FAA medical and OCD

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Zep86

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Zep86
Hello,
It's been a few years since I was in the seat of any aircraft and my medical has expired.

I possessed a class 3 medical and would like to renew it, but it seems there may be a plethora of hurdles ahead.

About a year ago I sought treatment for repetitive intrusive thoughts and was given the Dx of OCD and Zoloft as the med. I also sought ERP therapy.

I have been off the medicine for about six months with the MDs approval and he was fine with my next appoint being spaced at six months, which will be in March. He doesn't seem to be concerned with the severity of the dx

I realize that the medical form asks if I sought psychiatric care and I know that SSRIs are a touchy subject with the FAA. When I asked the MD about treatment impacting my ability to PIC, he didn't hesitate to let me know that it will not interfere with PIC abilities, but he's also not an AME lol. He even said he'd write a letter to the FAA saying my OCD theme and type wouldn't impact my abilities to operate an aircraft.

With that said, I know there's several folks here who are more knowledgeable in mental health and aviation. I would appreciate your input in regards to how I should approach this.
 
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Your truthful application for a renewal will necessitate a deferral to the FAA. They will initially request records. Upon reviewing your records they will outline the steps you need to take to rectify the situation.
 
Fortunately Zoloft (sertraline) may be eligible for the SSRI pathway 1 if you have been off for more than 2 months. I would suggest working with one of the experienced Senior HIMS AMEs here to make this go as smoothly (in terms of time and $) as possible.

Do NOT re-apply without working it out with one of them in advance. Mistakes here can cost years or delay and $10k.

https://www.faa.gov/about/office_or...am/ame/guide/media/SSRI Decision Path - I.pdf
 
Thank you.

I understand that applying now would just result in a failed application.

Would working with an AME allow me know which evaluations the FAA will require? Will I be able to do the evaluations prior to resubmitting the actual medical certificate?


Sent from my Pixel 3 XL using Tapatalk
 
Zep86 said:
Would working with an AME allow me know which evaluations the FAA will require? Will I be able to do the evaluations prior to resubmitting the actual medical certificate?
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Depends on the AME. You need to consult with an experienced AME to develop a plan of action.

Dr Fowler is one of those AMEs I’d listen to. So is Dr Bruce Chien (@bbchien). They have different approaches, but could serve you well in a consultative capacity.
 
Zep86 said:
Would working with an AME allow me know which evaluations the FAA will require? Will I be able to do the evaluations prior to resubmitting the actual medical certificate?
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Yes, working with a competent senior HIMS AME, they normally will not submit until they are confident that you have all the ducks in a row and your application will almost certainly be successful.

Otherwise you are better off not applying as you can still possibly fly light sport or use Basic Med. Can’t do those after a denied medical application.
 
Is this a situation that would require a one-time SI before opting for BasicMed?
 
A lot of people forget about Sport Pilot. It’s a valid way to fly without jumping through the FAA’s medical hoops and may be sufficient for your desires.
 
bbchien said:
Yes.
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Bruce, OCD isn't considered a psychosis, right? Does then OCD fall under this part of the Basic Med SI requirement?

A mental health disorder, limited to an established medical history or clinical diagnosis of—
  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
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The OP's original posting seemed like he had the obsessive thoughts, but not compulsive behaviors. Is the concern that behaviors could begin?

Just curious about how all this works, but I'm not compulsive about it.....
 
skier said:
A lot of people forget about Sport Pilot. It’s a valid way to fly without jumping through the FAA’s medical hoops and may be sufficient for your desires.
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You're right and that's certainly an option I am considering, but honestly I don't want to cut myself short quite yet on four seat a/c because of my family size.

At the end of the day, it is what it is.

Sent from my Pixel 3 XL using Tapatalk
 
Half Fast said:
Bruce, OCD isn't considered a psychosis, right? Does then OCD fall under this part of the Basic Med SI requirement?




The OP's original posting seemed like he had the obsessive thoughts, but not compulsive behaviors. Is the concern that behaviors could begin?

Just curious about how all this works, but I'm not compulsive about it.....
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Based on DSM V, OCD is neither personality or anxiety disorder. You're probably thinking of OCPD. How the FAA treats it is unknown by me, but I would hope they'd keep up with the most recent information.

Sorry, I like to learn about the things I'm facing.

This is where I'm having the most difficulty because the FAA is quite vague on the vast majority of mental health issues.

I'm going to contact Dr. Chien.

Sent from my Pixel 3 XL using Tapatalk
 
Half Fast said:
Bruce, OCD isn't considered a psychosis, right? Does then OCD fall under this part of the Basic Med SI requirement?




The OP's original posting seemed like he had the obsessive thoughts, but not compulsive behaviors. Is the concern that behaviors could begin?

Just curious about how all this works, but I'm not compulsive about it.....
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I had the same question. I've asked before why Bruce says that certain other mental health diagnoses (e.g. simple depression) that do not rise to the level of psychosis (or a personality disorder that HAS manifested in overt acts) also require the one-time SI. I'm not doubting his expertise, but would like to know why this is so, since a strict reading of the statute doesn't seem to lead to that conclusion. I think most airmen and PCPs doing a Basic Med exam wouldn't see a problem here, so this needs to be explained much more fully. Hopefully Bruce can point us to his source for this.
 
azure said:
I think most airmen and PCPs doing a Basic Med exam wouldn't see a problem here, so this needs to be explained much more fully. Hopefully Bruce can point us to his source for this.
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Exactly.

The way Basic Med works, you don't go to the FAA to get an opinion on whether an SI is needed; you show the published guidance to your physician and he makes the decision. If @Zep86 's physician has said "...OCD is neither personality or anxiety disorder..." and concluded that no SI is needed, then there seems to be no reason that physician couldn't do the Basic Med exam and sign the form. There isn't any guidance telling the non-AME doctor not to do it.
 
Could someone clarify. I thought if you were off antidepressants for 2 mo' s and had good supporting letter from psychiatrist you could get your medical without any major issues
 
Anonymous said:
Could someone clarify. I thought if you were off antidepressants for 2 mo' s and had good supporting letter from psychiatrist you could get your medical without any major issues
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I think it depends on whether the med was a one-time use (not multiple on-again, off-again uses), how long the med was used, and the circumstances/diagnosis. If the patient were ever suicidal, for example, being off the med might not be a good thing.

You need the appraisal of a knowledgeable AME, such as Dr Lou or Dr Bruce.
 
PeterNSteinmetz said:
Yes, working with a competent senior HIMS AME, they normally will not submit until they are confident that you have all the ducks in a row and your application will almost certainly be successful.

Otherwise you are better off not applying as you can still possibly fly light sport or use Basic Med. Can’t do those after a denied medical application.
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My friend was prescribed Zoloft. He was diagnosed with an acute stress reaction due to son facing brain surgery. He didn’t want to take it but decided to start but now wants to quit after only 2 weeks. What happens if he does?
 
Horizon Flight said:
My friend was prescribed Zoloft. He was diagnosed with an acute stress reaction due to son facing brain surgery. He didn’t want to take it but decided to start but now wants to quit after only 2 weeks. What happens if he does?
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Firstly, confer with the prescribing physician about quitting. Depending on dose a taper may be best.

In terms of the FAA, this may qualify for SSRI pathway 1 and could be issued after documented health for 2 months. Best to work with a senior HIMS AME to make sure it goes as smoothly as possible.
 
Hello all,

Has anyone ever heard of an airmen getting a First class going through the SSRI pathway on an approved SSRI for mild OCD? I know the FAA says airmen “may be considered” for an SSRI for “any non-depression related condition for which the SSRI is used”, but has anyone heard of anyone having any luck with this? What conditions other than depression have people got medicals for?


Also, does the FAA truly look at these as a case by case basis? Does the FAA look at the successful professional pilot/ATP self reporting and starting the process different then the first time new 3rd class GA pilot?
 
Woodrow said:
Hello all,

Has anyone ever heard of an airmen getting a First class going through the SSRI pathway on an approved SSRI for mild OCD? I know the FAA says airmen “may be considered” for an SSRI for “any non-depression related condition for which the SSRI is used”, but has anyone heard of anyone having any luck with this? What conditions other than depression have people got medicals for?


Also, does the FAA truly look at these as a case by case basis? Does the FAA look at the successful professional pilot/ATP self reporting and starting the process different then the first time new 3rd class GA pilot?
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Hope to know the answer to this very question soon. Light to mild OCD, 1st class, rêvenue, ATP, multiple type rating, no violations, etc. self reported/grounded, meds dosage for 6 months, passed cogscreen, and submitted to FAA December 2018. Still waiting on a response almost 11 months later.
I have been told an advocate HIMS AME can be successful in shortening that timeline, but I am not personally experiencing such advocacy (presumably) so I wait and wait. Would love to chat with someone from Congress on this pathway in serious need of an overhaul. Better than nothing I suppose though!
 
James Lacy said:
Hope to know the answer to this very question soon. Light to mild OCD, 1st class, rêvenue, ATP, multiple type rating, no violations, etc. self reported/grounded, meds dosage for 6 months, passed cogscreen, and submitted to FAA December 2018. Still waiting on a response almost 11 months later.
I have been told an advocate HIMS AME can be successful in shortening that timeline, but I am not personally experiencing such advocacy (presumably) so I wait and wait. Would love to chat with someone from Congress on this pathway in serious need of an overhaul. Better than nothing I suppose though!
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Thanks James, I’m very interested in how this works out for you. Would you mind updating this thread when you hear? That time line seems a bit long, I’ve heard of others going quite a bit faster, but it seems everyone is different.
 
Woodrow said:
Hello all,

Has anyone ever heard of an airmen getting a First class going through the SSRI pathway on an approved SSRI for mild OCD? I know the FAA says airmen “may be considered” for an SSRI for “any non-depression related condition for which the SSRI is used”, but has anyone heard of anyone having any luck with this? What conditions other than depression have people got medicals for?


Also, does the FAA truly look at these as a case by case basis? Does the FAA look at the successful professional pilot/ATP self reporting and starting the process different then the first time new 3rd class GA pilot?
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One of the AME's who haunts this board, Dr. Bruce Chien, might be a good resource for your questions. You can start the conversation through his website at: http://www.aeromedicaldoc.com/how-to-start.html
 
Woodrow said:
Thanks James, I’m very interested in how this works out for you. Would you mind updating this thread when you hear? That time line seems a bit long, I’ve heard of others going quite a bit faster, but it seems everyone is different.
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Will certainly keep this group apprised. I suspect my app disappeared into a black void for awhile. I, nor my AME, have been asked for anything. An expedite flag was put on the file Aug 2. It was opened Oct 2. That was the last thing I have heard with respect to movement.
 
James Lacy said:
Will certainly keep this group apprised. I suspect my app disappeared into a black void for awhile. I, nor my AME, have been asked for anything. An expedite flag was put on the file Aug 2. It was opened Oct 2. That was the last thing I have heard with respect to movement.
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I hate to say this but if it’s been Aug 2...it is taking 5 months from the flag :(
Done many, many of the.

“orig. petitioner for the SSRI protocol”
 
bbchien said:
I hate to say this but if it’s been Aug 2...it is taking 5 months from the flag :(
Done many, many of the.

“orig. petitioner for the SSRI protocol”
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That is unfortunate, but appreciate the comment. Looks like my medical would be “expired” before I get it. Frankly, this process and the timelines involved results in most folks I talk to saying “why would anyone disclose it?”. There is almost no incentive and that part should change. I think the path or process should streamlined a bit for those self-reporting/grounding, 1st class, revenue airmen. Perhaps a SIC only limitation until “approved by DC” if all the doctors and cogscreen give a thumbs up at submittal. Get folks working again. Families suffer in all this and it puts an incredible strain on health and happiness when you cannot work doing what you love. A return to normalcy would be nice :)
 
What are the SSRI requirements after the initial SI authorization? From reading it sounds like a check up every 6mth with your BCP and then a cog screen every 2 yrs, anything else? Can your HIMS AME issue the SI like normal afterwards or is there something else that needs to be done? I’m glad the FAA has made this pathway available (thanks to Dr B), but seems it could be streamlined especially in the case of James above.
 
Woodrow said:
What are the SSRI requirements after the initial SI authorization? From reading it sounds like a check up every 6mth with your BCP and then a cog screen every 2 yrs, anything else? Can your HIMS AME issue the SI like normal afterwards or is there something else that needs to be done? I’m glad the FAA has made this pathway available (thanks to Dr B), but seems it could be streamlined especially in the case of James above.
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Dr. B can of course speak with a much greater amount understanding, but I think 1st class has annual cogscreen. Though your other statement of HIMS AME issuing and 6 month checks are correct from what I know. Completely agree, very thankful there is a path.
 
PeterNSteinmetz said:
Firstly, confer with the prescribing physician about quitting. Depending on dose a taper may be best.

In terms of the FAA, this may qualify for SSRI pathway 1 and could be issued after documented health for 2 months. Best to work with a senior HIMS AME to make sure it goes as smoothly as possible.
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Thank you for the information. He has been waiting for his HIMS AME to return his call. Do you know if one takes Zoloft for 2-3 months then comes off it, then 60 days free can go back or do you have to take it for 6 months? I look at the Decision paths and read online but it states it’s the airman’s choice to discontinue. I am trying to help him but I can not find the answer that’s why I am here asking.
 
If you have disease that has recurred you can ONLY use the SSRI pathway.
If you stop SSRI too fast and you recur, then you have recurrent disease.

and it’s 90 not 60 days off.
 
Woodrow said:
Hey James, any update on your medical?
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No update from DC other than “under review, sorry”. The 4-5 weeks I was told back in October it would be have passed. I am now at 11+ months since submittal to FAA. Still no request for any info at any point. Looks like it will be an expired medical by the time it arrives. Disappointing to say the least.
 
James Lacy said:
No update from DC other than “under review, sorry”. The 4-5 weeks I was told back in October it would be have passed. I am now at 11+ months since submittal to FAA. Still no request for any info at any point. Looks like it will be an expired medical by the time it arrives. Disappointing to say the least.
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Thanks for the update James.

Dr. Chein, hypothetical question for you. Is it possible for a revenue airmen to attempt to be certified via SSRI pathway II (ocd) and be denied, and then be certified by pathway I? After denial, airmen discontinued use of SSRI, received treatment and had documentation stating ocd is in remission. Is this certifiable?

Thank you for taking the time to shed light on these topics.
 
Woodrow said:
Thanks for the update James.

Dr. Chien, hypothetical question for you. Is it possible for a revenue airmen to attempt to be certified via SSRI pathway II (ocd) and be denied, and then be certified by pathway I? After denial, airmen discontinued use of SSRI, received treatment and had documentation stating ocd is in remission. Is this certifiable?

Thank you for taking the time to shed light on these topics.
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Dr. @bbchien, would you have any insight or thoughts on this? Thank you again for your willingness to share your wealth of knowledge.
 
Today marks 12 months since my HIMS AME submitted for my 1st Class SI for SSRI (Passed Cogscreen, Revenue, ATP, CFI). Received a voicemail from someone in DC 4 days ago stating they were aware of my weekly calls to OK, I was now being fast-tracked (kind of a loose term at this point), and would receive word this week or next. He did not say whether good or bad news was coming my way so we shall see.

Only sharing to provide another peek into my experience. Will share final results soon (I hope). Merry Christmas all!
 
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