Approved for special issuance but lifetime monitoring... feeling really bummed out

Discussion in 'Medical Topics' started by Max P, May 3, 2021.

  1. Max P

    Max P Filing Flight Plan

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    Hi all, I am hoping for any advice or input from you all on this...

    TLDR: Haven't been seen for 15 years for a diagnosis I had as a young child, now (seemingly) have to be seen for the rest of my life every six months if I want to maintain my medical certificate.

    When I was around 7 or 8 I was diagnosed with OCD. I was on medication and being seen for it until I was 17. At age 17 I consulted the Doctor I was seeing and told them I no longer felt that I had any symptoms. We weaned me off of the already low dosage I was on and then I was seen another time or two in the following months to make sure that I was staying symptom free.

    Fast forward to today and I'm 32 and have never been seen for it since that last appointment, have had no symptoms, have never had anything OCD related at all in the last 15 years since that last appointment.

    The last year I've spent back and forth with the FAA trying to get my 3rd class medical certificate. I provided (literally) 600+ pages of all of my medical history down to every last cut and scrape I have ever been seen for.

    They required me to be evaluated by a HIMS certified Psychiatrist (cost $1,500) and finally a year later I got a letter saying that I have been approved for Special Issuance and it says this:

    "This authorization expires August 31st, 2025.

    At least 60 days prior to the expiration of your medical certificate, you must submit the following:
    - You will need to submit a current evaluation regarding your OCD every 6 months and performed by HIMS trained pyschiatrist."


    If I understand this text correct then I must be seen every 6 months for something I have not been seen for or medicated for over the last 15 years, is this correct? It's less important since aviation isn't exactly a cheap hobby, but this will also mean having to spend anywhere from $1-3k per year just to keep my medical certificate active. That's a decent amount of hours in the air.

    I would be ok with this decision if it was only to be seen to once every two years or something like that, but every 6 months really makes me question whether or not to go forward getting my PPL or not. This would become a commitment I need to constantly worry about having scheduled, making sure my HIMS psychiatrist gets things to them on time, etc.

    Do I have any other options? Is there any way to appeal this decision, or am I misunderstanding this letter? The confusing part to me is "At least 60 days prior to the expiration you must submit the following...".
     
  2. Stewartb

    Stewartb Final Approach

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    Say hello to BasicMed.
     
  3. av8orDave

    av8orDave Filing Flight Plan

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    Not an expert here, but... ask yourself:
    - Does the plane I intend to fly have a certificated take off weight greater than 6,000 lbs?
    - Do I plan to carry more than six occupants?
    - Do I plan to fly above 18,000 ft?
    - Do I plan to fly at greater than 250 kts?
    - Do I plan to fly for compensation or hire?
    - Do I plan to fly outside the US?

    If you answer no to all of the above, there is absolutely no reason to not go over to BasicMed.
     
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  4. Max P

    Max P Filing Flight Plan

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    For some reason I thought with BasicMed you could not fly with passengers? I've tried googling but not finding that restriction in my results.
     
  5. Stewartb

    Stewartb Final Approach

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    It’s pretty much a 3rd class equivalent. The only important restriction (to me) is Canada doesn’t recognize it. I maintained an SI medical with 6 month reporting requirements. I sure don’t miss it!
     
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  6. Capt. Geoffrey Thorpe

    Capt. Geoffrey Thorpe Touchdown! Greaser! PoA Supporter

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  7. Max P

    Max P Filing Flight Plan

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    Wow this is great information. I wish I had seen this a year and thousands of dollars ago. Oh well, we live and learn.

    BasicMed it is for me I suppose because I'm certainly not going to go through 6 month reporting for literally no extra benefit to me.
     
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  8. skier

    skier Line Up and Wait

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    I’m not an expert, so get confirmation from someone else. But my understanding is that to switch to Basic Med you’ll need to comply with your special issuance until that medical expires. Then you can switch to Basic Med.

    so you have a few years of testing every 6 months ahead of you, but you could then drop it.

    otherwise, let your medical get pulled and fly gliders, ultralights, or balloons.
     
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  9. Capt. Geoffrey Thorpe

    Capt. Geoffrey Thorpe Touchdown! Greaser! PoA Supporter

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    You have to get a medical before you can switch to basic med. So the only way to avoid the initial hoop jumping (and $ wasting) is Sport Pilot (or gliders (or hot air balloon (or part 103 ultralight))).
     
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  10. Lindberg

    Lindberg En-Route

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    There have been some posts to the effect that you have to make it to the end of your SI, but I haven't found reg support for that. Regardless, for the OP in this case, they seem to be coterminous (5 years for 3rd class under 40yo).
     
  11. Capt. Geoffrey Thorpe

    Capt. Geoffrey Thorpe Touchdown! Greaser! PoA Supporter

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    Some medical conditions require a one time special issuance. OP made it through that hoop.
     
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  12. Tommar98

    Tommar98 Pre-takeoff checklist

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    This is INCORRECT. As long as the SI is in effect (as it is now) he can switch to basic med before the SI expires. The language of the regulation is pretty clear that if an SI has been issued then you can apply for basic med. it does not require you reach the end of your 3rd class medical period. However IF the SI expires (as in he doesn’t complete the necessary steps to meet the 3rd class medical) then he’d have to start all over again.


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  13. bflynn

    bflynn Final Approach

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    If the SI is not maintained, the medical will be withdrawn. That will disqualify the pilot from BasicMed.

    sure, you can get BasicMed anytime now, but if you lose your regular medical then you become disqualified. It is not “switching” to BasicMed, they are two different systems. Getting BasicMed has zero impact on the rules for the 3rd class.
     
  14. Tommar98

    Tommar98 Pre-takeoff checklist

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    I’m confused by this explanation. Once the SI is issued he can apply for Basic Med. When he is on basic med (and he doesn’t send any tests results back for his SI in 6 months) the 3rd Class medical ends.


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  15. LesGawlik

    LesGawlik Pre-takeoff checklist

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    Is there any chance that Canada will recognize Basic Med/
     
  16. Stewartb

    Stewartb Final Approach

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    If you don’t comply with a 6-month requirement your medical cert isn’t valid but it isn’t withdrawn or revoked. At least that’s what I remember.
     
  17. Max P

    Max P Filing Flight Plan

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    Wow lots of great information in here, you've all given me a token of hope and I am grateful for it.

    If I understand this correct what you are saying is that once I get BasicMed if I do not maintain the 3rd class qualifications then that will expire. But this would still leave me with my end goal of BasicMed, right? Or are you saying that if I do not maintain my 3rd class that it would also expire my BasicMed?
     
  18. Tommar98

    Tommar98 Pre-takeoff checklist

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  19. bflynn

    bflynn Final Approach

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    What I'm finding challenging is determining, via regulation, what happens to your medical if you fail to comply with the instructions of the special issuance. If you don't provide the reports, you will receive a letter of withdrawal invalidating your SI authorization and 67.401 says your medical will be "invalidated". My understanding has always been that the FAA would withdraw the medical and the pilot would become ineligible for any flying.

    Unfortunately for us, "invalidated" is not a medical status. Does your medical become revoked, suspended, withdrawn, or merely expired? The first three cause the pilot to become ineligible for BasicMed, the fourth is benign.

    Your SI is in effect until 2025. If you fail to provide the periodic compliance reports they want to see, things do not just quietly go away.

    Does your letter of authorization for your SI say that you are required to comply?
     
  20. bflynn

    bflynn Final Approach

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  21. Warmi

    Warmi Pre-takeoff checklist

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  22. bflynn

    bflynn Final Approach

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    I believe if he doesn't send in the required SI information, the medical becomes withdrawn. I cannot verify what happens anywhere in regulations.

    However, when the medical expires, then you're no longer required to comply with the SI. The FAA can only require you to provide them with information they need to make a decision about your medical, so if your medical is expired and you haven't made a new application, they have no valid cause to ask. Furthermore, they cannot do anything to an expired medical, it's dead.
     
  23. clear_prop

    clear_prop Pre-takeoff checklist

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    This to me reads like you just have to meet with a HIMS psychiatrist and have them write up "he doesn't have OCD", not do the full HIMS testing deal. If so, that should just be an office visit fee, not the full $1,500. Still ridiculous to do it every six months, but that's the FAA.

    I'm not a doctor, but I have an SI for sleep apnea and after the initial huge pile of documents, I just have to submit a statement from my sleep doctor every year that I'm using my machine and my stats are good.
     
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  24. JimBirk

    JimBirk Filing Flight Plan

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    It appears that this is confusing to mere mortals like PoA members! ;)

    Are you seeing a HIMS AME for your third class medical? If so, I would ask the HIMS AME what the above quoted requirement means. Hopefully our wonderful HIMS AMEs (@bbchien or @lbfjrmd) can stop by to decipher that for us.

    I think the question is, if you plan to switch to BasicMed and have no desire to renew your third class medical: do you need to send the HIMS psychiatrist report to the FAA 60 days before your cert expires? If your current medical certificate requires that psychiatrist visit to keep it valid until it expires, then you probably need to do the psychiatrist visit. If psych doc visit is only needed for your renewal of a new third class cert, you probably don't have to do it.

    Basically, from what I have read on this forum in the past, it appears that one's goal for being able to switch to BasicMed is to do whatever it takes to keep your current six-month third class medical certificate valid until it expires on the exp. date on the medical certificate. You don't want the FAA to revoke it, or you will not be able to do BasicMed.

    I'm just some guy on the internet only offering food for thought--so this is all guessing on my part. Someone with info from the FAA will need to give the real answer.

    Good luck!
     
  25. Stewartb

    Stewartb Final Approach

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    I’d call AOPA medical assistance and talk to them. Back when I got my first SI that’s exactly what I did. I’ve maintained that membership as a result of their help. Don’t let the system best you!
     
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  26. Salty

    Salty Final Approach

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    I believe @Half Fast is in a similar situation, maybe he can explain.
     
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  27. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    I suspect his medical is marked "not valid for any class" after the 6 month period. It will expire just fine.
     
  28. OneCharlieTango

    OneCharlieTango Pre-takeoff checklist

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    I think the restrictions on your medical don’t apply once you’re under BasicMed. That’s the whole point. But it’s certainly possible that I have it wrong. Fortunately, AOPA has experts who’ll talk to members for free.


    Cue the anti-AOPA crowd. . . .
     
  29. Max P

    Max P Filing Flight Plan

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    Looks like I have some more digging to do. I will be contacting my AME as a starting point as the language in my letter is confusing enough to understand even if I did want to comply and not move to BasicMed. Oddly enough it says that my certificate expires on August 31st of 2021... meaning they just finally issued it and now it will expire in three months. The authorization itself expires August 31, 2025. (I'm assuming this means the SI authorization.)

    After reading these comments it seems there is some ambiguity, but that if it does expire in August of this year that could be a good thing because if I can switch to BasicMed before that date then I will not be out of compliance if I let it expire without sending in the 6 month reporting requirements I have.

    Hoping to have a chat with the AME today but I have a suspicion I'll have to make an appointment and see him in person.
     
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  30. Stewartb

    Stewartb Final Approach

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    I wouldn’t recommend an AME as the best source for the info you’re seeking.
     
  31. Matthew

    Matthew Touchdown! Greaser!

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    Not much I can add to the rest of your questions: FAA medical runs pretty far behind the rest of the world. Sounds here like they want to see your paperwork at least 60 days before expiration so they have time to review it and get back to you.
     
  32. DaleB

    DaleB En-Route

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    The fuse is already lit on the SI & medical, so flying with Sport Pilot privileges requires the same thing as Basic Med for the purposes of this exercise -- the OP's medical certificate must not be revoked, suspended, or withdrawn. It can just expire.
     
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  33. Max P

    Max P Filing Flight Plan

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    AOPA then?
     
  34. Stewartb

    Stewartb Final Approach

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    See my post about 9 posts up. AOPA helped me when I wasn’t sure how do navigate the SI process.
     
  35. JimBirk

    JimBirk Filing Flight Plan

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    I'm tending to agree with Matthew at this point. Because it seems like you didn't need an HIMS AME to get this SI, the sixty days is probably needed by the FAA to give them time to renew your certificate before it expires.

    In addition to AOPA, you might want to try contacting Dr. Bruce Chien (a HIMS AME), via his website at http://www.aeromedicaldoc.com. Click on the site's "How to Start" link, and briefly describe your situation about the dates and that you want to move to BasicMed. Last I checked, he answers web questions free of charge! Dr. Bruce (a PoA member) is excellent, and you will get great and correct advice from him about how to proceed.

    REMEMBER: Moving to BasicMed after receiving an SI requires one to be treated by a medical specialist for the medical issue that triggered the need for a SI. I'm thinking that a psychiatrist might be needed in your case because you needed to see a HIMS psych to get the SI. This might mean that you need to hire a board certified psychiatrist (the psychiatrist does NOT need to be a HIMS psychiatrist) to see you every so often so that you can comply with 14 CFR § 68.9(c)(2). Also, you will likely need to get a BasicMed physical every 2 years instead of every 4 years. Here's the regulation:

    14 CFR § 68.9(c)
    (2) Subject to paragraph (c)(1) of this section, an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that mental health condition.​

    Don't ask me how I know all of this stuff. ;)
     
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  36. Max P

    Max P Filing Flight Plan

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    Update:
    I joined the AOPA to try and get advice about all of this.

    I briefly explained the situation and the gentleman explained that if I switch to BasicMed that I'm no longer operating under a medical certificate. I do not need to worry about any of the special issuance requirements or keep anything active. Once you're under BasicMed you're operating under that and nothing else is how he explained it.

    He did seem a bit rushed (perhaps I picked a bad time to call around lunch time).

    So to me it sounds like I can get BasicMed and basically forget about the rest according to him as long as I follow the rules of BasicMed like reporting if I were to be seen for some new mental health issue or anything like that.
     
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  37. bflynn

    bflynn Final Approach

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    This isn't true. What happens in Part 68 (BasicMed) does not change Part 67 medicals. The two are separate systems and you can have both at the same time. If you do, you must comply with both.

    Again, I don't believe this is true.

    The entire issue is around the Part 67 medical. When you get BasicMed, your 3rd class and the SI don't just go away. If your medical expiration date is not at the 6 month point and you don't send in the 6 month test, then the FAA can/will withdraw your medical and you become ineligible for BasicMed.

    Once your medical expires, then the SI no longer holds any force because they can only ask for testing for a valid reason - no medical, no reason. So, if your medical does expire at the six month point, then you're free of it and the SI, just like you would be if you decided to quit flying.

    If I'm missing a regulation, someone please tell me. I'd be very happy to be wrong about this, but I can' t find a reason I would be.
     
    Last edited: May 5, 2021 at 11:31 AM
  38. hindsight2020

    hindsight2020 Final Approach

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    That's exactly the case here. His medical is due to expire in 3 months. The SI letter had some notional expiration date well into the future (2025). But as you point out, that becomes moot in 3 months, which was the OP's concern (having to comply with some SI kabuki all the way to 2025 just to protect his basicmed continued eligibility, even after his 3rd class would have been long expired).

    So in 3 months he's home free under basicmed. Do whatever the FAA wants for the 3rd class and SI up to the expiration of the medical, then ghost that whole certified mess.
     
  39. bflynn

    bflynn Final Approach

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    I have missed that it expires at the end of August - I am "sometimes" an impatient reader.

    I agree, on Sept 1, the SI doesn't expire, but also doesn't have any force and the OP should be clear for BasicMed.
     
  40. Max P

    Max P Filing Flight Plan

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    Update:

    I scheduled the BasicMed physical today and just got home.

    Long story short I started flying when I was around 18 years old (2007). I applied for my 3rd Class Medical around 19 (2008) and then being the stupid teenager I was I apparently got some letters from the FAA about seeing a HIMS Psychiatrist back then and ignored the letters, did the whole college thing and stopped flying (lack of funds).

    Now 14 years later I decided to start the journey over again and this time I decided to get the Medical Certificate out of the way before I start.

    Today the HIMS certified AME I saw said he can't pass me for BasicMed because I previously had the denial from the FAA around 14 years earlier.

    Is there anyway I can appeal this to the FAA? The denial 14 years ago wasn't because I had a medical reason to be denied, it was because I was a dumb broke college kid. Am I stuck now with having to report every 6 months?

    I called the HIMS Psychiatrist I saw to get the Special Issuance and he wants $800 per appointment every 6 months which then gets forwarded to the HIMS AME that wants another $250 to send that on to the FAA. I believe they want me to renew my medical yearly which would add another $250 on to that yearly total... ~$2,350 gets me a decent amount of hours in a 172. $23,500 every 10 years to just maintain a medical certificate seems kind of ridiculous.

    To make matters worse the letter I received specifically calls out me being seen by this specific HIMS Psychiatrist. I could live with going and seeing someone local every 6 months and telling them "no I still do not have OCD from nearly two decades ago", but this Psychiatrist is a 4 hour round trip for me.
     
    Last edited: May 6, 2021 at 12:57 PM