ITEM 45. Lymphatics

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds -

II. Examination Techniques

A careful examination of the lymphatic system may reveal underlying systemic disorders of clinical importance. Further history should be obtained as needed to explain findings.

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

• LYMPHOMA AND HODGKIN'S DISEASE
• All Classes

• LEUKEMIA, ACUTE AND CHRONIC
• All Classes
• (Updated 05/31/2023)

• CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) /
• SMALL LYMPHOCYTIC LYMPHOMA (SLL)
• All Classes
• (05/31/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Rai stage 0 – 1AND/ORBinet stage AFollowed by oncology for 5 or more yearsAND• Asymptomatic with no evidence of active disease;• Treated with observation only• Age 40 or older at time of diagnosis	See the CACI - Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) WorksheetThis requires a current, detailed Clinical Progress Note from the treating oncologist and lab.If the pilot meets all CACI worksheet criteria and is otherwise qualified	ISSUEAnnotate (elements or findings) in Item 60.Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
B.Rai stage 0 – 2AND/ORBinet stage A or BANDFollowed by oncology for less than 5 yearsAND• Asymptomatic with no evidence of active disease; and• Treated with observation only	Submit the following: 1. A CLL/SLL Status Summary (to expedite case processing);2. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified ONCOLOGIST no more than 90 days before the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;• Prognosis based on Rai/Binet stage and other clinically indicated markers; and• Follow-up;3. It must specifically include performance status, disease staging, and treatment plan (including observation);	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60.
	4. Lab performed no more than 90 days before the AME exam to include:• CBC• Beta-2 microglobulin;5. Flow cytometry; and6. Any other testing already performed or deemed clinically necessary by the treating physician.
C. All othersRai stage 3 or 4AND/ORBinet stage CORFollowed by oncology for less than 5 yearsOR• Active disease or symptomatic;• Relapsed disease; or• Treated with targeted therapy and/or chemotherapy	Submit the following:1. ALL information in Row B	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60.

Note: Rows B and C require the same initial evaluation data. Row B may qualify for AASI consideration after follow-up.

• Chronic Lymphocytic Leukemia (CLL) /
• Small Lymphocytic Lymphoma (SLL) Status Summary

(Updated 05/31/2023) Name: ________________________________ Birthdate: ____________________

Applicant ID: ___________________________ PI: _________________________

Please have your treating ONCOLOGIST who manages your CLL/SLL provide the requested information in the space. Submit this summary and a current, detailed Clinical Progress Note addressing each item. Attach a copy the lab results (item #6) and submit to your AME or mail to the FAA:

• Federal Aviation Administration
• Civil Aerospace Medical Institute, Building 13

Aerospace Medical Certification Division, AAM-313, PO Box 25082 Oklahoma City, OK 73125-9914 1. Diagnosed at age 40 or older and has been followed by oncology for five (5) or more years?

(Consider iwCLL criteria) *Examples of active disease include weight loss (unintentional) greater than 10 pounds; new palpable lymph notes

Total or absolute lymphocyte count doubling time is greater than 6 months.

• ___________________________________ __________________
• Treating Physician Signature Date of Evaluation
• ___________________________________ __________________
• Name or Office Stamp Phone Number

CACI – Chronic Lymphocytic Leukemia (CLL) /

Small Lymphocytic Lymphoma (SLL) Worksheet

(Added 05/31/2023) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

Applicants with CLL:

[ ] CACI qualified CLL.

[ ] Has current OR previous SI/AASI but now CACI qualified CLL. [ ] NOT CACI qualified CLL. I have deferred. (Submit supporting documents.)

Applicants with SLL:

[ ] CACI qualified SLL [ ] Has current OR previous SI/AASI but now CACI qualified SLL. [ ] NOT CACI qualified SLL. I have deferred. (Submit supporting documents.)

LYMPHATICS

All Classes