concern until you are going through it, at which time it becomes a very real concern. So, all pilots need to be aware of the medical landscape and demand better from the FAA. And the only way we can get change coming into a reauthorization year is for pilots to knock on the door of their representatives and say that they feel what is going on is unacceptable.” Furthermore, proactive representation and advocacy by an aviation law professional who understands the needs of regular pilots is vital in keeping your medical certificate valid.