I believe I’ve finally fixed my pilot’s license (name change, gender change, new multi-engine rating), but I recently learned a key assumption at the FAA Medical Branch regarding Gender Identity Disorder. After months of going around and around with their Oklahoma office and arguing that I already have a valid medical certificate by virtue of an exam last summer with Dr. F, I learned that GID is a disqualifying condition until certain paperwork has been filed with their office and thus, no individual medical examiner may issue a medical certificate on her own, based on the results of the exam in her office. Here’s the eye-opening email thread that finally put me and Dr. Salazar (Oklahoma City) on the same page:
Ms. Bailey - to make sure I have my facts correct since the last email sometime in April 2009. You reported you had an FAA physical August 7, 2008 by Dr. KF in Bedford Falls prior to him being dedesignated. To date we have not received a copy of that physical exam, i.e., the actual 8500-8. This has created the problem that even though you now have produced a second-class medical certificate, the agency has no formal verification of its existence except for the piece of paper in your possession. The last official examination/certificate on file for you was a second-class certificate issued July 12, 2006; at this time that
certificate is not valid for any class.
Even though you have a second-class medical in your possession, we now have to consider the fact you are undergoing sex reassignment surgery. In my opinion, Dr. F erred in issuing you that certificate in August of 2008. He had previously issued you a certificate in 2006 as a male ("oldname"), but issued you a new medical certificate in 2008 as a female (Joyce Bailey). He should not have done that - he needed to have deferred issuance to the agency.
Gender dysphoria, gender identity disorder, sex reassignment surgery and gender variant issues in general, are initially disqualifying conditions until all treatment records, including neuropsychological (NP) assessments are received, and the agency is satisfied that no adverse issues exist. To date we have received no treatment records; therefore, the agency cannot render an opinion on your qualification to hold a medical certificate. As I previously explained, this matter is further complicated by the fact we have no official record of a current physical exam on file for you, and you now have a certificate in your possession that was issued in error. Because we have no official record, it makes it difficult if not impossible to reexamine your qualifications to hold that certificate.
My recommendation at this time is to wipe the slate clean and this matter be started over again. I would request you go to an AME and make an application (either before the surgery, if you have time, or after you have recovered), explain the gender change and have the AME defer the issuance. The agency will then request you provide detailed treatment records, operative reports, and the NP evaluations. Once everything has been reviewed and the agency is satisfied successful recovery has been made, a proper certificate can be issued. By doing things this way no one can challenge the validity of that certificate.
At this time you have in your possession a medical certificate issued in error, with no supporting physical examination on record. Therefore, I am concerned that this presents a serious problem, and the agency will not issue you a replacement medical certificate at this time. I would strongly recommend you do not use the certificate in your possession to fly as pilot-in-command as this could represent a violation of 14 CFR Part 61.53.
My first reply
A bit unnerved by that last part, the suggestion that I may have been violating the FAR’s, I wrote the following for clarification (being a bit snarky, I admit):
I still have my previously issued medical certificate, which is still good through august 31. Are you saying this one is also tainted because a doctor did not turn in his form?
It sounds as if you're advising me to abandon my second class medical as well as one year of my third class medical, even though I had a stellar exam last August. Are pilots usually held responsible for AME actions beyond their control?
I will seek a new AME and get a new medical exam after i'm back from surgery in 2 weeks, then. I do think it all stinks, as I've asked the FAA and my AME about ny condition from the very beginning, and I find out only now that all that effort at full disclosure was for nought.
And here is Dr. Salazar’s definitive answer:
Ms. Bailey - We have 3 physicals on file for you: July 2, 2002, July 14, 2004, and July 12, 2006. The July 12, 2006 examination expired for ALL classes on July 31, 2008.
I cannot be any clearer in that Dr. F issued the August 2008 certificate in error and since he did not forward the application the agency could not have know. It was not until April 2009 that the agency found out about your intent for gender reassignment surgery and the fact there was a 2008 examination that had not been transmitted. At that time we had no record of a valid medical certificate. Today I receive confirmation from you in the form of a copy of that certificate. That changes the entire picture and it is my responsibility to inform the certificate holder of any problems with any certificate they hold.
Dr. F's issuance was "less than stellar" since you were not qualified at the time he gave you the certificate. I have discussed this matter with an agency attorney who concurs on questioning the validity of the 2008 certificate because no 8500-8 is on file and also because the AME knew you had a disqualifying condition and still issued the certificate.
However, the key issue is that you have a disqualifying condition; therefore, any certificate in your possession is called into question until the matter is reviewed by the Aerospace Medical Certification Division and a determination is made of your eligibility for medical certification. While I understand your concern about "walking away" from a medical certificate, but you must understand that certificate has major problems and could legally be viewed as an invalid certificate. Dr. F has created this problem and I am simply trying to undo his errors.
Since I had just earned my multi-engine rating and was on my way to Trinidad for GRS, I figured it was a good time to cry uncle and ground myself, seeking a new medical exam when I returned, and thus I wrote the following to Dr. Salazar after my surgery:
Dear Dr. Salazar,
On your advice, I have scheduled a new medical exam with Dr. R in Bedford Falls on July 28th, and we will try to fix this whole mess that Dr. F's inappropriately-documented medical exam last summer has caused. I will bring every scrap of medical and psychological paperwork I have so that Dr. R can make sure we submit a whole file of proper documentation required by your office.
Having just completed GRS in Trinidad, Colorado, last week, I'm obviously self-grounded, and I intend to remain so until Dr. R and I have satisfied your office.
Thank you for your frank and authoritative help. I apologize if I've sounded frustrated over the past few months; I was just perplexed about Dr. F's medical certificate from last summer and the steps I needed to take to rectify this situation so I can continue flying.
He returned with his own “uncle,” vowing to expedite my paperwork:
Ms. Bailey - as long as Dr. R defers certificate issuance to Oklahoma City under the special issuance process, your case will be handled appropriately. Although Oklahoma City will handle the issuing, if Dr. R notifies my office when the case is transmitted and deferred, I will have my staff work to expedite the processing. I cannot give you a specific timeframe, but if we monitor the progress it will move quicker.
While I’m relieved to finally have a clear plan, several things frustrate me. First is the FAA’s assumption that gender issues of all sorts are automatically disqualifying and put the onus of proving mental and physical health upon the trans* person. Hell, Dr. Salazar’s language puts ALL gender variance into this category, so I assume even weekend drag queens could have their pilot certificates called into question:
Gender dysphoria, gender identity disorder, sex reassignment surgery and gender variant issues in general, are initially disqualifying conditions until all treatment records, including neuropsychological (NP) assessments are received
My second frustration comes from my trust in my medical examiner last year — he told me quite authoritatively that the medications I was using (estradiol, progesterone, and spironolactone) were authorized drugs and that I was thus free to fly. As far as I knew, I had disclosed everything to the FAA, honestly and openly, and I only now find out that I have been skirting the edge of the law. It’s frustrating to follow all the regulations and to disclose everything and then discover that one key person didn’t follow their rules, thus putting my good name and my pilot certificate in jeopardy.
I’m sure my new medical exam will go swimmingly next week. I will be sure to remind the doctor that he cannot issue the certificate, but that we need to submit surgeons’ and physicians’ and psychologists’ letters to Oklahoma City so that they may issue the medical certificate.