Third Class Medical -- Frustrating Special Issuance (Pacemaker)
After having been away from flying for almost forty years, I once again got the “bug” to get back in the cockpit again.  Much had transpired over that 4 decade span – educated the children; completed a career; had spare time; in a better place financially – looking for a pursuit, a passion to satisfy a desire to travel, but not put up with the hassles of commercial travel.  No need to travel the world internationally – much to see and do domestically.  Hey, why not get back into flying.  But wait, what about that pacemaker implanted in 2005.  My intake diagnosis for that hospitalization was bradycardia; the decision as to whether to have a pacemaker was left up to me (without regard to thought of flying again, I thought I should have it).  My discharge diagnosis was SSS (Sick Sinus Syndrome).
I know that were I to get back into the cockpit again, my first step would be to secure my third class medical.  A little research and rejoining AOPA gave hope that notwithstanding the pacemaker, this was not an impossible task – or so I thought.  My first attempt to secure a third class medical began in June of 2014.  After a series of sequential submissions, and follow up tests over the following months, I received a denial due to, “evidence of myocardial ischemia by radionuclide scintigraphy”.  I reviewed the denial with my cardiologist, and his recommendation was to undergo a heart catherization which would confirm or refute their conclusion with objective evidence.  I was frankly somewhat neutral to the suggestion, thinking I’ll let the denial take effect and think about the catherization recommendation and see if my desire to fly again overrode my reluctance to undergo the procedure.
My desire to fly again won out, and on August 17, 2016, I underwent the catherization, thinking that if a blockage were serious enough, they would stent it and I would be pursuing a different path to securing my medical.  To my initial disappointment, the cardiologist said it wasn’t necessary to stent any arteries stating in his report that, “there were well developed right to left collaterals ...”, continuing with medical jargon.  Thinking it over further, I concluded this was a positive result.
I thought that armed with this report, a resubmission of my request for a third class medical would be a slam dunk.  How naive was I?  I completed my MedExpress application once again in September of 2016 and met with my AME.  The results of the appointment were “unremarkable” to again use medical jargon.  Everything went well.  He suggested what supplements and attachments should be included with his submissions.  Then 2 months later I get a letter from the FAA requesting that I undergo a stress test (9 minutes minimum – Bruce protocol), 24 hour Holter monitor, echo-cardiogram, etc..  I completed the requested testing and submitted the results in early December.  In late January (2017) I receive a follow up letter requesting additional testing consisting of a SPECT radionuclide myocardial perfusion study.  The FAA additionally requested imaging (on a CD) of the echocardiogram, and imaging of the August 17th catherization (on a CD).  All of this was submitted within the 60 day deadline and received by the FAA on March 10th.
Then, on May 25th (approximately 11 weeks later), I receive a one paragraph letter (2 sentences) stating that my records are being forwarded to the Federal Air Surgeon’s Office for review.  I was told that the Federal Air Surgeon’s office is located in Washington, so I guess I’ve gotten further than my previous application, but all of this delay and administration has been very unsettling and frustrating.
I guess what I am seeking by this posting (and my thanks to those who have wadded through this missive to this point) is some feedback from others who have gone this route and others who have familiarity with the process, and what to expect as I await word from on high as to whether I am eligible (worthy?) of getting back into flying.  I would appreciate all comments, whether positive or negative.
Thanks much.
A. F.
Member #05212867
2 Replies
Ronald Levy
1669 Posts
Probably the most knowledgable person in the USA on difficult medical certification issues is Dr. Bruce Chien in Peoria IL, who has a specialty practice in this area.  You can contact him via his website  If there's anyone who can help you with this, including an understanding of how the process operates, it's Bruce.
Thanks Ron -- much appreciated.  I'll be accessing his website within minutes.

Your's is the type feedback I'd been hoping for.

Again, thanks much.