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Special Issuance process

Old 05-18-2019, 06:55 PM
  #11  
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Without knowing your putative diagnosis it is impossible to answer the procedural issues because the procedural issues vary with the diagnosis. Different diagnoses require different protocols:

https://www.faa.gov/about/office_org...m47/amd/table/

Example:

Decision Considerations - Aerospace Medical Dispositions
Item 47. Psychiatric Conditions - Psychosis
Psychotic Disorders are characterized by a loss of reality testing in the form of delusions, hallucinations, or disorganized thoughts. They may be chronic, intermittent, or occur in a single episode. They may also occur as accompanying symptoms in other psychiatric conditions including but not limited to bipolar disorder (e.g. bipolar disorder with psychotic features), major depression (e.g. major depression with psychotic features), borderline personality disorder, etc.

All applicants with such a diagnosis must be denied or deferred.

....

But even in the case of a diagnosis that is OBVIOUSLY DISQUALIFYING, it still might be waived if it can be established that the diagnosis was not well founded to begin with (like many childhood ADD diagnoses) or that current testing is inconsistent with that diagnosis.

But this is not something the FAA is going to do FOR you. An individual AME MIGHT do it, although the vast majority of senior AMEs are old military flight surgeons or other docs who are themselves pilots who probably just about break even on an uncomplicated physical exam.

For complicated issues, it’s often best to go to the relatively few places that specialize in getting SIs for pilots - guys who work the FAA SI system often enough to be knowledgeable and proficient in doing so. And yes, that’s gonna cost some coin. Shop rates on automotive repair are $100 an hour in my town, lawyers are about $350 an hour, and the doctors doing this have a lot more investment getting qualified for their jobs than auto mechanics or lawyers do.

As for procedural/process issues, do you expect your lawyer to use the same procedure/process writing up your will as he/she does defending you in civil (or criminal) court? Or your mechanic to follow the same procedure/process aligning you cars front end and fixing the transmission? All these things are highly circumstance specific, as are psychiatric diagnoses.

So let me guess...OCD?
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Old 05-19-2019, 02:06 AM
  #12  
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Unless you are a medical professional, how are you able to determine what is necessary or unnecessary to reach a medical decision regarding certification?

The FAA uses designated authority with medical examiners, aircraft inspectors, pilot and mechanic examiners, etc. Where the FAA does not enable designated authority to make a final decision (AME's do not have discretion or blanket authority to issue a medical certificate for all conditions), the Administrator has reserved final decision for the aeromedical branch to make a special issuance.

By its very nature, special issuance means an exception to the standard: medical personnel (doctors) determine, based on requested tests and data, that the applicant is able to perform safely for the anticipated duration of the medical certificate, with a particular condition. Obviously this is subjective to the judgement of the medical professionals involved, as nearly all medicine is.

There are AME's who are very familiar with the special issuance process and who specialize in helping airmen through it, and there are others who will defer to Oklahoma City if there is any question at all. Most medical examiners sit somewhere in between.
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Old 05-19-2019, 09:02 PM
  #13  
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I fully understand your point - different diagnosis will be MEDICALLY evaluated differently - but the overall SI process is similar for many HIMS cases & gaining as much insight into the ADMINISTRATIVE/PROCEDURAL process is my primary goal right now.

As for the OCD “diagnosis” - well played, sir, well played and I laughed for sure...but it appears you did NOT stay in a Holiday Inn Express last night!

Again, thank you taking an interest in helping.

Originally Posted by Excargodog View Post
Without knowing your putative diagnosis it is impossible to answer the procedural issues because the procedural issues vary with the diagnosis. Different diagnoses require different protocols:

https://www.faa.gov/about/office_org...m47/amd/table/

Example:

Decision Considerations - Aerospace Medical Dispositions
Item 47. Psychiatric Conditions - Psychosis
Psychotic Disorders are characterized by a loss of reality testing in the form of delusions, hallucinations, or disorganized thoughts. They may be chronic, intermittent, or occur in a single episode. They may also occur as accompanying symptoms in other psychiatric conditions including but not limited to bipolar disorder (e.g. bipolar disorder with psychotic features), major depression (e.g. major depression with psychotic features), borderline personality disorder, etc.

All applicants with such a diagnosis must be denied or deferred.

....

But even in the case of a diagnosis that is OBVIOUSLY DISQUALIFYING, it still might be waived if it can be established that the diagnosis was not well founded to begin with (like many childhood ADD diagnoses) or that current testing is inconsistent with that diagnosis.

But this is not something the FAA is going to do FOR you. An individual AME MIGHT do it, although the vast majority of senior AMEs are old military flight surgeons or other docs who are themselves pilots who probably just about break even on an uncomplicated physical exam.

For complicated issues, it’s often best to go to the relatively few places that specialize in getting SIs for pilots - guys who work the FAA SI system often enough to be knowledgeable and proficient in doing so. And yes, that’s gonna cost some coin. Shop rates on automotive repair are $100 an hour in my town, lawyers are about $350 an hour, and the doctors doing this have a lot more investment getting qualified for their jobs than auto mechanics or lawyers do.

As for procedural/process issues, do you expect your lawyer to use the same procedure/process writing up your will as he/she does defending you in civil (or criminal) court? Or your mechanic to follow the same procedure/process aligning you cars front end and fixing the transmission? All these things are highly circumstance specific, as are psychiatric diagnoses.

So let me guess...OCD?
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Old 05-19-2019, 09:15 PM
  #14  
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You’re absolutely right - I’m not a medical professional and I’m not qualified to diagnose or assess what tests are necessary given the diagnoses. But, just thinking critically, it seems wild to me that an IQ test could be used as a mental health evaluation tool, especially without an established baseline to monitor change. That being said, if the FAA dictates an IQ test as part of my particular evaluation, then I’ll gladly submit to it and hopefully I’ll learn more about the utility of an IQ test for mental health diagnoses (and do well enough on my other evaluations to make up for the IQ test result...).

Thanks a lot for your help and insight.

Originally Posted by JohnBurke View Post
Unless you are a medical professional, how are you able to determine what is necessary or unnecessary to reach a medical decision regarding certification?

The FAA uses designated authority with medical examiners, aircraft inspectors, pilot and mechanic examiners, etc. Where the FAA does not enable designated authority to make a final decision (AME's do not have discretion or blanket authority to issue a medical certificate for all conditions), the Administrator has reserved final decision for the aeromedical branch to make a special issuance.

By its very nature, special issuance means an exception to the standard: medical personnel (doctors) determine, based on requested tests and data, that the applicant is able to perform safely for the anticipated duration of the medical certificate, with a particular condition. Obviously this is subjective to the judgement of the medical professionals involved, as nearly all medicine is.

There are AME's who are very familiar with the special issuance process and who specialize in helping airmen through it, and there are others who will defer to Oklahoma City if there is any question at all. Most medical examiners sit somewhere in between.
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Old 05-19-2019, 11:28 PM
  #15  
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Your discourse is hard to follow. Did an IQ test get ordered, or not?

Or are you just spitballing here?
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Old 05-20-2019, 07:52 AM
  #16  
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It shouldn’t be that hard to follow if the thread is read - I used it as an example earlier of ‘interesting’ FAA tests that I’ve seen mentioned by others.

Originally Posted by JohnBurke View Post
Your discourse is hard to follow. Did an IQ test get ordered, or not?

Or are you just spitballing here?
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Old 05-20-2019, 10:44 PM
  #17  
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Originally Posted by fenix1 View Post
It shouldn’t be that hard to follow if the thread is read - I used it as an example earlier of ‘interesting’ FAA tests that I’ve seen mentioned by others.
Not easy to follow at all. You refuse to provide information, speculate regarding things you know nothing about, suggest you can or should determine what medical tests are relevant, then infer the use of an IQ test to determine mental fitness. Did you receive such a test, or are you inventing something to stir the pot? In other words, what possible relevance does the IQ test have to your case? You seem to be invoking whatever suits your fancy in a sky-is falling series of rants, including tests you appear not to have been given.

You suggest that tests are given, which are ignored. which ones, specifically, and how do you know they were ignored? You suggest that physicians are ignoring data and using guesswork or opinion instead. Be specific. What has been ignored, and how do you know that they're using guesswork or opinion other than professional judgement?

Which tests are being administered that are "comically outdated," that you've had to take, which were unnecessary or irrelevant, and given that you've already said that you're not qualified to know, how is it that you claim to know, such that you can post it here?

I've read the thread. Several times. You sidestep questions, given answers invoking things which are not, and have invented or inferred quite a bit without a bit to back it up. Do so.
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Old 05-21-2019, 11:00 PM
  #18  
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How in the world do you know what I know?...

The specifics of my personal medical situation are no concern of yours for the very reasons you’ve cited - you’re no AME either - and your insistence that I divulge them is odd. I’m not looking for help on the medical side of things in this thread - that is the place of the AME - but instead I’m seeking to understand the SI PROCESS better and what really matters within it (hence the title of the thread).

I have read or heard multiple accounts of IQ tests being used by the FAA for folks involved in situations that fall under the purview of HIMS. I have no clue of the validity of the information, but - if true - it seems bizarre. But there’s plenty of bizarre out there sometimes.

I’m also read & heard of situations where quantitative testing has come back favorable, but the SI has still been denied, which seems bizarre as well. Again, not sure of the validity or the completeness of the info and I’m not going to indulge you with specificity.

This is an Internet forum, not gospel truth. It is a tool that - when used wisely in a discerning fashion - can reveal trends or general info. I’m not “side-stepping” anything and, in fact, have directly told you several times that I have no interest at all in your assessment of my particular medical situation, but I would appreciate any information that folks are good enough to share about the SI process for HIMS matters, which are subset of medical issues small enough to have many process/procedural (NOT medical evaluation or protocol!) commonalities. Think like a medical administrator, not a doctor, and - if you can’t or won’t do this - hopefully someone else with some meaningful info or experience can/will.

Originally Posted by JohnBurke View Post
Not easy to follow at all. You refuse to provide information, speculate regarding things you know nothing about, suggest you can or should determine what medical tests are relevant, then infer the use of an IQ test to determine mental fitness. Did you receive such a test, or are you inventing something to stir the pot? In other words, what possible relevance does the IQ test have to your case? You seem to be invoking whatever suits your fancy in a sky-is falling series of rants, including tests you appear not to have been given.

You suggest that tests are given, which are ignored. which ones, specifically, and how do you know they were ignored? You suggest that physicians are ignoring data and using guesswork or opinion instead. Be specific. What has been ignored, and how do you know that they're using guesswork or opinion other than professional judgement?

Which tests are being administered that are "comically outdated," that you've had to take, which were unnecessary or irrelevant, and given that you've already said that you're not qualified to know, how is it that you claim to know, such that you can post it here?

I've read the thread. Several times. You sidestep questions, given answers invoking things which are not, and have invented or inferred quite a bit without a bit to back it up. Do so.
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Old 05-22-2019, 04:40 AM
  #19  
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Originally Posted by fenix1 View Post
How in the world do you know what I know?...
We know what you tell us, which is a disjointed swill of speculation mixed with bad in formation and guesswork.

[QUOTE=fenix1;2824237
I have read or heard multiple accounts of IQ tests being used by the FAA for folks involved in situations that fall under the purview of HIMS. I have no clue of the validity of the information, but - if true - it seems bizarre. But there’s plenty of bizarre out there sometimes.
[/QUOTE]

Finally an answer to the question. You're taking a swipe and second or third hand information that you guess might not apply based on your lack of knowledge, training, and experience. That wasn't so hard to say after all, was it?

[QUOTE=fenix1;2824237
I’m also read & heard of situations where quantitative testing has come back favorable, but the SI has still been denied, which seems bizarre as well. Again, not sure of the validity or the completeness of the info and I’m not going to indulge you with specificity.
[/QUOTE]

Again, you're guessing regarding information which is rumor and at best third-hand that you read or heard somewhere, and somehow projecting that into your own world (and ours, as you've posted it). Your comments thus far have pointed to irrational and unprofessional acts by the Administration, and by AME's, none of which you can actually identify. You're venting, but you don't know what you're venting about because it's based on rumors.

Because you're not qualified to make these decisions, you're going to second guess those who do; the information that returns from a "quantitative test" is "favorable," and therefore you'd approve the applicant, but the applicant of these mythical situations is denied a medical. This is "bizarre" to you, even though you aren't qualified to diagnose the condition or it's applicability to aerospace safety or medicine, or the regulation that governs both. Because you think it's "bizarre," it makes the professionals who are qualified to make the decisions, wrong.

Originally Posted by fenix1 View Post
This is an Internet forum, not gospel truth.
Therefore, no need to deal truthfully, then?

Remember, everything said here is said because you introduced it, and every response ONLY to what you've elected to provide. It's muddled, filled with "I heard about" or "I read about" but a refusal to provide specifics about what you heard or read about, and you've introduced the IQ test as though it's applicable to you, when you don't know if it's applicable to anything or not, and have gone so far as to decide it's not and stand on that platform...yet when told that your comments are not clear, you're quick to bark back and tell us to "read the thread."

Again, we know only what you say. Do you not intend to say it truthfully?

Originally Posted by fenix1 View Post
I’m not “side-stepping” anything and, in fact, have directly told you several times that I have no interest at all in your assessment of my particular medical situation, but I would appreciate any information that folks are good enough to share about the SI process for HIMS matters, which are subset of medical issues small enough to have many process/procedural (NOT medical evaluation or protocol!) commonalities. Think like a medical administrator, not a doctor, and - if you can’t or won’t do this - hopefully someone else with some meaningful info or experience can/will.
The "administrator" is the FAA Administrator; the sole person charged by an Act of Congress to oversee aviation safety in the United States. The Administrator's delegates in the matter are physicians; the ones who make the decisions: these are not arbitrary or capricious calls made by secretaries and bureaucrats, but by panels of physicians who meet to discuss the cases and who will order additional information as needed. When matters are deferred to Oklahoma city, primarily when the Administrator (a term which collectively refers to the designees fo the Administrator and the FAA) has determined that local approval is not possible by the AME in the field, the matter is handled by physicians whose expertise is aviation medicine.

You seem to think that it's a matter of favoritism and rolling dice, and it's not. You seem to think that a failure to be approved is "bizarre," not based on any science, but based on your guesswork of second hand internet lore. You seem to think that everyone should think as you, and you seem to think that the entire process is decided by faceless bureaucrafts who haphazardly make the call.

You are wrong on all counts.
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Old 05-22-2019, 08:59 AM
  #20  
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Originally Posted by fenix1 View Post
I have read or heard multiple accounts of IQ tests being used by the FAA for folks involved in situations that fall under the purview of HIMS. I have no clue of the validity of the information, but - if true - it seems bizarre.
I served on a HIMS committee several years ago, and in cases involving substance abuse (which were the only kind we dealt with at that time), IQ and other mental tests were used to check for brain damage. Judging the effectiveness of such tests was above my pay grade.

I’m also read & heard of situations where quantitative testing has come back favorable, but the SI has still been denied, which seems bizarre as well.
Test results are not supposed to be released, and even if they were “favorable”, the SI could have been denied for other reasons. In my experience, most denials were for non-compliance with aftercare instructions or for a bad attitude. Appeals were rarely successful.
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