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Experiences with PTSD evaluations for Medical Certification?


Bighead

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Hi everybody,

 

I am a VA Ch. 33 student at Green River CC in Auburn, WA currently attending Aviation Technology courses on the Helicopter Pilot track. I also am 80% disabled through the VA for PTSD (70%) and "residuals" of a TBI (40%). My last VA C&P evaluation was in June 2011, over 2 years ago.

 

At this time, I have been denied for my class 2 Medical Certificate which is required for enrollment into Part 141 flight courses at the college's partnering helicopter flight school (Classic Helicopter Corp. at KBFI). My denial letter from the FAA Regional Office in Renton, WA states that the FAA requires:

 

1. A detailed evaluation from a mental health professional regarding the history of my PTSD to include the presence or absence of symptoms and what they are, an assessment of stability in future stressful situations, an assessment of my capability to handling the stress of aviation decision making and flight training detailing any coping mechanisms I have in place, and any other testing deemed necessary.

 

2. A current head CT or brain MRI and current status report from the treating physician regarding my history of TBI. Current status report should address any findings from the chosen scan, and any other testing deemed necessary.

 

However, after talking to my previous VA psychologist, he is not willing to provide me an evaluation for my PTSD and I will talk with my PCP tomorrow about the CT scan. I have also read through various threads on different sites and obtained what I thought would be a sufficient reassessment from my psychologist before going to my AME in October 2013. I thought it would help avoid this extra step that I am now facing. Unfortunately, his remarks don't satisfy the FAA's requirements (he noted a significant improvement in my overall condition, my coping mechanisms I mentioned, etc. but his findings "weren't thorough enough") and he stated he is unable to do anything more. He also claims that he cannot take on the liability of the evaluation that the FAA requires?

 

What are your recommendations and/or experiences with this subject? Have other vets on here that were in my same situation been shot down by the VA as well? Where did you go for your evaluations?

 

I have had a lot of time to think about it and a career in Rotorcraft Aviation is my dream. I have never wanted to pursue anything more. Any input is greatly appreciated

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Sadly, sometimes you can't have it both ways. If you got yourself an 80% disability for PTSD, perhaps...and I suggest this with as much kindness as I can...perhaps you shouldn't be flying. I'm sorry. Good luck to you!

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You don't need a medical to fly, you just need one to be PIC. You can take instruction, but you wouldn't be able to log it without a medical certificate under most circumstances.

It wouldn't keep you from flying, but it would keep you from getting any certificates or ratings. Needless to say it would keep you from pursuing your career desires.

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As someone who was also originally denied my medical certification (albeit for a different reason) I'll offer up my experience for what it's worth...

 

As you know, you are able to appeal the denial by completing the conditions set forth (which you listed in your original post)

 

I don't have military experience so I'm not sure why your VA psych won't offer a new evaluation. If you are able to fulfill these conditions through a civilian AME that's an option too, but I don't know your restrictions. Did he say why he would not provide an evaluation? Seems odd that you could be denied something like that...keep looking, because there must be someone out there who can provide the services you need.

 

 

In any event - be warned that this road is a long and arduous one as the FAA is very thorough with these things in an effort to avoid all liability. It took about six months for me to complete the required evaluations and get a response from the FAA (they are SLOW), and I was granted a special issuance medical certificate with a number of conditions that apply for three years. (I am now 1.5 years into it). Also remember that simply getting re-evaluated is not a guarantee of a special issuance. Now is a good time to accept the possibility that you may never be granted a medcert and will be restricted to Part 61 dual instruction for the rest of your life. (Still better than nothing for most.)

 

It's costly, annoying, and in my case really not all that necessary, but I chose to be honest and had to check one of their boxes, and if the FAA tells me to take a crap, all I can do is ask them where they would like it. I made the decision early on that I would do whatever it takes to get rated and so that's what I am doing. If you want to fly for a living, or just for fun because you love it, then do what it takes, but be aware of the money and time that will be required of you. It's going to add thousands of dollars to your training cost. I would suspect that in your case, the FAA would likely monitor you for some time, possibly much longer than three years, until they felt your PTSD was under wraps and that you didn't pose a threat to yourself and/or others.

 

 

If you intend to fulfill their conditions, write a letter to the medical branch and inform them of your intent to fulfill them so they don't close your file. Then find the appropriate doctors to complete the tests, and send your results. Expect a long wait time just to get a response. They will either send you another letter of denial, or you will receive your special issuance medical certificate with the mandated conditions attached. Your AME will be very involved throughout the entire process, so make sure it's someone you are comfortable with and who will fight for your cause.

 

You having a different condition than mine means that your case will be different, but hopefully my 2cents can help. If you want I can refer you to my AME but I don't know if he can or will be able to represent you in this case. He is in Bellevue, so not that far from you.

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Only thing I can think of to tell you is to start calling doctors all over the place that specialize in TBI and PTSD. Tell them your situation, exactly what the FAA requires (email/fax a copy of denial letter if required) and make sure they fully understand what you are asking of them and what EXACTLY will need to go in their diagnosis.

 

Like JCM5 said, it's going to take a while, but if you want it bad enough, it will be worth it.

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My denial letter from the FAA Regional Office in Renton, WA states that the FAA requires:

 

1. A detailed evaluation from a mental health professional regarding the history of my PTSD to include the presence or absence of symptoms and what they are, an assessment of stability in future stressful situations, an assessment of my capability to handling the stress of aviation decision making and flight training detailing any coping mechanisms I have in place, and any other testing deemed necessary.

 

2. A current head CT or brain MRI and current status report from the treating physician regarding my history of TBI. Current status report should address any findings from the chosen scan, and any other testing deemed necessary.

 

 

Either you:

 

1. Convince your previous VA psychologist to provide you with an evaluation that meets the FAA requirements.

 

2. Find another VA psychologist willing to provide you with an evaluation that meets the FAA requirements.

 

3. Hire, at your expense, your own psychologist/mental health professional to provide you with an evaluation that meets the FAA requirements.

 

4. Appeal the FAA’s denial of your medical. However, without #1, #2, or #3 above as backup, forget it.

 

The big problem is overcoming the established history that got you the disability for PTSD. That sword cuts on both sides. Consequently, like most people in your position, you’ll have to step outside the VA system, at your expense, and hire your own mental health professional, AME, etc.

 

The FAA is unwavering on these issues. You’re going to need a psychologist or other FAA recognized mental health professional to provide you an evaluation that meets the FAA requirements.

 

He also claims that he cannot take on the liability of the evaluation that the FAA requires?

In other words, it's not their job to worry about FAA requirements. They don't get paid for that. Don't expect any extracurricular efforts from the VA.

Edited by iChris
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If you get some physician to clear you of PTSD, you might lose your disability income.

 

 

He will also lose it If he starts a flying career...can't work if you are getting VA disability, at least not full time.

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Sadly, sometimes you can't have it both ways. If you got yourself an 80% disability for PTSD, perhaps...and I suggest this with as much kindness as I can...perhaps you shouldn't be flying. I'm sorry. Good luck to you!

 

This is just my rating, not a reflection of my current status. This rating is based from the VA's last C&P evaluation over 2 years ago (06/2011). I am currently symptom free for well over a year, coping mechanisms in place and fully cognitive. Currently holding a 3.7 GPA in aviation courses at Green River CC. I should also add that I was never medicated.

 

The problem isn't my condition, it's the label still stuck to my forehead from over 2 years ago.

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If you get some physician to clear you of PTSD, you might lose your disability income.

That's fine by me. I would much rather get this cleared up and be able to fly than keep getting a check for disabilities that haven't been a bother for some time now. I have no control over when the VA decides to evaluate me

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Just go get a full time job, the way they explained it to the girlfriend (70% also) was that if she was to work full time she would lose all her benefits because that means she is fit to work and no longer needs VA disability...But is a guaranteed monthly check plus health coverage for the rest of your life worth losing?

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Just go get a full time job, the way they explained it to the girlfriend (70% also) was that if she was to work full time she would lose all her benefits because that means she is fit to work and no longer needs VA disability...But is a guaranteed monthly check plus health coverage for the rest of your life worth losing?

 

That's incorrect. I know a bunch of people collecting disability (30-60 %) that work fulltime flying jobs. Pretty much all my friends that I flew with in the Army retired and are currently collecting disability. They all operate under a medical waiver allowing them to fly as commercial pilots.

 

Generally injuries that are awarded 100 % disability are considered non employable. Of course with the FAA it isn't about what percent, it's the extent of the injury that matters. One might be able to get a class III but some times a class II will be out of the question. PTSD diagnosis and TBI will be hard to overturn.

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This is just my rating, not a reflection of my current status. This rating is based from the VA's last C&P evaluation over 2 years ago (06/2011). I am currently symptom free for well over a year, coping mechanisms in place and fully cognitive. Currently holding a 3.7 GPA in aviation courses at Green River CC. I should also add that I was never medicated.

 

The problem isn't my condition, it's the label still stuck to my forehead from over 2 years ago.

 

Then find a private AME who is willing to help and appeal the denial. If what you say is true, then you should be able to navigate these roadblocks.

 

No promises that these two psychs can take new patients or satisfy the needs of the FAA, but it's worth a phone call. Both are in Seattle:

 

William Healey MD Seattle (206) 624-6987

Karen Ni, MD Seattle (206) 321-3618

 

Good luck.

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That's incorrect. I know a bunch of people collecting disability (30-60 %) that work fulltime flying jobs. Pretty much all my friends that I flew with in the Army retired and are currently collecting disability. They all operate under a medical waiver allowing them to fly as commercial pilots.

 

Generally injuries that are awarded 100 % disability are considered non employable. Of course with the FAA it isn't about what percent, it's the extent of the injury that matters. One might be able to get a class III but some times a class II will be out of the question. PTSD diagnosis and TBI will be hard to overturn.

 

Tell that to her VA Rep that told her. But as I've searched around, it seems it's all up to the Reps interpretation, there doesn't seem to be a single right answer.

 

And retired with disability pension is different too.

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Thanks for all the input everyone. I will be busy this afternoon but will try and read through all of this tonight.

 

I actually just got back from an hour of dual in an R22 with Nightsta1ker. It was blustery out today! METAR/TAF called for 12G22KT and it sure felt like it. Made it a bit interesting for only my 2nd flight hour.

 

The interesting thing about the TBI diagnosis is that there was no head imaging conducted. I only received the basic neuropsych testing battery and some of my PTSD symptoms previously experienced were co-related to the possible TBI (difficulty concentrating, lack of mental organization, mental fatigue). I hit 3 IEDs as a Stryker driver in Iraq, but never lost consciousness or anything like that.

 

I am waiting to hear back from the VA after finally getting ahold of my primary care provider (PCP). My PCP was able to submit 2 consult requests to the Seattle VA hospital, 1 for the PTSD eval and 1 for a head CT scan. I will wait and see what they have to say before venturing into the private sector. It all depends on how long it will take to do it through VA, IF they'll do it. I will likely have to wait some months before the VA can see for these two topics as well, unless I can convince them to expedite for the fact that this is for vocational training/education.

 

My concern is whether or not the VA will be able to address all the specifics requested by the FAA. Particularly, the "an assessment of my capability to handling the stress of aviation decision making and flight training" part since they aren't involved in aerospace psychology.

 

And yeah, I am 80% disabled but have held a job in the same company for over 4 years. The VA was aware of my job at the time of my claim evals but still gave me 80%. So i'm guessing Individual Unemployability probably comes into effect at 100% disability.

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Thanks! I will contact him monday. One fortunate thing in my case is that the lady in charge of my case at the Renton Regional Office (whose name I will respectfully keep anonymous) told me that I don't need to appeal to OK city. She said all this should be able to be managed within the region and to send any correspondence to her. So that's a nice perk. I've heard so many beauraceacy horror stories about the FAA in OK city!

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Update:

 

My VA Primary Care Provider has ordered a head/brain CT scan for me! I am waiting on a call from Radiology at Seattle VA hospital to schedule an appointment.

 

My PCP also spoke with the clincial psychologist of that establishment (the guy who refused to give me another evaluation for liability purposes). He recommends that I re-establish a primary care team based in the Seattle area (he's in Mount Vernon, WA, where I moved from to go to school in Auburn) and to seek the referral for psychological evaluation through them once established. Makes sense, but still adds to the headache.

 

Has ANYONE been able to receive a PTSD evaluation through the VA adequate enough to fullfil the demands of the FAA? Or should I save myself some time and stick to the private/AME sector?

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Bighead: Just want the thank you for the crap you had to endour and the best of success for you in the future. Keep your head up. Someone will be lucky to hire you. Same goes to all our other vets. Sure would be nice if we allowed our troops to finish the job. Little OT but dang, this is getting old.

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Bighead: Just want the thank you for the crap you had to endour and the best of success for you in the future. Keep your head up. Someone will be lucky to hire you. Same goes to all our other vets. Sure would be nice if we allowed our troops to finish the job. Little OT but dang, this is getting old.

Thanks, Hobie. Just trying to make the dream a reality here!

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I just want to clarify any VA Compensation and Pension (C&P for those of us in the VA system).

 

Your C&P rating does not affect your ability to work full-time. You are receiving VA Compensation for your injuries, not a disability payment. Social Security Disability will keep you from working in a job, but your VA Compensation rating will not. You can have a rating of 100%, like the OP has and still work full-time. The only way you cannot work is if you get a rating of 100% based on Unemployability.

 

Unemployability is for those that cannot get a rating of 100% based on their actual service connected injuries. You can have a rating of 70%, and not be physically or mentally able to work. In this case, the person can file for Unemployability with C&P. If approved, then they are given a rating Unemployable and paid at the 100% Compensation Rating.

 

Keep in mind, the main difference is that the VA is paying you as Compensation for your injuries or illnesses that you sustained while serving your country. It is not considered Disability payments. It is tax free but does not affect your ability to work in any way unless that Unemployability is attached.

 

I hope this helps.

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I went through this in the mid 1970's. I had to demonstrate I no longer had a disability. Get on the phone to the folks in Renton and stop writing to them. Find what they want you to do and do it. Bottom line: a disability disqualifies you for a 141 flight school. Get rid of the disability.

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My denial letter from the FAA Regional Office in Renton, WA states that the FAA requires:

 

1. A detailed evaluation from a mental health professional regarding the history of my PTSD to include the presence or absence of symptoms and what they are, an assessment of stability in future stressful situations, an assessment of my capability to handling the stress of aviation decision making and flight training detailing any coping mechanisms I have in place, and any other testing deemed necessary.

 

2. A current head CT or brain MRI and current status report from the treating physician regarding my history of TBI. Current status report should address any findings from the chosen scan, and any other testing deemed necessary.

 

 

Has ANYONE been able to receive a PTSD evaluation through the VA adequate enough to fullfil the demands of the FAA? Or should I save myself some time and stick to the private/AME sector?

 

Again, the big problem is overcoming the established history that got you the disability for PTSD. That sword cuts on both sides. Consequently, like most people in your position, you’ll have to step outside the VA system, at your expense, and hire your own mental health professional, AME, etc. Below is a list of a few Aviation Medicine Services that provide professional help with these types of medical cases.

 

You’re currently at the mercy of the VA system and the best that you can hope for is your case reaching someone in the system willing to go the extra mile.

 

The FAA is unwavering on these issues. You’re going to need a psychologist or other FAA recognized mental health professional to provide you an evaluation that meets the FAA requirements.

 

Under §67.107[c] No other personality disorder, neurosis, or other mental condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds:

 

1. Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

 

2. May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

 

In this context, PTSD is considered a “neurosis or other mental condition” (in part c). Any airman with a history of ongoing PTSD symptoms or a history of PTSD should be deferred to the FAA for further consultation.

 

It can be done as shown in references below:

 

Question - What effect does a PTSD disability rating from the VA have on an airman’s medical status?

Answer - The Veterans Administration’s requirement to make this determination is substantially different than the FAA’s requirement to ensure that PTSD does not interfere with safe flying. Consequently, the VA uses its own set of rules for disability determina­tion, which do not necessarily reflect the functional requirements for safe flying.

The FAA reviews every case on an individual basis. There are several aspects of PTSD, which could potentially interfere with the safe performance of pilot duties. The FAA uses the VA disability rating as just one indicator that the individual has some level of impairment that we need more information about. We attempt to put the entire picture together in making our determination.

REF: FAA Safety Briefing; May/June 2013; Aeromedical Concerns; Ask Medical Certification

 

Question - I’m a returning vet. Can I be treated for PTSD and still fly?

Answer - If you are being treated through counseling sessions, you may be able to gain medical certification. You need to get copies of your medical records, plus a good status report, and take them to an aviation medical examiner (AME). The AME should be able to give you some idea of your chances. Alternatively, the AME can phone the FAA to discuss your situation.

If you are taking one of the four acceptable medications and have been on a consistent dosage for 12 months, you need to follow the instructions on the FAA Medical Certification website. The requirements are listed here: Link

REF: FAA Safety Briefing January/February 2012

 

Case Background.

 

In 1989, the airman was piloting a commercial airliner on a routine flight when the aircraft encountered extreme turbulence, resulting in loss of aircraft control such that it nearly rolled inverted and almost stalled.

 

The airman was able to regain control of the aircraft through skill and sheer physical strength. The flight continued to its destination, where it landed without incident. No adverse outcomes resulted from the event.

 

However, the airman experienced increasing levels of anxiety related to weather and flying. He became obsessive about checking weather status and would grow anxious several days before flying. He experienced physical symptoms of nausea, diaphoresis, shaking hands, and stomach cramps, occurring whether he was a pilot or a passenger in an aircraft.

 

Three months later, he sought professional help for his fear of flying. He was diagnosed with post-traumatic stress disorder (PTSD) and specific phobia—flying an aircraft. He was highly motivated to overcome his symptoms and return to the cockpit. He worked with psychologists and psychiatrists over the next 20 months to manage his symptoms, improve his coping skills, and reframe distorted thought patterns.

 

He was offered anxiolytic and selective serotonin re-uptake inhibitor (SSRI) medications but declined them. He underwent cognitive therapy, constructivist self-development therapy, and eye movement desensitization reprocessing (EMDR). Ultimately, he was able to recall the 1989 event without feelings or symptoms of anxiety, and he was able to fly as a passenger without difficulty, at that time, he and his treatment team concluded he had improved enough to return to the cockpit.

 

The airman did not meet first-class medical requirements per 14 CFR 67.107[c] due to the diagnosis of PTSD and flying phobia. Item #47 III.B.4 of the Guide for Aviation Medical Examiners notes that phobias associated with flying are disqualifying.

 

Severe anxiety responses limit an individual’s ability to accurately interpret and respond to the environment, often due to distraction that causes failure to recognize important environ-mental cues or initiating inappropriate responses to environmental cues. This may result in the airman failing to take appropriate action when indicated.

 

For example, the airman could become so focused on his feelings of anxiety, thoughts of impending doom, and physical symptoms of nausea and stomach cramping that he fails to recognize and respond to radio transmissions or changes in aircraft altitude, airspeed, attitude, or configuration. This may result in the airman failing to take appropriate action when required.

 

In the aerospace environment, this can be fatal not only to the airman, but to the passengers and others as well. The presence of severe anxiety in the context of a phobic condition carries an unacceptably high risk of in-flight incapacitation.

 

Additionally, any physical or psychological comorbid conditions, such as PTSD or depression, may require evaluation and treatment to meet the requested flying class requirements. Psychological comorbid conditions may be more difficult to treat than phobias and also carry a risk for sudden incapacitation that must be fully evaluated.

 

Medications used to treat psychiatric diagnoses (e.g., tricyclic antidepressants, SSRIs, anxiolytics, and antipsychotics) are not compatible with flying due to medication side effects and the potential for break-through symptoms. In this case, the airman’s PTSD, Fear of Flying from Phobias are the third most common adult mental disorder in the United States (after substance abuse and major depression), but rarely cause significant impairment in function.

 

Outcome

Based on the guidance found in 14 CFR 67.401, the Aerospace Medical Certification Division (AMCD) may grant special issuances to airmen who do not meet flying class medical requirements. The decision to grant such an issuance is based on the individual considerations of each case. Medical certification of an airman diagnosed with specific phobia—flying an aircraft depends upon the successful resolution of symptoms and maintenance of symptom remission.

 

In this case, the airman demonstrated good insight and judgment in concluding he could not safely fly with the symptoms he experienced. He also actively participated in his treatment and demonstrated excellent insight, judgment, and motivation throughout the treatment process. Because the airman was able to normalize his distorted thought processes, he was able to over-come his anxiety associated with flying.

 

He was no longer obsessed with concerns about the weather or flying conditions, and he regained confidence in his flying ability. Given that his mental and physical symptoms resolved successfully, the AMCD concluded it was unlikely that his symptoms would relapse during flight, and there was no significant risk for incapacitation during flight, even when he encountered turbulence. Therefore, the AMCD exercised the guidance found in 14 CFR 67.401 and granted the airman a 1st-class, 6-month special issuance.

 

Additionally, the AMCD warned the airman that he must report any adverse changes in anxiety symptoms. Failure to report a change in status would result in removal of his medical authorization to fly. To renew the special issuance at the end of the 6-month period, the AMCD required the airman to provide a current status consultation report from his therapist noting the airman’s mental health status. Further issuances were dependent upon the continued remission of the airman’s anxiety symptoms. - REF: FAA Federal Air Surgeon’s Medical Bulletin Vol. 47, No. 1; 2009-1; The Fear of Flying Case Report, by Maureen Williams, MD, MPH; Also See §67.401 Special issuance of medical certificates.

 

Aviation Medicine Services

 

PHPA FAA Medical Certification Assistance and Aeromedical Advice

 

The Aviation Medicine Advisory Service

 

AOPA's Pilot Protection Services

 

 

I had to demonstrate I no longer had a disability. Get on the phone to the folks in Renton and stop writing to them. Find what they want you to do and do it.

 

You’re dealing with a different beast. This is not your local FSDO. If you’re lucky you may get a foot in the door; however, in most cases the best you’ll get is, “your case is under review.” Remember, your dealing with the Regional Flight Surgeon’s Office in Renton, WA. Most likely, your case will end up at the Aeromedical Certification Division in Oklahoma City

 

First try following AOPA’s advice:

 

AOPA: Ask your AME to call the Regional Flight Surgeons

Edited by iChris
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