Obtaining First-Class Medical with SSRI history
Answered By AOPA
Hello Everyone,
I'm seeking guidance and clarification on this whole SSRI process. I have read tons of material and documentation from the FAA website and countless forums, but none of them quite given me clear information.

Background: I am an Army Vet and full-time Army Reservists with 19 years of service, ERAU graduate, about to retire from the military, and want to transition careers to become a professional pilot. I deployed to Iraq in 2004-2005 during the climax of the Iraq war. I returned home 12/2005, went to the VA to use the free healthcare, was prescribed Fluoxetine, but never used it because I thought I didn't need it. Fast forward to 2019, I had a mental health hospitalization due to suicidal ideations. I was discharged, began treatment with the VA, and was awarded a disability for PTSD. January 2020, I had another hospitalization and was prescribed various mood and anxiety medicines. Throughout 2020 and after various conversations and sessions with my social workers and psychologist, I realized the military life wasn't for me anymore.

Therefore, I've made the decision to submit my retirement packet and pursue new endeavors, which is to become an airline pilot. It's something I have always wanted to become. I also elected to discontinue my medicines as I did not like the associated side-effects. Since stopping the medication, there has been great improvements on my daily life and well noted in my medical records.

Here's where the confusion comes in. Given I have so much history, I'm lost as to what to expect and how I should best go about going for me medical certificate. I researched on my own and concluded the following:

1. The convoluted SSRI process seems confusing and misleading.
*It's almost as if the FAA does not want pilots with any history (big or small) of depression, anxiety, or any other mental health history.
2. SSRI Decision Path 1 seems like what I've already elected, but from what I've read through forums I would still:
*require to be on a SSRI since I had 2 hospitalizations.
*require a Special Issuance/Special Authorization and an additional SI on recertification
*require a positive report from my psychologist after being off SSRIs for 90 days or more (preferred)
*require HIMS evaluation
3. Possible denial because I have history of suicidal ideation with no ability for appeal or re-application.
4. Recommendation letters carry no weight.
5. Electing SSRI Path 1 require several conditions to be met for a SI to be considered (based on the info in the AME guide - Item 47)
6. "An applicant with an established history of a personality disorder that is severe enough to have repeatedly manifested itself by overt acts, a psychosis disorder, or a bipolar disorder must be denied or deferred by the Examiner." My interpretation: If you've had more than 1 hospitalization, you're in this category and get ready to jump through hoops.

So far, I been off for over 60 days (the minimum requirement), pending the evaluation from my doctor, and obtained all medical records from the VA and military. I also found an AME/HIMS, once I start this process, who will schedule me for an appointment.

I'm willing to do whatever it takes to obtain a first-class certificate.

Any advice/guidance/clarification would be much appreciated!
4 Replies
AOPA Staff Answer
James, Gary at AOPA here.  Your history is one that keeps the FAA docs awake at night. Mental health issues are among the most difficult cases the FAA sees, and they're seeing a lot of them now among applicants such as you with a military PTSD combat history.  The FAA is the most "progressive" civil aviation regulatory body on the planet and really works hard to find a way to get to "yes" in as many cases as possible. Sometimes that pathway to yes is a long, frustrating, and expensive experience for the really difficult cases, and yours will be one of those.

Your case is complicated by two psychiatric hospitalizations for suicidal "ideation" which is a big red flag in itself.  You also have been prescribed multiple psychiatric meds.  Those factors alone on the surface makes it a troublesome case.

Your observations about the SSRI process are correct.  Your history is difficult and the SSRI process is a cumbersome route to a special issuance.  Even the FAA Federal Air Surgeon agrees that its a tough road to navigate, and the Office of Aerospace Medicine is trying to improve the pathway to a special issuance, but, again, trying to get to yes in these complex cases requires a lot of evaluation.

The FAA website information is intimidating and is misleading but probably not by design.  The FAA medical certification bureaucracy is just really hard to understand because the policy makers and regulators have the interests of the national airspace first and foremost priority, and balancing that mandate with the strong desire to medically qualify a pilot with a tough case to fly in that airspace is a difficult tightrope to walk.  Further, trying to synthesize the requirements for a special issuance under the SSRI policy has so many subtleties that simply cannot be clearly explained in the website language.
Everyone's case and situation is different, and the FAA tries to modify the "cookie cutter" requirements to consider the merits of each individual's situation.  That said, though, past history of a bad experience is a hard lesson for the FAA to overcome, and the GermanWings crash in 2015 made a huge mess for the FAA and as a result, the screws really tightened for satisfactory review of the complicated mental health cases such as yours.

So, if you apply for a medical, you will be in for that long, time consuming, frustrating, expensive, and not necessarily successful quest for a special issuance.  Your case will be reviewed by multiple specialists within and without the FAA, and it is possible that you ultimately will be denied, and that denial may not include an option for a favorable appeal.  Time is your best ally, and the more distance you put behind the hospitalizations and meds use, the more time you can demonstrate stability, and that works in your favor.

You don't mention if you have a pilot certificate already, or if you have applied for a medical previously.  I would strongly suggest you apply ONLY for a class three medical to start.  Although it may not matter in the long run, a third class may be looked at differently than if you apply for a first class just because you aspire to hold a Commercial or ATP certificate sometime down the road.

Sorry for the long response, but you need to know what you will be up against, and I tend not to sugar coat the process.  If you have further questions, you can email me at gary.crump@aopa.org.
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Regardless of whether you can get a First Class or not (Bruce Chien is the expert on that, and he should be around in the next day or two with his thoughts on that) I don't see a Part 121 air carrier hiring you with that history. Think about Egyptair, Germanwings, and the NTSB's recent push to get the FAA to do more psych screening of airline pilots.

Based on the history you listed, you would not be eligible for a medical certificate for a while. FAA typically requires a 10 year recovery period after suicidal ideations or attempts. After that it would depend on current treatment and evaluations. Because of your history FAA would require a thorough review of your treatment records and completing evaluations with a HIMS, a Psychiatrist, and a Neuropsychologist. If you apply before that 10 year recovery period you will likely be denied. FAA will not issue anyone who might have compromised judgement or emotional control issues.

Item 47. Psychiatric Conditions - General Considerations

It must be pointed out that considerations for safety, which in the mental area are related to a compromise of judgment and emotional control or to diminished mental capacity with loss of behavioral control, are not the same as concerns for emotional health in everyday life. Some problems may have only a slight impact on an individual's overall capacities and the quality of life but may nevertheless have a great impact on safety. Conversely, many emotional problems that are of therapeutic and clinical concern have no impact on safety.
I would be more blunt than Gary.   Suicidality in the record is informally a ten year grounding.  Four Federal psychiatrist in a row have operated under the informal notion that "psychiatry isn't as predictive as we would like. Sometimes you have to observe  the subject for a prolonged period of time before you known the precise diagnosis".

So since suicidailty is grounding they want ten years of no events, and well documented "successful life test" as documented by employers, social workers, psychologists.  It is confusing beucase they feel they can't come outright and say this.

HIMS (Psychiatry) AME