Regaining a JAA medical after a stroke or TIA

[Bald Rick]

Anyone who has seen the "is this the end?" thread will know that I had a mini-stroke in January and have lost my class 1 medical. During the short "event" I carried-on as normal and did not suffer any problems afterwards; the only way it has affected me is that there are two tiny areas of slightly reduced sensation - on one thumb and in an area of gum. Tests and assessments have failed to show a cause for the embolism or to identify any risk factors, but I am taking an antiplatelet (Clopidogrel) as a precaution. Logically I suspect that I now have a lower risk of suffering a disabling stroke than I had before the event, or of many other aircrew.

Has anyone suffered a TIA or mini-stroke and regained a JAA medical?

[BWBI]

Sorry to be blunt but having had a TIA myself 2 years ago firstly there is no such thing as a mini stroke as all are serious medical interventions!

From my experience ( I was a PPL on a JAR class 2 medical ) and my deliberations with the CAA and various AME's you have no chance of regaining a JAR medical in fact from memory I recall that a stroke ( however you dress it up ) is one of the Automatic disqualifying medical events.

The best you can hope for is a NPPL class 1 medical ( solo flying or with a safety Pilot ) or if you are extremely lucky a class 2 (for DVLA Professional driving standards ) which enables you to take non Pilot passengers. This is of course if you manage to convince your GP to sign the medical.

In my case my lady Doctor head of Practice signed for a NPPL class1 and then signed for Class 2 once I had remained medically incident free for a further 6 months and undertaken a Private Tread mill Test.

Obviously a NPPL Licence is no good what so ever if you need to make a living out of flying but fine if you were like me a hobby Pilot who flew mostly in the UK with the occasional trip to France.

Don't forget you have to notify both the CAA and DVLA within a set time period ( 6 weeks? ) and your Insurance will also be invalid if you don't declare it! Expect the CAA to pull your medical and likewise the DVLA suspend your Driving licence. It took me 6 months to get my Driving Licence back after the usual consultants reports.

The NPPL medical was relatively straight forward as it is based on DVLA Driving Standards and not your ability to fly! However some Doctors have some difficulty coming to terms with this! The NPPL licence was also straight forward. I was the sole owner of my aircraft and the Insurance Company ( Haywards ) were very good and didn't load my Policy but you have to inform them and I would suggest you get written confirmation that you have done so.

The CAA will look into what medication you are taking and Warfrin is one that they don't seem to like.

All this seems very depressing but if you are a hobby Pilot quite straight forward and I continued flying once I felt confident to so with an Instructor to get around the lack of a medical. This was whilst I waited for things to sort themselves out and keep myself current etc.

Best of luck and I hope you manage to eventually get back flying again, if you do you will be one of a select band who got back flying having suffered a stroke.

[Bald Rick]

Thanks for your reply but there are at least a couple of errors to correct: there is no requirement to notify the DVLA unless the effects last longer than 28 days, and mini-stroke is a medical term. In my case I suffered no impairment so a DVLA class 2 should be straightforward after 12 months, and a DVLA class 1 will keep the basic skills going until then.

It would be highly useful to make contact with anyone who has regained a JAA medical in my situation (a clinical stroke but with no physical or intellectual effects) but I realise that there may be a confidentiality concern; perhaps PM would be best.

[BWBI]

Everyones circumstances are different I guess, in my case I was in hospital for 6 days and down here in Swansea it seems automatic that the hospital advise the DVLA who wrote to me and asked that I return my licence. I am not sure if this is the case everywhere in the UK or exactly how the system works.

In respect of my JAR Medical my AME advised the CAA who also wrote to me basically withdrawing my Medical and subsequent telephone calls made it clear that my only way to possibly continue flying was via a NNPL Licence / Medical.

I used the term "mini stroke " to another AME who my own had suggested for further advice and was told in no uncertain terms that there was no such thing and I had suffered a TIA Stroke which was a serious medical issue and I had no chance of regaining my JAR class 2 Medical.

My Consultant also wrote a very favorable letter to the CAA Medical people but again this had no impact on the result.

It will be interesting to see if anyone has regained their medical in these circumstances but I suspect there will be very few, if any. Of Course EASA are involving themselves with Medicals now and I suspect that will lead to things becoming even harder!

All the best with your recovery and get back flying soon!

[homonculus]

Cant answer that, but there are indeed all sorts of cerebrovascular accidents and a mini stroke is indeed a recognised medical term.

The last time I saw a form for an NPPL it asked me to state the applicant was fit to hold the relevant driving license. It didnt ask for my views about flying. I cant see, although I realise I have very little data, any need for a treadmill, which is of poor correlation.

If I as a doctor am asked if someone is fit enought to meet a certain standard, it is my responsibility to say yes or no. Indeed, I have an obligation to care for the applicant so simply refusing is of questionable acceptance to the relevant medical authorities. I suggest if anyone gets the run around (as opposed to a denial on medical grounds) they complain and go elsewhere

[BWBI]

The GP signing a NPPL Medical as you correctly state is signing that the person concerned is meeting the relevant DVLA Driving Standard and nothing to do his / her ability to fly safely.

The Treadmill Test as I understand the situation is part of the requirement for the grant of a class 2 medical for professional driving standards and again nothing to do with flight safety. I am not sure if age comes into it at all but I know several older people who have been required by the DVLA to undertake a treadmill test as a result of being HGV / Coach Drivers.

It would seem from what my Doctor told me that the first 6 months post TIA are crucial in respect of a repeat or worse. This fitted in with the DVLA suspending my Driving Licence for what turned out to be 6 months. Likewise Holiday Insurance wouldn't take me on until I had passed that period medically incident free.

I now attend regular Blood Pressure / Cholesterol Testing and also take medication to further reduce the risks and of course this being along with a healthier life style!

I must say that the NPPL medical declaration and Grant of a NPPL licence was quite straight forward and it offers the potential for people to keep flying in medical circumstances which would have terminated their flying years ago.

[Gotyou]

Hi Guys
Do you have any information regarding the consequences of having to go through a angioplasty with stent instalation for an ATPL pilot. Is this suppose to be the end of my carrer?
I will have to go through this procedure next week and I am quite anxious with the possible consequences for my carrer.
Any in info willl be highly appreciated.

[Gotyou]

I mean ...possible consequences for my career!

[kui2324]

GotYou You listed your location as Dubai.

This is part of what the UK CAA say Heart - Coronary Artery Disease | Medical | Safety Regulation (http://www.caa.co.uk/default.aspx?catid=49&pagetype=90&pageid=546)

[Led Zeppelin]

Hi Gotyou -

I have been through this. Medical suspended for 6 months (this period is a bit of an overkill in my opinion. The reason is a slight risk of re stenosis occurring).

At the end of the 6 months, I did a thallium stress ECG followed by a full echo cardiogram, blood tests and a standard medical renewal. One of the things they look for is the heart's ejection fraction following the surgery and waiting period. From memory, it has to be above 50 %.

Got the medical back about a week after I submitted the cardiologists reports etc to the regulator. No additional requirements specified.

You may be on a blood thinning drug (PLAVIX or equiv) and aspirin for some time.

So don't lose hope. There is an end in sight and you can fly again !

[tgilson]

Hello All

Very interested in your post Led Zep, I have also had an angioplasty ( in 2008) with a couple of stents in one artery. I have had a lot of talks and correspondence with the CAA, including the top man Dr. Hunter and would have to go through a stress test and perfusion scan and probably some other stuff as well. What interests me is what they gave you back. Did you get an UNRESTRICTED Class 1 back or is it Class 1 OML (Multi-crew only). I've been told I can get Class 1 OML / Class2 (basically the same) only, which rules out a hell of a lot of jobs in the uk as you can't fly single pilot public transport any more. I had to give up my air ambulance job in Swansea after the angioplasty (best job I ever had) and to me it doesn't seem worth it to go to all the expense of getting a medical back which is next to useless unless you want to work in the N.Sea (I don't).
Thought about going back to instructing but the CAA says you cannot instruct ab-initio students, only those who have completed their first solo (multi-crew???) so even this is very restricted. To my knowledge and I would like to be proved wrong, the CAA have never given a full Unrestricted Class 1 back to anybody after angioplasty. I have thought about getting the OML and then going to a CAA medical review board to try and get it back - someone has to be first after all !
Anyway, sorry to be all doom and gloom for our friend in Dubai but these are the hard facts unless anything has changed in the last couple of years.

[Bald Rick]

Is there any chance you could hijack some elses's thread chaps? or even (shock) start your own?

(I must be getting touchy in my old age)

[White Knight]

Hi Gotyou - several guys here in UAE have had angioplasty and stents and are flying still for EK. Class 1 OML is not a big deal if you're already flying multi-crew.

It's 6 months no-fly, then a cardio assessment, medical and possibly a review board depending on other complications. But my feeling is that the GCAA are quite proactive and want to see you licensed again:ok:

PM me for more info!

[ZimmerFly]

Sorry to be a wet blanket Bald Rick, but I think recent NTSB findings may be noticed by and influence the CAA.

The Alaska Regional Flight Surgeon's decision to issue the pilot an unrestricted first-class airman medical certificate, based largely on a local neurologist's in-office evaluation and without conferring with any other Federal Aviation Administration physicians or consultants or attempting to address the etiology of the hemorrhage, the likelihood of recurrence, or the extent of any remaining cognitive deficit, was inappropriate.

It is not clear that a sufficiently thorough aeromedical evaluation of the pilot would have denied the pilot eligibility for a first-class airman medical certificate; however, a more rigorous decision-making process for evaluating this pilot with a history of intracerebral hemorrhage would have decreased the potential for adverse consequences.

The Federal Aviation Administration's internal guidance for medical certification of pilots following stroke is inadequate because it is conflicting and unclear, does not specifically address the risk of recurrence associated with such an event, and does not specifically recommend a neuropsychological evaluation (formal cognitive testing) to evaluate potential subtle cognitive impairment.

Board Meeting: Aircraft Accident Report: Collision into Mountainous Terrain, GCI Communication Corp., de Havilland DHC-3T, N455A, Aleknagik, Alaska, August 9, 2010 (http://ntsb.gov/Events/2011/Aleknagik_AK/synopsis.htm)

Report on Ted Stevens plane crash faults FAA | Reuters (http://www.reuters.com/article/2011/05/24/us-alaska-stevens-plane-idUSTRE74N8J520110524)

[BWBI]

More to the point perhaps EASA will be taking a good look at it!

It concerns me as to the new medical regime which will be introduced once EASA finally complete their deliberations? In particular will there be any "grandfather rights " for people like me who have suffered a TIA and managed to get back flying again all be it on a NPPL medical ( class 2 ) or perhaps even pilots with a JAA / JAR medical if you are flying for a living ? I suspect not!

The only hope for me may be that I fly an Annex 11 aircraft which may remain with the CAA but even that seems to be under some doubt now! Anybody have any update as to what is happening or perhaps likely to happen?

Perhaps Annex 11 aircraft will actually go up in value being snapped up by "Hobby Pilots " with health issues! but somehow I don't think that will happen either!

[Bald Rick]

Thanks for the link ZimmerFly (nice name!). My situation is slightly different from this guy and I think the FAA have a different approach to that of the CAA, but it's still interesting to read the NTSB report.

homonculus: the NPPL paperwork requires the GP to contact the medical adviser of the relevant organisation for advice if the chap has one of a range of defiend conditions

Rick