ANC24LA005

NTSB accident investigation · Diamond Aircraft Ind DA 40 · Kapolei, HI · December 4, 2023

Accident · Serious injuriesClass 3 · LimitedFinal report
Date
December 4, 2023, 12:50 local (22:50 UTC)
Place
Kapolei, HI · Dirt field
Injuries
1 serious, 1 minor
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N691YWDiamond Aircraft Ind DA 40
Defining event
Enroute: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Alaska Regional Office
Parties
FAA
FAA report
20231204020659A
Case key
193475

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

A partial loss of engine power due to lose baffling from the muffler, which resulted in an obstruction of the exhaust system.

Findings · 1

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Engine exhaust: collector/nozzleAircraft › Aircraft power plant · Damaged/degradedDiamond Aircraft Ind DA 40: 1 caseAll aircraft: 3 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

While enroute the pilot moved the throttle control lever forward and heard a “pop” sound come from the engine, followed by a rumbling noise and an airplane vibration. The pilot pulled the throttle back to its original position in an attempt to stop the rumbling and vibrations and turned the airplane back toward the runway for an emergency landing. Engine power was not restored, and the airplane began to lose altitude, so the pilot performed a forced landing, which resulted in substantial damage to the fuselage and both wings. Postaccident examination revealed that baffling from the exhaust muffler had broken loose, blocking about 3/4 of the opening. The blocked exhaust reduced the volumetric efficiency of the engine cylinders, resulting in the partial loss of engine power.

Factual narrative

On December 04, 2023, about 1250 Hawaii-Aleutian standard time, a Diamond DA-40 airplane, N691YW, sustained substantial damage when it was involved in an accident in Kapolei, Hawaii. The pilot sustained minor injuries, and the designated pilot examiner sustained serious injuries. The airplane was operated by the pilot as a Title 14 Code of Federal Regulations Part 91 flight test. The pilot reported that an engine run-up inspection was completed without any issues of concern before departure. They departed from Danial K Inouye International Airport (PHNL) Honolulu, Hawaii, about 1235. After departure they leveled off at 1,500 ft mean sea level and proceeded to the practice area to conduct an evaluation for an airplane instrument rating. The pilot configured the airplane for the first maneuver. When he moved the throttle control lever forward, they heard a “pop” sound come from the engine, followed by a rumbling noise and an airplane vibration. The pilot pulled the throttle back to its original position in an attempt to stop the rumbling and vibrations and turned the airplane back toward runway 11 at Kalaeloa Airport (PHJR), Kapolei, Hawaii, for an emergency landing. They scanned the ignition, control levers, fuel selector, and multi-function display. The pilot confirmed that the mixture control lever was full forward, the propeller control lever was full forward, and the throttle control lever was about 3/4 full forward. The ignition was positioned on "BOTH", the fuel selector knob was positioned directly over the right tank, and the multi-function display showed no discrepancies in engine instrument readings that would indicate a need for immediate corrective action. The airplane started a descent without any manual pitch adjustments. They increased the throttle lever to the full forward position, but this did not provide any additional thrust from the engine. They declared an emergency; the designated pilot examiner took the flight controls, and they began to look for a suitable area for a forced landing. They performed a forced landing to a flat area of land that was covered with dirt. After initial touchdown, the airplane continued to roll straight down the dirt path until it impacted a dirt hill, resulting in substantial damage to the fuselage and both wings. A postaccident examination conducted by a Federal Aviation Administration inspector and a certified airframe and powerplant mechanic revealed no internal failure of the engine. The fuel injection servo control was in the full throttle position and the mixture control was in the full rich position; neither cable could be moved in the cockpit due to impact damage. The fuel injection servo was removed for inspection, and it revealed that the throttle/butterfly did not move and was in the full-throttle position. The valve covers and lower sparkplugs were removed; no anomalies were noted. No obstructions were observed in the fuel system. The air filter was removed with no obstructionobserved. Internal baffling in the exhaust muffler had broken loose and had blocked about 3/4 of the opening. The last 100-hour inspection was completed on November 15, 2023, with the engine total time of 2,290.5 hours

Aircraft

Registration
N691YW
Reported as
Diamond Aircraft Ind DA 40
Category
Airplane
Serial number
40.690
Built
2006
Airframe hours
9,015.1
Engine
Lycoming IO-360-M1A+, 180 horsepower, reciprocating
Damage
Substantial damage
Flight
Flight test · Part 91
Registered owner
George'S Aviation Services Inc
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · November 15, 2023
Departed
PHNL · Honolulu, HI
Destination
PHJR · Kapolei, HI
Airport
PHJR · Kalaeloa (John Rodgers Field)
Equipment
Electronic multifunction display, Electronic primary flight display, Stall warning system, ADS-B, Auto-pilot, Electronic flight bag or handheld device

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
25
Injuries
Minor
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, With waivers/limitations
Last flight review
September 23, 2022
Seat
Left
Restraint
3-point
Flight hours
141 total · 72 in this make and model · 84 as pilot in command · 30 in the last 90 days · 1 in the last 30 days · 0 in the last 24 hours
Role
Other flight crew
Age
77
Injuries
Serious
Certificates
Airline transport, Flight engineer
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
November 9, 2023
Seat
Right
Restraint
3-point
Flight hours
16,800 total · 150 in this make and model · 15,000 as pilot in command · 35 in the last 90 days · 35 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Temperature
81 °F, dew point 66 °F
Altimeter
30.05 inHg
Observed at
HJR, 2 nm away
METAR
METAR PHJR 042153Z 05007G15KT 10SM BKN037 BKN048 27/19 A3005 RMK AO2 SLP181 T02720189

Docket · 6

The files NTSB released with the investigation on April 2, 2025, on NTSB’s docket system: statements, records, photos and specialists’ reports. 13.2 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.