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.

 

[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.

 

[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).

 

[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.

 

[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?

 

[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.

 

[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.

 

[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.

 

[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.

 

[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.

 

[PeterNSteinmetz]

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

Can you see how this is not necessarily always black and white? Health issues come in a wide variety of severities right?

Say your arm is a bit sore from a vigorous game of volleyball two days ago. Does that mean you shouldn’t fly?

What about you are now still feeling a little sore from a cold you had two weeks ago?

Some conditions are obviously dangerous to fly with, e.g. being on major anti-psychotics. Others are obviously safe to fly with. But a very large number live on a subtle boundary in between.

It is precisely these where a coercive regulatory agency is likely to act in an overly conservative manner. That may seem like the safe thing to do and “better safe than sorry”. However, the fact that it is coercive may create unintended consequences which actually DECREASE overall safety.

It is very tempting cognitively to ignore these effects because they are unintended and often somewhat less visible. But it is not good public policy.

 

[PeterNSteinmetz]

Whenever we let “the market decide,” the end is inevitable disaster.

A large body of literature on that subject obviously. What data do you base that conclusion on which pertains to aviation? (I don’t want to get in trouble for going off on pure politics).

Aviation in this country has been heavily regulated for nearly 100 years. Until 1978 we had the prices and routes for airlines assigned by a government board!

 

[PeterNSteinmetz]

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.

Do you have data or a citation for that? I am quite curious.

It may be that medical incapacity endangering flight is very rare, but it strikes me that may be due to two pilots in the cockpit. Alternately it may be due to the carriers own rules regarding fitness for duty, rather than the FAA’s aeromedical regulations.

It seems that data on this may be available. Certainly we heard many anecdotal stories about the commercial pilot who has a heart attack during a flight, and the other pilot has to take over.

 

[PeterNSteinmetz]

Because you never support it with anything but your own opinion and your own interpretation of numbers from which no conclusion can be drawn.

As to the numbers, that is incorrect. The data from the sport pilot are a small sample size, yet it does not indicate that the regulations improve the safety of flight in any statistically significant way.

One can discuss the power of that dataset to detect a change of a certain magnitude. However, it is incorrect to say “no conclusion can be drawn”. It is valid to say that those data are not terribly strong, I would agree there.

To be objective, they must be weighed appropriately against the other evidence. I find the evidence in favor of the hypothesis that FAA aeromedical regulation improves the safety of flight to be quite weak. It consists almost solely of the fact that we've had those regulations and our commercial safety record is good. Technically that is a form of the post hoc, ergo propter hoc fallacy. As I have noted many times, we have not seen evoked here any good study or data that this hypothesis is true.

 

[PeterNSteinmetz]

You just keep citing “all the evidence”.

Those statements have to do with the large body of literature having to do with the unintended side effects of regulation, the effects of regulatory capture, and the typical behaviors of regulatory agencies. Are you familiar with that literature?

I assume these are fairly well known to people who argue strongly for the positive need for regulations in public fora, but I may be mistaken.

Would you like me to provide you with some pointers?

 

[PeterNSteinmetz]

You’re the one who needs to support your opinion.

Let's review the context here with regard to the facts which have been provided and what constitutes opinion. You wrote:

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.

That is a direct assertion of a fact that commercial pilots who have a FAA issued medical have almost unheard of medical incapacities.

I then asked what data there was to support that.

Do you have data or a citation for that? I am quite curious.

I don't believe there has been any data provided here to support this assertion about the rate of medical incapacities, but please correct me if I am mistaken.

But perhaps the post making that assertion was a subjective impression based on limited anecdotal experience and thus sort of an opinion? (For reference, here is a definition o·pin·ion noun 1. a view or judgment formed about something, not necessarily based on fact or knowledge.)