c)
drug
dependence;
d)
any
personality disorder, particularly if severe
enough to have repeatedly resulted in overt
acts;
e)
a
mental abnormality,
or neurosis of a significant degree;
such as might render the applicant unable to
safely exercise the privileges of the
licence applied for or held, unless
accredited medical conclusion indicates that
in special circumstances, the applicant’s
failure to meet the requirement is such that
exercise of the privileges of the licence
applied for is not likely to jeopardize
flight safety.
6.4.2.2.1 Recommendation.— The
applicant should have no established
medical history or clinical diagnosis of any
mental abnormality, personality disorder or
neurosis which, according to accredited
medical conclusion, makes it likely that
within two years of the examination the
applicant will be unable to safely exercise
the privileges of the licence or rating
applied for or held.
Note.—
A history of acute
toxic psychosis need not be regarded
as disqualifying, provided that the
applicant has suffered no permanent
impairment.
6.4.2.3
The applicant shall have no established
medical history or clinical diagnosis of any
of the following:
a)
a progressive or non-progressive disease of
the nervous system,
the effects of which, according to
accredited medical conclusion, are likely to
interfere with the safe exercise of the
applicant’s licence and rating privileges;
b)
epilepsy;
c)
any
disturbance of consciousness without
satisfactory medical explanation of cause.
6.4.2.4
Cases of head injury,
the effects of which, according to
accredited medical conclusion, are likely to
interfere with the safe exercise of the
applicant’s licence and rating privileges
shall be assessed as unfit.
6.4.2.5
The applicant shall not possess any
abnormality of the
heart, congenital or acquired, which
is likely to interfere with the safe
exercise of the applicant’s licence and
rating privileges. A history of proven
myocardial infarction shall be
disqualifying.
Note.—
Such commonly occurring conditions as
respiratory arrhythmia, occasional
extrasystoles which disappear on exercise,
increase of pulse rate from excitement or
exercise, or a slow pulse not associated
with auriculoventricular dissociation may be
regarded as being within “normal” limits.
6.4.2.5.1
Recommendation.—
Electrocardiography
should form part of the heart
examination for the first issue of a
licence, at the first re-examination after
the age of 40 and thereafter no less
frequently than every five years, and in re-
examinations in all doubtful cases.
Note
1.— The purpose of routine
electrocardiography is case finding. It does
not provide sufficient evidence to justify
disqualification without further thorough
cardiovascular investigation.
Note
2.— Guidance on resting and exercise
electro- cardiography is published in the
Manual of Civil Aviation Medicine
(Doc 8984).
6.4.2.6
The systolic and diastolic
blood pressures
shall be within normal limits.
Note
1.— The use of drugs for control of high
blood pressure is disqualifying except for
those drugs, the use of which, according to
accredited medical conclusion, is compat-
ible with the safe exercise of the
applicant’s licence and rating privileges.
Note
2.— Extensive guidance on the subject is
published in the
Manual of Civil Aviation Medicine (Doc
8984).
6.4.2.7
There shall
be no significant functional nor structural
abnormality of the circulatory tree. The
presence of varicosities does not
necessarily entail unfitness.
6.4.2.8
There shall
be no acute disability of the
lungs nor any
active disease of the structures of the
lungs, mediastinum or pleura. Radiography
shall form a part of the medical examination
in all doubtful clinical cases.
6.4.2.8.1
Recommendation.— Radiography
should form a part of the initial
chest examination and should be repeated
periodically thereafter.
6.4.2.9
Any
extensive mutilation of the chest wall with
collapse of the thoracic cage and sequelae
of surgical pro- cedures resulting in
decreased respiratory efficiency at altitude
shall be assessed as unfit.
6.4.2.10
Recommendation.—
Cases of
pulmonary em-
physema
should be assessed as unfit only if the
condition is causing symptoms.
6.4.2.11
Cases of
active pulmonary tuberculosis, duly
diagnosed, shall be assessed as unfit. Cases
of quiescent or healed lesions which are
known to be tuberculous, or are presumably
tuberculous in origin, may be assessed as
fit.
Note
1.— Guidance material on assessment of
respiratory diseases is published in the
Manual of Civil Aviation Medicine
(Doc 8984).
Note
2.— Guidance material on hazards of
medications is published in the
Manual of Civil Aviation Medicine (Doc
8984).
6.4.2.12
Cases of
disabling disease with important impairment
of function of the
gastrointestinal tract or its adnexae
shall be assessed as unfit.
6.4.2.13
The
applicant shall be required to be completely
free from those hernias that might give rise
to incapacitating symptoms.
6.4.2.14
Any
sequelae of disease or
surgical intervention on any part of
the digestive tract or its adnexae, likely
to cause incapacity in flight, in particular
any obstructions due to stricture or
compression shall be assessed as unfit.
6.4.2.14.1
Recommendation.— An applicant who
has undergone a major surgical
operation on the biliary passages or the
digestive tract or its adnexae, which has
involved a total or partial excision or a
diversion of any of these organs should be
assessed as unfit until such time as the
medical authority designated for the purpose
by the Contracting State and having access
to the details of the operation concerned
considers that the effects of the operation
are not likely to cause incapacity in the
air.
6.4.2.15
Cases of
metabolic, nutritional or endocrine
disorders likely to interfere with the safe
exercise of the applicant’s licence and
rating privileges shall be assessed as
unfit.
6.4.2.16
Proven
cases of diabetes
mellitus shown to be satisfactorily
controlled without the use of any
anti-diabetic drug, may be assessed as fit.
The use of anti-diabetic drugs for the
control of diabetes mellitus is
disqualifying except for those oral drugs
administered under conditions permitting
appropriate medical supervision and control
and which, according to accredited medical
conclusion, are compatible with the safe
exercise of the applicant’s licence and
rating privileges.
6.4.2.17
Cases of
significant localized and generalized
enlargement of the lymphatic glands and of
diseases of the blood shall be assessed as
unfit, except in cases where accredited
medical conclusion indicates that the
condition is not likely to affect the safe
exercise of the applicant’s licence and
rating privileges.
Recommendation.—
Possession
of the sickle
cell trait
should not be a reason for disqualification
unless there is positive medical evidence to
the contrary.
Recommendation.—
Cases in
6.4.2.17 due to
a transient
condition should be assessed as only
temporarily unfit.
6.4.2.18
Cases presenting any signs of organic
disease of the kidney shall be assessed as
unfit; those due to a transient condition
may be assessed as temporarily unfit. The
urine shall contain no abnormal element
considered by the medical exam- iner to be
of pathological significance. Cases of
affections of
the urinary
passages and of the genital organs shall be
assessed as unfit; those due to a transient
condition may be assessed as temporarily
unfit.
6.4.2.19
Any sequelae of disease or surgical
procedures on the
kidneys and the urinary tract likely
to cause incapacity, in particular any
obstructions due to stricture or
compression, shall be assessed as unfit.
Compensated nephrectomy without hypertension
or uraemia may be assessed as fit.
6.4.2.19.1
Recommendation.— An applicant who
has undergone a major surgical
operation on the urinary system which has
involved a total or partial excision or a
diversion of any of its organs should be
assessed as unfit until such time as the
medical authority designated for the purpose
by the Contracting State and having access
to the details of the operation concerned
considers that the effects of the operation
are not likely to cause incapacity in the
air.
6.4.2.20
An
applicant for the first issue of a licence
who has a personal history of syphilis shall
be required to furnish evidence,
satisfactory to the medical examiner, that
the applicant has undergone adequate
treatment.
6.4.2.21
Applicants
who have a history of severe menstrual
disturbances that have proved unamenable to
treatment and that are likely to interfere
with the safe exercise of the applicant’s
licence and rating privileges shall be
assessed as unfit.
6.4.2.21.1
Recommendation.— Applicants who
have undergone gynaecological
operations should be considered
individually.
6.4.2.22
Pregnancy shall
be a cause of temporary unfitness.
6.4.2.22.1
Recommendation.— In the absence of
any significant abnormalities,
accredited medical conclusion may indicate
fitness during the middle months of
pregnancy.
6.4.2.23
Following
confinement or termination of preg- nancy,
the applicant shall not be permitted to
exercise the privileges of her licence until
she has undergone re- examination and has
been assessed as fit.
6.4.2.24
Any active
disease of the bones, joints, muscles or
tendons and all serious functional sequelae
of congenital or acquired disease shall be
assessed as unfit. Certain qualifying
functional after-effects of lesion affecting
the bones, joints, muscles or tendons and
certain anatomical defects compatible with
the safe exercise of the applicant’s licence
and rating privileges may be assessed as
fit.
6.4.2.25
There shall
be:
a)
no active
pathological process, acute or chronic, of
the internal ear or of the middle ear;
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