Getting your FAA medical with a history of Adjustment Disorder is not impossible. As with all mental health conditions, the Federal Aviation Administration (“FAA”) will assess whether your history of Adjustment Disorder presents a risk for recurrent symptoms. In other words, the FAA will want to know if they issue you a medical certificate today, will you experience aeromedically significant, mental health conditions tomorrow, next week, next month, next year, or ever? The FAA wants to know that the risk for recurrent symptoms is appropriately mitigated. Airmen who have experienced an Adjustment Disorder can typically present an argument to the FAA that the Adjustment Disorder was situational in nature, and therefore, not inclined to produce a risk for recurrent symptoms. Such an argument that the risk for recurrent symptoms is low or not aeromedically significant in these types of cases depends on the facts of your medical history. However, an Adjustment Disorder is typically easier to get medically certified than other mental health conditions, such as Major Depressive Disorder, Single Episode; Major Depressive Disorder, Recurrent; Generalized Anxiety Disorder; Persistent Depressive Disorders; etc.
The FAA has published protocol for Aviation Medical Examiners (“AME”) which authorizes your AME to issue you a FAA medical certificate at the time of application if you present with a situational mental health condition, such as Adjustment Disorder. Your AME will need to evaluate a detailed, clinical progress note from your treating physician at the time of your FAA medical exam. Largely, the FAA’s Situational Depression Decision Tool looks at whether your symptoms were reasonably related to a stressor or event. Nevertheless, your symptoms must be linked to a type of stressor which would likely cause the average person to experience depressive symptoms. For example, the death of a loved one or the loss of your job, would likely qualify as a reasonable stressor to cause depression for FAA purposes. Furthermore, the FAA expects your symptoms to have resolved within 6 months following the resolution of the stressor. For example, the FAA would expect that your depressive symptoms should have dissipated within the following 6 months after you lost your job. The FAA will also expect that your symptoms must be a single episode, rather than a recurrent event in a series of depressive episodes. Of course, other consideration will be given to any other psychiatric symptoms, such as whether you have ever experienced psychosis or substance use related concerns, etc.
In the event your AME decides to defer your medical application, the FAA’s Office of Aerospace Medicine will send you a letter and likely require that you provide all treatment records, if any, from any treatment you received for your Adjustment Disorder. The FAA will also request that you provide a detailed, clinical progress note from your treating physician identifying the following:
- Summary of the history of your Adjustment Disorder;
- List of current medications, dosages, and side effects, if any;
- Clinical exam findings;
- Results of any testing performed, if any;
- Your current diagnosis;
- A current assessment and plan for treatment, if any;
- Your prognosis.
Upon submission of this data, the FAA will review your history to assess whether you are currently stable and whether your history is aeromedically significant. Again, the FAA’s concern will be whether you are at a risk for recurrent symptoms. Aggravating factors for the FAA tend to be whether you have a history of suicidal ideation or attempts, psychiatric hospitalizations, substance induced symptoms, psychotic episodes, etc.
In some cases, however, your treating physician may feel that you are at risk for recurrent symptoms. Consequently, your treating physician may believe it is clinically indicated for you to utilize an antidepressant medication to treat your Adjustment Disorder. If this is the case, the FAA will want you to complete the SSRI Decision Pathway 2, for consideration of a special issuance authorization while on an antidepressant.
Whether you are done with treatment or you are continuing using a SSRI medication, there are a few things that you can do before submitting your next medical application, following a diagnosis of Adjustment Disorder, which may help your FAA medical application go smoothly:
- Gather all of your treatment records from your treating physician and make sure you know what is stated therein. In our practice, we speak to airmen who review their records from their treating physicians only because the FAA asks for a copy. Many times, airmen are shocked to see that they may have more diagnoses than Adjustment Disorder or there may be facts contained within those records which are problematic from an aeromedical standpoint. As such, it is always prudent to know what is in your medical records.
- Procure a detailed clinical progress note from your treating physician before you go and see your AME. If your diagnosis is Adjustment Disorder, a thorough report from your doctor will go a long way toward giving your AME the necessary tools to issue your certificate without deferring your application to the FAA’s Office of Aerospace Medicine.
- Prepare for a potential deferral to the FAA’s Office of Aerospace Medicine. Even though you may meet criteria to be issued by your AME at the time of exam, it is always prudent to prepare for a potential deferral. If your exam is deferred by your AME, in some cases, it may make sense to proactively supply the detailed clinical progress note and your medical records to the FAA before they send you a letter asking for same. Proactively providing records to the FAA may save you several weeks in processing by the Office of Aerospace Medicine. It is critical that you consult with someone experienced with FAA medical certification processes before submitting records to the FAA, especially when submitting records in a proactive fashion. Keep in mind that you will not have a medical certificate if you are deferred and you must wait for a decision from the FAA before operating as pilot-in-command, second-in-command, or as required crewmember.
- If you are utilizing a SSRI medication to actively treat your Adjustment Disorder, make sure that you are utilizing an antidepressant which is approved for special issuance authorization and that you meet all prerequisites for the SSRI special issuance program.
Why involve a FAA attorney when you are trying to get a FAA medical with a history of Adjustment Disorder? Despite what you may hear from your AME, the medical certification process is more so a legal process than a medical process. Ensuring that your doctor is developing the proper documentation regarding your Adjustment Disorder, as needed, can be a difficult task. 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 AME or FAA, and best argue your medical eligibility to the Federal Air Surgeon, with an eye for potential, future appeal. Furthermore, if your medical documentation is as strong as possible upon initial submission, in doing so, hopefully, you will avoid unnecessary delay. Also, if you have failed to report your Adjustment Disorder on your FAA medical application, a FAA medical attorney can give you counsel on how to rectify your omission.
If you are trying to get your FAA medical with a history of Adjustment Disorder 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.