In a recent NTSB decision, Petition of George Bruckert III, the Board held that the FAA does not need to show that an airman has been “diagnosed” with psychosis under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (“DSM-IV”), rather than simply having a medical history or symptoms of psychosis, in order to be ineligible for a medical certificate. When the airman applied for his medical certificate, the FAA denied the airman’s application based upon the airman’s history of obsessive compulsive disorder, psychosis, chronic paranoia, major depression, and disabling personality disorder—conditions that render an applicant ineligible for an airman medical certificate under FAR Part 67. The airman then appealed the denial to the NTSB.
A hearing was held at which the airman had the burden of presenting sufficient evidence to prove that he was qualified to hold a medical certificate. The FAA also presented evidence supporting its denial of the airman’s application. After hearing the evidence, the ALJ determined that the FAA had established a medical history or clinical diagnosis of a personality disorder or other mental condition that rendered the airman unable to safely perform the duties or exercise the privileges of the medical certificate for which the airman had applied. However, the ALJ also found that the FAA did not prove that the airman had a medical history or clinical diagnosis of a psychosis because he had not been “diagnosed” with psychosis under the DSM-IV. The ALJ then concluded that the airman had not satisfied his burden of showing that he met the mental standards for issuance of a medical certificate.
The FAA appealed the ALJ’s decision that a finding of a psychosis under the FARs requires proof of a “diagnosis” under the DSM-IV. The FAA focused on Part 67’s definition of psychosis which “refers to a mental disorder in which … [t]he individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition….” Of course the airman argued that he did not have an established history or clinical diagnosis of psychosis because there is no specific diagnosis of psychosis under the DSM-IV in his medical record.
Initially, the Board observed that the “voluminous airman medical file includes evidence of admissions to psychiatric facilities and numerous references to symptoms of psychosis, obsessive compulsive disorder, paranoia, major depression, and other significantly disabling personality disorders” and also showed that the airman took psychotropic medication for significant periods. In reversing the ALJ, the Board concluded that “[t]he applicable regulation requires petitioners to have no established medical history or clinical diagnosis of psychosis.” Thus, since the airman had a medical history and symptoms of psychosis, a “diagnosis” of psychosis under the DSM-IV was not required.
This decision isn’t surprising if you actually read Part 67’s definition of “psychosis.” And, under the circumstances, the result was going to be, and probably should have been, the same for the airman either way. Although the Board could have affirmed the ALJ’s determination of ineligibility without addressing the issue of whether a “diagnosis” was required, this decision highlights the broad reach of the definition even in the absence of a “diagnosis” under DSM-IV.