3rd Class SI stuck in HIMS

[Mileage]

Hi everyone - long time reader/first time poster, may need to go through the HIMS process in the future to qualify medically so am posting anonymously. There is so much confusion on this topic. Thanks Dr. Chien, these posts have been really helpful to me and other pilots.

I talked with AOPA legal (not helpful) and medical (confusing) yesterday for their advice on the HIMS SI -> Basic med situation. Their advice was to get the HIMS SI, do the full 6 year SI and then and only then go to BasicMed. This makes no sense, except we're dealing with the FAA.

She said what has happened "frequently enough that there are court cases about it" is that a pilot complies with everything in the SI, lets their medical expire (therefore there is nothing to revoke), goes to basic med, and then the FAA will move to withdraw the SI, in their opinion making the pilot ineligible for BasicMed. She also had some incorrect information (i.e. for third class to do HIMS you have to do intensive rehab) so this is why it's really important to get actual advice from an experience Lawyer and a Sr. HIMS AME. I'm in the process of doing both.

Fwiw the FAA has itself, though, circulated a legal opinion which states that there's no basis for withdrawing an SI authorization after a pilot lets their 3rd class medical certificate expire and goes basic med instead. In fact, the opinion states that Congress's intent with basic med was to make it less onerous to self certify in all situations after one SI medical (see attached)

 

[flyingron]

Did you mean advise against taking their advice?

You betcha.. Thanks for the correction. I fixed it.

 

[Mileage]

One of my concerns with going the Basic Med route would be "what happens if I develop a second condition that would require me to get an SI" because I was wondering if I would have to renew my substance dependence SI as well as get a new SI for the new condition. It appears the answer is no. On the Basic Med advisory circular (attached) it says that an airman only needs a single SI Medical Certificate for each condition in order to qualify for basic med.

The exact quote is:
"8.2 Special Issuance Medical Certificates Required. For certain conditions, a person wishing to operate under BasicMed must complete the process for obtaining an authorization for special issuance of a medical certificate in accordance with § 68.9. The person is required to obtain only one special issuance medical certificate for each condition, and may subsequently operate under BasicMed. Persons who have, or are newly diagnosed with, a cardiovascular, neurological, or mental health condition described in FESSA, may not use BasicMed until they have been found eligible for special issuance of a medical certificate. Once issued a medical certificate, the person may then use BasicMed if they meet all other requirements of FESSA."

 

[flyingron]

I'm not sure how you make the leap you did. The FAA doesn't just issue SI letters. They make special issuances of a medical certificate. You can't go in and say, "I want a SI for my heart attack" without them considering all the rest of your medical application and any SI conditions for things like substance abuse still also apply.

 

[Mileage]

I'm not sure how you make the leap you did. The FAA doesn't just issue SI letters. They make special issuances of a medical certificate. You can't go in and say, "I want a SI for my heart attack" without them considering all the rest of your medical application and any SI conditions for things like substance abuse still also apply.

For sure, they will do whatever they will do, but the language in the circular is unusually clear: "The person is required to obtain only one special issuance medical certificate for each condition, and may subsequently operate under BasicMed."

But this is why it would be useful to hear from actual people who have gone this route rather than just theoreticals.

 

[flyingron]

Right, that just means that if the FAA lets you off a SI (which they do over time for some conditions), your subsequent medicals don't need to address that. However, that's a far cry from saying, if I get a new SI-requiring condition I don't have to address the previous-issued SIs, that is incorrect.

 

[Mileage]

Right, that just means that if the FAA lets you off a SI (which they do over time for some conditions), your subsequent medicals don't need to address that. However, that's a far cry from saying, if I get a new SI-requiring condition I don't have to address the previous-issued SIs, that is incorrect.

I'm curious if that is your interpretation of the regs or if you are speaking from experience.

 

[flyingron]

It's the way things work. You can't get a special issuance unless you meet all the requirements of the medical certificate you are applying for. There's no provision to say "give me a special issuance for my heart attack but ignore my sleep apnea, diabetes, and substance abuse"

 

[Mileage]

Again, I'm just reading the regs here. It's also odd to me that basic med allows pilots to get one six month SI medical, let it expire, and then be on basic med for the rest of their lives conceivably, but that is apparently the case.

 

[Half Fast]

It's also odd to me that basic med allows pilots to get one six month SI medical, let it expire, and then be on basic med for the rest of their lives conceivably, but that is apparently the case.

It's not up to the FAA. Basic Med was created as a law and can't be changed without an act of Congress. Basic Med is NOT an FAA medical; it's an alternative. Don't argue, just accept it and enjoy it.

 

[Mileage]

It's not up to the FAA. Basic Med was created as a law and can't be changed without an act of Congress. Basic Med is NOT an FAA medical; it's an alternative. Don't argue, just accept it and enjoy it.

But my open question is about what happens if you go basic med and then develop a subsequent condition requiring a new SI. I'm not arguing against your interpretation, I'm trying to figure out the basis for it

 

[Half Fast]

But my open question is about what happens if you go basic med and then develop a subsequent condition requiring a new SI. I'm not arguing against your interpretation, I'm trying to figure out the basis for it

The basis is that an FAA medical evaluates your fitness to fly; it's impossible to evaluate one condition and ignore others. When the FAA issues a medical, they're saying "This airman's health is acceptable and meets standards." There's no provision in the regs to say "This airman's cardio health is acceptable but we're not going to evaluate his sleep apnea." If the previous evaluation of the sleep apnea has expired it will have to be redone.

When the FAA issues an SI medical, they evaluate all conditions you have at the time. If you're on Basic Med and develop something new requiring an SI, the FAA will again evaluate your total situation to decide whether you can hold a medical.

They can't issue you a medical for a heart condition and ignore other conditions. An FAA medical covers your TOTAL fitness for flight.

I had to get an SI for an autoimmune disease, then I switched to Basic Med. If I develop one of the trigger conditions, like a cardio problem, I will have to get a fresh 3rd class and that will mean another SI covering the new condition plus autoimmune condition. Or switch to Sport Pilot, which would be more likely.

 

[Palmpilot]

Again, I'm just reading the regs here.

One problem is that what you quoted before is not actually the reg; it's just an advisory circular, which as the name suggests, is advisory, not regulatory. Furthermore, advisory circulars tend to paraphrase, so when you want to be precise, you really need to read the actual regulation, which in this case is 14 CFR 68.9, shown below. Note carefully that under Paragraph (a), when you are seeking to exercise BasicMed privileges, it doesn't say anything about obtaining a Special Issuance by itself; it says you must obtain an Authorization for Special Issuance "of a Medical Certificate," and it says you must do this for "each of" the listed conditions that you have. There's no support there for the idea that you could get an SI for a newly diagnosed condition without applying for and obtaining a new medical certificate, and the rules for that are in Part 67, not Part 68.

§ 68.9 Special Issuance process.
Link to an amendment published at 87 FR 71238, Nov. 22, 2022.

(a) General. An individual who has met the qualifications to operate an aircraft under § 61.113(i) of this chapter and is seeking to serve as a pilot in command under that section must have completed the process for obtaining an Authorization for Special Issuance of a Medical Certificate for each of the following:

(1) A mental health disorder, limited to an established medical history or clinical diagnosis of -

(i) A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;

(ii) A psychosis, defined as a case in which an individual -

(A) Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or

(B) May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;

(iii) A bipolar disorder; or

(iv) A substance dependence within the previous 2 years, as defined in § 67.307(a)(4) of this chapter.

(2) A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:

(i) Epilepsy;

(ii) Disturbance of consciousness without satisfactory medical explanation of the cause; or

(iii) A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.

(3) A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:

(i) Myocardial infarction;

(ii) Coronary heart disease that has required treatment;

(iii) Cardiac valve replacement; or

(iv) Heart replacement.

(b) Special rule for cardiovascular conditions. In the case of an individual with a cardiovascular condition, the process for obtaining an Authorization for Special Issuance of a Medical Certificate shall be satisfied with the successful completion of an appropriate clinical evaluation without a mandatory wait period.

(c) Special rule for mental health conditions.

(1) In the case of an individual with a clinically diagnosed mental health condition, the ability to operate an aircraft under § 61.113(i) of this chapter shall not apply if -

(i) In the judgment of the individual's State-licensed medical specialist, the condition -

(A) Renders the individual unable to safely perform the duties or exercise the airman privileges required to operate an aircraft under § 61.113(i) of this chapter; or

(B) May reasonably be expected to make the individual unable to perform the duties or exercise the privileges required to operate an aircraft under § 61.113(i) of this chapter; or

(ii) The individual's driver's license is revoked by the issuing agency as a result of a clinically diagnosed mental health condition.

(2) Subject to paragraph (c)(1) of this section, an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that mental health condition.

(d) Special rule for neurological conditions.

(1) In the case of an individual with a clinically diagnosed neurological condition, the ability to operate an aircraft under § 61.113(i) of this chapter shall not apply if -

(i) In the judgment of the individual's State-licensed medical specialist, the condition -

(A) Renders the individual unable to safely perform the duties or exercise the airman privileges required to operate an aircraft under § 61.113(i) of this chapter; or

(B) May reasonably be expected to make the individual unable to perform the duties or exercise the privileges required to operate an aircraft under § 61.113(i) of this chapter; or

(ii) The individual's driver's license is revoked by the issuing agency as a result of a clinically diagnosed neurological condition.

(2) Subject to paragraph (d)(1) of this section, an individual clinically diagnosed with a neurological condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that neurological condition.
​

 

[Mileage]

These comments have been very helpful, so thank you all who have written responses here. I do get the sense, though, that we are all just offering our interpretations and speaking hypothetically rather than speaking from experience or citing actual cases. One of you wrote that the AOPA has been flooded with cases of pilots letting their SI medical certificates expire, going on basic med, and then having their unexpired SI Authorizations get withdrawn, which would then disqualify them for basic med and require them to seek an SI medical all over again. I'd like to hear from someone who has actually had that experience (or, by contrast, who has gone basic med without any issue whatsoever)

Similarly, the unresolved question for me remains, what exactly happens if I go on basic med and then develop a second condition requiring a special issuance? I get that I need to re-qualify for a medical certificate accounting for the entirety of my medical history, but I have already gotten the SI for substance dependence, so do I go back to square one on that or do I get credit for that in some fashion such that I do not have to re-do every step I did to get the substance dependence SI originally (e.g., re-take the neuro-psychological exam, re-see the FAA psychologist, secure letters of recommendation from people, etc)? Consider three scenarios:

1) I have gone on basic med but have continued to follow all the guidelines of my SI authorization but without applying for medical certificates
2) I have gone on basic med and have not followed every requirement of the SI authorization, but I can demonstrate my sobriety with forensic evidence (e.g., a continuous record of testing)
3) i have gone on basic med but have not followed most of the SI authorization requirements, but also have remained sober in recovery
4) I have followed the SI authorization until it expires and only then gone on basic med

Does anyone have actual experience here? If not, please feel free to respond but it would be helpful if you'd indicate the basis for your opinion

 

[mcmanigle]

I think an easier way to think about it is, BasicMed is this special thing created by Congress (with the literal required regulations written around it by the FAA) and it requires an FAA medical to get. But as others have said, the FAA in no way thinks of a medical as a door to BasicMed. BasicMed is this thing they have to allow, but they don't have a BasicMed SI process.

A more clear example is probably Sport Pilot and a driver's license. You require a driver's license to fly by Sport rules. But if you are otherwise completely healthy, but absolutely refuse to learn what a stop sign is, you can't go to your DMV and say "can I just get a driver's license that says I'm healthy enough to fly a plane? I'm never going to drive a car." The DMV doesn't know or care about Sport Pilot rules. They give you a driver's license, or they don't.

Same with an FAA Medical. They either give you a medical (with any SI required) or they don't. They don't "do the part you need for BasicMed" because their process has nothing to do with getting BasicMed pilots through.

 

[Mileage]

I think an easier way to think about it is, BasicMed is this special thing created by Congress (with the literal required regulations written around it by the FAA) and it requires an FAA medical to get. But as others have said, the FAA in no way thinks of a medical as a door to BasicMed. BasicMed is this thing they have to allow, but they don't have a BasicMed SI process.

A more clear example is probably Sport Pilot and a driver's license. You require a driver's license to fly by Sport rules. But if you are otherwise completely healthy, but absolutely refuse to learn what a stop sign is, you can't go to your DMV and say "can I just get a driver's license that says I'm healthy enough to fly a plane? I'm never going to drive a car." The DMV doesn't know or care about Sport Pilot rules. They give you a driver's license, or they don't.

Same with an FAA Medical. They either give you a medical (with any SI required) or they don't. They don't "do the part you need for BasicMed" because their process has nothing to do with getting BasicMed pilots through.

Absolutely, which is why I am asking my question about what the FAA would actually do in the situations I described.

 

[Palmpilot]

The people here who have the most experience with how the FAA handles SIs are the two AMEs who post here.

It seems me that one of them essentially told you what you need to know here:

https://www.pilotsofamerica.com/com...s-si-stuck-in-hims.128395/page-3#post-3345359

 

[guest user]

@Mileage Your approach to answer this question seems odd to me.

You come onto an internet forum, ask a question but become unhappy that an internet forum is unable to provide you a definite answer about how a government entity will handle a specific situation.

Since we random guys on the internet cannot tell you, to your satisfaction, how a government entity will handle your specific question, might I suggest you simply call them up and ask them directly? After all, that seems to be what you're after.

While I will not call or write them for you, I have looked up both their phone number and mailing address to help you out.

Aerospace Medical Certification Division
Regular 1st Class Mail
Federal Aviation Administration
Aerospace Medical Certification Division, AAM-300
CAMI, Bldg 13
PO Box 25082
Oklahoma City, OK 73125

Phone: (405) 954-4821

Good luck

 

[Mileage]

@Mileage Your approach to answer this question seems odd to me.

You come onto an internet forum, ask a question but become unhappy that an internet forum is unable to provide you a definite answer about how a government entity will handle a specific situation.

Since we random guys on the internet cannot tell you, to your satisfaction, how a government entity will handle your specific question, might I suggest you simply call them up and ask them directly? After all, that seems to be what you're after.

While I will not call or write them for you, I have looked up both their phone number and mailing address to help you out.



Good luck

Thank you. I was hoping to also hear the personal experience of pilots who have gone through this vs just the opinions of pilots reading the regs, and I was hoping to find such pilots in a pilot forum

I am, of course, pursuing other avenues to get answers at the same time.

 

[robin ardoin]

@Mileage As previously mentioned, two senior AME's that have experience in HIMS cases and have had client pilots in the mentioned situation advised you in prior posts. They were speaking from experience with the HIMS system and pilots allowing expiration of SI medicals and transitioning to BM.

 

[Palmpilot]

Thank you. I was hoping to also hear the personal experience of pilots who have gone through this vs just the opinions of pilots reading the regs, and I was hoping to find such pilots in a pilot forum

I am, of course, pursuing other avenues to get answers at the same time.

Given that the regs say what they say, and that BasicMed has been in effect for less than six years, I'd say the odds of finding people anywhere who have tried what you're suggesting are not good.

 

[Russ Hart]

These comments have been very helpful, so thank you all who have written responses here. I do get the sense, though, that we are all just offering our interpretations and speaking hypothetically rather than speaking from experience or citing actual cases. One of you wrote that the AOPA has been flooded with cases of pilots letting their SI medical certificates expire, going on basic med, and then having their unexpired SI Authorizations get withdrawn, which would then disqualify them for basic med and require them to seek an SI medical all over again. I'd like to hear from someone who has actually had that experience (or, by contrast, who has gone basic med without any issue whatsoever)

Similarly, the unresolved question for me remains, what exactly happens if I go on basic med and then develop a second condition requiring a special issuance? I get that I need to re-qualify for a medical certificate accounting for the entirety of my medical history, but I have already gotten the SI for substance dependence, so do I go back to square one on that or do I get credit for that in some fashion such that I do not have to re-do every step I did to get the substance dependence SI originally (e.g., re-take the neuro-psychological exam, re-see the FAA psychologist, secure letters of recommendation from people, etc)? Consider three scenarios:

1) I have gone on basic med but have continued to follow all the guidelines of my SI authorization but without applying for medical certificates
2) I have gone on basic med and have not followed every requirement of the SI authorization, but I can demonstrate my sobriety with forensic evidence (e.g., a continuous record of testing)
3) i have gone on basic med but have not followed most of the SI authorization requirements, but also have remained sober in recovery
4) I have followed the SI authorization until it expires and only then gone on basic med

Does anyone have actual experience here? If not, please feel free to respond but it would be helpful if you'd indicate the basis for your opinion

This is my experience…had a SI and my third class medical expired within that SI. Advised by my HIMS AME that I could go BasicMed. I took the class and saw my doctor and completed all BasicMed requirements. Then I got a letter from FAA withdrawing my SI. I was in BasicMed legally according to AME yet the AOPA attorney tells me that sine the FAA withdrew my SI, I’m now not eligible for BasicMed. I’m really confused. AME and AOPA don’t agree and that puts me in a precarious situation.

 

[Half Fast]

This is my experience…had a SI and my third class medical expired within that SI. Advised by my HIMS AME that I could go BasicMed. I took the class and saw my doctor and completed all BasicMed requirements. Then I got a letter from FAA withdrawing my SI. I was in BasicMed legally according to AME yet the AOPA attorney tells me that sine the FAA withdrew my SI, I’m now not eligible for BasicMed. I’m really confused. AME and AOPA don’t agree and that puts me in a precarious situation.

PoA's very own FAA mole, @Brad Z , might be able to advise here. Since you say your medical expired, it hasn't been revoked (and can't be), so it seems like you'd be eligible for Basic Med.

 

[Brad Z]

This is my experience…had a SI and my third class medical expired within that SI. Advised by my HIMS AME that I could go BasicMed. I took the class and saw my doctor and completed all BasicMed requirements. Then I got a letter from FAA withdrawing my SI. I was in BasicMed legally according to AME yet the AOPA attorney tells me that sine the FAA withdrew my SI, I’m now not eligible for BasicMed. I’m really confused. AME and AOPA don’t agree and that puts me in a precarious situation.

So you received a letter withdrawing your SI after your medical certificate expired? As in, completely expired, not downgraded from a 1st class to the privileges of a lower class?

There should have been contact information for the office that issued the letter. If you're unable to get assistance from AMCD, reach out to the BasicMed program office at:
9-AFS-800-Correspondence@faa.gov

 

[WingmanMed]

Withdrawing and SI is not the same is revoking or denying a medical.

 

[Brad Z]

Withdrawing and SI is not the same is revoking or denying a medical.

14 CFR 61.23(c)(3)(iii)

The most recently issued Authorization for a Special Issuance of a Medical Certificate cannot have been withdrawn;

 

[Anthem]

14 CFR 61.23(c)(3)(iii)

The most recently issued Authorization for a Special Issuance of a Medical Certificate cannot have been withdrawn;

thanks for pointing and referencing that out. I was just going to quote that as I read that it couldnt have been withdrawn either.. so while its different than being denied, for basicMed purposes - its essentially the same . .

 

[Mileage]

This is my experience…had a SI and my third class medical expired within that SI. Advised by my HIMS AME that I could go BasicMed. I took the class and saw my doctor and completed all BasicMed requirements. Then I got a letter from FAA withdrawing my SI. I was in BasicMed legally according to AME yet the AOPA attorney tells me that sine the FAA withdrew my SI, I’m now not eligible for BasicMed. I’m really confused. AME and AOPA don’t agree and that puts me in a precarious situation.

I would be curious is @bbchien has encountered situations like this one