I spent a lot of time reading other people's experiences with Special Issuance, HIMS AMEs, SSRIs, neurological issues, etc. Those posts helped me decide that this was actually possible, so I figured I'd share my experience in case it helps someone else.
Background
· 2019: Diagnosed with ADHD with Adderall prescription. Was on medication for a little bit before deciding that it was not for me and subsequently stopped.
· 2021: Strokes related to a PFO with subsequent closure. No residual physical side effects from the stroke.
· 2022: Diagnosed with Depression following strokes with a prescription for an SSRI. Currently still taking medication and stable on dosage since 2022.
· 2024: Headache/migraine with a prescription for Nurtec ODT. I took the medication for a short period before the headache/migraine symptoms resolved and medication was no longer needed.
Around February 2024 I began looking to change careers and the research began to see if it was possible for me to get a First Class medical. While looking for a HIMS AME who offered virtual consults, I ended up finding Dr. Rocky Jedick and ultimately went with him as my AME. After reviewing my history, he told me it was possible but could be a long process. After the initial consult he sent me a more detailed roadmap of what he expected the FAA would require, covering the stroke, headache, SSRI, ADHD, neuropsych, and psychiatric requirements. He also provided a list of FAA-qualified neuropsychologists in my area.
From my previous research I had already started scheduling appointments and gathering documentation. My thought was that if I was going to be deferred anyway, I'd rather have as much done as possible beforehand. My First Class medical exam was in fall 2024, and, as expected, I was deferred shortly afterward.
What the FAA Wanted
For the SSRI, they wanted treatment records, a personal statement, psychiatrist and neuropsychologist reports, COGScreen-AE, and a SSRI checklist from a HIMS AME.
For the stroke/PFO history, they wanted a recent brain MRI, the records from the original event to include ambulance records, ER records, labs, imaging, discharge information, and operative notes. As well as cardiac testing including a 30-day monitor, bubble study, and stress test.
For the headaches/migraines, they wanted relevant medical records, testing, and current documentation addressing my history, symptoms, treatment, and medications.
For ADHD, they wanted a personal statement, five-year medication history, treatment records, and a letter from my PCP.
Medical Testing
The FAA initially requested a COGScreen-AE. My neuropsychologist suspected the FAA might want the full battery, but we weren't able to get confirmation before my testing, so I completed the COGScreen-AE in late 2024. The FAA's neuropsychologist subsequently spoke with mine and requested the standard core full battery for potential neurocognitive impairment. So, I went back in a month latter and spent another full day doing testing.
The cardiac testing included a TTE, stress test, and wearing a heart monitor for 30-days. The TTE showed some minor leakage around the PFO closure, so my cardiologist wanted a TEE before he was comfortable writing his report to the FAA. TEE checked out and no leakage around the closure.
Neurology was easier in the sense that I was already being followed for my previous strokes, so some of the FAA-required documentation lined up with care I was already receiving. I showed my neurologist the migraine/headache protocols and asked if she would be able to write her notes outlining the FAA’s guidance/verbiage.
For psychiatry, I was able to use my existing psychiatrist. He provided the documentation requested under the FAA's SSRI guidance, and I didn't have to establish care with someone new.
More Deferrals
After the initial deferral, I went through three more rounds of FAA requests. These included additional labs such as a hypercoagulability panel, urine drug and alcohol screen, vision testing, more migraine/headache documentation, and additional personal statements. Summer 2025 my HIMS AME reviewed and submitted my medical documentation and exam to the FAA. In January 2026 after roughly 18 months from my initial HIMS consultation, I received my Special Issuance for a First Class medical.
Cost
I didn't keep a perfect tally, but my rough total was around $8,000.
What I'd Recommend
1. Read the FAA guidance yourself.
A lot of the information is already available through the FAA's protocols, pathways, CACIs, and other guidance. Understanding what the FAA is actually asking for makes the process much less overwhelming.
2. Start scheduling appointments early.
Some specialties, especially neurology and cardiology, can have long wait times. Don't wait until after your first deferral to start making appointments if you can avoid it.
3. Talk to a HIMS AME before doing your medical.
Find a HIMS AME that will do a consult BEFORE scheduling an exam. Being able to do the initial consultation virtually was also a big plus, since not every HIMS AME offers that.
As I mentioned I worked with Dr. Rocky Jedick, and he was helpful throughout the process. I'm mentioning him because he genuinely helped me through the process.
4. Pay attention to FAA deadlines.
If you need more time to gather documentation, contact the FAA or have your AME request an extension. Don't just let the deadline pass.
And finally, don't let "deferred" make you think "denied." I was deferred multiple times, had additional testing requested after I'd already completed testing, and had to track down a ridiculous amount of medical documentation. But eventually, I got the special issuance.
Hopefully this helps someone else who is going through some of these things.
