Holcombe Medical Consulting

06/04/2026

For any pilots out there — or anyone who flies with one — this one's worth reading.

Alcohol use disorder doesn't have to end a flying career. The FAA's HIMS program exists specifically to bring pilots back to the cockpit after treatment, with an 85 to 90 percent long-term success rate.

But the process is detailed, the rules are strict, and the mistakes pilots make — especially around disclosure — can be more damaging than the underlying condition itself.

My latest article covers:

✔️ How the FAA defines substance dependence (it's not the same as your doctor's definition)
✔️ What a DUI means for your medical certificate — and the two separate reporting requirements most pilots don't know about
✔️ The HIMS certification process from start to finish
✔️ What the 4-phase, 7+ year monitoring program actually looks like
✔️ Why FDA-approved medications for alcohol use disorder are still off the table for active pilots
✔️ The most common mistakes that end flying careers — and how to avoid them

Link in the comments. Questions welcome.

👉 Holcombe Medical Consulting, PLLC | FAA Aviation Medicine

05/21/2026

Are you a pilot with a history of ADHD or do you know one?

A diagnosis does not automatically disqualify a pilot from FAA medical certification. But the process is complicated, and small documentation errors can cause delays of six months or more.

The FAA updated its ADHD evaluation framework in October 2024.

There are now two pathways:

The Fast Track applies if you have had no symptoms, no ADHD medication of any kind, no major problems in work or daily life related to ADHD, and no other psychiatric history - all within the past four years. If all four conditions are met, a qualified Aviation Medical Examiner can issue your certificate the same day as your exam.

The Standard Track applies to everyone else. It involves a referral to a HIMS neuropsychologist, a 90-day medication washout period before testing, a full neuropsychological test battery, and FAA review. Well-organized cases still typically take six to twelve months from start to finish.

The most common mistakes - wrong track, incomplete records, the wrong type of urine drug screen - can set the process back significantly.

I have put together a complete guide covering both pathways, the full document checklist, the errors to avoid, and what the FAA is actually evaluating when it reviews these cases.

Read the full guide here:
https://holcombemedicalconsulting.com/resources/adhd-faa-medical-certification-pilots

I am a Senior Aviation Medical Examiner and board-certified occupational medicine physician. I work with pilots navigating complex FAA certification cases and also offer direct primary care for pilots who need physician-documented medical records as part of their submission. Feel free to reach out with questions.

Thomas P. Holcombe, MD, MPH, MA
Holcombe Medical Consulting, PLLC
holcombemedicalconsulting.com

04/21/2026

Proud to share this from AOHC 2026 in Chicago this week.

My friend and colleague Dr. Joe Abrams gave an outstanding presentation on a topic that deserves a lot more attention — a potential cancer cluster among U.S. military members who served as ICBM missile launch officers.

These are men and women who spent 24-hour shifts underground in facilities built in the 1960s, breathing recirculated air in spaces that contained PCBs, asbestos, diesel exhaust, and combustion products from burning classified materials — often with no protective equipment and no occupational health oversight. For decades, nobody was tracking what they were being exposed to or what was happening to their health after they left service.

Dr. Abrams laid out the science clearly and honestly — what the data shows, where the gaps are, and what physicians like me need to start doing differently: asking veterans what they did before they entered civilian life. A military occupational history can change the entire picture for a patient.

This is occupational medicine doing exactly what it's supposed to do — advocating for workers, following the evidence, and speaking up even when the answers aren't complete yet.

Joe, I'm glad you're in this fight. Well done.

🔗 Full writeup on the case study on my website — link in comments.

04/08/2026

Your FAA medical certificate depends on your documentation — not just your health.

Most pilots who run into trouble with FAA medical certification aren't medically unfit to fly. The problem is documentation that doesn't meet the FAA's standard.

The FAA requires a Current, Detailed Clinical Progress Note (DCPN) — not the After Visit Summary you download from your patient portal. They are different documents, and submitting the wrong one can delay or defer your certification. As of January 2025, a deferral now means an immediate initial denial on your record.

We put together a guide explaining exactly what the FAA requires in a DCPN, the most common documentation mistakes pilots make, and how to structure your care so your records support your certification instead of working against it.

Read the full guide here: https://holcombemedicalconsulting.com/resources/faa-detailed-clinical-progress-note-dcpn-guide

If you have questions about FAA medical certification, CACI documentation, Special Issuance renewals, or need a physician who understands what the FAA expects — we're here to help.

Learn about Direct Primary Care for Pilots: https://holcombemedicalconsulting.com/services/direct-primary-care

Holcombe Medical Consulting, PLLC — Aviation Medicine | Direct Primary Care | Occupational Medicine
Houston, TX · Serving pilots nationwide

04/02/2026

Worried that a medical condition means you can't fly? That's one of the most common concerns I hear from pilots — and most of the time, the answer is better than they expect.

The FAA has specific pathways for a wide range of conditions. Things like high blood pressure, thyroid issues, asthma, and even a history of depression don't automatically disqualify you. Many of these can be certified the same day if your AME has the right documentation in hand.

For more complex situations — cardiac history, diabetes on medication, ADHD — there are defined processes for getting cleared. It takes the right paperwork, submitted the right way.

And if you're a veteran with a VA disability rating, that rating alone doesn't ground you. But it does need to be disclosed correctly, and the path forward depends on what's been rated and how it's currently managed.

The biggest thing I tell pilots: don't guess, and don't avoid the exam because you're worried about the outcome. A little preparation goes a long way.

At Holcombe Medical Consulting we do FAA medical exams (Class 1, 2, and 3), help with complex certifications, and provide primary care for pilots and veterans who want a doctor that understands the aviation side of things.

If you have questions about your FAA medical or just want to make sure you're prepared before your exam, send us a message or schedule here:

https://holcombemedicalconsulting.com/services/aviation-medicine

Independent medical consulting services for employers, attorneys, insurance carriers, and organizations.

03/17/2026

What Is a Disability Evaluation — and Why Does It Matter?

When someone has a medical condition affecting their ability to work, the most important question is often not just what the diagnosis is, but how that condition affects real-world function and job performance.

At Holcombe Medical Consulting, PLLC, we provide physician-led Disability & Impairment Evaluations designed to help insurers, attorneys, employers, and agencies make informed decisions.

These evaluations may address questions such as:
✔ Has the individual reached Maximum Medical Improvement (MMI)?
✔ What functional limitations exist based on clinical findings?
✔ Are work restrictions necessary?
✔ Is there permanent impairment, and how should it be rated?

Each evaluation includes:
• Comprehensive medical record review
• Clinical interview and physician examination
• Functional capacity analysis
• A clear, objective medical report

Our goal is to provide structured, evidence-based medical opinions that help organizations navigate complex disability and occupational health questions.

If your organization needs independent disability or impairment evaluations, feel free to reach out or learn more about our services.
Holcombe Medical Consulting, PLLC

Physician-Led Occupational & Medical-Legal Consulting



https://holcombemedicalconsulting.com/services/disability-impairment-evaluation

03/10/2026

Jet Fuel Exposure and Veteran Health

Many military veterans worked around jet fuel every day—fueling aircraft, performing maintenance, or working in aviation environments. What many people don’t realize is that jet fuel exposure can affect multiple systems in the body, especially with repeated occupational exposure.

Research reviewing military jet fuel exposure has suggested potential links to:

• Respiratory irritation and lung inflammation
• Possible kidney and liver effects
• Immune system changes
• Possible long-term health risks that researchers are still studying

For veterans experiencing chronic health issues years after service, these exposures may be an important part of their medical and service history.

For attorneys representing veterans, these cases often require careful occupational exposure analysis and medical review because military aviation environments can involve multiple toxic exposures at the same time.

With increasing attention on military environmental exposures and legislation like the PACT Act, understanding the science behind these risks is becoming more important for veterans, families, and advocates.

If you’re a veteran who worked in aviation or fuel operations, documenting your occupational exposures during service may be an important step in understanding your health.

https://holcombemedicalconsulting.com/resources/jet-fuel-exposure-health-effects-veterans

03/06/2026

Workplace drug testing programs are about more than just laboratory results — they require careful medical review to ensure accuracy, fairness, and compliance.

That’s where a Medical Review Officer (MRO) plays a critical role.

A Medical Review Officer is a licensed physician responsible for reviewing drug testing results before they are reported to employers. This includes evaluating laboratory findings, reviewing prescription medications that may explain a result, and ensuring the testing process follows federal and industry regulations.

At Holcombe Medical Consulting, PLLC, we provide physician-led Medical Review Officer (MRO) services for DOT and non-DOT drug testing programs nationwide.

Our MRO services support:
✔ Transportation companies and DOT-regulated employers
✔ Businesses with workplace drug testing programs
✔ Third-party administrators (TPAs)
✔ Occupational health networks

An independent physician review helps ensure results are medically accurate, legally defensible, and compliant with federal drug testing regulations.

If your organization needs reliable MRO services or DOT drug test verification, we’re here to help.

Learn more about our Medical Review Officer services:

https://holcombemedicalconsulting.com/services/medical-review-officer

03/04/2026

VA Disability Claims Often Turn on One Critical Element: Medical Evidence

Many veterans assume that having a diagnosis is enough for a VA disability claim. In reality, the outcome of a claim often depends on whether the medical evidence clearly explains how the condition is connected to military service.

At Holcombe Medical Consulting, PLLC, I provide independent medical opinions and VA nexus evaluations designed to analyze:

✔ Service connection between military exposures/injuries and current conditions
✔ Secondary conditions caused by existing service-connected disabilities
✔ Functional impairment affecting work and daily life
✔ Medical record documentation supporting VA regulatory standards

As a board-certified physician in Occupational & Environmental Medicine, my approach focuses on causation analysis, exposure evaluation, and medically defensible reasoning—the same framework used in occupational and disability medicine.

In some cases, veterans also benefit from longitudinal medical documentation, which can be built through Direct Primary Care. Continuous clinical records may strengthen the evidentiary foundation for later medical opinions.

⚖️ The goal is not advocacy—it is objective, evidence-based medical analysis aligned with VA standards.

If you are a veteran, attorney, or accredited representative seeking independent medical review of a VA disability case, you can learn more here:

🔗 Link in the comments

03/02/2026

Most employers offer mental health benefits.

Most employees don’t use them.

That gap matters.

Across healthcare, aviation, manufacturing, and corporate environments, organizations are investing heavily in workforce wellbeing. Yet Employee Assistance Programs (EAPs) often see utilization rates in the single digits.

If support exists but isn’t accessed, risk isn’t truly reduced.

That’s why more employers are beginning to explore corporate chaplaincy — not as a religious program, and not as therapy — but as a voluntary, confidential, relational support presence in the workplace.

When structured properly, corporate chaplaincy:
- Is non-proselytizing and inclusive
- Does not diagnose or provide therapy
- Does not replace mental health professionals
- Serves as a bridge to appropriate care
- Reduces stigma barriers to early engagement

From an occupational medicine perspective, this connects directly to:
- Safety culture
- Burnout prevention
- Retention strategy
- Crisis preparedness
- Total Worker Health principles

Workforce wellbeing is no longer just an HR initiative — it is a risk management issue.

If your organization is evaluating how to better support employees while protecting operational stability, this is a conversation worth having.
—
Thomas Holcombe, MD
Holcombe Medical Consulting, PLLC
Occupational Medicine & Total Worker Health Advisory



Link in the comments.