What’s a psychiatric condition to the FAA?

[PiedPilot]

I was ‘diagnosed’ with adjustment disorder with anxiety by a Licensed Councling Practitioner Intern (LPC-I) in 2020. I wanted councling for some relationship issues and given that I was a student pilot with a class III I didn’t really consider the implications (famous last words). The councler needed a diagnosis to charge insurance so he went with something seemingly inconsequential, or so he said.

Now at the moment I’m looking to renew and shoot for my first class and weighing my options. I have a few questions accordingly.

Is a diagnosis by a non-board certified LPC-I even federally recognized? Is it even a valid diagnosis that needs to be denoted on my 8500-8? As far as I’ve researched you cannot receive disability or early social security benefits based on a diagnosis by an LPC, much less an intern. Oregon has a unique law that allows LPC-Is to make diagnoses for the purpose of insurance billing but I’m not sure this is applicable to anything beyond the realm of insurance. 8500-8 requires all visits to physicians, PAs, nurse practitioners and Licensed Clinical Social Workers - with no note of LPCs.

A few things to note about my case: I’ve never taken any psychotropic medications or been hospitalized. My trip to a councilor was just that, councling. I had my ‘diagnosis’ resolved after five months when I had worked to build better conflict resolution skills with my partner and reconnected with my parents. Pretty plain-Jane stuff.

That all being said - I have all of the pertinent, required documentation (medical records, letter from councilor, personal statement, detailed councling records, recent evaluation) to have no problem with being issued a medical by the HIMS-AME I’ve already consulted with. I’m worried about running the risk of having my medical revoked in six months at random over a diagnosis that might not have even been needed to be noted in the first place though. I have a CFI job lined up and if I can’t fly because of a medical fudge down the line I’ll surly loose that opportunity and waste money I don’t have getting a myriad of neuropsychological exams done.

Any expert opinions or real world experiences?

@bbchien or any other AMEs want to share their thoughts? Thanks all!

 

[Tools]

Well, that’s a good question. It means, as best I can tell, that “someone they trust” (generally a hims “qualified” person) says you do.

Now, how THAT person determines or qualifies that is COMPLETELY random. A VERY FEW determinations are completely legit. Hot on those heels is PAID FOR diagnoses, ya, it’s been adjudicated. Lots are based on unreasonable fear by the diagnoser, who is not well qualified medically to make THAT PSYCHIATRIC determination (as in the case of ophthalmologist doing it or something). Most determinations are reasonable, but still not well founded.

In the end, it’s basically a he said she said with deference given to the hims person. Hims training is really administrative training, on how to accurately navigate the administrative requirements of mental disorder special issuances. Has nothing to do with being medically qualified in the field of mental disorders.

So, what you want is a hims AME, who has a good relationship with a hims shrink, who you think will apply some appropriate qualified experience to reviewing your record. Not someone who wants easy money. One “easy money” scenario is a ear nose and throat guy who is hims AME qualified and says, “well, I’m not sure, better safe than sorry, let’s just enroll you in hims and make you a patient FOR LIFE. Let the feds sort it out.”

Well, the feds sort out precious little, they take the word of the first qualified opiner, that ENT HIMS AME. See the catch?

The correct way to do it would be a proper determination, a well thought out response that would pass muster in a REAL medical venue, present that to the feds. It’s A LOT of work. Probably very expensive up front, but what REAL medical anything isn’t?

If you didn’t like the results, it being quite properly done, wouldn’t likely have a leg to stand on. Problem is, in the first scenario, if you didn’t, your only recourse is an appeal to the NTSB, now making option two (a proper medical determination) much more appealing.

 

[Tools]

It should be noted, LOTS AND LOTS of AMEs say “the FAA is gonna want...” without asking. In fairness, the feds don’t make asking even practical... This is the basis of their fear.

On the other hand, they’re DOCTORS. They are highly educated, well paid, and EXPECTED to accomplish the uneasy.

 

[Joe LoRusso]

I was ‘diagnosed’ with adjustment disorder with anxiety by a Licensed Councling Practitioner Intern (LPC-I) in 2020. I wanted councling for some relationship issues and given that I was a student pilot with a class III I didn’t really consider the implications (famous last words). The councler needed a diagnosis to charge insurance so he went with something seemingly inconsequential, or so he said.

Now at the moment I’m looking to renew and shoot for my first class and weighing my options. I have a few questions accordingly.

Is a diagnosis by a non-board certified LPC-I even federally recognized? Is it even a valid diagnosis that needs to be denoted on my 8500-8? As far as I’ve researched you cannot receive disability or early social security benefits based on a diagnosis by an LPC, much less an intern. Oregon has a unique law that allows LPC-Is to make diagnoses for the purpose of insurance billing but I’m not sure this is applicable to anything beyond the realm of insurance. 8500-8 requires all visits to physicians, PAs, nurse practitioners and Licensed Clinical Social Workers - with no note of LPCs.

A few things to note about my case: I’ve never taken any psychotropic medications or been hospitalized. My trip to a councilor was just that, councling. I had my ‘diagnosis’ resolved after five months when I had worked to build better conflict resolution skills with my partner and reconnected with my parents. Pretty plain-Jane stuff.

That all being said - I have all of the pertinent, required documentation (medical records, letter from councilor, personal statement, detailed councling records, recent evaluation) to have no problem with being issued a medical by the HIMS-AME I’ve already consulted with. I’m worried about running the risk of having my medical revoked in six months at random over a diagnosis that might not have even been needed to be noted in the first place though. I have a CFI job lined up and if I can’t fly because of a medical fudge down the line I’ll surly loose that opportunity and waste money I don’t have getting a myriad of neuropsychological exams done.

Any expert opinions or real world experiences?

@bbchien or any other AMEs want to share their thoughts? Thanks all!

Great question, we run into this a lot. Most commonly, we see this with ADHD diagnoses...college kid complains to a PCP of an inability to focus during his or her 8am class, next thing you know they are prescribed Adderall and they now have a CPT code for ADHD in their medical records. Your suspicions with whether you were assigned a true clinical diagnosis are not without merit.

With respect to the 8500-8, it calls for an affirmation of any condition in which you have been 'diagnosed' with OR which you are currently suffering symptoms of. The term 'diagnosis,' as used on the 8500-8 references a clinical diagnosis. There is no such thing as a "federally recognized" diagnosis. There is, however, a notable and sizable difference between the clinical world and the regulatory one.

Notwithstanding the syntax arguments, the big question is... how are you now? It seems that your acute issue has resolved. How long ago? Are you suffering any symptoms of anxiety or an adjustment disorder?

These questions and, of course, the arguments discussed above, need to be vetted by and through an aviation attorney. I would strongly advise against seeing an AME until that point. An AME has an inherent conflict between acting as an evaluator for the FAA and acting as an advocate for you... and aviation attorney has no such conflict.

Moral of the story, good hunch and suspicion, get a consultation.

 

[Tools]

Joe said:

“An AME has an inherent conflict between acting as an evaluator for the FAA and acting as an advocate for you..”


THAT about sums it all up. And it seems actionable.

And it’s the kind of statement I think would make all this nonsense MUCH more clear to us tiny brained pilots!

 

[TCABM]

Great question, we run into this a lot...

I get you’re new here. You’ve mentioned elsewhere you’re an aviation attorney, but your posts seem to focus on the medical certification side… a quick google search makes me wonder if you’re shilling your practice.

 

[Dry Creek]

I get you’re new here. You’ve mentioned elsewhere you’re an aviation attorney, but your posts seem to focus on the medical certification side… a quick google search makes me wonder if you’re shilling your practice.

That's an interesting position.
But, I guess if you're going fishing, you need to go where there's water.

 

[TCABM]

That's an interesting position.
But, I guess if you're going fishing, you need to go where there's water.

I’ve rarely seem it a good idea to to turn a medical problem into a legal problem.

 

[Dry Creek]

I’ve rarely seem it a good idea to to turn a medical problem into a legal problem.

I agree, we tend to be a litigious society. I was just observing that the person was offering "free" advice, much along the lines as is offered by some of the excellent AMEs we have on this board. Didn't want him to feel as if he was unwelcome. Ultimately, it's up to the person being offered advice which nuggets of wisdom he chooses to apply.

 

[Half Fast]

I’ve rarely seem it a good idea to to turn a medical problem into a legal problem.

PoA’s house AMEs, @bbchien and @lbfjrmd , have a great track record of getting approvals for many airmen with challenging issues. I’ve never seen a similar record posted from an attorney on this site. And I’ve yet to see Bruce or Lou advise getting an attorney involved.

 

[TCABM]

…Ultimately, it's up to the person being offered advice which nuggets of wisdom he chooses to apply.

Agree. The user I quoted proffers his advice on aeromedical certification under the guise of expert legal counsel. He may be that, I don’t know.

What I do know is that most people coming here with a question on a difficult medical case are usually so motivated to “get the ticket” even in the face of daunting costs to do so that they forget they don’t know what they don’t don’t know and may assume legal counsel is needed as well when it’s very likely that’s the last thing needed.

 

[MalibuJim]

Sadly, from my personal experience, the FAA sees no good from ANY non-rev pilot getting in the plane with ANY anomaly. They see no good coming of it, and some of our FAA influential politicians would love to shut down GA altogether.

 

[OneCharlieTango]

What in the world could a lawyer add to this except cost and complication?

 

[Lindberg]

PoA’s house AMEs, @bbchien and @lbfjrmd , have a great track record of getting approvals for many airmen with challenging issues. I’ve never seen a similar record posted from an attorney on this site. And I’ve yet to see Bruce or Lou advise getting an attorney involved.

Oh, I don't remember the AMEs posting their records here. Where was that? Of course selection bias is a huge factor in any "win/loss" ratio, whether in administrative medicine or law.

 

[Half Fast]

Oh, I don't remember the AMEs posting their records here. Where was that? Of course selection bias is a huge factor in any "win/loss" ratio, whether in administrative medicine or law.

Both docs have, on multiple occasions, posted accounts of difficult medical cases they got approved. In addition, many pilots (including me) have posted successful outcomes with these doctors.

I have yet to see an attorney do the same thing on this forum, nor do I recall a post from a pilot telling us he got his medical thanks to his attorney.

 

[Tarheelpilot]

Being human.

 

[Lindberg]

Both docs have, on multiple occasions, posted accounts of difficult medical cases they got approved. In addition, many pilots (including me) have posted successful outcomes with these doctors.

I have yet to see an attorney do the same thing on this forum, nor do I recall a post from a pilot telling us he got his medical thanks to his attorney.

Ok. You referred to their track records. Obviously anyone can post their Ws. I don't really care bc I don't think anyone should hire a professional based on what they read on the internet, but to each his own.

 

[Half Fast]

Obviously anyone can post their Ws.

Obviously.

But I haven't seen those recommending lawyer involvement, like Joe did upthread, post any lawyer wins when it comes to pilot medicals. If it's so important to use an aviation attorney for a difficult medical, why aren't we seeing a few related success stories?