My Story

I am a physician and pilot with Attention Deficit Disorder (ADD). I was diagnosed with Adult ADD approximately 3 years ago while still in medical school. Approximately a year and a half before I was diagnosed with ADD I had begun to take lessons to become a private pilot. Between the time I received my 3rd Class Medical Certificate and sat for my checkride to become a licensed private pilot I was diagnosed and began treatment with Adderall XR.  For the last 2 years I have continued to take Adderall at the same dose with excellent results with respect to ADD symptoms as well as no appreciable side effects since I began taking it. Last year I went to my local FAA Medical Examiner to renew my 3rd Class Medical Certificate and was denied issuance based on my condition (ADD) and because I took a medication the FAA claimed was “incompatible with aviation safety”.

I subsequently appealed this ruling. The FAA then requested I submit my entire medical record up to that point and also that I undergo both a psychological and psychiatric evaluation.  I of course complied with their requests, had the evaluations performed, and forwarded to them the results of both evaluations and my medical file. The FAA reviewed the results of my psychological evaluations and medical records, then requested a written statement from my treating physician stating whether or not I intended to continue taking Adderall for the treatment of ADD.  My treating physician subsequently sent a letter to the FAA stating that I continued to respond favorably to treatment and that I was to continue taking Adderall. The FAA subsequently sustained their initial decision on the basis that I was “continuing to take medication (Adderall) which is currently unacceptable for medical certification purposes”. I was also informed by letter that based on this I would also not qualify for a Special Issuance Medical Certificate.

The next step in the appeals process was to appeal the decision to the NTSB and specifically to an Administrative Law Judge (ALJ).  Without going into extensive detail here (see NTSB Administrative Law Judges at http://ntsb.gov/abt_ntsb/olj.htm) , the purpose of an ALJ is to hear evidence in each specific case; with the burden of proof being on the petitioner/applicant (me) to prove that “despite the medical condition in question, he or she is medically able to safely operate as an airman.”

At my hearing I took the stand and essentially laid out the timeline of events including my diagnosis and treatment, testified to the profoundly positive effect it has had on my life not only as a physician but also in my personal relationships, and of course how it had resulted in the hearing that day.  For my part, I submitted my psychological evaluations, medical and pharmacy records, as well as a couple of recent articles on Adult ADHD speaking to the effective treatment using stimulants in adults with the condition. We also called to the stand the Director of my medical residency program as an expert witness in Family Medicine and as someone who was directly responsible for evaluating my performance as a physician in my day-to-day duties.

Both of my psychological evaluations were entered into evidence and were extremely favorable. One of them was a neuropsychological evaluation which evaluated me across numerous cognitive domains and was performed while I had been off my medication for 3 days as the FAA had requested. The results of this evaluation revealed that I performed in the “high average” or “superior” category in the majority of the fields measured. I had one category in which I scored in the “borderline” range in a verbal recognition category and it suggested (as would perhaps be expected) that I possessed some weakness in some attention/concentration domains. The overall evaluation was still extremely favorable and stated in summary, unequivocally, that my “neurocognitive abilities are, at least, at a level sufficient to allow a pilot to safely operate an aircraft.” The other psychological evaluation and my Residency Director echoed the same message.

Ultimately the NTSB Law Judge again sustained the original decision of the FAA and I was denied an unrestricted 3rd Class Medical Certificate on both  the medical condition standing alone by itself and/or “the continued use of a medication required to control the condition.”

~ Tyghe Lindbergh Nielsen, M.D.