SI renewal turns into alcohol history inquiry

Discussion in 'Medical Topics' started by FatherPilot, Dec 1, 2022.

  1. FatherPilot

    FatherPilot Filing Flight Plan

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    squawkvfr
    Pilot for 13 years now; just came back from a 5 year break from flying. My 3rd class medical application was deferred in October 2021 due to previous treatment for depression and SSRI use. I complied with the FAA letter requesting all records and in March 2022 received a 6 month SI.

    I began the renewal process, got in all my paperwork by September and waited for my next 6 month SI.

    On Thanksgiving Day i got a new certified FAA letter, never a great feeling. They were requesting new information due to my history of alcohol abuse disorder. This took me completely by surprise, as I had not been treated for substance abuse only depression. FAA want how long i have been sober, treatment history, personal letter statement, and if applicable letters from a sponsor/priest or someone familiar with my recovery.

    I checked with my Psychiatrist, nothing new had been recorded in recent meetings. The trigger must have been in our sessions almost 3 years ago where during my depression i was consuming alcohol every night, how alcohol is a depressant, how i should reduce alcohol consumption to feel better, etc. That was the worst evidence i could find of alcohol abuse in my history. It was not a major point of discussion in my treatment of depression going forward to this day.

    I intend to comply with the FAA request as best I can. I was never admitted to any program or hospital for alcohol treatment, the only medical care i received was for depression from my psychiatrist. I have no sponsor or AA record. I have no one to write letters on my behalf describing my recovery. I can write a personal letter, though. I greatly reduced drinking during my therapy, further reduced it later, and went alcohol free 16 months ago and have been extremely happy with the results.

    What can i expect to happen next from the FAA? Will i 100% be put on the HIMS train for life with testing and monitoring? I expect the worst, more records requests and waiting, and possible denial. Any advice i will take to heart.

    Coda: i recognize now i should have let my SI quietly expire and go Badic Med. I should have gone Basic to begin with, as i had an expired 3rd class from 5 years ago before the depression incident. Sigh......
     
  2. RussS

    RussS Pre-takeoff checklist

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    I would request your blue ribbon file from the FAA, “with applicant notes” and see what is really in there from your psychiatrist. My guess would be some form of monitoring (14 in 12 months urine tests). Something rung the “abuse bell” and it likely cannot be un-rung without evidence of “recovery”. I had a sort of similar situation (without knowing details) which took 2 and a half years to get released. A lot depends on your exact situation and full history. PM me if you want more details on mine. Alcohol and the FAA are not a good mix.
     
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  3. Half Fast

    Half Fast Touchdown! Greaser!

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    Once you get through these hoops and have your SI again, why not go to Basic Med? It’s a good way to avoid the FAA roulette wheel.
     
  4. FatherPilot

    FatherPilot Filing Flight Plan

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    That is the hope! I was out of the flying scene from 2016-2021 and did not know BasicMed existed when I applied for a new third class. Then I wrongly assumed after getting my first SI the renewals would be easy. Painful lessons.
     
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  5. FatherPilot

    FatherPilot Filing Flight Plan

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    I will definitely do the FOIA request for my jacket to see what they have. I am also consulting AOPA legal services to help formulate the best package response to their new request, my best chance to minimize the requirements they might come back at me with.
     
  6. ThatOtherGuy

    ThatOtherGuy Pre-takeoff checklist

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    AOPA isn't going to be of any real help.

    If you used insurance to pay for the psychiatrist they had to submit the claims through electronic billing. The insurance reimburses based on the ICD-10 codes that are transmitted in the electronic claim. Insurance will only pay for medically necessary procedures, which means the corresponding diagnosis code for the procedure must exist on the claim. If the psychiatrist sought reimbursement for treating your substance abuse/dependence (in addition to depression) they'd have to add the abuse/dependence ICD-10 to your chart to get paid. Once that code ends up on your chart you have been formally diagnosed with the condition.

    Of course there's also the less complex possibilities that the psychiatrist determined you had alcohol use disorder and noted your chart as such, or that someone at the FAA read the notes and became concerned.

    Either way, at this point you're committed. You have an open medical application that will either be issued, denied, or withdrawn. Anything but an issued medical and BasicMed isn't an option until you do get issued. The fact that they stated substance abuse rather than dependence is a good thing. Once you are diagnosed dependent you are dependent for life. Dependence is the path that leads to HIMS in some form for life and extended monitoring.

    Here's what I'd do:
    1. Get a copy of your completed medical record (including ICD-10s) from the Psychiatrist so you know exactly what the FAA has. Look for diagnosis codes F10.10-19 or F10.20-29 or F10.90-99
    2. As others have stated, request your complete medical record from the FAA. You're not going to get this back in time to respond to their request letter, but at least you'll be looking at what they're looking at.
    3. Consider paying a HIMS AME to do a consultative review of the medical records from your provider(s). Dr. Chien or Dr. Fowler would be excellent choices. Do what they tell you to do.
    4. Be very careful about how you word any personal statement you send to the FAA. Be factual, honest, and direct. A misstatement can convert the FAA abuse assertion to a dependence assertion.
    5. Unless the FAA specifically states they must receive medical records directly from a provider, NEVER let someone send your medical records directly to the FAA. Obtain them from the provider, make copies, review for accuracy, and then send them.
     
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  7. FatherPilot

    FatherPilot Filing Flight Plan

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    This is great info. I checked my FAA letter, they state my history of Alcohol Use Disorder is the concern. That term is also used on my Psych's appointment notes, never dependence. The next paragraph of FAA letter is an FYI..."part 67 requires evidence of recovery for applicants with established history or clinical diagnosis of substance dependence...etc"

    I don't know if this indicates they have categorized me as such, or an explanation that they are trying to determine if this is the case since I had a period of abuse.

    I will work on those diagnosis forms from my Psych (which I paid 100% out of pocket I am sure).

    Thank you for the straight shooting info!
     
  8. ThatOtherGuy

    ThatOtherGuy Pre-takeoff checklist

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    Glad I can help.

    Additional bit of advice. Remember that your psychiatrist and the FAA are speaking different language when they use the terms "alcohol dependence", "alcohol abuse", and "substance use disorder". The standards used for diagnosing mental health issues by everyone but the FAA is the DSM-V. The predecessor to the DSM-V was the DSM-IV. It included diagnoses for "alcohol abuse" and "alcohol dependence". The DSM-V uses the term "Alcohol Use Disorder" with an additional modifier of "mild", "moderate", or "severe". Your psychiatrist is most likely charting using language and criteria seen in DSM-V.

    The FAA uses criteria defined in the FARs for substance issues. Airmen with substance issues will either be classified into "substance abuse" or "substance dependence". The definitions and criteria are laid out in 14 CFR 67.307(a)(4) and 14 CFR 67.307(b).

    It's important to keep this in mind because the FAR criteria for abuse or dependence are much more strict than the DSM-V criteria used by the general medical community. When reading FAA communications or personal medical records remember the context of the writer. The implication is that the FAA doesn't care about your DSM-V diagnosis. They care about your FAR diagnosis. For example, you can be diagnosed as "Alcohol Use Disorder - Mild" (DSM-V) and still meet the criteria for FAR "alcohol dependence".

    Good luck!
     
  9. bbchien

    bbchien Touchdown! Greaser!

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    If the Letter sez "abuse disorder" there was enough in the for the agency to tell you that.

    Now the question is:
    Are you now abstinent-
    if so can you substantiate that?

    Asking your local psychiatrist for commentary isn't going to do a whole lot of good as he plainly does not understand part 67.

    You're going to need to get to a HIMS AME, start a private random test program, then slow roll the responses, buy the time you get to 4 months provably sober, get to the HIMS psychiatrist after 4 months sober and it'll fit (just from what you wrote) into abuse. You'll be given an SI for two years of abstinence and then it'll be over.

    Sigh.
     
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  10. flyingron

    flyingron Administrator Management Council Member PoA Supporter

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    Of course, it's not the first time the FAA misread something. I had them misinterpret a statement of "no signs of xxx" to mean that I did have xxx and spent two years fighting it before they finally sent me a letter essentially saying, "OK, you don't have xxx. But if you ever do get xxx stop flying and let us know." Of course, I'm no more likely to get xxx than the next person.
     
  11. midlifeflyer

    midlifeflyer Touchdown! Greaser!

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    There was a letter in an AME journal in which a Duke University medical professor took the FAA to task because it forced an individual to prove they did not have a disease based solely on the existence of a genetic marker. The response to the letter was a bunch of self justification which came down to, "what do you expect us to do when an applicant is truthful?"
     
  12. FatherPilot

    FatherPilot Filing Flight Plan

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    I have embraced the concept that this train is rolling so I better get on board quick.

    Should I initiate meeting a HIMS AME before I mail my reply info to the FAA and they respond? Is there any downside to starting on my own?

    Regarding establishing sobriety time, other than my Psychiatrist noting a stopping time August 2021 there is only one other source.

    On my own I did start attending a local AA group in December 2021. Even in this nameless forum I felt uncomfortable admitting to that fact earlier. After I eliminated alcohol 100% in August 2021, I applied for my medical and got the deferral in October for past treatment of depression. It really knocked me on my ***, I felt hopeless and that I would never fly again. My wife saw my decline, knew I had made the sober commitment and saw that I was in danger of going backwards. Her encouragement got me to AA and it was fantastic and what I needed. It got me to feel normal living alcohol free, showed me how rewarding it is if you stick to it, how there is a difference to just not drinking versus living free of alcohol. Best part? IT WAS FULL OF PILOTS. I had six others, one that I even went through primary with over a decade ago. So it was a great experience.

    I never hooked up with a sponsor, and stopped going to regular meetings after 6 months once school let out and summer got busy. But it stuck well.

    I still keep that private, only my wife knows I ever went (and my fellow pilots). It has a great stigma still, I hear my buddies who are big drinkers joke about going to AA or being alcoholic and it makes me sad. I get my one year chip soon dated to my first meeting, not necessarily when I stopped.

    Should I disclose that aspect of my recovery even though it was anonymous and no paperwork to prove I initiated it, no official sponsor either? Is it damaging that I kept it private or more helpful admitting that I did it because I felt I needed it?

    Thank you for your help and hard truths as I plan for this process.
     
  13. lbfjrmd

    lbfjrmd Line Up and Wait

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    1st step: you need a HIMS AME
     
  14. FatherPilot

    FatherPilot Filing Flight Plan

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    I just reached out to the one nearest me. Not a lot out there I see.
     
  15. WDD

    WDD En-Route

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    I know some have flown out of town to meet with one of this boards AME experts; found it was worth all the cost and time.