Difficult Medical for 3rd Class Student Pilot, Where to start

pseudoRandom

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pseudoRandom
Hey, I am a student pilot in Atlanta. It has been my dream since I was little to be a pilot and I now finally have a good enough job to do so. I was recently going over the medical form in preparation for my medical exam and realized that I may have some landmines in my past (childhood ADD & a single dehydration-induced fainting spell~5yrs ago)

I was wondering how to approach, and if the AME recommended to me by my flight school (Ted Carter) would be the best bet, as well as what costs I should expect. My plan was to try and gather all the medical documentation I can, schedule a consultation, and then present the issues and follow the advice of the AME. Is this a good approach? Are there others that I should consult?

Also is it prudent to start flight training with a differed medical or should I wait until everything is all said and done?

-- Other Info
  • I don't plan on getting class 1 or 2, but I would eventually like to become a CFI. From what I can tell, I can do that with a class 3 medical.
  • I have not taken ADHD medicine for 8 years now and think I have a fairly good chance of getting my ADHD diagnosis reversed
  • I did have neurological and heart screening for the fainting spell. All negative, but as much as I can remember the conclusion on the cause was not 100% definitive, and I was basically told that it's fairly normal and probably due to dehydration.
  • I have read on here to contact Bruce Chien but it looks like he is not taking on any 3rd class pilots any more =( Edit: He is in fact still taking on 3rd class pilots, see post below.
  • I also have Gout and I take Allopurinol (100mg) to control it. From what I have read, the AME should be able to handle that without a deferral.
 
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1. do not visit the AME for an FAA medical exam.
2. Visit the AME for a CONSULTATION. The two of you will then determine the next course of action, what documentation you’ll need and what tests/exams you’ll need.
3. Do not rush into anything
4. Do not get an FAA medical exam until #1,2,3 have been completed.
5. If the AME will not do a consult, find another AME.
 
It's Bruce Chien by the way, no "g" on the end.

I fear you're in for a tough haul. There's little that an AME can do but defer you. A good AME can help you collect the information needed so it shortens from an eternal delay to just unbearable. There's more to it than just getting to get a doctor say "he doesn't have ADHD anymore." I don't know how old you are now, but the medications are going to be a problem.

It used to be that if you had a childhood diagnosis, got off the drugs, went to college and succeeded without them, the FAA would cut you some slack. They've tightened that up now. You at least need to find an HIMS (not just a regular) AME, because your going to need him at least as a gatekeeper into the system. It used to be that the FAA would take a review from any board certified PSYCHIATRIST, but again, they've tightened that up and want the report from one of their HIMS guys (who you must get a referral from a HIMS AME for).

The gout and Allopurinol aren't an issue as long as things are under control.
 
It's Bruce Chien by the way, no "g" on the end.
Whoops. I'll edit the post

I don't know how old you are now, but the medications are going to be a problem.
I am 27. I haven't taken the meds for 8 years. Is that still going to be a problem?

2. Visit the AME for a CONSULTATION. The two of you will then determine the next course of action, what documentation you’ll need and what tests/exams you’ll need.
I still need to gather all my medical info before hand though right?
 
Whoops. I'll edit the post


I am 27. I haven't taken the meds for 8 years. Is that still going to be a problem?


I still need to gather all my medical info before hand though right?

Yes. The FAAs view is you have ADHD even if you're off meds and coping. You have to get documentation to prove you don't have ADHD. Tall (though not impossible) order. Dr. Chien is the gold standard in HIMS AMEs.

Having all your medical info is an excellent start.
 
Check out if there is a sport pilot certificate training program in your area. You do not need a medical to get a sport pilot certificate and the hours can go towards future certificates if you want to pursue a higher grade license.

As far as the add/adhd goes if you report that info to the AME you will be deferred and ultimately denied. You will have to do the full test battery of the neuropsychological testing which will cost approximately $3000. You will need a goods Senior/HIMS AME to get you thru this. Pm me and I can share some more information about some doctors to see.
 
Check out if there is a sport pilot certificate training program in your area. You do not need a medical to get a sport pilot certificate and the hours can go towards future certificates if you want to pursue a higher grade license.

As far as the add/adhd goes if you report that info to the AME you will be deferred and ultimately denied. You will have to do the full test battery of the neuropsychological testing which will cost approximately $3000. Good luck
Yeah, that's what I am afraid of. I am ok with the $3000, and actually just set aside an additional $6k for getting this stuff figured out. But my main goal is powered flight. Unfortunately, a sport pilot license just doesn't scratch the itch.

Also, there is no way I could hide the ADHD from the government. I had 504 plans, took Adderal, just way to many ways to track that down. I want to make sure everything is out in the open, then to run into issues down the road when the stakes are much higher (airplane ownership, insurance, etc.)
 
But my main goal is powered flight. Unfortunately, a sport pilot license just doesn't scratch the itch.


Huh?!

Light Sport Aircraft are certainly powered airplanes, and are quite capable craft that you can fly anywhere in the US and the Bahamas, day VFR, with a passenger.
 
Huh?!

Light Sport Aircraft are certainly powered airplanes, and are quite capable craft that you can fly anywhere in the US and the Bahamas, day VFR, with a passenger.
TIL. I always thought sport pilot was for gliders. I'll definitely have to check it out in that case then.
 
TIL. I always thought sport pilot was for gliders. I'll definitely have to check it out in that case then.


The planes are fixed gear, max of 2 people, GTOW of 1320 lbs or less, max indicated airspeed of 120 knots. Sport pilots are limited to daytime VFR flight only. But you can do a whole heckuva lot of fun flying within those limits. I flew as a sport pilot for a couple of years before going on to get my private.


https://www.faa.gov/licenses_certificates/airmen_certification/sport_pilot/

https://www.aopa.org/advocacy/advocacy-briefs/frequently-asked-questions-about-sport-pilot

https://www.eaa.org/eaa/aviation-in...me-a-sport-pilot-and-fly-light-sport-aircraft
 
LSAs are quite capable airplanes. I have a private certificate, but balked at the ongoing cost of maintaining a special issuance medical and let it lapse, then exercised the privileges of a sport pilot using my valid California driver's license in lieu of a medical certificate for almost a decade. I've been flying under BasicMed since May, 2017, but love flying the Zodiac LSA. When I need to carry more passengers I rent a 172 or 182 from the local FBO, but for 95% of the kind of flying I do the LSA is a perfect fit.
3947cr1k.jpg
 
In any case I'm in the same situation you are but also got a ridiculous (and false) diagnosis of Aspergers (now Autism Spectrum Disorder). What @murphey said is important, but I'll make a quick checklist that's IMPORTANT you follow for ADHD.

  • Receiving your medical when having a previous diagnosis is black and white to the FAA. You either have ADHD and are barred from receiving a medical, or you don't have it (determined by the tests mentioned below) and you are clear to fly. There is no spectrum of "He has ADHD but he's good to fly". Either you have it or you don't.
  • With that, be honest with yourself. My total cost has come out to $3,800 so far (3 consultations with my AME and a Cogscreen-AE). Don't throw $3,800 away if you can't assess yourself honestly and say whether you do or don't have ADHD.
  • Not to bash nor discredit the AME you mentioned, but he didn't show up on the FAA's HIMS AME list (https://www.faa.gov/pilots/amelocator/media/hims independent medical sponsors.pdf). On top of this, you should pick out a senior AME from this list. AND on top of that, research your AME. I found out my AME has been doing his work for over 30 years (and was a TWA pilot!)
  • If you find a reputable AME with a history of working with hard cases, there should be no issues scheduling only a consultation. You should bring ALL your medical records (Mine were 120+ pages) from the department you saw for ADHD checkups and medication issuance/changes (Usually department name is pretty close to Developmental and Behavioral Pediatrics). And I would also get that dehydration papers from your medical history too. They don't need to see every time you went in for a cold to your local doctor's office (unless you got severely sick and exposed a new diagnosis).
  • DO NOT fill out a MedXPress form. As previously stated, only schedule a consultation and bring your medical records. Your AME will look over your medical records and give you an idea of what you need to do.
  • If the AME you are seeing has been this for a while, they will be able to recommend you a good Neuropsychologist to see to administer the cogscreen. The cogscreen is mandatory for ADHD. There is no way you can have your diagnosis reversed without taking the cogscreen.
  • IF YOU LIVE on the east coast, tell your AME you would like to see Dr. Gary Kay in Washington D.C., he made the cogscreen program so he knows how to write the best report based off of your scores.
  • Once you finish, this report will be forwarded to you and your AME. You will schedule an appointment again with your AME and go in. If he sees that everything is good, he will take you to their computer and have you fill out a MedXPress form, then do a physical and eyesight test. If you pass the physical, he'll mark your medical request as being deferred and off it goes to Oklahoma City.
  • Now... cross your fingers. Well if your cogscreen scores were good, you shouldn't really need to worry, you'll most certainly get your medical issued. If you get a letter saying your medical request was approved, congratulations! If not, they will probably be asking for a psychological evaluation since they have concerns about your communication. This is only if your medical records report a history of communication problems and that your communication problems lasted for an extended period of time and never improved.

For the cogscreen, I prepared/assessed myself on whether I should continue by using PEBL 2.1. There are a slew of tests that you take for ADHD. I'll try to list as many of them as possible below and also send you the link to PEBL with the practice tests, though some tests aren't available on PEBL. The cogscreen looks like this (Page 2 and 3): http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.126.4724&rep=rep1&type=pdf

The tests listed below are what I took and the corresponding name in PEBL so you can practice
  • PASAT Paced auditorial serial addition test | PEBL pasat: This is hard to explain, so watch this video
  • (Backwards) Digit span | PEBL dspan: Numbers appear one at a time and remain on the screen for 1 second each. When the numbers are done appearing, you must type them backward.
  • Flagman/Manikin: You will see a man holding a flag. He could be facing towards you or away from you, and upside or right side up. You must determine which hand the flag is in from his perspective.
  • Symbol digit coding: Refer to the PDF linked above for a better explanation. Don't forget which symbols are assigned to which number. After about 2-3 tests later, you will be asked to remember which symbol goes with which number again.
  • Visual sequence: You will see to strings next to each other. They may be the exact same or different by 1 number or letter. You must respond as quickly and accurately as possible as to whether these strings are the same or different
  • Trails: Its like a game of scramble, you have A-Z 1-27 or A-F and 1-12 all scrambled out on the screen. You must tap each letter/number in order (A, B, C, D) (1, 2, 3, 4) or when you get the letters and numbers, tap each number to its corresponding position in the alphabet (1, A, 2, B, 3, C, 4, D, 5, E). After the cogscreen, give me a number and I can give you its corresponding letter via its position! Thanks, cogscreen!
  • Centerline triangle: You have a line that looks like a sea-saw and a triangle that moves to the left and right on the top of this seesaw. Pressing the arrow keys on the keyboard makes the triangle move in that direction. Your job is to make the triangle stay as close to the center as possible (refer to the PDF above)
  • Centerline: You will see a line moving up and down with red filling at the top and bottom of a circle. The line will move up and down sporadically and tease you when it gets close to the red. Once it touches the red, you click center and it will move the line back to the center (The other parts like the Same/Different and the strings at the top left and right are explained next https://www.pilotsofamerica.com/community/threads/cogscreen-ae-strategy-question.121786/)
  • Along with everything above, you will get dual-task sequences. This means you will get some of the smaller tests (like visual sequence) combined with the centerline tests. You will be required to use your nondominant hand to control the keyboard for the centerline tasks and your dominant hand to use the stylus and tap "same/different" or the other buttons associated with the small tests.
Additional tests that aren't on the cogscreen program
  • You must also be required to take the trails test on paper too to test your dexterity. This is actually kinda fun.
  • Verbal fluency: You will be asked to name as many words as possible that start with the letter "x" (The letter changes; you are asked 3 separate times with 3 different letters) in 60 seconds. This is kinda hard but a lot of people struggle with this, so don't worry. You will also be asked to read a list of words and must say them to determine your reading level and pronunciation
  • MMPI: Man this one's a b***h. 627 question personality tests. I can't describe the questions, they somehow pinpoint your mental stats. Take a look at the first 75 questions here to get an idea of what they look like. You can only answer "yes" or "no" to all of these questions. https://antipolygraph.org/cgi-bin/forums/YaBB.pl?num=1109032158/33#33

This seems daunting at first, and it took me a while to piece all the tests together but practice on PEBL and don't even worry about the MMPI. Try the tests at home first before you make a make a decision of whether you will go out and get your ADHD cleared. If you think you still have ADHD, then stick with a sport license. Once you apply for a medical if you get denied you are barred from getting a sport license.

Please message me privately if you would like to know more.

Pete
 
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I am still doing 3rd. I’m just rationing time spent on

Depression meds
Combined with alcohol
+PTSD
+”but I’m fine now”

.....because those are huge cases.....MONTHS long....

B
 
Though my want is different since I want to fly as a career, I couldn't ever be a sport pilot; it (was) either thrust or no flying. If @pseudoRandom has assessed what a sport pilot does vs 3rd class and has decided he wants in an aircraft that produces thrust for lift rather than just gliding, then he has made his decision.

In any case I'm in the same situation you are but also got a ridiculous (and false) diagnosis of Aspergers (now Autism Spectrum Disorder). What @murphey said is important, but I'll make a quick checklist that's IMPORTANT you follow for ADHD.

  • Receiving your medical when having a previous diagnosis is black and white to the FAA. You either have ADHD and are barred from receiving a medical, or you don't have it (determined by the tests mentioned below) and you are clear to fly. There is no spectrum of "He has ADHD but he's good to fly". Either you have it or you don't.
  • With that, be honest with yourself. My total cost has come out to $3,800 so far (3 consultations with my AME and a Cogscreen-AE). Don't throw $3,800 away if you can't assess yourself honestly and say whether you do or don't have ADHD.
  • Not to bash nor discredit the AME you mentioned, but he didn't show up on the FAA's HIMS AME list (https://www.faa.gov/pilots/amelocator/media/hims independent medical sponsors.pdf). On top of this, you should pick out a senior AME from this list. AND on top of that, research your AME. I found out my AME has been doing his work for over 30 years (and was a TWA pilot!)
  • If you find a reputable AME with a history of working with hard cases, there should be no issues scheduling only a consultation. You should bring ALL your medical records (Mine were 120+ pages) from the department you saw for ADHD checkups and medication issuance/changes (Usually department name is pretty close to Developmental and Behavioral Pediatrics). And I would also get that dehydration papers from your medical history too. They don't need to see every time you went in for a cold to your local doctor's office (unless you got severely sick and exposed a new diagnosis).
  • DO NOT fill out a MedXPress form. As previously stated, only schedule a consultation and bring your medical records. Your AME will look over your medical records and give you an idea of what you need to do.
  • If the AME you are seeing has been this for a while, they will be able to recommend you a good Neuropsychologist to see to administer the cogscreen. The cogscreen is mandatory for ADHD. There is no way you can have your diagnosis reversed without taking the cogscreen.
  • IF YOU LIVE on the east coast, tell your AME you would like to see Dr. Gary Kay in Washington D.C., he made the cogscreen program so he knows how to write the best report based off of your scores.
  • Once you finish, this report will be forwarded to you and your AME. You will schedule an appointment again with your AME and go in. If he sees that everything is good, he will take you to their computer and have you fill out a MedXPress form, then do a physical and eyesight test. If you pass the physical, he'll mark your medical request as being deferred and off it goes to Oklahoma City.
  • Now... cross your fingers. Well if your cogscreen scores were good, you shouldn't really need to worry, you'll most certainly get your medical issued. If you get a letter saying your medical request was approved, congratulations! If not, they will probably be asking for a psychological evaluation since they have concerns about your communication. This is only if your medical records report a history of communication problems and that your communication problems lasted for an extended period of time and never improved.

For the cogscreen, I prepared/assessed myself on whether I should continue by using PEBL 2.1. There are a slew of tests that you take for ADHD. I'll try to list as many of them as possible below and also send you the link to PEBL with the practice tests, though some tests aren't available on PEBL. The cogscreen looks like this (Page 2 and 3): http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.126.4724&rep=rep1&type=pdf

The tests listed below are what I took and the corresponding name in PEBL so you can practice
  • PASAT Paced auditorial serial addition test | PEBL pasat: This is hard to explain, so watch this video
  • (Backwards) Digit span | PEBL dspan: Numbers appear one at a time and remain on the screen for 1 second each. When the numbers are done appearing, you must type them backward.
  • Flagman/Manikin: You will see a man holding a flag. He could be facing towards you or away from you, and upside or right side up. You must determine which hand the flag is in from his perspective.
  • Symbol digit coding: Refer to the PDF linked above for a better explanation. Don't forget which symbols are assigned to which number. After about 2-3 tests later, you will be asked to remember which symbol goes with which number again.
  • Visual sequence: You will see to strings next to each other. They may be the exact same or different by 1 number or letter. You must respond as quickly and accurately as possible as to whether these strings are the same or different
  • Trails: Its like a game of scramble, you have A-Z 1-27 or A-F and 1-12 all scrambled out on the screen. You must tap each letter/number in order (A, B, C, D) (1, 2, 3, 4) or when you get the letters and numbers, tap each number to its corresponding position in the alphabet (1, A, 2, B, 3, C, 4, D, 5, E). After the cogscreen, give me a number and I can give you its corresponding letter via its position! Thanks, cogscreen!
  • Centerline triangle: You have a line that looks like a sea-saw and a triangle that moves to the left and right on the top of this seesaw. Pressing the arrow keys on the keyboard makes the triangle move in that direction. Your job is to make the triangle stay as close to the center as possible (refer to the PDF above)
  • Centerline: You will see a line moving up and down with red filling at the top and bottom of a circle. The line will move up and down sporadically and tease you when it gets close to the red. Once it touches the red, you click center and it will move the line back to the center (The other parts like the Same/Different and the strings at the top left and right are explained next https://www.pilotsofamerica.com/community/threads/cogscreen-ae-strategy-question.121786/)
  • Along with everything above, you will get dual-task sequences. This means you will get some of the smaller tests (like visual sequence) combined with the centerline tests. You will be required to use your nondominant hand to control the keyboard for the centerline tasks and your dominant hand to use the stylus and tap "same/different" or the other buttons associated with the small tests.
Additional tests that aren't on the cogscreen program
  • You must also be required to take the trails test on paper too to test your dexterity. This is actually kinda fun.
  • Verbal fluency: You will be asked to name as many words as possible that start with the letter "x" (The letter changes; you are asked 3 separate times with 3 different letters) in 60 seconds. This is kinda hard but a lot of people struggle with this, so don't worry. You will also be asked to read a list of words and must say them to determine your reading level and pronunciation
  • MMPI: Man this one's a b***h. 627 question personality tests. I can't describe the questions, they somehow pinpoint your mental stats. Take a look at the first 75 questions here to get an idea of what they look like. You can only answer "yes" or "no" to all of these questions. https://antipolygraph.org/cgi-bin/forums/YaBB.pl?num=1109032158/33#33

This seems daunting at first, and it took me a while to piece all the tests together but practice on PEBL and don't even worry about the MMPI. Try the tests at home first before you make a make a decision of whether you will go out and get your ADHD cleared. If you think you still have ADHD, then stick with a sport license. Once you apply for a medical if you get denied you are barred from getting a sport license.

Please message me privately if you would like to know more.

Pete


What on earth makes you think Sport Pilots don’t fly aircraft with thrust?
 
What on earth makes you think Sport Pilots don’t fly aircraft with thrust?
Yes that was my mistake. I was tired that night especially after writing the everything after (since I went back to add that at the end). I was thinking of a glider for some odd reason. My mistake thanks for catching
 
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I am still doing 3rd. I’m just rationing time spent on

Depression meds
Combined with alcohol
+PTSD
+”but I’m fine now”

.....because those are huge cases.....MONTHS long....

B

That's amazing news! I guess I misinterpreted your website. Sorry about that! I'll reach out shortly.

@MyDimeIsUp Thank you so much for your detailed response! Just having that information helps calm my fears, I really appreciate the time it took you to find the information, write it out, post it.
 
I couldn't find anything from the FAA for dehydration besides and article they posted letting us know about the effects of dehydration and how it affects pilots. Still take those papers to your AME as they will know if it will be of significance.
 
Hire Dr. Bruce Chien. Follow his advice TO THE LETTER. Otherwise, you may end up inadvertently stepping on an FAA “landmine” and will be in a more difficult situation than you’re in now.
 
Yes that was my mistake. I was tired that night especially after writing the everything after (since I went back to add that at the end). I was thinking of a glider for some odd reason. My mistake thanks for catching

Lots of good advice above so I will just add the following. Even if your ultimate goal is powered flight, learning to fly gliders is an excellent way to learn to fly and the time spent is can be credited to a private single engine land rating since you can do that as an add-on to your private certificate for gliders.

Learning to fly gliders is a great way to learn how a set of wings and controls behave in the air without distractions.

You can start on gliders and get your private without an FAA medical - must self certify you are safe but it sounds like you can do that.

And who knows, you might even enjoy soaring for its own sake -
 
Hire Dr. Bruce Chien. Follow his advice TO THE LETTER. Otherwise, you may end up inadvertently stepping on an FAA “landmine” and will be in a more difficult situation than you’re in now.

I absolutely intend to. I already contacted him, and he gave me some great first steps and advice on what I need to do.

I contacted all the Drs that I have seen regarding the ADHD and fainting, and my PCP to request my medical records, and I have set up a consultation with a cardiologist to get the necessary tests done.

I am also practicing for the cogscreen with PEBL and Lumosity, and plan on scheduling that once I get the full OK from the cardiologist. Although I am nearly 100% certain that there isn't a heart problem, there is no sense in spending 3K without knowing for sure that's the next step.

It looks like it's going to be along road ahead, but I am fully willing to give it all I can.
 
Hey all,

I just wanted to update this thread with what is currently happening. I have finally received most of my medical records, and am working on getting the rest (pediatrician and hospital admittance for fainting spell).

I found a few surprises in my old GP's, and my ADHD doctor's records that I wasn't expecting.

I am hoping that is it for the medical surprises. I have combed my brain backward and forwards to think of anything else that could pop up, and couldn't think of anything, so hopefully, this is it.

Also, in other news, I got my cardiologist's records from the fainting incident, and all turned out to be good. I have an appointment scheduled for a stress treadmill and a 24-hour Holter monitor in mid-July.

Thank you all for your help and support! I'll keep this updated as things progress.
 
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I feel bad for young folk who get labelled by a school by a non-doctor as having ADHD, seems when a child doesn’t follow what others are doing, the school is first to inform the parents to medicate them. Of course if the parents give in to advice by non medical personnel at their child’s school, going to a doctor with the story of the school will end up with the child being medicated without any testing, it’s like buying candy at a candy store, in & out.
 
One more update with much better news this time.

After the last update, things finally started falling into place after so much chaos. When getting all the medical records and starting out it seemed like every record brought with it another problem, but finally, there were no more records, and I could sort out the problems and tackle them one-by-one with the help of Dr. Bruce.

On the advice of Paul, I have removed most of the detailed info posted earlier, with the intention of updating after medical is received. But in general, I am going to be calling the FAA to try to get the process to move along a bit faster.

So far it has been nearly 10 months of work, and over $6,500 spent. I am happy to have everything finally submitted and the end (hopefully) insight!

Big thanks to Dr. Bruce and everyone else above. It's been a hell of a process!
 
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Good new psuedo, while I like the detail, personally I wouldn't post it, especially in such detail and before you get your medical. You just never know, and it's nobody's business. I'd stick with generic descriptions. Hope you get some good news soon.
 
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