Generalized Anxiety Disorder from VA C&P Exam

K

Kurt With You

Guest
Long time listener, first time caller.

I left the military a few years ago and went through the standard VA disability process. I was forthright in acknowledging what I felt, and it's now come back to bite me in the butt.

I claimed GAD for a variety of reasons. Namely, I was the victim of a violent crime a while back that left me a bit shaken up. In addition, I was going through some family health issues that further exacerbated normal stressors at work.

Now, I went to an AME for a Class 2 medical and self reported GAD on my Medxpress app, which led to the AME not submitting the exam before they could get further explanation.

I am still in the process of FOIA'ing my C&P exam results, but here is what's listed on my VA Disability claim letter sent to me.

We have assigned a X percent evaluation for your adjustment disorder with anxiety based on:
• Anxiety
• Chronic sleep impairment
• Depressed mood
• Difficulty in establishing and maintaining effective work and social relationships
• Occupational and social impairment with reduced reliability and productivity
• Panic attacks (less than weekly)
• Panic attacks (weekly)
​
Doesn't look good, right? But remember this was years ago, and I no longer have the panic attacks as listed, and I'd argue these bullet points sound worse than my actual condition, but saying that does me no good. Furthermore, I was never diagnosed with GAD or any other of these symptoms while in the military, and I have never been on any medication for it. The GAD is just what is listed as a VA Disability. I assume this may be a distinction without a difference.

So, what should my next step be? Do I request an appointment with the VA to discuss how this GAD shouldn't be described as it is? Heck, the GAD isn't even on my VA problem list. It's seemingly separate from my diagnoses and just how the VA/C&P exam could best describe it.

I am thankfully in no real hurry, but I'm lost as to what I should do next.

Appreciate all the help!
 
Hats off for overcoming the crap in your background and thank you for your service.

Do you want to fly for a hobby or a profession? "Hobby" = class 3 with many going to Basic Med after that. Class 2 indicates you want to be a commercial pilot. If you want to fly for the airlines, you should probably figure out if you can get Class 1 now, as you'll need it.

You might have some good news if the AME didn't activate your MedExpress number. Do you know if he/she did? I believe that getting all of your ducks in a row before you're denied is better than trying to scramble after the fact.

Other more knowledgeable people will be here shortly to be of help. Probably good that you had no medication for depression. I have a feeling the smart people will let you know you will need a bit of time and money to try and overcome the background you presented.
 
If this bell gets un-rung, I’d like to know more about the process.

Occasionally I talk to vets who desire flight instruction who are in a similar spot. I’d like to provide some general guidance like I do other prospective students.
 
It’s not so much as unrung as when does it ring.
 
to un-ring the bell, an airman/woman will need a psychiatrist to declare the at this time and in the future, there is no anxiety present and there are no psychiatric diagnoses to assign. Wait for your FAA letter and then proceed with an experienced AME! This happens frequently with the VA assignment of PTSD.
 
Last edited:
lbfjrmd said:
to un-ring the bell, an airman/woman will need a psychiatrist to declare the at this time and in the future, there is no anxiety present and there are no psychiatric diagnoses to assign. Wait for your FAA letter and then proceed with an experienced AME! This happens frequently with the VA assignment of PTSD.
Click to expand...


Lou, the OP wrote:
Kurt With You said:
...which led to the AME not submitting the exam before they could get further explanation.
Click to expand...

Sounds like the AME is trying to let him align his ducks first, so he's not presently awaiting a letter from the FAA. Or do I misunderstand?
 
Kurt, if nothing has been submitted to the FAA yet, you still have the option to become a Sport Pilot, which doesn't require an FAA medical; just a driver's license.

If you're just wanting to fly personally, not for money, Sport Pilot might be all you need. You'll be limited to flying in clear weather in the daytime, and you'll be limited to a single passenger, but that's how many of us fly anyway. The planes eligible for Sport Pilot are called "Light Sport Aircraft" (LSAs) and they're simple planes (fixed gear, fixed prop), lightweight, and run the gamut from 1940s vintage craft to modern planes with the latest avionics.

You might want to explore this option a bit. I suspect that getting a medical, if it's possible, will be very expensive and take quite a long time.
 
My apologies for the lack of information. I’m realizing now there’s quite a bit I left out.

I was previously a military aviator. The 2nd class medical I was seeking was so I could fly contract work.

Here comes the bad news which I should have been more clear on. I already submitted my Medxpress exam AND had my appointment with the AME. The confirmation number has been “activated”. However I apparently have 14 days before the AME has to submit their decision, otherwise it will be deferred. At least, this is how I interpreted it as.

It sounds like I need to scramble to get my regular doctor to determine that I don’t have GAD, or atleast none of the otherwise disqualifying symptoms. Ideally this gets done before my AME sends in their decision. I would love to be able to do this, but the amount of military and VA healthcare documents to get AND see my doctor is likely outside of that timeframe.

I can’t imagine being able to get that done, so I figure I’ll need to go a different route. I suppose I’m unclear as to what I should be preparing for. Even if I am able to see my doctor, how can I get them to say I don’t have these symptoms? Should they write a letter? Furthermore, how would that look when it conflicts with the VA claims letter description?
 
It’s a lot more complicated.

Probably many months of expensive specialist AME evaluations, sleep studies, cog screens, and whatnot. Hopefully our resident AME expert on difficult cases will stop by and give you a more accurate picture.

Maybe a year or two, $10,000 +, and no guarantee of success????
 
The FAA will likely require a psychiatric evaluation, not just a note from your PCP. This will probably require many months and many thousands of dollars. As Lou says, you will need to wait and see exactly what the FAA wants.

Are you receiving disability payments? If so, proving to the FAA that you don’t have the disability will also prove that you shouldn’t be receiving the payments. Some pilots have run into legal problems this way.
 
Kurt With You said:
…
It sounds like I need to scramble to get my regular doctor to determine that I don’t have GAD, or atleast none of the otherwise disqualifying symptoms…
Click to expand...
Retired .mil guy who was a .mil aviator amd receiving VA disability here. I don’t care what anyone told you, by law VA can’t oay disability for a condition that wasn’t already documented in your health record UNLESS it’s a presumptive condition and GAD isn’t a presumptive condition. In the VA packet with your disability rating and comp award it’s going to have a block that details the GAD diagnosis and each of the others. It will describe the symptoms recorded in your .mil health record and at the C&P exam. That’s the evidence that will need to be disputed with medical proof it’s no longer impacting you from an aeromedical perspective.

It’s possible, but not guaranteed your medical history is certifiable, but that won’t happen in a matter of weeks and it will be expensive.
 
So a federal award for a grounding disorder is acknowledgement from the federal administration of that disorder. Yo do need a psychiatrist to characterize what is left and you CANNOT successfully get that from the VAH. THEIR MISSION: award and treat.

So you are left with private forensic psychiatrists to HIMSPsychiatrists whose non insurance job is to fit you into correct high resolution diagnoses and to characterize how active the diagnosis, is.

The HIMS variety of psychiatrist will give the DSM 5 diagnosis, as well as the part 67 diagnosis, useful to FAA. they are both upward of $2K due to liability, and there is no insurance code for this sort of work.

If I could get a moment alone with each and every outplacement officer, this would NOT HAPPEN…..
 
Last edited:
Oh fun fun fun stuff.

This is what I was afraid of, but I can’t say I didn’t think it could happen. Thankfully flying contract work was just going to be a part time thing to do when I felt like it.

Three more questions!

Is there any possibility of flying GA without going through these hoops? I figure not, but have to ask.

Not exactly in the market for a new career, but if you all could go back and change everything, what would you do? Firefighter? Bank robber?

How should I proceed with my AME? Should I just call them and say “never mind”?
 
Kurt With You said:
Is there any possibility of flying GA without going through these hoops? I figure not, but have to ask.
Click to expand...

Not now. Had your AME not made the exam live by entering the number in the system, you could have flown under Sport Pilot rules. Once the AME submits the exam results, you will be deferred or denied. If he doesn't submit them, I believe the medical will default to a denial. That takes Sport Pilot off the table.

I think you can fly gliders with a denial but someone more knowledgeable than me needs to chime in. IF SO, that would include motor gliders, so you'd be limited to flying airplanes with very large glide ratios.


Kurt With You said:
Not exactly in the market for a new career, but if you all could go back and change everything, what would you do? Firefighter? Bank robber?
Click to expand...

Rock star.


Kurt With You said:
How should I proceed with my AME? Should I just call them and say “never mind”?
Click to expand...

At this point, why not just let him submit it and wait to see what the FAA will require? Make your decision whether to proceed from a basis of knowledge, not unknowns. You won't make things any worse, so I'd suggest you wait and see.
 
While GAD is listed as a VA disability, your annual flight physical asks if you have / had or since last physical, “depression or anxiety.” Why wasn’t it previously diagnosed when you were in?
 
You said your AME was going to hold your application open. Why? Have you given him everything he's asked for? If not, do that.

Then wait to see what the FAA demands of you. At that point, you will have a decision to make:

Jump through the FAA's hoops to fly whatever you like.

Or

Fly gliders, including motorgliders. You can do this commercially, and even instruct, with no medical. You can also fly balloons for fun.
 
lbfjrmd said:
because the VA foists it upon them
Click to expand...

Well the symptoms listed don’t seem like something that would be coerced by the VA. This isn’t like tinnitus or joint pain. This is some serious stuff.

Unfortunately while I agree the VA does a good job of selling disabilities, they also have a statement in the VA class that there are disabilities that can prevent one from getting employment. This might be a perfect example of that.
 
Last edited:
If your VA disability rating is from a while ago then you just have to prove that you are better now. What you can't do is get a NEW VA diagnosis for something like this and try to tell the FAA you are fine.
 
bbchien said:
So a federal award for a grounding disorder is acknowledgement from the federal administration of that disorder. Yo do need a psychiatrist to characterize what is left and you CANNOT successfully get that from the VAH. THEIR MISSION: award and treat.

So you are left with private forensic psychiatrists to HIMSPsychiatrists whose non insurance job is to fit you into correct high resolution diagnoses and to characterize how active the diagnosis, is.

The HIMS variety of psychiatrist will give the DSM 5 diagnosis, as well as the part 67 diagnosis, useful to FAA. they are both upward of $2K due to liability, and there is no insurance code for this sort of work.

If I could get a moment alone with each and every outplacement officer, this would NOT HAPPEN…..
Click to expand...
Right?!?! Wished I would have talked to you back around 2016, two years BEFORE retirement
 
Kurt With You said:
Is there any possibility of flying GA without going through these hoops? I figure not, but have to ask.
Click to expand...

You're best shot is to hire Dr. Fowler or Dr. Chien and have them walk you through the process. If anyone can get you there, it's one of them!
 
lbfjrmd said:
because the VA foists it upon them
Click to expand...
The door swings both ways. I have seen my fair share of patients coming in with printouts of the documentation they need to get a service connected disability rating to move up here and there. Very educated in how the system works and can be worked. Not saying the OP is this kinda person. Psych issues are much easier to claim as less burden of proof compared to missing limbs.
 
Kurt With You said:
My apologies for the lack of information. I’m realizing now there’s quite a bit I left out.

I was previously a military aviator. The 2nd class medical I was seeking was so I could fly contract work.

Here comes the bad news which I should have been more clear on. I already submitted my Medxpress exam AND had my appointment with the AME. The confirmation number has been “activated”. However I apparently have 14 days before the AME has to submit their decision, otherwise it will be deferred. At least, this is how I interpreted it as.

It sounds like I need to scramble to get my regular doctor to determine that I don’t have GAD, or atleast none of the otherwise disqualifying symptoms. Ideally this gets done before my AME sends in their decision. I would love to be able to do this, but the amount of military and VA healthcare documents to get AND see my doctor is likely outside of that timeframe.

I can’t imagine being able to get that done, so I figure I’ll need to go a different route. I suppose I’m unclear as to what I should be preparing for. Even if I am able to see my doctor, how can I get them to say I don’t have these symptoms? Should they write a letter? Furthermore, how would that look when it conflicts with the VA claims letter description?
Click to expand...

Here’s what the AME’s use to issue a first class to an applicant with a mental disorder:

https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-67/subpart-B/section-67.107

Remember the VA guidelines for a VA disability are not the same as the FAA. The VA is all about your worst day that you experienced something even if it was 20 years ago.

The FAA is all about are you still experiencing it and what are you doing about it or taking for it. I know plenty of of PTSD with Anxiety pilots out there working as professional pilots. My AME has told me that it’s not a big deal. Yes it will initially get deferred but as long as you’re not experiencing symptoms, you should be ok for the FAA.

It is possible to receive VA disability for a mental disorder and still get an FAA first class medical. I even know a pilot taking depression meds and currently flying on a first class. You should review the AME guide which the AME uses to issue the medical. Download the AME guide and search the flow chart for issuing a first class to someone with a mental disorder. It will help you be prepared.

The 2023 AME guide is here:

https://www.faa.gov/about/office_or...avs/offices/aam/ame/guide/media/AME_GUIDE.pdf
 
Fracpilot said:
Remember the VA guidelines for a VA disability are not the same as the FAA. The VA is all about your worst day that you experienced something even if it was 20 years ago.
Click to expand...

This is not true and this is how people think they should apply for VA benefits for things that happened in the past and are no long causing them problems. But a VA disability has to be based on something happening now. This is why it causes problems with FAA medicals.

We have several articles on VA disability and FAA medical certification.
 
WingmanMed said:
This is not true and this is how people think they should apply for VA benefits for things that happened in the past and are no long causing them problems. But a VA disability has to be based on something happening now. This is why it causes problems with FAA medicals.
Click to expand...

To be fair, the condition had be a qualifying condition that was service connected AND severity of symptoms present during the C&P exam.
 
TCABM said:
To be fair, the condition had be a qualifying condition that was service connected AND severity of symptoms present during the C&P exam.
Click to expand...

Exactly. Present at the time of the disability evaluation.
 
WingmanMed said:
Exactly. Present at the time of the disability evaluation.
Click to expand...

The “problem” becomes policy. Some conditions can be in the record, not present during the C&P exam, yet presumed to be present based on what is documented in the member’s military health record.

Insomnia is one such issue that the VA can diagnose in the C&P exam even if there was only one instance of a member being prescribed Ambien as part of a deployment.
 
TCABM said:
The “problem” becomes policy. Some conditions can be in the record, not present during the C&P exam, yet presumed to be present based on what is documented in the member’s military health record.

Insomnia is one such issue that the VA can diagnose in the C&P exam even if there was only one instance of a member being prescribed Ambien as part of a deployment.
Click to expand...

This is why we started our own VA service for pilots. The traditional path of VA disability is ripe with intentional and unintentional fraud at many levels. If a person doesn't have a current problem, then they shouldn't claim things. If the individual doesn't actually meet the diagnostic criteria, the C&P examiner shouldn't give it to you anyway.
 
WingmanMed said:
This is not true and this is how people think they should apply for VA benefits for things that happened in the past and are no long causing them problems. But a VA disability has to be based on something happening now. This is why it causes problems with FAA medicals.

We have several articles on VA disability and FAA medical certification.
Click to expand...

I know many VSO’s that will completely disagree with you. VA awards on a disability that was documented and occurred at its worse state. You can make a claim for a migraine you had 10 years ago that affected your ability to do your job on that day.
 
Last edited:
This HIMS AME perspective is a tad different than wingman meds’, I dare say, owing to the fact that many psychiatry items awarded carry the burden of proving that it is not a continued silent underlying diagnosis with tendency to recur.

For some of these psychiatry diagnoses, that burden of proof is quite heavy.
 
Last edited:
Fracpilot said:
I know many VSO’s that will completely disagree with you. VA awards on a disability that was documented and occurred at its worse state. You can make a claim for a migraine you had 10 years ago that affected your ability to do your job on that day.
Click to expand...

You highlight my point. Many VSOs don't actually understand VA disability. They know how to file paperwork and they know what conditions can rate what percentages. They may also know how the local C&P examiners will perform the exams. But they don't actually fully understand the process.
 
bbchien said:
This HIMS AME perspective is a tad different than wingman meds’, I dare say, owing to the fact that many psychiatry items awarded carry the burden of proving that it is not a continued underlying diagnosis with tendency to recur.

For some of these psychiatry diagnoses, that burden of proof is quite heavy.
Click to expand...

Which part do you disagree with? The part where I said an old diagnosis needs up to date proof that is no longer a current condition?
 
A HIMS AME should know that the distinction between an episode of anxiety/depression frequently has cues that “load” the probability that what you’re seeing is “disease with a high probability of recurrence” , and not just “an episode”. Andreas Lubitz is an exemplar for that.

There is never proof, but there are always risk factors that load the probability of having “recurrent disease, untreated and unmonitored” reappear during a “currently certified” period.

“Proof that is no longer a current condition” is an oversimplified view as to what the agency is trying to do, and reflects only what DOD and VAH are doing. “Proof“ is a way over simplistic view.

….that’ll get your airman with a psychiatry diagnosis.….not very far, I’m afraid.

A psychiatry certification is an effort after all to PREDICT how that airman will fare in the UPCOMING TERM, as much as “where he’s at” currently. And thus the VAH. Comp and Pen (15 mins zoomed with a contract ARNP) really only says, “at one time this condition likely existed”= award.

Psychiatry certification is about FUTURE probabilities, not proof that “Xyz is not a current condition”.
 
Last edited:
A HIMS AME should also be able to spot a poorly made diagnosis with a lack of quality documentation and that a pilot, or prospective pilot, should not forever be labeled and prevented from flying because they sought help from the wrong person.
 
WingmanMed said:
A HIMS AME should also be able to spot a poorly made diagnosis with a lack of quality documentation and that a pilot, or prospective pilot, should not forever be labeled and prevented from flying because they sought help from the wrong person.
Click to expand...
Well, with regard to Alcohol Dependency, and with regard to recurrent depression (on SSRI issuances), the agency regards these as "follow forever" diagnoses......and that is many pay grades above us, sir. What we can do is provide high quality information from sources known to the FAA, who speak in part 67 definitions (not DSM 5), as to the Future probabilities (in addition to the "current status"). Not "proof that XYZ is not a current condition" which is a signal to the FAA, that the AME "doens't get it".

"Poorly made" needs to recognize the difference between part 67 and DSM 5.

(Hey, I'm trying to find you guys in the FAA database....neither of you guys come up in DMS or in HIMS.....)
 
Last edited:
I think we're saying versions of the same thing. As fellow HIMS AMEs, I think we should discuss this topic privately and provide a joint statement that resolves confusion instead of creating it. The FAA's stance on this is pretty clear. You can reach me at contact@wingmanmed.com.

Also, if you look at the HIMS AME list dated 11-03-2022 you will find both of our names. And you should be able to figure out why you can't find us in any other ways.
 
WingmanMed said:
As fellow HIMS AMEs, I think we should discuss this topic privately and provide a joint statement that resolves confusion instead of creating it.
Click to expand...


I'm pretty sure POA has a rule against depriving the forum of entertainment in that manner. :biggrin:

And if not, just what do you expect me to do with all this popcorn?!
:popcorn:
 
Old Thread: Hello . There have been no replies in this thread for 365 days.
Content in this thread may no longer be relevant.
Perhaps it would be better to start a new thread instead.
Back
Top