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Guide for Aviation Medical Examiners

Decision Considerations
Disease Protocols - Substances of Dependence/Abuse (Drugs and Alcohol)

SPECIFICATIONS FOR PSYCHIATRIC AND NEUROPSYCHOLOGICAL EVALUATIONS FOR SUBSTANCE ABUSE/DEPENDENCE

The information shown on this page is also available in this Substance of Dependence/Abuse (Drugs and Alcohol) (PDF) document.

Why are both a psychiatric and a neuropsychological evaluation required? Substance use disorders, including abuse and dependence, not in satisfactory recovery make an airman unsafe to perform pilot duties. These evaluations are required to assess the disorder, quality of recovery, and potential other psychiatric conditions or neurocognitive deficits. Due to the differences in training and areas of expertise, separate evaluations and reports are required from both a qualified psychiatrist and a qualified clinical psychologist for determining an airman's medical qualifications. This guideline outlines the requirements for these evaluations.

  • Copies of all records regarding prior psychiatric/substance-related hospitalizations, observations or treatment not previously submitted to the FAA.
  • A complete copy of your agency medical records. You should request a copy of your agency records be sent directly to the psychiatrist and psychologist by submitting a Request for Airman Records (FAA Form 8065-2) (PDF)

THE PSYCHIATRIC EVALUATION

Who may perform a psychiatric evaluation? Psychiatric evaluations must be conducted by a qualified psychiatrist who is board-certified by the American Board of Psychiatry and Neurology or the American Board of Osteopathic Neurology and Psychiatry, and must either be board certified in Addiction Psychiatry or have received training in the Human Intervention Motivation Study (HIMS) program. Preference is given for those who have completed HIMS training. Using a psychiatrist without this background may limit the usefulness of the report.

What must the psychiatric evaluation report include? At a minimum:

  • A review of all available records, including academic records, records of prior psychiatric hospitalizations, and records of periods of observation or treatment (e.g., psychiatrist, psychologist, social worker, counselor, or neuropsychologist treatment notes). Records must be in sufficient detail to permit a clear evaluation of the nature and extent of any previous mental disorders.
  • A thorough clinical interview to include a detailed history regarding: psychosocial or developmental problems; academic and employment performance; legal issues; substance use/abuse (including treatment and quality of recovery); aviation background and experience; medical conditions, and all medication use; and behavioral observations during the interview.
  • A mental status examination.
  • An integrated summary of findings with an explicit diagnostic statement, and the psychiatrist's opinion(s) and recommendation(s) for treatment, medication, therapy, counseling, rehabilitation, or monitoring should be explicitly stated. Opinions regarding clinically or aeromedically significant findings and the potential impact on aviation safety must be consistent with the Federal Aviation Regulations.

What must be submitted by the psychiatrist? The psychiatrist's comprehensive and detailed report, as noted above, plus copies of supporting documentation. Recommendations should be strictly limited to the psychiatrist's area of expertise. Psychiatrists with questions are encouraged to call Charles Chesanow, D.O., FAA Chief Psychiatrist, at (202) 267-3767.

THE NEUROPSYCHOLOGICAL EVALUATION

Who may perform a neuropsychological evaluation? Neuropsychological evaluations must be conducted by a neuropsychologist who is included on the provider list, accessed through the following link: See FAA Neuropsychologist List (PDF).

What must the neuropsychological evaluation report include? At a minimum:

  • A review of all available records, including academic records, records of prior psychiatric hospitalizations, and records of periods of observation or treatment (e.g., psychiatrist, psychologist, or pediatric neuropsychiatrist treatment notes). Records must be in sufficient detail to permit a clear evaluation of the nature and extent of any previous mental disorders.
  • A thorough clinical interview to include a detailed history regarding: psychosocial or developmental problems; academic and employment performance; legal issues; substance use/abuse (including treatment and quality of recovery); aviation background and experience; medical conditions, and all medication use; and behavioral observations during the interview and testing.
  • A mental status examination.
  • Interpretation of a full battery of neuropsychological and psychological tests including but not limited to the core test battery (specified below).
  • An integrated summary of findings with an explicit diagnostic statement, and the neuropsychologist's opinion(s) and recommendation(s) regarding clinically or aeromedically significant findings and the potential impact on aviation safety consistent with the Federal Aviation Regulations.

What is required in the core test battery? To promote test security, itemized lists of tests comprising psychological/neuropsychological test batteries have been moved to a secure site. Authorized professionals should use the portal at FAA Neuropsychology Testing Specifications.

For access to the portal, email a request to 9-AMC-AAM-NPTesting@faa.gov.

What must be submitted? The neuropsychologist's report as specified in the portal, plus:

  • Copies of all computer score reports; and
  • An appended score summary sheet that includes all scores for all tests administered. When available, pilot norms must be used. If pilot norms are not available for a particular test, then the normative comparison group (e.g., general population, age/education-corrected) must be specified. Also, when available, percentile scores must be included.

Recommendations should be strictly limited to the psychologist's area of expertise.

For questions about testing or requirements, email 9-AMC-AAM-NPTesting@faa.gov.

What else does the psychologist need to know?

  • The FAA will not proceed with a review of the test findings without the above data.
  • The data and clinical findings will be carefully safeguarded in accordance with the APA Ethical Principles of Psychologists and Code of Conduct (2002) as well as applicable federal law.
  • Raw psychological testing data may be required at a future date for expert review by one of the FAA's consulting clinical psychologists. In that event, authorization for release of the data by the airman to the expert reviewer will need to be provided.

Additional Helpful Information

  1. Will additional evaluations or testing be required in the future? If eligible for unrestricted medical certification, no additional evaluations would be required. However, pilots found eligible for Special Issuance will be required to undergo periodic re-evaluations. The letter authorizing special issuance will outline the specific evaluations or testing required.
  2. Useful references for the psychologist:
    • MOST COMPREHENSIVE SINGLE REFERENCE: Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
    • Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the Psychological Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2), 227-245.
    • Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace Psychiatry. In J. R. Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.), Fundamentals of Aerospace Medicine (4th Ed.), (pp. 406-424). Philadelphia: Lippencott Williams & Wilkins.

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