I post the following complete psychiatric exam for this forum as I am not sure many have seen a complete 'HIMS' - level report before. This case was successful. And this airman had been in actual blood and lead combat! The format is typical to 'erase' other mental health issues such as ADHD, depression, drugs and alcohol, anger etc. Records were difficult to obtain. Two extensions were necessary. HIMS Psychiatrists, IMHO, earn their pay. I have deleted personal ID's etc... Does this negate his being paid disability by the VA? No. But now the FAA is satisfied, the VA still wanders in the darkness but the airman is very happy and young enough to launch a 2nd career flying helicopters. He was willing to give up his PTSD VA disability ... as he did not think that his combat exposure was a disabling!
As an aside, I recently erased an erroneous diagnosis of sleep apnea that was assigned by the VA. Did not require a psychiatrist. I wish it had ... it would have been easier!
deToqueville said of America 150 years ago: ~when that country fails, it will be because of bureaucracy!
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XXX, M.D., FAA & FAA-HIMS Certified, Diplomate, American Board of Psychiatry & Neurology / American Society of Addiction Medicine
FAA PSYCHIATRIC EVALUATION
XXXX is a forty-eight year old Caucasian male helicopter pilot who presents for an FAA Psychiatric Evaluation on referral from Dr. Louis Fowler, his HIMS AME. He states he is here today because, “I have a history of mild PTSD that the FAA would like evaluated".
Airman X reports he was active in the Air Force for twenty-two years from 1990 until retiring in 2012. He was not a pilot in the Air
Airman X reports among other duties in the military, he was in Iraq in 2003 and 2004. In addition, he reports he was a squadron commander for maintenance personnel between 2010 and 2012. He says this job was very stressful having to deal with personnel and difficult situations”. He says this triggered his previously undiagnosed PTSD symptomatology. He gave the example of dealing with people with severe PTSD and Borderline Personality Disorder who "threatened to shoot up the place" while he was squadron commander. He reports these stressors triggered his PTSD symptoms from 2003 and in particular 2004. Additional stressors, in addition to being the squadron commander as previously described, were numerous losses he experienced in 2012. He reports a friend of his committed suicide in front of his wife. Also, one of his subordinates that he fired eight months earlier died with his family in a motor vehicle accident returning from a job interview. He reports also an uncle died from liver cancer in 2012. He reports these stressors were also factors in his exacerbation of his PTSD symptoms in 2012 and 2013. He reports he was first diagnosed with PTSD in 2012 when he had his exit evaluation from the military. He reports he received an honorable discharge as a Major after serving twenty-two years active duty. He is 90% VA service connected for various health problems with 30% of his service connection being related to his diagnosis of PTSD.
Airman X reports in 2004, while in Iraq, a mortar killed one of his friends while he was laying in bed. He reports as a result, using Predator radio pilot aircraft, they sought to attack and kill the Iraq mortar team that fired the round of mortar. The next day he says they also went and attacked and killed an Iraq rocket team. He reports these events were some of his most difficult to deal with while serving in the military in 2004. He reports his symptoms in 2012 and 2013 included hypervigilance, problems with concentration and a startle reaction. He reports he had excessive anger and had a more difficult time controlling his emotions. He felt detached, isolative and had significant sleep disturbance. In addition, he had headaches, vertigo and tinnitus related to PTSD. As his stress decreased and his PTSD symptoms resolved, so did his headaches, vertigo and tinnitus. He again reports being asymptomatic or relatively so, prior to September 2013. He was mostly symptomatic between December 2013 and December 2014 and reports that he has now been asymptomatic for several years. He reports he will only occasionally have an intrusive thought which he manages quite well. He denies flashbacks, nightmares, hyperarousal or feelings of detachment. He reports his sleep has improved and he sleeps eight hours most nights without difficulty. He reports his anger would lead him to near road rage episodes and also his wife would complain he was lashing out in anger at their son. He reports all of these symptoms have resolved over the last several years. He reports they improved significantly with his individual therapy with Dr. X. He does report that he was shy as a child and some had performance and social anxiety, but these were manageable for him. He denies obsessive-compulsive symptomatology, panic attacks or any other anxiety spectrum symptoms.
Airman X denies a history of substance abuse. He reports he drinks now one to two beers during the week and sometimes a glass of wine. He reports he has never had any alcohol or drug related incidences of any kind at any point in his life. He does report his father was alcoholic. He denies any other family history. He reports he has never had a DUI, blackouts or withdrawal symptomatology. He reports over the last three weeks he estimates he consumed eight beers. He reports a six week period in 2014 when he and his wife were going out with their female pastor and were drinking nightly a glass of wine. He has never experimented with marijuana or any other illicit drugs. He has never been on benzodiazepines, hypnosedatives or stimulants. He has used opiates on one occasion for a couple of days after his fractured leg in 2013.
He has no history of psychosis, bipolar spectrum symptoms, suicidal ideation, hospitalizations. ECT. He has never been on multiple SSRI's and he has never been on a multi agent protocol. His only affective instability was related to his PTSD in the past.
Past Psychiatric History: Airman X reports no counseling, therapy, treatment or evaluations prior to 2013. In 2013, he was evaluated in his exit evaluation at the VA in X and he was diagnosed at that time with mild PTSD and was deemed 30% service connected. In September 2013 through 2015 he began seeing Dr. X in individual therapy. He says he saw her for over twenty visits and also participated in group therapy with her, as well. He reports he worked on his PTSD symptoms and stressors at that time. He reports he has been asymptomatic since, completing that treatment in 2015. He has never been on a psychotropic medication. He reports that when applying for his Medical Certificate, he needed a psychological evaluation, as well as a psychiatric evaluation and he sought his psychological evaluation through the military and saw Dr. X in November 2018. He denies any other history of psychiatric or substance abuse treatment.
Dr. Fowler was contacted regarding Airman X evaluation. He indicated his only information regarding this pilot's PTSD was contained in the Biloxi VA records. He had those, but due to federal rules these needed to be requested from the FAA by me, sent from the VA to the FAA, then to me.
Mental Status Exam: Mental Status Exam reveals a tall and thin male with reddish blonde hair who appears his stated age. He is casually attired. Affect is full. There are no psychomotor changes or tremor. Mood is euthymic. There is no evidence of neurovegetative signs and symptoms of depression or anxiety. There are no PTSD symptoms noted during the interview. There are no auditory, visual or tactile hallucinations. No paranoid ideations or delusions. There is no homicidal or suicidal ideation, past or present. He is alert and oriented times four. Insight is good. Judgement is intact. Impulse control is within normal limits evidenced by his ability to recall past personal information and common knowledge. Intelligence is considered above average estimated by vocabulary and fund of general knowledge.
Diagnosis:
PTSD, moderate with delayed onset, essentially resolved History of Recurrent Headaches, Vertigo and Tinnitus History of Polyarthritis and Radiculopathy S/P Squamous Cell Carcinoma Skin Legion Sjogren's Syndrome, by history History of Mitral Valve Prolapse and Palpitations S/P Varicocele and Fracture Leg and Hardware Removal GAF: 75
Discussion: X is a x-eight year old Caucasian male who served twenty-two years active duty in the Air Force. Although he was not a pilot in the Air Force, he began helicopter flight lessons in 2007. He previously had a Class II Medical Certificate, which he received in 2007 and expired in 2012. He only flew for one year between 2007 and 2008. He then received a Basic Med in 2017 and took additional flight lessons. He decided he wants a career as a helicopter pilot fighting fires or flying life flights. As a result, he decided to apply again for a Class II Medical Certificate, his previous diagnosis of PTSD was noted. The FAA requested this evaluation and he was referred to me for a psychiatric evaluation in my office by his HIMS AME, Dr. Louis Fowler.
Airman X has a history of delayed PTSD. He experienced traumatic events while in Iraq in 2003 and 2004. It was not until 2012, while a squadron commander dealing with stressful personnel issues and numerous losses in his family, that his PTSD symptoms were exacerbated. He is 30% service connected for PTSD. He sought treatment with a therapist, X between September 2013 and early 2015. This consisted of approximately twenty individual and group therapy sessions. He reports he has been asymptomatic since completing that therapy in 2015. He reports his only residual symptoms are occasional intrusive thoughts and a tendency to avoid situations where he may feel triggered. He has managed these symptoms quite well. His flight instructor in 2017 and 2018 indicated that Airman X had no psychological issues that were a factor during their sixty hours of flight training. I find that Airman X PTSD symptoms are mostly resolved and he is managing the residual symptoms well.
X, M.D. FAA HIMS Psychiatrist
