SSRI Basic Med

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Why is it that Oklahoma City claims when contacted that SSRI use for depression on Basic Med requires a special issuance medical first?

14 CFR 68.9 does not list Depression, Anxiety, or SSRI use as a disqualifying condition for Basic Med.

The folks at AOPA seem to think it doesn’t require a special issuance. I just don’t want to get violated if RX records and Basic Med were to be checked and compared (think Operation Safe Pilot).

What is the true answer since none of this seems to be covered in 14 CFR?
 
If it’s your first time applying for basic med and you do not have a previous special issuance, Any condition that requires a special issuance for a third class medical will require a special issuance for basic med. If you had a special issuance within the last 10 years u would not require another one.That’s my understanding.
 
If it’s your first time applying for basic med and you do not have a previous special issuance, Any condition that requires a special issuance for a third class medical will require a special issuance for basic med. If you had a special issuance within the last 10 years u would not require another one.That’s my understanding.
This is wrong in several ways.

There are lots of things that require special issuances that do not affect basic med eligibility. The only things that matter are SPECIFIC mental health, neurologic, or cardiac disorders listed in the reg.

Ten years also has squat to do with ANYTHING. The ten year requirement is that you have had to have held a medical from ten years from the date the REGULATION WAS ENACTED.

If you have one of the listed disqualifying conditions, you MUST get a special issuance before using basic med EVEN IF YOU HAD A MEDICAL OR SPECIAL ISSUANCE IN THE PAST.

Depression and prescribed SSRI use is NOT disqualifying for basic med. Here are the restricted mental disorders:

A mental health disorder, limited to an established medical history or clinical diagnosis of any of the following: 1. Personality disorder that is severe enough to have repeatedly manifested itself by overt acts. 2. Psychosis, defined as a case in which an individual: • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis. 3. Bipolar disorder. 4. Substance dependence within the previous 2 years, as defined in part 67, § 67.307(a)(4).
 
If it’s your first time applying for basic med and you do not have a previous special issuance, Any condition that requires a special issuance for a third class medical will require a special issuance for basic med. If you had a special issuance within the last 10 years u would not require another one.That’s my understanding.
BasicMed only requires an SI for the conditions listed in 14 CFR 68.9.

https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-68/section-68.9
 
Why is it that Oklahoma City claims when contacted that SSRI use for depression on Basic Med requires a special issuance medical first?

I suspect the reason is that they are focused on their world, which is FAA medicals and their answer is in that frame of reference. They are asked about SSRI and response it needs an SI. That doesn't apply to Basicmed.

Presuming you otherwise qualify for Basicmed, you're good here.
 
Depression and anxiety can cause warpage of reality testing and frequently do. So if you go the scofflaw route, make sure you have something in writing from a medical authority that you "Cannot reasonably be expected (section A(ii):

(A) IN GENERAL.—In the case of an individual with a clinically diagnosed mental health condition, the third- class medical certificate exemption under subsection (a) shall not apply if—
(i) in the judgment of the individual’s State- licensed medical specialist, the condition—
(I) renders the individual unable to safely per- form the duties or exercise the airman privileges described in subsection (a)(8); or
(II) may reasonably be expected to make the individual unable to perform the duties or exercise the privileges described in subsection (a)(8); or
(ii) the individual’s driver’s license is revoked by the issuing agency as a result of a clinically diagnosed mental health condition.

Licensed medical specialist means psychiatrist. Get it in writing. The intent of congress was PSYCHIATRIST (MD specialist for mental health). If he gives you the go ahead- then go ahead. And No your family APRN does not count.

The reason I quit being AOPAs medical advisor is that AOPA does this all the time. It's just inaccurate and self serving.
 
I believe the doctor is trying to point out that a SSRI could render you unable to make a rational judgement under 61.53...might be wrong about that.

Whether or not that is true is between the airman and his primary care physician, the FAA has made it pretty clear they are not part of that relationship.

Dr Chien, there's nothing I see in the basicmed law requiring a psychiatrist to be involved. If I'm missing it, please point me at it. 67.100/200/300 are interesting, but not regulatory for basicmed.
 
Akiss said:
Using basicmed is being a scofflaw? It is literally *the law*. OP is trying to understand how to properly follow *the law*. Jeez....
My quote is from the enabling congressional legislation. Basic is not a license to disregard medical conditions. Depression can be anything from "the PCP thinks you are unduly blue" to, depression that interferes with congnition and decision making. The INTENT of the legislation was ito insure that a Psychiatrist opines.

He can sure simply say, "hey this is not a problem" and if he can convince the unwitting doc into signature he wins. And we all lose. My point is that he has to get a qualifed opinion "that his condition can be said is NOT reasonably be expected to make the individual unable to perform the duties or exercise the privileges" and it be a qualified doc- not "hey I am fine".

Doing what AOPA advocates and what the OP is considering deos leave his estate wide open to the plaintiff's attorney, and scoffs at the intent of the legislation. Basic med is not "open season on psychiatry conditions".
 
I believe the doctor is trying to point out that a SSRI could render you unable to make a rational judgement under 61.53...might be wrong about that.

Whether or not that is true is between the airman and his primary care physician, the FAA has made it pretty clear they are not part of that relationship.

Dr Chien, there's nothing I see in the basicmed law requiring a psychiatrist to be involved. If I'm missing it, please point me at it. 67.100/200/300 are interesting, but not regulatory for basicmed.
So, who would be the state licensed specialist for mental health? A primary card doc? YGBSM, That's laughable: he's NOT a specialist! See post addressed to Akiss, as well.
 
Personal doctors aren't specialist in a lot of tasks, but they are the legal authority to sign the basicmed form. Legal and smart frequently don't overlap in aviation.
 
Personal doctors aren't specialist in a lot of tasks, but they are the legal authority to sign the basicmed form. Legal and smart frequently don't overlap in aviation.

Good thing you’re here to set Dr. Chien straight on all this SSRI and mental health stuff. I mean, hey- what would he know about it? It’s not like he had anything to do with establishing the pathway to obtain a special issuance for these things…. Oh, wait.

Bruce, your work is truly appreciated by so many aviators. Please don’t let a handful of goofballs around here discourage you from continuing to help others. PoA has turned into a dumping ground for unhappy souls to unload on strangers in an attempt to self-medicate their ills.
 
Hey, I share your respect for Dr Chien - he is the reason I am still a pilot. IMO, he is the #1 AME in the country.

When it comes to part 68, regular faa medical rules and standards don't apply,. The other point is 61.53, which is entirely on the airman. I agree the airman could be taking a drug that impairs their ability to make a rational decision, but that isn't a basicmed issue.

To my knowledge, there's no SSRI requirement in Basicmed. Of the quoted text, (ii) refers to a revoked driver's license, section (i) does not apply.
 
Doing what AOPA advocates and what the OP is considering deos leave his estate wide open to the plaintiff's attorney, and scoffs at the intent of the legislation. Basic med is not "open season on psychiatry conditions".

Bruce, I appreciate you highlighting this nuance of Basic Med. I hadn't noticed that before (didn't have a personal need to read much into that section). However, I think you are unfairly categorizing the OP here. He came here to ask the question because he didn't trust AOPA's answer. He specifically said he didn't want to be violated down the road for not doing the right thing up front. According to the OP's post, OKC didn't provide him the correct answer either.
 
Personal doctors aren't specialist in a lot of tasks, but they are the legal authority to sign the basicmed form. Legal and smart frequently don't overlap in aviation.
If a non-specialist signs the form without a specialist having made a determination on the matter, it would appear that the section of the law that Dr. Chien quoted would not be complied with. That would imply that operating as PIC would not be legal.
 
Are you referring to their telling him that he needs an SI for this condition?

Yes. My understanding of what Bruce wrote is that for Basic Med, if a specialist confirms the patient's condition for this diagnosis doesn't constitute an undue risk (this isn't exactly how it is phrased), then an SI would not be needed. TBF, I tried connecting the dots on this reading the CFRs, and the connections aren't well referenced.
 
Despite Dr. Chien's personal opinions of what constitutes safe and effective aviation, the regs are quite clear. Any clown who qualifies as a state-licensed physician can sign off basic med no matter what the conditions provided it isn't enumerated in the list of conditions that require an SI first.
 
Ron, it does say specialist.......or do you just read the convenient parts?
And who would the specialist for depression be.....?
 
Ron, it does say specialist.......or do you just read the convenient parts?
And who would the specialist for depression be.....?

Dr. Chien, I am not read up on the underlying law or the relevant FAA interpretations on CFR’s.

However if there is an absence of a defined definition narrowing it down to a psychiatric specialist in the relevant law/CFR’s, then, potentially a legitimate case could be made to view it as a legislative loophole.

Take commercial driver’s licenses, DOT has a medical procedure that must be passed, but they include chiropractors as authorized to sign off for medicals. Does that make any sense to anyone here? Do we truly believe a chiropractor is qualified in addressing those physicals and not just signing off for a appointment fee, regardless of whatever basic training DOT gave them?

https://www.nbcnews.com/id/wbna39383366
https://www.fmcsa.dot.gov/faq/who-can-serve-medical-examiner-and-perform-dot-physical-exams

From personal experience I can attest to, in the firearms business we do with this all the time. A good example would be bumpstocks, it increased the rate of fire to near that of a machine gun, any average person off the street uninformed on the specifics of how it worked probably would call it a machine gun, but technically it doesn’t meet the statutory definition. And in all likelihood the 2019 ban will be struck down eventually at scotus due to a circuit split.

https://firearmslaw.duke.edu/2021/0...-circuits-and-invalidates-the-bump-stock-ban/
(Granted it will be appealed and heard en banc ).

Is it unethical? Probably. However if they made the statue too vague then that’s their fault. I have little sympathy for the FAA for keeping their psychiatric medical policy looking like it was copied from the 1950s. If OP can otherwise safely conduct their duties on a single SSRI, then I’d say try it.

Personally I’d love to flip the proverbial bird and have a chiropractor or licensed massage therapist attempt to sign off, “Tension headaches were negatively affecting my sleep, which was causing my ADHD to get worse”/s (Not that my psychiatrist wouldn’t sign off for me).
 
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If the pilot is clinically diagnosed with a mental health condition - which you would have to be to have a prescription - then every 2 years, the pilot certifies that they are under the care of a state license medical specialist. The specialist themselves does not certify anything and the FAA is not part of that relationship. The certification is part of the medical education course

Reference, Federal Register, vol 82, #7 dated Jan 11, 2017, pp 3159-3160

The FAA is implementing section 2307(e)(3)(A)(i)–(ii) in § 68.9(c)(1)(i)–(ii). Section 2307(e)(3)(B) of FESSA requires that an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certifications under subsection (c)(10)(C), that the individual is under the care of a State licensed medical specialist for that mental health condition. The FAA is implementing this requirement in § 68.9(c)(2). This certification will be incorporated into the medical education course process. ...

So thank you to Dr Chien for pointing out the subtlety, I learned something today. For the OP, in terms of being qualified, you're good for BasicMed
 
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