Head Injury or Brain Injury Disposition Table

HEAD INJURY or BRAIN INJURY

Concussion, Closed Head Injury (CHI), Open Head Injury, Traumatic Brain Injury (TBI)

All Classes

(Updated 08/28/2024)

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

A. Head injury ONLY

This means:

• NO brain injury

• NO concussion

• NO neurological

symptoms

DO NOT use this row if

the individual had any

items listed in Row B,

C, or D (e.g., brain

injury, seizure, skull

fracture.)

If the AME can determine the condition was

• Head injury only (no brain injury)

such as superficial scalp injury or

globe (eyeball/eye injury) and/or

musculoskeletal injuries (facial/maxilla/

mandible fractures) that do not persist

and do not rise to the level of even a

mild concussion;

• No neurological symptoms; and

• No “mild concussion symptoms” such

as headache, dizziness, nausea, or

non-focal neurological symptoms such

as photo/phonophobia, tinnitus,

irritability, mental fogginess, etc., as a

result of the injury.

• If imaging (CT/MRI) was performed, no

evidence of brain trauma.

• Has completely resolved and the

individual has been released to full

activity by the treating physician:

Note: The AME should NOT use this row if any

symptoms, concerns for concussion/brain

injury, or any complications.

If any concerns in history, the AME should

review the most recent, detailed Clinical

Progress Note describing the incident, recovery,

and follow-up (if applicable).

ISSUE

Annotate this information

in Block 60 including

approximate mechanism

and date of injury.

B1. Brain injury

5 or more years ago

This includes:

• Concussion (a

type of mild brain

injury)

• MILD brain Injury

As long as NO seizure*

*Exception: An

immediate impact

seizure (within 24 hours

of injury) can be

reviewed

using Row B criteria.)

ote: High impact/

penetrating injuries (e.g.,

gunshot or severe

The AME should gather information regarding

the diagnosis, severity, treatment, symptoms,

and address ALL the questions on the

Brain

Injury Decision Tool for the AME.

If all items on the decision tool are in the

clear, “NO column, the AME may:

Note: For a remote injury with no concerns,

the most recent progress note is acceptable.

ISSUE

Summarize this history,

diagnosis, and annotate

Block 60: “Discussed the

history of BRAIN

INJURY, no positives to

screening questions, and

no concerns.”

If any “YES” answers,

any AME concerns, or

unable to verify history –

DEFER

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

trauma) may present

with few or no

concussive symptoms.

For high impact injuries,

see Row D.

B2. Brain injury

Within the past 5 years

This includes:

• Concussion

• MILD brain Injury

• Loss of

Consciousness

(LOC)

• Alteration of

Consciousness

(AOC)

• Post-Traumatic

Amnesia (PTA)

ALL less than 1 HOUR

AND

• No seizure

Exception: An

immediate impact

seizure (within 24

hours of injury) can

be reviewed using

Row B criteria.

Note: High

impact/penetrating

injuries (e.g., gunshot or

severe trauma) may

present with few or no

concussive symptoms.

For high impact injuries,

see Row D

Do NOT use this row if

the individual had any

items listed in Row C

or D (e.g., brain injury,

seizure, skull fracture)

After a 6-month recovery period obtain the

following evaluation(s) and submit for FAA

review:

1. A current, detailed Clinical Progress

Note generated from a clinic visit with

the treating physician or

neurologist 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); and follow-up.

2. It must specifically include:

• Any evidence of seizure;

• Any post-traumatic amnesia or

mental fogginess (incomplete

memory of the incident, does not

recall the impact/crash, etc.)

• Any post-concussive symptoms

such as headaches, dizziness,

irritability;

• Any changes in vision;

• Any focal deficit;

• Any imaging performed and if

(CT/MRI) was negative;

• Any clinical indication for further

brain imaging; initial CT head/face

negative.

3. Records from any hospitalization(s) for

this condition to include:

• Admission History and Physical;

• Hospital discharge summary.

(Typically, the patient portal notes

or After Visit Summary [AVS]

printed from the electronic medical

record are NOT sufficient for pilot

medical certification purposes.);

• Hospital consultant report(s) (such

as neurology, cardiology, internal

medicine, or other specialists);

• Operative/procedure report(s);

• Pathology report(s);

DEFER

Submit the information to

the FAA for a possible

Special Issuance

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

• Radiology reports*. The

interpretive report(s) of all

diagnostic imaging performed (CT

scan, MRI, X-ray, ultrasound, or

others);

• Lab report(s) including all drug or

alcohol testing performed; and

• Emergency Medical Services

EMS)/ambulance run sheet.

• DO NOT submit miscellaneous

hospital records such as

flowsheets, nursing notes,

physician orders, or medication

administration records.

• Submit the interpretive report on

paper and imaging on CD in

DICOM readable format (there

must be a file named 'DICOMDIR'

in the root directory of the CD-

ROM). Please verify the CD will

display the images before

sending. Retain a copy of all films

as a safeguard if lost in the mail.

Note: If any abnormalities noted, go to Row C.

C. Moderate BRAIN

Injury

This includes:

• LOC, AOC, or PTA

1 to 24 hours

• Non-depressed

skull fracture

• Small parafalcine

or tentorial

subdural

hematoma

(resolved by MRI)

• Small

subarachnoid

hemorrhage

(resolved by MRI)

Any hemorrhage

must be resolved

on MRI. If the MRI

shows signs of

hemosiderin

After a 12-month recovery period obtain the

following evaluation(s) and submit for FAA

review:

1. A current, detailed neurological

evaluation, in accordance with the FAA

Specifications for Neurologic

Evaluation, that is generated from a

clinic visit with the treating

neurologist no more than 90 days

before the AME exam.

2. It must specifically include if there is

(or is NOT) any concern or history

of seizure(s).

3. EEG only if a seizure occurred and an

EEG was obtained, submit results.

EEG* Sleep-deprived and sleep awake

state with activating procedures (with

provocation) performed at the time of

event or later.

4. A Neuropsychological evaluation that

meets FAA Specifications for

Neuropsychological Evaluations for

Potential Neurocognitive Impairment

from a clinic visit with the treating

DEFER

Submit the information to

the FAA for a possible

Special Issuance

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

deposition, go to

Row D.

neuropsychologist no more than 90

days before the AME exam.

5. MRI brain with hemosiderin-sensitive

sequences (with contrast as clinically

appropriate) performed any time after

the event.

• Submit the interpretive report on

paper and imaging on CD in

DICOM readable format (there

must be a file named 'DICOMDIR'

in the root directory of the CD-

ROM). Please verify the CD will

display the images before

sending. Retain a copy of all films

as a safeguard if lost in the mail.

6. Records from any hospitalization(s) for

this condition to include:

• Admission History and Physical.

• Hospital discharge summary.

(Typically, the patient portal notes

or after visit summary [AVS]

printed from the electronic medical

record are NOT sufficient for pilot

medical certification purposes.).

• Hospital consultant report(s) (such

as neurology, cardiology, internal

medicine, or other specialists).

• Operative/procedure report(s).

• Pathology report(s).

• Radiology reports. The

interpretive report(s) of all

diagnostic imaging (CT scan, MRI,

X-ray, ultrasound, or

others) performed. For all imaging,

submit the interpretive report(s)

AND the actual images on CD in

DICOM readable format.

• Lab report(s) including all drug or

alcohol testing performed.

• Emergency Medical

Services (EMS)/ambulance run

sheet.

• DO NOT submit miscellaneous

hospital records such as

flowsheets, nursing notes,

physician orders, or medication

administration records.

7. Progress notes from ALL clinic follow-

up visits related to this condition.

DISEASE/CONDITION

EVALUATION DATA

DISPOSITION

8. Other tests already performed or

clinically indicated.

Note: Small parafalcine or tentorial

Subdural Hematoma: If asymptomatic and

MRI 3-6 months after the injury shows

complete resolution, FAA may consider after a

6-month recovery period. Submit the

Evaluation Data in this row after the recovery

period.

D. Severe BRAIN Injury

This includes:

• Blood in the

Brain:

o Brain contusion

o Intracranial

bleed

o Hematoma

o Epidural

hematoma

o Subdural

hematoma

o Diffuse axonal

injury

• LOC, AOC, PTA:

24 hours or more

• Depressed skull

fracture

• Penetrating head

injury

After a five (5)-year recovery period submit

for FAA review:

• All items in Row B

Note: MRI, MRA/CTA, or

electroencephalogram (EEG) studies

are required. If not performed during

the initial management or monitoring of

the condition, new testing must be

obtained.

For all imaging, submit the interpretive

report(s) AND the actual images on CD

in DICOM readable format.

DEFER

Submit the information to

the FAA for a possible

Special Issuance

LOC: Loss of Consciousness

AOC: Alteration of Consciousness

PTA: Post-Traumatic Amnesia