One sunny afternoon in mid-June I grabbed a letter out of my mailbox. The return address sent a shiver down my spine: FAA Office of Aerospace Medicine in Oklahoma City, OK. I had no particular reason for concern, as I had a valid third class medical, which had just been renewed the previous September. Also, I have a practical joker friend who might pull off this exact stunt… I know, since I did the same thing to him before. He once got a letter from “Stephen Dickson” with a downloaded logo and everything, accusing him of environmental mayhem for spewing avgas across central Oklahoma when he had a fuel-line leak in his Mooney.

Pilot medical certificate

A precious commodity for most pilots.

But no, this one looked legit. And seemed more frightening. “Our Quality Assessment Program within the Aeromedical Certification Division had the opportunity to review your medical certification on file. Based upon our review of this information, we are unable to establish your eligibility to hold an airman medical certificate at this time.” I knew this had to be real… my friend could never string together those words in such an ominous way.

This initial letter was not a revocation of my certificate, but it did say I had 60 days to respond or face other legal action. So action I did take!

But first, some background. In 2012 I was diagnosed with a bladder condition known as interstitial cystitis. It’s a chronic condition that can have different effects on different people, but for me mostly just mild discomfort that I have managed easily with a drug called Elmiron. As time rolled around for each of my medical exams, I always made sure this medication wasn’t on the “no fly” list and my exams were not a problem.

When BasicMed became a reality, I decided that since it suits my flying perfectly, I would just go with that option and kiss the third class medical goodbye forever. This worked great until 2019, when I had the opportunity to participate in an FAA altitude training session using the PROTE system (Portable Reduced Oxygen Training Enclosure). They were offering this at our annual Mooney Summit safety seminar; the only catch was you had to have an FAA medical certificate to participate. (The logic behind this was never clear, but I’m sure a lot of lawyers were involved in the decision.) So back I went to the AME and emerged an hour later, class three docs in hand.

Fast forward now to nine months later and the letter referenced above. My first reaction was, I’m sure, similar to thousands of others who have received such a notice: “What the —-?” So I placed a call to my AME, who through coincidence also happens to be my personal physician and is well aware of my condition. He was also surprised, as there was nothing in his exam which would indicate any issues… and he had also ensured that Elmiron was not on any list.

But we went through the required repeat exam and he quickly sent in all the paperwork to his contacts to seek a resolution. And to their credit, in less than a week the FAA responded. Many folks reading this may be familiar with the language:

“The medical evidence reveals a history of [name your condition here]. You are ineligible for medical certification under Title 14 [blah blah blah lots of CFR codes that you’ll have to look up for yourself if you want to know what we’re really saying]. I have determined, however, that you may be granted Authorization for special issuance of the enclosed third-class medical…” at which point I breathed a sigh of relief and stopped reading for a moment.


Sometimes it really is worth reading the fine print.

But this is where the story takes a twist. Reading through the rest of the letter, the FAA finally explained why all this happened in the first place. Apparently, some time in 2019 evidence arose that prolonged use of Elmiron has the potential to cause macular degeneration and serious eye problems. So the Special Issuance simply requires that I complete a thorough eye exam and present the results for continuation each year.

The FAA had learned of this issue with Elmiron, and through its database of medical information was able to identify all pilots with my similar history. And if I ignored the stress-induced drinking binge this episode caused (okay, really just one double gin and tonic) I could see that the FAA was actually looking out for me. What a concept! Because I’ll be honest, I had been on the drug so long that I wasn’t paying attention to news and might never have learned of the potential new side effects of this drug.

The story ends mostly where it began. I had the eye exam with no drama, I do have a third class medical, and when that expires my Special Issuance will transfer over to BasicMed and that’s probably where I’ll stay for the rest of my flying days. And I will continue to get the regular eye exams because… you know… blindness.

Thus I can acknowledge that even though it may not always seem so, the FAA sometimes really does have our best interests in mind. The next time you get that letter from our Favorite Aviation Acronym, take a deep breath and hope for the best. But keep the bottle of gin handy just in case!