SI Issuance

I

Impatient ??

Guest
Been deferred since 01/2022. Two DUI arrests both were plead to reckless driving convictions. First one in 1988@.011BAC, second in 07/2021@.010BAC. All FAA directives completed and submitted in 06/2022 with ongoing breathalyzer and monthly random drug testing. Letter from OKC in 11/22 deferred decision to Washington. Two month trek from OKC to Washington arriving there January 2023. No movement since…
Can anyone with a recent issuance advise on their timeline ?
 
I have a similar situation.
One DUI conviction 24 years ago.
One DUI arrest 12 years ago which was dropped and fully expunged. But the FAA does not care about expungements. I even sent them the judge signed expungement.
I submitted all this on 1/17/2023.
I got a HIMS AME.
I had the HIMS psychiatrist done.
Did Soberlink and still doing soberlink monitoring for the last 120 days.
Attended 70 AA meetings with logs in a 100 days.
Did an IOP all on my own.
MY HIMS AME and a PHD wrote them letter strongly stating that I am not a dependent.
Nothing yet. No answers.

I did a lot of research upfront, so I knew they could eventually ask for all of this. I went ahead and got it all completed.
Do you have a HIMS AME?
 
It just takes a lonnnnngggg time.......TWO is abuse, so going to DC is a decision most likely abuse vs. dependency.....or Abuse with "educational components".
 
It just takes a lonnnnngggg time.......TWO is abuse, so going to DC is a decision most likely abuse vs. dependency.....or Abuse with "educational components".

Thank you Dr. Chien.
The FAA didn’t even mandate me to do anything yet, but I took everything into my own hands and did all of this in 110 days or so.
My last case was over 12 years ago and it was dismissed. While I understand the FAA does not really care of dummies and expungements, would that not weight in on their decisions.
I also now have 4 doctors of which two are HIMS trained and qualified showing them that I don’t meet the DSM criteria.
I even did an IOP all on my own. It’s been 5 moths now. In your experience, do you think they will respond soon. I am only applying for a 3rd class.
Thanks
 
Check my post history, quite similar background to yours
 
Check my post history, quite similar background to yours

Just did. Thank you very much. I have been at it for 5 months. I also knew these items would come up so I went after it as hard and fast as I could.
I have a very demanding job, so I use Soberlink.
I have been given a non dependent diagnosis using DMS criteria by 4 doctors now, but I do understand that the FAA does not follow this.
I am wondering if there is a chance they will give me abuse over dependent.
Regardless, very helpufl.
MY HIMS AME has sent them 3 letters now stating that I am not dependent and he advocates for an SI.
We shall see.

Thanks again.
 
Just did. Thank you very much. I have been at it for 5 months. I also knew these items would come up so I went after it as hard and fast as I could.
I have a very demanding job, so I use Soberlink.
I have been given a non dependent diagnosis using DMS criteria by 4 doctors now, but I do understand that the FAA does not follow this.
I am wondering if there is a chance they will give me abuse over dependent.
Regardless, very helpufl.
MY HIMS AME has sent them 3 letters now stating that I am not dependent and he advocates for an SI.
We shall see.

Thanks again.

in my experience, it doesn't matter what anyone else says, Dr Teague (the doc that'll review your case in DC) will make up his own rules without regard to the CFRs. Chances are you'll end up dependent and probably have to do some of this over due to the test “being expired” or some other excuse. There really isn’t anything you can do and the FAA wants to keep it that way. So buckle up because its going to get worse before it gets better.
 
in my experience, it doesn't matter what anyone else says, Dr Teague (the doc that'll review your case in DC) will make up his own rules without regard to the CFRs. Chances are you'll end up dependent and probably have to do some of this over due to the test “being expired” or some other excuse. There really isn’t anything you can do and the FAA wants to keep it that way. So buckle up because its going to get worse before it gets better.

Thank you. I was somewhat prepared for this. This is why I engaged with a HIMS AME and a HIMS Psychiatrist from the beginning.
Wouldn't Dr Teague follow the recommendations of them. They both recommended me for an SI. They both stated non DSM criteria. Which I understand the FAA does not follow. They both said 14 UA's in 12 months. With my HIMS AME, I am doing SOBERLINK. It is much more convenient for me. While it is expensive, I have a pretty complicated business I run.
I also did an IOP. I start aftercare next week.
I have done 70 AA meetings in a 110 days or so.

Thanks.
 
Thank you. I was somewhat prepared for this. This is why I engaged with a HIMS AME and a HIMS Psychiatrist from the beginning.
Wouldn't Dr Teague follow the recommendations of them. They both recommended me for an SI. They both stated non DSM criteria. Which I understand the FAA does not follow. They both said 14 UA's in 12 months. With my HIMS AME, I am doing SOBERLINK. It is much more convenient for me. While it is expensive, I have a pretty complicated business I run.
I also did an IOP. I start aftercare next week.
I have done 70 AA meetings in a 110 days or so.

Thanks.

Dr Teague can pretty much do whatever he wants because there is no oversight and no one will stand up for you because you are an “alcoholic.” The only part of the CFR he will follow is 2 years of proven sobriety. Thats the earliest you'll be able to be issued IF everything is 100% perfect. Any slightly incorrect paperwork and it'll cause delays. Remember, no one wants you to fly so they will find any excuse to deny you even if it is outside of whats written in CFR.Keep that in mind. They will change the rules as needed to keep you grounded as soon as you start getting close to the finish line.

Speaking from going through this process for the past 5 years and still haven't been issued my SI.
 
Dr Teague can pretty much do whatever he wants because there is no oversight and no one will stand up for you because you are an “alcoholic.” The only part of the CFR he will follow is 2 years of proven sobriety. Thats the earliest you'll be able to be issued IF everything is 100% perfect. Any slightly incorrect paperwork and it'll cause delays. Remember, no one wants you to fly so they will find any excuse to deny you even if it is outside of whats written in CFR.Keep that in mind. They will change the rules as needed to keep you grounded as soon as you start getting close to the finish line.

Speaking from going through this process for the past 5 years and still haven't been issued my SI.

Wow. Even with everything I have done. I see other posts and speaking with other airmen, if you are compliant, you will get an SI.
 

I have been given a non dependent diagnosis using DMS criteria by 4 doctors now, but I do understand that the FAA does not follow this….

Last I heard, FAA is DSM4 criteria for alcohol while everyone else is on DSM5. Unfortunately, this is a slow process; it’s not unheard of for first time submissions to drag on for a year or more.

It appears you and your AME are being proactive, which is a net positive, but doesn’t move your application to the head of the line. Control what you can control and don’t sweat what you can’t.
 
Similar timeline to yours. Class 1 HIMS SI submitted 06/2022. Packet sent to DC 09/2022. Absolutely no movement since. I call DC Once a month and the answer is always the same "Another 2+ months we can't tell you any more than that." With that knowledge its at least a 9 month backlog for issuance once your case gets to DC.
 
Last I heard, FAA is DSM4 criteria for alcohol while everyone else is on DSM5. Unfortunately, this is a slow process; it’s not unheard of for first time submissions to drag on for a year or more.

It appears you and your AME are being proactive, which is a net positive, but doesn’t move your application to the head of the line. Control what you can control and don’t sweat what you can’t.

Thank you for your words of encouragement. I do appreciate it. I was proactive from the start. I volunteered for everything. Did monitoring, AA meetings at least twice a week, HIMS Eval, HIMS Psychiatrist, even and IOP. I am just hoping when they see this, they will make some better considerations. My last DUI arrest was over 12 years ago. It was fully dismisses and expunged. I even provided the FAA with the expungement signed by a district judge. While I understand it was a bad choice and I should have not been driving, it appears the FAA does not care.
 
Similar timeline to yours. Class 1 HIMS SI submitted 06/2022. Packet sent to DC 09/2022. Absolutely no movement since. I call DC Once a month and the answer is always the same "Another 2+ months we can't tell you any more than that." With that knowledge its at least a 9 month backlog for issuance once your case gets to DC.

Wow. That is a long time. By the time that comes, my application will probably be expired. On a positive note, by that time I will have almost 2 years of proven abstinence.
 
..While I understand it was a bad choice and I should have not been driving, it appears the FAA does not care.

It’s leas that the FAA doesn’t care and more that FAA has a regulatory obligation and repeatable process for each applicant who checks certain blocks. All they know about you is what’s in the record. The stronger your record is through proactive steps you take to meet their requirements, the higher the likelihood certification occurs.

If you take the reactive path, they have a question, send you a letter with 30 days to respond with evidence, and set you application aside to work on others until your evidence makes it back and then the file goes back to the ‘inbox’ to work it’s way for review. Then another question comes up and rinse, lather, repeat.
 
It’s leas that the FAA doesn’t care and more that FAA has a regulatory obligation and repeatable process for each applicant who checks certain blocks. All they know about you is what’s in the record. The stronger your record is through proactive steps you take to meet their requirements, the higher the likelihood certification occurs.

If you take the reactive path, they have a question, send you a letter with 30 days to respond with evidence, and set you application aside to work on others until your evidence makes it back and then the file goes back to the ‘inbox’ to work it’s way for review. Then another question comes up and rinse, lather, repeat.

I totally understand. That is why I did all my research and fully committed to the process. As I mentioned before, I have seen my HIMS AME every month with a positive report from him to them. He also recently sent them my IOP report which they have not even asked for. I did all of this in about 5 months. Is it possible for them to deny me with 100% compliance?
 
As I understand it, 3rd class HIMS deferrals don't go to DC. Can someone either confirm or deny this?
 
As I understand it, 3rd class HIMS deferrals don't go to DC. Can someone either confirm or deny this?
When I called the regional flight surgeon's office, they told me the same thing. But who knows.
There has to be a way to speed this up. Particularly for candidates who have a HIMS AME and are 100% compliant. Someone suggested writing your congressman or women. Another suggested reaching out to your Senator. Anyone have any luck with this?
 
When I called the regional flight surgeon's office, they told me the same thing. But who knows.
There has to be a way to speed this up. Particularly for candidates who have a HIMS AME and are 100% compliant. Someone suggested writing your congressman or women. Another suggested reaching out to your Senator. Anyone have any luck with this?

I called my Senator in March at the 6 month mark from when my 1st Class HIMS SSRI was sent to DC, 9 months from when it was transmitted by the AME on medxpress. A representative responded to my senator's staffer that it would be another "2+ months" until my packet was reviewed. This is exact same public affairs statement they give you when you call DC. It will always be "2+ months" away until a Psych in DC decides to pull it and stamp or deny your application. Congress can't tell where you are in line, your regional flight surgeon can't tell where you are in line, and according to the analyst that responds to voicemail in DC (usually a week after you leave the voicemail) they can't tell either. DC is a complete black hole and unless you are a part 121 revenue airman you are not a priority. Even with the additional docs the FAA supposedly hired, just waiting for a response currently is taking well over a year.

The good news though? My senator's office emailed me back to inform me that the 2024 FAA omnibus bill includes language that the FAA must form a working group to make recommendations to the administrator by 2025 which the administrator can choose to implement or ignore completely. For the feds thats a pat on the back, hope those congressmen enjoy their summer break!
 
I called my Senator in March at the 6 month mark from when my 1st Class HIMS SSRI was sent to DC, 9 months from when it was transmitted by the AME on medxpress. A representative responded to my senator's staffer that it would be another "2+ months" until my packet was reviewed. This is exact same public affairs statement they give you when you call DC. It will always be "2+ months" away until a Psych in DC decides to pull it and stamp or deny your application. Congress can't tell where you are in line, your regional flight surgeon can't tell where you are in line, and according to the analyst that responds to voicemail in DC (usually a week after you leave the voicemail) they can't tell either. DC is a complete black hole and unless you are a part 121 revenue airman you are not a priority. Even with the additional docs the FAA supposedly hired, just waiting for a response currently is taking well over a year.

The good news though? My senator's office emailed me back to inform me that the 2024 FAA omnibus bill includes language that the FAA must form a working group to make recommendations to the administrator by 2025 which the administrator can choose to implement or ignore completely. For the feds thats a pat on the back, hope those congressmen enjoy their summer break!

That's insane. I am applying for a 3rd class. I am guessing OKC will review mine. Who knows.
 
That's insane. I am applying for a 3rd class. I am guessing OKC will review mine. Who knows.

Best of luck. About 90% of the frustration could be resolved with either an add on to medxpress that says "your packet is X of Y in line" or even just being able to say that over the phone.

If anyone from the FAA is reading this, please reach out to me. I can show you how to count rows in Microsoft excel or a SQL database. I'll even do it for free! That's just my patriotism and sense of civic responsibility.
 
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Best of luck. About 90% of the frustration could be resolved with either an add on to medxpress that says "your packet is X of Y in line" or even just being able to say that over the phone.

If anyone from the FAA is reading this, please reach out to me. I can show you how to count rows in Microsoft excel or a SQL database. I'll even do it for free!

LOL. I think the FAA needs to realize that individuals that want to fly have a passion and the majority of us have actually done something correct to be in a position to fly.
 
Best of luck. About 90% of the frustration could be resolved with either an add on to medxpress that says "your packet is X of Y in line" or even just being able to say that over the phone.

If anyone from the FAA is reading this, please reach out to me. I can show you how to count rows in Microsoft excel or a SQL database. I'll even do it for free! That's just my patriotism and sense of civic responsibility.

I think the secrecy of it all (keeping airmen in the dark) is all a part of their strategy tbh.

LOL. I think the FAA needs to realize that individuals that want to fly have a passion.

This assumes that the FAA actually cares and wants you to fly.

The FAA wonders why airmen aren't always truthful with them. Their process, lack of compassion, and their "We have something you want" attitude is EXACTLY why.
 
keep in mind - the faa doesnt actually want pilots that have issues. So its in their best interest to lean on not allowing what they consider to be problematic until you prove beyond a reasonable doubt that you will not have issues. So thats the take - but everyone feels like they should be issued - which is counter to their "Stance" on these issues.
 
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Getting off on a technicality doesn't address the problem.

I would agree. But the state laws that I currently reside in clearly expunged my arrest. It was dismissed and no where to be found.
Regardless, I am fully vested. I am proving to the FAA that I can have proven sobriety.
 
I would agree. But the state laws that I currently reside in clearly expunged my arrest. It was dismissed and no where to be found.
Regardless, I am fully vested. I am proving to the FAA that I can have proven sobriety.

You're doing exactly what they want.

The only problem is that it's on their schedule and their terms, and you can't change either of those.
 
keep in mind - the faa doesnt actually want pilots that have issues. So its in their best interest to lean on not allowing what they consider to be problematic until you prove beyond a reasonable doubt that you will not have issues. So thats the take - but everyone feels like they should be issued - which is counter to their "Stance" on these issues.

AAM-300 focuses on “history” and while that would help weed out some future cases, they make almost no attempt to weed out future cases. Since pilots “fear” AAM-300 and their prehistoric opinions and procedures, pilots are hesitant to seek medical care when ill.

Would the pilot of Delta 3343 in May of 2020 have sought care and prevented his heart attack while in midair over Canada?

Would the pilot of N333LD have left his passenger to land the plane?

These are both cases of pilots with valid medicals when their incidents occurred.

Far more pilots either LIE to AAM-300 on applications, take medication which is unapproved or just avoid visiting the doctor when something troubles them for fear of a “misdiagnosis” or “overdiagnosis” and the resulting trouble, and expense, on their next medical application. In this regard, their policies actually DECREASE safety.
 
AAM-300 focuses on “history” and while that would help weed out some future cases, they make almost no attempt to weed out future cases. Since pilots “fear” AAM-300 and their prehistoric opinions and procedures, pilots are hesitant to seek medical care when ill.

Would the pilot of Delta 3343 in May of 2020 have sought care and prevented his heart attack while in midair over Canada?

Would the pilot of N333LD have left his passenger to land the plane?

These are both cases of pilots with valid medicals when their incidents occurred.

Far more pilots either LIE to AAM-300 on applications, take medication which is unapproved or just avoid visiting the doctor when something troubles them for fear of a “misdiagnosis” or “overdiagnosis” and the resulting trouble, and expense, on their next medical application. In this regard, their policies actually DECREASE safety.

I disagree. And neither you nor I can prove anything beyond any reasonable measure. So let’s sssume they don’t do anything - anyone can fly without any restrictions. So any person who has suicidal ideation, depression, mpd, bipolar, ssri, drug / drunk issues can fly and be a atp pilot. Do you actually think that would be safer ? No possible way.
 
I disagree. And neither you nor I can prove anything beyond any reasonable measure. So let’s sssume they don’t do anything - anyone can fly without any restrictions. So any person who has suicidal ideation, depression, mpd, bipolar, ssri, drug / drunk issues can fly and be a atp pilot. Do you actually think that would be safer ? No possible way.

Appeal to extremes...nice.

To answer your question, the answer isn't to "do nothing". All I am saying is that what they ARE doing isn't the answer either. The entire system needs to be reworked and rebuilt.
 
Appeal to extremes...nice.

To answer your question, the answer isn't to "do nothing". All I am saying is that what they ARE doing isn't the answer either. The entire system needs to be reworked and rebuilt.

Basic Med has been a good start.

They've selected a segment of aviation that doesn't involve large numbers of passengers (paying or otherwise) and/or huge airplanes and put the medical certification (and medical choices for pilots) in the hands of pilots and their physicians, who presumably are strongly influenced by common sense ahead of bureaucratic committee constructed algorithms that result in expensive documentation that ends up eliminating a large number of applicants in the interest of "extreme caution".

Encouraging results from early data analysis of the program, which now involves some 80,000 pilots.
 
I agree with dbahn, Basic Med is a good start. And it might be getting a little better (see here). The FAA reauthorization bill might not survive the sausage factory but it did
pass out of committee unanimously so it has strong bipartisan support.

Any improvements will have to come legislatively, the "doctors" in OKC will not heal themselves.

I also agree with Jon Wilder. The FAA medical branch is a self-dealing mess. They are far more beholden to the bureaucracy than to any notion of safety. The AME on this board are great about pushing "Health First, FAA later" But the bureaucrats have created significant disincentives for doing so.

To a great degree, this could be solved (or at least greatly mitigated) by raising the Sport limits to 12,500 pounds, 6 PAX, and 250 IAS. No legislation required. The big winners would be the the revenue airman who would not have nearly as long a wait for SI with the Class 3 cleared out of the queue.

Relevant portions from link:

BasicMed: The legislation would expand BasicMed privileges by increasing the number of allowable passengers from five to six and increasing the allowable number of seats in an aircraft from six to seven. In addition, the maximum certificated takeoff weight of the aircraft would be increased from 6,000 pounds to 12,500 pounds. Language would also require the FAA to help facilitate the recognition of BasicMed in Canada and other countries and would allow designated pilot examiners (DPEs) to administer a practical test or proficiency check while flying under BasicMed.

Improving FAA medical processes: The bill would also establish an aviation medical working group to work with the FAA in reviewing and improving medical processes and policies to ensure timely and efficient certification of pilots. The working group would also address the special issuance process and the appropriateness of expanding the list of medical conditions an aviation medical examiner can issue; evaluate certain medications and treatments approved for use by pilots; address ADHD, ADD, and mental health processes and policies; and review technologies to help red-green color blindness and their possible application for pilots.
 
Cheers, new to PoA, flying since 1990. I guess this will be my first post here - so “hey”

as the FAA expands the privileges for BM, insurance companies may not share the same enthusiasm. rn some pilots flying under Part 91 are required by their insurance companies to possess an FAA Medical. Especially in the case of older pilots and those flying bigger and faster equipment. Local to me, a 69 yo private pilot now gets a Class 1 every 6 months since he upgraded to a Honda Jet. 80 yo CFII was doing BM with her Cherokee, she and her husband added a V35 to the hanger, insurance wants an annual Class 3 if she’s going to fly it. 71 yo COM pilot flies a P Baron, insurance wants an annual Class 2. For most of us (I drive a Skylane now) insurance companies don’t care if we have an FAA Medical or go BM, but that might change as the FAA expands the regs to include bigger and more complex aircraft.

cheers from SW Floriduh
 
Basic Med has been a good start.

They've selected a segment of aviation that doesn't involve large numbers of passengers (paying or otherwise) and/or huge airplanes and put the medical certification (and medical choices for pilots) in the hands of pilots and their physicians, who presumably are strongly influenced by common sense ahead of bureaucratic committee constructed algorithms that result in expensive documentation that ends up eliminating a large number of applicants in the interest of "extreme caution".

Encouraging results from early data analysis of the program, which now involves some 80,000 pilots.

I agree with dbahn, Basic Med is a good start. And it might be getting a little better (see here). The FAA reauthorization bill might not survive the sausage factory but it did
pass out of committee unanimously so it has strong bipartisan support.

Any improvements will have to come legislatively, the "doctors" in OKC will not heal themselves.

I also agree with Jon Wilder. The FAA medical branch is a self-dealing mess. They are far more beholden to the bureaucracy than to any notion of safety. The AME on this board are great about pushing "Health First, FAA later" But the bureaucrats have created significant disincentives for doing so.

To a great degree, this could be solved (or at least greatly mitigated) by raising the Sport limits to 12,500 pounds, 6 PAX, and 250 IAS. No legislation required. The big winners would be the the revenue airman who would not have nearly as long a wait for SI with the Class 3 cleared out of the queue.

Relevant portions from link:

BasicMed: The legislation would expand BasicMed privileges by increasing the number of allowable passengers from five to six and increasing the allowable number of seats in an aircraft from six to seven. In addition, the maximum certificated takeoff weight of the aircraft would be increased from 6,000 pounds to 12,500 pounds. Language would also require the FAA to help facilitate the recognition of BasicMed in Canada and other countries and would allow designated pilot examiners (DPEs) to administer a practical test or proficiency check while flying under BasicMed.

Improving FAA medical processes: The bill would also establish an aviation medical working group to work with the FAA in reviewing and improving medical processes and policies to ensure timely and efficient certification of pilots. The working group would also address the special issuance process and the appropriateness of expanding the list of medical conditions an aviation medical examiner can issue; evaluate certain medications and treatments approved for use by pilots; address ADHD, ADD, and mental health processes and policies; and review technologies to help red-green color blindness and their possible application for pilots.

While on the surface, Basic Med appears to be a great start, I also feel it's part of the problem.

Hear me out.

Congress passes Basic Med. If you've held a medical certificate, be it a standard or a special issuance, on or after July 14th, 2006, and your most recent certificate was never denied, suspended, nor revoked, you're eligible. No longer are you required to visit an AME for a standard medical so long as no new issues arise. Get the FAA out of your back pocket.

Sounds great right?

The problem comes in with those who have never held a medical on or after July 14th, 2006. Especially those of us who require a special issuance. Imagine if you will...you have a situation requiring a HIMS special issuance. You do all the tests. You do all the evaluations. You do everything single thing the FAA requires you to do to the letter.

They either keep requiring more tests or they deny altogether.

Why?

What's to stop you from jumping through the hoops, being issued, letting your certificate expire, then hopping onto Basic Med?

Now they can't control you with their HIMS step down plan.

While Basic Med has made it easier for those who have previously held a medical certificate, I feel the FAA retaliated by making it more difficult for those with deferred medicals to get a medical certificate of any kind. You damn near have to be a perfect human being to get one anymore.
 
What's to stop you from jumping through the hoops, being issued, letting your certificate expire, then hopping onto Basic Med?

Nothing, and that's what a huge number of airman have done (including me, for malignant melanoma, where it was cost rather than medical factors that drove the decision). Now I'm in exactly the same boat as any airman that has malignant melanoma but doesn't know it, at least yet. I've also been through this with prostate cancer, which a huge percentage of airmen over 60 have but don't know it don't want to find out if they do have it. Basic Med allows pilots to take care of their own health, albeit to the satisfaction of the FAA, then be on their own to self-certify after that, presumably for the rest of their lives.

I'm OK with all of that. You don't even need to let your certificate expire. You can go on Basic Med the day that your Special Issuance is approved.
 
I'm OK with all of that. You don't even need to let your certificate expire. You can go on Basic Med the day that your Special Issuance is approved.

Once your special issuance is approved 1-2 years later that is. Once you manage to navigate conflicting requirements, secret policies and lists, and an unending back and forth of new requirements passed to the airman at the last possible moment.

Again, if the FAA wants to claim the position that they are incentivizing cooperation with airmen and not just passing the buck of medical liability, they need to take good faith gestures to not make things as painful and obtuse as possible for those "in the system"
 
Yeah, I don't like the system either, and I hope it changes. But now with Basic Med you don't have to keep repeating that process year after year.

Malignant melanoma - in addition to all of the doctor's notes, the initial requirement is for a PET scan of the head and neck as well as an MRI, both looking for the unlikely appearance of metastases with NO CLINICAL EVIDENCE of their presence. The MRI needs to be repeated every year for the next four years after the Special Issuance. The problem is that there is no medical evidence that the screening MRI is useful, so insurance doesn't pay for it and the airman is paying $5k a year out of pocket for four years. That's why I bailed out and went to Basic Med. Now I have no qualms about seeing my own doctor and agreeing to any testing that is medically indicated rather than "FAA indicated", and I believe I'm healthier because of that.
 
You can’t. Some special issuances have progressive things jb their requiring compliance throughout the SI. And without compliance they withdraw the SI and you are then denied. So no - you can’t go right when you get it for some, you have to comply with the SI and let it expire.

Nothing, and that's what a huge number of airman have done (including me, for malignant melanoma, where it was cost rather than medical factors that drove the decision). Now I'm in exactly the same boat as any airman that has malignant melanoma but doesn't know it, at least yet. I've also been through this with prostate cancer, which a huge percentage of airmen over 60 have but don't know it don't want to find out if they do have it. Basic Med allows pilots to take care of their own health, albeit to the satisfaction of the FAA, then be on their own to self-certify after that, presumably for the rest of their lives.

I'm OK with all of that. You don't even need to let your certificate expire. You can go on Basic Med the day that your Special Issuance is approved.
 
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