On September 14, 2003, about 1323 eastern daylight time, a Mooney M20J, N205Z, registered to a private individual, crashed into the Atlantic Ocean, after the pilot reported medical difficulties in-flight. Visual meteorological conditions prevailed at the time and no flight plan was filed for the 14 CFR Part 91 personal flight. The airplane was presumed to be destroyed and the private-rated pilot, the sole occupant, was presumed to be fatally injured. The flight originated about 1251, from the Palm Beach International Airport (PBIA), West Palm Beach, Florida. At 1245:39, the pilot received his VFR clearance from Palm Beach to Fort Pierce and at 1250:56, was cleared for takeoff on runway 9R. At 1300:12, Palm Beach Departure advised the pilot that he was leaving Class C airspace and radar services were terminated. At 1311:35, the pilot reinitiated contact with Palm Beach Departure and reported that he was near Stuart and returning to the Palm Beach airport with an unspecified problem. At 1311:53, departure control asked the pilot if he wanted the equipment standing by which the pilot declined. At 1312:01, the pilot reported that he had a "severe, severe headache in the base of [his] neck." Approximately 2 minutes later the pilot reported "my defibrillator just went off on me." At 1314:23, departure control asked the pilot if he would like to continue to Palm Beach or turn back to Stuart to which the pilot responded he would continue to Palm Beach. At 1314:29, the controller asked the pilot if he wanted an ambulance standing by to which the pilot said, "I don't know, let me stay with this for a minute and see what happens." At 1315:08, the pilot declared "mayday" and reported that he was losing his eyesight and that he was going to head east. At 1315:28, the controller confirmed with the pilot that he wanted to proceed on an easterly course over the water to which the pilot responded, "yea, I don't wanna take anybody out I don't know whether I can make it back." At 1315:40, the controller questioned the pilot if he would like to continue southbound and the pilot responded, "I would rather no---augh uh I got that." There was no further radio communication with the pilot. The pilot of another airplane, N402JH, was given radar vectors to intercept the accident airplane. At 1322:37, the pilot of N402JH reported the accident airplane had impacted the water. Radar data indicates that the airplane departed Palm Beach International Airport at 1251, and flew northbound paralleling the east coast of Florida. At 1311, in the vicinity of Stuart, Florida, the airplane reversed course and began a track southbound paralleling the coast at 1,300 feet. In the vicinity of Jupiter, at 1315, the airplane turned eastbound over the Atlantic Ocean. From 1315 to 1320, the airplane climbed from 1,300 to 4,100 feet. From 1320 to 1322, the airplane descended from 4,100 feet to 300 feet where radar contact was lost at 1322:25. Just prior to loss of radar contact, the airplane had turned left and began tracking northbound. The last radar contact was located 27 degrees 01 minutes 03.48 seconds North latitude and 079 degrees 52 minutes 15.27 seconds West longitude. The U.S. Coast Guard responded to the accident site area, and spotted a debris field at 1453; the debris field was located at 27 degrees 05 minutes 36 seconds North latitude and 079 degrees 53 minutes 12 seconds West longitude. The depth of water at that location was reported to be 500 feet. Only a plastic bag with paper contents was recovered by the U.S. Coast Guard. An NTSB review of the pilot's medical records indicate that approximately 2 years prior to the accident, the pilot had his aortic valve replaced due to severe aortic insufficiency. At that time he also had a bypass graft placed around a partially blocked coronary artery. Approximately 1 1/2 years prior to the accident, the pilot had a cardioverter/defibrillator implanted due to frequent abnormal rhythms on EKG and Holter monitor and "inducible monomorphic ventricular tachycardia" on electrophysiology study. Subsequently, the pilot had episodes of lightheadedness and defibrillator discharge while flying, and multiple episodes of sustained and non-sustained abnormal heart rhythms documented from defibrillator interrogations. The latest defibrillator interrogation performed approximately 3 months prior to the accident documented seven instances of non-sustained abnormal rhythms within three weeks of the interrogation. His cardiologist noted approximately one year prior to the accident "As I discussed with [the pilot] on multiple previous occasions, at this time I do not see him as a candidate for being a airplane pilot..." A review of the pilot's airmen records revealed that the pilot was issued a second-class airmen medical certificate on June 26, 2000. Federal Aviation Regulation 14 Code of Federal Regulations (CFR) Part 61.23 states that a second-class medical certificate for operations requiring a private pilot certificate expires at the end of "the 24th month after the month of the date of the examination shown on the certificate if the person has reached his or her 40th birthday on or before the date of the examination." Federal Aviation Regulations 14 CFR Part 67.111, 67.211, and 67.311 state that for first-class, second-class, and third-class airmen medical certificates cardiovascular standards are that a person cannot have a clinical diagnosis or medical history of cardiac valve replacement or permanent cardiac pacemaker implantation.