3rd Class Medical Question

Beaker’s Flyin

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Beaker’s Flyin
I’ve read a lot of posts and it seems some are alike but many are different and require context.

In my case, I’m a relatively healthy person currently on a well controlled low dose hypertension protocol and can prove as such though a letter from my GP. However, over the years, I have developed situational anxiety related to commercial travel. My doctor would write a 3-6 pill prescription(Xanax .5 mg) for use “as needed for flying” as a prophylaxis to help me sleep and take the edge off not feeling comfortable.

Its been well over a year since I’ve flown, and don’t plan having it reissued going forward. It is not currently on any medication list. I’ve read it’s a very expensive uphill battle to get approval for use of such medications however I’m curious if the transient nature is any help in this matter.

Lastly, I was provided a script for an approved SSRI that was never filled and was prescribed in response to period over the past year that was resolved through talk therapy.

I started flying when I was young (19) and had no adverse medical history then however I had to stop due to money prior to being issued a medical certificate.

I’m now 44, and well, life has happened. What’s done is done, however in this case would it be a lost cause to pursue a class 3?
 
Well among the other issues the FAA will undoubtedly find in this one...documented anxiety over flying and looking to obtain a medical....to fly...might be cause for concern for the FAA.
 
My plan was to see if there were any medical issues that could result in a denial before committing the resources to train up to solo and ultimately be denied then.

In my early adult years, during the first few flights I would get queasy due to rudder misuse and during steep turns. As the flights continued, I would be anxious before hand which would exacerbate the queasiness. When I ran out of money, I was left with gift of getting anxious before flight regardless of the modality.

Many years had passed since I had logged time as a student pilot. After seeing my doc he felt what was happing was a situational anxiety and prescribed Xanax for commercial passenger flights.

I’m guessing at this point I will most likely go through the process to get with a school, get some hours under my belt and prove it’s not debilitating. I have flown successfully in the past without it, it was simply used to help sleep on flights. I know my word doesn’t mean squat but the medication isn’t used daily, or monthly, it’s only prescribed prior to travel which hasn’t happened in over a year.
 
Situational anxiety where the situation that causes the anxiety is flying? Frankly, I think your uphill battle with the FAA is going to be darned near vertical.
 

Appreciate the links.

I would guess that the FAA sees the script as “taken” even if it was filled but not taken? Meaning, I have script that has two refills, it was filled and never used. The script is still in the package staples from the pharmacy, none of the script had been consumed.

Not trying to be difficult but trying to understand from an FAA perspective what may be required for paperwork.


Appreciate the reply.
 
I'm glad @Half Fast and @RussS broached the subject.

"I take Xanax, but only when I fly." That will be quite the answer to:
Item 17.a. Do You Currently Use Any Medication (Prescription or Nonprescription)
 
Not trying to be difficult but trying to understand from an FAA perspective what may be required for paperwork.
You need to find a Senior or HIMS AME and do a consultation (not a medical application) in order to line up your ducks before you start the process, I suspect that the details will matter. Documenting that the scrip was unused should help.
 
Or go Sport Pilot. If your needs are limited to 2 seats and light baggage (50-ish pounds or less) and you don't need to get places in a big hurry... it's an option.
 
I'm sure other posts you've found the general pattern of things, but just in case, I would think about this from a few different directions:

First, the medications themselves. The FAA asks "Do you currently use any medication?" and then requires you to list them. In my understanding (though others may disagree), if you never took the SSRI, you don't have to list that. And if you no longer take the Xanax, especially if you no longer have a current prescription for it "as needed," I wouldn't list that either. That being said, assume that if you are investigated for any reason, those prescriptions will come up, and the burden will be on you to prove that they're not medications you currently use.

The bigger issue is that the FAA asks "Have you ever in your life been diagnosed with, had, or do you presently have . . . mental disorders of any sort; depression, anxiety, etc." If you've been prescribed Xanax for flying, there's very little chance your doc didn't diagnose you with (at least) situational anxiety and (at most) generalized anxiety disorder. Similarly, if you were prescribed an SSRI, you were probably diagnosed with some sort of depressive disorder, likely (just because it's easy to write down) major depressive disorder but maybe (if you were lucky) adjustment disorder with depressed mood, sometimes called "situational depression."

So let's take those in reverse order: The SSRI issue probably isn't a big deal. Depending on your AME, it might be easier or harder to satisfy them that this was a single episode not requiring pharmacologic treatment. But if you were able to do so, the guide for AMEs allows AMEs to issue medicals in the office to people with adjustment disorder or minor depression who have never required medications (or required medications for less than 6 months, and now have been off meds for 3 months). There are two other big potential "gotchas" here -- even if your AME approves and issues the medical, they send the records along to the FAA, which might turn around and say "wait a minute, the original diagnosis record said major depression, and now the AME is issuing for adjustment disorder; we need to look very deeply into this" which could cost both time and money. Finally, one thing to have in the back of your mind is that someone (the AME, the FAA, who knows) could say "wait a minute, this person was prescribed an SSRI and then didn't take it? Sounds to me like a patient with a psychiatric disorder who didn't follow through with prescribed treatment." While I'm sure we'd all agree that's a ridiculous framing, it only takes one person to think/say it before things become practically impossible.

Finally, as many others have said, the big/weird one is the anxiety/Xanax issue. Even if you don't have to report the Xanax, you'll have to report whatever anxiety diagnosis came with it. Tellingly, the little chart of things AMEs can issue doesn't include anxiety. One comment on anxiety in the AME guide says:
Although they may be rare in occurrence, severe anxiety problems, especially anxiety and phobias associated with some aspect of flying, are considered significant. Organic mental disorders that cause a cognitive defect, even if the applicant is not psychotic, are considered disqualifying whether they are due to trauma, toxic exposure, or arteriosclerotic or other degenerative changes.​

I suspect there's almost no way to get a medical with a history of anxiety requiring medication in situations related to flight. I say "almost" because the only way I could think of would be to spend many many thousands of dollars to prove that whatever anxiety you once had, you no longer have. But I don't know of any commonly offered way to prove that. Short of taking a test flight with the federal air surgeon while hooked up to vital sign monitors, I don't know how it would happen. Maybe someone out there does.

That leaves you with a few options:
1. BasicMed - mentioning first because it would be the most convenient, but probably doesn't apply to you. If you're 44 now (2021) and got your last medical when you were 19 (1996), it was probably good until 2001, which is still too early for the BasicMed cutoff of 2006. Edit: Just re-read your post and saw you were actually never issued a medical. So this option is out.
2. Sport Pilot - this is probably the big winner. You can look up the restrictions (2-seat airplanes with a speed and weight limit, day VFR only), but lots of people are very happy flying this way.
3. Gliders, balloons, ultralights or other "non-medical" options - These are out there too, and some "self-launching motor gliders" aren't much different than light airplanes.
4. Fly dual - maybe / probably not an option long term, but if you last flew when you were 18 and got anxiety around it and now you're 44 and don't know how you would feel about it, maybe fly several lessons just to see if you like it. Training hours could still go towards a sport pilot license later. Or, maybe you'll find that you don't have much use for a license, but want to take a "fly with an instructor or other pilot" fun splurge every once in a while.
5. Lie - I certainly don't advocate this, but you'll find people who say "just find an AME, don't tell them any of the above, and hope for the best." Let's be honest, you probably won't get caught for a good long while. When you do get caught, two things will happen: first, you'll lose your medical and all of your pilots' licenses. Second, and more important to some, your insurance policy will probably say "you're out of luck." So if the way you "get found out" is to bump into something with your plane, it will be incredibly expensive. There's also a possibility that the FAA will fine you or the DOJ will get interested enough to try to send you to jail, but that doesn't seem to happen unless there's something else going on.
 
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I'm sure other posts you've found the general pattern of things, but just in case, I would think about this from a few different directions:

First, the medications themselves. The FAA asks "Do you currently use any medication?" and then requires you to list them. In my understanding (though others may disagree), if you never took the SSRI, you don't have to list that. And if you no longer take the Xanax, especially if you no longer have a current prescription for it "as needed," I wouldn't list that either. That being said, assume that if you are investigated for any reason, those prescriptions will come up, and the burden will be on you to prove that they're not medications you currently use.

The bigger issue is that the FAA asks "Have you ever in your life been diagnosed with, had, or do you presently have . . . mental disorders of any sort; depression, anxiety, etc." If you've been prescribed Xanax for flying, there's very little chance your doc didn't diagnose you with (at least) situational anxiety and (at most) generalized anxiety disorder. Similarly, if you were prescribed an SSRI, you were probably diagnosed with some sort of depressive disorder, likely (just because it's easy to write down) major depressive disorder but maybe (if you were lucky) adjustment disorder with depressed mood, sometimes called "situational depression."

So let's take those in reverse order: The SSRI issue probably isn't a big deal. Depending on your AME, it might be easier or harder to satisfy them that this was a single episode not requiring pharmacologic treatment. But if you were able to do so, the guide for AMEs allows AMEs to issue medicals in the office to people with adjustment disorder or minor depression who have never required medications (or required medications for less than 6 months, and now have been off meds for 3 months). There are two other big potential "gotchas" here -- even if your AME approves and issues the medical, they send the records along to the FAA, which might turn around and say "wait a minute, the original diagnosis record said major depression, and now the AME is issuing for adjustment disorder; we need to look very deeply into this" which could cost both time and money. Finally, one thing to have in the back of your mind is that someone (the AME, the FAA, who knows) could say "wait a minute, this person was prescribed an SSRI and then didn't take it? Sounds to me like a patient with a psychiatric disorder who didn't follow through with prescribed treatment." While I'm sure we'd all agree that's a ridiculous framing, it only takes one person to think/say it before things become practically impossible.

Finally, as many others have said, the big/weird one is the anxiety/Xanax issue. Even if you don't have to report the Xanax, you'll have to report whatever anxiety diagnosis came with it. Tellingly, the little chart of things AMEs can issue doesn't include anxiety. One comment on anxiety in the AME guide says:
Although they may be rare in occurrence, severe anxiety problems, especially anxiety and phobias associated with some aspect of flying, are considered significant. Organic mental disorders that cause a cognitive defect, even if the applicant is not psychotic, are considered disqualifying whether they are due to trauma, toxic exposure, or arteriosclerotic or other degenerative changes.​

I suspect there's almost no way to get a medical with a history of anxiety requiring medication in situations related to flight. I say "almost" because the only way I could think of would be to spend many many thousands of dollars to prove that whatever anxiety you once had, you no longer have. But I don't know of any commonly offered way to prove that. Short of taking a test flight with the federal air surgeon while hooked up to vital sign monitors, I don't know how it would happen. Maybe someone out there does.

That leaves you with a few options:
1. BasicMed - mentioning first because it would be the most convenient, but probably doesn't apply to you. If you're 44 now (2021) and got your last medical when you were 19 (1996), it was probably good until 2001, which is still too early for the BasicMed cutoff of 2006. Edit: Just re-read your post and saw you were actually never issued a medical. So this option is out.
2. Sport Pilot - this is probably the big winner. You can look up the restrictions (2-seat airplanes with a speed and weight limit, day VFR only), but lots of people are very happy flying this way.
3. Gliders, balloons, ultralights or other "non-medical" options - These are out there too, and some "self-launching motor gliders" aren't much different than light airplanes.
4. Fly dual - maybe / probably not an option long term, but if you last flew when you were 18 and got anxiety around it and now you're 44 and don't know how you would feel about it, maybe fly several lessons just to see if you like it. Training hours could still go towards a sport pilot license later. Or, maybe you'll find that you don't have much use for a license, but want to take a "fly with an instructor or other pilot" fun splurge every once in a while.
5. Lie - I certainly don't advocate this, but you'll find people who say "just find an AME, don't tell them any of the above, and hope for the best." Let's be honest, you probably won't get caught for a good long while. When you do get caught, two things will happen: first, you'll lose your medical and all of your pilots' licenses. Second, and more important to some, your insurance policy will probably say "you're out of luck." So if the way you "get found out" is to bump into something with your plane, it will be incredibly expensive. There's also a possibility that the FAA will fine you or the DOJ will get interested enough to try to send you to jail, but that doesn't seem to happen unless there's something else going on.



wow, very detailed answer. I will not lie....so option 5 is out the window. I am considering option 2 after I consult with my primary MD and after a consultation appointment I just scheduled with a HIMS AME for March 12th to get some feedback.

My goal with all of this was to fly dual to see how I responded without meds and to also get some positive reinforcement while successfully taking lessons while not experiencing issues that lead me down this path. Having said that, option 4 would also work until I get my air legs under me. However, I know for a fact that regardless of what I feel, it’s something I would have wanted to pursue and rather than go the route of fly and guess, I’d rather know up front what is limiting for me as far as medical.

I know it seems strange, Xanax RX for flying and I want to fly. What’s even more interesting is the anxiety is more related to sensory conflicts experienced while flying and the resulting impact of making me feel ill. While flying commercially, I would end up getting wound up before the flight, as a former student pilot I was well aware of all phases of flight, all the noises, sensations etc yet when piled into a plane with other people, the thought of getting sick.

I was in the Air Force for 21 years, deployment flights were drug free, no issues reported, f-15 incentive ride was drug free (I was VERY green afterwards but didn’t hurl) however my experiences in GA aircraft weren’t the best in the world. Each time I flew with friends or an instructor lead to some feeling of mild motion sickness after my issues with coordination and steep turns. It didn’t help that when I did fly with others in GA, they would do things like stalls, and other maneuvers, akin to a joy ride that left a negative impression, hence the medicine for flight, but I guess that doesn’t matter in the eyes of the FAA.
 
but I guess that doesn’t matter in the eyes of the FAA.
Keep in mind that the FAA isn’t as interested in your personal experiences and accomplishments of the past (with or without meds), but what could happen should the underlying medical condition get the best of you and become a safety of flight problem.

Look up Andreas Lubitz and Germanwings Flight 9525 to obtain some background on how the FAA is thinking when it comes to psychological illnesses, properly declared or otherwise
 
Keep in mind that the FAA isn’t as interested in your personal experiences and accomplishments of the past (with or without meds), but what could happen should the underlying medical condition get the best of you and become a safety of flight problem.

Look up Andreas Lubitz and Germanwings Flight 9525 to obtain some background on how the FAA is thinking when it comes to psychological illnesses, properly declared or otherwise

I'll give it a look.
 
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