Doc's general comments Volunteer Aviation Questions about my SI Current Projects Stones
Well, today a local flight school soloed another one successfully.....and then the CFI discovered that he had forgotten to verify the guy had a medical. No endorsement for solo, clearly. sigh. Airman says to me "I thought you only had to get the medical before the checkride!". Uh Yeah......not so much.
Guy says, "I'm healthy". "No" to my verbal as to DUIs, Ritalin or meds in grade school and high school. Trying to save the day, I squeeze in a paper based medical. He declares he passed a stone six months ago, use E.R. for care as his primary's office was jammed. CT- right vesico-ureteral 2 mm stone. Didn't capture it. He hasn't been to see the primary in a year. Great....not, I'm thinking. The guy is now committed to exam (he's done a paper medical- not enough time for a MedXpress. If the stone is still there I am running out of time to get him telephone authorizied for the retained stone SI (nearing 4:00 PM CDT).
He hasn't seen his primary doc in a year, but nontheless the office gets the HIPAA release and gets hospital record for us. We send him out for a KUB- but he disregards instructions to go to his digitally enabled Hospital vendor, eight minutes away, and takes my Rx for the KUB to the Prompt Care up the street....who is totally analog, e.g, no reading until the next AM, after the film is shipped to "mother" hospital. Just GREAT. The guy cannot follow instructions- (What was I thinking?), he's a software developer and lives in the land of "no rules". You can't barely help those that can't follow instruction. I sure hope he's a better pilot candidate than all that.
So I go over to the facility to physically look at the KUB (I am an Internist, not a radiologist). It's clean at least to my eye. No forest of stones above, nothing down by the bladder.
So he gets a student pilot certificate and a second class medical, and the CFI endorses him - same day. Somehow we got it done, but the CFI gets a little niggle from me. This is NOT how it's done.
CFIs out there, please do better than this. I am really really happy to have made this all work.
Sign me, a CFI.
Well, my first question is, "Was it a boy or a girl"? Passing a 0.3mm stone or larger can TRULY be incapacitating.
Of course, if you can be made stone free, that will get you certified. You do need to capture the stone, know it's composition, and know the metabolic maneuvers to reduce future stone formation.
However, many/most have residual stones and the question is, can I get an SI? The answer is, because most (90%) of urologists are noncommital as to the likelihood that remaining stones will break loose and lodge, the agency will grant an SI to the airman with stable or diminishing remaining stones evaluated at 90 days, if ALL REMAINING stones are less than 0.2mm in size. 0.3 can cause a load of trouble, 0.2 are likely to pass without much in the way of symptoms. That means TWO CT scans 90 days apart; however, if you're a professional aviation, the lost revenue (that you didn't lose waiting to get stone free) easily pays for the second CT.
We get this one on the phone, routinely.
Questions about my SI
April 9, 2013
Expansion of AME Authority
MOST OF THE BENEFIT GOES TO 3rd CLASS AVIATORS
As a result of efforts by Dr. Tilton and the staff, encouraged by a meeting in Atlanta in May 2012 (See "New Addition 05/05/2012" under AOPA/EAA Draft Exemption Petition, below) with some of the AMEs, Nine new protocols were published that allow the AME some additional authority to issue, without “Special Issuance Authorization”. These worksheets are posted in the Photos section in the order below- the last nine photographs “Asthma, through “Renal Cancer”. These are TWO YEAR issuances, FIVE years for 3rd class under 40 y.o. For upperclass certitificates, as of June 13, 2013, these are limited to documentation annually AT time of flight physical, NOT twice yearly for first class airmen.
ASTHMA: Asthma that required multiple disease modifying medications with any history of episodes has been a special issuance requiring annual doc’s evaluations and pulmonary functions. Those with disease modifying medications and only distant episodes were not. The new criteria are: Most of the usual medications, pulmonary functions >80% of normal, and no more than two urgent care visits per year, are now office issueable. The down side, is that the middle group are going to now get pulmonary functions. The Agency, while delegating authority, clearly wants objectification. Note that if you are a THIRD class airman, these are only going to be every OTHER year.
ARTHRITIS: We’re talking inflammatory arthritis here. The usual meds, methotrexate, Plaquenil, prednisone, are permitted on exactly the same terms as before, but with the addition of a blood count, Liver functions and kidney monitoring (creatinine) need be normal. The 8500-7 for plaquenil is still required. However if you are a THIRD class airman, these are only required every TWO years, and we just issue it.
GLAUCOMA: The group with IOPs less than 24 mms (23 or less, each eye) and normal Visual fields (Humphrey, Goldman, and now Octopus (cheaper)) on most meds can just be issued. This SI was already a two year period for THIRD class airmen. Some medications remain unacceptable.
HEPATITIS C: When declared by the treating physician to be in CHRONIC STABLE phase, and the liver functions are within 10% over max normal-->issue. And this is a two year issuance for THIRD CLASS.
HYPERTENSION: No essential changes, although the EKG (first time) has been DELETED. No more 3rd class airman getting hit with a stress test for a first time EKG that shows a BUNDLE BRANCH BLOCK.
HYPOTHYROIDISM: Everything is as before- nml TSH <90 days prior, plus the appearance of “euthryoid” state, is now just “issue”. Hallelujah. Long overdue.
MIGRAINE: an IMPROVEMENT! If the treating MD records headache which is non-ocular in either Aura or actual Headache, and no TIA type symptoms occur, the usual meds are permitted provided no more than one episode per month and two or fewer urgent care visits per year. NO MRI, and documentation only at each issuance. Again THIRD CLASS airmen benefit from the reduced burden. AME issues when he has all of the above.
PreDIABETES: There are going to be some simple oral controlled diabetics in this group: Hb A1c <6.5 with a FBG less than 126, +/- Metformin (only Metformin) are permitted. No longer an SI, documentation only with issuances (relief for the THIRD CLASS airman).
RENAL CANCER: If extirpated, and the treating MD says no extension of disease, and the Airman is recovered from surgery, this is “issue”.
"Super", now known as "Advanced" AME is a program that was originally designed to allow certain well trained AMEs with good records, the ability to issue some Special issuances without waiting in the call queue. It was never launched due to the inability of the Federal Air Surgeon to transfer authority to a designee, as opposed to an employee.
Having gotten back (2-15-11 through 2-19-11) from this program (4 guys at a time), it was good to renew old professional acquaintances, as well as see how the DIWS system impacts how the examiners function. It was pretty tiring- it felt like Officer Candidate School. 34 hours of doing special issuances..... :)
Well, the day has come. It's taken five years since the proposal by a small group of AMEs (yours truly) and pursued by AOPA. The fact of four (not all) SSRIs in and of themselves is no longer grounding in and of themselves. However, not the issue is the underlying condition.
Succinctly, for Chronic Simple Depression (NEVER a manic phase!), that has gone stably into remission for more than a year, maintained on a low stable dose of a single (one of Fluoxetine, Sertraline, Citalopram, or Escitalopram) you can jump through a lot of hoops and be certified. ALL CLASSES of certificates. This is a very restricted group.
No, you can't certify on Lexapro for an anxiety disorder. The underlying disorder becomes controlling.
If you've been dishonest and have been taking them in the past, unreported, and have this single condition, an amnesty is now on until September 30, to come clean. The document is [Docket No. FAA-2009-0773] and is in the federal register.
This may not be for you, or it might fit well. There ARE a lot of hoops through which to jump......
06/06/2012 We now have FORTY airmen flying with this SI. The expense has certainly been limiting. No know problems amongst the 40 however.
Well, it appears that the Agency, still without clear direction (a good thing!) as to how to field airmen who are coming clean from undeclared andepressive use, still will certify pilots who come clean, if they have the proper psychological evaluation (4 axis). They're more concerned that you are without a CURRENT condition, than to take punitive action (after all, willful vs. inadvertant is difficult to prove). The most recent case is an IT guy from about 400 miles away who realized in retrospect that he needed to hang out his laundry. Well, three months later, a psych evaluation by a state licensed psychologist, and some record gathering, we have a completely legitimate airman!
Recently, there's been another, the time a professional airman who had a midlfe crisis, left his family, got snookered by the "GF", started taking mood meds, who after discontunance, we managed to get certified. The common string- 180 days off the meds, recovery of his marriage and family, NOT a hint of Manic Depressive disease, and GOOD documentation.
All is not necessarily lost. The downside is that the Psychologist is usually pricey and CANNOT be paid for with insurance- insurance usually only pays the psych to MAKE a diagnosis, the opposite of what we want.
(Please honor the copyright of what's below)
A Special Issuance is but one of three ways to obtain a waiver, or variance, from the FAA. For a fixed medical condition, that is unlikely to change, such as monocular vision, the mechanism is usually an operational checkride. This is performed by the Operations branch (aka the FSDO) at the request of the Medical Branch in OKC. Sometimes it is sufficiently obvious, as in after 8000 hours, that an acquired static deficiency has not hampered an airman’s safety and effectiveness. This is the waiver based on operational experience, e.g, a 9000 hour captain who trips on a color vision test. But, for most readers of this blog, we’re concerned with medical conditions that are acquired and are not completely static. This is the Medical Branch Special Issuance.
An airman emailed me, now about a month after I mailed him a third class certificate valid for the second year of his two year issuance. He had developed atrial fibrillation, probably of the “lone atrial fibrillation” type, and had gone through the workup: a treadmill run to 90% of Vmax for age, 24 hour holter monitor, echocardiogram. He’d also had a not-required thallium scan at the end of his successful run and thank heavens he had NOT had a false positive.
He was wondering if he needed a special issuance this round. I was flabbergasted. He’s on a six year Special Issuance authorization that allows the AME to determine annually, if his situation has continues to meet the critera set forth in his 2006 SI grant. He was unaware that the issuance of this second certificate (a one year third class) actually IS execution of the SI letter of June 2008, and valid through June 2013.
He had, with correspondence, sent me the result of another 24 hour “holter” heart monitor, and a current status letter from his cardiologist. As it turns out his condition has improved and he was off of Coumadin and sotalol, still staying in normal rhythm. His letter (June 2008) states, “If the AME is able to determine that there has been no significant adverse change….” We can reissue one year at a time.
As he was still going to remain within two years of his third class exam through 6/2010, (6/2008 exam), he met all criteria and needed neither another exam nor more paperwork.
He was completely fixated on “getting something from FAA”. In fact the point of the AME assisted special issuance is to eliminate correspondence from the FAA, and that the yearly issuance of certificates by the AME is continuation of the Special Issuance.
The SI letter, though it makes perfect sense to the AME, is completely greek to the airman, and to the cardiologist. Maybe it’s even worse. Maybe it’s Cyrillic to the airman. A special issuance has two components: First, the usual Third/second/First class elements have to be present. Secondly, the documentation of the abnormal condition has to be satisfied, sometimes a yearly intervals, sometimes at six monthly intervals.
During the periods specified in the authorization letter, the FAA will either (1) Tell the AME the criteria to use in the interval periods, or (2) reserve judgment within the FAA, necessitating that the six monthly or 12 monthly data be shipped directly to OKC for authorization. When FAA subsequently authorizes, it is good for the interval specified in the authorization, provided that the third/second/first class elements are also favorable and within the six/twelve/24 or 60 month timelines.
So, it becomes essential that the airman actually READ his authorization letter and understand that there are TWO components to a special issuance: the usual components, and the lesser time limited documentation of the waivered condition. There are many many conditions which are amenable to AME delegation (the “AME Assisted Special Issuance“), and are amenable because the technology of medicine allows precise measurement: these include noninsulin dependent diabetes mellitus, some aspects of coronary disease, atrial fibrillation, renal insufficiency, recurrent kidney stones, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis and many, more.
My question is this - when do I have to take my next 3rd class physical? There are multiple dates that are confusing me. Page 1 of the SI states that it's a 6 year authorization. Later on page 1, it states this authorization expires July 31, 2011. On the Medical Certificate Third Class (separate page) it states under limitations "Not valid for any class after 7/31/2009". My wife who is a urologist and a whole bunch smarter than I :) thinks that I need to see my AME on 7/31/09 and bring the AASI to be completed. And then have another follow-up 12 months from July 31st that's dated on the Medical Certificate. That's what I'm reading too. Also, I'm not sure if it matters for this but I am 35 years old.
I haven't done anything with SI, although being thankful and really happy that it was issued, since we just had our 2nd daughter late in December and life's been a bit hectic. I'm trying to finish my PP-ASEL soon and don't want to miss any deadlines or not take any action now that may cause issues down the road.
I greatly appreciate any guidance you may have!
You turn 40 in 2013.
You have to separate the two components of your issuance. The Third class is due every five years (for now). That means, since your exam in July 2005 is good (less than age 40) till July 2010, you can only be issued out to the earlier of your expiration dates- that for the five year third class, and annually after each submission of a favorable current status letter (reading the chip, physical exam, statement that you are compliant, have no tendancy beyond normals to fall asleep, etc).
So starting 90 days before July 2009 (90 days means the information is “current”), or in May 2009, you need to visit your “sleepologist” and get another current status letter. If your SI letter demands that get another MWT, then you have also to do that. When you get the results, you take the results with the SI letter to the AME (or mail directly to FAA, see below), and he determines that according to the SI letter you meet the requirements; he can issue you for a year to expire in July 2010 for one year (the sleep evaluation is only good for a year) to July 31, 2010 (which is the same time your third class components expire). Then the current SI authorization for sleep apnea expires.
In May of 2010 you will need to do the same again but this time, as your third class components are expired, you also need an exam (in July 2010, GET THE FULL 12 MONTHS!).
In May of 2011, you will need to do whatever you did for the first SI- full sleep study, normal MWT, letter from the sleepologist, and resubmit to FAA at PO box 26200, Ok City OK. If you get it done close to May 15, you will get a new certificate directly from them by mid July 2011, again for a year, and hopefully if the reports are good, you’ll get a SIX YEAR AME assisted SI in which in subsequent years to 2017. Subsequently, all you have to do is take the annual sleep information (the evaluation letter) to the AME, with your SI letter, and he’ll type out a certificate for the next July to July. No exam will be necessary as the 2010 Third Class exam will cover your year-by years through to 2015.
If you are on a tight budget, or if you want to DIY, you don’t have to go back to the AME in the intervening years. You CAN send everything to FAA and THEY will mail you a one year certificate, each year after year until the one that expires in July 2015. But this negates the value of not having OKC directly involved. The AME determines if your status is stable, and then he submits the evidence to the file at OKC.
So in summary, you have two components to manage: the Third Class components, and the annual Sleep evaluation components, which in some years can be managed by the AME (if the letter so authorizes) and in some years the FAA must decide.
It makes sense but is pretty opaque from the outside!
So, sleep apnea screen has been forced into formal rulemaking, which of course will eventually lock SA screening in stone. When the data are looked at, they will see they need to screen all the way down to BMI = 35. The current focus needs to be on getting the AMCD to write a home overnight specification for the "home sleepover" O2 tracing, e.g, if no desaturations below 82 and less than si below 88, the airman does not have Sleep Apnea, "issue the certificate and send in the overnight printout".
I don't have much trouble with the idea of screening- after all, SA was found to be a critical component both of the GO airlines overflight of HNL (2008) and of NWA's 2011 Overflight of MSP, and the Thanksgiving Weekend Hudson North line crash. But, hey, let's keep this economical, fellas, and let's not create a Sleep Lab Boondoggle. What with the average response time for anything now up to 56 weekdays (90 days), pushing everyone through will just CRUSH the system.
NOW EVERYONE NOTE: SLEEP APNEA is a SPECIAL ISSUANCE, but once treated, it's a pretty easy one to get. I can routinely get 121 airmen done in 6 weeks, e.g, back on the flight deck.
In most insurance plans, the sleep doc will refer you to a $300 (but it's covered") overnight at home desaturation test, per requirements of the health plan. If negative you are off the hook. If positive, you go to an overnight sleep study; we then have to get you onto good treatment (CPAP of some sort, or a jaw advancement device) and you need a special issuance. I have to note that my ~30 or so airmen on that SI UNIVERSALLY say they would not go back to pre-CPAP. They have more energy and concentrate better.
I have appended to the PHOTOS page, a copy of the relevant page from this Quarters' Federal Air Surgeon's Medical Bulletin. It's the second to the LAST Photo.
"Don't Panic, Lads!"
Well I've been silent for a couple of years on thsi but I'm getting fed up.
On 5/4/2012 I got a "I got a nastygram from the FAA" call, and the airman in question had just recertified with another AME in 7/2011. His AME had taken his infomationr, declared hypertension and issued the guy. Now the agency was demanding the CV evaluation, EKG and some lab, which should have been filed with the physical, and wanted it by May 27. He couldn't even get an appointment before June 15! I fail to understand how his AME continues again and again to simply check "hypertension" and issue. Had the materials been sent in and file, this would never have happened.
As it turned out, with encouragement, his family doc responded with a nice letter, on a "same afternoon turnaround" with some help from us; we got the lab this morning, and he has a normal EKG. It all got sent in. Fire put out.
Once, twice, I can see it. But this is the umpteenth time I've been in this situation. Even when the "AME Prior Exam information sheet" is had from Medxpress, it only tells that the prior AME had declared hypertension, not whether or not the workup has been turned in. I'm now in the situation that every time I get a refugee from this errant AME, I call the agency to find out what they have on file. The nastygram with "25 days to provide" (30 from the date of the letter) is totally avoidable. You simpy have to perform competently. That's not asking too much.
See the letter posted under PHOTOS. It has been redacted.
Up to Special Issuance #16 originated in the office this month.
Update 02/2013: 20 for 20 at this time :)
No doubt about it, third class airmen flying aircraft below 2,900 pounds and 180 hp, daytime only, need relief. That idea has merit becuase the documentary burden is simply getting out of control. IF I HAD $10 and only $10 to spend on medical vs. training, I would choose training. Third Class Airmen are spending boodles of dollars on documentation.
In the summer of 2011 AOPA and EAA together internally drafted a proposal for an exemption to third class, with no medical component, without input from their respective medical councils. It called for a two hour educational internet course as to medical self certification and they requested their respective councils to commence. We did. However, many of us were appalled that it was undertaken without advice and they are not accepting input into changes we think might make it a success. And they began trumpeting, “The FAA will find the expertise of our medical councils difficult to resist”.
I am aware of two LSA medical incapacitation accidents and now perhaps a third. Anyone who does a chi-square will realize that with denominator numbers so small, there is no good statistical data to present. Thus the shepherding of such a proposal for easing is essentially political.
As I said, the idea has merit. AOPA/EAA’s stewardship to this point has been not so much. A call to the Federal Air Surgeon’s office (which had not occurred) would have revealed that AAM 1 is following the blogs and they are not favorable. When there is no data, the endorsement of the Association of AMEs would have been critical- and I do still believe that that endorsement might have been had, if the proposal had a State CDL signoff every two years. That’s just a checklist by your family doc and a statement that the doc thinks you can safely operate a heavy truck. The rationale: "Slightly bigger airplane-->slightly bigger driver's license". Had the endorsement been obtained at the October AME gathering, it would have been “reluctant agency vs. all its designees”. It might have flown.
One also has to give away things to the compliance folks as well. “No constant speed propeller” would have eased their concerns as to “below 10,000 feet” and not given anything away from the RV 7 and Archer crowd. But to quote Saturday Night Live, “but Noooooooooooo!”
I am now one of three resignations from the advisory councils. I am willing to spend energy on substantive change that succeeds. But this one is DOA, and that’s per Dr. Fraser, the Deputy Federal Air Surgeon.
NEW ADDITION: 5/5/12. Just a week to go before we try to convince the Federal Air Surgeon to go down another path: allow certain special issuances to be done in the offices, like hypertension was done in the late 70's. We're thinkin, "Pill controlled Diabetes; Thyroid replacement; Sleep Apnea; Kidney stones to name a few. This would do a LOT to breakup the current federal logjam. We'll see soon enough.
5/31/2012. It sure looks like the FAS is going to try to move many of the normal special issuance into the offices (Sleep Apnea, Stones, Thyroid replacement, etc.). There are some really odd limitations- for example, pill controlled diabetes. Because Diabetes is a specificially disqualifying condition (FAR 67), that can't be moved out.....
As for fundamental 3rd class relief, not much movement is visible. What is needed now is for the adversarial approach to end, and the discussion approach to be begun.
Warren will be sorely missed, and will be remembered as the man who brought Medical into the computer age. He was tireless, and in all my interactions, "never takes a break". He defended his agency from the relentless political "this would look better" interference from above.
He will be available, I understand, in Tulsa as a private AME after January 2. MASELTOV, Warren!
Got up to #14 originated in the office this month. Yes, with a good file, OKC is granting them on the phone, a positive change. The file has to be pretty sparkling, though. :)
5/31/2012 We're up to eighteen successful originations for this SI from this office. :)
Much to my amazement I got the seventh originating Initial SI for Insulin Requiring Diabetes Mellitus out of the office this week (10/28/09). The airman had travelled from afar; we'd put together a terrific file. He's on an insulin pump and had 2 HbA1cs of 6.1. He had the "we've seen him check his blood glucose while flying" letter from the CFI, the diabetes educator letter, a GOOD summary from the endocrinologist, a negative dilated eye exam, and a terrific treadmill run.
After the exam (10/20/2009) we got the stuff certified to FAA before that day's mail had even gone out. It was reviewed by the examiner and authorized; the certificate went out in the mail today. Total elapsed time was less than two weeks. It amazed me; the previous record was 44 days.
Another airman called after having been given the nth degree about seventeen year inactive ulcerative colitis. He couldn't understand why this was an issue for FAA after a colectomy (it's a disease of ONLY the colon, and it's GONE, I mean, NO COLON). Turns out that in the letter to the FAA, the doc mentions that the airman has since started on Lopressor for hypertension. This all happened since AFTER the electronic 8500-8 was completed.
The normal way for handling this would have been, at the NEXT certification, the airman would need a fasting lipid profile, serum Creatinine, fasting Glucose, and if on a diuretic,- a serum potassium, along with an EKG and a doc's evaluation letter stating good control, no side effects, and no overt Coronary disease. However, as the FAA now knows that he is on hypertension medications, all that needs to be submitted ONE time, NOW before issuance. Once we have those, we can issue.
So, the airman got a bit bent out of shape as it appeared that his Ulcerative Colitis was not an issue but no certiiffcate was forthcoming. All we have to do is gather the hypertension materials and get them sent in and he can either be issued by FAA directly (a wait), or my myself directly. He's waiting for a checkride and I suspect he'll be in shortly.
I need to add a tale of really, really complex certification. This is posted only to let you know that the folks in Oklahoma City really are competent and are trying to let you fly. In February of this year I was contacted by an airman from the atlantic seaboard. He had gone to an AME in January and was deferred. The inquiry was as to what he had to do for his conditions- corrected hypothyroidism, rather big league but controlled hypertension, an episode of chest pain followed by a negative cath; uvulopalatoplasty for snoring (in which the words “sleep apnea” had carefully not appeared, and a 22 year ago possession conviction followed by numerous traffic tickets until 2002.
75 pages appeared and he had current T4 and TSH values, a negative driver’s license search as of Jan 2006 for the last 4 years; no brushes with the law since 1985; well controlled hypertension complete with EKG, lipid profile, creatinine, potassium, and fasting glucose. I discussed this with an examiner at OKC and he asked for a summary cover letter, and the record sent to his personal fax (see, people TRY to help).
The next AM we again discussed the case and he felt it to be certifiable. However, his suggestions were (1) an updated DL/arrest search, through Feb 09, and a mandatory watchfulness test, to put the Sleep Apnea issue to “bed”. He also noted the case would have to go through the RFS as the man had possession of a 2006-2008 medical that was nowhere in the federal computer (that means AME discipline).
After telephoning that regional office, I faxed the updated DL/arrest search and the negative MWT to the RFS (not in my region). The RFS bumped it down to the deputy, who promptly issued a demand for everything that was already in the federal computer. Sigh. I ovenighted a DVD with the entire content to him; three days later he issued a demand for a nuclear scan report (which was on page 74).
Two weeks later, I discussed this again with OKC and admittedly added the prod that we were beginning to look a bit ridiculous. The examiner agreed and issued a one year third class; a ninety day faxed authorization was sent.
I subsequently received an e-mail indicating that the issuance had been reviewed and as the airman was taking clonidine, the reviewer indicated He would not have issued. Notably, however, the reviewer did NOT reverse the issuance; we changed the airman’s medication was changed and that was documented. The first examiner, however, subsequently opined, that “we issue with that medication all the time- they just have to wait for a month….” So despite the great confusion, this airman was issued, and the agency forbore some details until all could agree. They really do TRY HARD.
Doc's general comments
I currently provide commentary and limited advice at http://forums.aopa.org . Go to the "Medical Matters" Section, where I am the moderator.
I haven't got enough breath to tell you how frustrating it is that kids who are going to SIU School of Aviation simply cannot get a medical certificate because in the past parent accepted a bogus defacto diagnosis of ADD and gave their son or daughter a pill. I'm VERY able to guide you through that certification mess.
Yes, there are some who truly have sufficient ADD /ADHD that they should not fly. But the vast majority of middle school "diagnoses" are made by educators or social workers who don't even own an American Psychological Assn. Diagnostic and Statistical Manual v4 ("DSM4").
Another item that is learned painfully: AVOID UNNECESSARY TESTS. There are items for which an EEG will be problemmatic. FAA usues a screening system- if you pass on the screening tests, that's OK, it's the federal strategy. However, if there is additional information, it MUST be considered. ONLY obtain what is necessary!
Lastly, to the airmen whom I already serve, if you go to your doc and are given an Rx, and there is ANY question as to whether or not it's disqualifying or not, for heaven's sake CALL ME UP before you fill it! It saves a TON of heartache.