Unique Medical/BAC question


Well-Known Member
Hello everyone. I have a unique medical situation and am seeking flight doctor guidance. I'm asking the peanut gallery to keep the random thoughts, criticism, and banter to minimum. I'm looking for constructive feedback that's relevant to this situation please.

I'm a military pilot (Air Force Reserves) and a new-hire pilot with a Legacy airline. I successfully completed INDOC with my airline last February and had a month off before starting qualification training. While on break some friends and I went to Savannah Georgia for Saint Patricks day. While walking home to my hotel I was jumped randomly and assaulted. Following the attack I was hospitalized for 2 months due to sustaining a traumatic brain injury (Subdural Hematoma; Traumatic intracerebral hemorrhage with loss of consciousness of 30 minutes or less, Closed fracture of left side of occipital bone; Glasgow coma scale 12-13). I'm being told by many AME's that the FAA will require a 5 years wait before re-issuing my class-1 medical. My question with this is, is it at all possible to accelerate the 5-year timeline, or is "fixed" regardless of actual healing progress (at this point, 5 months later, I feel fully recovered & back to a cognitive state equal to or better than before the attack).

To further complicate the situation, I was drunk at the time of the attack. This was captured in the ER medical records with a high BAC (over .20). I've never had any pervious episodes of substance abuse, DUI, etc, and I wasn't breaking any laws at the time (there's a police report identifying me as the victim of a violent crime). My question is, will the FAA automatically require me to process through the substance abuse pipeline (i.e. HIMS) based solely on a BAC number in a medical record? I've spoken to several AME's and have been receiving mixed opinions on this subject. Some saying I'll be forced to undergo a HIMS substance abuse evaluation and likely be diagnosed with alcohol dependancy. Others saying the FAA will take the entire situation into consideration and possibly consider it a substance abuse event, requiring less serious (and lengthy) treatment. While others further assert that the FAA will do nothing, look at the entire picture, and assess this as an isolated incident with me being the victim of a crime. This part of the situation that's frustrating for me is, I was truly the victim of a criminal act, but feel like I'm going to be punished because I was drinking responsibly at a holiday festival and was at the wrong place at the wrong time. My goal here is to find a way to avoid being labeled as dependent alcoholic so I can eventually recover from this situation and live a normal life in the future (without a lifetime of HIMS).

Again, looking for actual tangible information or stories similar to this with the actual outcome. I'm attempting to gain credible and constructive information if possible. Thanks for your time and responses.
You need to talk to AMEs and possibly lawyers if it comes to it. Not pilots on a message board.
That said do shop for an AME that can actually get you where you want and isn't lazy about it.
Have you spoken with your union? If you’re at a legacy, you have one. I’d get them onboard with aeromedical, even if you’re still an apprentice member.
I agree that you need to discuss your issues with an AME that will be an advocate for you. I have no affiliation or experience with these guys, but they claim that they have helped many pilots.Home - Pilot Medical Solutions - LeftSeat.com

I knew a guy that crashed his home built and suffered a TBI. He battled the FAA for years trying to get his medical back. He had all of the documentation from his doctors that showed he had no lasting deficits from his accident. He asked me to go fly with him and then write a letter to the FAA attesting to his abilities. I went up with him and I would've thought he had 5000 hours flying a 172. He flew every maneuver and approach beautifully. I wrote the letter but it didn't seem to do any good. I don't think he ever got his medical back before he and another guy were killed flying a different home built.

Definitely get with a really good AME group that has the resources -- and contacts within the FAA Aeromedical -- to help you out.

Good luck!
Anecdotally, I feel like a denial and requirement to take HIMS in this situation would be a gross overreach. You weren’t driving or operating. But that’s just anecdotally, so uhh, lawyer.
Thanks for the replies everyone! I really appreciate the time, opinions, and insight. I've spoken with several aviation attorneys (to include ALAP, my union). In addition I've spoken to about 6 HIMS AME's. I've gotten different responses and opinions from almost everyone. I posted on this board because the name of this forum room is "Ask A Flight Surgeon". So, I'm not exactly "calling the internet" for help or "asking other pilots" specifically. I was hoping an actual flight surgeon reads these pages and could weigh in.

When I step back and look at this situation from a big picture I'm inclined to agree with what gotWXdagain says...but...I'm at the whim of the FAA, so I think we can probably remove logic from the equation. May a lawyer and AME have told me I need to try and "head this off at the pass" by getting a substance abuse evaluation from a HIMS psychiatrist to rule out dependancy. I'm hesitant though because I feel like I'd be exposing myself to risk by announcing this to someone associated with the FAA and could be imposing needless damage to my career. Just trying to figure out the most logical path forward.

Thanks again for the posts. As this develops I'll post updates.

First off, I'm really sorry to hear about your situation. It's a sad statement about our society when we punish the victims of a crime.

I can't speak to the TBI. I agree with the above on calling your union. I would also contact a HIMS AME and schedule a meeting with them on a consultative basis. As always it doesn't hurt to ask around a bit when selecting an AME.

Even without the alcohol, a HIMS AME would most likely be the best to work through the TBI. Drug/alcohol issues require establishing healthy neurocognitive function, and I would guess TBIs are similar in some regard. Do not even enter a MedXPress until you've received multiple opinions from qualified professionals. Get ALL the medical records from the hospital prior to the consultation so the AME can perform a thorough review. You're going to need them anyway.

That said, here's my amateur $.02 from someone familiar with the alcohol hoops.

From what I've seen alcohol falls into 3 FAA buckets:
1. No alcohol issue
2. Alcohol abuse
3. Alcohol dependence

These categories are defined by the FARs, and not the DSM-IV/V or other clinical definition. The FAR definition is what counts to the FAA, and it's more stringent than established clinical definitions for Substance Use Disorder.

67.107 Mental.
Mental standards for a first-class airman medical certificate are:
(a) No established medical history or clinical diagnosis of any of the following:
(4) Substance dependence, except where there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. As used in this section -
(i) “Substance” includes: Alcohol; ....
(ii) Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by -
(A) Increased tolerance;
(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.

In DUIs BAC over .15 is used as face value evidence of tolerance. Your .20+ will be treated as tolerance and at a minimum raise the suspicion of alcohol dependence.

(b) No substance abuse within the preceding 2 years defined as:
(1) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous;
(2) A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or
(3) Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds -
(i) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
(ii) 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.

Your incident definite qualifies as use that was physically hazardous under (b)(1). If they establish a 2nd incident in your medical history you will be labeled with substance abuse.

By the letter of the FARs you had an alcohol test with a result of .04 or greater.

The TBI is going to require you to provide a mountain of medical documentation. They're going to see the high BAC in the documentation. My guess is that you'll be asked to engage a substance abuse professional for an evaluation. It could very likely be a HIMS psychiatrist and cost a pretty penny.

I'm sure working through the TBI is going to be a drawn out process. It couldn't hurt your case to begin immediately establishing abstinence from alcohol. You could do this via a DOT consortium type monitoring program administered by a 3rd party to submit random urine ETG at least 14 times in 12 months. There are other electronic monitoring options you could use to establish abstinence.

Do not continue drinking after this event, 14 CFR 67.107(a)(4)(ii)(D)

Again, I'm not an expert but I hope the info helps.
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I thought long and hard about whether or not to post this, but in the end thought that perhaps someone else can learn from your misfortune.

There's more to "drinking responsibly" than simply not getting behind the wheel afterwards. Having a glass of wine with dinner is drinking responsibly. Having a beer after work is drinking responsibly. Having a cocktail or two out with friends, with a cab ride home afterwards, is drinking responsibly. Getting stumbling-home-drunk in strange city, where you can be, and likely were, targeted, is not drinking responsibly.

Best of luck to you.