FAA Medical Denied Because Of Depression?

  • ON Jan 12, 2022
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because of depression? Fortunately, depression is not a condition which is specifically identified by the Federal Aviation Regulations (14 CFR Part 67) as being a disqualifying medical condition. Instead, however, the FAA has identified depression as a condition which warrants evaluation regarding its aeromedical significance for any given airmen. As is authorized by Part 67 (the body of regulations which speaks to medical certification standards), the Federal Air Surgeon can deny an airman medical certification for a history of a mental condition which either makes the airman unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or may reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. See 14 C.F.R. Sec. 67.107(c), 67.207(c), and 67.307(c). In other words, the Federal Air Surgeon can deny you a medical certificate if your history is significant for depressive symptoms which may manifest in an aeromedically significant fashion.

In our practice, we have found that the FAA’s primary concern when evaluating an individual’s history of depression is whether the individual’s case history suggests a risk for recurrence of symptoms. Typically, this assessment manifests through the FAA doctors’ review of your medical records. As you may be aware, when you report a history of depression on your medical application, the FAA’s first response is usually to request that you send all of your medical records relative to your history of depression for their review. Within that review, the FAA is typically looking at whether you have had multiple recurrences of depressive symptoms, whether you are using a disqualifying medication to treat your depressive symptoms, whether treatment has been successful in the past, and what your risk for recurrence of symptoms may be. If this assessment of your medical records (and current evaluations, if available) renders a risk for recurrence of depressive symptoms, the FAA will typically deny your application.

As with all certification matters, the element of proper presentation of evidence is relevant in cases dealing with depression. The key question is: what can you do to sufficiently satisfy the FAA’s concerns that risk is mitigated in light of your history of depression? Sometimes, the answer is consideration of treatment with a SSRI and seeking a special issuance authorization, or maybe it is appropriate to challenge whether your diagnosis of depression was accurate in the first place. No matter the approach, the FAA needs to see that risk is sufficiently mitigated, despite your medical history.

Why involve a FAA attorney in your FAA medical application? Despite what you may hear from your AME, the medical certification process is more so a legal process than a medical process. As with denials for the use of a disqualifying medication, ensuring that your doctor is developing the proper documentation regarding your discontinuation of the medication, as well as the status of your underlying condition, can be a delicate process. To that end, everything that is submitted to the FAA (i.e. records, statements, evaluations, etc.) goes into your airman medical file. This file is what the FAA then utilizes to evaluate whether you are eligible to hold a medical certificate. If you are later denied and wish to appeal that denial, your airman medical file becomes “Exhibit A” before the NTSB or upon reconsideration by the Federal Air Surgeon. So, a FAA attorney can evaluate your records, prepare a plan for best presentation of your case to the FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal.

Is your FAA medical denied because of depression? 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 for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

 

FAA Medical Denied Because of Coronary Artery Disease?

  • ON Jun 14, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because of coronary artery disease? The Federal Aviation Regulations relevant to standards for airman medical certification are found in Part 67 of the Code of Federal Regulations. Therein, the FAA has identified 15 specific conditions which are disqualifying; other conditions not specifically stated therein may be disqualifying at the Federal Air Surgeon’s discretion. One such specifically disqualifying condition, however, is “coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant.” As you can see, there is some nuance to this regulation, such that your case may be arguable as to whether you have “required treatment” or if your case has been “symptomatic or clinically significant.” What is “treatment?” What are “symptoms?” What is “clinical significance?”

Many times, airmen are denied a medical certificate because of coronary artery disease following treatment with a stent or bypass surgery. The FAA has a protocol for certification following such surgical intervention. The tests associated with that protocol sometimes reveal a discrepancy, however, between what your treating physician feels is medically acceptable risk, versus what the FAA feels is an acceptable risk for the purposes of aviation safety. Oftentimes, in practice, our firm handles cases where a treating physician opted not to treat an occlusion with a stent, but rather treated the occlusion with medication. This less invasive approach may be medically acceptable. The FAA may look at this information, however, and suggest that the level of plaque buildup left behind presents a risk which is not sufficiently mitigated. In those circumstances, for example, the FAA will suggest that that this is “untreated” coronary artery disease which is “clinically significant.” Arguing your physician’s position of sufficiently mitigated risk may be the key to certification.

There are many ways that your arteries may get on the FAA’s radar (i.e. ischemia on a stress test, concerns on an echocardiogram, etc.). The key, however, is first understanding what the FAA’s concerns are (not always a simple task) and then pinpointing an argument as to why any disease is either not “significant” or no longer presenting with symptoms. Reversing a denial because of coronary artery disease (or being issued a special issuance authorization) means methodically going through the data and arguing to the FAA why you do not pose a risk to aviation safety and/or why any risk is appropriately mitigated with medication and observation.

Why involve a FAA attorney in your FAA medical application? Despite what you may hear from your AME, the medical certification process is more so a legal process than a medical process. As you can see with denials for coronary artery disease, presentation of medical data to the FAA for such a condition is a delicate application of fact to law (i.e. why does your situation not meet the level of “clinical significance”)? Furthermore, everything that is submitted to the FAA (i.e. records, statements, evaluations, etc.) goes into your airman medical file. This file is what the FAA then utilizes to evaluate whether you are eligible to hold a medical certificate. If you are later denied and wish to appeal that denial, your airman medical file becomes “Exhibit A” before the NTSB or upon reconsideration by the Federal Air Surgeon. So, a FAA attorney can evaluate your records, prepare a plan for best presentation of your case to the FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal.

Is your FAA medical denied because of coronary artery disease? 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 for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

FAA Medical Denied Because of a Colostomy Bag

  • ON Jun 07, 2021
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  • BY Anthony Ison
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  • IN Pilot Law

Is your FAA medical denied because of a colostomy bag? Having a history of ileostomy or colostomy may not necessarily mean you are ineligible for a Federal Aviation Administration medical certificate. An applicant with an ileostomy or colostomy may receive FAA consideration in some circumstances and qualify for aeromedical certification.

In situations where the airman has a history of colon cancer, the Guide for Aviation Medical Examiners specifically enumerates various situations and stages in which the disease/condition should affect the AME’s decision making process for issuance of a medical certification. For example, if the airman has non metastatic colon cancer and treatment completed five (5) or more years prior, and there has been no recurrence or ongoing treatment, the AME may issue a medical certificate. To that end, if the airman had a pedunculated cancerous polyp (adenocarcinoma) that was removed by colonoscopy less that five (5) years prior to the flight physical, the AME may issue a medical certificate if a status report shows that there was only a local lesion (TNM stage 0 or I), complete resection with no additional treatment needed, follow up is annual or less frequent, and there are no clinical concerns.

The attorneys at The Ison Law Firm are well versed in the Guide for Aviation Medical Examiners, as well as the applicable Federal Aviation Regulations under Part 67. While 14 CFR Part 67 does not specifically speak to airmen with a history of colostomy, the Guide for Aviation Medical Examiners does briefly discuss these matters. For those airmen that have successfully recovered from a history of cancer but require ileostomy or colostomy, the FAA will require a report from the airman’s physician to confirm that the applicant has fully recovered from the surgery and is completely asymptomatic.  Oftentimes, however, the FAA will require additional information on the underlying cause for the airman’s usage of a colostomy bag.

Is your FAA medical denied because of a colostomy bag or the underlying reasons thereof, 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 for consideration by the Federal Air Surgeon. Aviation law is all we do. Nothing else.

Selecting a HIMS AME

  • ON Dec 03, 2020
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  • BY Anthony Ison
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  • IN Pilot Law

Selecting a HIMS AME for your FAA medical certification can be a daunting process. What is a HIMS AME? What does a HIMS AME do? A HIMS AME is a senior Aviation Medical Examiner which has undergone the necessary training in the “HIMS” program in order to monitor airmen for certain medical conditions. “HIMS” stands for “Human Intervention Motivational Study” and is a substance use recovery program that has received grants from the Federal Aviation Administration “FAA” to develop aeromedical programs for airman medical certification and special issuance authorization. As with many elements of airman medical certification, the HIMS program comes with issues and may not be an appropriate pathway to medical certification for all airmen (especially if the airman has erroneously been identified as having a disqualifying medical condition). Identifying concerns with the HIMS program is not the purpose of this article (these issues will be identified in subsequent writings). Be that as it may, there are times when engagement with a HIMS AME may be the most efficient and legitimate pathway to medical certification. A HIMS AME may be needed for many different issues, including SSRI medication use, substance abuse/dependence, HIV, and others.

What should you look for in selecting a HIMS AME? In the event you have a legitimate need for a HIMS AME, one of the most important things to look for is how many HIMS cases the AME has actually handled. Consider that an AME can undergo training to become a HIMS AME, but that doesn’t necessarily mean that he or she is well-versed in the FAA procedures, best practices to efficiently obtain medical certification, and cost-efficient ways to perform monitoring and other necessary tasks. So, experience matters.

Another element to evaluate is how the HIMS AME will monitor your case. What methods will the HIMS AME use to establish abstinence in substance use cases? What are the HIMS AME’s practices when there is a concern for a false-positive result on a drug or alcohol test? Also, establishing with the HIMS AME what his or her practice is to communicate and present your case to the FAA is important, too.

Don’t forget that you have to feel comfortable working with the HIMS AME, as you will be spending a lot of time with this individual – make sure your personalities don’t clash!

Selecting a HIMS AME is a matter of knowing what you are getting into before it’s too late. Remember, however, that contrary to a popular misconception, while your HIMS AME can be helpful in your case, the HIMS AME, per FAA guidance, is not your advocate. The HIMS AME is your monitor. Oftentimes having an aviation attorney who regularly helps with medical certification issues can be a valuable asset in working your case through the HIMS program and looking out for your interests in the process.  Learn more about what an aviation attorney can do to help you with the HIMS program: FAA Medical – The Pilot Lawyer If you need help selecting a HIMS AME, call an aviation attorney at The Ison Law Firm to discuss your case today.

You can find the HIMS AME locator offered by the FAA, here: https://www.faa.gov/pilots/amelocator/

*The opinions expressed in this article regarding the HIMS program are opinions. This article is not intended to provide medical or legal advice and should not be treated as such.

FAA Medical Denial for ADHD

  • ON Nov 15, 2020
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  • BY Anthony Ison
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  • IN Pilot Law

Have you received a FAA medical denial for ADHD?

Let’s analyze how you got to a denial and what can be done to appeal the denial.

At least three questions on the FAA medical application (Form 8500-8) can identify to the FAA that an individual potentially has a history of ADHD. Specifically, those questions are question 17 (the question about “current use” of medications), question 18m (the question about “mental disorders of any sort”), and question 19 (the question about visits to healthcare professionals in the past 3 years).

Question 17 can identify for the FAA that an individual is currently taking a disqualifying medication such as Adderall, Ritalin, Concerta, Strattera, etc, commonly used to treat ADHD. Perhaps most problematic is that these medications are disqualifying in and of themselves. Even if you can disprove a legitimate history or diagnosis of ADHD (discussed further below), use of a disqualifying medication within 90 days of application will usually lead to a denial. If you are currently taking any of these medications or other type of stimulant, expect your Aviation Medical Examiner (“AME”) to defer your application and ultimately for the FAA to deny your application until the medication is discontinued (and potentially for at least 90 days thereafter).

Question 18m. speaks to “mental disorders of any sort.” It goes on to give examples of “depression, anxiety, etc.” The FAA typically expects applicants to also identify at question 18m. whether, in their life, have they been diagnosed with, had, or presently have a history of ADHD. What does this mean? If you were diagnosed with ADHD when you were in school but haven’t taken medication or experienced symptoms in 15 years, you still are required to answer “yes” to question 18m. Ultimately, a “yes” response to 18m. will most definitely warrant deferral by the AME and evaluation of your eligibility for a medical certificate by the FAA.

Question 19 speaks to “visits to healthcare professionals within the last 3 years.” If on this question, an applicant identifies that he or she has been to see his or her doctor for treatment of ADHD, this will likely warrant deferral. Be careful that if you have seen your doctor and are responding “yes” to question 19 and your doctor diagnosed you with ADHD (or suggested that you had ADHD), you will also likely need to respond “yes” to question 18m.

Assuming you appropriately responded to one of these three questions, your application was likely deferred and the FAA sent you a letter, requesting medical records. If after that the FAA denied your application, you can seek reconsideration of that denial by making a few substantive arguments. First, if you’ve not taken a disqualifying medication for greater than 90 days, you can potentially argue to the FAA that your underlying diagnosis was not accurate to begin with. In this case, you can cast doubt on the original diagnosis and attempt to avoid further evaluation.

Alternatively, upon 90-days of discontinuation of medication, you can potentially undergo the requested neuropsychological testing prescribed by the FAA. If successful with testing, you can then make further arguments that you do not have an aeromedically significant medical condition. Here’s more information on the FAA’s battery of neuropsychological testing: https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/adhd/ 

There are also considerations for appeal to the National Transportation Safety Board, but this option will be also be dependent on discontinuation of the disqualifying medication and your ability to develop an argument that the underlying diagnosis was not accurate.

Ultimately, a FAA medical denial for ADHD is almost never the end of the road for an airman. The FAA’s denial letter may look daunting, but time and time again, airmen with a history of ADHD are being issued medical certification following the appropriate presentation of the airmen’s fitness for flight.

If you have a FAA medical denial for ADHD, call your aviation attorney at The Ison Law Firm for a consultation. An attorney that focuses on FAA medical denials may be able to guide you through the process and work with the FAA to achieve certification. Learn more here:  thepilotlawyer.com/faa-medical/

This article does not in any way counsel the reader as to how to appropriately respond to questions on the FAA medical application, nor does it give medical advice regarding the accuracy of the reader’s medical history. The reader should always consult his or her doctor before discontinuation of any medication.

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