This story originally appeared at flyingmag.com.

Nearly 5,000 civilian pilots may be providing false information — or excluding it — during their medical examinations in order to continue flying, according to the FAA.

The agency is investigating some 4,800 former military pilots, who told it they were healthy enough to fly but “might have submitted incorrect or false information about certain medical conditions that qualify for Veterans Administration benefits as part of their most recent FAA medical application.”

The FAA probe, which began around a year ago, discovered that just less than 1% of the nation’s more than 600,000 certified pilots could be concealing medical information that would otherwise ground them. 

So far, it has closed about half of those cases and temporarily suspended some 60 pilots who “posed a clear danger to aviation safety.” In most closed cases, pilots have been ordered to correct their records and undergo new aeromedical examinations to restore their medical certificates.

Prior to a June blog post, the FAA had largely hidden the investigation from the public. According to The Washington Post, former Office of Aerospace Medicine (OAM) staffers contracted to review the cases were even told the nature of their work was secret.

“The FAA’s medical staff completed a preliminary review of all of the cases to identify pilots who might have disqualifying medical conditions,” the agency said in the June blog post, which it indicated to FLYING serves as its statement on the investigation. “The FAA identified approximately 60 pilots in this group and notified them that they must cease flying while our staff works with them to reconcile their records.”

The agency noted around 1,250 pilots under scrutiny no longer hold a valid medical certificate, which is not required for those operating light sport aircraft, light twins or singles under BasicMed or for glider operations. However, the majority of pilots with open cases are being permitted to conduct business as usual.

Sources told The Post that about 600 cases involve veterans certificated to fly for Part 121 passenger operations. But most are commercial pilots who fly for Part 121 cargo, Part 135 charter or air tour operators.

The Post found that the FAA’s OAM last year allocated $3.6 million to hire former staffers to reexamine the medical records in question. Officials said some pilots failed to disclose their VA benefits because FAA-affiliated physicians advised against it.

The U.S. Department of Veterans Affairs opened its own investigation in 2019, suspecting that some of its members were exaggerating or outright lying about their medical conditions to receive benefits. The VA inspector general’s office cross-checked disability benefits records with an FAA database of veterans certificated as civilian pilots. It uncovered the approximately 4,800 cases with inconsistencies, referring them to the FAA in June 2021.

“I attach great importance to the function of our inspector general, and there is a process there that’s being worked through,” Denis McDonough, secretary of Veterans Affairs, told FLYING. “We continue to stay in touch with him on this.”

The following summer, the FAA began notifying former military pilots their records were under scrutiny.

The number of pilots suspected of falsifying medical information and the FAA’s lack of forthcomingness raise concerns about the transparency of the process. At the same time, the conversation has scrutinized the flaws in the aviation regulator’s medical examination process, which many pilots say incentivizes them to obscure their conditions or disabilities.

How the FAA evaluates pilots

In the U.S. the FAA requires pilots who exercise the privileges of certain categories of airman certificate — specifically a commercial or airline transport pilot qualification — to hold a standard medical certificate of the class appropriate to the operation.

The first step in the process is to take an exam with an aviation medical examiner — somewhat similar to a general physical at a doctor’s office. Prospective pilots must also report all health professional visits from the past three years and disclose any physical or psychological conditions and medications. Certain conditions, such as bipolar disorder, epilepsy or substance abuse, are considered automatic disqualifiers.

Others, like depression or anxiety, are considered treatable, requiring the pilot to participate in reporting or monitoring programs to obtain a certificate, under certain conditions. These are assessed on a case-by-case basis. However, the FAA only recognizes four mental health medications — Prozac, Zoloft, Lexapro and Celexa, all for depression — as safe for flying, in general terms, though they must be reported and monitored. The rest are considered unapproved and could be cause for denial.

Pilots must pass the required FAA medical exams every six months to five years, depending on the pilot’s age and the class of medical certificate sought. But these can be more cursory, often taking less than an hour and relying heavily on self reporting for conditions such as post-traumatic stress disorder, which can be difficult to detect. FAA physicians are also not required to examine records of previous doctor’s visits or those outside the aviation system.

Pilots say the current framework incentivizes them to conceal information. According to research by Dr. William Hoffman, a neurology resident and aeromedical researcher for the U.S. Air Force, the bulk (56%) of 3,765 pilots surveyed reported health care avoidance because they feared losing their medical certification. Other research suggests up to two-thirds of pilots could be obscuring information.

Often, pilots limit what they report because it can take months to receive FAA waivers to fly with certain conditions, jeopardizing their careers. Some argue the agency does not adequately communicate what’s required of them, and many say it’s an open secret that the majority lie on medical examination forms. But not everyone is sympathetic.

Accusations leveled against vets — and the FAA

Some have placed more blame on the veterans than the FAA. Per The Post, many agency physicians and former officials said some veterans minimize their health conditions with the FAA to continue flying. But at the same time, they talk them up to the VA to maximize their benefits.

“One of the agencies has been fooled,” said Louis Celli, former executive director of the American Legion, one of the largest veterans associations in the U.S.

According to the VA and FAA probes, many pilots gave the agencies conflicting information. He and other sources cited by The Post contend veterans are intentionally gaming the system. But are the discrepancies truly nefarious or are they a case of simple miscommunication?

The Airline Owners and Pilots Association (AOPA) argues the latter. Earlier this year, it urged amnesty for veterans caught up in the investigation, citing past cases in which the FAA awarded leniency to pilots who corrected their applications. It also claimed the agency’s communication and education on medical examinations and reporting is insufficient, causing veterans to make inadvertent errors.

“The volume of FAA inquiries to airmen about VA disability benefits is evidence of a systemic problem, one that has led too many pilots to make inadvertent mistakes or misunderstand FAA medical application requirements,” said AOPA President Mark Baker. “Airmen need a clear pathway to correct their FAA medical records and an understanding of what will happen when they do.”

Some pilots allege the agency is discriminating against veterans because it has access to their disability records through the VA. Rick Mangini, a former Army pilot cited in The Post report, said the FAA notified him in May he was grounded for failing to disclose his sleep apnea. However, he said he checked the box on his application indicating he receives VA benefits for a condition but was unaware he had to specify. He felt he was singled out.

“If they’re going to shine a light on veterans, they need to shine a light everywhere,” said Mangini, characterizing the agency’s actions as “the definition of harassment.”

In short, many veterans believe they are being unfairly prosecuted for mistakes on their medical applications or for concealing diagnoses such as mild depression, which have little to no impact on their performance but pose a major roadblock to their FAA permissions. It’s an issue that has plagued the industry for decades.

A long-standing problem

The FAA has known about the problems with its medical examination process for more than two decades. But the agency has so far done little to address it.

A 2002 investigation, called Operation Safe Pilot, uncovered a scam involving some 3,200 Northern California pilots, who were collecting Social Security disability benefits but telling the FAA they were fit to fly. Many worked as commercial pilots. The U.S. attorney’s office in San Francisco prosecuted 45 of these cases, winning convictions or guilty pleas in all of them.

The investigation provided evidence that the issue is not limited to veterans and raised concerns about the scale of the problem. But despite calls for greater scrutiny, the FAA said it lacked the money and resources to implement data-sharing programs between itself and agencies like Social Security or the VA. 

In 2008, it began requiring pilots to disclose whether they receive government disability benefits. But it wasn’t until 2018 that it began sharing pilot medical records with the VA, leading to a handful of additional prosecutions of Northern California pilots.

U.S. passenger airlines have not had a fatal accident since 2009. However, a handful of fatal and near-fatal incidents involving former military pilots signal the need for a reassessment of FAA procedures. It’s unclear whether the agency will improve communication regarding medical examinations or expand its data-sharing program with the VA and other federal agencies in the wake of its investigation.

At the same time, improvement in mental health support for pilots would take away much of the incentive for pilots to leave critical medical conditions undisclosed.