SSRI Deferral/Round 2 Application for Class 3 Medical

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UTLonghorn_1979

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UTLonghorn_1979
Hi,

I got on zoloft back in 2020, coming out of Covid, for stress/anxiety related to the presentation and "public" speaking demands of my job. Prior to being prescribed zoloft I was self medicating with alcohol in the evenings, which admittedly was a habit that got worse during lockdown. I did a HIMS round for the SSRI seeking special issuance, which was denied, I assume, after the treating physician's report showed history of alcohol "dependence," general anxiety and panic disorder. The FAA said they would reevaluate upon additional requirements (i.e. more evaluations, alcohol/drug tests, IOP treatment, etc).


During the deferment process I actually self admitted myself to an IOP treatment for alcohol, which FAA said I needed to do this go around, and was sober for 6 months. All this transpired while in the 15+ months process of doing the HIMS/SSRI deferral.

I've since quit the job that was causing so much stress, but I did have a relapse in January and have been on and off of sobriety for the past 6 months - I'm a week and a half into sobriety this time. I met with my AME again and I'm going through the steps requested of the FAA, most of which I've already done other than the mandatory alcohol/drug testing (first random test was today), but I'm wondering:

1. Will this be another 1-2 year process (I'm 44 now) or quicker since it's has already been reviewed once for the SSRI, and
2. Since I'm not longer exposed to the situational/job related anxiety trigger, is it better to get off of the zoloft and start the 60 day window or just stay on it?

It's so disheartening dealing with this when I know I'm a very safe pilot, I already had 200 hours prior to being prescribed zoloft, and gained another ~ 200 hours between 2022 and now, flying with various instructors while working towards my IFR. My medical lapsed and I needed to get current for the IFR check ride, but now I'm over a year past taking the IFR written (got a 97 grade) and that test will likely be expired by the time this is all sorted out.

Thanks in advance for any guidance/feedback.
 
It's disheartening that you relapsed. Unfortuantely, FAA view is going to be you need rehab. AGAIN....or a very long period of monitored (urine) sobriety, AND stepwork. Why? You're a dual diagnosis candidate.

And your moniting will be more "dense" than normal (translation: $$s). Huge mountain to climb here (wish I could be more encouraging); This is not for the faint of determination.
 
bbchien said:
It's disheartening that you relapsed. Unfortuantely, FAA view is going to be you need rehab. AGAIN....or a very long period of monitored (urine) sobriety, AND stepwork. Why? You're a dual diagnosis candidate.

And your moniting will be more "dense" than normal (translation: $$s). Huge mountain to climb here (wish I could be more encouraging); This is not for the faint of determination.
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Insurmountable in your opinion?

"Relapse" makes it sounds like day drinking all day, everyday. That wasn't the case for me, I just drank more than I wanted to during the evenings, I recognized it was unhealthy and self admitted myself, no legal issues or otherwise causing this. I know plenty of pilots that drink a lot or more than they should, or I would consider not of the greatest judgement...unfortunately honesty gets you in more trouble than it's worth. I even had an instructor tell me "I don't tell the FAA or my AME sh*t." No good deed goes unpunished, as they say.

I've already started addressing the items the FAA laid out in the denial letter. I'm committed to proving I'm a qualified, sound and fit pilot, at least for special issuance.

What about the getting off of the SSRI question? I've removed the situational stressor from my life. I was fine prior to the work stressor, I should be fine with it no longer in my life. Obviously I need the treating physician to determine that, but from a procedural standpoint with the FAA, is it better to stay on the meds, or get off over the 60 days, address the alcohol portion of the requirements, and then seek my medical free of the meds and clean from alcohol?

Thanks again for your feedback!
 
wellknow said:
But how safe a pilot could u be as an active alcoholic?
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As safe, or safer, as the next person that wouldn't define themselves as an alcoholic, but who still drinks and adheres to the FAA regulations regarding such. I'd bet my decision making and judgement as a pilot is better than a large % of pilots that have never drank/abstain.

"Active alcoholic" is redundant, but would you argue that someone that has been sober for 6 months, a year, 10 years is unsafe because they are an alcoholic? There are spectrums of alcohol abuse...did I use alcohol in an unhealthy way (as if there is really a healthy way) to cope with work stresses, yes. But was I dependent upon it, or did it cause me legal woes, job woes, etc...the answer to these is no.

In any event, if the FAA says I need to not drink to get and keep my medical, I'll do that. I know what I need to do on this front, I'm more interested in the SSRI item at this point.
 
Ever heard of the sitting president's only remaining son, and what the jury thought?
His defense was "well, I was just out of rehab and I didn't use that day"...Jury thought otherwise.

The judgement of an alcoholic.....well, includes the determination as to "whether or not I'm alcoholic" and it is very common for the person in question, to "get it wrong".
 
bbchien said:
Ever heard of the sitting president's only remaining son, and what the jury thought?
His defense was "well, I was just out of rehab and I didn't use that day"...Jury thought otherwise.

The judgement of an alcoholic.....well, includes the determination as to "whether or not I'm alcoholic" and it is very common for the person in question, to "get it wrong".
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I thought Hunter was a crack/cocaine addict? So alcoholics, who previously consumed a legal intoxicant and one that the FAA otherwise allows pilots to consume within guidelines, are on par with people actively doing illicit drugs and lying on federal firearms forms? Damn, I didn't realize alcohol was such a stigma in the flying community.

So no amount of sobriety, evidence of recovery will ever satisfy the FAA? I'm confused on the feedback I'm getting here. If I'm just peeing in the wind and spending $ for no reason, I'd prefer to have that feedback now vs. invest that $ to only end up frustrated.

Can I please get some feedback on the SSRI question? Staying on it or getting off of it at the physicians recommendation/approval and how the FAA interprets that?

Thanks again in advance!
 
UTLonghorn_1979 said:
I recognized it was unhealthy and self admitted myself, no legal issues or otherwise causing this.
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I'm not judging you, but if I read your history correctly, you were already deferred and being monitored for the HIMS program when you relapsed (your word). How would you characterize being deferred for your medical if not "legal issues or otherwise"? After being deferred, and knowing that abstinence was what it would take to get your medical, you have been unable to maintain your sobriety for more than a week and a half. That seems to me like drinking despite significant negative consequences. If that's not alcoholism, then I guess it's just exceptionally bad judgment. As I said, I'm not judging, and I consider myself blessed that I don't have this particular disease, but your posts reek of denial. And that denial will kill any chance of getting a medical.
 
Lindberg said:
I'm not judging you, but if I read your history correctly, you were already deferred and being monitored for the HIMS program when you relapsed (your word). How would you characterize being deferred for your medical if not "legal issues or otherwise"? After being deferred, and knowing that abstinence was what it would take to get your medical, you have been unable to maintain your sobriety for more than a week and a half. That seems to me like drinking despite significant negative consequences. If that's not alcoholism, then I guess it's just exceptionally bad judgment. As I said, I'm not judging, and I consider myself blessed that I don't have this particular disease, but your posts reek of denial. And that denial will kill any chance of getting a medical.
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Hi Lindberg, thanks for the note. You're incorrect in the reading of the history. My HIMS deferral was solely for SSRI use related to work related stress/anxiety, NOT for any alcohol or substance abuse. The full AME report for SSRI deferral was sent to FAA in May of 2023. I subsequently checked myself into an IOP program as I knew my use of alcohol was becoming unhealthy/not what I wanted. This was in June of 2023. I graduated from the program in August of 2023 and was sober until January of 2024. The FAA is not aware that I already did an IOP program and graduated, that was subsequent to the initial deferral (SSRI). The denial was issued upon reports from the treating SSRI physician that I had a history of alcohol abuse. Thus the FAA is now addressing the alcohol history and making sure that the SSRI is still working effectively.

I am back in sobriety, I have been since the FAA said this was a requisite to reconsideration. I'm committed to this process...if staying sober gets me flying, and wanting to keep flying keeps me sober, it's a win/win.

Any feedback on the SSRI? :)
 
If the faa or your ame are aware of the on and off again drinking since January you’re probably looking at another 3 years till you have a medical in your hand. If they were not made aware of that I’d probably say 12-18 months. As far as the ssri I’m going to probably say the faa will want you on the meds
 
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UTLonghorn_1979 said:
Hi Lindberg, thanks for the note. You're incorrect in the reading of the history. My HIMS deferral was solely for SSRI use related to work related stress/anxiety, NOT for any alcohol or substance abuse. The full AME report for SSRI deferral was sent to FAA in May of 2023. I subsequently checked myself into an IOP program as I knew my use of alcohol was becoming unhealthy/not what I wanted. This was in June of 2023. I graduated from the program in August of 2023 and was sober until January of 2024. The FAA is not aware that I already did an IOP program and graduated, that was subsequent to the initial deferral (SSRI). The denial was issued upon reports from the treating SSRI physician that I had a history of alcohol abuse. Thus the FAA is now addressing the alcohol history and making sure that the SSRI is still working effectively.

I am back in sobriety, I have been since the FAA said this was a requisite to reconsideration. I'm committed to this process...if staying sober gets me flying, and wanting to keep flying keeps me sober, it's a win/win.

Any feedback on the SSRI? :)
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So your treating physician was aware you had a history of alcohol abuse and dependence. Were you not aware of that, or did you disagree with his assessment? Did you report that history on your Medxpress application?
 
George S said:
If the faa or your ame are aware of the on and off again drinking since January you’re probably looking at another 3 years till you have a medical in your hand. If they were not made aware of that I’d probably say 12-18 months. As far as the ssri I’m going to probably say the faa will want you on the meds
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The AME is aware, I've already set up random alcohol/drug tests, had first one yesterday, and I'm meeting with him every month for at least the next 3-6 months. Thanks for the feedback!
 
Lindberg said:
So your treating physician was aware you had a history of alcohol abuse and dependence. Were you not aware of that, or did you disagree with his assessment? Did you report that history on your Medxpress application?
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Yes, the treating physician was aware of that, I reported it to them when getting prescribed the SSRI. I agree with the assessment that I was abusing alcohol, no argument there. My question is process going forward since I've already addressed the SSRI aspect, all the specialists I went to showed I was stable and didn't see any issues with being issued SI medical. I'm on the track to sobriety, I have an even bigger motivator in flying being a huge passion. I'm just trying to set expectations for myself and this process.

Thanks!
 
The whole focus is out of whack. What do I need to do to get my pilot’s license versus I have a serious, deadly disease that will kill me. What do I need to do to save my life
 
If you were flying for an airline you’d be back in the cockpit in 12 months. But for some reason when you’re not flying hundreds of people the faa is less lenient in getting your medical back. You’d think it would be the other way around but the faa is full of corrupt, dishonest and lazy bureaucrats who pretend to be doctors.
 
George S said:
If you were flying for an airline you’d be back in the cockpit in 12 months. But for some reason when you’re not flying hundreds of people the faa is less lenient in getting your medical back. You’d think it would be the other way around but the faa is full of corrupt, dishonest and lazy bureaucrats who pretend to be doctors.
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Unfortunately, that's the feeling I get. I don't understand why they make you actually meet face to face for evaluations with FAA certified HIMS psychologists, neuropsychologists who have met you and evaluated you in person, concluded they don't see any issues with you getting issued a medical to have it shot down by someone that's never even interacted with you out of D.C. Doesn't help that they are backed up by 12-15 months from an issue of their own making. The irony is thick when they say send us a current HIMS psychologists and neuropsychologists eval along with current report from your treating physician because, surprise surprise, the ones your AME sent us for the deferral from 12 months ago that we're just getting around to reviewing are no longer "current."
 
George S said:
If you were flying for an airline you’d be back in the cockpit in 12 months. But for some reason when you’re not flying hundreds of people the faa is less lenient in getting your medical back. You’d think it would be the other way around but the faa is full of corrupt, dishonest and lazy bureaucrats who pretend to be doctors.
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Quite the irony, isn't it.
 
UTLonghorn, you are now a dual diagnosis candidate. And, Dual diagnosis candidates (Alcohol dependence requiring rehab + On SSRI for recurrent disease) means, you have to complete the full hims regimen for consideration even under the SSRI track:

9 months of proven sobriety (can be as little as six but read on...)
Weekly group aftercare
90 AA meetings logged in 90 days thence two per week
At the end of>6 months of proven sobrfiety, HIMS pscyhiatry eval - Favorable as to alochol reiteratve as ttoe recurrent depresive/anxiety disorder
Favorable neurocognitive evaluation.

You can get there but it'll take some time.....

B
 
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bbchien said:
UTLonghorn, you are now a dual diagnosis candidate. And, Dual diagnosis candidates (Alcohol dependence requiring rehab + On SSRI for recurrent disease) mean you have to complete the full hims First class regimen for consideration even under the SSRI track:

9 months of proven sobriety (can be as leittle as six but read on...
Weekly gorup aftecare
90 Aa meetings logged in 90 days thence two per week
At the end of>6 months of proven sobrfiety, HIMS pscyhiatry eval - Favorable as to alochol reiteratve as ttoe recurrent depresive/anxiety disorder
Favorable neurocognitive evaluation.

You'll get there but it'll take some time.....

B
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Thanks so much! My AME pretty much already directed me down this same path/expectation, but good to hear a second opinion. Now we just need to lobby the sh*t out of Congress to fund more HIMS reviewers or amend their process to allow actual full time professional psychologists and neuropsychologists to evaluate and recommend issuance or declination of medical cert. You'd think this would be a better/more common sense practice considering the private Drs. have medical/professional liability if they aren't thorough/responsible in their assessment vs. the FAA having immunity.
 
robin ardoin said:
Quite the irony, isn't it.
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Robin, in the airline he would be supervised by an educated Chief pilot, a HIMS fully in recovery union peer mentor and they are required to submit reports monthly (to the HIMS AME). That means, if the Captain is a little rough around the edges, the chief steward (via the Chief pilot) will know about it and so will I. There ARE some things we can do in part 121 that we cannot do in part 91.

Same goes for SARP, the USN's pilot recovery program. It's SHORTER and intense, and then the Naval medical officers keep an eye on them. And they really do. A second bust on a medical officer's watch (after upchit) is a FAIL.

So not ironic at all. It would be as if the hospital had an addictionologist who keeps track of the monitored medical and nursing staff, who have had a problem.....There are simply more eyes on the airline guy. MANY MANY more eyes.
 
bbchien said:
Robin, in the airline he would be supervised by an educated Chief pilot, a HIMS fully in recovery union peer mentor and they are required to submit reports monthly (to the HIMS AME). That means, if the Captain is a little rough around the edges, the chief steward (via the Chief pilot) will know about it and so will I. There ARE some things we can do in part 121 that we cannot do in part 91.

Same goes for SARP, the USN's pilot recovery program. It's SHORTER and intense, and then the Naval medical officers keep an eye on them. And they really do. A second bust on a medical officer's watch (after upchit) is a FAIL.

So not ironic at all. It would be as if the hospital had an addictionologist who keeps track of the monitored medical and nursing staff, who have had a problem.....There are simply more eyes on the airline guy. MANY MANY more eyes.
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Thank you for the clarification.
 
UTLonghorn_1979 said:
Thanks so much! My AME pretty much already directed me down this same path/expectation, but good to hear a second opinion. Now we just need to lobby the sh*t out of Congress to fund more HIMS reviewers or amend their process to allow actual full time professional psychologists and neuropsychologists to evaluate and recommend issuance or declination of medical cert. You'd think this would be a better/more common sense practice considering the private Drs. have medical/professional liability if they aren't thorough/responsible in their assessment vs. the FAA having immunity.
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UT, the problem here is that FAA issues you a certificate in ADVANCE of of your PIC activities. they are stringent because they want to have pretty good reassurance that you're in recovery not just sober (which you can break on 3 minute's notice). Their task is DIFFERENT from the local doc's task which is much more "here and now" (not so much 6 months into the future).
 
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It’s all about money. If the airline wants their pilots flying again the faa always obliges. Kind of like how the faa would let Boeing self certify with little oversight. Air travel is an essential part of the economy and the garbage doctors at the faa aren’t interested in safety. They want to keep their jobs so they pretty much rubber stamp the 121 guys and get them back in the air whether they are actually fit to fly or not. I don’t care how much monitoring the airline pilots are under, if an addict/alcoholic is drinking or using and they want to hide they’re going to hide it.

The HIMS program is basically its own self sufficient corrupt economy. HIMS ame, HIMS psychiatrist, HIMS psychologist, treatment center, random drug tests, aftercare counselor. Once all these guys get your money then and only then can you get your medical back.
 
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bbchien said:
UT, the problem here is that FAA issues you a certificate in ADVANCE of of your PIC activities. they are stringent beucase they wenat to have pretty good reassurance that you're in recovery not just sober (whcih you can break on 3 minute's notice). Their task is DIFFERENT from the local doc's task which is much more "here and now" (not so much 6 mos into the future).
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Isn't that the point of a Human Intervention Motivational Study specialist? Wouldn't someone who meets with the individual, has that specialty, and deals with nothing but these cases be more qualified than the people at the FAA? Or are the 3 reviewers and the Federal Air Surgeon experts in substance abuse, mental health, physical health, and all iterations in each field? Sigh...
 
One of the big problems is alcoholics and drug users who don’t commit to sobriety and go through that rigorous process but clog up the faa with applications prior to being anywhere near safe and reliable pilots.
 
wellknow said:
One of the big problems is alcoholics and drug users who don’t commit to sobriety and go through that rigorous process but clog up the faa with applications prior to being anywhere near safe and reliable pilots.
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OR, maybe it's the continuation of a one size fits all approach to a variability of different potential maladies and a spectrum of degrees within those maladies. And maybe we shouldn't be so quick to diagnose or prescribe things that have potential long term consequences and/or create unfair judgment and biases towards other people.
 
UTLonghorn_1979 said:
maybe it's the continuation of a one size fits all approach to a variability of different potential maladies and a spectrum of degrees within those maladies.
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Gray area drinking is a thing. I don't know the numbers on how many gray area drinkers "graduate" to alcoholism, but I bet @bbchien does, and the FAA does.

I'm guessing the trick is keeping the folks in the 9th decile out of the 10th decile...

deciles.png

from
 
wellknow said:
sobriety is binary. u either are sober or not
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But you are assuming everyone who drinks is an alcoholic, everyone who has had a depressive episode is suicidal, everyone who has anxiety is a nervous wreck, and all are incapable of sound decision making or unfit to fly. I'm saying you, and the FAA, are painting too broad a brush, lumping everyone with one of these maladies into the same bucket. Clearly there are degrees within each set and should be addressed accordingly.

The reason the FAA is backlogged is because they are trying to be specialists of everything, while becoming masters of bureaucratic inefficiency. I think we can all agree the system to address deferment situations is broken. Otherwise, tell the AOPA and every other GA lobbying group there's no reason to keep addressing medical certification with the FAA, and move the efforts and funds elsewhere as this is clearly running swimmingly.

I'm addressing my own situation as requested by the FAA. I'm just saying, many of the existing practices don't make sense...especially once the MOSAIC effort is enacted. No medical needed to fly up to 250 kts in a complex aircraft, or medical needed to fly a glider (which can also carry a passenger), and which has absolutely no room for error by definition. Why doesn't the FAA just create a new privilege class that doesn't allow passengers, no medical needed, can only fly in D, E and G airspace and adheres to the current LSA or MOSAIC TBD rules.

Perhaps I'll be limited to part 103 UL operations, that's fine, but that doesn't address the need for reform.
 
GeorgeC said:
Gray area drinking is a thing. I don't know the numbers on how many gray area drinkers "graduate" to alcoholism, but I bet @bbchien does, and the FAA does.

I'm guessing the trick is keeping the folks in the 9th decile out of the 10th decile...

View attachment 130003
from
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Thanks for the note, GeorgeC. I was somewhere between the 9th and 10th at my peak drinking. I didn't want to get into the 10th, which is why I checked myself into IOP. I didn't do this because it was court ordered, or FAA ordered, it was of my own volition. A few people in this chain have stated an alcoholic is so warped they don't realize they have an issue...so where do I or should I stand in the eyes of the FAA? I recognized I had a problem and wanted to address it before/in case it went there. It's definitely a process, but it's not accurate or fair to say that anyone in the 7th - 10th area, and that are also pilots, are more or less likely to fly while drinking or after drinking heavily...I never did.
 
good for u. have u committed to sobriety? do you work a recovery program?
 
Between the 9th and 10th? You definitely have a problem. You also have a bit of a hazzardous attitude. That much booze and relapses? Work the program, play by their rules or go find another sandbox to play in.
 
RadialGal said:
Between the 9th and 10th? You definitely have a problem. You also have a bit of a hazzardous attitude. That much booze and relapses? Work the program, play by their rules or go find another sandbox to play in.
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Please elaborate on "hazardous" attitude. Perhaps you didn't read all that I noted, what I've already done to address my situation...I AM playing by the rules they have established. I wouldn't be on this forum seeking feedback, guidance and, honestly, support as a fellow lover of all things aviation, if I intended otherwise. If I wanted to be like the unquantifiable # of pilots that just fly without a medical, and in some instances even without a PPL, as I so often read about, I'd just be doing that.

I'd venture to guess that there are people on this forum, some that are awfully judgmental, that aren't reporting all potential red flags for the FAA medical issuance. Have sleep apnea? Better report that. On BP meds? Better report that. Every had postpartum depression? Better report that too.

Just wait until your number is called and you'll be singing a different tune, assuming you're being honest in the first place.

I'll play by the FAA's rules, doesn't mean I have to enjoy it. I'm saying that the existing rules, or processes, of proving you're fit to fly don't account for the varying degrees of a certain malady. I'd think we could all agree that the process could be better and more efficient.
 
Very interesting research on pilots not reporting mental health, released in 2023.

2021 study showed 67% of female pilots withheld information about their personal health. Larger sample of both sexes showed 46% did the same.

57% of pilot school students met the criteria for some level of depression and 14% said they though about self harm and suicidal idealization.

Based upon those sample statistics, it appears many on these threads aren’t being honest and judging hypocritically.

 
DJTorrente said:
Did "active alcoholic" come from the same source as your ".01 pct" statistic?
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I don’t understand the people on this forum that lord their unencumbered situation over people having medical situations.

There are people that aren’t willing to address their situation or meet the FAA where they are. That’s a problem.

Then you have people like myself, already with 400 hours flying without incident, even when dealt with inflight issues such as engine or prop issues, or full electrical failure, that are absolutely willing to do what it takes. Doesn’t mean I can’t question the process.

You’d think one pilot to another would understand the defeating feeling of losing your wings after years and hours demonstrating you’re more then capable and fit, and when you don’t believe your individual circumstance merits it. That’s the reasons so many people aren’t being truthful with their AME, they don’t want to be in this position.

Instead many of the responses are akin to tough ****, glad I’m not you. Juvenile.
 
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