Acute Anxiety with Emergency Room Visit - Complete Disqualifier?

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Hopeful_Future_Pilot

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Hi all,

I have read a lot about anxiety as it relates to medical certificates, but this seems a bit different from the ordinary situation. Curious if anyone has any experience or thoughts on this.

Summer of 2020, a parent died and another was diagnosed with cancer, while I moved halfway across the country in the middle of the pandemic. One night that summer, I woke up at 4 a.m. and felt like I was having a heart attack. Went to the emergency room, they checked everything, was diagnosed as a panic attack. They offered me a benzo and I declined. Followed up with PCP, took Lexapro and went to therapy for three months, then stopped therapy and Lexapro because the therapist and doctor agreed that it was no longer necessary. I am confident I can get a letter from my doctor saying I am stable and don't need medication; I haven't been in touch with the therapist for some time now, but could request it of her too.

I want to apply for first class medical. Is this a complete disqualifier? Considering whether I should try for it now, or wait the three years until I don't need to report the ER visit. I know I'll still need to report the diagnosis, but I'm just worried that the ER visit is particularly damning. Interested in any other thoughts or advice people have.

Thanks very much in advance for any help.
 
Welcome back, Dr. Lou!
 
Lou! Glad to see you back! Where ya been?

I’m guessing that the rumors of your demise were greatly exaggerated, but you know PoA..... :D
 
Last edited:
Hopeful_Future_Pilot said:
Hi all,

I have read a lot about anxiety as it relates to medical certificates, but this seems a bit different from the ordinary situation. Curious if anyone has any experience or thoughts on this.

Summer of 2020, a parent died and another was diagnosed with cancer, while I moved halfway across the country in the middle of the pandemic. One night that summer, I woke up at 4 a.m. and felt like I was having a heart attack. Went to the emergency room, they checked everything, was diagnosed as a panic attack. They offered me a benzo and I declined. Followed up with PCP, took Lexapro and went to therapy for three months, then stopped therapy and Lexapro because the therapist and doctor agreed that it was no longer necessary. I am confident I can get a letter from my doctor saying I am stable and don't need medication; I haven't been in touch with the therapist for some time now, but could request it of her too.

I want to apply for first class medical. Is this a complete disqualifier? Considering whether I should try for it now, or wait the three years until I don't need to report the ER visit. I know I'll still need to report the diagnosis, but I'm just worried that the ER visit is particularly damning. Interested in any other thoughts or advice people have.

Thanks very much in advance for any help.
Click to expand...

I'm not a doctor. I'm not even a damn pilot. But I know a lot about this process because my story is similar (though honestly more severe). I'm just now starting this process.

Like Dr. Lou said, you may need to undergo some further evaluation. However, here's what I've learned: the only way you to know what the FAA will want is to submit your application to them and see what they say. You will want to consult with an AME beforehand, and it is likely best to consult with a senior, HIMS trained AME due to the mental health aspect of your case. It is possible, however likely/unlikely, that the FAA could review your medical records, your diagnoses, and your treatment history and determine that it was simply a "bump in the road" and require very little follow up from you. That's not something you should count on, but it's something you could at least think of to maintain some optimism.

One thing you want to figure out beforehand is what your goal for aviation is. Do you want to fly as a career? Do you want to fly for fun? Do you want to fly to take your family places? Ultimately, you need to determine not only what class of medical certification you will need, but whether you need one at all. If your goal is to fly around in a little plane every once in a while, you might consider sport pilot certification. All you need for that is a valid driver's license. If your goal requires a medical certification, you need to be prepared for a potentially long, costly road toward a special issuance. In your case, though, I don't think you need to worry about the FAA denying your application. However, that will also depend on the rest of your medical history. Question 18 on the 8500-8 doesn't ask just for current medical issues, it asks for medical issues since the day you were born, effectively. That means that the BS ADHD diagnosis you received when you were 7 because you were a hyper kid could come back to bite you (not saying you had one, but you get my meaning). It's still not necessarily a full-stop disqualifier, but it is something you will have to disclose to the FAA regardless of how long it has been.

On that note, don't even consider for one second withholding anything from the FAA. Is is likely they will find out? No. Is it possible they will find out? Yes. Is it possible that if the FAA finds out you willfully omitted something from your medical certification application that you could face fines up to $250,000, up to 5 years in federal prison, and a complete revocation of any and all flight certifications/privileges you have with little to no chance of ever getting them back? YES. It's not worth the risk. Period. Be honest up front, deal with the red tape and jump through the hoops, and get everything squared away on the front end. In this case, it is MUCH easier to ask permission than ask for forgiveness.

Finally, I am sorry for your loss. I lost my mother to breast cancer last year and lost 2 grandparents to cancer and a heart attack not long before that. I know what it can do to you, because it destroyed me. The important part is that you put your health first. It's easy to regret doing so now that you know that your treatment will make things harder for you with the FAA, but don't think for one second that you did the wrong thing. Health always comes first. If you haven't gone already, I would highly recommend grief counseling. I also have a few other tips that will gladly share in a private message, so feel free to shoot one my way.

Good luck and stay safe.
 
BEFORE you submit your application for a medical, retain/hire Dr. Fowler (lbfjrmd in this thread) or Dr. Chien (www.aeromedicaldoc.com). They specialize in difficult or unusual medical situations for pilots. Follow the advice you get TO THE LETTER. Your best chance to navigate these waters is with one of these experts guiding you through the process.
 
Hopeful- A single episode of panic is insufficient to diagnose panic disorder. However one of the most common cause of panic in young men is actually.....excess use of alcohol and then being OFF
of it. You'll end up with a thorough evaluation and all this will wash out....

It doesn't mean you can't be a pilot but you now have a long road to travel.
 
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