Are you trying to get a FAA medical certificate with ADHD? You aren’t alone. In our experience, ADHD is one of the most common reasons why an Aviation Medical Examiner would defer a medical certificate application to the FAA for further evaluation. In our practice, it has been our concern that the threshold for being diagnosed with ADHD as a child or even as an adult has been fairly low. To underscore that point, the Centers for Disease Control and Prevention has produced data showing that an estimated number of children aged between 3 and 17 having ever been diagnosed with ADHD is 6 million! The problem with this from a FAA medical certification perspective is that even if an applicant was diagnosed with ADHD as a child, the applicant must report that diagnosis to the FAA on his or her application for airman medical certification. Fortunately, having a history of ADHD does not have to end your flying endeavors.
Currently, the process for obtaining a FAA medical certificate with ADHD can be broken down into two tracks or thought processes:
- FAA ADHD Fast Track: if you are an applicant meeting very specific criteria, you can avoid deferral to the FAA by the AME if you undertake specific preparations prior to submitting your application. These preparations would include gathering your records, undertaking an abbreviated evaluation with a psychologist or neuropsychologist, as well as preparing additional, specific documents for review by the AME. You can learn more about the FAA’s ADHD Fast Track in our previous blog on the subject.
- FAA Standard Track: if you fall outside of the FAA’s ADHD Fast Track criteria, you will require what the FAA calls the “standard track.” Most applicants that we encounter fall within this category. Most commonly, applicants fall into this category because they have either recently used or are using medication to treat ADHD or the applicant has a history of additional mental health diagnoses. Under this track, however, the FAA will require the airman to undertake a complete battery of neuropsychological testing with a HIMS-trained neuropsychologist.
Most applicants that our firm encounters can achieve FAA medical certification with ADHD if they follow one of the above-referenced tracks. But what happens if you fail to be successful with initial interview under the Fast Track or initial testing with the evaluating neuropsychologist under the standard track? In the event you perform inadequately during an examination with the neuropsychologist (in either track), you always have the option to undertake additional testing. Specifically, the FAA offers a supplemental battery of testing for individuals whose initial testing demonstrates aeromedically significant concerns. Notwithstanding, our firm has encountered airmen who have undertaken neuropsychological testing multiple times, only to ultimately demonstrate that the applicant’s cognitive abilities are not aeromedically deficient.
The takeaway? Neuropsychologist testing for FAA medical certification is not a “one and done” ordeal. There are usually multiple opportunities for further examination and investigation in order to establish eligibility for airman medical certification.
If you are trying to get a FAA medical certificate with ADHD, we recommend you consider the following:
- You must discontinue treatment with ADHD medication (such as Adderall, Ritalin, Vyvanse, Focalin) and remain stable for 90 days prior to undertaking neuropsychological evaluation. It is important that you consult with your treating physician prior to discontinuing medication and that your treating physician document the date upon which you discontinued treatment. Documentation from your treating physician stating how you are doing following discontinuation of medication can aid the neuropsychologist in formulating an opinion regarding your current function and risk to aviation safety.
- You must understand what is contained within your medical records. Time and time again, airmen will contact our firm not understanding that the FAA will want to review a complete copy of your treating physician’s records relative to your ADHD history. Even if you perform flawlessly on neuropsychological testing or if you are issued a certificate under the FAA’s ADHD Fast Track, the FAA will still want to review your medical records. Oftentimes, an applicant’s medical records contain additional information which may be significant to the FAA. For example, we frequently find that treatment records may contain information about additional diagnoses or information about social history (such as alcohol or drug use) which might be concerning to the FAA. Obtaining and reviewing a copy of your medical records before applying for an airman medical certificate can give you sufficient lead time to address any concerns which may be in your medical records.
- You must understand that just like every licensed pilot is not the best pilot, every neuropsychologist may not be the best neuropsychologist. Just because there may be a HIMS evaluator close to where you live, doesn’t always mean you should go to that HIMS neuropsychologist. We recommend that before you undertake evaluation with any psychologist or neuropsychologist that you have at least a phone call with the evaluator in order to ensure that you can develop an appropriate rapport and that you are comfortable with the evaluator’s level of experience and understanding of the FAA’s policies and procedures. Learn more about this process here.
- You must start early. Even with the FAA’s ADHD Fast Track, the process takes time. If you or your loved one is trying to obtain a FAA medical certificate by a certain date or time period, you must start on obtaining the FAA medical certificate as soon as possible.
- You should consider taking a few flight lessons before undertaking neuropsychological testing if you are a student pilot. The reason for doing this is because a letter from a Certified Flight Instructor can go a long way toward assuaging any concerns the neuropsychologist or the FAA may have regarding your performance as a pilot.
- You should always be well rested before undertaking neuropsychological testing.
- Learn more about getting your FAA medical certificate by listening to The Pilot Lawyer Podcast. Learn more about the FAA’s ADHD Fast Track, too!
If you are trying to obtain a FAA medical certificate with ADHD, consider a consultation with a FAA medical defense attorney at The Ison Law Firm before seeing an Aviation Medical Examiner. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.
On August 30, 2023, the FAA published guidelines for what is being called the FAA ADHD Fast Track. The FAA ADHD Fast Track appears to be an effort by the agency to limit the requirement for neuropsychological testing for some applicants with a history of ADHD and treatment with ADHD medication. The scope of these new guidelines are limited to a small population of applicants who have a history of ADHD or have received treatment with ADHD medication. For those eligible for the FAA ADHD Fast Track, those applicants may be able to avoid a battery of neuropsychological testing in order to establish eligibility for a first-, second-, or third- class airman medical certificate. For those note eligible for the program, the standard process for achieving medical certification with a history of ADHD still applies. The eligibility requirements for the new program will be discussed below and is further discussed on The Pilot Lawyer Podcast.
An applicant who wishes to avoid deferral by his or her Aviation Medical Examiner (“AME”) due to a history of ADHD may be able to take advantage of the FAA ADHD Fast Track if he or she meets certain criteria. More specifically, an AME will only be able to issue a medical certificate under these guidelines if an applicant presents for examination with the following history:
- The applicant has had NO treatment or use of ADHD medication (for any reason) within the past four (4) years;
- The applicant has had NO ADHD symptoms in the past four (4) years;
- The applicant has had NO instability in academic, occupational, or social functioning within the last four (4) years;
- The applicant has had NO other psychiatric condition(s) or diagnosis (current or historical).
In the event the applicant meets these criteria, the AME must also review the following:
- Records in accordance with FAA guidelines;
- FAA ADHD Summary completed by a doctoral level (PhD or PsyD) licensed psychologist or neuropsychologist with training and experience in the evaluation of ADHD; and,
- Clinical summary report from the evaluating psychologist or neuropsychologist.
In the event the AME finds the applicant meets the criteria presented above, the AME reviews the documentation required under the guidelines, and the applicant is found to be otherwise qualified, the AME may issue the applicant a medical certificate. All of the documentation reviewed by the AME will then be forwarded to the FAA, despite issuance of a certificate to the airman, for review by the FAA. In the event the applicant does not meet the criteria above, the AME is required to defer the application to the FAA for further consideration and neuropsychological evaluation.
The individual steps pursuant the FAA ADHD Fast Track guidelines are still a bit involved and will require a good deal of understanding and workup on behalf of the applicant in order to be successful. As such, we will discuss each requirement, below, in turn.
No Treatment or Use of ADHD Medication Within Four (4) Years
This requirement appears fairly straightforward. If an applicant has not used ADHD or undertaken treatment for ADHD within the past four (4) years, the applicant would meet this threshold requirement. Open for interpretation is what the FAA means by “treatment.” As time goes on, it is possible that “talk therapy” or treatments to not include medication could be considered “treatment” for ADHD and thus, disqualifying for the guidelines. Furthermore, even if you do not use your medication consistently, but still have a prescription for an ADHD medication, you will likely be considered to have used ADHD medication within the last four (4) years.
No Symptoms of ADHD Within Four (4) Years
This requirement also appears somewhat straightforward; however, what remains unclear is if this is to include only documented symptoms or also symptoms reported only by the applicant. Furthermore, it remains to be seen how the FAA will handle situations wherein the applicant may report symptoms which have not been documented by his or her physician but cannot remember if the symptoms occurred within or outside four (4) years. Furthermore, the definition of an ADHD symptom could lend itself to some level of subjectivity.
No Academic, Occupational, or Social Instability Within Four (4) Years
Perhaps the most subjective of the requirements is that the applicant must have had no academic, occupational, or social instability within the past four (4) years. At issue is the definition of academic instability, occupational instability, and social instability. What is the threshold that an AME will consider when rendering his or her decision when assessing instability? For example, will the AME consider an applicant’s GPA in school? If so, what will be the threshold GPA for instability? If an applicant received a bad work performance report or moved between a few jobs, will that be considered occupational instability? Social instability, likewise, is open for vast interpretation.
No Other Psychiatric Diagnosis or Conditions (EVER)
In our practice, it is rare to see an individual who only has a diagnosis of ADD or ADHD. Most times, we will see ADHD accompany other diagnoses such as anxiety, depression, Aspergers, Autism, etc. Our recommendation would be for all applicants to carefully review their records to ensure that their treating providers have never diagnosed the applicant with any other psychiatric conditions. Note that this requirement seemingly has a lifetime lookback and is not limited to the past four (4) years. As an example, it an applicant is 30-years old and has had a brief history of ADHD in kindergarten, but later had an episode of depression, the FAA ADHD Fast Track will not be available that applicant.
Assuming an applicant can meet the criteria to be eligible for the FAA ADHD Fast Track, the procedural steps to then avoid deferral appear to be a bit involved. Specifically, the applicant must carefully gather records and undergo evaluation within 90 days of presenting for an exam with the AME. Those procedural steps are discussed in more detail, below.
Records in Accordance with FAA Guidelines
An applicant’s first step in the process should be gathering all medical records. This goes beyond a simple request for medical records to a primary care provider. Instead, the FAA has identified a very specific list of documents which must be procured. Those records are as follows:
- Pharmacy records within the last four (4) years
- Medical records related to the diagnosis and treatment for ADHD;
- Any other evaluations or treatment records related to ADHD or learning issues from any of the following, if applicable: Psychiatrist; Psychologist; Therapist; School counselor; Education specialist/teacher; Speech Therapist; and/or Occupational Therapist;
- Medical records related to any other condition (for a non-ADHD diagnosis) which was treated with ADHD medication(s);
- Driver’s license records from all states where a license has been issued within the past four (4) years, as applicable;
- Academic records: All transcripts through highest grade or degree, Section 504 Plans, and any Individualized Education Programs (IEP); and,
- Personal Statement which describes all items on the FAA ADHD Personal Statement Guideline.
It is worth noting that each and every document provided to the evaluating psychologist, AME, and ultimately, to the FAA, should be carefully scrutinized. An applicant should make sure that there is no information in the records which could otherwise sabotage the airman medical certification process. In that, an applicant should ensure that any complicating medical factors presented in the records do not prohibit medical certification. If there is such a complicating factor, that issue should be addressed, in addition to ADHD, for presentation to the AME.
A special note with respect to the personal statement required by the FAA: be honest. An applicant must ensure that the personal statement is consistent with the applicant’s history and medical records. Failing to provide an honest and accurate statement may very well subject an applicant to enforcement action by the FAA. See 14 C.F.R. § 67.403.
Evaluation by Licensed Psychologist or Neuropsychologist with Training and Experience in the Evaluation of ADHD
Perhaps the only benefit of the FAA ADHD Fast Track is that if an applicant meets the criteria mentioned above, then the applicant will not have to undertake neuropsychological testing with a HIMS-trained neuropsychologist. This means that an applicant might even be able to avoid taking a CogScreen-AE. Nevertheless, even if an applicant meets the criteria for the FAA ADHD Fast Track, then there must still be a mental health evaluation conducted by a licensed psychologist or neuropsychologist with training and experience in the evaluation of ADHD.
First, with respect to the credentials of the evaluator, the FAA does not explicitly require that the licensed psychologist or neuropsychologist be HIMS-trained, as has been the requirement before these guidelines were published. Instead, the FAA notes that the evaluator must be trained and experienced in the evaluation of ADHD. The word “experienced” allows some room for interpretation. Unfortunately, especially in cases where eligibility for certification might appear equivocal, it is possible that the credentials of the evaluating psychologist or neuropsychologist may be a deciding factor. To that end, the FAA appears to strongly suggest that applicants utilize an evaluator with an understanding of aerospace medicine. While this still does not require an evaluation to be conducted by a HIMS provider, it seems obvious that these evaluations would be best suited for HIMS-trained providers in order to avoid pushback from the FAA. Fortunately, however, these evaluations can be conducted virtually, which may open a wider array of evaluators to applicants who may not have qualified practitioners in their community.
It would seem that the mental health evaluation leaves room for potential failure by the applicant. In that, the licensed psychologist or neuropsychologist is required to evaluate the items referenced on the FAA Fast Track – FAA ADHD Evaluation Report Requirements. Following such an evaluation, a detailed clinical report as to the practitioner’s findings must be submitted to both the AME and FAA. It is possible that if such a report is not generated appropriately or equivocates as to any material fact, the applicant could be subjected to deferral or further neuropsychological testing.
Ultimately, while time may be the best test for the FAA’s ADHD Fast Track, it would appear that these guidelines will only be useful to a very small population of applicants. Nevertheless, built into the guidelines appears to be an extent of subjectivity, which could otherwise impede an otherwise qualified applicant from taking advantage of these new processes.
If you are trying to get your FAA medical through the FAA ADHD Fast Track call the FAA attorneys at The Ison Law Firm. We are happy to evaluate your case and discuss with you a plan for presenting your case to your AME or the FAA. Aviation law is all we do. Nothing else.