BasicMed and Anxiety w/Meds

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anonymous user

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Assume I have an expired Third Class medical that was issued recently enough that I am eligible for BasicMed.

Since the time it expired, I was put on a low dose of one of the four SSRIs for generalized anxiety, and am still taking that medication. Obviously I haven't gone through the SSRI special issuance process, as I haven't needed to do so. And I don't intend to ever get a Class 3 or higher medical, just BasicMed.

And of course I disclose the medication on my BasicMed form.

1. If a doctor signs off my BasicMed checklist, with that disclosed, and I complete the quiz and register the signoff do I have a valid BasicMed certification?

2. If the doctor and I know that the medication causes no impairments in my ability to fly, am I legal to fly with that BasicMed certification (assuming the answer to 1 was yes) ?

3. If the doctor I ask to sign off the BasicMed checklist is also an AME, what are the odds he or she will sign it off given the above?

My reading of the regulations is: 1: Yes, because it doesn't trigger one of the four categories that require a new SI. 2: Probably yes, because it didn't trigger an SI and it isn't a definitely excluded medication. 3: Likely not, just because they'll default to Class 3 medical mode.

Other opinions solicited...
 
Two weeks ago I would have agreed with all of your answers, but both Dr. Lou and Dr. Bruce (and others) have pointed out that those SSRIs are on the no-fly list, so your only path to flying legally while taking them is the path 2 SI, and assuming you're taking one of the four that are certifiable under that program and your situation is stable. I don't think this can be done for anxiety, but only for simple depression.

And, the AME may refuse to sign off, not because he is defaulting to 3rd class mode, but because he knows the meds are disqualifying.
 
I'll be interested in seeing educated responses.

My understanding is as @azure stated. The form for the MD on the basic Med checklist includes a reference to FAA materials for doctors including a list of disqualifying meds. Someone gave me that link on AOPA last year and I'll try to find it.

All SSRIs and other anti depressants and anti anxiety meds are on the list.

IF your PCP reads everything and follows the path to that list of meds, they likely won't sign you off. It is possible your doc won't follow the trail to that list and they will sign you off through ignorance. I've considered this (being honest).

I can't see how an AME would ever sign you off with full knowledge under basic Med. They'll be aware of the no fly list of meds.

My laymans understanding is also that there is no "path 2" for anxiety. That's a DQ unless you can prove you do t actually have medical anxiety. That's from a class 3 perspective.

Basic Med - I'm hoping that if I prove I can operate off the meds I'll get a signoff.
 
IANAL but...

61.53(a)(2) "Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation." only applies to "Operations that require a medical certificate"

Those operations are defined in 61.23(a). Flying under BasicMed is *not* one of those operations (because flying under BasicMed is covered by 61.23(c), not 61.23(a)).

61.23(c)(3) is what points to 61.113(i) for BasicMed. 61.23(c)(3)(i)(A) simply requires complying with the restriction on the drivers license, and 61.23(c)(i)(E) says you need to be under the treatment of a physician if you have any medical condition that requires it.

The SI for SSRIs (if you get one under one of the paths) overrides 61.53(a)(2)'s "Is taking medication" for those particular medications... But BasicMed doesn't require 61.53(a) to be overridden at all.

So the *only* reason a doctor would not sign off on BasicMed is if they thought that the underlying condition is in fact a "medical condition that would make the person unable to operate the aircraft in a safe manner" (as outlined in 61.53(b))... because simply taking the medication (or receiving treatment) isn't prohibited for BasicMed (or gliders, or sport pilot, etc.) the way it is by 61.53(a)(2)

Yes, they point physicians at the list of meds, but only as reference material, IMO.
 
even if you quit said meds, the condition you took them for remains and thus you are DQ
 
And the obvious followup (assuming consensus is that one wouldn't be able to fly on the meds) is, what would "Path 1" look like under BasicMed (as "Path 2" is for uncomplicated depression only)? Once off the meds, they don't need to be noted on the BasicMed checklist,... so as long as the doctor likes the story on the disclosed anxiety history is there still a need for a "Path 1" SI? (Legally and/or practically)?
 
lbfjrmd said:
even if you quit said meds, the condition you took them for remains and thus you are DQ
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I can't find anything to support the idea that a history of anxiety is automatically disqualifying under BasicMed. I get the whole "underlying condition" thing, but the BasicMed law says "I certify that I am not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft."

That's all the doctor is signing. How would a history of anxiety as presently treated by no medication because it was in the past trigger not signing? For that matter, how would a history of anxiety and successful treatment with an SSRI that does not impair function trigger not signing?

Again, I get what you're saying, but I can't find any reference to you being correct (or, likewise, for the contrary being true).
 
And the FAA materials about BasicMed all say:

Conditions requiring ONE Special Issuance (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)

I don't see how a previous history of anxiety treated by medication meets any of these (though I'm not a doctor either, so maybe it is a "personality disorder that is severe enough to have repeatedly manifested itself by overt acts"?

But again, I'd love to hear from some of the experts here who have insight into what the FAA really means by what they publish.
 
anonymous user said:
And the FAA materials about BasicMed all say:

Conditions requiring ONE Special Issuance (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)

I don't see how a previous history of anxiety treated by medication meets any of these (though I'm not a doctor either, so maybe it is a "personality disorder that is severe enough to have repeatedly manifested itself by overt acts"?

But again, I'd love to hear from some of the experts here who have insight into what the FAA really means by what they publish.
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I agree, based on what I've read, and I suspect Dr. Lou @lbfjrmd was talking about 3rd class rather than BasicMed. Hopefully Dr. Lou will clarify further.

These issues were discussed recently in this thread, though the context was simple depression rather than anxiety; see post #40. Dr. Bruce @bbchien seemed to be implying a couple of times that the BasicMed equivalent of "Path 1" was also not allowed, but I believe he was talking about more complicated cases where the depression rises to the level of psychosis and/or is recurrent. I'm still unclear about what he meant, and he hasn't come back to offer further clarification.
 
lbfjrmd said:
both! unfortunately your thread seem to continue to pursue the 'surreptitious', in gaining a doctors signature.
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You could convince me that, based on the do-not-fly medication list, I should self-ground while taking the SSRI.

But I don't think you've convinced me that if I stopped the SSRI that even recurrent anxiety is grounds for denial of BasicMed or requires me to self-ground. Congress was pretty clear that they want lower standards for BasicMed (and corresponding restrictions on speed/altitude/number of passengers), and called out some pretty explicit things that are required to trigger the need for special issuance, and this isn't one of them.

Plus, if anxiety required one to self-ground, almost nobody would be able to take a checkride :)
 
lbfjrmd said:
both! unfortunately this thread seem to continue to pursue the 'surreptitious', in gaining a doctors signature.
Click to expand...
I don't think anyone here is talking about hiding a condition from the doctor. The question is whether the BasicMed rule, as it is written, forbids a physician from signing off an applicant with an unmedicated (but NOT undisclosed) anxiety condition, as a disqualifying mental health issue.

If you're saying that the rule DOES so forbid the examining doctor, could you please cite a source? Because to me, as a lay person, anxiety doesn't seem to fall under any of the types of mental health disorder called out in the statute: personality disorder manifested in overt acts; bipolar disorder; psychosis; substance abuse.

And for the record, I'm not the anon here either and this doesn't apply to me personally. I'd just like to better understand what the statute says, so that I can better answer people's questions on this forum and in person, since in a couple of cases recently, both you and Dr. Bruce have really turned my understanding of it upside down in the area of the mental health limitations to BasicMed eligibility.
 
azure said:
I don't think anyone here is talking about hiding a condition from the doctor. The question is whether the BasicMed rule, as it is written, forbids a physician from signing off an applicant with an unmedicated (but NOT undisclosed) anxiety condition, as a disqualifying mental health issue.

If you're saying that the rule DOES so forbid the examining doctor, could you please cite a source?
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Yes, that's my updated question. Assuming the medication is discontinued, and the anxiety is disclosed to the physician signing the form, it seems to me that as long as I'm honest there, and that when I check the "I am being treated by a state-licensed specialist if I have a mental health condition" box I'm also being honest, then I'm done (and legal to fly under BasicMed, as long as I ground myself upon any recurrence that impacts my ability to fly safely)

If the physician can't legally sign off the BasicMed checklist in those circumstances, or if I'm not legal to fly under BasicMed even if I did get a doctor to sign it off, what's the source?
 
There's the anxiety that most of us feel when, say, under the eyes of a DPE. Then there's debilitating anxiety, perhaps with panic attacks, that may result in a person who shouldn't be operating an airplane, or even a car. Heck, a professional baseball player had to take time off for this. It's that person who may be a danger to themselves and/or others when flying. Who gets to decide? Would a sufferer "self-ground", as we would if we had the flu?
 
The 3 previous comments are noted. And I agree anxiety and depression are not on the Basic Medical form. Let's see how Dr B chimes in!
 
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lbfjrmd said:
The 3 previous comments are noted. And I agree anxiety and depression are not on the Basic Medical form. Let's see how Dr B chimes in!
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So my take is that the PCP has to make a judgment call as to whether or not the depression and anxiety and maybe (?beer, the third in the triad?), rise to the level of changing reality testing, e.g. changes cognition. Those disorders ARE called out in the federal legislation, page 6 attached.

In the old DSM4 which was the reference when the legislation was readied, there were "31X.XX" diagnoses and if they were severe enough they became 300.XX diagnoses. The drafters of the legislation meant that the 300.xx varieties of anxiety/depression were to need a special issuance.

In the modern day terminology of DSM 5 it's a matter of if the diagnosis appears on axis 2, or on axis one or has a severity modifier, "major depressive disorder, severe" would be in need of the SI, first. And, it would be a gutsy PCP to make that call (Dr Lou is a PCP, he gets "being in the hot seat"). He has to really know about the function of his patient, and be willing to defend it.

Most of you won't remember but in the early 2000s there was rebellion of PCP AMES (about 40 of them) who issued scripts for an antidepressive and also issued the medical. They were all removed from their appointments. The agency clearly, does not think the PCP is expert enough in this area, but that is not relevant. It is what Congress thinks and that can only be determined by Case Law.

I have several airmen who accomplished the SSRI issuance and then went to basic Med. They are UNEQUIVOCALLY in compliance.

ME? I'd rather not be involved in the creation of case law. See the attachment, page 6. To sign off a basic med in the presence of a severe episode of depression, would be "unlawful" per the act of Congress.
 

Attachments

  • ThirdClassReform(Short.Final)07.14.16.pdf
    37.4 KB · Views: 340
I'll eventually find out, but I feel strongly that I'll be good here. I don't believe I've had "severe" either.

And based on 500 hours and almost an instrument rating (I realize almost doesn't count) in actual and with a ton of partial panel (under the hood, not in actual) I'm confident the condition didn't impact my ability to safely operate a plane.

My BFR/return to the cockpit (via Basic Med of sport) will involve a healthy amount of time with a CFI based on my attitude towards safety and if S/he or I feel I'm not up to it, I'll go gliders.

The tow plane at the glider club near me crashed earlier this Summer and it doesn't seem like they are launching many students. Maybe next Summer (or the Summer after). I'm just looking for hope!
 
Can the original poster comment on the out come or development in the situation?

I am more or less in your exact situation. I have an expired 3rd class that was issued in 2007, so it fits in the 10 year roll back. In the years following I started taking Lexapro due to my wife indicating that I was generally an a$$ hole a fair amount of the time. Since starting the prescription 5+ years ago, my wife says I am a delight. The difference in my situation and yours is that I never finished my PPL training due to money and kids being on the way. I would like to finish it now. I didn't even consider that Lexapro would be a concern until I started looking into renewing the medical. Thus it seems as though Basic Med might be the way to go assuming my PCP or AME agree that the drug does not hinder my abilities.

...and I would like to stay married.
 
anonymous user said:
And the FAA materials about BasicMed all say:

Conditions requiring ONE Special Issuance (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)

I don't see how a previous history of anxiety treated by medication meets any of these (though I'm not a doctor either, so maybe it is a "personality disorder that is severe enough to have repeatedly manifested itself by overt acts"?

But again, I'd love to hear from some of the experts here who have insight into what the FAA really means by what they publish.
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As a Physician I completely agree that your Physician has to use their own judgment and is under no obligation to think that an SSRI would DQ you from doing anything, no matter what list it is on, they are no obligated to even reference the FAA's list. Aside from this if you do not have any of the above noted psychiatric symptoms noted above you should be free and clear.
 
anonymous user said:
And the FAA materials about BasicMed all say:

Conditions requiring ONE Special Issuance (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)

I don't see how a previous history of anxiety treated by medication meets any of these (though I'm not a doctor either, so maybe it is a "personality disorder that is severe enough to have repeatedly manifested itself by overt acts"?

But again, I'd love to hear from some of the experts here who have insight into what the FAA really means by what they publish.
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Anxiety is not a personality disorder.

Being a narcissist or sociopath or being a borderline is. Example of Sociopath? King Joffrey on GOT or Bolton's bastard, Both of those guys were textbook personality disorders.
 
I am not a doctor, a lawyer and I don't work for the FAA. I didn't even stay at a Holiday Inn last night but my advice on most of this kind of stuff is...

Don't over think it.
 
Another Anon said:
Can the original poster comment on the out come or development in the situation?
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My primary care physician said her insurance wouldn't let her sign it, and the local AME said he wouldn't even discuss it once I mentioned SSRIs.

But I was able to find an occupational health MD (same people who do DMV physicals for truck drivers) who had no problem signing the Basic Med paperwork with the SSRI use disclosed and I've been flying since.
 
anonymous user said:
My primary care physician said her insurance wouldn't let her sign it, and the local AME said he wouldn't even discuss it once I mentioned SSRIs.

But I was able to find an occupational health MD (same people who do DMV physicals for truck drivers) who had no problem signing the Basic Med paperwork with the SSRI use disclosed and I've been flying since.
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Congratulations and fly safe!! Are you taking lessons or just recreational flying??
 
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