"Panic Disorder" probable misdiagnosis, no meds/followup. Problem?

[scitofly]

I'm looking to get my Class 1 soon. I was reviewing my old charts to make sure there were no surprises. I remembered that 4 years ago I told a PCP at an annual physical that I had had a few panic attacks in a month, so I pulled that chart, and of course he wrote "Panic disorder (episodic paroxysmal anxiety) (ICD-10: F41.0)." I literally haven't had a problem before or after this one month. He wrote that he referred me to "Behavioral Health" but I never had an appointment there, never had any meds, never talked about it again.

Will this present any issue? I'm hoping to get issued in-office and not get deferred and do any expensive follow up. I'm confident I could get a letter from my current PCP that I do not have "Panic Disorder."

I appreciate your thoughts!

 

[Daleandee]

Hopefully Doc @bbchien will be along shortly. I know nothing but I'm thinking that diagnosing you with Panic Disorder & giving a referral to Behavioral Health might have put you on the merry-go-round ... . Hopefully not!

 

[bbchien]

What records do you possess?
From what level practitioners?
You need them ALL.
For heaven's sake what's on your 10 year phamracy dispensed printout (from the vendor)?

PANIC disorder is NOT on the Fast track pathway. no be caught beating your chest and saying "but I'm okay, now!". They're not going to accpet such testimony from an applicant forwhom anybod with a liscense "sez it's so".

 

[scitofly]

What records do you possess?
From what level practitioners?
You need them ALL.
For heaven's sake what's on your 10 year phamracy dispensed printout (from the vendor)?

PANIC disorder is NOT on the Fast track pathway. no be caught beating your chest and saying "but I'm okay, now!". They're not going to accpet such testimony from an applicant forwhom anybod with a liscense "sez it's so".

Thanks for your reply!

This was the first time I've seen a doctor since my pediatrician. He is a family medicine PCP. Not sure if I can get a hold of my pediatrician records, but they 100% don't say anything about mental health. I've had one recent annual physical since with another PCP, also doesn't say anything about mental health.

My pharmacy record is literally nothing but antibiotics for routine illnesses, and one time oxycodone from getting my wisdom teeth out 2 years ago.

That's it. I've never seen any doctor or clinician but my pediatrician, those 2 PCPs, and my dentist.

 

[bbchien]

You're going to need a forensic psychiatry consult to get anyplace with the FAA.

 

[UTLonghorn_1979]

Thanks for your reply!

This was the first time I've seen a doctor since my pediatrician. He is a family medicine PCP. Not sure if I can get a hold of my pediatrician records, but they 100% don't say anything about mental health. I've had one recent annual physical since with another PCP, also doesn't say anything about mental health.

My pharmacy record is literally nothing but antibiotics for routine illnesses, and one time oxycodone from getting my wisdom teeth out 2 years ago.

That's it. I've never seen any doctor or clinician but my pediatrician, those 2 PCPs, and my dentist.

 

[UTLonghorn_1979]

Is it possible to have the Dr amend the diagnosis to situational or panic disorder with a specifier? Does that matter? We don’t have much to go off here but if say the panic attacks were related to a specific life event during that month vs walking around randomly having panic attacks?

Does having a few episodes substantiate a life long diagnosis? Or does it not matter since “it was written down?”

 

[Lindberg]

You need to find a "hard case" AME and go in for a consult. If the AME you call doesn't do consults, he's not the right one. Do what he tells you to do, and do not submit anything to the FAA until you both are confident the FAA will issue your medical certificate.

 

[scitofly]

Is it possible to have the Dr amend the diagnosis to situational or panic disorder with a specifier? Does that matter? We don’t have much to go off here but if say the panic attacks were related to a specific life event during that month vs walking around randomly having panic attacks?

Does having a few episodes substantiate a life long diagnosis? Or does it not matter since “it was written down?”

The month was a couple months after starting my PhD and moving across the country. I was also eating terribly and not exercising. Once I sorted those things out I never had a problem again.

Guess it doesn't matter to the FAA though. I had no idea I'd be trying to become a pilot back then, serves me right for talking to a doctor I guess.

 

[bbchien]

Two panic attacks is sufficent for the diagnosis of panic disorder. FAA will wnat to know the current state of that disorder, and will demand a psychiatrist's "take" on the situation....

 

[Lindberg]

The month was a couple months after starting my PhD and moving across the country. I was also eating terribly and not exercising. Once I sorted those things out I never had a problem again.

Guess it doesn't matter to the FAA though. I had no idea I'd be trying to become a pilot back then, serves me right for talking to a doctor I guess.

So I've gotta ask, what is it you think the FAA should do different in this situation? Should they take your word for it that you're recovered?

 

[scitofly]

So I've gotta ask, what is it you think the FAA should do different in this situation? Should they take your word for it that you're recovered?

No, but I think they should be able to see there's no prior history, no medication, no follow up for 4+ years, current physician says there's no ongoing problem, old diagnosis technically doesn't even meet the DSM-5 criteria for panic disorder, which says it must be ongoing for greater than 1 month.

Imo the medical judgement of my current PCP and the AME, based on this evidence, should override a 1 off billing code.

 

[Clip4]

I'm looking to get my Class 1 soon. I was reviewing my old charts to make sure there were no surprises. I remembered that 4 years ago I told a PCP at an annual physical that I had had a few panic attacks in a month, so I pulled that chart, and of course he wrote "Panic disorder (episodic paroxysmal anxiety) (ICD-10: F41.0)." I literally haven't had a problem before or after this one month. He wrote that he referred me to "Behavioral Health" but I never had an appointment there, never had any meds, never talked about it again.

Will this present any issue? I'm hoping to get issued in-office and not get deferred and do any expensive follow up. I'm confident I could get a letter from my current PCP that I do not have "Panic Disorder."

I appreciate your thoughts!

One reason aviation has a medical requirement is so people with untreated medical issues aren’t flying planes with unsuspecting passengers on board.

And no, your PCP can’t magically certify you didn’t have the panic attacks you reported to another doctor.

 

[Half Fast]

Guess it doesn't matter to the FAA though. I had no idea I'd be trying to become a pilot back then, serves me right for talking to a doctor I guess.

Try to see things from the FAA's point of view. You yourself stated that:

...I told a PCP at an annual physical that I had had a few panic attacks in a month,...

and that

The month was a couple months after starting my PhD and moving across the country.

Now, on top of that, a licensed practicing physician has documented that you have a panic disorder and he signed his name to that.

With those things to go on, the FAA has every reason to believe that, when presented with another stressful situation (like an in-flight emergency), you might have another panic attack. A panic attack while piloting an airplane has a good chance of causing a fatal crash.

I will note that, while starting PhD work and moving across the country can certainly be stressful (and your attacks actually came months later), they're hardly life-threatening and the stress should be trivial compared to what you'll experience in a truly life-threatening flight emergency.

You do have an opportunity to prove the FAA's belief to be wrong, but their position is actually quite reasonable, and if they're in error they have erred on the side of caution.

The onus is on you to prove there's nothing to worry about.

 

[Lindberg]

No, but I think they should be able to see there's no prior history, no medication, no follow up for 4+ years, current physician says there's no ongoing problem, old diagnosis technically doesn't even meet the DSM-5 criteria for panic disorder, which says it must be ongoing for greater than 1 month.

Imo the medical judgement of my current PCP and the AME, based on this evidence, should override a 1 off billing code.

If the FAA allowed take backs, then no one would have anything in their medical history. A licensed medical professional after hearing your complaints in history, diagnosed you with a condition. If you didn't have that condition at the time, then your issue is with the licensed medical professional, not the FAA.

 

[Tools]

Why would a doctor just accept your word stating “I had a few panic attacks”?

Wouldn’t a panic attack disorder have other tangible things to notice?

Is it then too late to say “well, I don’t know the medical definition of a panic attack not being a doctor and all, maybe I was wrong”?

And doesn’t proper training, generally required in airplanes, not usually provided for many life events, mitigate the possibility of having one due to a flight related situation?

 

[Tools]

…. A licensed medical professional after hearing your complaints in history, diagnosed you with a condition. …

That alone would make me question “the licensed medical professional.”

The FAA does allow take backs. Some days I decide I’m too sad to go flying. Then later that day, I decide I’m no longer too sad to go flying, and I go. This is the self certification we do EVERY FLIGHT, and not as a “licensed medical professional.”

The OP may not be fit to fly. But I don’t think what some random “licensed medical professional” says once has any bearing on it. What type of training in that venue does he have? Does the faa even bother to check the quality of that report? Of course not, but worse, they don’t allow you to point its deficiency out… that’s wrong. It ain’t an overabundance of caution, it’s just wrong.

 

[Lindberg]

That alone would make me question “the licensed medical professional.”

And he might question your competence as a pilot. So what?

The FAA does allow take backs. Some days I decide I’m too sad to go flying. Then later that day, I decide I’m no longer too sad to go flying, and I go. This is the self certification we do EVERY FLIGHT, and not as a “licensed medical professional.”

Nonsensical hyperbole doesn't advance your argument. "Sad" isn't a condition that makes you unable to meet medical certification requirements. However, if you decided that you were clinically depressed or suffering from panic disorder, you would have to disclose that. And then you couldn't just take it back if you changed your mind.

The OP may not be fit to fly. But I don’t think what some random “licensed medical professional” says once has any bearing on it.

I guess that's what Sport Pilot is good for. But the OP wants a medical certificate, and what some "random" doctor actually treating him (so not remotely random in any way) diagnosed him with has a large bearing on whether he meets certification standards.

What type of training in that venue does he have?

You're asking what kind of training a medical doctor has in practicing medicine? Are we still having a serious conversation?

 

[bbchien]

And doesn’t proper training, generally required in airplanes, not usually provided for many life events, mitigate the possibility of having one due to a flight related situation?

No, it does not.

Wouldn’t a panic attack disorder have other tangible things to notice?

Not necessarily, doctor.

Is it then too late to say “well, I don’t know the medical definition of a panic attack not being a doctor and all, maybe I was wrong”?

...which discredits the doctor in the eyes of the FAA. Yeah, that's the ticket.

Panic disorder is NOT on the fast track form, JUST BECAUSE of these issues.

No, but I think they should be able to see there's no prior history, no medication, no follow up for 4+ years, current physician says there's no ongoing problem, old diagnosis technically doesn't even meet the DSM-5 criteria for panic disorder, which says it must be ongoing for greater than 1 month.

And how is that documented into teh current time? And who sez it was <1 month and what your current status is?

At worst, I think we might be, being trolled, here.....at best this poster came for validation but that's not how the national airspace works.

 

[nauga]

This thread is locked for MC review.

 

[Pilots Of America Management]

Thread reopened.

 

[WDD]

Interesting thread. A few thoughts for the discussion:

1) Let's agree that a pilot, especially an ATP/Airline Pilot should not be prone to panic attacks. Many fine, upstanding, successful people aren't meant to be an airline pilot.

2) Did you actually have panic attacks or something else? When you say "Panic Attack" according to Google it would have been a distinct event with sweating, chest pains, dizziness, cognitive impairment, incapacitation, etc. Something that could be confused for a heart attack. OR did you have a feeling of burden, some anxiety, whatnot that wasn't overwhelming.

3) Your doctor wrote down what you told him, "Panic Attack" probably without clarifying what you had. So, if it was a medically defined Panic Attack then that leads you to some decisions, such as don't fly for a living. If it was "damn, life is hard right now" moment, then maybe it wasn't a panic attack. I'll leave that to other experts on how this could, if possible, be worked through.

4) Even if you get your 1st class, the Airlines are going to dig into your past on their own. And what if you get into the left seat and then it pops up? Your job ended, and now your resume has that on it as well. You'll need a career change to something else which is going to be problematic, starting over at whatever age you are, etc.

5) Although not helpful for your current situation, it could help others: How did it come to pass that you didn't get your First Class, made sure everything was OK before you started your training? Don't mean this to be a stinging question.


Best of luck with whatever path you end up on!

 

[scitofly]

Interesting thread. A few thoughts for the discussion:

1) Let's agree that a pilot, especially an ATP/Airline Pilot should not be prone to panic attacks. Many fine, upstanding, successful people aren't meant to be an airline pilot.

2) Did you actually have panic attacks or something else? When you say "Panic Attack" according to Google it would have been a distinct event with sweating, chest pains, dizziness, cognitive impairment, incapacitation, etc. Something that could be confused for a heart attack. OR did you have a feeling of burden, some anxiety, whatnot that wasn't overwhelming.

3) Your doctor wrote down what you told him, "Panic Attack" probably without clarifying what you had. So, if it was a medically defined Panic Attack then that leads you to some decisions, such as don't fly for a living. If it was "damn, life is hard right now" moment, then maybe it wasn't a panic attack. I'll leave that to other experts on how this could, if possible, be worked through.

4) Even if you get your 1st class, the Airlines are going to dig into your past on their own. And what if you get into the left seat and then it pops up? Your job ended, and now your resume has that on it as well. You'll need a career change to something else which is going to be problematic, starting over at whatever age you are, etc.

5) Although not helpful for your current situation, it could help others: How did it come to pass that you didn't get your First Class, made sure everything was OK before you started your training? Don't mean this to be a stinging question.


Best of luck with whatever path you end up on!

2) they met some of those criteria, I mostly just felt "really bad" for 30 mins or so (dread, dizzy, etc). That said, they were never incapacitating. A couple happened at work in front of coworkers, and none of them noticed anything, was able to hold conversation fine, perform complex laboratory tasks, etc. Although they occurred only in the course of a couple weeks 4+ years ago, I have no doubt that even if one happened again while I was driving or flying I'd have no issue being safe, or carrying out emergency procedures.
4) Obviously I'm no expert here, but I am almost certain that employers don't have access to your medical history, they can just see if you have a FAA med clearance or not.
5) I am just starting training; I've only done a few lessons so far. You need a med clearance before you can even solo. I'm not even 100% committed to going the career route, but I definitely want PPL, and like I said you need a clearance to even solo so I figured I'd start with a Class 1 to make sure I can hold one.

And how is that documented into teh current time? And who sez it was <1 month and what your current status is?

At worst, I think we might be, being trolled, here.....at best this poster came for validation but that's not how the national airspace works.

Not trolling, honestly I was expecting a "shouldn't be a problem, just make sure you have all your documentation." Obviously I'm no expert here.

As a final question, do you think there's any hope for getting a clearance if I jump through whatever hoops necessary? Or is it a "don't bother" situation?

Thanks everyone.

 

[Half Fast]

I'm not even 100% committed to going the career route, but I definitely want PPL, and like I said you need a clearance to even solo so I figured I'd start with a Class 1 to make sure I can hold one.

So why not start with a Sport Pilot certificate, no medical required, and fly for a while before deciding whether it's worth the hassle of getting a medical?

 

[WDD]

So why not start with a Sport Pilot certificate, no medical required, and fly for a while before deciding whether it's worth the hassle of getting a medical?

Spot on. With MOSAIC, you can now solo / fly in a Skywawk, and even a little bit larger like a C182. But if you apply for and get denied / deferred / whatever for an FAA medical, you can't do Sport Pilot.

Should be easy enough to tell your CFI you're going for Sport, take the Sport written test, etc.

BUT/AND ......... have an honest, frank discussion with your PCP on whether or not this could pop up again. Your health comes first. Then you have to decide if it's appropriate / something you should do even as a hobby. I don't know the situation like you do, not suggesting yeah or nay either way. Just suggesting to have the conversation with your doc.

BONUS: Do not go near an AME at this time. Even if you intend to only have a consultation, there is a slight chance your visit could activate an application if someone does something wrong with the paperwork, which can't be undone.

 

[bflynn]

Does having a few episodes substantiate a life long diagnosis? Or does it not matter since “it was written down?”

The single answer to that question is that for the FAA what was diagnosed is the fact. You could have a brain tumor with schizophrenia, but if your doctor diagnosed you with a migraine, then migraines is what they're interested in. Vice versa applies.

 

[Dwayne]

Here we are again. Suggesting to people they can fly sport pilot even though they may have a disqualifying "disorder" that might keep them from obtaining a medical.
Per 14 CFR 61.53b - A person using a driver's license to meet the requirements of this paragraph ... "must not know or have reason to know of any medical condition that would make the person unable to operate a light sport aircraft in a safe manner". This person as well as most all of the previous ones that have been recommended by readers here to fly under sport pilot rules is aware of the possibility of a problem, but the readers are basically saying to do it anyway.

 

[Half Fast]

Here we are again. Suggesting to people they can fly sport pilot even though they may have a disqualifying "disorder" that might keep them from obtaining a medical.
Per 14 CFR 61.53b - A person using a driver's license to meet the requirements of this paragraph ... "must not know or have reason to know of any medical condition that would make the person unable to operate a light sport aircraft in a safe manner". This person as well as most all of the previous ones that have been recommended by readers here to fly under sport pilot rules is aware of the possibility of a problem, but the readers are basically saying to do it anyway.

Here we go again.

Being "unable to operate a light sport aircraft in a safe manner" is NOT the same thing as being unable (or unwilling, due to expense and hassle) to obtain an FAA medical certificate.

This has been discussed over and over and over on this forum, and I'm not going to rehash all the hash that's already been hashed. Feel free to use the search function.

Suffice to say that the FAA did not write "...must not know or have reason to know of any medical condition that would make the person unable to obtain an FAA medical certificate," though they certainly could have.

 

[MauleSkinner]

Here we go again.

Being "unable to operate a light sport aircraft in a safe manner" is NOT the same thing as being unable (or unwilling, due to expense and hassle) to obtain an FAA medical certificate.

This has been discussed over and over and over on this forum, and I'm not going to rehash all the hash that's already been hashed. Feel free to use the search function.

Suffice to say that the FAA did not write "...must not know or have reason to know of any medical condition that would make the person unable to obtain an FAA medical certificate," though they certainly could have.

And the OP obviously believes this doesn’t make him “unable to operate a light sport aircraft in a safe manner.”

He’s not asking, “can I lie about this on my medical application?” like some do.

 

[WDD]

Here we are again. Suggesting to people they can fly sport pilot even though they may have a disqualifying "disorder" that might keep them from obtaining a medical.

1) Did you read the reply?

Then you have to decide if it's appropriate / something you should do even as a hobby. I don't know the situation like you do, not suggesting yeah or nay either way. Just suggesting to have the conversation with your doc.

2) And this....

Being "unable to operate a light sport aircraft in a safe manner" is NOT the same thing as being unable (or unwilling, due to expense and hassle) to obtain an FAA medical certificate.

BASIC MED was created because of the times where the FAA 3rd class process is inadequate in assessing whether a person can fly a Cessna or Piper.

There are those who believe anyone with a BASIC MED has it because they aren't fit to fly. The data comparing 3rd class vs BASIC MED just doesn't support that prejudice.

 

[bbchien]

bu.....bu.....bu....but........you have to win a 3rd class B4 you can get a valid Basic Med. If you don't you get "the letter"......

 

[Clip4]

Here we go again.

Being "unable to operate a light sport aircraft in a safe manner" is NOT the same thing as being unable (or unwilling, due to expense and hassle) to obtain an FAA medical certificate.

This has been discussed over and over and over on this forum, and I'm not going to rehash all the hash that's already been hashed. Feel free to use the search function.

RSuffice to say that the FAA did not write "...must not know or have reason to know of any medical condition that would make the person unable to obtain an FAA medical certificate," though they certainly could have.

Hopefully the insurance industry will be more restrictive.

 

[Lindberg]

The suggestion was to consider Sport Pilot rules, not Basic Med.

 

[midlifeflyer]

Here we are again. Suggesting to people they can fly sport pilot even though they may have a disqualifying "disorder" that might keep them from obtaining a medical.
Per 14 CFR 61.53b - A person using a driver's license to meet the requirements of this paragraph ... "must not know or have reason to know of any medical condition that would make the person unable to operate a light sport aircraft in a safe manner". This person as well as most all of the previous ones that have been recommended by readers here to fly under sport pilot rules is aware of the possibility of a problem, but the readers are basically saying to do it anyway.

You referred to two statements. You treated them as equivalents. But inability to obtain a third class certificate does not automatically equal inability to operate an aircraft in a safe manner.

(And, while in this case the concept is the same, when you quote regs, it’s generally a good idea to quote the current one. I noticed your error because you quoted “unable to operate a light sport aircraft.” The term “light sport aircraft” no longer exists in Part 61.)

I think it’s unfair to make the assumption you are making - that anyone who decides to forego an FAA medical certificate is automatically unsafe to fly. That they are only doing it because they are a blind, bipolar schizophrenic currently suffering from a stroke and plan to fly while drinking alcohol. I heard the same assumptions made about BasicMed too so, indeed, “Here we go again.”

 

[midlifeflyer]

Hopefully the insurance industry will be more restrictive.

They often are. They probably will be very restrictive for a few years until we start seeing some metrics. It happened for a period with BasicMed. I’ve already heard of some flight schools getting the word from insurers to require BasicMed.

Might be a bit longer with sport privileges because of the lack of any medical certification requirement.

Then, we still might see smaller restrictions. For example, even without some insurance-generated medical certification requirement, we might see things such as requirements for annual flight reviews to show ability “to operate an aircraft meeting the performance limits and design requirements of §61.316 in a safe manner.”

 

[SebIp]

Maybe OP should consider if this can happen to them:

Good ending. However if she was incapacitated by fear more, could have been another story.

 

[Half Fast]

They often are. They probably will be very restrictive for a few years until we start seeing some metrics. It happened for a period with BasicMed. I’ve already heard of some flight schools getting the word from insurers to require BasicMed.

Might be a bit longer with sport privileges because of the lack of any medical certification requirement.

Then, we still might see smaller restrictions. For example, even without some insurance-generated medical certification requirement, we might see things such as requirements for annual flight reviews to show ability “to operate an aircraft meeting the performance limits and design requirements of §61.316 in a safe manner.”

The flight school where I trained specialized in SP and had several LSAs in the fleet. No insurance hassles at all.

 

[WDD]

Actually, Sport Pilot accident rate should go down if more heavy wing loaded Skyhawks, etc.

 

[Half Fast]

Actually, Sport Pilot accident rate should go down if more heavy wing loaded Skyhawks, etc.

An LSA landing in a gusting crosswind is akin to a butterfly blown by a leafblower. But you do learn some stick & rudder skills, not to mention ADM.

 

[WDD]

If I remember the analysis correctly, accident rate for LSA is higher than non LSA for both PPL and Sport. It’s the landing phase that’s the problem.

Source is a Paul B AvWeb.