VA Disability and Medical

Discussion in 'Medical Topics' started by Asking for a friend, Nov 5, 2018.

  1. OK, asking for a friend. This person collects VA Benefits that is reported on his FAA medical along with the majority of the conditions. However, he has not disclosed ONE of the conditions that he is also collecting benefits for. How can he rectify this, disclose and apply for the SI, without any punitive action by the FAA? any helpful replies appreciated.
     
  2. lbfjrmd

    lbfjrmd Pre-takeoff checklist

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    do another medical ... report all ... no punitive action. The FAA determines if A SI is needed. Just come clean ... by the new medical. No mea culpas, begging.
     
  3. bbchien

    bbchien Touchdown! Greaser!

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    i’ll be even more blunt. He needs a HIMS psychiatrist or a VAH psychiatrist to be able to declare all symptoms are resolved. He will lose the PTSD award. If they aren’t all gone he needs therapy. FAA is very serious about this one. Lie thrice and you will be lucky to have the ATP not suspended (61.153).

    Lying to Uncle rarely works out.

    I turned down four airmen today in this situation. I am just swamped.

    One guy has lawyered up. He won’t be flying for a good long while....
     
    Last edited: Nov 5, 2018
  4. Salty

    Salty En-Route

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    I’m confused. Do you know something more of this situation than is in the thread? I don’t see anything about ptsd or an atp in the OP.
     
  5. No PTSD related issues, OSA related
     
  6. benyflyguy

    benyflyguy Line Up and Wait

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    Sound like ur a good candidate for getting PTSD from all the PT S D work/bs you are dealing with lol
     
  7. Thanks for the reply, so even though this friend was diagnosed with mild OSA a few years ago and never reported on 18Y, if he reports now and goes through the process, the FAA wont comeback with any punitive action? No sleep problems, or symptoms, not in any OSA risk categaory. was one of those who threw at everything to see what would stick upon retirement. took a sleep study and was diagnosed with mild OSA, never even used my CPAP.
     
  8. Wheels

    Wheels Pre-takeoff checklist

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    Why would “your friend” use your CPAP?
     
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  9. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    Friends don’t let friends share CPAPs....
     
  10. benyflyguy

    benyflyguy Line Up and Wait

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    I’m really hoping it’s a typo....please be a typo!!!
     
  11. vman

    vman Pre-takeoff checklist

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    no big deal, Freudian slip ..could even be a dyslexic moment..

    first i'm hearing about mild osa, thought everyone who goes there flunks $$$$

    cha ching..
     
    Last edited: Nov 6, 2018
  12. bbchien

    bbchien Touchdown! Greaser!

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    If it’s just Sleep Apnea, simply present good evidrnce that he is now in compliance...

    90 day CPAP compliance report at least somewhat better than standards
    Hood current status with the 4 doc observations, expect to be warned not to lie again, and expect a certificate.

    We are currently overwhelmed with PTSD, of which FAA is quite concerned with. “Alarmed by” might be accurate.
     
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  13. Kenny Phillips

    Kenny Phillips Line Up and Wait

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    Yeah, because of "do gooders" somewhere along the line (get your free money here, folks!) you now have to discern between people truly affected and those that shouldn't have been diagnosed.
     
  14. Rushie

    Rushie Pattern Altitude

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    So OP needs to tell "his friend" to get out that CPAP machine, read the instructions and crank it up every night for 90 days and get a printed (or digitally saved?) report which shows compliance which means x hours used and y saturation numbers am I right? I assume that's "good" current status with 4 documented observations? I don't know what that means.

    Anyway is it true the airman will need to continue using the CPAP in order to be in compliance with his (or her) medical?
     
  15. Matthew

    Matthew Touchdown! Greaser!

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    To maintain an SI - yes. You'll need to present the compliance data from the machine. Unless it's a "brick", you can copy the internal data and print out reports using 3rd party, free, s/w. You need to show an annual report, so you do have to continue with CPAP usage. For OSA SI compliance, the report has to show that >75% (? pretty sure it's 75%) of the 365 days of the year had > 6 hrs of use. Most of the time, when insurance is paying for a CPAP, they want to see you are using it >4 hrs, so reporting s/w generally defaults to 4 hr compliance reports. FAA specifically wants 6 hrs, so you need to account for that.

    In addition to the annual machine reports, you need a statement from your treating physician that not only are you using the machine but that the treatment is actually working. If the OP's friend does not have a "treating physician", he needs to get one.
     
  16. Thank you for the replies, they are appreciated, a couple of follow up Qs:

    1. If the OSA is Mild (AHI < 15 per HR), is it possible that the Sleep Specialist may not recommend a CPAP, and if so will the FAA issue an SI without a CPAP?

    2. What does "Hood current status with the 4 doc observations" mean?
     
  17. Some recent literature on the net suggests that for mild OSA, a CPAP is does not make a huge difference and my not be the go to solution
     
  18. Last thing, If my bud meets all other criteria (he will) for a medical and falls into the category below, he will be issued a medical, regardless of class and be required to begin CPAP compliance, get the status letter from sleep doc and submit all documentation within 90 days, should be no period without a medical, correct?

    Should he expect any punitive action or push back from the FAA? He wants to do the right thing and be in full compliance

    If the applicant has had a prior sleep assessment (Group/Box 2 of OSA flow chart (PDF)), select Group 2 on the AME Action Tab:
    • If the airman is under treatment, provide the requirements of the AASI and advise the airman they must get the Authorization of Special Issuance;
    • Give the applicant Specification Sheet A (PDF) and advise that a letter will be sent from the Federal Air Surgeon requesting more information. The letter will state that the applicant has 90 days to provide the information to the FAA/AME;
    • Notate in Box 60;
    • Issue, if otherwise qualified
     
  19. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    No. From what I’ve been told (I recently obtained an SI for OSA, anything over 5 AHI requires a CPAP for the FAA. I was right at 14 or 15.
     
  20. Matthew

    Matthew Touchdown! Greaser!

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    1) My understanding: ≥ 5 AHI means OSA. The "gold standard" treatment is CPAP. OSA means an SI. It really is a simple SI. And if you can go Basic Med you don't even need that SI.

    2) ?
     
  21. Any tidbits about getting the SI you would like to share?.....for my friend. did you lose your medical for any period?
     
  22. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    Well, I wasn't in the position of not reporting it on a previous medical, so I wasn't worried about losing it.

    I'm actually one of the few who went through the VA process when I got out and got a whopping Zero disability rating, so I had nothing to report the FAA on that front.

    My BMI didn't quite fit the automatic FAA OSA screening profile, but my wife had been complaining about my snoring for a while and asked me to get checked. So in between medicals I was referred for a sleep study, got the diagnosis and started treatment.

    I did not lose my medical, but did effectively self ground while I was starting treatment. It actually worked out well for me since I was on active duty as a reservist at the time and not flying when I started on the CPAP.

    I then went in for my next medical when I had a few months of compliance to show like Bruce recommended. Had all the paperwork (sleep study/doc statement/compliance report..etc) and was issued my medical on the spot. Took almost 6 months to get the actual letter from OKC due to the backlog, but that won't stop you from flying as long as the AME issues it while you are in the office.
     
  23. Thanks for the gouge, my concern is he has not complied. Under the 2015 guidelines, he can be issued a medical by his AME, but will the 90 days he has to get the documentation to OKC be enough CPAP compliance for the FAA? What is a "compliance report", read out from CPAP or a separate FAA document?
     
  24. Matthew

    Matthew Touchdown! Greaser!

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    There will be a few documents he'll need to provide:

    1) Compliance report - this will be a report from the machine data. It needs to show the information I mentioned in post #15. There is a 3rd party s/w called Sleepyhead that can be installed on Mac or PC. It reads the SD card from the CPAP, formats the reports, and prints them. FAA will accept those reports. Make sure to get into the Sleepyhead report settings and change the default compliance timer from 4 hrs to 6 hrs first.

    2) A statement from his treating physician saying that the treatment is effective. There are specific words to use, like "no excessive daytime somnolence", and a comment about heart health.

    3) There is another document, downloadable from the FAA website, that should be signed. It's essentially a personal statement saying that the airman is using the CPAP, not cheating, and that the treatment is effective. It seems, from the way I read it, to be a catch-all for pilots that do not have a full year of data. This document probably was created for people like me - we had older machines that would record 90-days of basic data and not the full year of detailed data that FAA started to require. This document let us get newer CPAPs with the full recording capability, but still turn in partial reports from our older systems. Give me a few minutes and I'll find the link to that document.

    Annually, he'll need all three (I'm not sure about #3, but I turn it in anyway). He can then send it to FAA and they'll mail back a new medical, or he can go to an AME and get a new medical in office but have to pay whatever the AME charges for his services. Your friend will still be on his normal AME physical schedule, so every so many years he'll get the SI renewal and the physical at the same time but every year he'll have to get the SI renewed. The medical will always have a 1 year expiration, but the physical exam is still done on its regular schedule.

    edit:

    Here's that document I mentioned:

    https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/Airman Compliance with Treatment signature.pdf

    After the initial SI is granted, he'll get a letter with a copy of that document and some other instructions on how to renew. It will also have an SI expiration date, probably 6 years. After 6 years he'll get another SI letter saying it's good for another 6 years. The last time I got that letter it was only after 3 or so years and extended it for another 6. Not sure what happened there, but I didn't complain. I'll be due to get that letter again in 2020. Save that letter, it's the only one you'll get so you'll have to make copies of some of the pages each year.
     
  25. Ok, new wrinkle, forget the "friend" stuff. I just had anew sleep study last night. went well, the tech hinted that he did not see many Apneas and thinks I may be below the 5 AHI threshold. (obviously, the report and consult with Sleep Doc to follow). If, hopefully that is the case, then what? if the Dr recommends no CPAP, will FAA concur and issue an SI or even just a normal medical? I'm not worried about the VA, my original diagnosis was for mild OSA and was legit. From what I've been told by the my Dr, given my lifestyle, exercise regimen, weight, etc its likely that the OSA can improve. I just want to know how the FAA will proceed if I have improved to that point? if not, then CPAP compliance it is. Do any of you think the Feds will come after me punitively after all is said and done?
     
  26. Velocity173

    Velocity173 Final Approach

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    Why didn’t you report the condition in the first place? Sleep Apnea slip your mind?
     
  27. Matthew

    Matthew Touchdown! Greaser!

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    It's up to the sleep doc now, but if the study shows <5 then yeah, you have apneas, but you might not have a sleep apnea diagnosis (unless he writes it up that way). At <5 you would be in the normal range. I'm not sure there really is a mild, moderate, severe diagnosis, it's either OSA or it isn't.

    Weight loss will help. If you have an OSA diagnosis then make a lot of lifestyle changes and get another sleep study that shows <5 AHI, your OSA is gone.

    edit:

    And there is such a thing as CSA (central sleep apnea) and that's a whole nuther situation.
     
  28. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    First off, if you have a sleep study saying no OSA and show that to the FAA to avoid an SI, but are still collecting disability for OSA from the VA, that is disingenuous and I would fully expect the FAA and the VA to hammer you.

    Hopefully Bruce or another AME will chime in on how painful it is to clear the diagnosis. That seems to be right way to do it.
     
  29. Like I admitted in my OP, when I retired I follower the VSO's lead and went for everything and saw what stuck. Not the best move, when I got the OSA diagnosis which was well after initial VA awards, which I reported, I did nor bring it up to my AME just continued "previously reported, no changes". A huge error in judgement which I would like to rectify before it bites me in the ass. Reality is I did meet the VA criteria for OSA back then (just barely) but I maintain a solid fitness regimen, no weight gain, eat right the whole nine and it may have gotten better. if the sleep doc says no OSA, I have no issue going back to the VA and telling them. I was told (not confirmed) that due to my age, VA will not reverse an award at this point, but no issue telling them.
     
  30. Let me be CLEAR, I have ZERO issue with going back to the VA and telling them, I no longer have OSA, if that is the case. My initial diagnosis was legit, all I did was submit the sleep study and report to the VA in a claim, they awarded it. My understanding is that OSA can improve or go away, am I wrong? now, I have been told over 55, VA will not reverse award, but I have no idea if that,s true or not.
     
  31. Look Guys, the VA and the FAA are two separate entities with separate requirements. WRT the VA, I did nothing wrong, I reported a condition, was evaluated and awarded a rating legitimately. I FAILED to report to the FAA, that was wrong! And now, i am looking to rectify the situation and get right with the FAA. It appears my condition may have improved which is a huge bonus, but the rules of the VA are different from the FAA and my interest is to get right with the FAA and report all conditions for which I am receiving benefits, and still renew my medical with no interruption so I can pay the bills. Certainly, if they wish, the FAA can hammer me for the not reporting, my hope and understanding from the replies, is they will not if I report on my next visit to the AME. I am getting my ducks ( latest sleep study, report from sleep Doc, etc.) in a row in perpetration. I don't think the VA has any beef as my award was legit. As to reducing my OSA award, I think there are some age and some time thresholds, but I don't know how I fit in that bucket yet
     
  32. Matthew

    Matthew Touchdown! Greaser!

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    OSA can go away. It's a structural thing where throat tissue closes off the airway. Physical changes, like weight loss or surgery, can sometimes lower the incidence of apneas to below the threshold.

    Not sure about the FAA side of things. I think the medical might ask, "Have you ever...". Assuming you don't, now, have OSA you might not have anything to report, but the "have you ever..." part might be the trick. Of course you'll have to mention the visit to the doc and explain the sleep lab and results, so you might need to submit copies of all that.

    The early responses from the AMEs in this thread probably should be reviewed.
     
  33. Fearless Tower

    Fearless Tower Touchdown! Greaser!

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    Understand, and to be clear wasn’t accusing you of doing it, just know that there are unfortunately people out there that are doing just that.

    Yes, OSA can go away depending on what is causing it. For many, it’s just a weight thing. As you get bigger/fatter, the tissues in your throat start to obstruct your breathing, particularly when you are relaxed/sleeping. As you lose weight, that often improves.

    Problem that a lot have is that as you get fatter and OSA develops, your sleep quality sucks which jacks your metabolism and results in either further weight gain or no appreciable weight loss even with exercise.

    But, there are thin, fit and athletic people out there who have OSA just due to the way their neck throat are and weight isn’t the driving factor. I worked with a guy on active duty that weighed probably 160, fit as could be (was a marathon runner) and he had OSA. Not everyone is the same.
     
  34. Velocity173

    Velocity173 Final Approach

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    Well if this has gone on for years and not have been reported, there could be an issue with the FAA. You’d still have to disclose it on medexpress. “Have you ever..”
     
  35. AggieMike88

    AggieMike88 Touchdown! Greaser!

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    Adding to what Matthew is saying here.... The preamble of Question 18 is "HAVE YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH, HAD, OR PRESENTLY HAVE ANY OF THE FOLLOWING:"

    So, Mr. Asking For A Friend, with regards to the OSA, you'll have to answer yes to Question 18X and 18Y, then supply appropriate documentation to explain why you answered yes. 18X will cover you were dx'd with OSA. and 18Y will need an explanation that one of the disability benefits was from OSA.

    So even if you are able to have prove that TODAY you do not have OSA, or it is so low that your various risk factors aren't too over the top, you still must answer yes to 18X and 18Y.

    Doing a consult with the correct AME would be of value. This way you can discuss the case before ANY info is officially submitted to the FAA and determine the right way to proceed.
     
    Last edited: Nov 9, 2018
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  36. Rushie

    Rushie Pattern Altitude

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    According to Dr. Lou in post no. 2 no punitive action if he fesses up to the FAA first.

    OP if you are a revenue pilot I highly recommend you contact Dr. Lou or Dr. Chien privately and follow their advice to fix this without risking your paycheck.

    How it affects your VA claim is something to address separately and nobody's opinion here counts.

    For either, I think you've got all you're going to get out of the general commentary here. Best of luck to you!

    Edit: my post crossed with AggieMike above. I almost said "unless AggieMike chimes in" :D
     
  37. Velocity173

    Velocity173 Final Approach

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    An issue in that just because the op no longer has OSA doesn’t mean the FAA still won’t require documentation from a past diagnosis.
     
  38. Rushie

    Rushie Pattern Altitude

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    Ah! I see what you meant. I thought you meant punitive issue.
     
  39. Velocity173

    Velocity173 Final Approach

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    Well I believe they have some sort of grace period if you self disclose a previous falsification without punitive action. Hopefully that’s the case here.
     
  40. I’d like to thank everyone for the informative replies and I appreciate everyone’s willingness to help I will probably reach out to Dr. Lou and see what’s required for a phone consultation
     
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