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Gary G. Kay, Ph.D. Clinical Neuropsychologist

REPORT OF NEUROPSYCHOLOGICAL ASSESSMENT NAME: TEST DATE: AGE: PI:

Case 2; POE, Eduardi X. December 3, 2012 35 9876543

Eduardo Poe is a 35 year old, right handed, married, Hispanic male, Regional America, Embraer 170/175 Captain with 7800 logged flight hours referred for neuropsychological assessment as part of the FAA special issuance program for recovering alcoholic pilots seeking a special issuance medical certificate. RELEVANT HISTORY: Captain Poe was arrested for DWI on April 4, 2012. His BAC level was 0.25. A former girlfriend had called the police prior to telling Captain Poe that he needed to re-park his car closer to the curb. When he moved his vehicle 6 feet he was arrested. The girlfriend also claimed that Captain Poe was refusing to leave her property. He disputes her complaint. He explained that he was trying to put an end to the affair. He admitted that he had started drinking at around noon and that by 6 or 7 p.m. that day he had consumed a pint of vodka and approximately two quarts of beer. He admitted that he was inebriated when he drove to the girlfriend’s house. One week later the former girlfriend accused Captain Poe and his wife of assault. She had also made complaints about Captain Poe’s alcohol use to his employer and to the FAA. All of the charge’s against Captain Poe, except for the DWI, were dropped. Captain Poe notified his employer the following week of his alcohol-related arrest. His airline recommended that he enter a 30-day inpatient alcohol rehabilitation program. He entered XYZ Recovery in Lubbock, Texas in April. He reports his sobriety date as 4/14/2012. He reports that prior to treatment he was drinking 5 to 7 days per week, typically a pint of vodka or 22 ounces of beer. He had been drinking at this level for the past 8 years. He planned his flying schedule around his drinking. He drank beer if he had a long layover and liquor if he had a short layover. He denies ever having violated his company’s 12-hour rule. He stated that he had been having blackouts, a couple a month, in the year prior to entering treatment. He had tried unsuccessfully to stop drinking following an argument with his wife in 2011. Following his discharge from inpatient treatment Captain Poe began weekly aftercare consisting of group therapy sessions. He stated that he is still attending the therapy sessions. He attends AA meetings 4 days per week. He meets with his company’s monitor and a fellow pilot peer counselor. In June 2012, Captain Poe underwent a Psychology and Neuropsychology HIMS evaluation with Drs. Prescott and Smith. CogScreen was administered by Dr. Victor. Captain Poe states that he was told that he had performed well on testing (except for finger tapping) by Dr. Prescott and Dr. Victor. He was later notified by the FAA that his results indicated the presence of cognitive deficiencies and that he would require further evaluation. Background History: Captain Poe was raised in Little Rock, Arkansas. His mother worked as a housekeeper. They are very close. Captain Poe reported that his mother has been very supportive of his recovery. His father was described as being an alcoholic who held “random” jobs. He died of cancer at the age of 64. He has two brothers and three sisters, none of whom were

POE, Eduardo Page 2 reported to have alcohol-related problems. His parents divorced when he was 14 years of age. He was not close with his father. He reports no history of physical or sexual abuse. Captain Poe attended public schools. He stated that he was an average student. He had no learning disabilities and was never held back in school. In high school his grades were mostly A’s and B’s. He graduated from high school in 1995. He attended Famous Aeronautical University for 1 semester before dropping out due to the high cost of tuition. He enrolled in Western State University where he graduated in 2000. Following graduation he worked for 3 years as an instructor at the school. He completed his single, multi and commercial licenses. He received his ATP license 4½ years ago. His first commercial, non-training job involved flying cargo for a Dallas based operation for a period of one year. He was next hired by Regional America and has been based out of many different cities. He is an Embraer 170/175 Captain with 7800 logged flight hours. Captain Poe reported that his Chief Pilot has been “extremely supportive.” Captain Poe has no prior history of mental health treatment or evaluation. He reported that there is no family history of mental health disorders. Captain Poe married his wife, who is employed as a licensed architect, in 2007. They have one child together. There are three other children (his wife’s children), who live with them. He also supports three other children that he fathered prior to his marriage. According to Captain Poe his wife no longer consumes alcohol. She visited the treatment center, and attended an ALANON meeting, but didn’t like the meeting. Captain Poe reported that his wife is fully supportive of his recovery. He stated that the “marriage feels good” and that they are no longer fighting. Captain Poe described himself as “healthy.” He has lost weight and his blood pressure is no longer elevated. He exercises. He feels that his thinking is more clear. REVIEW OF RECORDS: On November 14, 2012, the FAA notified Captain Poe that he did not meet medical standards for certification due to his history of alcohol dependence and cognitive deficits. It was recommended that he undergo a repeat neuropsychological examination and that the examiner be provided the evaluations of Dr. Prescott and Dr. Smith. The case was reviewed at the FAA by Dr. Alan Sager in a memorandum dated October 29, 2012. His review included discussion of Dr. Skinner’s review of the testing performed by Dr. Prescott and Dr. Victor. Dr. Skinner was described as finding moderate impairments in the areas of visuospatial reasoning, visuospatial memory, and finger tapping speed. In addition, mild weaknesses were found in nonverbal problem solving, working memory and sensorimotor integration. Captain Poe had performed poorly with his non-dominant hand on the TPT. Dr. Skinner interpreted CogScreen results on measures of speed as being in the mildly impaired range. Dr. Sager recommended denial of certification. He also recommended that Captain Poe undergo follow-up neuropsychological assessment with a senior FAA neuropsychology consultant. In a report dated October 11, 2012, Dr. Skinner presented his review of Captain Poe’s FAA case file. Dr. Skinner noted impaired performance on the following tests: WAIS-IV Visual Puzzles, TPT Memory, Finger Tapping Speed, and CogScreen Response Speed. Dr. Skinner recommended follow-up neuropsychological assessment and referral to a neurologist to evaluate lateralized psychomotor deficits.

POE, Eduardo Page 3 In a letter dated August 12, 2012, Dr. A.B. Hardy recommended that Captain Poe be granted a first-class special issuance medical certificate for alcohol dependence, including a minimum three years of monitoring, annual psychiatric examination, weekly attendance in an aftercare group, month meetings with ALPA and employer peer monitors, and random ETH/PETH or hair tests for drugs and alcohol. Captain Poe was seen by Dr. Prescott for a psychological evaluation on June 26, 2012. Dr. Prescott interpreted the results as supporting Captain Poe being granted a first-class special issuance medical certificate. Captain Poe was evaluated by Dr. J.S. Dalhyrhymple, a psychiatrist, on 6/26/2012. Dr. Dalhyrhymple gave Captain Poe a diagnosis of Alcohol dependence, in early full remission. TESTS ADMINISTERED: Wechsler Adult Intelligence Scale-IV (Perceptual Reasoning & Working Memory) CogScreen-Aeromedical Edition Trail Making Test Rey Complex Figure Test Rey Auditory Verbal Learning Test Conners’ Continuous Performance Test Tactual Performance Test Grooved Pegboard Test MENTAL STATUS EXAMINATION/TEST BEHAVIOR: Captain Poe was fully alert, oriented and cooperative. He readily established good rapport with the examiner. He had no difficulty understanding or following test instructions. He appeared to be highly motivated to perform at the best of his ability. He did not appear to be particularly anxious or depressed. His affect was full and mood congruent. Conversation was logical and goal directed. The following results are considered to accurately reflect his current level of functioning. The airman’s FAA case file arrived at this office several days after the evaluation had been conducted. TEST FINDINGS (NOTE: data attached at end of report): CogScreen Captain Poe’s LRPV score is slightly lower than his June 2012 score (0.14). The score is completely in the Normal range. His overall performance on measures of speed falls in the Average range. His speed on the Manikin subtest declined slightly from the 7.5 percentile to the 5th percentile. However, his accuracy on this measure improved from the 7.5 percentile to the 97.5 percentile. On measures of response accuracy he had no scores at or below the 5th percentile and only 1 score at or below the 15th percentile. This compares very favorably to his June 2012 response accuracy performance which shows 5 scores at or below the 15th percentile. His accuracy was relatively weak on a measure of following a brief written instruction from working memory. None of the Taylor Aviation Factor Scores was in the deficient range. All 3 of the Aviation Factor scores that fell below the 15th percentile on previous testing are now well above average.

POE, Eduardo Page 4 Intelligence Test Findings Captain Poe was re-administered the WAIS-IV Perceptual Reasoning and Working Memory subtests. His performance on the Perceptual Reasoning subtests was only slightly improved and falls at the 25th percentile compared to population norms. His Matrix Reasoning subtest score remains at the 50th percentile, however his Block Design subtest score is at the 16th percentile. His score improved on the Visual Puzzles subtest, a measure of perceptual speed and visuospatial reasoning, from the 9th percentile to the 25th percentile. His scores on the Visual Puzzles subtest and Block Design subtest are unusually poor for a pilot and reflect a marked weakness in visuospatial ability. In contrast, the aviator’s performance significantly improved on the Working Memory subtests, with his WMI score of 108 is at the 70th percentile. He performed exceptionally well on the Digit Span subtest (91st percentile) but below average on mental arithmetic (37th percentile). This score does reflect an improvement compared to his June 2012 score (16th percentile). Captain Poe’s performance on the Arithmetic subtest is also unusually weak for an aviator. Processing Speed Captain Poe’s WAIS-IV Processing Speed Index when tested by Dr. Prescott was in the midAverage range (97). On CogScreen his response speed at the current evaluation places him at the 42nd percentile compared to regional airline pilots. At the prior evaluation he performed well on Part A of the Trail Making Test and on the PASAT. There is clearly no deficiency in processing speed. Working Memory Captain Poe scored at the 70th percentile on the WAIS-IV measure of Working Memory (WM Index = 108). Performance on individual subtests ranged from the 37h to the 91st percentile. Initial trial recall was in the expected range on the RAVLT (84th percentile). Sustained Visual Attention (Vigilance) Performance on the Conners’ Continuous Performance Test shows faster reaction times than in June 2012 (98th percentile). There was only one CPT index score that was weak (18th percentile). This was found on a measure of increased variability as a function of time on test. There were no other findings of difficulties with alertness or vigilance. Results suggest against the likelihood of a clinical problem with attention. Memory Captain Poe performed well on a test of verbal memory. After five presentations of a 15 item word list he was able to recall all 15 items (92nd percentile). Following presentation of a second word list he was still able to recall all 15 words from the original list (95th percentile). On delayed recall testing he recalled 14 of the list words (88th percentile). In contrast, performance on visual memory testing was far below expectation. Immediate recall of the Rey Complex Figure was in the Low Average range. His score is above the 5th percentile cut-off compared to aviator norms. After a 30-minute delay his recall was below expectation for his age, but was still above the 5th percentile aviator norm. On recognition testing he correctly recognized only 19 of the 24 design components. This score places him at the 6th percentile compared to adult norms. It is important to note that Captain Poe was not informed that he would be asked to draw the Complex Figure from memory. In addition, there was only one presentation of the design (i.e., the copy trial). Performance on CogScreen memory testing was markedly improved at the second evaluation (from the 5th percentile to the 97.5 percentile).

POE, Eduardo Page 5 The Tactual Performance Test was also repeated at this examination. Mr. Poe’s scores on the memory components of the TPT improved from the 33rd percentile to the 99th percentile. This is probably due to the fact for the second administration the patient knew that he was going to be tested on his recall of block shape and location. Psychomotor Functioning Captain Poe’s performance improved on the Tactual Performance Test. His performance with his dominant right hand and non-dominant left hand was far above expectation. He also performed above average with both hands on a test of fine motor speed and coordination. Executive Functions Captain Poe performed well on CogScreen measures of executive functioning. No other executive function testing was performed at this evaluation. SUMMARY AND RECOMMENDATIONS: Neuropsychological assessment generally reveals improved neurocognitive functioning in the areas of concern based on the June 2012 examination. Much of this improvement can be attributed to practice effects. According to Dr. Skinner’s review, the June examination revealed moderate impairments in the areas of visuospatial reasoning, visuospatial memory, and finger tapping speed. The present evaluation demonstrates that the aviator has a weakness involving visuospatial reasoning and memory. Although weak, his performance in these areas falls within the Normal range. This weakness is likely a longstanding characteristic of the aviator. Testing of psychomotor speed and coordination shows no evidence of deficiencies with his right or left hand. There are also no deficiencies in processing speed. In addition, Dr. Skinner reported that the June evaluation showed mild weaknesses in nonverbal problem solving, working memory and sensorimotor integration. The present evaluation shows no deficits in working memory or sensorimotor integration. The weakness seen in non-verbal problem solving appears to be longstanding. Based on these findings I recommend that Captain Poe be granted a special issuance 1st Class FAA medical certificate and that he continue with the HIMS program of treatment and monitoring. No further neuropsychological assessment is indicated. Thank you for referring Captain Poe for neuropsychological assessment. If you have any further questions please don't hesitate to contact me.

Gary G. Kay, Ph.D. Clinical Neuropsychologist