SI Issuance

[dbahn]

The HIMS SI is different in that the Authorization has conditions for the continued validity of the authorization, not just conditions for the issuance of a new medical certificate during the authorization period. It requires continued compliance with HIMS conditions or, as it says, "your Special Issuance will be withdrawn." Unlike the "normal" SI, the HIMS SI has requirements to retain the validity of the authorization. Don't comply, and FAA withdraws the Authorization itself. And as the BasicMed rules say, to be eligibal for BasicMed, the pilot must "Not have had his or her most recently issued medical certificate (if the person has held a medical certificate) suspended or revoked or most recent Authorization for a Special Issuance of a Medical Certificate withdrawn."

Does this mean that the FAA could exert its authority to require "continuous" obligations for other conditions in order to avoid withdrawal of the SI authorization? Could they apply that tactic to sleep apnea? Melanoma? Prostate cancer? Diabetes? Would airmen with those conditions be subject to potential withdrawal of the SI authorization during the full term of the authorization, i.e. long after the medical certificate had expired?

 

[midlifeflyer]

The Domingo letter addresses the scenario perfectly.



Domingo states specifically that the FAA would not have a basis to withdraw the Authorization because there is no reasonable basis for requiring an airman who does not hold a current special issuance medical certificate under 67.401 to provide medical information that is not needed for determining medical certification under 67.401.

What is more, the Authorization's longer duration period conveys no independent medical privilege as evidenced by the requirement for an airman to demonstrate that he remains qualified for a new special issuance medical certificate when the current special issuance medical certificate expires. This states that as long as you can demonstrate that you remain qualified for a new SI medical certificate at the time the current SI medical certificate expires, the Authorization cannot be withdrawn for non-compliance AFTER the most recent SI medical certificate is expired and the airman is not currently seeking another SI medical certificate.

This is precisely what Dr Bruce has said many times about "complying with the Authorization to the letter up to and through the date of expiration of the current SI medical certificate".

Maybe, but I'm not convinced by your analysis that that the FAA's position is that all someone who has been a raging alcoholic for 40 years has to do to qualify for Basic Med is comply with HIMS for 3 months.

 

[Jon Wilder]

Does this mean that the FAA could exert its authority to require "continuous" obligations for other conditions in order to avoid withdrawal of the SI authorization? Could they apply that tactic to sleep apnea? Melanoma? Prostate cancer? Diabetes? Would airmen with those conditions be subject to potential withdrawal of the SI authorization during the full term of the authorization, i.e. long after the medical certificate had expired?

No.

Authorizations often have a longer duration than the associated special issuance medical certificate. These longer durations are for internal FAA administrative purposes and aid the Office of Aerospace Medicine with the processing of special issuance medical certificates under 67.401. The Authorization's longer duration period conveys no independent medical privilege as evidenced by the requirement for an airman to demonstrate that he remains qualified for a new special issuance medical certificate when the current special issuance medical certificate expires. As such, an airman's responsibility to comply with the terms of an unexpired Authorization - including a term that requires regular submission of medical information - terminates when the associated special issuance medical certificate expires. Because there is no reasonable basis for requiring an airman in those circumstances to provide medical information that is not needed for determining medical certification under 67.401, the FAA would not have a basis to withdraw the Authorization.

 

[Jon Wilder]

Maybe, but I'm not convinced by your analysis that that the FAA's position is that all someone who has been a raging alcoholic for 40 years has to do to qualify for Basic Med is comply with HIMS for 3 months.

There is A LOT more that an alcoholic has to do before they're even granted the SI Authorization and medical certificate. A LOT more. You have to convince the FAA docs that you are deep into your recovery. By the time an alcoholic 3rd class airman gets his SI Authorization, he's been in recovery (to include random abstinence testing) a good long while.

Furthermore, HIMS SI medical certificates are valid for 6 months. But again, you have to be well established in recovery long before AAM-300 will even issue it in the first place. And that takes a lot longer than your "3 months".

 

[midlifeflyer]

Does this mean that the FAA could exert its authority to require "continuous" obligations for other conditions in order to avoid withdrawal of the SI authorization? Could they apply that tactic to sleep apnea? Melanoma? Prostate cancer? Diabetes? Would airmen with those conditions be subject to potential withdrawal of the SI authorization during the full term of the authorization, i.e. long after the medical certificate had expired?

I don't know. And I don't know the answer to my own question. I wish it were indeed as simple as @Jon Wilder thinks. Being able to spend 3-months in HIMS to get a 3-month medical and then quit the program and do BasicMed would mitigate some of the harshness surrounding the FAA's no tolerance policy. But the problem is I see is Domingo is in a vacuum memo with no specific context. One of our medical gurus can set me straight but I see a potential conceptual difference between completing a program and getting a test. And I don't think it's about the FAA asking for a medical report after certificate expiration. They are not asking for any information at all (the subject of Domingo) In the HIMS situation.

 

[midlifeflyer]

There is A LOT more that an alcoholic has to do before they're even granted the SI Authorization and medical certificate. A LOT more. You have to convince the FAA docs that you are deep into your recovery. By the time an alcoholic 3rd class airman gets his SI Authorization, he's been in recovery (to include random abstinence testing) a good long while.

Furthermore, HIMS SI medical certificates are valid for 6 months. But again, you have to be well established in recovery long before AAM-300 will even issue it in the first place. And that takes a lot longer than your "3 months".

You may well be right, but I have seen initial HIMS medicals that are only valid for 3 months from the date of the SI. That's probably just the usuall delay between providning information and the letter going out. Yes, the rest are 6-month certificates.

 

[Jon Wilder]

You may well be right, but I have seen initial HIMS medicals that are only valid for 3 months from the date of the SI. That's probably just the usuall delay between providning information and the letter going out. Yes, the rest are 6-month certificates.

It's far different for airline pilots. They cannot fly BasicMed at all since they carry far more than 5 pax. They can also get their HIMS medicals processed faster due to having an internal HIMS program within the airline itself.

But 3rd class HIMS SI medicals take forever to get. First you have to convince a HIMS AME to take you, which is admitting you're an alcoholic (or an addict, whichever applies), and convince them that you want help and recovery. Then your recovery progress has to be convincing enough for the HIMS AME to write their recommendation for special issuance. Then your recovery has to convince the FAA drug & alcohol doc. By the time you get your SI Authoriation + medical certificate, you've been in a holding pattern working your recovery program for quite some time. It's not just a "3 month SI and you're done". All of that time, money spent, and hoop jumping prior to the issuance definitely counts for something. There are lots more who get into the process and quit before issuance due to the costs involved than there are those who get issued. It's not an easy process to get through by any means.

 

[Jon Wilder]

You may well be right, but I have seen initial HIMS medicals that are only valid for 3 months from the date of the SI. That's probably just the usuall delay between providning information and the letter going out. Yes, the rest are 6-month certificates.

Also, and this is where your "3 months and you're done" logic wouldn't work...in order to maintain BasicMed eligibility, I believe you have to remain on a SI medical certificate until your most recent MedXpress application no longer has standing. For 3rd class medical certificates, MedXpress applications are in standing for 2 years from date of your most recent medical exam for those age 40+, and 5 years for those under age 40. For unrestricted medical certificates, this is a non-issue as the MedXpress application would no longer have standing once the medical certificate expires. However, with time limited special issuance medical certificates, this isn't always the case. As long as that application has standing, the FAA views this as an airman "in the process of seeking a new special issuance medical certificate".

If your SI medical certificate expires while your most recent MedXpress application still has standing, you would normally just be issued a new medical certificate so long as you have demonstrated that you remain qualified for a new special issuance medical certificate.

My take away from this is to get BasicMed once you're issued a special issuance (you can have both at the same time), but keep renewing your SI medical certificate until your most recent MedXpress application no longer has standing. This way, you don't run into the risk of the FAA viewing as "in the process of seeking a new special issuance medical certificate".

 

[dbahn]

I believe you have to remain on a SI medical certificate until your most recent MedXpress application no longer has standing.

Interesting. But what is the source of that information?

 

[Jon Wilder]

Interesting. But what is the source of that information?

In the Domingo letter, it states -

As explained further in this memorandum, when an airman's special issuance medical certificate has expired and the airman is not in the process of seeking a new special issuance medical certificate, additional medical information is not reasonably needed for certification under 14 CFR 67.401. Consequently, the Federal Air Surgeon may not withdraw the Authorization based on the airman's failure to provide information "not reasonably needed by the Federal Air Surgeon for certification under this section [§ 67.401(f)(4)]." If an airman does not hold a special issuance medical certificate and has no application pending, there is no need for the Federal Air Surgeon to request information necessary to determine whether the airman meets the standards for special issuance medical certificate.

It can very easily be argued that, while your most recent MedXpress application still has standing, and a new special issuance medical certificate can be issued against that MedXpress application, that you are "in the process of seeking a new special issuance medical certificate". Therefore, while you can certainly forego having a new SI medical certificate issued when the accompanying SI medical certificate expires, and continue to fly under BasicMed, you're on the hook to comply with the terms of the SI Authorization until your most recent MedXpress application no longer has standing.

 

[Half Fast]

It can very easily be argued that, while your most recent MedXpress application still has standing, and a new special issuance medical certificate can be issued against that MedXpress application, that you are "in the process of seeking a new special issuance medical certificate".

I don't believe that can be argued as easily as you suppose. The process of seeking a new medical begins when the airman visits an AME for an examination and the AME submits the code number at the bottom of the application following an exam. No AME exam and no AME submittal, there's no "seeking a new medical."

@Brad Z might want to weigh in, as he's perhaps the most knowledgeable about the Basic Med process.

 

[dbahn]

It can very easily be argued that, while your most recent MedXpress application still has standing, and a new special issuance medical certificate can be issued against that MedXpress application, that you are "in the process of seeking a new special issuance medical certificate". Therefore, while you can certainly forego having a new SI medical certificate issued when the accompanying SI medical certificate expires, and continue to fly under BasicMed, you're on the hook to comply with the terms of the SI Authorization until your most recent MedXpress application no longer has standing.

"Has standing"??

During the period of SI authorization, I don't see how the most recent MedXpress "has standing", whatever that means. MedXpress was used to collect information needed for the issuance of the most recent medical certificate, which typically occurred in many cases 6 months earlier (or some other time frame specified in the SI valid period). Once that medical certificate has been issued, the typical SI requires updated information as specified in the SI letter but does not need to directly involve the AME and does not require submission of a new MedXpress form. In fact, the original MedXpress information may at that point be "stale", in that it does not even accurately reflect the airman's current medical information. It only includes information that existed at the time the airman applied for the most recent medical certificate. New doctor visits, new diagnoses, new medications, etc. may have occurred that have nothing to do with the condition necessitating the SI. The airman is only required to submit the information specified in the Special Issuance. He is not required to update MedXpress, and I would argue that the original MedXpress has no current "standing" for FAA purposes on that basis.

 

[flyingron]

SI approval times when to fudge before basic med came down the pike. You can't put the blame on that.

 

[redbaron]

SI approval times when to fudge before basic med came down the pike. You can't put the blame on that.

No that's not on basic med, that's on the FAA posturing for increased funding at CAMI. By slow rolling the SI backlog as much as possible they are able to have quantifiable data to tell congress that they need $X additional funding for physician hiring. Its a well known government agency strategy to say "we're tried nothing and we're all out of ideas!"

It also doesn't hurt that a side effect of the sisyphean SI process is that many airmen are discouraged or forego medical applications altogether, reducing the FAA Medical certification workload and consequently liability even further. It's a win win game for the FAA to make the process as slow, opaque, expensive, and unattainable as possible.

 

[Jon Wilder]

"Has standing"??

Sorry I misspoke. Not the MedXpress itself, but the underlying exam. As long as the underlying exam still has standing (the exam would have standing for 2 years from date of exam for airman ages 40+ on a 3rd class medical application), the FAA considers the airman to be "actively seeking a new special issuance medical certificate".

you have time left on an exam, say you got an SI but the underlying exam has standing for the second year, and something is recieved on your file, the agency interprets that as reappication.

Our resident FAA guy sez that shouldn't happen, but it keeps happening. Now if it were > 2 years since your medical was done, that wouldn't happen until you formally reapplied.

So yeah, you have to respond and if you don't you get denied.
You need to revoke all permissions from your healthcare providers to send your records anyplace. There is always a helpful hanna in back who does not "get it", sends it off, and starts the cascade.

 

[Half Fast]

...the FAA considers the airman to be "actively seeking a new special issuance medical certificate".

Not exactly.

That has happened a few times but only when a doctor’s office submitted something to make the FAA think the airman was applying. Airmen have been able to get the bell unrung (though it was a bit of a struggle) by letting the agency know they weren’t in fact seeking a fresh medical.

The “resident FAA guy” Bruce mentions is @Brad Z so perhaps he can clarify further.

 

[Brad Z]

Sorry, a little late to the party.

As noted in the Domingo Interp, the ability of the FAA medical to withdraw a Special Issuance ceases when the medical certificate expires. Otherwise, conceivably, they could issue 20 year SI letters and never allow anyone with an SI to get out of the hamster wheel without getting their SI authorization withdrawn and subsequently disqualified for BasicMed and Sport pilot privileges.

Note that the Domingo letter makes no distinction for the type of SI. So yes, a medical issued with HIMS requirements can be transitioned to BasicMed once the initial medical certificate expires. Is that good policy? That’s a different question and probably one that ultimately Congress will have to determine. Otherwise, an alcoholic who falls from sobriety will ultimately be in violation of 61.53(b) should he attempt to fly. Obviously this presents significant enforcement hurdles, but that’s another issue altogether.

Regarding the post expiration wirhdrawl of a special issuance authorization; occasionally it happens. If it is done in error the withdrawal can be rescinded.

 

[Half Fast]

Otherwise, an alcoholic who falls from sobriety will ultimately be in violation of 61.53(b) should he attempt to fly. Obviously this presents significant enforcement hurdles, but that’s another issue altogether.

One partial mitigation is that an alcoholic who gets a DUI and loses his driver’s license is no longer eligible for Basic Med. Having a driver’s license is a requirement.

 

[Brad Z]

One partial mitigation is that an alcoholic who gets a DUI and loses his driver’s license is no longer eligible for Basic Med. Having a driver’s license is a requirement.

That's assuming they drink & drive, get caught, and lose their license.

 

[Jon Wilder]

Otherwise, an alcoholic who falls from sobriety will ultimately be in violation of 61.53(b) should he attempt to fly.

How would the FAA interpret "falling out of sobriety"? Would the alcoholic have to resume drinking? Or would they make a legal presumption that the alcoholic fell from sobriety due to transitioning off of HIMS to BasicMed (as if to say your sobriety is presumed to have ended when you transitioned out of HIMS as your sobriety would not be "provable" to the FAA)? I ask for those who are committed to sobriety, but can't afford to sustain HIMS participation throughout the step-down process.

 

[midlifeflyer]

How would the FAA interpret "falling out of sobriety"? Would the alcoholic have to resume drinking? Or would they make a legal presumption that the alcoholic fell from sobriety due to transitioning off of HIMS to BasicMed (as if to say your sobriety is presumed to have ended when you transitioned out of HIMS as your sobriety would not be "provable" to the FAA)? I ask for those who are committed to sobriety, but can't afford to sustain HIMS participation throughout the step-down process.

At that point we'd be most likely dealing with the plain vanilla 61.53(b) "getting caught" at something that gains the FAA's attention, assuming complete honesty with the BasicMed physician.

 

[Half Fast]

So far, we don’t seem to have an epidemic of drunken Basic Med pilots falling out of the sky. In fact, the safety record of Basic Med is about the same as the 3rd class medical.

This would seem to imply that all the HIMS hoops are either unnecessary or ineffective, probably both, and all this hand-wringing about pilots switching to Basic is needless.

 

[WingmanMed]

While I appreciate the call out in the thread for our expertise, we do limit our expertise to FAA medical certification. Basic Med has a lot of value for many people, but it is not something we advise on.

 

[Brad Z]

So far, we don’t seem to have an epidemic of drunken Basic Med pilots falling out of the sky. In fact, the safety record of Basic Med is about the same as the 3rd class medical.

This would seem to imply that all the HIMS hoops are either unnecessary or ineffective, probably both, and all this hand-wringing about pilots switching to Basic is needless.

Yes, at least as recently as 2020. So it's still a relatively small sample size of operations. Further, as hard as it is to pin down medical causation, it's even hard to pin down alcohol related crashes, as ethanol naturally forms as a result of decomposition, making tox reports unreliable.

There seems to be a recent uptick in people inquiring about departing HIMS for BasicMed. Time will tell whether it's a good idea or not.

I personally think it's the biggest potential safety risk to BasicMed. Most airmen of sound mind can make reasonable decisions about operating aircraft based on their evaluation of their medical status. By definition, pilots with substance issues don't make good decisions when they consume alcohol. Active monitoring under HIMS either offers an additional incentive to stay sober, or serves as a deterrent from those who are not committed to long-term sobriety.

 

[dbahn]

There seems to be a recent uptick in people inquiring about departing HIMS for BasicMed. Time will tell whether it's a good idea or not.

I personally think it's the biggest potential safety risk to BasicMed. Most airmen of sound mind can make reasonable decisions about operating aircraft based on their evaluation of their medical status. By definition, pilots with substance issues don't make good decisions when they consume alcohol. Active monitoring under HIMS either offers an additional incentive to stay sober, or serves as a deterrent from those who are not committed to long-term sobriety.

I share the concern. What we don't know is whether the substance abusers are departing HIMs to continue their abuse or to avoid the expense of perpetual compliance. After all, with the FAA's step down program proof of compliance is a lifetime obligation as long as an FAA medical certificate is the goal. I like to believe (with no validity to the belief) that once an alcoholic has gone through the whole HIMS process they will have a sufficient fresh start for a very large number of them to remain abstinent, knowing that any subsequent alcohol related event reported to the FAA will likely result in airman certificate revocation, where Basic Med itself becomes useless.

Similarly, it would interesting to know how many other Basic Med users switched primarily for economic reasons. I know I did, for malignant melanoma, where none of the FAA documentation was medically necessary and had to be paid out of pocket.

 

[Half Fast]

Similarly, it would interesting to know how many other Basic Med users switched primarily for economic reasons. I know I did, for malignant melanoma, where none of the FAA documentation was medically necessary and had to be paid out of pocket.

My SI was for an autoimmune condition. The economics were part of my reason for going to Basic Med. The requirement for annual renewal (with attendant medically-unecessary data) was another, but even bigger was the possibility that some OKC doc (who doesn't know me and has never examined me and is not an expert in this specialty) could deny a future renewal.

Nope. Not ever gonna play FAA medical roulette again. Nope. Ain't gonna.

 

[Jon Wilder]

I share the concern. What we don't know is whether the substance abusers are departing HIMs to continue their abuse or to avoid the expense of perpetual compliance. After all, with the FAA's step down program proof of compliance is a lifetime obligation as long as an FAA medical certificate is the goal. I like to believe (with no validity to the belief) that once an alcoholic has gone through the whole HIMS process they will have a sufficient fresh start for a very large number of them to remain abstinent, knowing that any subsequent alcohol related event reported to the FAA will likely result in airman certificate revocation, where Basic Med itself becomes useless.

Similarly, it would interesting to know how many other Basic Med users switched primarily for economic reasons. I know I did, for malignant melanoma, where none of the FAA documentation was medically necessary and had to be paid out of pocket.

Some will switch to BasicMed for economic reasons, but keep the random testing in place. @bbchien has one such patient. There are ways to go about HIMS to BasicMed while still ensuring at least partial compliance (like still requiring testing for instance) so that those wishing for a financial break can at least still be monitored partially.

 

[Half Fast]

There seems to be a recent uptick in people inquiring about departing HIMS for BasicMed.

Funny how that happened after the FAA started requiring HIMS for life for some airmen, huh?

Active monitoring under HIMS either offers an additional incentive to stay sober, or serves as a deterrent from those who are not committed to long-term sobriety.

Maybe. It'd be interesting to know how many folks are simply staying off the radar by not reporting substance abuse. We know from anonymous surveys that many folks with psych problems are not reporting or going untreated. It's likely there's a pretty good overlap between the groups.

I understand your concern, but I wouldn't be surprised to learn that the number of people who jump through the substance-abuse HIMS hoops then switch to Basic Med so they can abuse again is tiny compared to the number of abusers who aren't caught in the HIMS net to begin with.

 

[Jon Wilder]

I understand your concern, but I wouldn't be surprised to learn that the number of people who jump through the substance-abuse HIMS hoops then switch to Basic Med so they can abuse again is tiny compared to the number of abusers who aren't caught in the HIMS net to begin with.

Someone here once said if HIMS were required for all aero medical applicants, someone would be rewriting the regs real quick.

 

[Palmpilot]

...It also doesn't hurt that a side effect of the sisyphean SI process is that many airmen are discouraged or forego medical applications altogether, reducing the FAA Medical certification workload and consequently liability even further....

I was under the impression that federal employees were protected from liability for actions in the performance of their duties.

 

[redbaron]

I was under the impression that federal employees were protected from liability for actions in the performance of their duties.

Not liability in the sense of a member of the public having standing to sue the agency, but liability in terms of exposure to backlash from congress and the public. The specter of Germanwings continues to haunt aviation medical regulatory agencies around the world, and the FAA is no exception. Their congressional mandate is to protect the safety of the flying public, not to protect the rights or due process of individual airmen. Every GS-grade administrator and medical officer in the entire agency has top cover for restricting or denying medical certification if it results in even the smallest reduction in likelihood that someone will plow an airliner with 150 innocent people into a mountain. Having to answer to congress or the public, God forbid an event like that were to occur again, is the stuff of nightmares for career minded aspiring SES/future cabinet level leaders.

This mindset is applied broadly to any mental health cases presented to CAMI because of the overall poor understanding of etiology, prognosis, and treatment of various maladies withing the field of psychiatry today. Psychiatry is now roughly equivalent to where medicine was in the 1940s, lots of guesses about how to treat a patient in general but very minimal comprehension of the underlying mechanisms of disease. Because of that we can see an extreme difference in how the FAA treats physiological disorders and psychiatric disorders. The agency has greatly expanded the number of reasonable avenues for issuance with AASIs and CACI work flows for conditions such as kidney stones, various cancers et. Whereas they will not delegate the risk of approval for mental health conditions beyond the purview of 1 or 2 psychiatrists at HQ in DC for Class 1-3 medicals.

 

[HIMSpilot]

LOL. I think the FAA needs to realize that individuals that want to fly have a passion and the majority of us have actually done something correct to be in a position to fly.

Thank you!

 

[Al1606]

Does anyone know if you can be released from an SI to an unrestricted medical?

 

[bbchien]

Generally, after five years since the first date of SI auth. But there are some execeptions. And drug/alchol isuances for substance depenency are forever in some way/shape or form.

 

[dbahn]

Does anyone know if you can be released from an SI to an unrestricted medical?

Generally, after five years since the first date of SI auth. But there are some execeptions. And drug/alchol isuances for substance depenency are forever in some way/shape or form.

They are effectively eliminating pilots from the active pilot pool by making it too expensive in time and money to continue with the authorization. It's a shame, because all of those "eliminated" people are still perfectly legal to drive cars on public highways, buy and own an unlimited number of guns, handle explosives, and perform many other public endangering activities without anything resembling the amount of oversight the FAA puts on pilots.

Personally, I wouldn't worry about the pilot that got the initial $pecial I$$uance who then bailed out of the process because of expense. It can cost a fortune to obtain that in the first place. Why not at least let those people go to Basic Med?

 

[Half Fast]

Why not at least let those people go to Basic Med?

Uh, who says they can't?

 

[dbahn]

Uh, who says they can't?

Because, as I understand it, if you don't continuously meet the requirements on a HIMS SI your SI is denied, rather than expired.

 

[bbchien]

You serve the terms of your HIMS SI auth through the last end date on the certificate, then you do not renw. then you can exercise Basic med. For many this is a good thing, For some, I have some concerns....

 

[Brad Z]

Because, as I understand it, if you don't continuously meet the requirements on a HIMS SI your SI is denied, rather than expired.

There is an off-ramp when the certificate issued expires. Otherwise you'd never be able to transition to BasicMed, which was not Congress's intention. Whether that's a good idea for certain mental health conditions is a different question. 61.53 always applies. FAA's clarification:

https://www.faa.gov/sites/faa.gov/files/faa_migrate/interps/2018/Domingo-AFX-1-2_2018_Legal_Interpretation.pdf

 

[Half Fast]

Because, as I understand it, if you don't continuously meet the requirements on a HIMS SI your SI is denied, rather than expired.

Only until the “Not Valid After” date on your medical expires. The FAA can’t revoke an expired medical so you’re free to go Basic Med and forget about SI compliance.

That may or may not be wise, but it’s legal.