Seeking medical cert help!!

[znorth53]

Good afternoon everyone! I have been coming to these forums and reading most of them that pertain to a medical cert and obtaining one. I have been denied medical but am able to appeal as long as i write a letter to NTSB. To briefly explain my situation

I served in the Navy as a Corpsman (medical) for 6 years. I did one deployment to the middle east. I began taking an SSRI (lexapro) in 2016 for some depression i was having. I had a pretty bad drinking problem and I was also drinking a lot at the time but i decided to stop drinking cold turkey that day. I stay on the meds 10mg daily. I get deployed in 2017. During that deployment I had saw some combat, nothing crazy, and also was dealing with an unfaithful wife back home. Learning of this news I start to experience some auditory hallucinations. They are telling me to hurt myself and that's it. I get home from deployment, begin the divorce process, and was admitted to a psych hospital for 5 days. The voices stopped, i was never put on any antipsychotics, and i was discharged from the Navy 7 months after that. I started doing research to fly in april of 2019. I got deferred so i went to see a neuropsychologist specialist and had all of the exams performed, the cog testing and all of those fun tests. After the doctors report was sent in, i was then asked to go see a HIMS. I didnt have the money at the time, so the doctor said i was able to see a local psychiatrist as long as he called the neuropsychologist and made sure the verbiage in his report is what the FAA is looking for.

The psychiatrist i paid to write the report has NOT submitted it yet. It has been over a month since i paid him to write this for me. In that time frame, I received a denial letter from the FAA due to a history and/or a clinical diagnosis of psychosis, substance dependence, major depressive disorder and personality disorder.

I have been off of the Lexapro since April of 2019 and completed all of my cog screen evaluations in June of 2019.

Is there any way I can win an appeal or do I just accept my fate that I won't get to be a commercial pilot? any and all help is appreciated. Thank you so much.

 

[AggieMike88]

After the doctors report was sent in, i was then asked to go see a HIMS. I didnt have the money at the time, so the doctor said i was able to see a local psychiatrist as long as he called the neuropsychologist and made sure the verbiage in his report is what the FAA is looking for.

I'm highlighting this for the benefit of Doctor's Lou and Bruce to make sure they see it and provide their input about it.. @lbfjrmd @bbchien

I am in no means an expert on this situation, and barely know what's asked for in a general sense. But I do recall that it isn't having the report written in "FAA language", but more about having the neuropsychological examination done by someone known to the FAA Medical Certification Division. Which is why the denial letter specifically called for a HIMS doctor.

From here, I'll defer to our experts Dr. Bruce Chien and Dr. Lou Fowler.

 

[PeterNSteinmetz]

I defer to the experts mentioned above who will likely shortly chime in. You could probably just go ahead and contact one of them.

Much will depend on the exact history and evaluations. The history of hallucinations will make this more difficult. If this is issuable, it will be a special issuance and need to be on an SSRI pathway. It will require evaluation by expert HIMS neuropsychiatrists and neuropsychologists (cannot be just the local psychologist) and document ongoing treatment. Figure at least $5-10k and a year.

You will need the services of an expert HIMS AME. Normal AME is unlikely to get this done properly.

 

[PeterNSteinmetz]

Also, I believe the first step is to make a new application and request reconsideration. If that is denied then the appeal.

 

[AggieMike88]

Also, I believe the first step is to make a new application and request reconsideration. If that is denied then the appeal.

I think he has applied.... this was included in the OP

I started doing research to fly in april of 2019. I got deferred

But while he was deferred, he has not yet put into evidence that he was denied, nor if he has received a letter from the FAA with the list of what to do.

 

[PeterNSteinmetz]

But while he was deferred, he has not yet put into evidence that he was denied, nor if he has received a letter from the FAA with the list of what to do.

Third paragraph of initial post says he was denied. So I believe the procedure will be to get everything done properly with senior HIMS AME, the re-apply and request re-consideration (though I am not certain).

 

[znorth53]

Thank you for replies! I have applied and was denied. My exams were performed by an FAA approved neuropsychologist. My options were 1. accept results and move on. 2. request an appeal by submitting a letter to NTSB. I plan on submitting an appeal. If i have to go the SI route I will do so indeed. I am already in about $6k with all my exams and appointments so far.

 

[znorth53]

I was initially deferred in May, then saw the Neuropsychologist late June.

 

[znorth53]

Third paragraph of initial post says he was denied. So I believe the procedure will be to get everything done properly with senior HIMS AME, the re-apply and request re-consideration (though I am not certain).

yes that is indeed my plan. I will be appealing the decision the FAA made. I received that letter today ;(

 

[PeterNSteinmetz]

yes that is indeed my plan. I will be appealing the decision the FAA made. I received that letter today ;(

Before sending that formal appeal, I would definitely get in touch with Dr. Chien or Fowler. They are experts at these cases. I believe there are some other approaches and the chance of the appeal to the NTSB working are slim (review the case of John King, for example).

Also, neither of these guys will waste your time or resources. They will only proceed if they think it has a reasonable chance of working and will only submit a new application if they are rather certain it will be approved.

I will add that their fees are quite reasonable and they are quite timely to respond. I suggest just contacting one of them.

 

[Half Fast]

I will add that their fees are quite reasonable and they are quite timely to respond. I suggest just contacting one of them.

Amen. I got my medical through Dr. Chien. Bruce would make more money if he just put a "Tips" jar on his desk.

If this can be worked, Dr. Lou or Dr. Bruce will be your best bet.

 

[lbfjrmd]

Find a HIMS-AME and re-apply. There is no verbiage, no wiggle room. Appealing to the NTSB is your right ... but in 30+ years in this business I have never personally seen success.

 

[bbchien]

To be more succinct, “any history of psychosis is grounds for denial”.

 

[PeterNSteinmetz]

To be more succinct, “any history of psychosis is grounds for denial”.

Does this mean an SI is not possible at all in a case such as this with a one time incident and underlying disease which is presently controlled?

Would 10 years off meds and no further symptoms be issuable?

 

[bbchien]

Does this mean an SI is not possible at all in a case such as this with a one time incident and underlying disease which is presently controlled?

Would 10 years off meds and no further symptoms be issuable?

at that point they would CONSIDER him...

 

[mryan75]

That looks like the exact list of medical conditions I would not want my commercial pilot to have ever been diagnosed with. To have been diagnosed with all of them? With all due respect and my sympathy to the OP, I sincerely hope there is no chance he ever becomes a commercial pilot.

 

[PeterNSteinmetz]

That looks like the exact list of medical conditions I would not want my commercial pilot to have ever been diagnosed with. To have been diagnosed with all of them? With all due respect and my sympathy to the OP, I sincerely hope there is no chance he ever becomes a commercial pilot.

Well, on that point, I can ask the same question I always have about this. Is there evidence that FAA medical certification improves the safety of flight, perhaps for commercial pilots?

We have previously discussed at length that there does not appear to be such evidence with respect to 3rd class.

 

[PeterNSteinmetz]

For the OP. Sorry about the money you spent on this. Seems like a very long shot.

 

[bbchien]

This is a “failure to get good advice”..."

 

[mryan75]

Well, on that point, I can ask the same question I always have about this. Is there evidence that FAA medical certification improves the safety of flight, perhaps for commercial pilots?

We have previously discussed at length that there does not appear to be such evidence with respect to 3rd class.

The evidence cited to the contrary is not even slightly conclusive. You can’t prove a negative. The argument in favor can be summarized in one word: Germanwings. And if you’ve never seen the devastation wrought by a 121 accident on the lives of friends and family, I have, and I can tell you it’s not pretty. The passengers’ right not to have a depressed, psychotic guy hearing voices in the cockpit far outweighs any other consideration. Sorry.

 

[Kenny Phillips]

The evidence cited to the contrary is not even slightly conclusive. You can’t prove a negative. The argument in favor can be summarized in one word: Germanwings. And if you’ve never seen the devastation wrought by a 121 accident on the lives of friends and family, I have, and I can tell you it’s not pretty. The passengers’ right not to have a depressed, psychotic guy hearing voices in the cockpit far outweighs any other consideration. Sorry.

OTOH ... what percentage of flights are taken down by psychotic pilots? Bear in mind that in the US alone, a city's worth of people [~200K] are killed by preventable medical errors each year.
But I'm just playing devil's advocate; I also don't want that pilot in the pointy end (though you certainly never know if your pilot is depressed, etc. on any given flight).

 

[mryan75]

OTOH ... what percentage of flights are taken down by psychotic pilots?

Ask the families of the Germanwings victims if they care. I can assure you of their answer. If the traveling public doesn’t deserve this level of safety, then essentially what we are saying is that they don’t deserve any.

Here’s the thing: we have the safest aviation system in the world. I personally see no value in removing the safeguards that have made it such in hopes it doesn’t get worse. Because you cannot make the argument that allowing psychotic pilots to fly passengers might make us safer. All we are doing is lowering standards. And I see absolutely no reason to do that in order to fulfill the dreams of a few people.

I get that you’re playing devil’s advocate. But my opinion is iron clad.

 

[Kenny Phillips]

Ask the families of the Germanwings victims if they care.

Sorry, they have no say in the matter, and emotion should never trump logic (although our court system seems to have forgotten that.) But I was playing devil's advocate, and I did say that I don't want a mentally impaired airplane driver.

 

[PeterNSteinmetz]

The evidence cited to the contrary is not even slightly conclusive.

Several evidentiary issues here. In general, the burden of proof is on the party asserting existence. Is there any evidence that the FAA’s aeromedical regulations improve the safety of flight? None has been presented so far. As noted, it is very difficult to prove a negative (that is - has no such effect), which is why such a general burden of proof exists.

OTOH, there is a presumption for the status quo, especially when proposing making changes. I think in this case that would suggest careful studies (which so as we can tell, have never been performed) and proceeding carefully.

The fact that we have in the US the safest commercial air travel certainly suggests something works well in terms of safety. But that in and of itself does not mean the FAA or government regulations are responsible. There are myriad possible causative factors. Indeed, it appears that a primary factor has been improved procedures and training. A government bureaucracy attempting to ensure medical safety may have little or nothing to do it.

A good reason to consider this more carefully is that there is a large body of work on the inability of coercive regulations to achieve their intended effects generally. This is often due to unintended consequence of the coercive regulations.

In terms of aeromedical regulations, this would be the many pilots who may avoid receiving medical care because they don’t want to jeopardize their medical certification. Since the number of such pilots may vastly exceed the number of pilots such as the GermanWings pilot, the negative consequences of the former’s behavior may exceed those of the latter group. In that case, the regulations, while well intended, would actually _decrease_ safety overall.

These can be treated as empirical questions, but have not been due to strong emotional reactions to high profile disasters.

In general I would certainly agree that passengers on commercial airliners deserve not to have pilots having psychotic reactions in the cockpit. I just am not convinced a coercive regulatory regime is the best way to achieve that. It may be better to have a greater role for market forces.

As to “my opinion is iron-clad”, please correct me if I am mistaken, but that would seem to suggest your views are fixed and not amenable to facts or reason. Is that correct? If so, I don’t imagine this or further discussion will be of interest. Apologies then, but hopefully my thoughts may have been of interest to other readers.

 

[bbchien]

However, if one has a choice between a pilot in command who has such a history vs. one who has no such history, which do you prefer? Thsu the dilemma.

And there is No such dilemma in Washington, DC.

 

[Mooney Fan]

Look at what they put Bob Hoover through.

 

[Half Fast]

However, if one has a choice between a pilot in command who has such a history vs. one who has no such history, which do you prefer? Thsu the dilemma.

And there is No such dilemma in Washington, DC.

Agreed. But how effective are the medical exams in detecting psychosis in someone who has not already sought treatment, including those who may deliberately avoid treatment because of the aviation impact?

Heck, even NASA's astronaut-level medical screening can't detect crazy:
https://www.denverpost.com/2007/02/05/diaper-wearing-astronaut-jailed-in-love-triangle-plot/

 

[PeterNSteinmetz]

If we were to posit a system with market forces mostly in play, I imagine the airlines would have a strong economic incentive to not employ pilots with psychotic conditions.

The questions would then be how much it was worth it to them to pry into past history of actual psychosis or other metal health conditions to try and ensure that. No doubt it would be worth some effort to investigate some historical data. OTOH, there are likely some indicators, such as very distant histories of minor problems, that have sufficiently low predictive value that they wouldn’t bother.

As noted, one of the issues with coercive regulatory agencies attempting to perform the same function is that they have little to no incentive to balance the costs. The attitude adopted is one of “we will never allow that to happen again”, no matter what the costs. That attitude is encouraged by the fact that the agencies don’t have to bear the economic costs of overly conservative decisions.

This is pretty much standard sort of criticism in the large literature on the problems with coercive regulation. It really should be an empirical sort of issue - which is why I always ask where is the data?

 

[PeterNSteinmetz]

Agreed. But how effective are the medical exams in detecting psychosis in someone who has not already sought treatment, including those who may deliberately avoid treatment because of the aviation impact?

My sense would be quite low. A longer forensic psychiatric exam would probably be somewhat more effective, but of course those are not done on all applicants for a medical.

And good point. It is the balance between the effects of these regulations on people who avoid treatment and disclosure against the danger of the reported and known cases that matters in terms of overall safety of flight — not simply one side of that equation, eliminating risk in reported and known cases.

 

[mryan75]

Sorry, they have no say in the matter, and emotion should never trump logic (although our court system seems to have forgotten that.) But I was playing devil's advocate, and I did say that I don't want a mentally impaired airplane driver.

I completely understand you were playing devil’s advocate. No worries. And their emotion does not trump logic in any way. They are in complete accord.

 

[mryan75]

As noted, one of the issues with coercive regulatory agencies attempting to perform the same function is that they have little to no incentive to balance the costs.

And that is the beauty of government. Their concern is singular: safety. I’m glad that can be said. What you consider a problem, I consider a positive.

 

[MuseChaser]

And that is the beauty of government. Their concern is singular: safety....

The only thing government, and therefore our elected officials, is/are concerned about is safety? Really?!?! Speaking only about the USA for now, our Constitution speaks to a lot more than just safety.

 

[mryan75]

The only thing government, and therefore our elected officials, is/are concerned about is safety? Really?!?! Speaking only about the USA for now, our Constitution speaks to a lot more than just safety.

Yes, let’s discuss the entire constitution.

My (I though obvious) point is that government does not have a profit motive. The goal is safety. I would rather have the government spending what it takes rather than private companies spending as little as possible (and often less than necessary). Whenever we let “the market decide,” the end is inevitable disaster.

 

[MuseChaser]

Yes, let’s discuss the entire constitution.

My (I though obvious) point is that government does not have a profit motive. The goal is safety. I would rather have the government spending what it takes rather than private companies spending as little as possible (and often less than necessary). Whenever we let “the market decide,” the end is inevitable disaster.

My apologies if I misconstrued your post.. I really did think you meant that the only concern of the government was safety, as that's what you wrote, but I can understand how you meant it only in the context of regulation. Even so, I can't agree. Yes, and hopefully of course, a driving force (and again hopefully but I'd cynically state possibly unlikely) behind safety regulation creation and regulatory decisions is safety, but there are many other concerns that government must take in to consideration. Economic impact, the desires of their constituents, personal freedoms, powerful lobbying groups (whether or not they SHOULD be listened to... but they are an inarguable factor in regulatory decisions, regardless of what positions we each may individually support or decry).... there are a HOST of factors beyond safety that go into creating safety regulations. The fact that, theoretically, the government doesn't profit by these regulations doesn't mean that therefore safety is the only factor influencing legistlation and enforcement thereof.

Returning to the specifics of this thread, @PeterNSteinmetz writes very articulately and cogently about the topic and his point of view. @bbchien 's reply, as usual, cuts directly to the entire heart of the matter.. "However, if one has a choice between a pilot in command who has such a history vs. one who has no such history, which do you prefer? Thsu the dilemma." The answer is completely self-evident. The question lies in how to get there. I wish I knew what the solution was. For every unsafe, unstable pilot currently flying now despite all the current regulation, there are probably hundreds of safe, stable pilots grounded because of current regulations. Both are very regrettable, and unjust.

 

[mryan75]

My apologies if I misconstrued your post.. I really did think you meant that the only concern of the government was safety, as that's what you wrote, but I can understand how you meant it only in the context of regulation. Even so, I can't agree. Yes, and hopefully of course, a driving force (and again hopefully but I'd cynically state possibly unlikely) behind safety regulation creation and regulatory decisions is safety, but there are many other concerns that government must take in to consideration. Economic impact, the desires of their constituents, personal freedoms, powerful lobbying groups (whether or not they SHOULD be listened to... but they are an inarguable factor in regulatory decisions, regardless of what positions we each may individually support or decry).... there are a HOST of factors beyond safety that go into creating safety regulations. The fact that, theoretically, the government doesn't profit by these regulations doesn't mean that therefore safety is the only factor influencing legistlation and enforcement thereof.

Returning to the specifics of this thread, @PeterNSteinmetz writes very articulately and cogently about the topic and his point of view. @bbchien 's reply, as usual, cuts directly to the entire heart of the matter.. "However, if one has a choice between a pilot in command who has such a history vs. one who has no such history, which do you prefer? Thsu the dilemma." The answer is completely self-evident. The question lies in how to get there. I wish I knew what the solution was. For every unsafe, unstable pilot currently flying now despite all the current regulation, there are probably hundreds of safe, stable pilots grounded because of current regulations. Both are very regrettable, and unjust.

My apologies for the rude reply. Got in from a trip at 3:20 this morning and a bit tired.

The libertarian argument always sounds good, but inevitably they love the upside of their argument (freedom) and don’t like the downside (responsibility). Matters of public safety should be left to government, and its lack of profit motive. As I stated above, we have the safest aviation system in the world. If anyone seriously has a way to make it more safe with less regulation, I’m all ears. But stripping away regulation - and in this case allowing people with a history of multiple, very serious mental illnesses to fly the public around - is just patently unacceptable to me. If we get to the point where we’ve plum run out of pilots to fly the great unwashed around and the only solution is to let crazy people start flying, we can talk about it. But that will never happen.

The arguments in favor, specifically the history of basic med and sport pilot, just doesn’t hold water. That’s a minuscule sample size. And we have a very large sample size of well-regulated (to coin a phrase) pilots where medical incapacities are extremely, extremely rare. Almost unheard of. So why would we lower those standards?

Again, I apologize for being rude.

 

[mryan75]

Also, the goal here can’t be perfection. Yes, some people will be blocked from chasing their dreams. And yes, some people who shouldn’t be flying will sneak through the cracks. But neither is a reason to change a system that on whole has worked extremely well. We haven’t had a major aviation accident in this country in what, 12 years? Works for me.

Also, to Peter’s point, anyone who forgoes their own medical care so they can keep flying is an idiot, I’m sorry. I’ve never understood the logic behind the idea that because some people will break a rule, the rule shouldn’t exist.

And I have not even addressed the OP. To him or her, I have all the empathy in the world for you. I wish you the absolute best. I hope you get the treatment you need and live a long, healthy and productive life. I’m sorry for all that you’ve gone through, and I’m not unappreciative of the courage you’ve shown in fighting the fight that you have. But with all due respect, I don’t want you flying the traveling public around.

 

[PeterNSteinmetz]

For every unsafe, unstable pilot currently flying now despite all the current regulation, there are probably hundreds of safe, stable pilots grounded because of current regulations. Both are very regrettable, and unjust.

Thanks for the kind remark. A critical question is what are the numbers really? 100 to 1 or 100,000 to 1?

And what are the costs, in terms time and money, of this type of regulation. Knowing these things is necessary to make rational policy decisions. Yet we have not seen studies of such and the data here, or elsewhere from what I have been able to find in quick searches.

When this sort of calculation had been done for other aspects of airline security, such as the TSA, they indicate the TSA’s approach is off by at least 2 orders of magnitude.

 

[MuseChaser]

...Also, to Peter’s point, anyone who forgoes their own medical care so they can keep flying is an idiot, I’m sorry...

I'm a violinist. I've been playing professionally for 40 years, and for 11 years prior to that, for a total of 51 years. Being a musician is who I am...yes, there's other things I love to do, and I'm also a father, husband, pilot, and a lot of other things, but musician is way up there. I've got some shoulder problems after all of these years, and am working on them with the help of my Docs and physical therapy, but I'm not about to stop playing violin if they tell me I have to.. I'll just tell them I'm feeling much better. I say this only to illustrate that, while I agree with you that hiding things and jeopardizing your health so you can keep flying is a very unintelligent thing to do, I can understand why some people do. Personally, I wouldn't.. I don't endanger anyone by playing violin (although one certain @#$#$ conductor may disagree), but I'd never put my life or another person's life at risk by flying an airplane if I had a disqualifying health issue.

And I have not even addressed the OP. To him or her, I have all the empathy in the world for you. I wish you the absolute best. I hope you get the treatment you need and live a long, healthy and productive life. I’m sorry for all that you’ve gone through, and I’m not unappreciative of the courage you’ve shown in fighting the fight that you have. But with all due respect, I don’t want you flying the traveling public around.

Absolutely. I wish I had written that.

and, @mryan75 , no apologies at all necessary, but thank you.

 

[PeterNSteinmetz]

If anyone seriously has a way to make it more safe with less regulation, I’m all ears. But stripping away regulation - and in this case allowing people with a history of multiple, very serious mental illnesses to fly the public around - is just patently unacceptable to me.

Why keep ignoring parts of the argument and against regulation?

One main point is there is lots of evidence regarding the unintended effects of coercive regulations. More specifically in the case of aeromedical regulation that suggests that these regulations actually make us LESS safe.

One plausible mechanism causing lower safety would be that there are a lot of pilots who skip medical treatment, ending up on flight decks and endangering the public, whereas the number of people with very serious detected illnesses who would be allowed to fly by commercial airlines, thereby endangering the public, is quite small.

 

[PeterNSteinmetz]

Matters of public safety should be left to government, and its lack of profit motive.

There are whole books (e.g. Mises “Bureaucracy”) about how this is not really the case in operation. What is the true motive of the actual actors in a coercive regulatory system? Their own self interest, in other words, their salary, prestige, retirement package etc. They tend to be captured by the very industries they are supposed to regulate (again much literature on regulatory capture which is being ignored here). There is of course also lobbying which provides a powerful financial incentive to members of the legislature.