Chances with Adjustment Disorder

[JakeTrilla]

This is an issue I have looked around for, but I understand each case is different, so here's my story/question to "random pilot strangers" on the internet...

Overall I want to know generally what to expect (maybe we don't know because the FAA is an unpredictable agency)

I came home from Afghanistan and got out of the military. I went through the VA claims process. I did not seek, nor did I request, any claim relating to mental health.

I can only assume that the VA thought they were doing me a favor by sending me to a Psych as part of their C&P exam process. When I left that C&P exam, I had a diagnosis: "Adjustment Disorder with mixed anxiety and depressed mood".

This was in January. No medications, no recommendations to see anyone again, just a blanket "you came from war overseas, so you have this diagnosis" I have not been in contact with any mental health professional prior to, or since, that C&P exam.

My rating letter states the diagnosis. I am not rated (not even 0%) for the Adjustment disorder. The VA letter states that it is "service connected for treatment purposes only"

Again for clarity: No medications were ever discussed, prescribed, or taken. I saw a PsyD once. No disability rating. Service connected for treatment purposes only. I am stable, this "issue" is long "resolved".

In May I disclosed this information to my AME, who issued a First Class medical based on the guidance from the FAA: "If stable, resolved, no associated disturbance of thought, no recurrent episodes, and psychotropic medication(s) used for less than 6 months and discontinued for at least 3 months - Issue"

Got a letter from the FAA on day 57 (August) "Due to your history of Adjustment...mood you must provide the following..." a current copy of the Veteran's rating decision letter, treatment records (all I have is my C&P notes), and a current history of clinical examination. I understand that current history means within 90 days, so I have scheduled an evaluation with the same PsyD so that I can send in a follow up that shows I am well within the FAA guidance.

My question: how likely am I to have to go to a HIMS? Should I prepare now for thousands of dollars to be spent to fix what seems to be an absolutely benign issue created without my seeking it?

What things can I do to be proactive here?
What things can I ask the PsyD to write or ask them to be very clear about on their report when I see them? I have the FAA letter and I have printed the "FAA CERTIFICATION AID – SSRI INITIAL Certification/Clearance - PSYCHIATRIST" paperwork to try to help them out with the lingo. Any other suggestions?

@lbfjrmd @bbchien @Brad Douglas MD MPH AME figured you guys are the authority on this type of thing...

Any and all help is appreciated!
Thanks!

 

[lbfjrmd]

For now, you can only supply the info requested by the FAA and wait for a response. then post back.

 

[Anonymous]

I had the same diagnosis from a therapist I was seeing. No prior mental health issues and no Rx drugs for the related diagnosis. I'm a civilian.

I was put in HIMS, paid almost close to $10K between the various PsyD's including CogScreen and have been jumping through FAA's hoops for more than 2 years :-((((.

I wish I knew what the chances were of being approved or not, but you either want to take that chance and not regret that you didn't or don't.

Good luck! Make sure you pick a solid HIMS AME.

 

[Beaker’s Flyin]

Dr. Lou knows best, however here is something I found on Reddit that show a few folks who were successful in getting normal issuance with adjustment disorder diagnosis. Perhaps they were different because it was anxiety only and not combined? Seems like a hit or miss thing with the FAA as of late. What's confusing is an AME is allowed to issue provided certain criteria is established yet the FAA comes back and asks for more.

 

[Anon]

I had same dx, but with one week of SSRI use. Also added GAD dx during CBT for adjustment disorder. Legacy airline pilot, then and now. Had to see HIMS psychiatrist but avoided the cogscreen and HIMS program. PsyD monitored for 90 days, single event, no recurrence of symptoms. HIMS psychiatrist and AME went to bat for me. AME deferred app and it was issued 3 months later by OKC.

Get a good AME and you will be fine.

 

[bbchien]

This is an issue I have looked around for, but I understand each case is different, so here's my story/question to "random pilot strangers" on the internet...

Overall I want to know generally what to expect (maybe we don't know because the FAA is an unpredictable agency)

I came home from Afghanistan and got out of the military. I went through the VA claims process. I did not seek, nor did I request, any claim relating to mental health.

I can only assume that the VA thought they were doing me a favor by sending me to a Psych as part of their C&P exam process. When I left that C&P exam, I had a diagnosis: "Adjustment Disorder with mixed anxiety and depressed mood".

This was in January. No medications, no recommendations to see anyone again, just a blanket "you came from war overseas, so you have this diagnosis" I have not been in contact with any mental health professional prior to, or since, that C&P exam.

My rating letter states the diagnosis. I am not rated (not even 0%) for the Adjustment disorder. The VA letter states that it is "service connected for treatment purposes only"

Again for clarity: No medications were ever discussed, prescribed, or taken. I saw a PsyD once. No disability rating. Service connected for treatment purposes only. I am stable, this "issue" is long "resolved".

In May I disclosed this information to my AME, who issued a First Class medical based on the guidance from the FAA: "If stable, resolved, no associated disturbance of thought, no recurrent episodes, and psychotropic medication(s) used for less than 6 months and discontinued for at least 3 months - Issue"

Got a letter from the FAA on day 57 (August) "Due to your history of Adjustment...mood you must provide the following..." a current copy of the Veteran's rating decision letter, treatment records (all I have is my C&P notes), and a current history of clinical examination. I understand that current history means within 90 days, so I have scheduled an evaluation with the same PsyD so that I can send in a follow up that shows I am well within the FAA guidance.

My question: how likely am I to have to go to a HIMS? Should I prepare now for thousands of dollars to be spent to fix what seems to be an absolutely benign issue created without my seeking it?

What things can I do to be proactive here?
What things can I ask the PsyD to write or ask them to be very clear about on their report when I see them? I have the FAA letter and I have printed the "FAA CERTIFICATION AID – SSRI INITIAL Certification/Clearance - PSYCHIATRIST" paperwork to try to help them out with the lingo. Any other suggestions?

@lbfjrmd @bbchien @Brad Douglas MD MPH AME figured you guys are the authority on this type of thing...

Any and all help is appreciated!
Thanks!

If I could reach out to each and every DOD outplacement officer you unfortunately might read about it in the paper. Sigh.

"Adjustment disorder" is limited by DSM 5 to two years. That's why this is likely to turn out the way the fifth poster turned out. Psychiatrist known to FAA, but not the other components.

The difficulty with using an insurance psychiatrist is that he ONLY does DSDM 5 definitions.

B

 

[Clip4]

Adjustment disorder is very common for a number of life events and are not forever disqualifying.

 

[bbchien]

Adjustment disorder is very common for a number of life events and are not forever disqualifying.

.....But can only be called that by a civil psychiatrist, if the definition is <= 2 years. Otherwise, by criteria, isn't an adjustment disorder.

 

[JakeTrilla]

.....But can only be called that by a civil psychiatrist, if the definition is <= 2 years. Otherwise, by criteria, isn't an adjustment disorder.

So by that definition I should not have considered the diagnosis from the *psychologist* as reportable?

I've never seen a psychiatrist in my life.

Does that change anything in the eyes of the FAA now that the dreaded mental health box has been opened?

 

[JakeTrilla]

Sent the packet of information to the FAA via two day priority mail on 1 OCT. Will follow up with results. Thank you all for your help!

 

[JakeTrilla]

*Update*
I received a letter from the FAA dated Oct 21 yesterday (October 29 2021).

No further mention of the former requests for information about adjustment disorder. I think this is a good thing.

However, due to my submitting "a full current copy of the Veteran's rating decision letter" (as requested in the previous letter) the FAA obviously dug into it and they feel there is more to be asked.

This time they are requesting information concerning a Venous malformation on my lip. They are also looking for more information concerning a cold weather injury (and the associated neuropathy) I sustained while serving.

So while I am not currently denied, the letter is requesting further evidence about other things they found while reviewing my ratings letter.
Round two of gathering medical information begins.

 

[JakeTrilla]

*Update*
A third letter came in January requesting another test unrelated to mental health. Those tests were completed by early April 2022 and submitted to the FAA.

As Of May 23 2022 I received a letter that stated I was eligible for the first class medical originally issued to me by my AME May 25 2021.

The letter also listed several of my VA rated disabilities and stated that if any deterioration of those issues occurred I am obligated to report that information to the FAA.

So to summarize my experience:
I had VA disability ratings, one of which was a mental health rating.
In my case; A letter from the "treating physician" (whom I only saw one time during the VA process) clearing me of the diagnosis was sufficient for the FAA to adjudicate the issue.
The FAA went through my VA ratings with a fine tooth comb. Some triggered a request for further tests and other were only mentioned for the purpose of reporting if things get worse.

After one year and three FAA letters, I was "awarded" the First Class medical my AME originally issued.

hope this helps anyone else in a similar situation!

 

[Stan Cooper]

Jake, it's a damn shame you had to go through this apparently unnecessary yearlong exercise. The VA Doc probably was clueless of the unintended consequences of his/her diagnosis.

 

[TCABM]

Jake, it's a damn shame you had to go through this apparently unnecessary yearlong exercise. The VA Doc probably was clueless of the unintended consequences of his/her diagnosis.

VA codes for disability are *technically* diagnostic codes and compensation ratings, not diagnoses. They are medical conditions, though which is why the fall into the Q18 catchall.

The VA compensation and pension (C&P) letter has very specific reasons why certain conditions and ratings are applied based on the C&P exam. Everything looked at during the C&P exam must have been present in the member’s DoD health record.

 

[edcba]

I just recently discovered I had this diagnosis in my record and have not reported it on previous medicals.

I was going through old military records chasing down some unrelated info, and, to my horror, found an entry for the same "Adjustment disorder, anxiety, depressed mood." It was from my first deployment many years ago. I was indeed having some difficulty adjusting, so I sought some advice from the mental health clinic.

I was never informed of a diagnosis, never took any meds, and never really thought about it again until stumbling upon it recently. How screwed am I if I disclose it now?

 

[Stan Cooper]

VA codes for disability are *technically* diagnostic codes and compensation ratings, not diagnoses. They are medical conditions, though which is why the fall into the Q18 catchall.

The VA compensation and pension (C&P) letter has very specific reasons why certain conditions and ratings are applied based on the C&P exam. Everything looked at during the C&P exam must have been present in the member’s DoD health record.

The distinction eludes me, but whatever; I still think it's a shame the OP was subjected to having to respond to three different requests for more information and a yearlong delay in validating his first class medical. Now it looks like @edcba is potentially facing a similar ordeal.

 

[Half Fast]

How screwed am I if I disclose it now?

Depends on what you’re trying to do. You answered to the best of your knowledge on your previous medical app and you’ll be required to do the same on your next renewal application.

If you’re a private pilot flying a small plane, you can go Basic Med and you’ll not be required to submit anything to the FAA. There won’t be a renewal application, so you won’t be screwed at all. You will need to disclose it to whatever doc does your Basic Med exam but that shouldn’t be an issue. If the doc does have a problem with it, find another doc. Nothing goes to the FAA.

If you’re an ATP flying an airliner, though, you’re pretty well screwed. You will be required to disclose it when you renew your medical and then you will have many hoops through which to jump at not inconsiderable time and expense.