Pilot Debrief

SOCATA TB21 near Silverton, CO — 2011-12-03

Final reportCEN12FA098
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Date
2011-12-03
Location
Silverton, CO, USA
Aircraft
SOCATA TB21
Registration
N25153
Category
Airplane
Highest injury
Fatal
Fatalities
4
Phase of flight
Cruise

Probable cause

The non-instrument-rated pilot’s decision to embark on a flight through forecasted instrument meteorological conditions (IMC), and his subsequent flight into IMC, which resulted in the pilot’s spatial disorientation and subsequent maneuvering of the airplane in a manner that exceeded the airplane’s structural limits.

NTSB narrative

The non-instrument-rated pilot departed for his destination with active weather advisories for his route of flight for instrument flight rules (IFR) conditions and mountain obscuration due to clouds, precipitation, and mist. After departure, the pilot attempted to remain in visual flight rules (VFR) flight by climbing above 18,000 feet mean sea level and proceeding toward his destination. When queried by an air traffic controller, the pilot stated that he could not descend due to weather. In addition, he stated that he was not instrument rated or qualified. No further transmissions were made by the pilot. Witnesses near the accident site reported low clouds with light snow flurries. On-site wreckage distribution was consistent with an in-flight breakup. Further, an examination of the wreckage revealed signatures on the airplane’s right wing consistent with it failing in overload in the upward direction and signatures on the empennage and tail section consistent with their failure in overload in the downward direction, indicating the failures were due to loads that exceeded the airplane’s structural limits. A weather study revealed the potential for clouds at the pilot’s cruising altitude, which increased the potential for VFR flight into instrument meteorological conditions (IMC). Therefore, it is likely that the pilot encountered IMC, became spatially disoriented, and then maneuvered the airplane in a manner that exceeded the airplane’s structural limits while trying to return to level flight and avoid mountainous terrain.

Analysis

Primary failure mode
VFR into IMC
First missed decision gate
Pilot should have avoided VFR flight in IMC conditions.

NTSB coding

Evidence available

  • ADS-B / radar
  • Photos
  • 12 docket documents
View NTSB final reportView NTSB docket

Docket documents12

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