Medical Certification - Pilots with Leg Amputations

More than 1.2 million Americans live with the loss or absence of a limb. Each year over 1,000 children are born with limb deficiencies.

Over 130,000 amputations are performed annually as a result of trauma or disease, with 86 % of these amputations involving the legs. Of these, 93% are related to peripheral vascular disease — lousy circulation mostly due to diabetes, hardening of the arteries or cigarette-smoking.

Modern prosthetic limbs allow many motivated amputees to achieve very active and productive lives. This sometimes involves flying. So, what does the FAA look for when an amputee pilot applies for medical certification?

The two greatest concerns they have are the ability of the airman to safely operate the aircraft, and his/her ability to get out of the aircraft in an emergency situation. Safe operation of the aircraft depends on how well the prosthesis fits and functions. Bad fit can cause distracting pain. Loss of sensation can interfere with joint proprioception — the ability to know where your limb is. This can affect your ability to egress or to operate the rudder pedals and brakes.

When you show up for your medical examination these will be things the Aviation Medical Examiner (AME) will be looking at. The other big issue is what caused the amputation. If it was due to a birth defect, have things been stable over the past few years? If it was due to an accident, is recovery complete? If it was due to an underlying disease such as cancer, diabetes or blood vessel disease, how is this medical problem doing?

Your AME will want a current status report from your physician. It should address your functional status measured by strength, range of limb motion and pain.

Also be sure to indicate what medications you are currently taking. If you need narcotics for pain, you should wait until you’re off them before going through the certification process.

Your AME will not be able to issue a medical certificate at your initial examination. He will have to defer to the FAA for further evaluation. Most of the time, the FAA will review the information submitted and authorize a Medical Flight Test (MFT). For airmen here in Minnesota that usually involves going to the Flight Standards District Office (FSDO) on the north side of the Minneapolis-St. Paul Airport (KMSP). There an examiner will assess your ability to reach and operate flight controls and to perform emergency procedures. This can be done in actual flight or in a simulator. How extensive the test will be depends on what grade of medical certificate you’re going for. Obviously, a First Class Certificate examination is a bit more involved than a Third Class. If you pass, you’ll be given a Statement of Demonstrated Ability (SODA). This is a letter

stating you have a stable condition and your AME can issue subsequent medical certificates without the FAA’s recurrent approval as long as everything else is OK. Depending on how you do, the SODA may or may not restrict you to a specific make or model of aircraft or an aircraft with special equipment or control arrangements.

If your amputation was caused by complications of an underlying disease such as diabetes, blood-vessel problems or cancer, you might also have to also get a so-called Special Issuance. That however is a separate process that we’ve talked about in the past. Your AME can give you direction.

I know that all of this sounds like a lot of hoops to jump through but stick with it. Remember that it is a one-time event. SODAs don’t expire. Also remember that if you and your AME think you are OK to fly, the odds are very good that you’ll get your SODA. Back in 2007 the FAA looked at cases of this type over the preceding three years. Out of 403 applicants with lower-extremity amputations only one airman was denied. This fellow had a 20-year history of bad diabetes with near-blindness, bad high blood pressure, several near-strokes and a heart attack. He’s not a guy I’d fly with! Fly wisely. See you next month.

As always, comments, questions and suggestions are welcome: jdlakinmd@gmail.com. Also, we’ve moved our office to Airlake Airport’s FBO (KLVN)! Call 952-469-4414 or email hannah@wpflights.com for a flight physical appointment.