Guide for Aviation Medical Examiners
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FAA SPECIFICATIONS FOR NEUROLOGIC EVALUATION
(Updated 03/27/2024)
INFORMATION FOR THE AIRMAN: To ensure the neurological evaluation meets FAA
requirements, we strongly recommend that you share all pages of this
specification sheet with your neurologist. Your Aviation Medical Examiner (AME) or
personal physician may help you locate a board-certified neurologist.
The FAA requires a neurological evaluation to determine your ability to hold a medical
certificate. The evaluation must meet the following criteria to be considered:
Current (must be performed within the last 90 days);
Performed by a board-certified physician (M.D., D.O., or physician degree
equivalent (e.g. MBBS), who also holds a current board certification by the
American Board of Psychiatry and Neurology or equivalent accrediting authority.
(if you are uncertain, consult your AME); and
Evaluation must meet the Comprehensive Neurological Evaluation criteria
listed in Item A below.
The following will cause a delay in the processing of your medical application:
- Evaluations which do not meet the above criteria;
- Neurologist evaluation which does not address all the requested information
in Item A;
- Missing or incomplete information requested in Items B - D.
IMPORTANT:
• !! Please verify that all CDs submitted will open in an UNENCRYPTED DICOM
READABLE FORMAT!!
• *EEG –
provide both interpretive report (on paper) and tracings (on a CD with
embedded stand-alone viewing software).
• The airman’s name and FAA reference identification (MID, PI, and/or APP ID#)
should be on all correspondence and reports.
• Mail all requested records and tests, including the neurological evaluation, in ONE
complete package to:
Regular First Class Mail OR Special Delivery/Overnight Mail
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
CAMI Building 13, Room 308 AAM-300 6500 S. Macarthur Boulevard
P.O. Box 25082 CAMI Building 13, Room 308 AAM-300
Oklahoma City, OK 73125 Oklahoma City, OK 73169
INFORMATION FOR THE NEUROLOGIST: Your patient is an airman who must meet
regulatory requirements in order to be issued a medical certificate. Your
comprehensive report should provide a complete neurological picture for the FAA to
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review in making a determination for issuance. The information you provide will be
reviewed by a physician with expertise in aerospace medicine, therefore, it is not our
expectation that you address the aerospace implications in this evaluation, but to
provide the clinical facts, historical and exam findings, and specialist opinion pertaining
to this airman’s neurologic concerns and/or conditions.
A. COMPREHENSIVE NEUROLOGICAL EVALUATION
The neurological evaluation and examination must be done in accordance with the
1997 documentation guidelines published by the Centers for Medicare and Medicaid
Services and must be detailed enough for a clear understanding of the nature and
extent of the neurological disorder and any limitations. The report submitted to the
FAA must include, at a minimum, the following:
1. Name, address, and phone number of the neurologist conducting the
evaluation.
2. Date of the evaluation.
3. A detailed history of the neurological condition in chronological order from the
time of symptom onset, diagnosis, or presentation to present. It must include a
detailed description of any symptoms as well as relevent positive and negative
findings. Keep in mind that for aviation safety, a history of cognitive and
functional limitations is as important as physical symptoms. Please identify
information sources when appropriate, such as history obtained directly from the
patient, history from other persons/witnesses, and/or history obtained from record
review noting the source record(s).
4. Detailed description of past treatments and outcome(s).
5. Past medical, surgical, and psychiatric history.
6. Medications:
a. Include all herbal, over-the-counter, and/or prescription medications;
b. Document the name, dosage, frequency, reason for use, and side effects;
c. If medications were recently started, stopped, or changed, note the date
and reason; and
d. Note any drug allergies
7. Social and family history:
a. Current occupational or educational functioning;
b. Use of caffiene, alcohol, tobacco, and other substances; and
c. Any pertinent neurologic family history (e.g. seizures, stroke, migraine,
neurodegenerative and/or neuromuscular disease, etc.)
8. Physical exam:
a. A comprehensive neurological exam: Vital signs; ophthalmoscopic
exam; focused cardiovascular exam (e.g. carotid, cardiac auscultation,
peripheral pulses/perfusion); mental status exam (with a standardized
screening instrument [see below]); cranial nerves II-XII, motor examination
to include mention of bulk, tone, strength, and range of motion; sensory
examination; deep tendon reflexes; coordination; praxis; gait and station;
and other specific examination as deemed necessary;
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b. Assessment of mental status, using one of the following screening
instruments*: The Montreal Cognitive Assessment (MoCA), Kokmen
Short Test of Mental Status, or St. Louis University Mental Status
(SLUMS), performed in accordance with the published instructions for the
specific test. Submit a copy of the testing score sheets; and
*Notes:
• The screening is not required if a current comprehensive
neuropsychological assessment has been performed. The
neuropsychological report and testing scores must be submitted.
• The Folstein Mini Mental Status Examination (MMSE) is NOT acceptable.
c. Describe all pertinent positive and negative examination findings and all
functional limitations identified.
9. Results of diagnostic imaging, testing, or procedures conducted and their
significance.
10. Primary diagnosis, any secondary diagnosis, and etiology of the condition.
As applicable, include a discussion of any differential diagnosis that were
considered and why they were excluded.
11. Treatment plan to include:
a. Investigations/testing to be performed;
b. New medications, medication changes, or other therapies;
c. Future treatment plan; and
d. Interval for next scheduled follow up
12. Prognosis and risk assessment: While the final aeromedical risk assessment
will be determined by the FAA, we value your opinion on the potential for sudden
incapacitation (stroke, seizure, etc.); subtle incapictation (slow reaction times,
impaired memory, impaired multi-tasking); or other impairment that may
negatively impact aviation safety.
13. Copies of any pertinent medical records reviewed, including tests performed
as part of the the evaluation. Note: When submitting treatment records from other
physicians make sure they include the actual clinical physician notes, NOT
just the patient after care visit summary or patient summary.
PRIOR TESTING, TREATMENT, OR OTHER RECORDS:
In addition to the Comprehensive Neurological Evaluation, the airman should provide the
following (Items B-D below). See the following page for specifications of document submission.
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B. PRIOR TREATMENT RECORDS
Prior treatment records from the current or previous treating physician(s) are an
important aspect of the evaluation. When submitting the following treatment records
to the FAA, include all of the following in the format* noted:
1. Doctor’s office visit and/or progress notes to date with the actual clinical
physician notes, NOT the patient after care visit summary, or patient summary;
and
2. Copies of any EEG, CT, MRI, lab, or other tests performed*
C. IMAGES/TESTING*
This may include CT, MRI, Ultrasound, X-Rays, CT Angiogram, MR Angiogram,
EEG, or other testing ordered by the neurologist or other physician. Test records
submitted must include:
1. Interpretive reports (the final radiology report, ALL pages);
2. Actual images on a compact disc (CD); and
3. EEG recordings*: Sleep-deprived EEG: awake, asleep, and with provocation
(hyperventilation, photic/strobe light)
D. HOSPITAL, EMERGENCY ROOM (ER), AND TREATMENT RECORDS
For each hospitalization or ER visit for a neurological condition or concern, you must
submit:
1. Emergency Transport reports (e.g. ambulance, first responder, EMS). If
transported by personal conveyance (not emergency transport), please attach a
memorandum attesting to this;
2. ER record, testing, lab results, and drug screens;
3. Admission History and Physical;
4. Discharge summary from hospital (NOT the patient discharge instructions);
5. Consultant reports (e.g., neurology consult, cardiology consult, etc.);
6. Operative and Procedure reports (e.g., surgery report, angiograms, etc.);
7. Laboratory and pathology testing;
8. Blood tests, surgical pathology specimens;
9. Images/testing*; and
10. EEG reports and CDs of actual EEG recordings*
The airman’s name and FAA reference identification (MID, PI, and/or APP ID#) should
be on all correspondence and reports.