Is my AME making a mistake???

[HappiShootr]

Hello, brand new here, so a brief rundown:
Ex-military pilot, with several desert deployments. Was concerned about respiratory issues due to exposure to chemicals, dust, etc. During my transition out of service, the VA tested me extensively for lung issues out of my concern for future problems. Sure enough, they discovered significant lung degradation, capacity, and function. So I met with the VA doc who very dismissively attributed ALL of my symptoms on GERD. I was not convinced, but he assured me my GERD diagnosis would prove him correct. Basically he was saying that when I sleep, acid goes into my lungs and is damaging the tissues. He said he would prove it to me, and ordered a sleep test at the VA clinic which I completed.

After the sleep test, he confirmed the GERD diagnosis, explaining that the throat valve and tissues were weak, and issued me a CPAP to keep positive pressure on the throat so no acid would come. I have been using the CPAP for about a year with no problems, no more GERD symptoms, and everything seems great.

A few months ago, I received 2 letters from the VA. One refusing compensation for my lung and respiratory problem, GERD due to "no diagnosis and insufficient evidence". I called and questioned this, since I personally had no idea I even HAD gerd, but that it was their own VA doc that diagnosed me. Apparently they have no record of any of this (testing, treatment, diagnosis, doc visits, etc), so I was denied compensation. The other letter was a statement that I would now begin receiving compensation (which I never even applied for!) for sleep apnea due to my sleep study results a year earlier. Talk about backwards!! I raised the problem with the VA and said how can you deny the cause, but are now compensating the symptom? They just said this is how it works once you have a sleep study. Their response is that sleep apnea is causing the gerd, so thats what they cover and give the machine out for.

Subsequently, after getting out of the military and not flying for the last 2 years, I have been hired on at an airline, and needed to get my first class 1 medical since receiving the cpap and receiving the va compensation. I read a few things online about the necessary paperwork, reports, etc. So I gathered all the machine data, reports, etc. I have moved to a new area and went to a local AME. I marked everything on the forms about receiving VA compensation, my GERD, apnea, Airman Compliance, etc.

However, the doc (who I have since found out is basically ONLY an eye Dr!) did not want any of the sleep data reports, or anything. He said that since he believed the CPAP was to treat the GERD symptoms, he did not have to do anything about the apnea. He insisted that I did not need a special issuance, and did not really want to have anything to do with it. When I asked about all the required paperwork I had heard about, he said if the FAA wants anything they will call me and ask for it, but not to contact him for anything, it will only slow things down. He gave me the class 1 and just said if the FAA wants anything they will let me know.

Is this correct?
Is there now a discrepancy because I am receiving VA compensation for cpap but AME did not turn in the reports?
Is the AME setting me up for a problem, or is this the normal pathway for hearing back from the FAA if they want more info or not?
I have heard about pilots getting in trouble receiving VA compensation for sleep apnea, but not listing it on their medical. I am wondering what the process is if I list everything on the medexpress, but then the AME does not send in anything other than a brief explanation.

Maybe I am worrying about nothing, but I was fairly certain that using a cpap (GERD or anything), or receiving VA compensation for apnea, would require a SI, so thats what I was prepared for.

Most importantly, IF the faa contacts me and wants an SI or additional stuff, can I NOT fly during this process? I am scheduled to start line flying next month.

I appreciate any experience with things like this!

 

[PaulS]

Tough situation, you are right to be concerned and I have no medical or certification advice for you. But, I would write up the notes, much like what you have done here, memorializing what happened, sign and date it, and have someone witness that you signed it and wrote it, then file it in case you have issues later on.

I will defer to the docs as far as what you should do, the AME is the gatekeeper for this stuff. He may have noted that the CPAP is for gerd, not apnea and that may be good enough.

This is a tough one, sometimes it's better to let sleeping dogs lie, you did everything correctly as long as you filled the form out honestly, which it sounds like you did.

 

[Cooter]

If I understand it correctly, your 1st class will get audited by OK City at some point. They may or may not support the AME’s decision, but as long as you were honest then you’ve done all you can do. I am in a similar situation, and was recently surprised in being issued a 1st class. I gave the AME all the doctor’s notes and he made his own decision. He said the FAA may give me a call in a few months for some follow up, but he was comfortable with his decision. The VA docs have a separate interest so they view things differently. I don’t care if they come to a different conclusion as long as I’ve been honest w/both parties.

 

[lbfjrmd]

If I understand it correctly, your 1st class will get audited by OK City at some point. They may or may not support the AME’s decision, but as long as you were honest then you’ve done all you can do. I am in a similar situation, and was recently surprised in being issued a 1st class. I gave the AME all the doctor’s notes and he made his own decision. He said the FAA may give me a call in a few months for some follow up, but he was comfortable with his decision. The VA docs have a separate interest so they view things differently. I don’t care if they come to a different conclusion as long as I’ve been honest w/both parties.

I agree. Let's see what if any response there is from the FAA.

 

[58driver]

If I understand it correctly, your 1st class will get audited by OK City at some point. They may or may not support the AME’s decision, but as long as you were honest then you’ve done all you can do. I am in a similar situation, and was recently surprised in being issued a 1st class. I gave the AME all the doctor’s notes and he made his own decision. He said the FAA may give me a call in a few months for some follow up, but he was comfortable with his decision. The VA docs have a separate interest so they view things differently. I don’t care if they come to a different conclusion as long as I’ve been honest w/both parties.

Yep! Totally agree! I too am a recently retired Helo pilot and went to my local AME and was honest and am now in the process of getting everything together to send to the FAA. No doubt, honesty is the best policy.

 

[HappiShootr]

Yep! Totally agree! I too am a recently retired Helo pilot and went to my local AME and was honest and am now in the process of getting everything together to send to the FAA. No doubt, honesty is the best policy.

Did the FAA contact you subsequently, or did your AME submit a regular class 1? What did they tell you they wanted to see?

 

[58driver]

Did the FAA contact you subsequently, or did your AME submit a regular class 1? What did they tell you they wanted to see?

He submitted a Class II for EMS. It took almost 70 days for the FAA to send me the instructions for what all they wanted for PTSD and Sleep Apnea.

 

[benyflyguy]

Wild story. I was along for the ride for GERD causing lung issues. I was long for the ride that you needed a test at night to prove. Rarely done is 24hour pH monitoring. But that’s where I thought we were going. VA can do all kinds of crazy tests sometimes. But then you say sleep study. So you have sleep apnea as an “oh by the way dx”. Ok.
But insurance won’t approve a CPAP for the dx of GERD. But VA is funny about that too.
In the end they assign the right diagnoses and you move forward. Glad you don’t have a horrible degenerative chemically induces lung condition!!
Will be interesting what the upper level AME docs on the site have to say about the process.

 

[Kelvin]

A) You have the wrong AME. He has hung you out to dry. He isn't from North Carolina by any chance, is he?

Contact D. Bruce Chien
www.aeromedicaldoc.com

Ask him these same questions.

The chronology of your story is confusing...I may have this all wrong...but here is my read...

1) The doc diagnoses you with GERD dismissively.
2) You were not convinced.
3) You get treated with a CPAP to deal with the GERD
4) Symptoms disappear
5) You don't realize you HAVE GERD.

This is confusing to me...

Great advice I got here on POA.

"Own you medical. Do not place it in anyone's hands."

Hello, brand new here, so a brief rundown:
Ex-military pilot, with several desert deployments. Was concerned about respiratory issues due to exposure to chemicals, dust, etc. During my transition out of service, the VA tested me extensively for lung issues out of my concern for future problems. Sure enough, they discovered significant lung degradation, capacity, and function. So I met with the (1)VA doc who very dismissively attributed ALL of my symptoms on GERD. (2)I was not convinced, but he assured me my GERD diagnosis would prove him correct. Basically he was saying that when I sleep, acid goes into my lungs and is damaging the tissues. He said he would prove it to me, and ordered a sleep test at the VA clinic which I completed.

After the sleep test, he confirmed the GERD diagnosis, explaining that the throat valve and tissues were weak, and (3)issued me a CPAP to keep positive pressure on the throat so no acid would come. (4)I have been using the CPAP for about a year with no problems, no more GERD symptoms, and everything seems great.

A few months ago, I received 2 letters from the VA. One refusing compensation for my lung and respiratory problem, GERD due to "no diagnosis and insufficient evidence". I called and questioned this, (5)since I personally had no idea I even HAD gerd, but that it was their own VA doc that diagnosed me. Apparently they have no record of any of this (testing, treatment, diagnosis, doc visits, etc), so I was denied compensation. The other letter was a statement that I would now begin receiving compensation (which I never even applied for!) for sleep apnea due to my sleep study results a year earlier. Talk about backwards!! I raised the problem with the VA and said how can you deny the cause, but are now compensating the symptom? They just said this is how it works once you have a sleep study. Their response is that sleep apnea is causing the gerd, so thats what they cover and give the machine out for.

Subsequently, after getting out of the military and not flying for the last 2 years, I have been hired on at an airline, and needed to get my first class 1 medical since receiving the cpap and receiving the va compensation. I read a few things online about the necessary paperwork, reports, etc. So I gathered all the machine data, reports, etc. I have moved to a new area and went to a local AME. I marked everything on the forms about receiving VA compensation, my GERD, apnea, Airman Compliance, etc.

However, the doc (who I have since found out is basically ONLY an eye Dr!) did not want any of the sleep data reports, or anything. He said that since he believed the CPAP was to treat the GERD symptoms, he did not have to do anything about the apnea. He insisted that I did not need a special issuance, and did not really want to have anything to do with it. When I asked about all the required paperwork I had heard about, he said if the FAA wants anything they will call me and ask for it, but not to contact him for anything, it will only slow things down. He gave me the class 1 and just said if the FAA wants anything they will let me know.

Is this correct?
Is there now a discrepancy because I am receiving VA compensation for cpap but AME did not turn in the reports?
Is the AME setting me up for a problem, or is this the normal pathway for hearing back from the FAA if they want more info or not?
I have heard about pilots getting in trouble receiving VA compensation for sleep apnea, but not listing it on their medical. I am wondering what the process is if I list everything on the medexpress, but then the AME does not send in anything other than a brief explanation.

Maybe I am worrying about nothing, but I was fairly certain that using a cpap (GERD or anything), or receiving VA compensation for apnea, would require a SI, so thats what I was prepared for.

Most importantly, IF the faa contacts me and wants an SI or additional stuff, can I NOT fly during this process? I am scheduled to start line flying next month.

I appreciate any experience with things like this!

 

[lbfjrmd]

We are hearing and seeing one side of this saga. There are times where issuance is appropriate. If the FAA has ?, rarely is AME overruled. Airman has months to respond.

 

[6t6]

Here I wrote a basic DOS program to help solve your problem

1 Chien
2 Chien
3 Chien
4 Chien
5 Chien
6 go to 1

All kidding aside. You need a health professional that is versed on rulings and interruption from the FAA with regard to health
issues and how to resolve these issues
in your favor in the minimum time. key words: Resolve, time

 

[HappiShootr]

Yes, thank you for the feedback, and I did reach out to Dr Chien and he was very helpful.

Summary is: during last 4 years of active duty slowly developed respiratory difficulty after extended periods of strenuous exertion.
Figured it was deployment dust, chemicals, sand, the proverbial airborne fecal matter, burn pits, etc.
Had my VA medical done during outprocessing, Dr dismissively says GERD 100%. I had never heard of GERD and was not convinced that would explain everything. Seemed too simple of an answer. Doc insisted he sees hundreds of patients with same problems, and its "always GERD".
He said he would prove the diagnosis with sleep study. Sleep study complete, doc calls me and says he was right, confirms GERD, prescribes a CPAP to provide positive pressure and keep valve closed and acid down at night. Now realizing I have GERD, I file VA claim based on docs findings.
Worked construction for 2 years, used cpap, no further respiratory damage or gerd symptoms while using cpap every night.
8 months later VA claim paperwork is denied for GERD for "no diagnosis and lack of substantiating evidence". Second letter the same day: "congratulations you are going to start receiving compensation for sleep apnea because you have a cpap".
Got hired by airline, went for class 1 medical, checked all the boxes for compensation, and wrote comments on issues, printed all the cpap reports, airmans cert, etc. Went in prepared for SI.
AME did not do anything except check my eyes and blood pressure. I explained everything about compensation, gerd, cpap, sleep study, etc. He didnt want to hear it. Said if the faa wants anything they will call me. Gave me class 1 and said have a nice day.

 

[Rushie]

How does a sleep study confirm GERD? Do they test for HCl up near your trachea or something?

 

[HappiShootr]

How does a sleep study confirm GERD? Do they test for HCl up near your trachea or something?

I have no idea, they just hooked me up to a bunch of electrical and respiratory sensors. The doc said he could tell from the sleep study that acid was being pulled up and going in my lungs, damaging the valve and tissue.

 

[Kelvin]

What did Bruce say?

 

[Lindberg]

How does one receive compensation for GERD or sleep apnea?

 

[Lindberg]

Here I wrote a basic DOS program to help solve your problem

1 Chien
2 Chien
3 Chien
4 Chien
5 Chien
6 go to 1

All kidding aside. You need a health professional that is versed on rulings and interruption from the FAA with regard to health
issues and how to resolve these issues
in your favor in the minimum time. key words: Resolve, time

A very qualified AME has already commented on the thread. Not to mention how dismissive this is of his advice, how would it help the OP to get a third or fourth opinion at this point? He had his medical, just wait to hear something.

 

[Fearless Tower]

How does one receive compensation for GERD or sleep apnea?

Whenever someone leaves active military service, they get a complete physical to document any health issues that you might have developed while on active duty. Those issues are all investigated/examined to determine if you should receive any disability compensation.

For the VA, a diagnosis of OSA is automatically at least 50% disability.

My guess is the VA removed the GERD diagnosis and ‘assigned’ him the OSA diagnosis to give him more money.

 

[HappiShootr]

How does one receive compensation for GERD or sleep apnea?

Your VA doc can order a sleep study to confirm the diagnosis, but then you still have to file the claim to establish service connected.

 

[HappiShootr]

Whenever someone leaves active military service, they get a complete physical to document any health issues that you might have developed while on active duty. Those issues are all investigated/examined to determine if you should receive any disability compensation.

For the VA, a diagnosis of OSA is automatically at least 50% disability.

My guess is the VA removed the GERD diagnosis and ‘assigned’ him the OSA diagnosis to give him more money.

I also questioned this with the VA, however in their words, the monetary compensation dept has nothing to do with the medical decision side ordering the sleep study and prescribing the machine. The problem is that "apparently" they cannot prescribe a CPAP and it be covered for GERD: you get no compensation. But if the Sleep study somehow connects the gerd to apnea, then you are allowed to have a machine, and only then is it prescribed and you receive compensation. Sounds convoluted to me, and I challenged the logic with the VA, but they said that is just how it is.

 

[HappiShootr]

What did Bruce say?

To compile all my paperwork, sleep report, compliance data, airmans cert, etc and send it in to the FAA.

 

[Fearless Tower]

I also questioned this with the VA, however in their words, the monetary compensation dept has nothing to do with the medical decision side ordering the sleep study and prescribing the machine. The problem is that "apparently" they cannot prescribe a CPAP and it be covered for GERD: you get no compensation. But if the Sleep study somehow connects the gerd to apnea, then you are allowed to have a machine, and only then is it prescribed and you receive compensation. Sounds convoluted to me, and I challenged the logic with the VA, but they said that is just how it is.

The way the VA works, that doesn’t surprise me.

On a separate note: you mentioned being around burn pits. I’m not trying to scare you, but be very alert to any early signs of cancer. A lot of guys who have spent time around the burn pits in Iraq have been developing cancer.

 

[HappiShootr]

The way the VA works, that doesn’t surprise me.

On a separate note: you mentioned being around burn pits. I’m not trying to scare you, but be very alert to any early signs of cancer. A lot of guys who have spent time around the burn pits in Iraq have been developing cancer.

YES, that is precisely why I made sure i was extensively tested for lung and respiratory function. My last day in kandahar I honestly didnt think I would make it out alive without catching cancer, the burn pit was covering the base with the thickest, blackest smoke you have ever seen in your life. It was almost solid!!! This is the reason why when the VA doc pretty much instantly chalked all my symptoms up to GERD, I really did not believe that. But he ordered the sleep study to prove it....apparently.... because the VA subsequently "lost" all the lung test results, and the docs gerd diagnosis.....

 

[Lindberg]

Your VA doc can order a sleep study to confirm the diagnosis, but then you still have to file the claim to establish service connected.

Interesting. I thought OSA was always anatomical.

 

[John221us]

Ok, slight thread drift. I am not military. I have gerd (diagnosed a very long time ago). I was prescribed Pepcid, daily and it worked (I felt a lump in my throat). I also have persistent “allergies” year round. I have tried to reduce, eliminate the Pepcid over the years. I can reduce it, but not eliminate it. Does a CPAP perhaps offer a non drug solution to my problem?

 

[HappiShootr]

Ok, slight thread drift. I am not military. I have gerd (diagnosed a very long time ago). I was prescribed Pepcid, daily and it worked (I felt a lump in my throat). I also have persistent “allergies” year round. I have tried to reduce, eliminate the Pepcid over the years. I can reduce it, but not eliminate it. Does a CPAP perhaps offer a non drug solution to my problem?

I dont know about your situation specifically, but basically what the VA doc explained to me was that when I sleep, acid is coming up and damaging the tissue in my lungs, because the valve is not tight. So the cpap provides a little pressure to keep the valve closed, and no acid leaks through.