I have a third class medical that was issued in 4/2021. In 11/2021 I started talking to a therapist to help me cope with some big stressors in my life last year, went through a separation, and moved across state. I haven't flown since I moved. Things are a lot better now, and stopped therapy. Last week I found out that the therapist had been billing my insurance for single episode major depressive disorder. The therapist never discussed the diagnosis with me, though. I don't think this is an accurate diagnosis as how I felt then does not fit the criteria for such diagnosis and have no previous history. Anyway, I want to continue working towards my PPL, but I am having a hard time finding whether I need to report this to the FAA before I continue, or if this is something I would report when it's time to renew my medical? I should also mention that I was never prescribed any medication while I was in therapy. How should I proceed?
Just for clarification purposes, a pilot may not require a Special Issuance prior to initiating Basic Med. Major depressive disorder is not listed as a Basic Med disqualifying condition. According to AC68-1A and FAR 68.9a1 – the pilot only needs to obtain a Special Issuance if they have developed a Basic Med disqualifying condition. See below
“Special Issuance Medical Certificates Required. For certain conditions, a person wishing to operate under BasicMed must complete the process for obtaining an authorization for special issuance of a medical certificate in accordance with § 68.9. The person is required to obtain only one special issuance medical certificate for each condition and may subsequently operate under BasicMed. Persons who have, or are newly diagnosed with, a cardiovascular, neurological, or mental health condition described in FESSA, may not use BasicMed until they have been found eligible for special issuance of a medical certificate. Once issued a medical certificate, the person may then use BasicMed if they meet all other requirements of FESSA. These conditions are listed below:
8.2.1 A mental health disorder, limited to an established medical history or clinical diagnosis of any of the following:
1. Personality disorder that is severe enough to have repeatedly manifested itself by overt acts.
2. Psychosis, defined as a case in which an individual:
• Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
• May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis.
3. Bipolar disorder.
4. Substance dependence within the previous 2 years, as defined in part 67, § 67.307(a)(4). “
There is no need to report anything to the FAA at this time. As long as you feel you still meet the standards in 61.53 to keep flying, you can, However, you're going to have to report all this on your next medical application, and when you check the box in section 18 about having been diagnosed with depression, that application will probably get deferred to FAA HQ. So before you get to that point, consult with an expert in these matters like Dr. Bruce Chien, who will probably drop in and comment here. You can also find him at www.aeromedicaldoc.com.
This is a tough one. 61.53(a) says that no person may act as PIC while that person “knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation”. You would be at the mercy of the FAA attorneys who might want to bring an action on this. You said that you didn't have a previous history, but now you do and it is documented. You can argue the therapist's conclusion, but that would probably require a conflicting diagnosis from someone more qualified. If you were to ask the FAA Medical people, they would probably tell you to go get another medical, which would require reporting the disorder and providing all the records. This will happen anyway on your next application.
Unfortunately, 14 CFR 68.9c also requires getting a Special Issuance medical for mental health conditions to fly under Basic Med.
You can certainly continue with dual instruction with no problems.
Ron is right about consulting with Dr. Bruce Chien.
What would AOPA medical people and attorneys say about this and what would be their regulatory / policy references?
In the old days, things were much simpler. If we had problems, we talked them over with a bartender or close friend.
The FAA guidance on this is here. It sounds like a one-time episode resolved without the use of medication, in which case the disposition guidance in that table is to issue, which suggests that under 61.53, you can keep flying. But do prepare the necessary documentation to have with you when you go for your next medical, and that's where someone like Bruce can tell you what you'll need.
And as Bruce is a HIMS AME, he can help you determine if you were misdiagnosed with major versus minor depression, which is a significant difference to the FAA. Keep in mind that sometimes medical practitioners sometimes bill insurers for the easiest code to justify than the most accurate diagnosis. A story on point…
In 1981, while in the Air Force, I felt some tingling in my shoulder. I was examined by the squadron’s assigned flight surgeon, who turned me over to an orthopedist on a visit from the big USAF medical center. X-rays, physical exam, and he writes "Spondylosis" in my medical record (it's all Greek to me -- even if it's in Latin). He gives me some exercises to do, and in less than a month the symptoms are gone, never to return. Unfortunately, while this guy is a board-certified orthopod, he’s new to the Air Force, and doesn't know he's supposed to discuss things with the flight surgeon any time a flyer is examined. The flight surgeon didn’t bother to follow up. My record goes back in the records room, and that's that. I'm happy, I'm flying, life is good (or at least as good as it can be in Clovis NM, which my wife called "The US Air Force's answer to Soviet internal exile").
Six months later, my flight surgeon happens to review my medical record. "Spondylosis"? OHMIGAWD! That's unwaiverably and permanently grounding. Panic and consternation (not to mention irresponsibility -- the flight surgeon is supposed to immediately review anything anyone puts in a flyer's medical record, but that's another story). Levy's grounded, and the wing commander is in the hospital commander's face over how one of his crewmembers could have been allowed to fly for six months with a grounding medical condition. (Had there been an accident, this would have come out, and the wing and squadron commanders would have been barbecued.) They compromise -- send Levy to the big USAF medical center for another consult, this time with a neurosurgeon.
More X-rays, more examinations, more tests. Fortunately, this particular neurosurgeon is a wily old colonel and a rated flight surgeon, wise to the ways of both the Air Force and fighter pilots. He looks at all the data and says, "Well, you really can't tell spondylosis from mild degenerative joint disease without going inside your neck, and that's pretty risky and pretty pointless since the condition is asymptomatic and not progressing noticeably. The difference is that while spondylosis is grounding, DJD isn't. So I'm going to rewrite the diagnosis as mild DJD and you're back on flying status." So after ten days grounded, I'm flying again, all's well, etc.
No problem, right? Guess what. That damn fool squadron flight surgeon, in reviewing the medical record, noted that I got a Class II FAA Medical last time I took my annual USAF flight physical. Suddenly, this guy is conscientious -- at the same time he grounds me and wraps the Air Force around the axle, and without telling me, he writes the FAA a letter telling THEM I've got spondylosis. About two months later, after the USAF situation was resolved I get a letter from ol' Audie Davis, MD (long-time chief FAA flight surgeon) telling me to send back my Class II FAA Medical Certificate because of the spondylosis. Another two months of back-and-forth between the neurosurgeon, the flight surgeon, me, and Audie before it's straightened out.
I was fortunate -- it didn't cost me a dime to resolve the situation, but had I been a civilian, the costs would have been in the thousands (thanks, taxpayers). But the point is that if a medical professional writes or says the wrong words, it could be a nightmare getting it straightened out.
Thanks for answering my question and for the story, glad to hear it all worked out for you in the end. As soon as I found out about the diagnosis, I knew I'd have to jump through some hoops at some point. I kind of regret seeking therapy. Also, it sucks that there will always be small chance that a doctor visit can potentially turn into a nightmare if they misdiagnose or write something the FAA doesn't like to see.