Pulmonary Embolisms
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Hello, I am a Private Pilot and was 8 hours from my checkride for Instrument. 
on January 8, 2021, I got covid, which led to three pulmonary embolisms. My doctors have said I should be 100% recovered and off meds by May 11, 2021. 
My question, if anyone can help, is what are my reporting requirements, and when will I be allowed to fly. 
Without knowing the law, I am NOT flying, nor do I intend to until or unless I can answer the questions. To be honest, I'm afraid to ask the AME, because I don't want to walk down the path of making things worse. Can anyone provide any guidance?
3 Replies
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Bruce Chien:
The medical officers are of the current view that they want to review the hospital record: Admission note, discharge summary and all radiologic reports.  At a minimum you need:

Signoff from a board certified pulmonologist, not sooner than 60 days after the PE. It needs resolved.
If on Eliquis or Pradaxa, statement that "no side effects noted"
Set of normal pulmonary function tests. 
If the record had ANY pericardial effusion and the echocardiogram was in any way abnormal they will want a current resolved echocardiogram, EKG and Full stress run.  To know this we need to see the hospital record.  I have already taken airmen through this gauntlet.

Good to hear you recovered from such a rough ride.

 

Thank you for this information. Pulmonary Doc is working with me and says full recovery by May 11. Hospital EKG showed nothing abnormal and heart functioning perfectly, at least per the doctor. I have a CT Scan scheduled for first week May and, if clear, she said she will pull me off the Elliquis, of which I have had no side effects and I'm now 3 weeks into. I'm positive if we are there she will write the letter. Do you recommend me reaching out to a local AME here to make sure I've got my ducks in a row. I don't need a new medical for two years, but will I need clearance to fly again, or to just have the supporting documentation? Sorry to bombard, I just want to be legal....and hopefully to fly again. 

Votes
The medical officers are of the current view that they want to review the hospital record: Admission note, discharge summary and all radiologic reports.  At a minimum you need:

Signoff from a board certified pulmonologist, not sooner than 60 days after the PE. It needs resolved.
If on Eliquis or Pradaxa, statement that "no side effects noted"
Set of normal pulmonary function tests. 
If the record had ANY pericardial effusion and the echocardiogram was in any way abnormal they will want a current resolved echocardiogram, EKG and Full stress run.  To know this we need to see the hospital record.  I have already taken airmen through this gauntlet.

Good to hear you recovered from such a rough ride.

 
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1108 Posts
First and foremost, you are not under any obligation to report anything to the FAA until your next medical application.  That said, per 61.53(a)(1), you are obligated to self-ground until you are satisfied you meet the standards for your medical certificate.  Unfortunately, a history of PE requires a Special Issuance, so until you get that SI, you cannot determine you meet the requirements for the SI, and thus cannot fly.  Here is the process in the FAA's AME guide for a new medical with an SI for PE:

An applicant with a history of thromboembolic disease must submit the following if consideration for medical certification is desired:

  1. Hospital admission and discharge summary
  2. Current status report including:
    • Detailed family history of thromboembolic disease
    • Neoplastic workup, if clinically indicated
    • Any blood clotting disorder (e.g. PT/PTT, Protein S and C, Factor V Leiden); AND
    • Minimum observation time of 2 weeks after initiation of therapy; AND
    • Must also meet any required observation time for the underlying condition
  3. If still anticoagulated with warfarin (Coumadin), submit all (no less than monthly) INRs from time of hospital discharge to present
    • Minimum observation time of 6 weeks after initiation of warfarin therapy;
    • Must also meet any required observation time for the underlying condition; AND
    • 6 INRs, no more frequently than 1 per week
  4. NOAC/DOACs: For applicants who are just beginning treatment with NOAC/DOACs, the following is required:

    • Minimum observation time of 2 weeks after initiation of therapy; AND
    • Must also meet any required observation time for the underlying condition
After that initial SI issuance, you'll need to do the following for subsequent applications to re=issue the SI:

Special Issuances
AME Assisted - All Classes - Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE), and/ or Hypercoagulopathies

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition and the applicant has all the required medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Aviation Medical Examiners may re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance, if the applicant provides the following:

  • A valid Authorization for Special Issuance granted by the FAA;
  • A summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of DVT, PE or other complication of hypercoagulopathy (see below*), future treatment plan, and prognosis;
  • The name and dosage of all medication(s) used for treatment and/or prevention with comment regarding side effects, if any; and
  • If using Coumadin (Warfarin), obtain a minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months (see below*); and
  • If using other types of anticoagulants such as NOAC/DOAC (i.e. Xarelto, Eliquis, Pradaxa, Savaysa, etc.), the airman should obtain a statement from their treating/prescribing physician with details of the underlying condition, tolerance of the medication to include the presence or absence of side effects, any bleeding episodes requiring medical attention, and any occurrence/recurrence of deep vein thrombosis or pulmonary embolism.

* The Examiner must defer to the AMCD or Region if:

  • If using Coumadin (Warfarin) and more than 20% of INR values are <2.0 or >3.0; or
  • If applicant experienced any side effects or bleeding episodes requiring medical attention; or
  • The applicant develops emboli, thrombosis, bleeding, or any other cardiac or neurologic condition previously not diagnosed or reported.
All that said, you really do want to talk to an expert on these issues like AME Dr. Bruce Chien, who specializes in complex SI cases, and whom I hope will stop by soon and comment.