Neurologic

I. Code of Federal Regulations

Legal References: 14 CFR 67.109(b)(c), 67.209(b)(c), 67.309(b)(c),

Legal Extract (Applies to All Classes):

§67.109   Neurologic.

Neurologic standards for a first-class airman medical certificate are:

1. No established medical history or clinical diagnosis of any of the following:

   1. Epilepsy;

   2. A disturbance of consciousness without satisfactory medical explanation of the cause; or

   3. A transient loss of control of nervous system function(s) without satisfactory medical explanation of the cause.

2. No other seizure disorder, disturbance of consciousness, or neurologic condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

   1. Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

      1. May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

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   II. Examination Techniques

   1. Observation: The Examiner should note any unusual shape or contour, skin color, moisture, temperature, and presence of scars. Hernias, hemorrhoids, and fissure should be noted and recorded. A history of acute gastrointestinal disorders is usually not disqualifying once recovery is achieved, e.g., acute appendicitis. Many chronic gastrointestinal diseases may preclude issuance of a medical certificate (e.g., cirrhosis, chronic hepatitis, malignancy, ulcerative colitis). Colostomy following surgery for cancer may be allowed by the FAA with special followup reports.
   2. The Examiner should not issue a medical certificate if the applicant has a recent history of bleeding ulcers or hemorrhagic colitis. Otherwise, ulcers must not have been active within the past 3 months. In the case of a history of bowel obstruction, a report on the cause and present status of the condition must be obtained from the treating physician.
   3. Palpation: The Examiner should check for and note enlargement of organs, unexplained masses, tenderness, guarding, and rigidity.

   A neurologic evaluation should consist of a thorough review of the applicant's history prior to the neurological examination. The Examiner should specifically inquire concerning a history of weakness or paralysis, disturbance of sensation, loss of coordination, or loss of bowel or bladder control. Certain laboratory studies, such as scans and imaging procedures of the head or spine, electroencephalograms, or spinal paracentesis may suggest significant medical history. The Examiner should note conditions identified in Item 60 on the application with facts, such as dates, frequency, and severity of occurrence.

   A history of simple headaches without sequela is not disqualifying. Some require only temporary disqualification during periods when the headaches are likely to occur or require treatment. Other types of headaches may preclude certification by the Examiner and require special evaluation and consideration (e.g., migraine and cluster headaches).

   One or two episodes of dizziness or even fainting may not be disqualifying. For example, dizziness upon suddenly arising when ill is not a true dysfunction. Likewise, the orthostatic faint associated with moderate anemia is no threat to aviation safety as long as the individual is temporarily disqualified until the anemia is corrected.

   An unexplained disturbance of consciousness is disqualifying under the medical standards. Because a disturbance of consciousness may be expected to be totally incapacitating, individuals with such histories pose a high risk to safety and must be denied or deferred by the Examiner. If the cause of the disturbance is explained and a loss of consciousness is not likely to recur, then medical certification may be possible.

   The basic neurological examination consists of an examination of the 12 cranial nerves, motor strength, superficial reflexes, deep tendon reflexes, sensation, coordination, mental status, and includes the Babinski reflex and Romberg sign. The Examiner should be aware of any asymmetry in responses because this may be evidence of mild or early abnormalities. The Examiner should evaluate the visual field by direct confrontation or, preferably, by one of the perimetry procedures, especially if there is a suggestion of neurological deficiency.