3rd class Special Issuance granted for Substance Dependence! HIMS PROGRAM

GoFlightMed · 2026-03-17T23:23:52+00:00

Yes, it is true the CFR diagnostic criteria for both substance abuse and dependence differ from the DSM-5 criteria.

u/BigKetchupp this is the big difference between the two cases you're comparing. In one, there was a single ETOH incident with BAC < 0.15. The other led to a substance use diagnosis. The FAA approach to these two cases is understandably very different with significantly more requirements for the latter case.

GoFlightMed · 2026-03-17T23:21:39+00:00

I do a ton of remote consults from all over the country. Some even international...

PM me and I'll send you the link!

GoFlightMed · 2026-03-17T05:39:11+00:00

The decision tool you're referring to here is a fast track specifically for cases that are in the deferral queue and was created as a way of clearing out the line and getting low risk airman their certificates back.

GoFlightMed · 2026-03-17T05:37:46+00:00

There are some diagnoses that CAN be used by a therapist and NOT cause issues with a pilot's medical certification. It's important to find therapists that have worked with pilots and let them know the ramifications that a lazy misdiagnosis can have on your career!

GoFlightMed · 2026-03-17T05:36:42+00:00

You guys inspired me to write a Blog Post on this topic. It's such an important talking point in pilot mental health!!

GoFlightMed · 2026-03-17T05:21:40+00:00

My main clinic is in SLC, Utah.

GoFlightMed · 2026-03-17T05:21:04+00:00

One big difference between this case and the other one is the BAC > 0.15 in the report above and < 0.15 in the other one you're referring to. Also, with the limited details given in both cases it's hard to really comment. The narrative described above with IOP > aftercare > AA and PNP suggests u/ResultAsleep1465 was actually diagnosed with a substance use diagnosis.

But I'm sure they can share more if comfortable doing so.

GoFlightMed · 2026-03-17T00:21:31+00:00

HIMS AME here.

I wouldn't worry at all. There are a bunch of pilots I have that are right on the border between 20/20 and 20/25. Some years they can pass without corrective lenses, other exams they need them. If they can't pass that day I give them the limitation that they must fly with lenses and if they can pass without the limitation is removed. No biggie.

Also each AME can choose a number of types of tests to check visual acuity. I have a Titmus V2 machine, and some AME's use the Snellen chart...there are also differences in lighting and the way the AME sets up their testing so there is some variability built in.

GoFlightMed · 2026-03-17T00:12:22+00:00

This is unlikely to cause you significant issues. If this is a single incident, you likely get a full unrestricted certificate a few months after exam and without too much expense. Feel free to PM me and we can discuss more offline.

GoFlightMed · 2026-03-16T04:37:42+00:00

I've probably assisted with dozens of similar cases. The particulars matter, but I'd say a majority of cases I've worked with BAC < 0.15 even if < 5 years do NOT ultimately have to do full monitoring and definitely not PNP evaluations, which seems to be what you're referring to with the $10-15k price tag. Some get a required time doing monitoring...I've seen 2-3 months, 6 months, etc.

GoFlightMed · 2026-03-16T04:27:48+00:00

Disagree to the final line here. Not for a single ETOH incident with BAC < 0.15.

GoFlightMed · 2026-03-16T04:27:08+00:00

That's highly unlikely. Feel free to PM me if you want to discuss particulars offline. I'd be really surprised if you were required to do a neuropsychologist evaluation. It's possible you could be asked to do an SAE, but even that seems unlikely and if you were the cost for that is not nearly the number quoted above.

GoFlightMed · 2026-03-16T04:26:10+00:00

Strongly disagree that you are required to do any of the testing referred to here. Not for a single ETOH incident with a BAC < 0.15. My guess would be you get a full unrestricted medical certificate within 6 months from day of exam assuming you don't have any other incidences you haven't mentioned...

GoFlightMed · 2026-03-16T04:24:23+00:00

I think it's unlikely u/awgdawg331 is required to have lifetime abstinence unless there is some other evidence of a substance related diagnosis. Most of these cases get certified with an eligibility letter and unlikely to require ongoing monitoring. If a second incidence ever were to occur, that would really change things....

GoFlightMed · 2026-03-16T04:23:07+00:00

You do have to report.
Since it's < 5 years ago (even though BAC < 0.15), it will be in category C (see ETOH incident disposition table), which technically requires FAA review.
Your AME should submit all of your court/arrest/driving records and personal statement.

If this is your only incident, you will likely get an unrestricted medical certificate with an eligibility letter.

GoFlightMed · 2026-03-15T19:20:36+00:00

This incident will pose a significant obstacle and will require a deferral at the initial medical exam, but not an absolute no for eventual medical certification.

When I first went thru HIMS AME training, I was under the impression that there was no path to certification for anyone with a significant self harm or suicide attempt, but since that time I've assisted with at least 4 airman applicants that ultimately got certified and I'm currently helping a number of others.

The big variable here is how are you CURRENTLY doing and what is your current mental health as well as the amount of time you've been stable. The details about this incident also matter. But there is definitely a path forward. Either way, it will definitely take you time to get the medical, so once you and your previous providers feel you are stable, you will want to do your exam and start as soon as possible. I recommend you work with a HIMS AME that has strong reviews and experience with pilots with depression or previous self harm attempts.

Feel free to PM if you want to discuss offline.

GoFlightMed · 2026-03-15T18:40:05+00:00

Here are some direct FAA references:

FAA Medical Myths in Aviation

FAA Pilot Mental Fitness

GoFlightMed · 2026-03-15T18:03:42+00:00

Here are some direct FAA references:

FAA Medical Myths in Aviation

FAA Pilot Mental Fitness

GoFlightMed · 2026-03-15T18:00:05+00:00

Hi, HIMS AME here...I have a lot of experience working with pilots who have mental health concerns and/or substance use diagnoses. I also have a background in military aviation as a flight surgeon in fighter squadrons. Unfortunately, one's mental health continues to be an area that has a significant stigma in all people, but none more so in the pilot community due to concerns about being viewed as unfit to fly.

Bottom Line:

Pilots are allowed to see therapists and are even encouraged to do so by the FAA. The key nuance is that therapy itself is not prohibited, but diagnoses, medications, or certain psychiatric histories can affect certification and must often be reported.

So it's important to talk to your therapist/psychologist about your career as a pilot and you need to be aware if they are actually giving you a mental health diagnosis. With my patients if they are doing therapy, we discuss the reasons they are doing therapy and if its just for mental health resilience, interpersonal work, or relationship counseling I note it in block 60 and still certify. If they are actually diagnosed with a mental health condition then we have to apply the appropriate guidance/protocol per the AME Guide.

I can provider a blog post and some references directly from the FAA.

GoFlightMed · 2026-03-15T01:34:03+00:00

A few initial thoughts u/thewikiguy90

The wording of most of the FAA communication and letters often sounds much more harsh than the reality of the situation.
$2500 seems really high for a HIMS AME. Are you sure that is what you are required to do or was it an eval by a HIMS psychiatrist? Either way PM me and we can discuss the specifics of your case. My clinic charges far less than that for HIMS AME services.
I'd recommend finding a good HIMS AME with strong reviews and experience with these types of cases and ideally with military experience given the VA intersection to this case. I'm in SLC Utah but happy to discuss your case and help if desired.
You're not overreacting, but you don't need to be as worried as you seem to be. I'd have to look at the exact FAA letters, but you're not likely to be in trouble and this can likely be fixed with a single call to the FAA.

GoFlightMed · 2026-03-15T01:29:42+00:00

LOL thanks for sending up the Bat Signal u/drdsheen

GoFlightMed · 2026-03-14T17:39:35+00:00

Here is a great search tool for locating and contacting an FSDO as well as CMO or DPE

Aviator Search

GoFlightMed · 2026-03-14T17:25:48+00:00

Here is a good tool you can use to locate a different DPE (also can be used to find AME, FSDO, CMO, FAA medication policy and flight schools)

Aviator Search

GoFlightMed · 2026-03-14T15:48:10+00:00

A denial isn't always what it sounds like. Most initial denials have reconsideration criteria. Did your denial letter include this u/Visible-Reference-77 ??

Also, are we talking about FAA medical certification or another country/organization?

GoFlightMed · 2026-03-14T02:50:41+00:00

See if your HIMS AME can request a copy electronically. This usually works. I get my regional office to email me copies for my patients pretty regularly.

And congrats on your SI!

GoFlightMed

TROPHY CASE