Another “Can I Pass Medical With This Litany of Issues?” Post

[HopefulPilot]

Hello, I am a software engineer in my early thirties living in south Florida seeking any information and assistance that could help me acquire my pilot's license. This topic has already been discussed many times on this forum and others, and I have probably read them all, but I wanted to get some opinions on my own predicament. There seems to be quite the knowledge base here, and I would greatly appreciate any input.

Like many others, I have wanted to fly my entire life and will soon be in a financial position to do so. I would strongly prefer to get my PPL. I want to someday have my own C-182 and be able to fly across the country on a whim without worrying too much about cargo capacity or weather conditions (within reason).

I understand this requires a third class medical certificate, and that I should speak to an AME who can evaluate my case without actually "pulling the trigger". I am aware that my case will probably require the assistance of an expert, and that I should choose my AME wisely.

First, I do not intend to lie to or mislead the FAA about anything. Absolutely zero chance. I like to account for every possible risk factor when making decisions, and I hate gimmicks.

Secondly, I am aware of and have looked into the LSA license. Worst case scenario, this is the route I will take, with the expectation that some heavier aircraft will fall into this class once the FAA finishes whatever they are doing at the end of 2023.

Third, I am aware of the battery of tests I will be required to take. I found an awesome write-up around here somewhere with a list of the tests. I plan on studying and practicing any way I can, along with increasing my exercise regimen to get in tip-top mental condition.

I apologize for the long post. I have recently acquired my entire medical history, and even called afterwards to verify that nothing could be missing. I have tried to organize my background the best that I can:

2000-2001, 10-12 years old (ADHD)
My mother took me to see my pediatrician, because I wasn't turning in assignments during middle school. The pediatrician said I had ADHD and tried to medicate me, but I refused the medication at the time. I knew that I didn't need it, and that I was just lazy about turning in assignments. Since I did well on exams, my teachers always let me progress to the next grade despite typically failing their classes. I went to the same provider from birth to adulthood, and I have all of my medical records. It is not clear to me if I was ever actually tested for ADHD, if I was, no record of it apparently exists.

2002-2007, 13-17 years old (DL Suspension from Speeding, Battery Conviction)
While in high school, I began to feel that my academic performance mattered, and as a result, I obtained pretty good grades - mostly A's and B's and sometimes in classes like AP physics. I was never medicated or seen by a doctor regarding mental health issues during this time period. However, my home life was rough, and I ended up on the streets when I was 16/17. I bought myself a used car for $750 bucks and lived in it. I ended up getting mixed up with some bad people, and I made some really bad choices. I was careless, rebellious, and racked up half a dozen criminal charges in a six month period of time. I ultimately ended up pleading guilty to a felony battery when I was 17 in a plea deal (2006). Additionally, and in the same time period, I got several speeding tickets and my license was suspended for six months. Since this short phase of my life, by any objective measure, I have been an upstanding and productive citizen who contributes to society as much as I can.

2009-2011, 19-20 years old (Anxiety, Depression)
I began waiting tables at a restaurant in order to pay for part-time classes at a community college. Approaching tables made me pretty anxious for a while at first, and during a routine physical I mentioned this to my doctor who prescribed me Zoloft to deal with the anxiety. I took it for maybe a couple of weeks and stopped. At a later appointment in this time period, he prescribed it to me again, but I don't believe I even picked it up from the pharmacy. In my medical file, the doctor noted "anxiety, nervousness, and depression". To be clear, I am not and have never been depressed. By 2012, it was made clear in my medical file that I no longer suffer anxiety of any kind. This is the only time in my medical history I see the term depression and anxiety is never discussed again.

2012-2021, 21-32 years old (ADHD, Adderall)
After studying business at a community college for a few years, I transferred to a university and began studying finance and MIS. After a semester or two, I mentioned to my doctor that I sometimes find myself spacing out during class, and that I was diagnosed with ADHD as a child (I was seeking medication). He put me on Concerta, which I eventually stopped taking, but later on we switched to Adderall, which I have continued to take to this day. I have continued to take it, because my career is pretty intellectually demanding and I wanted to wait until I was in a good place to stop taking the medication (withdrawal involves pretty severe sluggishness). I don't think I need the medication though; I am not even sure I have ADHD. I have always figured that even if the benefits of taking the medication are marginal, I might as well. I have a reasonably high IQ. There are remarks like "no cognitive deficits", "good eye contact", and "good attention span" all over my medical file, and during periods of time where I was doing well in school. The only real deficit in this area I may have, is that sometimes it seems like I have trouble processing sound. I was given an OWL test when I was a child and scored pretty low, like around 70 (100 is average). My actual hearing is fine though, and this has never really inhibited me from doing anything, just something I have noticed.

So is it doable? Any thoughts? AME suggestions? Again, sorry for the long post, and thanks for any advice!

 

[PeterNSteinmetz]

Of course the senior HIMS AMEs mentioned above by AggieMike are the ones you will need to contact and do a consultation with.

My sense also from threads here is that this may well be issuable, depending on current evaluation and testing, but expect needing the full work up costing $5-10k and 6-18 months of work on it.

Perhaps see my medical information page at http://faamed.info, if you have not already done so, for some ideas on how to start your training in the meantime.

 

[PeterNSteinmetz]

Sounds good. Do you know how the SSRI process works? I am having trouble wrapping my head around it. There was a 14 month period of time, where on month 1, I was prescribed an SSRI but discontinued it on my own immediately, and then did not see my doctor again until month 13th, where he put me back on it for the same "condition", and then on month 14 there was a follow up where I said it seemed to be working, but then discontinued it on my own forever. The next appointment after that I clarified that I did not think I need it and that I wasn't really experiencing anxiety. This was about 10 years ago.

From the history here and above, you may be able to go on pathway 1, but I suspect you will be in for the full “P&P”, forensic Psychiatric evaluation and neuro Psychological testing and evaluation.

Start by consulting with a senior HIMS AME. You will also need to have all pertinent medical records sent directly to them. Coordinating all that can take months, so perhaps start the consult now.

 

[PeterNSteinmetz]

We make enough money that we can pretty much do what we want, and this is a worthy cause in my view. Honestly my biggest concern about flying light sport is the potential for significant depreciation of the aircraft when/if the FAA removes the current weight limit in 2023.

My understanding from a person on that committee is - not going to happen anytime soon. The issue is the total kinetic energy in heavier aircraft being a danger to those on the ground.

Never mind that that is apparently a very small risk given that is not what drives insurance premiums. This is the FAA after all.

So I would not let that be a determining factor.

 

[PeterNSteinmetz]

I wonder if they have any data on how many sport pilots have hit people on the ground.

Probably would have to scrape the NTSB database like the author of the prior paper did. Unfortunately he longer had the results of his prior scrape.

 

[PeterNSteinmetz]

But what I gather so far, is that if I was prescribed the SSRI on two different occasions with a 90+ day separation, that this would be considered de facto a "recurrent illness", making pathway 1 a no-go. I need to try and get a list of every prescription over the past 10 years or so to verify if this is the case. But if it is, does that mean my only route would be the "SSRI pathway", which means starting back on the SSRI under the evaluation of a willing HIMS AME, and that after six months if my HIMS AME says that my "condition" is stable, I could potentially receive a special issuance 3rd class medical certificate (no psychosis, suicidal ideation, etc.)?

Yes, if it looks like recurrent illness than you will be on pathway 2 in all likelihood for an SI. Determining if that is true will be the job of the forensic psychiatrist.

Also it would be worse if I had stopped taking the SSRI without the direction of the prescribing doctor, right? Or if that happened in between the two prescriptions, could I use that to demonstrate that it was not a "recurrent disease" but an irresponsible young adult suffering a "one-off disease" (guessing not)?

This will likely be regarded by the FAA aeromedical people as a sign of lack of insight and untreated illness. You will have to convince the forensic psychiatrist otherwise.

Also, I seem to recall Dr. Chien mention some place about the possibility of a "successful life test", which involves demonstrating ten years of no medication and no issues. Could that potentially help me in the event I am stuck going the recurrent disease route? Or is it that recurrent disease has been found to reoccur over long periods of time on average (I read this someplace but didn't save it)?

That means 10 years, no meds and no illness and no signs of it. Documented.

I think it might be best to stop trying to parse this too deeply as much will depend on how exactly the evidence is interpreted by the forensic psychiatrist. The variations in your possible outcomes now are well within the noise of these type of evaluations.

Go consult with the senior HIMS AME and know that in the meantime there is likely a decent chance that with enough money and time you can probably get an SI.

Then I would stop reading and worrying about it and get out and start your flight training in one manner or another. Without a medical you can’t solo a non-LSA. You can start your training for LSAs or gliders without a 3rd class and apply that training to a regular private later when you get your medical. Get out and have some fun!

 

[PeterNSteinmetz]

What would be the consequences of the FAA regarding my actions (stopping the medication on my own) as a lack of insight and untreated illness? Could that support the argument that the multiple prescriptions (if 90+ days apart) were to treat a "on-off" instead of a "recurrent" condition?

Also do you handle this stuff in some capacity professionally? Just wondering. Thanks!

It just means that the forensic psychiatrist is going to have to opine on all of this. You and I cannot really predict here how that is going to turn out with any degree of accuracy. Once you consult with the AME and have the forensic psych exam, you will know more.

I understand the anxiety about getting a medical, but I seriously do suggest that in the meantime, just get out and train. Spend your time studying the Pilot’s Handbook of Aeronautical Knowledge or Kershner’s book or study a video program. You’ll be making progress toward your certificate and likely have more fun and be happier.

I am a research neurologist with a strong interest in aeromedical issues but am not an AME and just fly as a hobby.

 

[PeterNSteinmetz]

… so I am probably going to keep putting in work until I accomplish this. I will definitely look into those books you mentioned though. Thanks. I thought about trying out flight simulators as well. Is this something you recommend?

I think that with persistence and effort you will be successful - good job.

For primary flight training I do not recommend flight simulators as they don’t teach the feel of the plane and can lead to an over-focus on the instruments. They are fun and probably provide some familiarity with the process if you have not been in small planes. There was actually a recent thread that discussed this at length - Microsoft Flight Simmer takes a real flight lesson
https://r.tapatalk.com/shareLink/to...t-lesson.131202/&share_type=t&link_source=app

The Airplane Flying Handbook and the Pilot’s Handbook of Aeronautical Knowledge can be downloaded for free from the FAA website. Perhaps a bit dry. The Gold Seal online course has a free trial IIRC. There are lots of free resources to get started with. Have fun with them!

And if you can find a local glider club, they usually welcome new members with open arms and will give you some introductory flights. http://www.ssa.org. Also if you tell people here where you live, either on this or a different account if you want to be more anonymous, many local members will offer you a local flight.

 

[PeterNSteinmetz]

I meant to follow up with you about this. Are you saying there is a good chance the weight limit will not be increased 2023?

The most recent information I could find was this: https://generalaviationnews.com/2021/08/05/major-course-change-for-faa-on-lsa-update/

That is my understanding from a member who sits on the committee looking at this, yes. However, that report predates this more recent reported meeting.

Whenever it involves the FAA changing a regulation, you can count on a long time. I would not hold my breath.

 

[PeterNSteinmetz]

Actually, wouldn't it make sense for the OP to start a sport pilot license (no medical) and actually get going on training before he takes on a potential 2 year process to navigate the medical stuff for private?

I think that is what people have been suggesting.