Deferral - Syncopic History (File review triggered by submitting additional docs)

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Fade8439

Filing Flight Plan
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Fade8439
Hello everyone,

This post has a few different purposes. First, I hope my situation can serve as a warning to others who may be in a similar situation. Second, I'm hoping to solicit the feedback of the members here who may have useful advice for myself and others. And third, to vent my frustrations!

Story:
I was issued a first class medical back in May of 2024 by my AME. I answered "yes" to having a history of syncope, which consisted of two episodes that occurred 5 years ago. Both occurred when I stood up too quickly from a lying down position. I went to my doctor to be on the safe side, who referred me to a cardiologist. I had an EKG done and wore a Holter monitor for a few days. No abnormalities found, and the conclusion from both cardiologist and doctor was that it was due to orthostatic hypotension. All of the test results and doctor's statements were provided to my AME (as per his request), and he reviewed and submitted them to the FAA. Note: I did not pass the Ishihara color vision test, so my medical had the night flying restriction.

Great news! With my medical out of the way, I can begin flight lessons in earnest!

Fast forward about a month, and I successfully passed an alternate color vision test, so I submitted the results to my regional flight surgeon. After a few weeks of not hearing back, I emailed them to ask for an update, and they said my case required further review because of the syncopic history. Cue nervous sweats. Lo and behold, a couple weeks after that email I receive a deferral letter from the FAA stating that they do not currently find me fit to hold a medical certificate, and I need to submit a current EKG and statement from cardiologist, blah blah blah. Unfortunately, it seems as though my submitting my new color vision test result triggered this additional review of my file. My AME confirmed that this is likely the case as well. The real kicker is that I was supposed to solo on Monday (I received the letter on Saturday). So I could have at least solo'd once before finding out that my medical is deferred. Instead of soloing at 18 hrs, I will now be soloing at... TBD.

Hindsight:
I should have not been so gung-ho about submitting my new color vision test result. I'm currently 20 hrs into my PPL and have no need to solo at night, so having that restriction would not have hindered my PPL progress at all. However, not having my medical DOES hinder my progress quite a bit.

I did also consult via email with Dr. Bruce Chien and he suggested a much more thorough approach including getting a treadmill stress test done before scheduling my medical, but my local AME sounded knowledgeable enough and I trusted his judgement. I should have taken Dr. Chien's advice instead. Another benefit is that I could have knocked out all of my color vision testing with him.

Seeking advice:
- I already contacted Wingman Med and Mayo Clinic Clear Approach. Decided against using Pilot Medical Services and AOPA due to some unfavorable reviews I read. Any other services I should be aware of?
- How should I continue with my PPL training? I've been taking 3-4 lessons a weeks and progressing at a pace that I am very happy with. Now that I can't solo, I guess I could continue on working on every other aspect up to PPL and leaving the solo bits till the end. But I'm concerned with how long this process with the FAA will take, and am worried that I will basically finish my PPL training (minus solo portions) and then will just be burning money while I stay current and wait for my medical to be issued. I could also slow down my pace significantly to 1 lesson per week or so, hopefully still learning incrementally but not progressing too quickly. I am very hesitant to completely put things on hold, as I don't want to need to spend a bunch of time to gain currency again.
- I'm seeing a lot of horror stories on this forum and /r/flying about how long the turnaround times are with the FAA. However, most, if not all, of the stories I read are with regards to HIMS cases. Is there any chance that my case is a bit simpler and may be processed more quickly?

Venting:
Overall I'm feeling very frustrated with myself, my AME, and the FAA. When initially doing my consults I was attracted to the simpler/cheaper option presented by my local AME, instead of the expensive/time-consuming option from Dr. Chien. However, following Dr. Chien's advice would have saved me a lot of time and trouble in the long run. I'm also frustrated that my AME did not mention to me that submitting the additional color vision test result would likely trigger a further review of my case. His email response back to me was very cavalier and just stated that I should go do my solo while I wait for the response from the FAA. To the best of my knowledge, I CANNOT solo without a medical, so that's yet again some bad advice. I'm also frustrated that I, as a healthy, fit, active person in my 30's, am under review for something like this. I understand that syncope is a serious hazard in the cockpit, but my episodes had a very clear cause, and I have not had any issues since the two episodes 5 years ago. It's also not a scenario that would occur in the cockpit to begin with (standing up from lying down). Not sure how many thousands of dollars it will cost to see a new cardiologist and get the required tests done, but I'm sure it won't be cheap.


Apologies for the wall of text - I realize this is just a minor set back in the grand scheme of things, especially compared to some of the much more serious issues others here are having with the FAA medical process. In any case, I hope this can help at least one other person, and I'm looking forward to any advice that the members on this forum can provide!
 
Why don’t you ask Lindbergh?
He seems to claim, “you did not have to” expertise, here.

Sorry for your pain. But you will overcome… just not easily.
 
Fade8439, nothing much to contribute here except to note that you almost certainly would have gotten the deferral letter eventually. While perhaps submitting the color vision triggered an earlier review, you would have had to deal with the deferral regardless.

Since you've already been in touch with Dr. Chien and he's familiar with your case, why not hire him to coordinate further workup and submission?

If he's not able to take your case, WingmanMed, GoFlightMed, and lbfjrmd are all active AMEs who post here and have a history of giving solid advice. (There are probably more, those are just the ones I recall.)

There's no sense in beating yourself up further. Yeah, you should've listened to Dr. Chien the first time, but you learned your lesson, focus now on moving forward and solving the problem. He said you're issueable, so go do what you need to get it done!
 
Thanks for the responses and encouragement, Dr. Chien and Brian. Yes, I didn't even think of retaining Dr. Chien's services after the fact - I will get in touch with him. For some reason I thought I saw something on his website saying he doesn't take on clients after they've been deferred, but I can't seem to find that now.

Re: specific wording on the letter, mine says "we are unable to establish your eligibility to hold an airman medical certificate." I interpret this to mean that my certificate is no longer valid until I provide the requested info, but my AME says that it is still valid. I plan on asking my CFI today, but any thoughts on this?
 
"Unable to determine" means they've not taken any action. It's up to you to determine if you meet the requirements of the certificate you still hold.
 
bbchien said:
Why don’t you ask Lindbergh?
He seems to claim, “you did not have to” expertise, here.

Sorry for your pain. But you will overcome… just not easily.
Click to expand...
Are personal attacks and trolling still prohibited on this forum?

(Even though you misspelled my screen name and didn't tag me, I'm assuming this was directed at me since you called my attention to it in a different thread.)
 
flyingron said:
"Unable to determine" means they've not taken any action. It's up to you to determine if you meet the requirements of the certificate you still hold.
Click to expand...

Thank you for confirming, that is a very big difference! I explicitly confirmed with my AME and he had the same interpretation. So I guess this means my medical is not actually "deferred," and I will be able solo as planned. Still have to spend the $$$ to provide the requested test results to the FAA, but I can continue with my training at my current pace.


Lindberg said:
Are personal attacks and trolling still prohibited on this forum?

(Even though you misspelled my screen name and didn't tag me, I'm assuming this was directed at me since you called my attention to it in a different thread.)
Click to expand...

Lindberg - thanks for chiming in! I don't know the history between you and Dr. Chien but I would kindly request that we keep this thread on-topic. But since you are here, do you have any advice for my situation? Anything you would advise others to have done the same/differently?
 
flyingron said:
Your application IS deferred.
Click to expand...

OK, I guess I was misunderstanding the definition of a deferred certificate. So I was issued a medical certificate, but now it is deferred. But just to be clear, is my medical certificate still valid as my AME has indicated? In other words, am I able to solo before I have provided the additional required docs to the FAA?
 
If the AME doesn't issue or deny you in his office, your APPLICATION is deferred. Certificates aren't deferred, just applications. Until someone approves or denies your application, it really doesn't matter to your existing certificate (it does put the kibosh on certificate-less sport pilot or basic med operations however).
 
flyingron said:
If the AME doesn't issue or deny you in his office, your APPLICATION is deferred. Certificates aren't deferred, just applications. Until someone approves or denies your application, it really doesn't matter to your existing certificate (it does put the kibosh on certificate-less sport pilot or basic med operations however).
Click to expand...

This is starting to make sense now, thank you. In this case, my "application" that is deferred is the process I started by submitting my alternate color vision test results. My current certificate that was issued at my medical is still valid.

Side note - I keep seeing a message above every reply I make saying that it needs to be approved by a moderator. I couldn't find anything about a minimum post count or anything like that on the forum website, but is this supposed to keep happening?
 
You're probably getting close to the post needed for approval. The moderators do this to keep scam post down.
 
Not an AME, but my interpretation has always been the same as flyingron. Your valid medical certificate was not withdrawn, so when they are "unable to determine..." you are allowed to continue exercising the privileges of the medical certificate while submitting the requested data and awaiting their decision. If FAA's interpretation was that you're immediately medically unfit, they would have WITHDRAWN the medical. Of course, ultimately there are only two possible decision paths, the medical is either approved or denied. I guess a third possibility is special issuance, though it doesn't sound as if your issue would lead down that pathway. Obviously, if you don't now submit everything they requested by their deadlines, you will eventually be denied, which does indeed preclude sport pilot or basic med options.
 
BrianR said:
Not an AME, but my interpretation has always been the same as flyingron. Your valid medical certificate was not withdrawn, so when they are "unable to determine..." you are allowed to continue exercising the privileges of the medical certificate while submitting the requested data and awaiting their decision. If FAA's interpretation was that you're immediately medically unfit, they would have WITHDRAWN the medical. Of course, ultimately there are only two possible decision paths, the medical is either approved or denied. I guess a third possibility is special issuance, though it doesn't sound as if your issue would lead down that pathway. Obviously, if you don't now submit everything they requested by their deadlines, you will eventually be denied, which does indeed preclude sport pilot or basic med options.
Click to expand...

Thank you, it took me a while to get there, but that makes perfect sense. I have every intention of complying with their requests in a timely manner :thumbsup:
 
Fade8439 said:
Lindberg - thanks for chiming in! I don't know the history between you and Dr. Chien but I would kindly request that we keep this thread on-topic. But since you are here, do you have any advice for my situation? Anything you would advise others to have done the same/differently?
Click to expand...
Your AME is the best person to answer your questions, since he's actually reviewed your records, and there's a reason he felt comfortable using you a medical. Anyone who hasn't interviewed you and reviewed your file would be making guesses. Orthostatic hypotension as a diagnosis would often result in deferral in the first instance.....

As for what you could have done differently, it sounds like you had a consult before the live exam, which is the usual advice. Not poking the bear is also the usual advice. There's always a review period after insurance when the FAA can ask for more info. No one here knows whether your file would have gotten flagged without your submitting additional results unsolicited, but it didn't help.

At this point, I think your best bet is to continue working with your AME and give the FAA what they ask for.

But my advice is as good as any other from SGOTI.
 
FADE: just get a stress treadmill to 90% of your Heart Rate age related Vmax (& 9 minutes), get the tracings (all 35 dupl. originals) and an Echocardiogram, and a 24 hour holter monitor recording, and eval by a cardiologist (commenting he thinks your history is that a of 2 vasovagal events), (per our communications), and send them in, certified. That's what FAA requries for this situation.

Costly. But how much does dual cost? (!) This is about "Joy".
NOT just SGOTI.
 
Last edited:
I’m not a medical person but thought I’d share this.

It appears that knowing what causes a Syncope episode is significant.

A badly bruised knee that swelled up and a ventral hernia are 2 causes.

The biggest problem I had was finding a way to fax all the records to

Ok!
 
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