Guide For Aviation Medical Examiners 2016 PDF
Guide For Aviation Medical Examiners 2016 PDF
Guide For Aviation Medical Examiners 2016 PDF
Welcome to the Guide for Aviation Medical Examiners. The format of this version of the
Guide provides instant access to information regarding regulations, medical history,
examination procedures, dispositions, and protocols necessary for completion of the
FAA Form 8500-8, Application for Airman Medical Certificate.
To navigate through the Guide PDF by Item number or subject matter, simply click on
the “BOOKMARK” tab in the left column to search specific certification decision-making
criteria. To expand any “BOOKMARK” files, click on the corresponding + button located
in the front of the text. To collapse any of the expanded files, click on the + button
again.
The most current version of this guide may be found and downloaded at the following
FAA site:
http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/
http://www.faa.gov/licenses_certificates/medical_certification/rfs
http://www.faa.gov/about/office_org/field_offices/fsdo
http://ecfr.gpoaccess.gov/
http://www.icao.int/safety/AirNavigation/Pages/peltrgFAQ.aspx
Title 49, United States Code (U.S.C.) (Transportation), sections 109(9), 40113(a),
44701-44703, and 44709 (1994) formerly codified in the Federal Aviation Act of 1958,
as amended, authorizes the FAA Administrator to delegate to qualified private persons;
i.e. designated Examiners, matters related to the examination, testing, and inspection
necessary to issue a certificate under the U.S.C. and to issue the certificate.
Designated Examiners are delegated the Administrator's authority to examine
applicants for airman medical certificates and to issue or deny issuance of certificates.
Approximately 450,000 applications for airman medical certification are received and
processed each year. The vast majority of medical examinations conducted in
connection with these applications are performed by physicians in private practice who
have been designated to represent the FAA for this purpose. An Examiner is a
designated representative of the FAA Administrator with important duties and
responsibilities. It is essential that Examiners recognize the responsibility associated
with their appointment.
At times, an applicant may not have an established treating physician and the Examiner
may elect to fulfill this role. You must consider your responsibilities in your capacity as
an Examiner as well as the potential conflicts that may arise when performing in this
dual capacity.
"Whoever in any matter within the jurisdiction of any department or agency of the
United States knowingly and willfully falsifies, conceals, or covers up by any trick,
scheme, or device a material fact, or who makes any false, fictitious or fraudulent
statements or representations, or entry, may be fined up to $250,000 or
In addition, when an airman has been issued a medical certificate that should not have
been issued, it is frequently necessary for the FAA to begin a legal revocation or
suspension action to recover the certificate. This procedure is time consuming and
costly. Furthermore, until the legal process is completed, the airman may continue to
exercise the privileges of the certificate, thereby compromising aviation safety.
• Examine applicants for, and holders of, airman medical certificates to determine
whether or not they meet the medical standards for the issuance of an airman
medical certificate.
3. Equipment Requirements
For the conduct of the medical examination, Examiners shall have adequate facilities for
performing the required examinations and possess the following equipment prior to
conducting any FAA examinations. History or current findings may indicate a need for
special evaluations. Examiners shall certify at the time of designation, re-designation,
or upon request that they possess (and maintain as necessary) the equipment
specified.
1. Standard Snellen Test. Types for visual acuity (both near and distant) and
appropriate eye lane. FAA Form 8500-1, Near Vision Acuity Test Card may be used for
near and intermediate vision testing. Metal, opaque plastic, or cardboard occluder.
2. Eye Muscle Test-Light. May be a spot of light 0.5cm in diameter, a regular muscle-
test light, or an ophthalmoscope.
7. A Wall Target consisting of a 50-inch square surface with a matte finish (may be
black felt or dull finish paper) and a 2-mm white test object (may be a pin) in a suitable
handle of the same color as the background. Note: this is not necessary if an AME
chooses the acceptable option of performing field of vision testing by direct
confrontation.
10. Audiometric equipment. All Examiners must have access to audiometric equipment
or a capability of referring applicants to other medical facilities for audiometric testing.
The format of the Guide establishes aerospace medical dispositions, protocols, and
AME Assisted Special Issuances (AASI) identified in Items 21–58 of the FAA Form
8500. This guidance references specific medical tests or procedure(s) the results of
which are needed by the FAA to determine the eligibility of the applicant to be medically
After reviewing the medical history and completing the examination, Examiners must:
• Defer the action to the Manager, AMCD, AAM-300, or the appropriate RFS
Examiners may issue a medical certificate only if the applicant meets all medical
standards, including those pertaining to medical history unless otherwise authorized by
the FAA.
Examiners may not issue a medical certificate if the applicant fails to meet specified
minimum standards or demonstrates any of the findings or diagnoses described in this
Guide as "disqualifying" unless the condition is unchanged or improved and the
applicant presents written documentation that the FAA has evaluated the condition,
found the applicant eligible for certification, and authorized Examiners to issue
certificates.
The following medical conditions are specifically disqualifying under 14 CFR part 67.
However, the FAA may exercise discretionary authority under the provisions of
Authorization of Special Issuance, to issue an airman medical certificate. See
Special Issuances section for additional guidance where applicable.
• Angina pectoris;
• Bipolar disorder;
• Coronary heart disease that has required treatment or, if untreated, that has
been symptomatic or clinically significant;
• Epilepsy;
• Myocardial infarction;
• Psychosis;
An airman who is medically disqualified for any reason may be considered by the FAA
for an Authorization for Special Issuance of a Medical Certificate (Authorization). For
medical defects, which are static or nonprogressive in nature, a Statement of
Demonstrated Ability (SODA) may be granted in lieu of an Authorization.
The Examiner always may defer the application to the FAA for action. In the interests
of the applicant and of a responsive certification system, however, deferral is
appropriate only if: the standards are not met; if there is an unresolved question about
the history, the findings, the standards, or agency policy; if the examination is
incomplete; if further evaluation is necessary; or if directed by the FAA.
The Examiner may deny certification only when the applicant clearly does not meet the
standards.
5. Authorization for Special Issuance and AME Assisted Special Issuance (AASI)
At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a
Medical Certificate (Authorization), valid for a specified period, may be granted to a
person who does not meet the established medical standards if the person shows to the
satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical
certificate applied for can be performed without endangering public safety during the
period in which the Authorization would be in force. The Federal Air Surgeon may
authorize a special medical flight test, practical test, or medical evaluation for this
purpose. A medical certificate of the appropriate class may be issued to a person who
fails to meet one or more of the established medical standards if that person possesses
a valid agency issued Authorization and is otherwise eligible. An airman medical
certificate issued in accordance with the special issuance section of part 67 (14 CFR §
In granting an Authorization, the Federal Air Surgeon may consider the person's
operational experience and any medical facts that may affect the ability of the person to
perform airman duties including:
• The combined effect on the person of failing to meet one or more than one
requirement of part 67; and
In granting an Authorization, the Federal Air Surgeon specifies the class of medical
certificate authorized to be issued and may do any or all of the following:
• State on the Authorization, and any medical certificate based upon it, any
operational limitation needed for safety; or
An Authorization granted to a person who does not meet the applicable medical
standards of part 67 may be withdrawn, at the discretion of the Federal Air Surgeon, at
any time if:
• The holder fails to provide medical information reasonably needed by the Federal
Air Surgeon for certification under the special issuance section of part 67
(14 CFR 67.401); or
• The holder makes or causes to be made a statement or entry that is the basis for
withdrawal of an Authorization under the falsification section of part 67
(14 CFR 67.403).
A person who has been granted an Authorization under the special issuance section of
part 67 (14 CFR 67.401), based on a special medical flight or practical test, need not
take the test again during later medical examinations unless the Federal Air Surgeon
determines or has reason to believe that the physical deficiency has or may have
degraded to a degree to require another special medical flight test or practical test.
The authority of the Federal Air Surgeon under the special issuance section of part 67
(14 CFR 67.401) is also exercised by the Manager, AMCD, and each RFS.
• The holder of the Authorization will be served a letter of withdrawal, stating the
reason for the action;
• By not later than 60 days after the service of the letter of withdrawal, the holder of
the Authorization may request, in writing, that the Federal Air Surgeon provide for
review of the decision to withdraw. The request for review may be accompanied
by supporting medical evidence;
• Within 60 days of receipt of a request for review, a written final decision either
affirming or reversing the decision to withdraw will be issued; and
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability
to re-issue an airman medical certificate under the provisions of an Authorization to an
applicant who has a medical condition that is disqualifying under 14 CFR part 67.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. Examiners may re-issue an airman medical certificate under
the provisions of an Authorization, if the applicant provides the requisite medical
information required for determination. Examiners may not issue initial Authorizations.
An Examiner's decision or determination is subject to review by the FAA.
The Examiner, as a representative of the FAA, should treat the applicant's medical
certification information in accordance with the requirements of the Privacy Act.
Therefore, information should not be released without the written consent of the
applicant or an order from a court of competent jurisdiction. Whenever a court order or
subpoena is received by the Examiner, the appropriate RFS or the AMCD should be
contacted In order to ensure proper release of information. Similarly, unless the
applicant's written consent for release routine in nature (e.g., accompanying a standard
insurance company request), the FAA must be contacted before releasing any
information. In all cases, copies of all released information should be retained.
B. Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Examiner’s
activities for the FAA.
This Act provides specific patient protections and depending upon an Examiner’s
activation and practice patterns, you may have to comply with additional requirements.
7. Release of Information
MANAGER
AEROSPACE MEDICAL CERTIFICATION DIVISION, AAM-300
CIVIL AEROMEDICAL INSTITUTE
FEDERAL AVIATION ADMINISTRATION
POST OFFICE BOX 26200
OKLAHOMA CITY, OK 73125-0080
The Examiner is to conduct all medical examinations at their designated address only.
An Examiner is not permitted to conduct examinations at a temporary address and is
not permitted to name an alternate Examiner. During an Examiner's absence from the
permanent office, applicants for airman medical certification shall be referred to another
Examiner in the area.
There are, however, minimum age requirements for the various airman certificates (i.e.,
pilot license certificates) are defined in 14 CFR part 61, Certification: Pilots and Flight
Instructors, and Ground Inspectors as follows:
Note: As of April 1, 2016 (per Final Rule [81 FR 1292]), AMEs will no longer be able to
issue the combined FAA Medical Certificate and Student Pilot Certificate. See Student
Pilot Rule Change.
b. Language Requirements
There is no language requirement for medical certification. However, if the AME has
concerns about the applicant’s English proficiency, they should contact their local FSDO
and/or the RFS and document this in Block 60.
Effective March 5, 2008, the International Civil Aviation Organization (ICAO) (Annex 1
Personnel Licensing) standards require that all Private, Commercial, or Airline Transport
pilots as well as Flight Engineers and Flight Navigators operating internationally as
required crewmembers of an airplane or helicopter have an airman certificate with an
endorsement of language proficiency. In the case of persons holding a U.S. airman
certificate, the language proficiency endorsement will state “English Proficient.” An
applicant must meet the ICAO definition of “English Proficient,” which is equivalent to
the FAA’s long-standing, basic English standard.
At each exam, the Examiner must observe the applicant’s ability to understand and
communicate in English. This may be accomplished by observing the applicant reading
instructions, answering questions, and conversing with the AME.
• In all cases:
o The AME must notify the applicant of their concern, document the notification
in Block 60, and advise the applicant to report to the local FSDO for further
testing.
o The AME must also notify the FSDO and/or the RFS and document this in
Block 60. If the AME notifies only the RFS, then the RFS must notify the
FSDO closest to the examining AME’s office. The AME must also document
in Block 60 the name of the person contacted.
The ICAO standard rates individuals from Level 1 (pre-elementary) to Level 6 (expert).
Operational Level 4 is considered the minimum for proficiency. The following is
provided as information only:
1. PRONUNCIATION
Assumes that English is not the applicant’s first language and that the applicant has a dialect or accent that is
intelligible to the aeronautical community. Pronunciation, stress, rhythm, and intonation are influenced by the
applicant’s first language, but only sometimes interfere with ease of understanding.
2. STRUCTURE
Relevant grammatical structures and sentence patterns are determined by language functions appropriate to the
task. Basic grammatical structures and sentence patterns are used creatively and are usually well controlled by
3. VOCABULARY
The applicant’s vocabulary range and accuracy are usually sufficient to communicate effectively on common,
concrete, and work-related topics. The applicant can often paraphrase successfully when lacking vocabulary in
unusual or unexpected circumstances.
4. FLUENCY
The applicant produces stretches of language at an appropriate tempo. There may be occasional loss of fluency
on transition from rehearsed or formulaic speech to spontaneous interaction, but this does not prevent effective
communication. The applicant can make limited use of discourse markers or connectors. Fillers are not
distracting.
5. COMPREHENSION
Comprehension by the applicant is mostly accurate on common, concrete, and work-related topics when the
dialect, accent or variety used is sufficiently intelligible. When the applicant is confronted with a linguistic or
situational complication or an unexpected turn of events, comprehension may be slower or require clarification
strategies.
6. INTERACTIONS
Responses by the applicant are usually immediate, appropriate, and informative. The applicant initiates and
maintains exchanges even when dealing with an unexpected turn of events. The applicant deals adequately with
apparent misunderstandings by checking, confirming, or clarifying.
An applicant may apply and be granted any class of airman medical certificate as long
as the applicant meets the required medical standards for that class of medical
certificate. However, an applicant must have the appropriate class of medical certificate
for the flying duties the airman intends to exercise. For example, an applicant who
exercises the privileges of an airline transport pilot (ATP) certificate must hold a first-
class medical certificate. That same pilot when holding only a third-class medical
certificate may only exercise privileges of a private pilot certificate. Finally, an applicant
need not hold an ATP airman certificate to be eligible for a first-class medical certificate.
Listed below are the three classes of airman medical certificates, identifying the
categories of airmen (i.e., pilot) certificates applicable to each class.
An airman medical certificate is valid only with the original signature of the AME who
performed the examination or with the digital signature of an authorized FAA physician
(e.g., Regional Flight Surgeon, manager of the Aerospace Medical Certification Division,
Federal Air Surgeon). Note:
Glider and Free Balloon Pilots are not required to hold a medical certificate of any class.
To be issued Glider or Free Balloon Airman Certificates, applicants must certify that
they do not know, or have reason to know, of any medical condition that would make
them unable to operate a glider or free balloon in a safe manner. This certification is
made at the local FAA FSDO.
“Sport” pilots are required to hold either a valid airman medical certificate or a current
and valid U.S. driver’s license. When using a current and valid U.S. driver’s license to
qualify, sport pilots must comply with each restriction and limitation on their U.S. driver’s
license and any judicial or administrative order applying to the operation of a motor
vehicle.
To exercise sport pilot privileges using a current and valid U.S. driver’s license as
evidence of qualification, sport pilots must:
• Not have been denied the issuance of at least a third-class airman medical
certificate (if they have applied for an airman medical certificate)
• Not have had their most recent airman medical certificate revoked or suspended
(if they have held an airman medical certificate); and
• Not have had an Authorization withdrawn (if they have ever been granted an
Authorization).
Sport pilots may not use a current and valid U.S. driver’s license in lieu of a valid airman
medical certificate if they know or have reason to know of any medical condition that
would make them unable to operate a light-sport aircraft in a safe manner.
Sport pilot medical provisions are found under 14 CFR §§ 61.3, 61.23, 61.53, and
61.303).
For more information about the sport pilot final rule, see the Certification of Aircraft and
Airmen for the Operation of Light-Sport Aircraft; Final Rule.
• Each medical certificate must bear the same date as the date of medical
examination regardless of the date the certificate is actually issued.
• Each medical certificate must be type-written either by typewriter or computer
print-out. Handwritten or obviously corrected certificates are not acceptable.
AMEs are required to use the electronic transmission capability of AMCS and must
forward the FAA/Original Copy to the FAA in Oklahoma (see address below). The AME
Work Copy must be retained as the file copy.
An airman medical certificate is valid only with the original signature of the AME who
performed the examination or with the digital signature of an authorized FAA physician
(e.g., Regional Flight Surgeon, manager of the Aerospace Medical Certification Division,
Federal Air Surgeon).
• Copies are NOT valid.
• An AME may only issue ONE originally signed certificate to an airman. A
replacement for a lost or destroyed certificate must be issued by the FAA.
Note: Each medical certificate must bear the same date as the date of medical
examination regardless of the date the certificate is actually issued. Each medical
certificate must be type-written, either by typewriter or computer print-out.
NOTE: 14 CFR § 61.53 was revised on July 27, 2004 by adding subparagraph (c)
(1) Knows or has reason to know of any medical condition that would make the
person unable to meet the requirements for the medical certificate necessary
for the pilot operation; and/or
(2) Is taking medication or receiving other treatment for a medical condition that
results in the person being unable to meet the requirements for the medical
certificate necessary for the pilot operation.
(b) Operations that do not require a medical certificate. For operations provided for
in § 61.23(b) of this part, a person shall not act as pilot in command, or in any
other capacity as a required pilot flight crewmember, while that person knows or
has reason to know of any medical condition that would make the person unable
to operate the aircraft in a safe manner.
(1) Paragraph (a) of this section if that person holds a valid medical certificate
issued under part 67 of this chapter and does not hold a current and valid
U.S. driver's license
(2) Paragraph (b) of this section if that person holds a current and valid U.S.
driver's license
A medical certificate holder may be required to undergo a reexamination at any time if,
in the opinion of the Federal Air Surgeon or authorized representative within the FAA,
there is a reasonable basis to question the airman's ability to meet the medical
standards. An Examiner may NOT order such reexamination.
The FAA does not establish fees to be charged by Examiners for the medical
examination of persons applying for airman medical certification. It is recommended
that the fee be the usual and customary fee established by other physicians in the same
general locality for similar services.
Medical certificates that are lost or accidentally destroyed may be replaced upon proper
application provided such certificates have not expired. The request should be sent to:
FOIA DESK
AEROSPACE MEDICAL CERTIFICATION DIVISION, AAM-331
FEDERAL AVIATION ADMINISTRATION
CIVIL AEROSPACE MEDICAL INSTITUTE
POST OFFICE BOX 26200
OKLAHOMA CITY, OK 73125-0080
• Class of certificate;
The replacement certificate will be prepared in the same manner as the missing
certificate and will bear the same date of examination regardless of when it is issued.
In an emergency, contact your RFS or the Manager, AMCD, AAM-300, at the above
address or by facsimile at 405-954-4300 for certification verification only.
All completed applications and medical examinations, unless otherwise directed by the
FAA, must be transmitted electronically via AMCS within 14 days after completion to the
AMCD. These requirements also apply to submissions by International AMEs.
Forms are available electronically in AMCS. Examiners are accountable for all blank
FAA forms they may have printed and are cautioned to provide adequate security for
such forms or certificates to ensure that they do not become available for illegal use.
Examiners are responsible for destroying any existing paper forms they may still have.
MANAGER
AEROSPACE MEDICAL CERTIFICATION DIVISION, AAM-300
CIVIL AEROSPACE MEDICAL INSTITUTE
FEDERAL AVIATION ADMINISTRATION
POST OFFICE BOX 26080
OKLAHOMA CITY, OK 73125
MANAGER
AEROSPACE MEDICAL EDUCATION DIVISION, AAM-400
CIVIL AEROSPACE MEDICAL INSTITUTE
FEDERAL AVIATION ADMINISTRATION
POST OFFICE BOX 26080
OKLAHOMA CITY, OK 73125
An Examiner's denial of a medical certificate is not a final FAA denial. An applicant may
ask for reconsideration of an Examiner's denial by submitting a request in writing to:
The AMCD will provide initial reconsideration. Some cases may be referred to the
appropriate RFS for action. If the AMCD or a RFS finds that the applicant is not
qualified, the applicant is denied and advised of further reconsideration and appeal
procedures. These may include reconsideration by the Federal Air Surgeon and/or
petition for NTSB review.
In granting a SODA, the Federal Air Surgeon may consider the person's operational
experience and any medical facts that may affect the ability of the person to perform
airman duties including:
• The combined effect on the person of failure to meet more than one requirement
of part 67; and
In granting a SODA under the special issuance section of part 67 (14 CFR 67.401), the
Federal Air Surgeon specifies the class of medical certificate authorized to be issued
and may do any of the following:
• State on the SODA, and on any medical certificate based upon it, any operational
limitation needed for safety; or
• Condition the continued effect of a SODA, and any second- or third-class medical
certificate based upon it, on compliance with a statement of functional limitations
issued to the person in coordination with the Director of Flight Standards or the
Director's designee.
A SODA granted to a person who does not meet the applicable standards of part 67
may be withdrawn, at the discretion of the Federal Air Surgeon, at any time if:
• The holder fails to provide medical information reasonably needed by the Federal
Air Surgeon for certification under the special issuance section of part 67
(14 CFR 67.401);
• The holder makes or causes to be made a statement or entry that is the basis for
withdrawal of a SODA under the falsification section of part 67 (14 CFR 67.403);
or
• A person who has been granted a SODA under the special issuance section of
part 67 (14 CFR 67.401), based on a special medical flight or practical test need
not take the test again during later medical examinations unless the Federal Air
Surgeon determines or has reason to believe that the physical deficiency has or
may have degraded to a degree to require another special medical flight test or
practical test.
The authority of the Federal Air Surgeon under the special issuance section of part 67
(14 CFR 67.401) is also exercised by the Manager, AMCD, and each RFS.
• The holder of the SODA will be served a letter of withdrawal stating the reason
for the action;
• By not later than 60 days after the service of the letter of withdrawal, the holder of
the SODA may request, in writing, that the Federal Air Surgeon provide for
review of the decision to withdraw. The request for review may be accompanied
by supporting medical evidence;
Within 60 days after a final FAA denial of an unrestricted airman medical certificate, an
airman may petition the NTSB for a review of that denial. The NTSB does not have
jurisdiction to review the denial of a SODA or special issuance airman medical
certificate.
The NTSB is an independent agency of the Federal Government that has the authority
to review on appeal the suspension, amendment, modification, revocation, or denial of
any certificate or license issued by the FAA Administrator.
An Administrative Law Judge for the NTSB may hold a formal hearing at which the FAA
will present documentary evidence and testimony by medical specialists supporting the
denial decision. The petitioner will also be given an opportunity to present evidence and
testimony at the hearing. The Administrative Law Judge’s decision is subject to review
by the full NTSB.
This section contains guidance for items on the Medical History and General
Information page of FAA Form 8500-8, Application for Airman Medical Certificate.
All applicants must show proof of age and identity under 14 CFR §67.4. On
occasion, individuals have attempted to be examined under a false name. If the
applicant is unknown to the Examiner, the Examiner should request evidence of
positive identification. A Government-issued photo identification (e.g., driver’s
license, identification card issued by a driver’s license authority, military
identification, or passport) provides age and identity and is preferred. Applicants
may use other government-issued identification for age (e.g., certified copy of a
birth certificate); however, the Examiner must request separate photo
identification for identity (such as a work badge). Verify that the address
provided is the same as that given under Item 5. Record the type of
identification(s) provided and identifying number(s) under Item 60. Make a copy
of the identification and keep it on file for 3 years with the AME work copy.
An applicant who does not have government-issued photo identification may use non-
photo government-issued identification (e.g. pilot certificate, birth certificate, voter
registration card) in conjunction with a photo identification (e.g. work identification card,
student identification card).
If an airman fails to provide identification, the Examiner must report this immediately to
the AMCD, or the appropriate RFS for guidance.
• Once the applicant successfully completes Items 1-20 of FAA Form 8500-8
through the FAA MedXPress system, he/she will receive a confirmation number
and instructions to print a summary sheet. This data entered through the
MedXPress system will remain valid for 60 days.
• Examiners must not begin the exam until they have imported the MedXPress
application into AMCS and have verified the identity of the applicant.
The Examiner must review all Items 1 through 20 for accuracy. The applicant must
answer all questions. The date for Item 16 may be estimated if the applicant does not
recall the actual date of the last examination. However, for the sake of electronic
transmission, it must be placed in the mm/dd/yyyy format.
Verify that the name on the applicant's identification media matches the name on the
FAA Form 8500-8. If it does not, question the applicant for an explanation. If the
explanation is not reasonable (legal name change, subsequent marriage, etc.), do not
continue the medical examination or issue a medical certificate. Contact your RFS for
guidance.
The applicant's Social Security Number (SSN) is not mandatory. Failure to provide is
not grounds for refusal to issue a medical certificate. (See Item 4). All other items on
the form must be completed.
Applicants must provide their home address on the FAA Form 8500-8. Applicants may
use a private mailing address (e.g., a P.O. Box number or a mail drop) if that is their
preferred mailing address; however, under Item 18 (in the "Explanations" box) of the
FAA Form 8500-8, they must provide their home address.
An applicant cannot make updates to their application once they have certified and
submitted it. If the examiner discovers the need for corrections to the application during
the review, the Examiner is required to discuss these changes with the applicant and
obtain their approval. The examiner must make any changes to the application in
AMCS.
Strict compliance with this procedure is essential in case it becomes necessary for the
FAA to take legal action for falsification of the application.
The applicant indicates the class of medical certificate desired. The class of medical
certificate sought by the applicant is needed so that the appropriate medical standards
may be applied. The class of certificate issued must correspond with that for which the
applicant has applied.
The applicant may ask for a medical certificate of a higher class than needed for the
type of flying or duties currently performed. For example, an aviation student may ask
for a first-class medical certificate to see if he or she qualifies medically before entry into
an aviation career. A recreational pilot may ask for a first- or second-class medical
certificate if they desire.
The Examiner applies the standards appropriate to the class sought, not to the airman's
duties - either performed or anticipated. The Examiner should never issue more than
one certificate based on the same examination.
Items 3-10 on the FAA Form 8500-8 must be entered as identification. While most of the
items are self-explanatory (as indicated in the MedXPress drop-down menu next to
individual items) specific instructions include:
*If an applicant has no middle name, leave the middle name box blank. Do not
use nomenclature which indicates no middle name (i.e. NMN, NMI, etc.). If the
applicant has used such a nomenclature on their MedXPress application, delete
it and leave the middle name box blank.
Note: If the applicant's name changed for any reason, the current name is listed
on the application and any former name(s) in the EXPLANATIONS box of Item
18 on the application.
There is a maximum age requirement for certain air carrier pilots. Because this
is not a medical requirement but an operational one, the Examiner may issue
medical certificates without regard to age to any applicant who meets the medical
standards.
Occupational data are principally used for statistical purposes. This information, along
with information obtained from Items 10, 14 and 15 may be important in determining
whether a SODA may be issued, if applicable.
11. Occupation
This should reflect the applicant's major employment. "Pilot" should only be reported
when the applicant earns a livelihood from flying.
12. Employer
ITEM 13. Has Your FAA Airman Medical Certificate Ever Been Denied,
Suspended, or Revoked?
The applicant shall check "yes" or "no." If "yes" is checked, the applicant should enter
the date of action and should report details in the EXPLANATIONS box of Item 18.
The Examiner may not issue a medical certificate to an applicant who has checked
"yes." The only exceptions to this prohibition are:
• The applicant presents written evidence from the FAA that he or she was
subsequently medically certificated and that an Examiner is authorized to issue a
renewal medical certificate to the person if medically qualified; or
LAST UPDATE: March 30, 2016 30
Guide for Aviation Medical Examiners
____________________________________________________________________
The applicant should indicate the total number of civilian flight hours and whether those
hours are logged (LOG) or estimated (EST).
The applicant should provide the number of civilian flight hours in the 6-month period
immediately preceding the date of this application. The applicant should indicate
whether those hours are logged (LOG) or estimated (EST).
If a prior application was made, the applicant should indicate the date of the last
application, even if it is only an estimate of the year. This item should be completed
even if the application was made many years ago or the previous application did not
result in the issuance of a medical certificate. If no prior application was made, the
applicant should check the appropriate block in Item 16.
If the applicant checks yes, give name of medication(s) and indicate if the medication
was listed in a previous FAA medical examination.
For example, any airman who is undergoing continuous treatment with anticoagulants,
antiviral agents, anxiolytics, barbiturates, chemotherapeutic agents, experimental
hypoglycemic, investigational, mood-ameliorating, motion sickness, narcotic, sedating
antihistaminic, sedative, steroid drugs, or tranquilizers must be deferred certification
unless the treatment has previously been cleared by FAA medical authority. In such an
instance, the applicant should provide the Examiner with a copy of any FAA
correspondence that supports the clearance.
Further information concerning an applicant's use of medication may be found under the
items pertaining to specific medical condition(s) for which the medication is used, or you
may contact your RFS.
ITEM 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying?
The applicant should indicate whether near vision contact lens(es) is/are used while
flying. If the applicant answers "yes," the Examiner must counsel the applicant that use
of contact lens(es) for monovision correction is not allowed. The Examiner must
note in Item 60 that this counseling has been given. Examples of unacceptable use
include:
• The use of a contact lens in one eye for near vision and in the other eye for
distant vision (for example: pilots with myopia plus presbyopia).
• The use of a contact lens in one eye for near vision and the use of no contact
lens in the other eye (for example: pilots with presbyopia but no myopia).
If the applicant checks "yes" and no further comment is noted on FAA Form 8500-8 by
either the applicant or the Examiner, a letter will automatically be sent to the applicant
informing him or her that such use is inappropriate for flying.
Each item under this heading must be checked either "yes" or "no." For all items
checked "yes," a description and approximate date of every condition the applicant has
ever been diagnosed with, had, or presently has, must be given in the EXPLANATIONS
box. If information has been reported on a previous application for airman medical
certification and there has been no change in the condition, the applicant may note
"PREVIOUSLY REPORTED, NO CHANGE" in the EXPLANATIONS box, but the
applicant must still check "yes" to the condition.
The Examiner should ensure that the applicant has checked all of the boxes in Item 18
as either "yes" or "no." The Examiner should use information obtained from this review
in asking the applicant pertinent questions during the course of the examination.
Certain aspects of the individual’s history may need to be elaborated upon. The
Examiner should provide in Item 60 an explanation of the nature of items checked “yes”
in items 18.a. through 18.y. Please be aware there is a character count limit in Item 60.
If all comments cannot fit in Item 60, the Examiner may submit additional information on
a plain sheet of paper and include the applicant’s full name, date of birth, signature, any
appropriate identifying numbers (PI, MID or SSN), and the date of the exam.
Affirmative answers alone in Item 18 do not constitute a basis for denial of a medical
certificate. A decision concerning issuance or denial should be made by applying the
medical standards pertinent to the conditions uncovered by the history.
Experience has shown that, when asked direct questions by a physician, applicants are
likely to be candid and willing to discuss medical problems.
The Examiner should attempt to establish rapport with the applicant and to develop a
complete medical history. Further, the Examiner should be familiar with the FAA
certification policies and procedures in order to provide the applicant with sound advice.
18.c. Unconsciousness for any reason. The applicant should describe the event(s)
to determine the primary organ system responsible for the episode, witness statements,
initial treatment, and evidence of recurrence or prior episode. Although the regulation
states, “an unexplained disturbance of consciousness is disqualifying,” it does not mean
18.d. Eye or vision trouble except glasses. The Examiner should personally explore
the applicant's history by asking questions, concerning any changes in vision, unusual
visual experiences (halos, scintillations, etc.), sensitivity to light, injuries, surgery, or
current use of medication. Does the applicant report inordinate difficulties with eye
fatigue or strain? Is there a history of serious eye disease such as glaucoma or other
disease commonly associated with secondary eye changes, such as diabetes?
For glaucoma or ocular hypertension, obtain a FAA Form 8500-14, Report of Eye
Evaluation for Glaucoma. For any other medical condition, obtain a FAA Form 8500-7,
Report of Eye Evaluation. Under all circumstances, please advise the examining eye
specialist to explain why the airman is unable to correct to Snellen visual acuity of
20/20. (See Items 31-34, Item 53, and Item 54)
18.e. Hay fever or allergy. The applicant should report frequency and duration of
symptoms, any incapacitation by the condition, treatment, and side effects. The
Examiner should inquire whether the applicant has ever experienced any barotitis (“ear
block”), barosinusitis, alternobaric vertigo, or any other symptoms that could interfere
with aviation safety. (See Item 26)
18.f. Asthma or lung disease. The applicant should provide frequency and severity of
asthma attacks, medications, and number of visits to the hospital and/or emergency
room. For other lung conditions, a detailed description of symptoms/diagnosis, surgical
intervention, and medications should be provided. (See Item 35)
18.g. Heart or vascular trouble. The applicant should describe the condition to
include, dates, symptoms, and treatment, and provide medical reports to assist in the
certification decision-making process. These reports should include: operative reports
of coronary intervention to include the original cardiac catheterization report, stress
tests, worksheets, and original tracings (or a legible copy). When stress tests are
provided, forward the reports, worksheets and original tracings (or a legible copy) to the
FAA. Part 67 provides that, for all classes of medical certificates, an established
medical history or clinical diagnosis of myocardial infarction, angina pectoris, cardiac
valve replacement, permanent cardiac pacemaker implantation, heart replacement, or
coronary heart disease that has required treatment or, if untreated, that has been
symptomatic or clinically significant, is cause for denial. (See Item 36)
18.h. High or low blood pressure. The applicant should provide history and
treatment. Issuance of a medical certificate to an applicant with high blood pressure
may depend on the current blood pressure levels and whether the applicant is taking
anti-hypertensive medication. The Examiner should also determine if the applicant has
a history of complications, adverse reactions to therapy, hospitalization, etc.
(Details are given in Item 36 and Item 55)
18.j. Kidney stone or blood in urine. The applicant should provide history and
treatment, pertinent medical records, current status report and medication. If a
procedure was done, the applicant must provide the report and pathology reports.
(See Item 41)
18.k. Diabetes. The applicant should describe the condition to include symptoms and
treatment. Comment on the presence or absence of hyperglycemic and/or
hypoglycemic episodes. A medical history or clinical diagnosis of diabetes mellitus
requiring insulin or other hypoglycemic drugs for control are disqualifying. The Examiner
can help expedite the FAA review by assisting the applicant in gathering medical
records and submitting a current specialty report. (See Item 48)
18.m. Mental disorders of any sort; depression, anxiety, etc. An affirmative answer
to Item 18.m. requires investigation through supplemental history taking. Dispositions
will vary according to the details obtained. An applicant with an established history of a
personality disorder that is severe enough to have repeatedly manifested itself by overt
acts, a psychosis disorder, or a bipolar disorder must be denied or deferred by the
Examiner. (See Item 47)
18.q. Motion sickness requiring medication. A careful history concerning the nature
of the sickness, frequency and need for medication is indicated when the applicant
responds affirmatively to this item. Because motion sickness varies with the nature of
the stimulus, it is most helpful to know if the problem has occurred in flight or under
similar circumstances. (See Item 29)
18.r. Military medical discharge. If the person has received a military medical
discharge, the Examiner should take additional history and record it in Item 60. It is
helpful to know the circumstances surrounding the discharge, including dates, and
whether the individual is receiving disability compensation. If the applicant is receiving
veteran's disability benefits, the claim number and service number are helpful in
obtaining copies of pertinent medical records. The fact that the applicant is receiving
disability benefits does not necessarily mean that the application should be denied.
18.s. Medical rejection by military service. The Examiner should inquire about the
place, cause, and date of rejection and enter the information in Item 60. It is helpful if
the Examiner can assist the applicant with obtaining relevant military documents. If a
delay of more than 14-calendar days is expected, the Examiner should transmit FAA
Form 8500-8 to the FAA with a note specifying what documents will be forwarded later.
Disposition will depend upon whether the medical condition still exists or whether a
history of such a condition requires denial or deferral under the FAA medical standards.
18.t. Rejection for life or health insurance. The Examiner should inquire regarding
the circumstances of rejection. The supplemental history should be recorded in Item 60.
Disposition will depend upon whether the medical condition still exists or whether a
history of such a condition requires denial or deferral under the FAA medical standards.
18.u. Admission to hospital. For each admission, the applicant should list the dates,
diagnoses, duration, treatment, name of the attending physician, and complete address
of the hospital or clinic. If previously reported, the applicant may enter "PREVIOUSLY
REPORTED, NO CHANGE." A history of hospitalization does not disqualify an
applicant, although the medical condition that resulted in hospitalization may.
Note: If the applicant documented ALL of the above information on previous exams
AND there are no new arrest(s), conviction(s), and/or administrative action(s) since
the last application, the applicant may enter PREVIOUSLY REPORTED, NO
CHANGE.
For all first-time reports of arrest(s), conviction(s), and/or administrative action(s) the
Examiner must do the following prior to issuing an airman medical certificate:
• Obtain a detailed history of the applicant's alcohol use, the circumstances
surrounding all alcohol-related incidents (include those reported in 18v and any
others that may have occurred);
• Obtain copies of all court records and arrest reports related to the event(s) if the
incident(s) occurred within the 5 years prior to the exam. This includes
copies of relevant military records if the incidents occurred while the applicant
was a member of the U.S. armed forces (includes military court records, records
of non-judicial punishment, and military substance abuse records);
• Document those findings in Item 60. (See Item 47);
• Forward the court records, arrest reports, and any military records to AMCD; and
• Advise the applicant that the reporting of alcohol or drug offenses (i.e., motor
vehicle violation) on the history part of the medical application does not relieve
the airman of responsibility to report each motor vehicle action to the FAA within
60 days of the occurrence to the:
Deferral Criteria: The Examiner must defer certification for any of the following:
• Inability to obtain and review the court and arrest records within 14 days of the
date of the exam
• For the alcohol- or drug-related driving incidents:
o Any arrest, conviction, and/or administrative action for which the applicant
registers a blood alcohol level 0.15 or higher
If the applicant is deferred, the FAA will require the applicant to:
Provide:
• A detailed personal statement regarding his/her past and present patterns
of alcohol or drug use;
• A complete copy of his/her current driving record in any state that he/she
has held a driver’s license in the last 10 years; and
• Copies of any court records and arrest reports related to the event(s) that
have not already been provided to the AME. This includes copies of
relevant military records if any event(s) occurred while the applicant was a
member of the U.S. armed forces. “Relevant military records” means
military court records, records of non-judicial punishment, and military
substance abuse records
Obtain:
• A substance abuse evaluation from an addictionologist or addiction
psychologist/psychiatrist familiar with aviation standards.
18.w. History of nontraffic convictions. The applicant must report any other
(nontraffic) convictions (e.g., assault, battery, public intoxication, robbery, etc.). The
18.x. Other illness, disability, or surgery. The applicant should describe the nature
of these illnesses in the EXPLANATIONS box. If additional records, tests, or specialty
reports are necessary in order to make a certification decision, the applicant should so
be advised. If the applicant does not wish to provide the information requested by the
Examiner, the Examiner should defer issuance.
If the applicant wishes to have the FAA review the application and decide what ancillary
documentation is needed, the Examiner should defer issuance of the medical certificate
and forward the completed FAA Form 8500-8 to the AMCD. If the Examiner proceeds
to obtain documentation, but all data will not be received with the 2 weeks, FAA
Form 8500-8 should be transmitted immediately to the AMCD with a note that additional
documents will be forwarded later under separate cover.
18. y. Medical Disability Benefits. The applicant must report any disability benefits
received, regardless of source or amount. If the applicant checks “yes” on this item, the
FAA may verify with other Federal Agencies (ie. Social Security Administration,
Veteran’s Affairs) whether the applicant is receiving a disability benefit that may present
a conflict in issuing an FAA medical certificate. The Examiner must document the
specifics and nature of the disability in findings in Item 60.
The applicant should list all visits in the last 3 years to a physician, physician assistant,
nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for
treatment, examination, or medical/mental evaluation. The applicant should list visits for
counseling only if related to a personal substance abuse or psychiatric condition. The
applicant should give the name, date, address, and type of health professional
consulted and briefly state the reason for the consultation. Multiple visits to one health
professional for the same condition may be aggregated on one line.
Routine dental, eye, and FAA periodic medical examinations and consultations with an
employer-sponsored employee assistance program (EAP) may be excluded unless the
consultations were for the applicant's substance abuse or unless the consultations
resulted in referral for psychiatric evaluation or treatment.
When an applicant does provide history in Item 19, the Examiner should review the
matter with the applicant. The Examiner will record in Item 60 only that information
needed to document the review and provide the basis for a certification decision. If the
Examiner finds the information to be of a personal or sensitive nature with no relevancy
to flying safety, it should be recorded in Item 60 as follows:
"Item 19. Reviewed with applicant. History not significant or relevant to application."
FAA medical authorities, upon review of the application, will ask for further information
regarding visits to health care providers only where the physical findings, report of
examination, applicant disclosure, or other evidence suggests the possible presence of
a disqualifying medical history or condition.
If an explanation has been given on a previous report(s) and there has been no change
in the condition, the applicant may enter "PREVIOUSLY REPORTED, NO CHANGE."
Of particular importance is the reporting of conditions that have developed since the
applicant's last FAA medical examination. The Examiner is asked to comment on all
entries, including those "PREVIOUSLY REPORTED, NO CHANGE." These comments
may be entered under Item 60.
EXAMINATION TECHNIQUES
The Examiner must personally conduct the physical examination. This section provides
guidance for completion of Items 21-58 of the Application for Airman Medical Certificate,
FAA Form 8500-8.
The Examiner must carefully read the applicant's history page of FAA Form 8500-8
(Items 1-20) before conducting the physical examination and completing the Report of
Medical Examination. This alerts the Examiner to possible pathological findings.
The Examiner must note in Item 60 of the FAA Form 8500-8 any condition found in the
course of the examination. The Examiner must list the facts, such as dates, frequency,
and severity of occurrence.
When a question arises, the Federal Air Surgeon encourages Examiners first to check
this Guide for Aviation Medical Examiners and other FAA informational documents. If
the question remains unresolved, the Examiner should seek advice from a RFS or
AMCD.
Measure and record the applicant's height in inches. Although there are no medical
standards for height, exceptionally short individuals may not be able to effectively reach
all flight controls and must fly specially modified aircraft. If required, the FAA will place
operational limitations on the pilot certificate.
Kilograms and meters (or centimeters) Formula: weight (kg) / [height (m)]2
With the metric system, the formula for BMI is weight in kilograms
divided by height in meters squared. Since height is commonly
measured in centimeters, divide height in centimeters by 100 to
obtain height in meters.
Ask the applicant if a SODA has ever been issued. If the answer is "yes," ask the
applicant to show you the document. Then check the "yes" block and record the nature
and degree of the defect.
SODA's are valid for an indefinite period or until an adverse change occurs that results
in a level of defect worse than that stated on the face of the document.
The FAA issues SODA's for certain static defects, but not for disqualifying conditions or
conditions that may be progressive. The extent of the functional loss that has been
cleared by the FAA is stated on the face of the SODA. If the Examiner finds the
condition has become worse, a medical certificate should not be issued even if the
applicant is otherwise qualified. The Examiner should also defer issuance if it is unclear
whether the applicant's present status represents an adverse change.
The Examiner must take special care not to issue a medical certificate of a higher class
than that specified on the face of the SODA even if the applicant appears to be
otherwise medically qualified. The Examiner may note in Item 60 the applicant's desire
for a higher class.
26. Nose
27. Sinuses
(b) No disease or condition of the middle or internal ear, nose, oral cavity, pharynx,
or larynx that -
(2) Interferes with, or may reasonably be expected to interfere with, clear and
effective speech communication.
1. The head and neck should be examined to determine the presence of any
significant defects such as:
2. The external ear is seldom a major problem in the medical certification of applicants.
Otitis externa or a furuncle may call for temporary disqualification. Obstruction of the
canal by impacted cerumen or cellular debris may indicate a need for referral to an ENT
specialist for examination.
The same approach should be taken when considering the significance of prior surgery
such as myringotomy, mastoidectomy, or tympanoplasty. Simple perforation without
associated symptoms or pathology is not disqualifying. When in doubt, the Examiner
should not hesitate to defer issuance and refer the matter to the AMCD. The services of
consultant ENT specialists are available to the FAA to help in determining the safety
implications of complicated conditions.
5. Bilateral Deafness. It is possible for a totally deaf person to qualify for a private
pilot certificate. When the applicant initially applies for medical certification, the AME
should defer the exam with notes in Block 60 explaining this and include which FSDO
the airman wants to use to take a Medical Flight Test.
The student may practice with an instructor before undergoing a pilot check ride for the
private pilot’s license. When the applicant is ready to take the check ride, he/she must
have an authorization to take a medical flight test (MFT) from either RFS/AMCD. Upon
successful completion of the MFT, the applicant will be issued a SODA and an
operational restriction will be placed on his/her pilot’s license that restricts the pilot
from flying into airspace requiring radio communication.
6. Hearing Aids. Under some circumstances, the use of hearing aids may be
acceptable. If the applicant is unable to pass any of the above tests without the use of
hearing aids, he or she may be tested using hearing aids.
history of epistaxis with exposure to high altitudes and if there is any indication of loss of
sense of smell (anosmia). Polyps may cause airway obstruction or sinus blockage.
Infection or allergy may be cause for obtaining additional history. Anosmia is at least
noteworthy in that the airman should be made fully aware of the significance of the
handicap in flying (inability to receive early warning of gas spills, oil leaks, or smoke).
Further evaluation may be warranted.
9. The mouth and throat should be examined to determine the presence of active
disease that is progressive or may interfere with voice communications. Gross
abnormalities that could interfere with the use of personal equipment such as oxygen
equipment should be identified. Also see Protocol for Obstructive Sleep Apnea.
10. The larynx should be visualized if the applicant's voice is rough or husky. Acute
laryngitis is temporarily disqualifying. Chronic laryngitis requires further diagnostic
workup. Any applicant seeking certification for the first time with a functioning
tracheostomy, following laryngectomy, or who uses an artificial voice-producing device
should be denied or deferred and carefully assessed.
The following is a table that lists the most common conditions of aeromedical
significance, and course of action that should be taken by the examiner as defined by
the protocol and disposition in the table.
Conditions AMEs Can Issue (CACI) Certification Worksheets are also found within the
Dispositions tables. These are a series of conditions which allow AMEs to regular issue
if the applicant meets the parameters of the CACI Condition Worksheets. The
worksheets provide detailed instructions to the examiner and outline condition-specific
requirements for the applicant. If the requirements are met, and the applicant is
otherwise qualified, the AME may issue without contacting AMCD first. If the
requirements are not met, the AME must defer the exam and send the supporting
documents to the FAA.
Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or
subtle incapacitation without consulting the AMCD or the RFS. Medical documentation
must be submitted for any condition in order to support an issuance of an airman
medical certificate.
Active fistula of neck, All Submit all pertinent Requires FAA Decision
either congenital or medical information
acquired, including and current status
tracheostomy report
Loss of bony All Submit all pertinent Requires FAA Decision
substance involving medical information
the two tables of the and current status
cranial vault report
Deformities of the face 1st & 2nd Submit all pertinent Requires FAA Decision
or head that would medical information
interfere with the and current status
proper fitting and report
wearing of an oxygen 3rd Submit all pertinent If deformity does not
mask medical information interfere with
administration of
supplemental O²
- Issue
Nose
(Updated 02/24/2015)
• Applicants with seasonal allergies requiring any other antihistamine (oral and/or nasal)
may be certified by the examiner with the stipulation that they do not exercise the
privileges of airman certificate until they have stopped the medication and wait after the
last dose until:
o At least five maximal dosing intervals have passed. For example, if the
medication is taken every 4-6 hours, wait 30 hours (5x6) after the last dose to fly.
o At least five times the maximum terminal elimination half-life has passed. For
example, if the medication half-life is 6-8 hours, wait 40 hours (5x8) after the last
dose to fly.
• Airmen who are exhibiting symptoms, regardless of the treatment used, must not fly.
• In all situations, the examiner must notate the evaluation data in Block 60.
*AME must warn airman to not operate aircraft until four hours after any hay fever
desensitization injection.
Sinus Tumor
Inner Ear
Acoustic Neuroma All Submit all pertinent Requires FAA Decision
medical information and
current status report
Acute or chronic All Submit all pertinent If no physiologic effects -
disease without medical information Issue
disturbance of
equilibrium and
successful
miringotomy, if
applicable
Acute or chronic All Submit all pertinent Requires FAA Decision
disease that may medical information and
disturb equilibrium current status report
Motion Sickness All Submit all pertinent If occurred during flight
medical information and training and resolved
current status report - Issue
If condition requires
medication - Requires
FAA Decision
Mastoids
Mastoid fistula All Submit all pertinent Requires FAA Decision
medical information and
current status report
Mastoiditis, acute or All Submit all pertinent Requires FAA Decision
chronic medical information and
current status report
Middle Ear
Impaired Aeration All Submit all pertinent Requires FAA Decision
medical information and
current status report
Outer Ear
Impacted Cerumen All Submit all pertinent If asymptomatic and
medical information and hearing is unaffected
current status report - Issue
Otherwise - Requires
FAA Decision
Otitis Externa that may All Submit all pertinent Requires FAA Decision
progress to impaired medical information and
hearing or become current status report
incapacitating
Ear Drums
(e) No acute or chronic pathological condition of either the eye or adnexa that
interferes with the proper function of the eye, that may reasonably be
expected to progress to that degree, or that may reasonably be expected to
be aggravated by flying.
For guidance regarding the conduction of visual acuity, field of vision, heterophoria, and
color vision tests, please see Items 50-54.
The examination of the eyes should be directed toward the discovery of diseases or
defects that may cause a failure in visual function while flying or discomfort sufficient to
interfere with safely performing airman duties.
The Examiner should personally explore the applicant's history by asking questions
concerning any changes in vision, unusual visual experiences (halos, scintillations,
etc.), sensitivity to light, injuries, surgery, or current use of medication. Does the
applicant report inordinate difficulties with eye fatigue or strain? Is there a history of
serious eye disease such as glaucoma or other disease commonly associated with
secondary eye changes, such as diabetes? (See Item 53., Field of Vision and Item
54., Heterophoria)
1. It is recommended that the Examiner consider the following signs during the
course of the eye examination:
b. Pupils and Iris — check for the presence of synechiae and uveitis. Size,
shape, and reaction to light should be evaluated during the
ophthalmoscopic examination. Observe for coloboma, reaction to light, or
disparity in size.
3. Ocular Motility. Motility may be assessed by having the applicant follow a point
light source with both eyes, the Examiner moving the light into right and left
upper and lower quadrants while observing the individual and the conjugate
motions of each eye. The Examiner then brings the light to center front and
advances it toward the nose observing for convergence. End point nystagmus is
a physiologic nystagmus and is not considered to be significant. It need not be
reported. (For further consideration of nystagmus, see Item 50., Distant
Vision.)
In addition, it takes time for the monocular airman to compensate for his or her
decrease in effective visual field. A monocular airman’s effective visual field is
reduced by as much as 30% by monocularity. This is especially important
because of speed smear; i.e., the effect of speed diminishes the effective visual
field such that normal visual field is decreased from 180 degrees to as narrow as
42 degrees or less as speed increases. A monocular airman’s reduced effective
visual field would be reduced even further than 42 degrees by speed smear.
5. Contact Lenses. The use of contact lens(es) for monovision correction is not
allowed:
• The use of a contact lens in one eye for near vision and in the other
eye for distant vision is not acceptable (for example: pilots with myopia
plus presbyopia).
• The use of a contact lens in one eye for near vision and the use of no
contact lens in the other eye is not acceptable (for example: pilots with
presbyopia but no myopia).
Additionally, designer contact lenses that introduce color (tinted lenses), restrict
the field of vision, or significantly diminish transmitted light are not allowed.
The FAA may grant an Authorization under the special issuance section of Part
67 (14 CFR 67.401) on an individual basis. The Examiner must obtain a report
of Ophthalmological Evaluation for Glaucoma (FAA Form 8500-14) from an
ophthalmologist. See Glaucoma Worksheet. Because secondary glaucoma is
caused by known pathology such as; uveitis or trauma, eligibility must largely
depend upon that pathology. Secondary glaucoma is often unilateral, and if the
cause or disease process is no longer active and the other eye remains normal,
certification is likely.
Applicants with primary or secondary narrow angle glaucoma are usually denied
because of the risk of an attack of angle closure, because of incapacitating
symptoms of severe pain, nausea, transitory loss of accommodative power,
blurred vision, halos, epiphora, or iridoparesis. Central venous occlusion can
occur with catastrophic loss of vision. However, when surgery such as
iridectomy or iridoclesis has been performed satisfactorily more than 3 months
before the application, the likelihood of difficulties is considerably more remote,
and applicants in that situation may be favorably considered.
10. Refractive Procedures. The FAA accepts the following Food and Drug
Administration approved refractive procedures for visual acuity correction:
Please be advised that these procedures have potential adverse effects that
could be incompatible with flying duties, including: corneal scarring or opacities;
worsening or variability of vision; and night-glare.
The FAA expects that airmen will not resume airman duties until their treating
health care professional determines that their post-operative vision has
stabilized, there are no significant adverse effects or complications (such as
halos, rings, haze, impaired night vision and glare), the appropriate vision
standards are met, and they have been reviewed by an Examiner or AMCD.
When this determination is made, the airman should have the treating health
care professional document this in the health care record, a copy of which should
be forwarded to the AMCD before resumption of airman duties. If the health care
professional's determination is favorable and after consultation and review by an
Examiner, the applicant may resume airman duties, unless informed otherwise
by the FAA.
If the procedure was done 2 years ago or longer, the FAA may accept the
Examiner's eye evaluation and an airman statement regarding the absence of
adverse sequela.
If the procedure was performed within the last 2 years, the airman must provide a
report to the AMCD from the treating health care professional to document the
date of procedure, any adverse effects or complications, and when the airman
returned to flying duties. If the report is favorable and the airman meets the
appropriate vision standards, the applicant may resume airman duties, unless
informed otherwise by the FAA.
Applicants with many visual conditions may be found qualified for FAA certification
following the receipt and review of specialty evaluations and pertinent medical records.
Examples include retinal detachment with surgical correction, open angle glaucoma
under adequate control with medication, and narrow angle glaucoma following surgical
correction.
The Examiner may not issue a certificate under such circumstances for the initial
application, except in the case of applicants following cataract surgery. The Examiner
may issue a certificate after cataract surgery for applicants who have undergone
cataract surgery with or without lens(es) implant. If pertinent medical records and a
current ophthalmologic evaluation (using FAA Form 8500-7 or FAA Form 8500-14)
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition
in the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Eyes, General
Amblyopia* All Provide completed FAA Form If applicant does not correct to
Initial certification 8500-7 standards, DEFER.
*In amblyopia ex anopsia, the visual acuity of one eye is decreased without presence of organic eye disease, usually
because of strabismus or anisometropia in childhood.
Eyes - Procedures
Aphakia/Lens Implants All Submit all pertinent medical If visual acuity meets
information and current standards - Issue
status report (See additional
disease dependent Otherwise - Requires FAA
requirements) Decision
Conductive All See Protocol for Conductive See Protocol for Conductive
Keratoplasty - Keratoplasty Keratoplasty
Farsightedness
Intraocular Devices All See Protocol for Binocular See Protocol for Binocular
Multifocal and Multifocal and
Accommodating Devices Accommodating Devices
Refractive Procedures All Provide completed FAA If visual acuity meets
other than CK Form 8500-7, type and date standards, is stable, and no
of procedure, statement as complications exist - Issue
to any adverse effects or
complications (halo, glare, Otherwise - Requires FAA
haze, rings, etc.) Decision
Ophthalmoscopic
Initial Special
Issuance - Requires
FAA Decision
Followup Special
Issuances - See AASI
Protocol
Macular Degeneration; All Submit all pertinent Requires FAA Decision
Macular Detachment medical information and
current status report
Tumors All Submit all pertinent Requires FAA Decision
medical information and
current status report
Vascular Occlusion; All Submit all pertinent Requires FAA Decision
Retinopathy medical information and
current status report
[ ] Not CACI qualified glaucoma. Issued per valid SI/AASI. (Submit supporting documents.)
Pupils
Ocular Motility
1
Nystagmus of recent onset is cause to deny or defer certificate issuance. Any recent neurological or other evaluations
available to the Examiner should be submitted to the AMCD. If nystagmus has been present for a number of years and
has not recently worsened, it is usually necessary to consider only the impact that the nystagmus has upon visual
acuity. The Examiner should be aware of how nystagmus may be aggravated by the forces of acceleration commonly
encountered in aviation and by poor illumination.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the condition involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges;
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
Breast examination: The breast examination is performed only at the applicant's option or if
indicated by specific history or physical findings. If a breast examination is performed, the results
are to be recorded in Item 60 of FAA Form 8500-8. The applicant should be advised of any
abnormality that is detected, then deferred for further evaluation.
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Allergies
1
Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that
they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or
within 24 hours after taking an antihistamine. The Examiner should document this in Item 60.
2
Individuals who have hay fever that requires only occasional seasonal therapy may be certified by the Examiner with
the stipulation that they not fly during the time when symptoms occur and treatment is required.
3
Nonsedating antihistamines including loratadine, or fexofenadine may be used while flying, after adequate individual
experience has determined that the medication is well tolerated without significant side effects.
Asthma
Initial Special
Issuance - Requires
FAA Decision
Followup
Special Issuances -
See AASI Protocol
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-
class must provide this information annually; applicants for third-class must provide the information with
each required exam.
[ ] Not CACI qualified asthma. Issued per valid SI/ASSI. (Submit supporting documents.)
5
Certification may be granted by the FAA when the condition is mild without significant impairment of pulmonary
functions. If the applicant has frequent exacerbations or any degree of exertional dyspnea, certification should be
deferred.
6
A history of a single episode of spontaneous pneumothorax is considered disqualifying for airman medical
certification until there is x-ray evidence of resolution and until it can be determined that no condition that would be
likely to cause recurrence is present (i.e., residual blebs). On the other hand, an individual who has sustained a repeat
pneumothorax normally is not eligible for certification until surgical interventions are carried out to correct the
underlying problem. A person who has such a history is usually able to resume airmen duties 3 months after the
surgery. No special limitations on flying at altitude are applied.
Pulmonary
Sleep Apnea
Followup
Special Issuance
See AASI
Periodic Limb All Submit all pertinent Requires FAA Decision
Movement, etc. medical information
and current status
report. Include sleep
study with a
polysomnogram, use
of medications and
titration study results,
along with a
statement regarding
Restless Leg
Syndrome
(3) Coronary heart disease that has required treatment or, if untreated, that has been
symptomatic or clinically significant
(b) A person applying for first-class airman medical certification must demonstrate an
absence of myocardial infarction and other clinically significant abnormality on
electrocardiographic examination:
(1) At the first application after reaching the 35th birthday; and
Cardiovascular standards for a second- and third-class airman medical certificate are no
established medical history or clinical diagnosis of any of the following:
(c) Coronary heart disease that has required treatment or, if untreated, that has been
symptomatic or clinically significant
2. The Examiner should keep in mind some of the special cardiopulmonary demands of flight,
such as changes in heart rates at takeoff and landing. High
G-forces of aerobatics or agricultural flying may stress both systems considerably.
Degenerative changes are often insidious and may produce subtle performance decrements
that may require special investigative techniques.
a. Inspection. Observe and report any thoracic deformity (e.g., pectus excavatum),
signs of surgery or other trauma, and clues to ventricular hypertrophy. Check the
hematopoietic and vascular system by observing for pallor, edema, varicosities,
stasis ulcers, and venous distention. Check the nail beds for capillary pulsation and
color.
b. Palpation. Check for thrills and the vascular system for arteriosclerotic changes,
shunts, or AV anastomoses. The pulses should be examined to determine their
character, to note if they are diminished or absent, and to observe for synchronicity.
The medical standards do not specify pulse rates that, per se, are disqualifying for
medical certification. These tests are used, however, to determine the status and
It is recommended that the Examiner conduct the auscultation of the heart with the
applicant both in a sitting and in a recumbent position.
Aside from murmur, irregular rhythm, and enlargement, the Examiner should be
careful to observe for specific signs that are pathognomonic for specific disease
entities or for serious generalized heart disease. Examples of such evidence are:
(1) the opening snap at the apex or fourth left intercostal space signifying mitral
stenosis; (2) gallop rhythm indicating serious impairment of cardiac function; and
(3) the middiastolic rumble of mitral stenosis.
These specifications have been developed by the FAA to determine an applicant’s eligibility for
airman medical certification. Standardization of examination methods and reporting is essential to
provide sufficient basis for making determinations and the prompt processing of applications.
b. Family, Personal, and Social History. A statement of the ages and health status of
parents and siblings is required; if deceased, cause and age at death should be included.
Also, any indication of whether any near blood relative has had a “heart attack,”
hypertension, diabetes, or known disorder of lipid metabolism must be provided. Smoking,
drinking, and recreational habits of the applicant are pertinent as well as whether a program
of physical fitness is being maintained. Comments on the level of physical activities,
functional limitations, occupational, and avocational pursuits are essential.
c. Records of Previous Medical Care. If not previously furnished to the FAA, a copy of
pertinent hospital records as well as out-patient treatment records with clinical data, x-ray,
laboratory observations, and originals or copies of all electrocardiographic (ECG) tracings
should be provided. Detailed reports of surgical procedures as well as cerebral and
coronary arteriography and other major diagnostic studies are of prime importance.
A history of coronary artery bypass surgery is disqualifying for certification. Such surgery does not
negate a past history of coronary heart disease. The presence of permanent cardiac pacemakers
and artificial heart valves is also disqualifying for certification.
The FAA will consider an Authorization for a Special Issuance of a Medical Certificate
(Authorization) for most cardiac conditions. Applicants seeking further FAA consideration should
be prepared to submit all past records and a report of a complete current cardiovascular evaluation
(CVE) in accordance with FAA specifications.
C. Medication.
• Medications acceptable to the FAA for treatment of hypertension in airmen include all Food
and Drug Administration (FDA) approved diuretics, alpha-adrenergic blocking agents, beta-
adrenergic blocking agents, calcium channel blocking agents, angiotension converting
enzyme (ACE inhibitors) agents, and direct vasodilators.
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Arrhythmias
Otherwise - Requires
See GXT Additional FAA Decision
BBB Requirements
History of Implanted All See Implanted Requires FAA Decision
Pacemakers Pacemaker Protocol
PAC All Requires evaluation, If no evidence of
(2 or more on ECG) e.g., check for MVP, structural, functional or
caffeine, pulmonary coronary heart disease –
disease, thyroid, etc. Issue
Otherwise - Requires
FAA Decision
PVC’s All Max GXT – to include If no evidence of
(2 or more on a baseline ECG structural, functional or
standard ECG) coronary heart disease
and PVC’s resolve with
exercise - Issue
Otherwise - Requires
FAA Decision
Arrhythmias
Otherwise -
Requires FAA Decision
Supraventricular All CHD Protocol Initial Special
Tachycardia with ECHO and Issuance - Requires
24-hour Holter FAA Decision
Followup
Special Issuances -
See AASI Protocol
Atrial Fibrillation
Followup
Special Issuances -
See AASI Protocol
History of Resolved All Document previous If no ischemia, history
Atrial Fibrillation workup for CAD and of emboli, or structural
>5 years ago structural heart or functional heart
disease disease - Issue
Otherwise - Requires
FAA Decision
Coronary Heart 1st & 2nd See CHD Protocol Requires FAA Decision
Disease:
Angina Pectoris
Atherectomy;
Coronary Bypass 3rd Initial Special
Grafting; Issuance - Requires
Myocardial Infarction; FAA Decision
PTCA; See CHD Protocol
Rotoblation; and Followup
Stent Insertion Special Issuances -
See AASI Protocol
Hypertension (HTN)
All Classes
Updated 10/28/15
Disease/Condition Evaluation Data Disposition
A. No medication If airman meets standards:
ISSUE
(If treating physician Summarize this history
discontinued medications 30 in Block 60.
days ago or longer.)
If this airman is new to you or you are not certain of their HTN control, you may request a
current status report from the treating physician for your review.
If the airman did not meet standards on exam, See Item 55. Blood Pressure.
The Examiner should review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. HOWEVER, the AME is not required to
review a current status report from the treating physician IF the AME can otherwise determine that the
applicant has had stable clinical blood pressure control on the current antihypertensive medication for at
least 7 days, without symptoms from the hypertension or adverse medication side-effects, and no treatment
changes are recommended. If the applicant meets ALL the acceptable certification criteria listed below,
the Examiner can issue. Applicants for first- or second- class must provide this information annually;
applicants for third-class must provide the information with each required exam.
Symptoms [ ] None
Blood pressure in office [ ] Less than or equal to 155 systolic and 95 diastolic
[ ] Not CACI qualified hypertension. Issued per valid SI/AASI. (Submit supporting documents.)
We continue to see deferrals when an airman has HTN and is on medications. Please review the
following FAQs before making a determination.
GENERAL:
1. What is the FAA specified limit for blood pressure during an exam?
The maximum systolic during exam is 155mmHg and the maximum diastolic is 95mmHg
during the exam. (See Item 55. Blood Pressure.)
2. If during the exam the airman’s blood pressure is higher than 155/95, do I have to
defer?
Not necessarily. If the airman’s blood pressure is elevated in clinic, you have any the
following options:
• Recheck the blood pressure. If the airman meets FAA specified limits on the
second attempt, note this in Block 60 along with both readings. If the airman
is still elevated, follow B:
• Have the airman return to clinic 3 separate days over a 7-day period. If the
airman meets FAA specified limits during these re-checks, note this and the
readings in Block 60. Also note if there was a reason for the blood pressure
elevation. If the airman does not demonstrate good control on re-checks,
follow C:
3. Can I hold an exam longer than 14 days to allow the airman time provide the
necessary information?
No.
MEDICATION(S):
6. The airman had medication(s) adjusted and now meets the standards, but it took
longer than 14 days and the exam was deferred. What can the airman do now?
7. What if the treating physician stopped the medications less than 30 days ago?
See Section B of the Hypertensive Disposition Table and follow the CACI - Hypertension
Worksheet.
8. What if the airman stopped the medication on his/her own so they could fly?
Educate your airman (and their treating physician, if needed) that most HTN medications are
acceptable and almost no one is denied for HTN.
9. What if the airman has multiple conditions, e.g. HTN, Obstructive Sleep Apnea, and/or
prior heart attack?
The airman must provide the required information for each condition.
10. What if the airman is on a HTN medication that is not allowed by the FAA?
The treating physician can evaluate if the airman can safely be changed to an acceptable
HTN medication.
• If the medication(s) can be changed and the airman meets the required
criteria, they should submit the items as detailed in Section C of the
Hypertensive Disposition Table for FAA review. The treating physician note
should describe the clinical rationale as to why the unacceptable medication
was previously chosen and why it is ok for the airmen to be on a different
medication now.
Syncope
Syncope All CHD Protocol Requires FAA Decision
with ECHO and 24- Syncope, recurrent or not
hour Holter; satisfactorily explained, requires
bilateral carotid deferral (even though the syncope
episode may be medically
Ultrasound explained, an aeromedical
certification decision may still be
precluded). Syncope may involve
cardiovascular, neurological, and
psychiatric factors.
Followup
Special Issuances -
See AASI
Mitral Valve Repair All See CACI – Mitral Follow the CACI –
Valve Repair Mitral Valve Repair
Worksheet Worksheet
Annotate Block 60
st nd
Single Valve 1 &2 See Cardiac Valve Requires FAA Decision
Replacement (Tissue, Replacement
Mechanical, or
Valvuloplasty)
Single Valve 3rd See Cardiac Valve Initial Special
Replacement (Tissue, Replacement Issuance - Requires
Mechanical, or FAA Decision
Valvuloplasty)
Followup
Special Issuances -
See AASI Protocol
Multiple Valve All Document history Requires FAA Decision
Replacement and findings, CVE
Protocol, and submit
appropriate tests.
All Other Valvular All CHD Protocol Requires FAA Decision
Disease with ECHO
Annotate Block
60.
B.
Less than 5 years ago After a 3 month recovery period submit DEFER
the following to the FAA for review: Submit the
OR information to the
Hospital admission history and physical; FAA for review.
Any of the co-morbid Operative report/surgical report;
conditions below* Hospital discharge summary; Follow up
Current status report from the treating Issuance
cardiologist which should describe the type Will be per the
of repair, any complications, current airman’s
treatment needed, and follow up plan; authorization
List of medications and side effects, if any; letter
Cardiac testing performed AFTER the 3
month recovery period and within the last
90 days:
o 24-hour Holter;
o Electrocardiogram (ECG);
o Echo;
o Exercise Stress Test (EST); and
Other imaging reports (if any) for studies
performed by the treating cardiologist (eg.
Cath, CTA, or MRA).
Notes:
*Co-morbid conditions for FAA purposes include:
• Cardiac disease (disease of other valves, ischemia, CHF, Left Ventricular Systolic Dysfunction (LVSD), Secondary or
Functional mitral valve disease, arrhythmia, etc.);
• Connective tissue disorder (such as Marfan’s or Ehlers-Danlos, etc.);
• Coumadin or other anticoagulation (other than ASA) due to a cardiac condition;
• Lung disease such as COPD (considered moderate to severe; any FEV1 or FVC less than 70%) or Pulmonary
Hypertension; or
• Residual Mitral valve regurgitation listed as moderate or higher on cardiac echo.
[ ] Not CACI qualified Mitral Valve Repair. Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified Mitral Valve Repair. I have deferred. (Submit supporting documents.)
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the condition involved, finds –
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges;
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
1. Inspection. Observe and report any thoracic deformity (e.g., pectus excavatum), signs of
surgery or other trauma, and clues to ventricular hypertrophy. Check the hematopoietic and
vascular system by observing for pallor, edema, varicosities, stasis ulcers, venous
distention, nail beds for capillary pulsation, and color.
2. Palpation. Check for thrills and the vascular system for arteriosclerotic changes, shunts or
AV anastomoses. The pulses should be examined to determine their character, to note if
they are diminished or absent, and to observe for synchronicity.
3. Percussion. N/A.
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Vascular Conditions
Otherwise - Requires
FAA Decision
Vascular Conditions
Otherwise -
Requires FAA Decision
Raynaud's Disease All Document history and If no impairment
findings - Issue
Otherwise - Requires
FAA Decision
Phlebothrombosis or 1st & See Thrombophlebitis Requires FAA Decision
Thrombophlebitis 2nd Protocol
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the medication or other treatment involved, finds-
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
1. Observation: The Examiner should note any unusual shape or contour, skin color, moisture,
temperature, and presence of scars. Hernias, hemorrhoids, and fissure should be noted
and recorded.
Many chronic gastrointestinal diseases may preclude issuance of a medical certificate (e.g.,
cirrhosis, chronic hepatitis, malignancy, ulcerative colitis). Colostomy following surgery for
cancer may be allowed by the FAA with special followup reports.
The Examiner should not issue a medical certificate if the applicant has a recent history of
In the case of a history of bowel obstruction, a report on the cause and present status of the
condition must be obtained from the treating physician.
2. Palpation: The Examiner should check for and note enlargement of organs, unexplained
masses, tenderness, guarding, and rigidity.
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Followup Special
Issuance - See AASI
Protocol
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-
class must provide this information annually; applicants for third-class must provide the information with
each required exam.
[ ] Not CACI qualified colitis. Issued per valid SI/AASI. (Submit supporting documents.)
Followup Special
Issuances - See AASI
Protocol
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or
second- class must provide this information annually; applicants for third-class must provide the
information with each required exam.
[ ] CACI qualified Hepatitis C - Chronic. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified Hepatitis C - Chronic. Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified Hepatitis C - Chronic. I have deferred. (Submit supporting documents.)
Otherwise - Issue
Liver Transplant - All Submit items listed on Initial Special Issuance -
Recipient the Protocol for Liver Requires FAA decision
Transplant (Recipient)
Follow up Special
Issuance – per
Authorization Letter
requirements
Liver Transplant - All Review a current status Initial certification - If
Donor report from the the current status report
transplant surgeon or shows there were no
transplant team complications, the
physician airman is off all pain
medications, functional
status has returned to
normal, and the treating
physician has granted a
full release - ISSUE
Follow up Certification
–No follow up is required
unless there are changes
in condition
Liver + kidney All Submit the required Defer - Requires FAA
Liver + heart items on the transplant Decision
Liver + other protocol for each
individual organ
Combined Transplants transplanted
Malignancies
An applicant with an ileostomy or colostomy may also receive FAA consideration. A report is
necessary to confirm that the applicant has fully recovered from the surgery and is completely
asymptomatic.
In the case of a history of bowel obstruction, a report on the cause and present status of the
condition must be obtained from the treating physician.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the medication or other treatment involved, finds
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
1. Digital Rectal Examination: This examination is performed only at the applicant's option
unless indicated by specific history or physical findings. When performed, the following
should be noted and recorded in Item 59 of FAA Form 8500-8.
2. If the digital rectal examination is not performed, the response to Item 39 may be based on
direct observation or history.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or other
treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
A careful examination of the skin may reveal underlying systemic disorders of clinical importance.
For example, thyroid disease may produce changes in the skin and fingernails. Cushing's disease
may produce abdominal striae, and abnormal pigmentation of the skin occurs with Addison's
disease.
Needle marks that suggest drug abuse should be noted and body marks and scars should be
described and correlated with known history. Further history should be obtained as needed to
explain findings.
The use of isotretinoin (Accutane) can be associated with vision and psychiatric side effects of
aeromedical concern – specifically decreased night vision/night blindness and depression. These
side-effects can occur even after the cessation of isotretinoin. See Aeromedical Decision
Considerations.
Cutaneous
All classes
DISEASE/CONDITION EVALUATION DATA DISPOSITION
Dermatomyositis; Submit all pertinent medical Requires FAA Decision
Deep Mycotic information and current status report
Infections;
Eruptive Xanthomas;
Hansen's Disease;
Lupus Erythematosus;
Raynaud's
Phenomenon;
Sarcoid; or Scleroderma
Kaposi's Sarcoma Submit all pertinent medical Requires FAA Decision
information and current status
report.
See HIV Protocol
Use of isotretinoin For applicants using isotretinoin, Any history of psychiatric
(Accutane) there is a mandatory 2-week waiting side-effect requires FAA
period after starting isotretinoin prior Decision.
to consideration. This medication If there is no vision,
can be associated with vision and psychiatric, or other
psychiatric side effects of aeromedically unacceptable
aeromedical concern - specifically side-effects – Issue with
decreased night vision/night restriction: “NOT VALID
blindness and depression. These FOR NIGHT FLYING.”
side-effects can occur even after
cessation of isotretinoin. A report To remove restriction:
must be provided with detailed, *See note
specific comment on presence or
absence of psychiatric and vision
side-effects. The AME must
document these findings in Item 60.,
Comments on History and Findings.
*Note:
• Use of isotretinoin must be permanently discontinued for at least 2 weeks prior to consideration date
(confirmed by the prescribing physician);
• An eye evaluation in accordance with specifications in 8500-7; and
• Airman must provide a statement of discontinuation
o Confirming the absence of any visual disturbances and psychiatric symptoms, and
o Acknowledging requirement to notify the FAA and obtain clearance prior to performing any
aviation safety-related duties if use of isotretinoin is resumed.
Skin Cancer
All Classes
Updated 8/26/2015
DISEASE/CONDITION EVALUATION DATA DISPOSITION
Unknown pathology If unable to verify pathology, have airman More info needed
collect: Once reports are received, refer to
Medical records describing the the appropriate skin cancer
diagnosis and treatment; and diagnosis in this section.
Pathology report(s)
ISSUE
Basal cell cancer AME interview and exam findings consistent Note BCC or SCC treated in block
(BCC) with uncomplicated local BCC or SCC 60.
completely treated (excised, destroyed, or
Squamous cell cancer Mohs procedure) and resolved. If complicated lesion, see below.
(SCC)
Urticarial Eruptions
All Classes
Chronic Urticaria Submit all records and a current Requires FAA Decision
status report to include treatment
NOTE: The pelvic examination is performed only at the applicant's option or if indicated by specific history or
physical findings. If a pelvic examination is performed, the results are to be recorded in Item 60 of FAA
Form 8500-8.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or other
treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
The Examiner should observe for discharge, inflammation, skin lesions, scars, strictures, tumors,
and secondary sexual characteristics. Palpation for masses and areas of tenderness should be
performed. The pelvic examination is performed only at the applicant's option or if indicated by
specific history or physical findings. If a pelvic examination is performed, the results are to be
recorded in Item 60 of FAA Form 8500-8. Disorders such as sterility and menstrual irregularity are
not usually of importance in qualification for medical certification.
Special procedures for evaluation of the G-U system should best be left to the discretion of an
urologist, nephrologist, or gynecologist.
(See Item 48.,General Systemic, for details concerning diabetes and Item 57., Urine Test, for
other information related to the examination of urine).
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
General Disorders
All Classes
The Examiner must review a current status report by the treating physician and any
supporting documents to determine the applicant’s eligibility for certification. If the applicant
meets ALL the acceptable certification criteria listed below, the Examiner can issue.
Applicants for first- or second-class must provide this information annually; applicants for
third-class must provide the information with each required exam.
[ ] Not CACI qualified Chronic Kidney Disease. Issued per valid SI/AASI. (Submit supporting
documents.)
[ ] NOT CACI qualified Chronic Kidney Disease. I have deferred. (Submit supporting
documents.)
Inflammatory Conditions
All Classes
Kidney Stone(s)
(Nephrolithiasis, Renal Calculi)
or Renal Colic
All Classes
Updated 4/27/16
Metabolic evaluations and imaging should be performed as clinically indicated by the treating physician.
Acceptable imaging includes KUB, ultrasound, IVP, or CT/MRI as clinically appropriate per the treating physician.
The Examiner must review a current status report by the treating physician and any
supporting documents to determine the applicant’s eligibility for certification. If the applicant
meets ALL the acceptable certification criteria listed below, the Examiner can issue.
Applicants for first- or second-class must provide this information annually; applicants for
third-class must provide the information with each required exam.
• Asymptomatic;
• Stable (no increase in number or size of
stones);
• Unlikely to cause a sudden incapacitating event;
• If surgery has been performed, the airman:
o Is off pain medication(s);
o Has made a full recovery; and
o Has a full release from the surgeon;
• No history of complications (including chronic
hydronephrosis; metabolic/underlying condition;
procedures (3 or more in the last 5 years); renal
failure or obstruction; sepsis; or recurrent UTIs
due to stones.)
Is there an underlying cause for stone recurrence? [ ] No
Current or recommended treatment [ ] None
After a single stone event - if follow up imaging verifies Supportive treatments such as hydration
no further stone(s) present, annotate this in Block 60. or medications (such as thiazides,
No further follow up is required unless there is a allopurinol, or potassium citrate) to
change in condition. decrease recurrence (with no side
effects) are allowed.
[ ] CACI qualified Retained Kidney Stones. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified Retained Kidney Stones. Issued per valid SI/AASI. (Submit supporting
documents.)
[ ] NOT CACI qualified Retained Kidney Stones. I have deferred. (Submit supporting documents.)
Neoplastic Disorders/Cancer
Bladder Cancer
All Classes
Updated 8/26/2015
Notes: If the airman is currently on radiation or chemotherapy, the treatment course must be completed before
medical certification can be considered.
The Examiner must review a current status report by the treating physician and any
supporting documents to determine the applicant’s eligibility for certification. If the applicant
meets ALL the acceptable certification criteria listed below, the Examiner can issue.
Applicants for first- or second-class must provide this information annually; applicants for
third-class must provide the information with each required exam.
Symptoms [ ] None
Current treatment [ ] None or maintenance intravesical
BCG or mitomycin.
Notes: If it has been 5 or more years since the airman (If these medications are used, the
has had any treatment for this condition, with no airman should not fly until 24 hours
history of metastatic disease and no reoccurrence, post treatment and asymptomatic.)
CACI is not required. Note this in Block 60. (See
disposition table.)
[ ] CACI qualified Bladder cancer. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified Bladder cancer. Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified Bladder cancer. I have deferred. (Submit supporting documents.)
Prostate Conditions
All Classes
Updated 8/26/15
Prostate Cancer
All Classes
A. Prostate Cancer If NO recurrence or ongoing treatment:
Non metastatic ISSUE
With treatment Summarize this history
completed in Block 60.
5 or more years ago
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or
second- class must provide this information annually; applicants for third-class must provide the
information with each required exam.
[ ] CACI qualified prostate cancer. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified prostate cancer. Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified prostate cancer. I have deferred. (Submit supporting documents.)
Renal Cancer
All Classes
Updated 9/30/15
The Examiner must review a current status report by the treating physician and any
supporting documents to determine the applicant’s eligibility for certification. If the applicant
meets ALL the acceptable certification criteria listed below, the Examiner can issue.
Applicants for first- or second-class must provide this information annually; applicants for
third-class must provide the information with each required exam.
[ ] CACI qualified Renal Cancer. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified Renal Cancer. Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified Renal Cancer. I have deferred. (Submit supporting documents.)
Testicular Cancer
All Classes
Updated 8/26/15
DISEASE/CONDITION EVALUATION DATA DISPOSITION
C. Metastatic disease Submit the following to the FAA for review: DEFER
Current OR any time in
the past Current status report from oncologist Submit the
describing treatment plan and information to the
prognosis; FAA for a possible
Recurrence of disease List of medications with attention to any Special Issuance.
chemotherapy agents and dates used;
Treatment records including clinic notes
or summary letter describing disease
course and initial staging;
Operative notes and discharge summary
(if applicable);
Pathology report(s) (if applicable);
MRI/CT or PET scan reports (in some
cases, the actual CDs will be required in DICOM
format for FAA review); and
Serum tumor markers results (if
applicable).
Notes: If the airman is currently on radiation or chemotherapy, the treatment course must be
completed before medical certification can be considered.
The Examiner must review a current status report by the treating physician and any
supporting documents to determine the applicant’s eligibility for certification. If the applicant
meets ALL the acceptable certification criteria listed below, the Examiner can issue.
Applicants for first- or second-class must provide this information annually; applicants for
third-class must provide the information with each required exam.
[ ] CACI qualified Testicular cancer. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified Testicular cancer. Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified Testicular cancer. I have deferred. (Submit supporting documents.)
Nephritis
All Classes
Nephrectomy Submit all pertinent medical If the remaining kidney function and
(non-neoplastic) information and status report anatomy is normal, without other
system disease, hypertension,
uremia, or infection of the remaining
kidney – Issue
Otherwise – Requires FAA Decision
All Classes: 14 CFR 67.113 (b)(c), 67.213 (b)(c), and 67.313 (b)(c)
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition involved finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or other
treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
Standard examination procedures should be used to make a gross evaluation of the integrity of the
applicant's musculoskeletal system. The Examiner should note:
1. Pain - neuralgia, myalgia, paresthesia, and related circulatory and neurological findings
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
For all the above conditions: If the applicant is otherwise qualified, the FAA may issue a limited certificate.
This certificate will permit the applicant to proceed with flight training until ready for a MFT. At that time, at
the applicant's request, the FAA (usually the AMCD) will authorize the student pilot to take a MFT in
conjunction with the regular flight test. The MFT and regular private pilot flight test are conducted by an
FAA inspector. This affords the student an opportunity to demonstrate the ability to control the aircraft
despite the handicap. The FAA inspector prepares a written report and indicates whether there is a safety
problem. If the airman successfully completes the MFT, a medical certificate and SODA will be sent to the
airman from AMCD.
When prostheses are used or additional control devices are installed in an aircraft to assist the amputee,
those found qualified by special certification procedures will have their certificates limited to require that the
devices (and, if necessary, even the specific aircraft) must always be used when exercising the privileges of
the airman certificate.
1
Essential tremor is not disqualifying unless it is disabling.
Arthritis
Osteoarthritis and variants All Symptoms are well Issue – warn for
on PRN NSAIDS only controlled with no changes in condition or
persistent daily additional medications
symptoms and no use
functional limitations
Osteoarthritis, All Review a current status Follow the CACI -
Rheumatoid Arthritis, and report to include Arthritis Worksheet. If
variants on medications functional status (degree airman meets all
other than NSAIDS of impairment as certification criteria –
measured by strength, Issue.
range of motion, pain),
medications with side All others require FAA
effects and all pertinent Decision. Submit all
medical reports evaluation data.
Initial Special
Issuance - Requires
FAA Decision
Followup
Special Issuances -
See AASI Protocol
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-
class must provide this information annually; applicants for third-class must provide the information with
each required exam.
[ ] Not CACI qualified arthritis. Issued per valid SI/AASI. (Submit supporting documents.)
Collagen Disease
A history of intervertebral disc surgery is not disqualifying. If the applicant is asymptomatic, has
completely recovered from surgery, is taking no medication, and has suffered no neurological
deficit, the Examiner should confirm these facts in a brief statement in Item 60. The Examiner may
then issue any class of medical certificate, providing that the individual meets all the medical
standards for that class.
The paraplegic whose paralysis is not the result of a progressive disease process is considered in
much the same manner as an amputee. The Examiner should defer issuance and may advise the
applicant to request a Medical Flight Test.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition finds-
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges
A careful examination for surgical and other scars should be made, and those that are significant
(the result of surgery or that could be useful as identifying marks) should be described. Tattoos
should be recorded because they may be useful for identification.
The Examiner should question the applicant about any surgical scars that have not been previously
addressed, and document the findings in Item 60 of FAA Form 8500-8. Medical certificates must
not be issued to applicants with medical conditions that require deferral without consulting the
AMCD or RFS. Medical documentation must be submitted for any condition in order to support an
issuance of a medical certificate.
Disqualifying Condition: Scar tissue that involves the loss of function, which may interfere with the
safe performance of airman duties.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or other
treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
A careful examination of the Iymphatic system may reveal underlying systemic disorders of clinical
importance. Further history should be obtained as needed to explain findings.
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Lymphatics
All Classes: 14 CFR 67.109 (a)(b), 67.209 (a)(b), and 67.309 (a)(b)
(1) Epilepsy
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
A neurologic evaluation should consist of a thorough review of the applicant's history prior to the
neurological examination. The Examiner should specifically inquire concerning a history of
weakness or paralysis, disturbance of sensation, loss of coordination, or loss of bowel or bladder
control. Certain laboratory studies, such as scans and imaging procedures of the head or spine,
electroencephalograms, or spinal paracentesis may suggest significant medical history. The
Examiner should note conditions identified in Item 60 on the application with facts, such as dates,
frequency, and severity of occurrence.
A history of simple headaches without sequela is not disqualifying. Some require only temporary
disqualification during periods when the headaches are likely to occur or require treatment. Other
types of headaches may preclude certification by the Examiner and require special evaluation and
consideration (e.g., migraine and cluster headaches).
One or two episodes of dizziness or even fainting may not be disqualifying. For example, dizziness
upon suddenly arising when ill is not a true dysfunction. Likewise, the orthostatic faint associated
with moderate anemia is no threat to aviation safety as long as the individual is temporarily
disqualified until the anemia is corrected.
The basic neurological examination consists of an examination of the 12 cranial nerves, motor
strength, superficial reflexes, deep tendon reflexes, sensation, coordination, mental status, and
includes the Babinski reflex and Romberg sign. The Examiner should be aware of any asymmetry
in responses because this may be evidence of mild or early abnormalities. The Examiner should
evaluate the visual field by direct confrontation or, preferably, by one of the perimetry procedures,
especially if there is a suggestion of neurological deficiency.
A history or the presence of any neurological condition or disease that potentially may incapacitate
an individual should be regarded as initially disqualifying. Issuance of a medical certificate to an
applicant in such cases should be denied or defer, pending further evaluation. A convalescence
period following illness or injury may be advisable to permit adequate stabilization of an individual's
condition and to reduce the risk of an adverse event. Applications from individuals with potentially
disqualifying conditions should be forwarded to the AMCD. Processing such applications can be
expedited by including hospital records, consultation reports, and appropriate laboratory and
imaging studies, if available. Symptoms or disturbances that are secondary to the underlying
condition and that may be acutely incapacitating include pain, weakness, vertigo or in coordination,
seizures or a disturbance of consciousness, visual disturbance, or mental confusion. Chronic
conditions may be incompatible with safety in aircraft operation because of long-term
unpredictability, severe neurologic deficit, or psychological impairment.
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Transient Ischemic Attack All • All pertinent inpatient and Requires FAA Decision
(TIA): outpatient medical
records, including work up
for any correctable
underlying cause(s)
• Current neurologic
evaluation by a
neurologist with a detailed
written report addressing
motor, sensory, language,
and intellectual/cognitive
function; all medications
(dosage and side effects)
• MRA or CTA of the head
and neck
• Current FBS and lipids
• Carotid artery ultrasound
studies
• Cardiovascular Evaluation
1
Complete neurological evaluations supplemented with appropriate laboratory and imaging studies are required of
applicants with these conditions.
• Neurocognitive testing to
"SPECIFICATIONS FOR
Cerebrovascular Disease
2
A variety of intracranial tumors, both malignant and benign, are capable of causing incapacitation directly by
neurologic deficit or indirectly through recurrent symptomatology. Potential neurologic deficits include weakness, loss
of sensation, ataxia, visual deficit, or mental impairment. Recurrent symptomatology may interfere with flight
performance through mechanisms such as seizure, headaches, vertigo, visual disturbances, or confusion. A history or
diagnosis of an intracranial tumor necessitates a complete neurological evaluation with appropriate laboratory and
imaging studies before a determination of eligibility for medical certification can be established. An applicant with a
History of benign supratentorial tumors may be considered favorably for medical certification by the FAA and returned
to flying status after a minimum satisfactory convalescence of 1 year.
Demyelinating Disease 3
Acute Optic Neuritis; All Submit all pertinent Requires FAA Decision
medical records,
Allergic current neurologic
Encephalomyelitis; report, to comment
Landry-Guillain-Barre on involvement and
Syndrome; persisting deficit,
Myasthenia Gravis; or period of stability
Multiple Sclerosis without symptoms,
name and dosage of
medication(s) and
side effects
3
Factors used in determining eligibility will include the medical history, neurological involvement and persisting deficit,
period of stability without symptoms, type and dosage of medications used, and general health. A neurological and/or
general medical consultation will be necessary in most instances.
4
Extrapyramidal, Hereditary, and Degenerative Diseases of the Nervous System: Considerable variability exists in the
severity of involvement, rate of progression, and treatment of the above conditions. A complete neurological
evaluation with appropriate laboratory and imaging studies, including information regarding the specific neurological
condition, will be necessary for determination of eligibility for medical certification.
Headaches 5
Atypical Facial Pain All Submit all pertinent Requires FAA Decision
medical records,
current neurologic
report, to include
name and dosage of
medication(s) and
side effects
Ocular or complicated All Submit all pertinent Requires FAA Decision
migraine medical records,
current neurologic
report, to include
characteristics,
frequency, severity,
associated with
neurologic
phenomena, name
and dosage of
medication(s) and
side effects
Migraines, Chronic All Review all pertinent Follow CACI - Migraine
Tension or Cluster medical records, and Chronic Headache
Headaches current neurologic Worksheet. If airman
report, to include meets all certification
characteristics, criteria – Issue.
frequency, severity,
associated with All others require FAA
neurologic decision. Submit all
phenomena, and evaluation data.
name and dosage of
medication(s) and Initial Special
side effects Issuance - Requires
FAA Decision
Followup Special
Issuances - See AASI
Protocol
5
Pain, in some conditions, may be acutely incapacitating. Chronic recurring headaches or pain syndromes often
require medication for relief or prophylaxis, and, in most instances, the use of such medications are disqualifying
because they may interfere with a pilot's alertness and functioning. The Examiner may issue a medical certificate to an
applicant with a long-standing history of headaches if mild, seldom requiring more than simple analgesics, occur
infrequently, are not incapacitating, and are not associated with neurological stigmata.
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-
class must provide this information annually; applicants for third-class must provide the information with
each required exam.
[ ] CACI qualified migraine and chronic headaches. (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified migraine and chronic headaches. Issued per valid SI/AASI. (Submit supporting
documents.)
[ ] NOT CACI qualified migraine and chronic headaches. I have deferred. (Submit supporting documents.)
Neurologic Conditions
6
Unexplained syncope, single seizure. An applicant who has a history of epilepsy, a disturbance of consciousness
without satisfactory medical explanation of the cause, or a transient loss of control of nervous system function(s)
without satisfactory medical explanation of the cause must be denied or deferred by the Examiner. Rolandic seizures
may be eligible for certification if the applicant is seizure free for 4 years and has a normal EEG. Consultation with the
FAA required.
Otherwise – Requires
FAA Decision
Transient loss of nervous All Submit all pertinent Requires FAA Decision
system function(s) medical records,
without satisfactory current status report,
medical explanation of to include name and
the cause; e.g., transient dosage of
global amnesia medication(s) and
side effects
7
Infrequently, the FAA has granted an Authorization under the special issuance section of part 67 (14 CFR 67.401)
when a seizure disorder was present in childhood but the individual has been seizure-free for a number of years.
Factors that would be considered in determining eligibility in such cases would be age at onset, nature and frequency
of seizures, precipitating causes, and duration of stability without medication. Followup evaluations are usually
necessary to confirm continued stability of an individual's condition if an Authorization is granted under the special
issuance section of part 67 (14 CFR 67.401).
B. When was the first one? Enter approximate date, how long ago, or your age at the time
C. When was the last one/most recent Enter the approximate date
D. Do you ever have a warning before your big seizure(s)? Yes No Don’t know
Go to E
D1. Did you ever have this warning and not have a seizure? Yes No Don’t know
D2. When was the last warning? Enter actual date OR how long ago (in months) Date:
Or months ago:
D3. Did this warning consist of any Unusual feeling in stomach or chest Yes No Don’t know
of the following? Unusual smells or tastes? Yes No Don’t know
Hearing unusual sounds or hearing difficulty? Yes No Don’t know
See anything unusual, or have any change in your vision? Yes No Don’t know
Behave in unusual ways such as smacking your lips, Yes No Don’t know
touching your clothes, or doing any other unusual things
without intending to?
Have difficulty speaking or understand speech? Yes No Don’t know
E. Of the grand mal or big seizures that you had while awake, did they usually occur shortly after waking Yes No Don’t know
up? (Either in the morning or after a nap.) Go to F
E1. How many minutes after waking up would you say the grand mal [ ]15 min or less
or big seizure(s) usually occurred? Check one [ ]16-30 min
[ ]31-45 min
[ ]46-60 min
[ ]More than 60 min
F. Before the seizure started did you have jerking, shaking, or uncontrolled body movements or did your Yes No Don’t know
Go to
whole body jump suddenly, as if someone had startled you from behind?
Section 2
(next page)
F1. Which side was affected? Check one [ ] Left side only
[ ] Right side only
[ ] Both sides
[ ] One side; unsure of which
[ ] Don’t know
A. When was the last time you had one of these spells? Write in the approximate date OR age at Date: Or age:
which it occurred.
B. How long would you say the spell lasted? Check one
[ ] 15 seconds or less [ ] 1-2 min
[ ] 16-30 seconds [ ] More than
[ ] 31 -59 seconds 2 minutes
C. During this most recent spell, which of the following best describes your awareness of [ ] Fully aware [ ] Fully unaware
[ ] Somewhat aware,
the surroundings? Check one
but less aware than usual
D. During this spell, were you able to FUNCTION as you normally do? Yes No Don’t know
E. During this spell, were you able to COMMUNICATE as you normally do? Yes No Don’t know
F. After the spell was over, did you remember what happened during the spell or did you [ ] Yes, I [ ] No, someone else had
remembered to tell me
learn about it from someone else?
G. During this spell, did any parts of your body move uncontrollably? Yes No Don’t know
Go to H
G1. Which parts of the body were involved? [ ] Arm [ ] Face [ ] Don’t know
[ ] Leg [ ] Other
G2. Was this only on one side? Yes No Don’t know
H. During this spell, did any parts of your body JERK suddenly and unexpectedly? Yes No Don’t know
Go to I
H1. Which parts of the body were involved? [ ] Arm [ ] Face [ ] Total body
[ ] Leg [ ] Other [ ] Don’t know
H2. Was this on only ONE SIDE? Yes No Don’t know
H5. Would you say the jerking felt like an electric shock going through your body? Yes No Don’t know
H6. Has this type of spell usually occurred shortly after waking up (either in the Yes No Don’t know
morning or after a nap)?
H7. Does this type of spell occur only when you are going to sleep? Yes No Don’t know
H8. Did this type of spell ever occur as a result of lights shining in your eyes (for Yes No Don’t know
example strobe lights, video games, reflections or sun glare?)
I. During this spell, did you behave in unusual ways such as smacking your lips, touching Yes No Don’t know
your clothes, or doing any other unusual things without intending to?
J. Did your eyelids flutter during this spell? Yes No Don’t know
K. Do you tend to be clumsy in the morning such as dropping things or spilling coffee or Yes No Don’t know
other drinks?
L. During your spells, did you ever have any other symptoms? Yes (explain No Don’t know
in Section 5)
D. Seeing anything unusual or have any changes in your vision Yes No Don’t know
E. Behaving in unusual ways such as smacking your lips, touching your clothes, or doing Yes No Don’t know
any other unusual things without intending to?
F. Having periods of lost time due to “spacing out” or daydreaming? Yes No Don’t know
G. Awaking in the morning with a bitten tongue or a bloody pillow? Yes No Don’t know
H. Awaking in the morning with unexplained bed wetting? Yes No Don’t know
If anyone other than the airman completed this form, list name and relationship to the airman:
Other Conditions
Head Trauma associated All Submit all pertinent Requires FAA Decision
with: medical records,
current status report,
Epidural or Subdural to include pre-
Hematoma; hospital and
emergency
Focal Neurologic Deficit; department records,
operative reports,
Depressed Skull neurosurgical
Fracture; evaluation, name and
dosage of
or medication(s) and
side effects
Any loss of
consciousness, alteration
of consciousness, or
amnesia, regardless of
duration
Conditions that are All Submit all pertinent Requires FAA Decision
stable and non- medical records,
progressive may current neurologic
be considered for report, to include
medical certification etiology, degree of
involvement, period
of stability,
appropriate
laboratory and
imaging studies
Vertigo or Disequilibrium8
Nonfunctioning
Labyrinths; or
Orthostatic
Hypotension
8
Numerous conditions may affect equilibrium, resulting in acute incapacitation or varying degrees of chronic recurring
spatial disorientation. Prophylactic use of medications also may cause recurring spatial disorientation and affect pilot
performance. In most instances, further neurological evaluation will be required to determine eligibility for medical
certification.
(1) Use of a substance in a situation in which that use was physically hazardous,
if there has been at any other time an instance of the use of a substance also in a
situation in which that use was physically hazardous;
(2) A verified positive drug test result, an alcohol test result of 0.04 or greater
alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S.
Department of Transportation or an agency of the U.S. Department of Transportation; or
(3) Misuse of a substance that the Federal Air Surgeon, based on case history
and appropriate, qualified medical judgment relating to the substance involved, finds-
(i) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(ii) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
(c) No other personality disorder, neurosis, or other mental condition that the Federal
Air Surgeon, based on the case history and appropriate, qualified medical judgment relating
to the condition involved, finds-
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.
The FAA does not expect the Examiner to perform a formal psychiatric examination. However, the
Examiner should form a general impression of the emotional stability and mental state of the
applicant. There is a need for discretion in the Examiner/applicant relationship consonant with the
FAA's aviation safety mission and the concerns of all applicants regarding disclosure to a public
agency of sensitive information that may not be pertinent to aviation safety. Examiners must be
sensitive to this need while, at the same time, collect what is necessary for a certification decision.
When a question arises, the Federal Air Surgeon encourages Examiners first to check this Guide
for Aviation Medical Examiners and other FAA informational documents. If the question remains
unresolved, the Examiner should seek advice from a RFS or the Manager of the AMCD.
Review of the applicant's history as provided on the application form may alert the Examiner to
gather further important factual information. Information about the applicant may be found in items
Psychiatric information can be derived from the individual items in medical history (Item 18). Any
affirmative answers to Item 18.m., “ Mental disorders of any sort; depression, anxiety, etc.," or
Item 18.p., "Suicide attempt," are significant. Any disclosure of current or previous alcohol or drug
problems requires further clarification. A record of traffic violations may reflect certain personality
problems or indicate an alcohol problem. Affirmative answers related to rejection by military
service or a military medical discharge require elaboration. Reporting symptoms such as
headaches or dizziness, or even heart or stomach trouble, may reflect a history of anxiety rather
than a primary medical problem in these areas. Sometimes, the information applicants give about
their previous diagnoses is incorrect, either because the applicant is unsure of the correct
information or because the applicant chooses to minimize past difficulties. If there was a hospital
admission for any emotionally related problem, it will be necessary to obtain the entire record.
Valuable information can be derived from the casual conversation that occurs during the physical
examination. Some of this conversation will reveal information about the family, the job, and
special interests. Even some personal troubles may be revealed at this time. The Examiner's
questions should not be stilted or follow a regular pattern; instead, they should be a natural
extension of the Examiner's curiosity about the person being examined. Information about the
motivation for medical certification and interest in flying may be revealing. A formal Mental Status
Examination is unnecessary. For example, it is not necessary to ask about time, place, or person
to discover whether the applicant is oriented. Information about the flow of associations, mood, and
memory, is generally available from the usual interactions during the examination. Indication of
cognitive problems may become apparent during the examination. Such problems with
concentration, attention, or confusion during the examination or slower, vague responses should
be noted and may be cause for deferral.
The Examiner should make observations about the following specific elements and should note on
the form any gross or notable deviations from normal:
A. General Considerations. It must be pointed out that considerations for safety, which in the
"mental" area are related to a compromise of judgment and emotional control or to diminished
mental capacity with loss of behavioral control, are not the same as concerns for emotional health
in everyday life. Some problems may have only a slight impact on an individual's overall capacities
and the quality of life but may nevertheless have a great impact on safety. Conversely, many
emotional problems that are of therapeutic and clinical concern have no impact on safety.
B. Denials. The FAA has concluded that certain psychiatric conditions are such that their presence
or a past history of their presence is sufficient to suggest a significant potential threat to aviation
safety. It is, therefore, incumbent upon the Examiner to be aware of any indications of these
conditions currently or in the past, and to deny or defer issuance of the medical certificate to an
applicant who has a history of these conditions. An applicant who has a current diagnosis or
history of these conditions may request the FAA to grant an Authorization under the special
issuance section of part 67 (14 CFR 67.401) and, based upon individual considerations, the FAA
may grant such an issuance.
All applicants with any of the following conditions must be denied or deferred:
Attention deficit/hyperactivity, bipolar disorder, personality disorder, psychosis,
substance abuse, substance dependence, suicide attempt.
In some instances, the following conditions may also warrant denial or deferral:
Adjustment disorder; bereavement; dysthymic; or minor depression; use of psychotropic
medications for smoking cessation
NOTE: The use of a psychotropic drug is disqualifying for aeromedical certification purposes.
This includes all sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs (including
SSRI’s -see exceptions below), analeptics, anxiolytics, and hallucinogens. The Examiner should
defer issuance and forward the medical records to the AMCD.
C. Use of Antidepressant Medications. The FAA has determined that airmen requesting first,
second, or third class medical certificates while being treated with one of four specific selective
serotonin reuptake inhibitors (SSRIs) may be considered. The Authorization decision is made on a
case-by-case basis. The Examiner may not issue.
If the applicant opts to discontinue use of the SSRI, the Examiner must notate in Block 60,
Comments on History and Findings, on FAA Form 8500-8 and defer issuance. To reapply for
An applicant may be considered for an FAA Authorization of a Special Issuance (SI) of a Medical
Certificate (Authorization) if:
2.) For a minimum of 6 continuous months prior, the applicant has been clinically stable
as well as on a stable dose of medication without any aeromedically significant side
effects and/or an increase in symptoms. If the applicant has been on the medication under 6
months, the Examiner must advise that 6 months of continuous use is required before SI
consideration.
3.) The SSRI used is one the following (single use only):
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escialopram (Lexapro)
If the applicant is on a SSRI that is not listed above, the Examiner must advise that the
medication is not acceptable for SI consideration.
If applicant meets the all of the above criteria and wishes to continue use of the SSRI, advise the
applicant that he/she must be further evaluated by a Human Intervention Motivation Study
(HIMS) AME. See SSRI Decision Path II (HIMS AME). The HIMS AME will also conduct the
follow up evaluation after initial issuance. See SSRI Follow Up Path , SSRI Specification Sheet –
for Initial Consideration, and Disease Protocols, Specifications for Neuropsychological
Evaluations for Treatment with SSRI Medications.
Acceptable diagnosis
and treatment
See:
1. HIMS AME FACE-TO-FACE, IN OFFICE EVALUATION: Required EVERY 6 months for ALL CLASSES No Yes
• Interval visit summaries (if any) are unfavorable or reflect concerns.………...……….……………………
• Any concerns about the airman’s current psychiatric status based on your clinical interview,
evaluation, and review of reports? …………………………………………………………………………....
• Any new psychiatric conditions identified or any change in medication or dose during this period?..….
• Any abnormal physical exam or mental exam findings? ……………………………………………………
• Any NEW condition(s) that would require Special Issuance? (Do not include any new CACI qualified
Condition.) ……………………………………………………………………………………………….………
________________________________________ ___________________________________
HIMS AME Signature Date of Evaluation
If ALL items fall into the clear column, the AME may issue with the time limitation specified in the Authorization letter.
If ANY SINGLE ITEM falls into the SHADED COLUMN, the AME MUST DEFER or contact the FAA AND EXPLAIN in the
HIMS evaluation report.
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical
certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a
determination on an airman medical certificate. You should strongly consider taking a copy to each evaluator so
they understand what specific information is needed in their report to the FAA. If each item is not addressed
by the corresponding provider there may be a delay in the processing of your medical certification until that
information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.
REPORT FROM REQUIRED MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING (SSRI Recertification)
INTERVAL
HIMS AME Every 6 months or 1. Must be a face-to-face, in person evaluation every 6 months.
per Authorization 2. Summarize findings from additional interim evaluations that were performed by any other venue
Letter for all (phone/ video/ email), either at the AME’s discretion or as required by the Authorization Letter (every
classes 1-3 months).
3. Summarize your aeromedical impression and evaluation as a HIMS AME based on the face-to-face
evaluation AND review of the supporting documents.
4. If you do not agree with the supporting documents, or if you have additional concerns not noted in
the documentation, please discuss your observations or concerns.
5. State if the airman meets all the requirements of the Authorization Letter or describe why they do
not.
6. Review and comment if there has been any change in the dose or type of medication stated in the
Authorization Letter.
7. Do you recommendation continued Special Issuance in this airman?
8. Agreement to continue to serve as the airman’s HIMS AME and follow this airman per FAA policy.
9. Agreement to immediately notify the FAA (at 405-954-4821) of any change in condition, deterioration
in psychiatric status or stability, if the medication dosage has changed, or there is a plan to reduce or
discontinue any medication.
10. Using the HIMS AME Checklist –SSRI Recertification, comment on any items that fall into the
shaded category.
11. Submit the SSRI check list, your HIMS AME written report, and all required supporting
documentation that you reviewed with your package.
PSYCHIATRIST Every 6 months or 1. Summarize clinical findings and status of how the airman is doing.
INTERIM HISTORY per Authorization 2. Have there been any new symptoms or hospitalizations?
REPORT Letter 3. Did a change in dose or medication occur or is one recommended or anticipated?
4. Have there been any clinical concerns or changes in treatment plan?
(or treating physician as
5. Has the clinical diagnosis changed?
noted in the Authorization
6. Agreement to immediately notify the FAA (at 405-954-4821) or AME if there are any changes in the
letter)
airman’s condition, dosage, change in medication or if the medication is stopped.
7. Interval treatment records such as clinic or hospital notes should also be submitted.
If the prescribing
physician is not a
psychiatrist, items #2-7
must be submitted from
the prescribing physician
IN ADDITION TO the
psychiatrist report.
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical
certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a
determination on an airman medical certificate. You should strongly consider taking a copy to each evaluator so
they understand what specific information is needed in their report to the FAA. If each item is not addressed
by the corresponding provider there may be a delay in the processing of your medical certification until that
information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.
REPORT FROM REQUIRED MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING (SSRI Recertification)
INTERVAL
CLINICAL 1st and 2nd class: CogScreen information results that must be addressed in the narrative:
PSYCHOLOGIST OR Every 12 months 1. Specify the norm used:
NEUROPSYCHOLOGIST or per • Major Carrier (age-corrected); or
Authorization • Regional Carrier (NOT age-corrected) [also acceptable for GA pilots]; or
Letter • GA Pilot Norms (age-corrected)
CogScreen Results
(or neurocognitive testing as 2. Specify Session Number administered (listed on Page 1 and Page 2 of printout).
3rd class: Every 24 Session 1 for initial test only; retests should be Session 2 or incrementally higher.
required per the
months or per
Authorization Letter)
Authorization Clinical report MUST specifically comment on the following CogScreen items. If they have changed
Letter or are not normal, the narrative must discuss these findings and if they are of any clinical or
AND Neurocognitive
evaluation aeromedical concern:
1. Any increase in LRPV (page 4)
2. Taylor Factor scores (page 5)
3. Base Rate for Speed, Accuracy, or Process (page 4)
ADDITIONAL Every 6 months or Varies. See the airman’s Authorization Letter. Include any drug testing results, therapist follow up
PROVIDERS per Authorization reports, social worker reports, etc.
Letter
Additional reports for SSRI If the prescribing physician is NOT a psychiatrist, reports from the prescribing physician and their clinic
or any other condition noted office notes must be submitted in addition to the required psychiatric evaluations (see above).
in Authorization Letter
If the airman has other non-SSRI conditions that require a special issuance, those reports should also
be submitted according to the Authorization Letter.
1. A written statement from you and in your own words describing your history of
antidepressant usage and mental health status.
2. Medical/treatment records related to your history of antidepressant usage from the date
you began treatment to the present.
4. If your treating physician is not a board certified psychiatrist, a current detailed evaluation
by a board certified psychiatrist regarding your psychiatric and behavioral status is
required. The psychiatrist must document that he/she has reviewed your personal written
statement, all of your treatment/medical records, and the current evaluation by your
treating/prescribing physician.
6. If you have held a first- or second-class airman medical certificate and have flown for a
commercial carrier within the last 2 years, obtain a letter from airline management (Chief
Pilot or designee) attesting to your competence, crew interaction and mood (if available).
7. A detailed evaluation by your HIMS AME. The evaluation must address the following:
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition
in the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
NOTE – See Disease Protocols for specifications for Neurocognitive, Psychiatric, and/or
Psychiatric and Psychological Evaluations.
Psychiatric Conditions
Adjustment Disorders All Submit all pertinent If stable, resolved, no
medical information and associated disturbance of
clinical status report. thought, no recurrent
episodes, and
psychotropic
medication(s) used for
less than 6 months and
discontinued for at least 3
months - Issue
Psychiatric Conditions
b). No use of
psychotropic
medication(s) - Issue
Otherwise - Requires
FAA Decision
Depression requiring All Submit all pertinent Requires FAA Decision
the use of medical information
antidepressant and clinical status
medications report.
See Use of
Antidepressant
Medication Policy and
Disease Protocols,
Specifications for
Neuropsychological
Evaluations for
Treatment with SSRI
Medications.
Personality Disorders All Submit all pertinent Requires FAA Decision
medical information
and clinical status
report. Also see 1.
below.
1. The category of personality disorders severe enough to have repeatedly manifested itself
by overt acts refers to diagnosed personality disorders that involve what is called "acting
out" behavior. These personality problems relate to poor social judgment, impulsivity, and
disregard or antagonism toward authority, especially rules and regulations. A history of
long-standing behavioral problems, whether major (criminal) or relatively minor (truancy,
military misbehavior, petty criminal and civil indiscretions, and social instability), usually
occurs with these disorders. Driving infractions and previous failures to follow aviation
regulations are critical examples of these acts.
Certain personality disorders and other mental disorders that include conditions of limited
duration and/or widely varying severity may be disqualifying. Under this category, the FAA
is especially concerned with significant depressive episodes requiring treatment, even
outpatient therapy. If these episodes have been severe enough to cause some disruption
of vocational or educational activity, or if they have required medication or involved
suicidal ideation, the application should be deferred or denied issuance.
2. Psychotic Disorders are characterized by a loss of reality testing in the form of delusions,
hallucinations, or disorganized thoughts. They may be chronic, intermittent, or occur in a
single episode. They may also occur as accompanying symptoms in other psychiatric
conditions including but not limited to bipolar disorder (e.g. bipolar disorder with psychotic
features), major depression (e.g. major depression with psychotic features), borderline
personality disorder, etc. All applicants with such a diagnosis must be denied or
deferred.
4. Although they may be rare in occurrence, severe anxiety problems, especially anxiety and
phobias associated with some aspect of flying, are considered significant. Organic mental
disorders that cause a cognitive defect, even if the applicant is not psychotic, are
considered disqualifying whether they are due to trauma, toxic exposure, or arteriosclerotic
or other degenerative changes.
(See Item 18.m.).
6. Substance abuse includes the use of the above substances under any one of the following
conditions:
a. Use of a substance in the last 2 years in which the use was physically hazardous
(e.g., DUI or DWI) if there has been at any other time an instance of the use of a
substance also in a situation in which the use was physically hazardous;
b. If a person has received a verified positive drug test result under an anti-drug
program of the Department of Transportation or one of its administrations; or
c. The Federal Air Surgeon finds that an applicant's misuse of a substance makes him
or her unable to safely perform the duties or exercise the privileges of the airman
certificate applied for or held, or that may reasonably be expected, for the maximum
duration of the airman medical certificate applied for or held, to make the applicant
unable to perform those duties or exercise those privileges.
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or
other treatment involved, finds -
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
A protocol for examinations applicable to Item 48 is not provided because the necessary history-
taking, observation, and other examination techniques used in examining other systems have
already revealed much of what can be known about the status of the applicant's endocrine and
other systems. For example, the examination of the skin alone can reveal important signs of
thyroid dysfunction, Addison's disease, Cushing's disease, and several other endocrine
disorders. The eye may reflect a thyroid disorder (exophthalmos) or diabetes (retinopathy).
When the Examiner reaches Item 48 in the course of the examination of an applicant, it is
recommended that the Examiner take a moment to review and determine if key procedures have
The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the examiner as defined by the protocol and disposition
in the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.
Pre-Diabetes (Metabolic All Review all pertinent Follow the CACI - Pre-
Syndrome, Impaired Fasting medical records; Diabetes Worksheet
Glucose, Insulin Resistance, current status to If airman meets all
Glucose Elevation/Intolerance,
Polycystic Ovary Syndrome)
include names and certification criteria –
dosage of Issue.
medication(s) and
side effects All others require FAA
decision. Submit all
evaluation data.
The Examiner must review a current status report by the treating physician and any supporting
documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the
acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or
second- class must provide this information annually; applicants for third-class must provide the
information with each required exam.
[ ] CACI qualified Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, Glucose
Elevation/Intolerance, Polycystic Ovary Syndrome). (Documents do not need to be submitted to the FAA.)
[ ] Not CACI qualified Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, Glucose
Elevation/Intolerance, Polycystic Ovary Syndrome). Issued per valid SI/AASI. (Submit supporting documents.)
[ ] NOT CACI qualified Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, Glucose
Elevation/Intolerance, Polycystic Ovary Syndrome). I have deferred. (Submit supporting documents.)
Endocrine Disorders
Acromegaly All Submit all pertinent Requires FAA Decision
medical records;
current status to
include names and
dosage of
medication(s) and side
effects
Addison's Disease All Submit all pertinent Requires FAA Decision
medical records;
current status to
include names and
dosage of
medication(s) and side
effects
Cushing's Disease or All Submit all pertinent Requires FAA Decision
Syndrome medical records;
current status to
include names and
dosage of
medication(s) and side
effects
Hypoglycemia, whether All Submit all pertinent Requires FAA Decision
functional or a result of medical records;
pancreatic tumor current status to
include names and
dosage of
medication(s) and side
effects
Hyperparathyroidism All Submit all pertinent If status post-surgery,
medical records; disease controlled, stable
current status;include and no sequela
names and dosage of - Issue
medication(s) and side
effects, and current Otherwise - Requires
serum calcium and FAA Decision
phosphorus levels
Hypoparathyroidism All Submit all pertinent Requires FAA Decision
medical records;
current status; include
names and dosage of
medication(s) and side
effects and current
serum calcium and
phosphorus levels
Endocrine Disorders
Hyperthyroidism All Submit all pertinent Initial Special
medical records; Issuance – Requires
current status to FAA Decision
include names and
dosage of Followup Special
medication(s) and Issuances – See AASI
side effects and Protocol
current TFTs
Hypothyroidism All Review all pertinent Follow the CACI -
medical records; Hypothyroidism
current status to Worksheet. If
include names and airman meets all
dosage of certification criteria –
medication(s) and Issue.
side effects and
current TFTs All others require FAA
decision. Submit all
evaluation data.
Initial Special
Issuance – Requires
FAA Decision
Followup Special
Issuances – See AASI
Protocol
Proteinuria & Glycosuria All Submit all pertinent Trace or 1+ protein
medical records; and glucose
current status to intolerance ruled out
include names and - Issue
dosage of Otherwise - Requires
medication(s) and FAA Decision
side effects
Symptoms and signs [ ] None of the following: fatigue, mental status impairment, or
symptoms related to pulmonary, cardiac, or visual systems
[ ] Not CACI qualified hypothyroidism. Issued per valid SI/AASI. (Submit supporting documents.)
Gender Dysphoria
All Classes
Updated 01/27/16
The AME may ISSUE (no further information is needed), if the airman:
• Was evaluated for or diagnosed with Gender Dysphoria and has never undergone treatment (counseling or support group for GD does
not require information);
• Has no history of other mental health diagnoses or treatment; and
• Is otherwise qualified
*Side effects from hormone therapy can be aeromedically significant. The airman should be warned not to fly per Title 14 CFR 61.53 if they
experience medication side effects.
The following information must be addressed in the treating provider’s evaluation. Evaluation should be performed in accordance
with a comprehensive mental health assessment following the World Professional Association for Transgender Health (WPATH)
guidelines. Submit either this form* or supporting documentation addressing each item to your AME or to the FAA at:
Federal Aviation Administration
Aerospace Medical Certification Division AAM-300
PO Box 26080
Oklahoma City, OK 73125-9914
2. This airman meets the DSM-5 diagnostic criteria for Gender Dysphoria [ ] Yes [ ] No-explain
and the condition is not secondary to, or better accounted for, by other
diagnoses.
3. PSYCHIATRIC HISTORY:
Current mental health diagnosis or coexisting mental health concerns….............. [ ] None [ ] Yes-explain
Previous mental health diagnosis or coexisting mental health concerns................ [ ] None [ ] Yes-explain
ER visit or hospitalization for any psychiatric illness or condition ever………......... [ ] None [ ] Yes-explain
Any suicide attempt(s) ever.....………..………………………………………….......... [ ] None [ ] Yes-explain
Substance Use disorder per DSM-5…………………………………………………… [ ] None [ ] Yes-explain
(e.g. alcohol, cannabis, stimulants, hallucinogens, opioids)
4. PSYCHIATRIC TREATMENT: (List start and end dates on each. For medications,
also note name, dose, and side effects, if any.)
Current use………………………………………………………………………………. [ ] None [ ] Yes-explain
Previous use…………………………………………………………………………….. [ ] None [ ] Yes-explain
Psychotherapy for any condition other than GD (e.g. depression, anxiety)……….. [ ] None [ ] Yes-explain
Other treatments (e.g. cognitive therapy, talk therapy, electroconvulsive therapy) [ ] None [ ] Yes-explain
5. CURRENT STATUS: Airman is doing well. There are no mental health [ ] Yes [ ] No-explain
concerns. Psychotherapy (if any) is for gender dysphoria only. No other
treatment is needed (do not include support group or support
group counseling).
___________________________________________ ___________________________________
Treating Provider Signature Date of Evaluation
________________________________________ ____________________________________
Name or Office Stamp Phone Number
*For any response which requires further explanation, submit supporting documentation. In some
cases, actual records will be required.
Acoustic Neuroma
Colon/ Rectal Cancer and other
Abdominal Malignancies
G-U System Cancers
Kaposi’s Sarcoma
Leukemias and Lymphomas
Malignant Melanomas
Eye Tumors
Pregnancy
(a) The person shall demonstrate acceptable hearing by at least one of the following
tests:
(b) No disease or condition of the middle or internal ear, nose, oral cavity, pharynx,
or larynx that-
(2) Interferes with, or may reasonably be expected to interfere with, clear and
effective speech communication.
A. Order of Examinations
2. If an applicant fails the conversational voice test, the Examiner may administer pure
tone audiometric testing of unaided hearing acuity according to the following table of
worst acceptable thresholds, using the calibration standards of the American
National Standards Institute, 1969:
If the applicant fails an audiometric test and the conversational voice test had not
been administered, the conversational voice test should be performed to determine if
the standard applicable to that test can be met.
3. If an applicant is unable to pass either the conversational voice test or the pure tone
audiometric test, then an audiometric speech discrimination test should be
administered. A passing score is at least 70 percent obtained in one ear at an
intensity of no greater than 65 Db.
B. Discussion
1. Conversational voice test. For all classes of certification, the applicant must
demonstrate hearing of an average conversational voice in a quiet room, using both
ears, at 6 feet, with the back turned to the Examiner. The Examiner should not use
only sibilants (S-sounding test materials). If the applicant is able to repeat correctly
the test numbers or words, "pass" should be noted and recorded on FAA
Form 8500-8, Item 49. If the applicant is unable to hear a normal conversational
voice then "fail" should be marked and one of the following tests may be
administered.
2. Standard. For all classes of certification, the applicant may be examined by pure
tone audiometry as an alternative to conversational voice testing or upon failing the
conversational voice test. If the applicant fails the pure tone audiometric test and
has not been tested by conversational voice, that test may be administered. The
requirements expressed as audiometric standards according to a table of acceptable
thresholds (American National Standards Institute [ANSI], 1969, calibration) are as
follows:
3. Audiometric Speech Discrimination. Upon failing both conversational voice and pure
tone audiometric test, an audiometric speech discrimination test should be
administered (usually by an otologist or audiologist). The applicant must score at
least 70 percent at intensity no greater than 65 Db in either ear.
C. Equipment
1. Approval. The FAA does not approve or designate specific audiometric equipment
for use in medical certification. Equipment used for FAA testing must accurately and
reliably cover the required frequencies and have adequate threshold step features.
Because every audiometer manufactured in the United States for
screening and diagnostic purposes is built to meet appropriate standards, most
audiometers should be acceptable if they are maintained in proper calibration and
are used in an adequately quiet place.
3. ASA/ANSI. Older audiometers were often calibrated to meet the standards specified
by the USA Standards Institute (USASI), formerly the American Standards
Association (ASA). These standards were based upon a U.S. Public Health Service
survey. Newer audiometers are calibrated so that the zero hearing threshold level is
now based on laboratory measurements rather than on the survey. In 1969, the
American National Standards Institute (ANSI) incorporated these new
measurements. Audiometers built to this standard have instruments or dials that
read in ANSI values. For these reasons, it is very important that every audiogram
submitted (for values reported in Item 49 on FAA Form 8500-8) include a note
indicating whether it is ASA or ANSI. Only then can the FAA standards be
appropriately applied. ASA or USASI values can be converted to ANSI by adding
corrections as follows:
* The decibels added figure is the amount added to ASA or USASI at each
specific frequency to convert to ANSI or older equivalent ISO values.
1. Special Issuance of Medical Certificates. Applicants who do not meet the auditory
standards may be found eligible for a SODA. An applicant seeking a SODA must
make the request in writing to the Aerospace Medicine Certification Division, AAM-
300. A determination of qualifications will be made on the basis of a special medical
examination by an ENT consultant, a MFT, or operational experience.
2. Bilateral Deafness. See Items 25-30. If otherwise qualified, when the student pilot's
instructor confirms the student's eligibility for a private pilot checkride, the applicant
should submit a written request to the AMCD for an authorization for a MFT. This
test will be given by an FAA inspector in conjunction with the checkride. If the
applicant successfully completes the test, the FAA will issue a third-class medical
certificate and SODA. Pilot activities will be restricted to areas in which radio
communication is not required.
3. Hearing Aids. If the applicant requires the use of hearing aids to meet the standard,
issue the certificate with the following restriction:
Some pilots who normally wear hearing aids to assist in communicating while on the
ground report that they elect not to wear them while flying. They prefer to use the
volume amplification of the radio headphone. Some use the headphone on one ear
for radio communication and the hearing aid in the other for cockpit communications.
(a) Distant visual acuity of 20/20 or better in each eye separately, with or without
corrective lenses. If corrective lenses (spectacles or contact lenses) are necessary
for 20/20 vision, the person may be eligible only on the condition that corrective
lenses are worn while exercising the privileges of an airman certificate
(a) Distant visual acuity of 20/40 or better in each eye separately, with or without
corrective lenses. If corrective lenses (spectacles or contact lenses) are necessary
for 20/40 vision, the person may be eligible only on the condition that corrective
lenses are worn while exercising the privileges of an airman certificate.
Equipment:
b. The chart or screen should be placed 20 feet from the applicant's eyes and the 20/20
line should be placed 5 feet 4 inches above the floor.
c. A metal, opaque plastic, or cardboard occluder should be used to cover the eye not
being examined.
d. The examining room should be darkened with the exception of the illuminated chart
or screen.
e. If the applicant wears corrective lenses, the uncorrected acuity should be determined
first, then corrected acuity. If the applicant wears contact lenses, see the
f. Common errors:
6. Failure to obtain the corrected acuity when the applicant wears glasses.
2. Acceptable Substitutes for Distant Vision Testing: any commercially available visual
acuities and heterphoria testing devices.
There are specific approved substitute testers for color vision, which may not
include some commercially available vision testing machines. For an
approved list, see Item 52. Color Vision.
Examination Techniques:
A. When corrective lenses are required to meet the standards, an appropriate limitation
will be placed on the medical certificate. For example, when lenses are needed for
distant vision only:
For multiple vision defects involving distant and/or intermediate and/or near vision
when one set of monofocal lenses corrects for all, the limitation is:
For combined defective distant and near visual acuity where multifocal lenses are
required, the appropriate limitation is:
For multiple vision defects involving distant, near, and intermediate visual acuity
when more than one set of lenses is required to correct for all vision defects, the
appropriate limitation is:
HOLDER SHALL WEAR LENSES THAT CORRECT FOR DISTANT VISION AND
POSSESS GLASSES THAT CORRECT FOR NEAR AND INTERMEDIATE VISION
B. An applicant who fails to meet vision standards and has no SODA that covers the
extent of the visual acuity defect found on examination may obtain further FAA
consideration for grant of an Authorization under the special issuance section of
part 67 (14 CFR 67.401) for medical certification by submitting a report of an eye
evaluation. The Examiner can help to expedite the review procedure by forwarding
a copy of FAA Form 8500-7, Report of Eye Evaluation, that has been completed by
an eye specialist (optometrist or ophthmologist) 1.
C. Applicants who do not meet the visual standards should be referred to a specialist
for evaluation. Applicants with visual acuity or ocular muscle balance problems may
be referred to an eye specialist of the applicant's choice. The FAA Form 8500-7,
Report of Eye Evaluation, should be provided to the specialist by the Examiner.
Any applicant eligible for a medical certificate through special issuance under
these guidelines shall pass a MFT, which may be arranged through the
appropriate agency medical authority.
1
In obtaining special eye evaluations in respect to the airman medical certification program, reports from an
eye specialist are acceptable when the condition being evaluated relates to a determination of visual acuity,
refractive error, or mechanical function of the eye. The FAA Form 8500-7, Report of Eye Evaluation, is a form
that is designed for use by either optometrists or ophthalmologists.
(b) Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye
separately, with or without corrective lenses. If age 50 or older, near vision of 20/40
or better, Snellen equivalent, at both 16 inches and 32 inches in each eye
separately, with or without corrective lenses.
(b) Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye
separately, with or without corrective lenses.
Equipment:
1. FAA Form 8500-1, Near Vision Acuity Test Chart, dated April 1993.
There are specific approved substitute testers for color vision, which may not
include some commercially available vision testing machines. For an approved
list, see Item, 52. Color Vision.
Examination Techniques:
1. Near visual acuity and intermediate visual acuity, if the latter is required, are
determined for each eye separately and for both eyes together. Test values are
recorded both with and without corrective glasses/lenses when either are worn or
required to meet the standards. If the applicant is unable to meet the intermediate
acuity standard unaided, then he/she is tested using each of the corrective lenses or
glasses otherwise needed by that person to meet distant and/or near visual acuity
standards. If the aided acuity meets the standard using any of the lenses or
glasses, the findings are recorded, and the certificate appropriately limited. If an
applicant has no lenses that bring intermediate and/or near visual acuity to the
required standards, or better, in each eye, no certificate may be issued, and the
applicant is referred to an eye specialist for appropriate visual evaluation and
correction.
2. FAA Form 8500-1, Near Vision Acuity Test Chart, dated April 1993, should be used
as follows:
b. The applicant holds the chart 16 inches (near) and 32 inches (intermediate)
from the eyes in a position that will provide uniform illumination. To ensure
that the chart is held at exactly 16 inches or 32 inches from the eyes, a string
of that length may be attached to the chart.
c. Each eye is tested separately, with the other eye covered. Both eyes are
then tested together.
d. The smallest type correctly read with each eye separately and both eyes
together is recorded in linear value. In performing the test using FAA
Form 8500-1, the level of visual acuity will be recorded as the line of smallest
type the applicant reads accurately. The applicant should be allowed no
more than two misread letters on any line.
e. Common errors:
This may be used when a borderline condition exists at the certifiable limits of
an applicant's vision. If successfully completed, a favorable certification
action may be taken.
When correcting glasses are required to meet the near and intermediate vision standards,
an appropriate limitation will be placed on the medical certificate. Contact lenses that
correct only for near or intermediate visual acuity are not considered acceptable for aviation
duties.
If the applicant meets the uncorrected near or intermediate vision standard of 20/40, but
already uses spectacles that correct the vision better than 20/40, it is recommended that
the Examiner enter the limitation for near or intermediate vision corrective glasses on the
certificate.
For all classes, the appropriate wording for the near vision limitation is:
Possession only is required, because it may be hazardous to have distant vision obscured
by the continuous wearing of reading glasses.
For first- and second-class, the appropriate wording for combined near and intermediate
vision limitation is:
For multiple defective distant, near, and intermediate visual acuity when unifocal glasses or
contact lenses are used and correct all, the appropriate limitation is:
For multiple vision defects involving distance and/or near and/or intermediate visual acuity
when more than one set of lenses is required to correct for all vision defects, the
appropriate limitation is:
HOLDER SHALL WEAR LENSES THAT CORRECT FOR DISTANT VISION AND
POSSESS GLASSES THAT CORRECT FOR NEAR AND INTERMEDIATE VISION
Pass
Fail
(c) Color vision: Ability to perceive those colors necessary for the safe performance
of airman duties.
(c) Color vision: Ability to perceive those colors necessary for the safe performance
of airman duties.
TESTS APPROVED FOR AIRMEN ARE NOT ALL ACCEPTABLE FOR AIR TRAFFIC CONTROLLERS
(ATCS - FAA employee 2152 series and contract tower air traffic controllers). For ATCS color vision
criteria, see Acceptable Test Instruments for Color Vision Screening of ATCS chart at the end of
this section or contact a Regional Flight Surgeon.
TESTS APPROVED FOR AIRMEN ARE NOT ALL ACCEPTABLE FOR AIR TRAFFIC CONTROLLERS
(ATCS - FAA employee 2152 series and contract tower air traffic controllers). For ATCS color vision
criteria, see Acceptable Test Instruments for Color Vision Screening of ATCS chart at the end of
this section or contact a Regional Flight Surgeon.
An applicant meets the color vision standard if he/she passes any of the color vision tests
listed in Examination Techniques, Item 52. Color Vision. If an applicant fails any of these
tests, inform the applicant of the option of taking any of the other acceptable color vision
tests listed in Item 52. Color Vision Examination Equipment and Techniques before
requesting the Specialized Operational Medical Tests in Section D below.
Inform the applicant that if he/she takes and fails any component of the Specialized
Operational Medical Tests in Section D, then he/she will not be permitted to take any
of the remaining listed office-based color vision tests in Examination Techniques,
Item 52. Color Vision as an attempt to remove any color vision limits or restrictions
on their airman medical certificate. That pathway is no longer an option to the airman,
and no new result will be considered.
An applicant does not meet the color vision standard if testing reveals:
A. All Classes
1. AOC (1965 edition) pseudoisochromatic plates: seven or more errors on plates 1-15.
2. AOC-HRR (second edition): Any error in test plates 7-11. Because the first 4 plates
in the test book are for demonstration only, test plate 7 is actually the eleventh plate
in the book. (See instruction booklet.)
3. Dvorine pseudoisochromatic plates (second edition, 15 plates): seven or more errors
on plates 1-15.
4. Ishihara pseudoisochromatic plates: Concise 14-plate edition: six or more errors on
plates 1-11; the 24-plate edition: seven or more errors on plates 1-15; the 38-plate
edition: nine or more errors on plates 1-21.
5. Richmond (1983 edition) pseudoisochromatic plates: seven or more errors on plates
1-15.
6. OPTEC 900 Vision Tester and Farnsworth Lantern test: an average of more than
one error per series of nine color pairs in series 2 and 3. (See instruction booklet.)
B. Certificate Limitation. If an applicant fails to meet the color vision standard as interpreted
above, but is otherwise qualified, the Examiner must issue a medical certificate bearing the
limitation:
C. The color vision screening tests above (Section A) are not to be used for the purpose of
removing color vision limits/restrictions from medical certificates of airmen who have failed
the Specialized Operational Medical Tests below (Section D). See bold paragraph in the
introduction of this section (above).
D. Specialized Operational Medical Tests for Applicants Who Do Not Meet the Standard.
Applicants who fail the color vision screening test as listed, but desire an airman medical
certificate without the color vision limitation, may be given, upon request, an opportunity to
take and pass additional operational color perception tests. If the airman passes the
operational color vision perception test(s), then he/she will be issued a Letter of Evidence
(LOE).
• The operational tests are determined by the class of medical certificate requested.
The request should be in writing and directed to AMCD or RFS. See NOTE for
description of the operational color perception tests.
• Applicants for a third-class medical certificate need only take the Operational Color
Vision Test (OCVT).
• The applicant is permitted to take the OVCT only once during the day. If the
applicant fails, he/she may request to take the OVCT at night. If the applicant elects
to take the OCVT at night, he/she may take it only once.
• For an upgrade to first- or second-class medical certificate, the applicant must first
pass the OCVT during daylight and then pass the color vision Medical Flight Test
(MFT). If the applicant fails the OCVT during the day, he/she will not be allowed to
apply for an upgrade to First- or Second-Class certificate. If the applicant fails the
color vision MFT, he/she is not permitted to upgrade to a first- or second-class
certificate.
E. An LOE may restrict an applicant to a third-class medical certificate. Airmen shall not be
issued a medical certificate of higher class than indicated on the LOE. Exercise care in
reviewing an LOE before issuing a medical certificate to an airman.
F. Color Vision Correcting Lens (e.g. X-Chrom). Such lenses are unacceptable to the FAA
as a means for correcting a pilot's color vision deficiencies.
G. Any tests not specifically listed above are unacceptable methods of testing for FAA
medical certificate. Examples of unacceptable tests include, but are not limited to, the
OPTEC 5000 Vision Tester (color vision portion), “Farnsworth Lantern Flashlight,” “yarn
tests,” and AME-administered aviation Signal Light Gun test (AME office use is prohibited).
Web-based color vision applications, downloaded, or printed versions of color vision
tests are also prohibited. Examiners must use actual and specific color vision plates and
testing machinery for applicant evaluations.
NOTE: An applicant for a third-class airman medical certificate who has defective color vision and
desires an airman medical certificate without the color vision limitation must demonstrate the ability
to pass an Operational Color Vision Test (OCVT) during the day. The OCVT consists of the
following:
1. A Signal Light Test (SLT): Identify in a timely manner aviation red, green, and white
2. Aeronautical chart reading: Read and correctly interpret in a timely manner aeronautical
charts, including print in various sizes, colors, and typefaces; conventional markings in
several colors; and, terrain colors
An applicant for a first- or second- class airman medical certificate who has defective color
vision and desires an airman medical certificate without the color vision limitation must first
demonstrate the ability to pass the OCVT during the day (as above) and then must pass a
color vision Medical Flight Test (MFT). The color vision MFT is performed in the aircraft,
including in-flight testing. It consists of the following:
Applicants who take and pass both the OCVT during the day and the color vision MFT will be given
a letter of evidence (LOE) valid for all classes of medical certificates and will have no limitation or
comment made on the certificate regarding color vision as they meet the standard for all classes.
Applicants who take and pass only the OCVT during the day will be given an LOE valid only for
third-class medical certificate.
An applicant who fails the SLT portion of the OCVT during daylight hours may repeat the test at
night. Should the airman pass the SLT at night, the restriction:
NOT VALID FOR FLIGHT DURING DAYLIGHT HOURS BY COLOR SIGNAL CONTROL
will be placed on the replacement medical certificate. The airman must have taken the daylight
hours test first and failed prior to taking the night test.
Limitation
Medical certificate limitation: “Not valid for
night flying or by color signal controls.”
YES
Pass ?
Airman opts to take
Color Vision Medical Flight Test
NO
LOE;
Upgrade
YES to Class 1
Medical certificate limitation remains: “Not valid Pass ? or Class 2
for night flying or by color signal controls.”
NO
YES
Pass ? Medical certificate limitation: “Not valid for flight
during daylight hours by color signal controls.”
NO
Normal Abnormal
(d) Field of Vision: No acute or chronic pathological condition of either eye or adnexa
that interferes with the proper function of an eye, that may reasonably be expected
to progress to that degree, or that may reasonably be expected to be aggravated by
flying.
1. Fifty-inch square black matte surface wall target with center white fixation point;
2 millimeter white test object on black-handled holder:
3. The applicant should be instructed to keep the left eye focused on the fixation
point.
4. The white test object should be moved from the outside border of the wall
target toward the point of fixation on each of the eight 4-degree radials.
6. The test should be repeated with the applicant's left eye occluded and the
right eye focusing on the fixation point.
2. Alternative Techniques:
a. A standard perimeter may be used in place of the above procedure. With this
method, any significant deviation from normal field configuration will require
b. Direct confrontation. This is the least acceptable alternative since this tests
for peripheral vision and only grossly for field size and visual defects. The
Examiner, standing in front of the applicant, has the applicant look at the
Examiner's nose while advancing two moving fingers from slightly behind and
to the side of the applicant in each of the four quadrants. Any significant
deviation from normal requires ophthalmological evaluation.
A. Ophthalmological Consultations.
If an applicant fails to identify the target in any presentation at a distance of less than
23 inches from the fixation point, an eye specialist's evaluation must be requested. This is
a requirement for all classes of certification. The Examiner should provide FAA Form 8500-
14, Ophthalmological Evaluation for Glaucoma, for use by the ophthalmologist if glaucoma
is suspected.
B. Glaucoma.
The FAA may grant an Authorization under the special issuance section of part 67
(14 CFR 67.401) on an individual basis. The Examiner can facilitate FAA review by
obtaining a report of Ophthalmological Evaluation for Glaucoma
(FAA Form 8500-14) from a treating or evaluating ophthalmologist.
If considerable disturbance in night vision is documented, the FAA may limit the medical
certificate: NOT VALID FOR NIGHT FLYING
Third-Class: No Standards
Equipment:
There are specific approved substitute testers for color vision, which may not
include some commercially available vision testing machines. For an
approved list, See Item, 52. Color Vision.
Examination Techniques:
Test procedures to be used accompany the instruments. If the Examiner needs specific
instructions for use of the horizontal prism bar and red Maddox rod, these may be obtained
from a RFS.
(b). No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds -
(1). Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2). May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.
(c). No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication
or other treatment involved finds -
(1). Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2). May reasonably be expected, for the maximum duration of the airman
In accordance with accepted clinical procedures, routine blood pressure should be taken
with the applicant in the seated position. An applicant should not be denied or deferred
first-, second-, or third-class certification unless subsequent recumbent blood pressure
readings exceed those contained in this Guide. Any conditions that may adversely affect
the validity of the blood pressure reading should be noted.
A. Examining Options
1. An applicant whose pressure does not exceed 155 mm mercury systolic and 95 mm
mercury diastolic maximum pressure, who has not used antihypertensive medication
for 30 days, and who is otherwise qualified should be issued a medical certificate by
the Examiner.
2. If the airman’s blood pressure is elevated in clinic, you have any of the following
options:
• Recheck the blood pressure. If the airman meets FAA specified limits on the
second attempt, note this in Block 60 along with both readings.
• Have the airman return to clinic 3 separate days over a 7-day period. If the
airman meets FAA specified limits during these re-checks, note this and the
readings in Block 60. Also note if there was a reason for the blood pressure
elevation.
The Examiner must defer issuance of a medical certificate to any applicant whose
hypertension has not been evaluated, who uses unacceptable medications, whose
medical status is unclear, whose hypertension is uncontrolled, who manifests
56. Pulse
(Resting)
The medical standards do not specify pulse rates that, per se, are disqualifying for medical
certification. These tests are used, however, to determine the status and responsiveness
of the cardiovascular system. Abnormal pulse rates may be reason to conduct additional
cardiovascular system evaluations.
The pulse rate is determined with the individual relaxed in a sitting position.
Normal Abnormal
(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds:
(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.
Glycosuria or proteinuria is cause for deferral of medical certificate issuance until additional
studies determine the status of the endocrine and/or urinary systems. If the glycosuria has
been determined not to be due to carbohydrate intolerance, the Examiner may issue the
certificate. Trace or 1+ proteinuria in the absence of a history of renal disease is not cause
for denial.
The Examiner may request additional urinary tests when they are indicated by history or
examination. These should be reported on FAA Form 8500-8 or attached to the form as an
addendum.
(1) At the first application after reaching the 35th birthday; and
(c) An ECG will satisfy a requirement of paragraph (b) of this section if it is dated no
earlier than 60 days before the date of the application it is to accompany and was
performed and transmitted according to acceptable standards and techniques.
Note: All applicants for certification may be required to provide ECGs when indicated by
history or physical examination.
A. Date. The date of the most recent ECG shall be entered in Item 58 of FAA Form 8500-
8 for all first-class applicants.
1. If a first-class applicant is due for a periodic ECG, the Examiner performs and
transmits a current tracing according to established procedures. (See Section II. D.
below).
However, some applicants (such as airline transport pilots who are employed by air
carriers with medical departments) may have their company transmit a current ECG
directly to the FAA. The Examiner need not require such an applicant to undergo
another ECG examination and, if the applicant is otherwise qualified, a medical
certificate may be issued. The Examiner should attach a statement to FAA
Form 8500-8 to verify that a tracing has been transmitted from another source. The
date of that ECG should be entered in Item 58.
2. If a first-class applicant is not required to have a periodic ECG with the current
examination, the Examiner should record the date of the preceding ECG in Item 58.
4. If the applicant provides no statement and refuses to have a current ECG submitted
by the Examiner, the Examiner should defer issuance of the medical certificate.
When an ECG is due but is not submitted, the FAA will not affirm the applicant's
eligibility for medical certification until the requested ECG has been received and
interpreted as being within normal limits. Failure to respond to FAA requests for a
required current ECG will result in denial of certification.
B. Currency
C. Interpretation
1. All ECGs required to establish eligibility for medical certification must be forwarded
for interpretation to the Manager of the AMCD. This does not preclude submission
of an interpretation by or through the Examiner.
The method for recording and transmitting ECGs is by digital electronic data transfer by the
Examiner to the AMCD. Senior Examiners who perform first-class medical examinations
are required to have access to this capability.
International Examiners who submit ECGs should use the following format for preparation
and submission:
2. Such hard-copy ECGs are microfilmed for permanent retention in the AMCD. Only
tracings that can be microfilmed are acceptable.
3. Provide a Resting tracing. Tracings must be stapled to the ECG report form to
ensure that all leads are appropriately coded and interpreted.
This section provides guidance for the completion of Items 59-64 of the
FAA Form 8500-8. The Examiner is responsible for conducting the examination.
However, he or she may delegate to a qualified physician's assistant, nurse, aide, or
laboratory assistant the testing required for Items 49-58. Regardless of who performs
the tests, the Examiner is responsible for the accuracy of the findings, and this
responsibility may not be delegated.
The medical history page of FAA Form 8500-8 must be completed and certified by the
applicant or it will not appear in AMCS. After all routine evaluations and tests are
completed, the Examiner should review FAA Form 8500-8. If the form is complete and
accurate, the Examiner should add final comments, make qualification decision
statements, and certify the examination.
(a) Whenever the Administrator finds that additional medical information or history is
necessary to determine whether an applicant for or the holder of a medical certificate
meets the medical standards for it, the Administrator requests that person to furnish
that information or to authorize any clinic, hospital, physician, or other person to
release to the Administrator all available information or records concerning that
history. If the applicant or holder fails to provide the requested medical information
or history or to authorize the release so requested, the Administrator may suspend,
modify, or revoke all medical certificates the airman holds or may, in the case of an
applicant, deny the application for an airman medical certificate.
(b) If an airman medical certificate is suspended or modified under paragraph (a) of this
section, that suspension or modification remains in effect until the requested
information, history, or authorization is provided to the FAA and until the Federal Air
Surgeon determines whether the person meets the medical standards under this
part.
If possible, all ancillary reports such as consultations, ECGs, x-ray release forms, and
hospital or other treatment records should be attached. If the delay for those items
would exceed 14 days, the Examiner should forward all available data to the AMCD,
with a note specifying what additional information is being prepared for submission at a
later date.
If there are no significant medical history items or abnormal physical findings, the
Examiner should indicate this by checking the appropriate block.
The Examiner must check the proper box to indicate if the Medical Certificate has been
issued. The Examiner must indicate denial or deferral by checking one of the two lower
boxes. If denied, a copy of the Examiner's Letter of Denial, should be forwarded to the
AMCD.
B. Anticipated Delay. When the Examiner anticipates a delay of more than 14 days in
obtaining records or reports concerning additional examinations, the exam should be
transmitted to AMCD with a note in Block 60 stating that additional information is still
needed. The exam should be transmitted deferred. No medical certificate should
be issued.
C. Issuance. When the Examiner receives all the supplemental information requested
and finds that the applicant meets all the FAA medical standards for the class
sought, the Examiner should issue a medical certificate.
D. Deferral. If upon receipt of the information the Examiner finds there is a need for
even more information or there is uncertainty about the significance of the findings,
certification should be deferred. The Examiner's concerns should be noted in Block
60 and the application transmitted as deferred to the AMCD for further consideration.
E. Denial. When the Examiner concludes that the applicant is clearly ineligible for
certification, the applicant should be denied, using the AME Letter of Denial. Use of
this form will provide the applicant with the reason for the denial and with appeal
rights and procedures. (See General Information 4. Medical Certification Decision
Making)
The Examiner must check the “Disq” box on the Comments Page beside any
disqualifying defect. Comments or discussion of specific observations or findings may
be reported in Item 60. If all comments cannot fit in Item 60, the Examiner may submit
additional information on a plain sheet of paper and include the applicant’s full name,
date of birth, signature, any appropriate identifying numbers (PI, MID or SSN), and the
date of the exam.
If the Examiner denies the applicant, the Examiner must issue a Letter of Denial, to the
applicant, and report the issuance of the denial in Item 60.
• The FAA designates specific individuals as Examiners and this status may not be
delegated to staff or to a physician who may be covering the designee's practice.
• Before transmitting to AMCD, the Examiner must certify the exam and enter all
appropriate information including his or her AME serial number.
CACI CONDITIONS
(Updated 6/24/15)
Conditions AMEs Can Issue (CACI) is a series of conditions which allow AMEs to
regular issue if the applicant meets the parameters of the CACI Condition Worksheet.
The worksheets provide detailed instructions to the examiner and outline condition-
specific requirements for the applicant.
1. Review the disposition table BEFORE the CACI worksheet to verify a CACI is
required.
2. If all the CACI criteria are met and the applicant is otherwise qualified, the
AME may issue on the first exam or the first time the condition is reported to the
AME without contacting AMCD/RFS. Document the appropriate notes in Block
60 and keep the supporting documents in your files; they do not need to be
submitted to the FAA at this time.
3. If the requirements are not met, the AME must defer the exam and send the
supporting documents to the FAA.
ARTHRITIS HYPOTHYROIDISM
COLITIS PRE-DIABETES
DISEASE PROTOCOLS
PROTOCOLS
The following lists the Guide for Aviation Medical Examiners Disease Protocols, and
course of action that should be taken by the Examiner as defined by aeromedical
decision considerations. (Also see condition-specific CACI Certification Worksheets,
which can be found in the Dispositions Section.)
• ALLERGIES, SEVERE
• ATTENTION DEFICIT/HYPERACTIVITY DISORDER
• BINOCULAR MULTIFOCAL AND ACCOMMODATING DEVICES
• CARDIAC TRANSPLANT
• CARDIOVASCULAR EVALUATION (CVE)
• CONDUCTIVE KERATOPLASTY
• CORONARY HEART DISEASE (CHD)
• DEPRESSION TREATED WITH SSRI MEDICATIONS
• DIABETES MELLITUS - DIET CONTROLLED
• DIABETES MELLITUS Type II - MEDICATION CONTROLLED (Non Insulin)
• DIABETES MELLITUS Type I or Type II - INSULIN TREATED
• GRADED EXERCISE STRESS TEST REQUIREMENTS (Maximal)
• GRADED EXERCISE STRESS TEST REQUIREMENTS (Bundle Branch Block)
• HUMAN IMMUNODEFICIENCY VIRUS (HIV)
• IMPLANTED PACEMAKER
• LIVER TRANSPLANT (RECIPIENT)
• METABOLIC SYNDROME – MEDICATION CONTROLLED
• MUSCULOSKELETAL EVALUATION
• NEUROCOGNITIVE IMPAIRMENT
• PEPTIC ULCER
• PSYCHIATRIC EVALUATION
• PSYCHIATRIC AND PSYCHOLOGICAL EVALUATIONS
• RENAL TRANSPLANT
• SUBSTANCES of DEPENDENCE/ABUSE (Drugs and Alcohol)
• THROMBOEMBOLIC DISEASE
• VALVE REPLACEMENT
* OSA Reference Materials are located at the end of the Protocols below
In the case of severe allergies, the Examiner should deny or defer certification and
provide a report to the Aerospace Medical Certification Division, AAM-300, that details
the period and duration of symptoms and the nature and dosage of drugs used for
treatment and/or prevention.
Will I need to provide any of my medical records? You should make records
available to the neuropsychologist prior to the evaluation, to include:
• Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations, or treatment not previously submitted to the FAA.
• A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by the
Aerospace Medical Certification Division (AMCD) in Oklahoma City, OK. For
further information regarding this process, please call (405) 954-4821, select the
option for “duplicate medical certificate or copies of medical records,” then select
the option for “certified copies of medical records.”
What is required in the “core test battery?” The core test battery listed below
provides a standardized basis for the FAA’s review of cases, and must include:
• The complete Wechsler Adult Intelligence Scales (Processing Speed and
Working Memory Indexes must be scored)
• Trail Making Test, Parts A and B (Reitan Trails A & B should be used since
aviation norms are available for the original Reitan Trails A & B, but not for
similar tests [e.g., Color Trails; Trails from Kaplan-Delis Executive Function, etc.])
• Executive function tests to include:
(1) Category Test or Wisconsin Card Sorting Test, and
(2) Stroop Color-Word Test
• Paced Auditory Serial Addition Test (PASAT).
• A continuous performance test (i.e., Test of Variables of Attention [TOVA], or
Conners’ Continuous Performance Test [CPT-II], or Integrated Visual and
Auditory Continuous Performance Test [IVA+]), or Gordon Diagnostic System
[GDS].
• Test of verbal memory (WMS-IV subtests, Rey Auditory Verbal Learning Test, or
California Verbal Learning Test-II).
• Test of visual memory (WMS-IV subtests, Brief Visuospatial Memory Test-
Revised, or Rey Complex Figure Test).
• Tests of Language including Boston Naming Test and Verbal Fluency (COWAT
and a semantic fluency task).
• Psychomotor testing including Finger Tapping and Grooved Pegboard or Purdue
Pegboard.
• Personality testing, to include the Minnesota Multiphasic Personality Inventory
(MMPI-2). (The MMPI-2-RF is not an approved substitute. All scales, subscales,
content, and supplementary scales must be scored and provided. Computer
scoring is required. Abbreviated administrations are not acceptable.)
• Additional testing: If problems are noted on tests of reading or math, follow-up
testing with appropriate achievement tests should be conducted (e.g.,
Woodcock-Johnson Tests of Achievement-III; Nelson-Denny Reading Test,
especially Fluency and Comprehension; WRAT-IV Math; PIAT Reading
Comprehension).
• CogScreen-Aeromedical Edition (CogScreen-AE) is recommended but not
required.
NOTES: (1) All tests administered must be the most current edition of the test unless
specified otherwise; (2) At the discretion of the examiner, additional tests may be
clinically necessary to assure a complete assessment.
What must be submitted? The neuropsychologist’s report as noted above, plus the
supporting documentation below:
• Copies of all computer score reports (e.g., Pearson MMPI-2 Extended Score
Report, TOVA, CPT-II or IVA+ Report).
• An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are not
available for a particular test, then the normative comparison group (e.g., general
population, age/education-corrected) must be specified. Also, when available,
percentile scores must be included.
1. Will additional testing be required in the future? If eligible for unrestricted medical
certification, no additional testing would be required. However, pilots found eligible
for Special Issuance will be required to undergo periodic re-evaluations. The letter
authorizing special issuance will outline required testing, which may be limited to
specific tests or expanded to include a comprehensive test battery.
2. Useful references for the neuropsychologist:
• MOST COMPREHENSIVE SINGLE REFERENCE:
Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
• Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the
Psychological Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2),
227-245.
• Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace
Psychiatry. In J. R. Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.),
Fundamentals of Aerospace Medicine (4th Ed.), (pp. 406-424). Philadelphia:
Lippencott Williams & Wilkins.
This Protocol establishes the authority for the Examiner to issue an airman medical certificate to
binocular applicants using multifocal or accommodating ophthalmic devices.
Devices acceptable for aviation-related duties must be FDA approved and include:
• Must provide a report to include the FAA Form 8500-7, Report of Eye Evaluation, from
the operating surgeon or the treating eye specialist. This report must attest to stable
visual acuity and refractive error, absence of significant side effects/complications, need
of medications, and freedom from any glare, flares or other visual phenomena that could
affect visual performance and impact aviation safety
• The following visual standards, as required for each class, must be met for each eye:
Third-Class
20/40 or better in each eye separately, with or without correction
Third-Class
No requirement
Note: The above does not change the current certification policy on the use of monofocal non-
accommodating intraocular lenses.
• A 1 year recovery period shall elapse after the cardiac transplant before consideration
• A current report from the treating transplant cardiologist regarding the status of the
cardiac transplant, including all pre- and post-operative reports. A statement regarding
functional capacity, modifiable cardiovascular risk factors, and prognosis for
incapacitation
• Current blood chemistries (fasting blood sugar, hemoglobin A1C concentration, and
blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides), within 30
days
• Any tests performed or deemed necessary by all treating physicians (e.g., myocardial
biopsy)
• Coronary Angiogram
• Graded Exercise Stress Test (see disease protocol) and stress echocardiogram
• Complete documentation of all rejection history, whether treated or not; include hospital
records and reports of any tests done
It is the responsibility of each applicant to provide the medical information required to determine
his/her eligibility for airman medical certification. A medical release form may help in obtaining
the necessary information. Please ensure full name appears on any reports or correspondence.
• Blood chemistries (fasting blood sugar, current blood lipid profile to include total
cholesterol, HDL, LDL, and triglycerides) performed within the last 90 days
• The airman must provide all medical records related to the procedure
• A current status report by the surgical eye specialist with special note regarding
complications of the procedure or the acquired monocularity, or vision complaints
by the airman
Recovery time before consideration and required tests will vary by the airman medical
certificate applied for and the categories above.
A SPECT myocardial perfusion exercise stress test using technetium agents and/or
thallium may be required for consideration for any class if clinically indicated or if the
exercise stress test is abnormal by any of the usual parameters. The interpretive report
and all SPECT images, preferably in black and white, must be submitted.
Note: If cardiac catheterization and/or coronary angiography have been performed, all
reports and actual films (if films are requested) must be submitted for review. Copies
should be made of all films to safeguard against loss. Films should be labeled with the
applicant’s name and return address.
Will I need to provide any of my medical records? You should make records
available to the neuropsychologist prior to the evaluation, to include:
• Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
• A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by the
Aerospace Medical Certification Division (AMCD) in Oklahoma City, OK. For
further information regarding this process, please call (405) 954-4821, select the
option for “duplicate medical certificate or copies of medical records,” then select
the option for “certified copies of medical records.”
NOTES: (1) All tests administered must be the most current edition of the test unless specified
otherwise; (2) At the discretion of the examiner, additional tests may be clinically necessary to
assure a complete assessment.
What must be submitted? The neuropsychologist’s report as noted above, plus the
supporting documentation below:
• Copies of all computer score reports (e.g., Pearson MMPI-2 Extended Score
Report, CogScreen-AE Report).
• An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test, then the normative comparison group (e.g.,
general population, age/education-corrected) must be specified. Also, when
available, percentile scores must be included.
Applicants with a diagnosis of diabetes mellitus controlled by diet alone are considered
eligible for all classes of medical certificates under the medical standards, provided they
have no evidence of associated disqualifying cardiovascular, neurological, renal, or
ophthalmological disease. Specialized examinations need not be performed unless
indicated by history or clinical findings. The Examiner must document these
determinations on FAA Form 8500-8.
This protocol is used for all diabetic applicants treated with oral agents or incretin
mimetic medications (such as exenatide), herein referred to as medication(s).
When medication is started the following time periods must elapse prior to certification
to assure stabilization, adequate control, and the absence of side effects or
complications from the medication.
• Metformin only. A 14 day period must elapse.
• Any other single diabetes medication requires a 60-day period.
The initial Authorization decision is made by the AMCD and may not be made by the
Examiner. An Examiner may re-issue a subsequent airman medical certificate under
the provisions of the Authorization.
If, upon further review of the deferred case, AMCD decides that re-issuance is
appropriate, the Examiner may again be given the authority to re-issue the medical
certificate under the provisions of the Authorization based on data provided by the
treating physician, including such information as may be required to assess the status of
associated medical condition(s).
An applicant with diabetes mellitus - Type II should be counseled by his or her Examiner
regarding the significance of the disease and its possible complications.
The applicant should be informed of the potential for hypoglycemic reactions and
cautioned to remain under close medical surveillance by his or her treating physician.
The applicant should also be advised that should their medication be changed or the
dosage modified, the applicant should not perform airman duties until the applicant and
treating physician has concluded that the condition is:
• under control;
• stable;
• presents no risk to aviation safety; and
• consults with the Examiner who issued the certificate, AMCD or RFS.
Please have the provider who treats your diabetes enter the information in the space below.
Return the completed form to your AME or to the FAA at:
If YES is circled on any of the questions below, please attach narrative, tests, etc.
6. Any side effects from medications Yes No
7. ANY episode of hypoglycemia in the past year Yes No
8. Any evidence of progressive diabetes induced end organ disease
Cardiac……………………………………………. Yes No
Neurological………………………………………. Yes No
Ophthalmological……………………….……… Yes No
Peripheral neuropathy…………………………… Yes No
Renal disease…………………………………….. Yes No
__________________________________ ________________
Treating Provider Signature Date
Consideration will be given only to those individuals who have been clinically stable on their
current treatment regimen for a period of 6 months or more. The FAA has an established policy
that permits the special issuance medical certification to some insulin treated applicants.
Individuals certificated under this policy will be required to provide medical documentation
regarding their history of treatment, accidents, and current medical status. If certificated, they
will be required to adhere to monitoring requirements and are prohibited from operating aircraft
outside the United States. The following is a summary of the evaluation protocol and an outline
of the conditions that the FAA will apply for third class applicants. First and second class
applicants will be evaluated on a case-by-case basis by the Federal Air Surgeon’s Office.
A. Initial Certification
1. The applicant must have had no recurrent (two or more) episodes of hypoglycemia in
the past 5 years and none in the preceding 1 year which resulted in loss of
consciousness, seizure, impaired cognitive function or requiring intervention by
another party, or occurring without warning (hypoglycemia unawareness).
2. The applicant will be required to provide copies of all medical records as well as
accident and incident records pertinent to their history of diabetes.
e. Verification that the applicant has been educated in diabetes and its control
and understands the actions that should be taken if complications, especially
hypoglycemia, should arise. The examining physician must also verify that
the applicant has the ability and willingness to properly monitor and manage
his or her diabetes.
NOTE: Student pilots may wish to ensure they are eligible for medical certification prior to
beginning or resuming flight instruction or training. In order to serve as a pilot in command, you
must have a valid medical certificate for the type of operation performed.
2. At 3-month intervals, the airman must be evaluated by the treating physician. This
evaluation must include a general physical examination, review of the interval
medical history, and the results of a test for glycosylated hemoglobin concentration.
The physician must review the record of the airman's daily blood glucose
measurements and comment on the results. The results of these quarterly
evaluations must be accumulated and submitted annually unless there has been a
change. (See No. 1 above - If there has been a change the individual must report the
change(s) to the FAA and wait for an eligibility letter before resuming flight duties).
3. On an annual basis, the reports from the examining physician must include
confirmation by an eye specialist of the absence of significant eye disease.
4. At the first examination after age 40 and at 5-year intervals, the report, with ECG
tracings, of a maximal graded exercise stress test must be included in consideration
of continued medical certification.
To ensure safe flight, the insulin using diabetic airman must carry during flight a recording
glucometer; adequate supplies to obtain blood samples; and an amount of rapidly
absorbable glucose, in 10 gm portions, appropriate to the planned duration of the flight. The
following actions shall be taken in connection with flight operations:
1. One-half hour prior to flight, the airman must measure the blood glucose
concentration. If it is less than 100 mg/dl the individual must ingest an appropriate
(not less than 10 gm) glucose snack and measure the glucose concentration
one-half hour later. If the concentration is within 100 -- 300 mg/dl, flight operations
may be undertaken. If less than 100, the process must be repeated; if over 300, the
flight must be canceled.
2. One hour into the flight, at each successive hour of flight, and within one half hour
prior to landing, the airman must measure their blood glucose concentration. If the
concentration is less than 100 mg/dl, a 20 gm glucose snack shall be ingested. If the
concentration is 100 -- 300 mg/dl, no action is required. If the concentration is greater
than 300 mg/dl, the airman must land at the nearest suitable airport and may not
resume flight until the glucose concentration can be maintained in the 100 -- 300
mg/dl range. In respect to determining blood glucose concentrations during flight, the
In patients with bundle branch blocks, LVH, or diffuse ST/T wave changes at rest, it will be
necessary to provide a stress echo or nuclear stress test.
Remember, a phone call to either AMCD or RFS may avoid unnecessary deferral.
• The applicant is unable to achieve at least 85% of maximal heart rate on stress testing
or less than 9 minutes (6 minutes if age 70 or greater);
• The applicant develops 1 mm or greater ST segment depression at any time during
stress testing, unless the applicant has additional medical evidence such as a nuclear
imaging study or a stress echocardiogram showing the absence of reversible ischemia
or wall motion abnormalities reviewed and reported by a qualified cardiologist;
• The nuclear stress testing shows evidence of reversible ischemia, a stress
echocardiogram shows exercised induced wall motion abnormalities, or either study
demonstrates a negative change from the prior study of the same type;
• The ejection fraction on a nuclear stress test or stress echocardiogram is 40% or less; or
a 10% decrease from a prior study; or
• The applicant reports any other disqualifying medical condition or undergoes therapy not
previously reported
If areas of ischemia are noted, a coronary angiogram may be indicated for definitive
diagnosis. According to the current literature, approximately 40% of individuals with
LBBB will demonstrate a false positive thallium reperfusion defect in the septal area. If
significant CAD is diagnosed, refer to Special Issuance guidelines. Some cases may be
forwarded to a FAA-selected cardiology consultant specialist for review and
recommendation for medical certification.
• After the first 2 years of surveillance: see the After 2 Years Surveillance HIV
Specification Sheet
Persons who are infected with the HIV and who do not have a diagnosis of Acquired
Immunodeficiency Syndrome (AIDS) may be considered for any class medical
certificate, if otherwise qualified. Persons on an antiretroviral medication will be
considered only if the medication is approved by the U.S. Food and Drug Administration
and is used in accordance with an acceptable drug therapy protocol. Current studies
should be submitted no later than 30-days from test date. In order to be considered for
a medical certificate the following data must be provided:
1. A current report from a physician knowledgeable in the treatment of HIV-infected
persons and a medical history emphasizing symptoms and treatment referable to the
immune system;
2. Current viral load determination by polymerase chain reaction (PCR) – for persons
who have had an AIDS defining illness 2 determinations, 1 month apart);
3. Current CD4 (for persons who have had an AIDS defining illness, 2 determinations, 1
month apart) and lymphocyte count;
4. Current complete blood count (CBC) with differential;
5. Results of current liver function tests;
6. BUN and creatine;
7. a. A current assessment of cognitive function (preferably by
CogScreen-AE [Aeromedical Edition] or other test battery) must be
provided with the Initial application. Follow-up neurological-
psychological evaluations are required annually for first and
second-class pilots and every other year for third-class.
1. MMPI
2. WAIS-R
3. Memory Test (one of the following)
a. Wechsler Memory Scale
b. Rey auditory Verbal Learning Test
4. Trails Making Test (A&B)
5. Category Test (booklet or machine)
6. Sensory-Motor Screening
7. Language Functioning Test (one of the following)
a. Speech Sounds Perception Test
b. Aphasia Screening Test
1. For applicants with a history of cytomegalovirus (CMR) retinitis, a current ophthalmological evaluation
with visual fields must be provided with the initial application and at 6 month-intervals thereafter.
Please provide our office with a current status report from a treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. This report
should include the information outlined below, along with any separate additional
testing.
The results should be sent to the Aerospace Medical Certification Division (AMCD) After
review, if the airman is determined qualified, AMCD/Regional Flight Surgeon (RFS) will
send a letter to the airman authorizing the Aviation Medical Examiner (AME) to issue a
new time-limited medical certificate, as applicable.
Both the initial and subsequent medical determinations may only be made by the RFS
or AMCD.
• Every 6 months a written current status report from the treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. To
include the following: a medical history emphasizing symptoms and treatment
referable to the immune system, any signs or symptoms of atherosclerotic
cardiovascular disease, and diabetes mellitus or insulin resistance and a clinical
assessment of cognitive function;
Please provide our office with a current status report from a treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. This report
should include the information outlined below, along with any separate additional
testing.
The results should be sent to the Aerospace Medical Certification Division (AMCD) After
review, if the airman is determined qualified, AMCD/Regional Flight Surgeon (RFS) will
send a letter to the airman authorizing the Aviation Medical Examiner (AME) to issue a
new time-limited medical certificate, as applicable.
Both the initial and subsequent medical determinations may only be made by the RFS
or AMCD.
• Every 12 months a written current status report from the treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. To
include the following: a medical history emphasizing symptoms and treatment
referable to the immune system, any signs or symptoms of atherosclerotic
cardiovascular disease, and diabetes mellitus or insulin resistance and a clinical
assessment of cognitive function;
A 2-month recovery period must elapse after the pacemaker implantation to allow for
recovery and stabilization. Submit the following:
5. A report of current fasting blood sugar and a current blood lipid profile to include:
total cholesterol, HDL, LDL, and triglycerides.
No consideration can be given for special issuance until all the required data has been
received.
The use of the airman's full name and date of birth on all correspondence and reports
will aid the agency in locating the proper file.
The Examiner must defer initial issuance. An applicant with a history of liver transplant
must submit the following for consideration of a medical certificate. Applicants found
qualified will be required to provide annual follow up evaluations per their authorization
letter.
• A six (6) month post-transplant recovery period with documented stability for the
last three (3) months;
• Lab and images to include copies of most recent lab performed by the treating
physician (CBC, CMP with LFTs) and any other tests deemed necessary by the
treating physician such as imaging or liver biopsy
This protocol is used for all applicants with Glucose Intolerance, Impaired Glucose
tolerance, Impaired Fasting Glucose, Insulin Resistance, and/or Pre-Diabetes treated with oral
agents or incretin mimetic medications (exenatide), herein referred to as medication(s).
When medication is started the following time periods must elapse prior to certification
to assure stabilization, adequate control, and the absence of side effects or
complications from the medication.
• Metformin only. A 14 day period must elapse.
• Any other single diabetes medication requires a 60-day period.
The initial Authorization decision is made by the AMCD and may not be made by the
Examiner. An Examiner may re-issue a subsequent airman medical certificate under
the provisions of the Authorization.
The initial Authorization determination will be made on the basis of a report from the
treating physician. There must be sufficient information to rule out diabetes mellitus.
For favorable consideration, the report must contain a statement regarding the
medication used, dosage, the absence or presence of side effects and clinically
significant hypoglycemic episodes, and an indication of satisfactory control of the
metabolic syndrome. The results of an A1C hemoglobin determination within the past
30 days must be included. Note must also be made of the presence of cardiovascular,
neurological, renal, and/or ophthalmological disease. The presence of one or more of
these associated diseases will not be, per se, disqualifying but the disease(s) must be
carefully evaluated to determine any added risk to aviation safety.
If, upon further review of the deferred case, AMCD decides that re-issuance is
appropriate, the Examiner may again be given the authority to re-issue the medical
certificate under the provisions of the Authorization based on data provided by the
treating physician, including such information as may be required to assess the status of
associated medical condition(s).
The applicant should be informed of the potential for hypoglycemic reactions and
cautioned to remain under close medical surveillance by his or her treating physician.
The applicant should also be advised that should their medication be changed or the
dosage modified, the applicant should not perform airman duties until the applicant and
treating physician has concluded that the condition is:
• under control;
• stable;
• presents no risk to aviation safety; and
• consults with the Examiner who issued the certificate, AMCD or RFS.
NOTE: If the applicant is otherwise qualified, the FAA may issue a limited certificate.
This certificate will permit the applicant to proceed with flight training until ready for a
medical flight test. At that time, and at the applicant's request, the FAA (usually the
AMCD) will authorize the student pilot to take a medical flight test in conjunction with the
regular flight test. The medical flight test and regular private pilot flight test are
conducted by an FAA inspector. This affords the student an opportunity to demonstrate
the ability to control the aircraft despite the handicap. The FAA inspector prepares a
written report and indicates whether there is a safety problem. A medical certificate and
statement of demonstrated ability (SODA) may be provided to the airman from
AMCD/RFS office if the MFT is successful and the airman is otherwise qualified.
When prostheses are used or additional control devices are installed in an aircraft to
assist the amputee, those found qualified by special certification procedures will have
their certificates limited to require that the device(s) (and, if necessary, even the specific
aircraft) must always be used when exercising the privileges of the airman certificate.
SPECIFICATIONS FOR
NEUROPSYCHOLOGICAL EVALUATIONS
FOR POTENTIAL NEUROCOGNITIVE IMPAIRMENT
Why is a neuropsychological evaluation required? Head trauma, stroke,
encephalitis, multiple sclerosis, other suspected acquired or developmental conditions,
and medications used for treatment, may produce cognitive deficits that would make an
airman unsafe to perform pilot duties. This guideline outlines the requirements for a
neuropsychological evaluation.
Will I need to provide any of my medical records? You should make records
available to the neuropsychologist prior to the evaluation, to include:
• Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
• A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by the
Aerospace Medical Certification Division (AMCD) in Oklahoma City, OK. For
further information regarding this process, please call (405) 954-4821, select the
option for “duplicate medical certificate or copies of medical records,” then select
the option for “certified copies of medical records.”
What is required in the “core test battery?” The core test battery listed below
provides a standardized basis for the FAA’s review of cases, and must include:
• CogScreen-Aeromedical Edition (CogScreen-AE).
• The complete Wechsler Adult Intelligence Scales (Processing Speed and
Working Memory Indexes must be scored),
• Trail Making Test, Parts A and B (Reitan Trails A & B should be used since
aviation norms are available for the original Reitan Trails A & B, but not for
similar tests [e.g., Color Trails; Trails from Kaplan-Delis Executive Function, etc.])
• Executive function tests to include:
(1) Category Test or Wisconsin Card Sorting Test, and
(2) Stroop Color-Word Test
• Paced Auditory Serial Addition Test (PASAT).
• A continuous performance test (i.e., Test of Variables of Attention [TOVA], or
Conners’ Continuous Performance Test [CPT-II], or Integrated Visual and
Auditory Continuous Performance Test [IVA+]), or Gordon Diagnostic System
[GDS].
• Test of verbal memory (WMS-IV subtests, Rey Auditory Verbal Learning Test, or
California Verbal Learning Test-II),
• Test of visual memory (WMS-IV subtests, Brief Visuospatial Memory Test-
Revised, or Rey Complex Figure Test),
• Tests of Language including Boston Naming Test and Verbal Fluency (COWAT
and a semantic fluency task),
• Psychomotor testing including Finger Tapping and Grooved Pegboard or Purdue
Pegboard.
• Personality testing, to include the Minnesota Multiphasic Personality Inventory
(MMPI-2). (The MMPI-2-RF is not an approved substitute. All scales, subscales,
content, and supplementary scales must be scored and provided. Computer
scoring is required. Abbreviated administrations are not acceptable.)
NOTES: (1) All tests administered must be the most current edition of the test unless
specified otherwise; (2) At the discretion of the examiner, additional tests may be
clinically necessary to assure a complete assessment.
What must be submitted? The neuropsychologist’s report as noted above, plus the
supporting documentation below:
• Copies of all computer score reports (e.g., CogScreen-AE score report, Pearson
MMPI-2 Extended Score Report, TOVA, CPT-II or IVA+ Report).
• An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test, then the normative comparison group (e.g.,
5. Will additional testing be required in the future? If eligible for unrestricted medical
certification, no additional testing would be required. However, pilots found eligible
for Special Issuance will be required to undergo periodic re-evaluations. The letter
authorizing special issuance will outline required testing, which may be limited to
specific tests or expanded to include a comprehensive test battery.
6. Useful references for the neuropsychologist:
• MOST COMPREHENSIVE SINGLE REFERENCE:
Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
• Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the
Psychological Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2),
227-245.
• Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace
Psychiatry. In J. R. Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.),
Fundamentals of Aerospace Medicine (4th Ed.), (pp. 406-424). Philadelphia:
Lippencott Williams & Wilkins.
Sleep apnea has significant safety implications due to cognitive impairment secondary
to the lack of restorative sleep and is disqualifying for airman medical certification. The
condition is part of a group of sleep disorders with varied etiologies. Specifically, sleep
apneas are characterized by abnormal respiration during sleep. The etiology may be
obstructive, central or complex in nature. However, no matter the cause, the
manifestations of this disordered breathing present safety risks that include, but are not
limited to, excessive daytime sleepiness (daytime hypersomnolence), cardiac
dysrhythmia, sudden cardiac death, personality disturbances, refractory hypertension
and, as mentioned above, cognitive impairment. Certification may be considered once
effective treatment is shown.
This protocol is designed to evaluate airmen who may be presently at risk for
Obstructive Sleep Apnea (OSA) and to outline the certification requirements for airmen
diagnosed with OSA. While this protocol focuses on OSA, the AME must also be
mindful of other sleep-related disorders such as insomnia, parasomnias, sleep-related
movement disorders (e.g. restless leg syndrome and periodic leg movement), central
sleep apnea and other hypersomnias, circadian rhythm sleep disorders, etc., that may
also interfere with restorative sleep. All sleep disorders are also potentially medically
disqualifying if left untreated. If one of these other sleep-related disorders is initially
identified during the examination, the AME must contact their RFS or AMCD for
guidance.
Risk Information
The American Academy of Sleep Medicine has established the risk criteria (utilizing
Tables 2 and 3) for OSA. When applying Table 2 and 3, the AME is expected to employ
their clinical judgment.
Educational information for airmen can be found in the FAA Pilot Safety Brochure on
Obstructive Sleep Apnea. Supplemental information for AMEs can be found in OSA
Reference Materials, which can be found at end of the Protocols section.
Persons with physical findings such as a retrograde mandible, large tongue or tonsils,
neuromuscular disorders, or connective tissue anomalies are at risk of OSA requiring
treatment despite a normal or low BMI. OSA is also associated with conditions such as
refractory hypertension requiring more than two medications for control, diabetes
mellitus, and atrial fibrillation. Over 90% of individuals with a BMI of 40 or greater have
OSA requiring treatment. Up to 30% of individuals with OSA have a BMI less than 30.
• AME Actions - On every exam, the Examiner must triage the applicant into one
of 6 groups:
• If the applicant has had a prior sleep assessment (Group/Box 2 of OSA flow
chart), select Group 2 on the AME Action Tab:
• If the applicant does not have an AASI/SI or has not had a previous
assessment, the AME must:
o If the applicant is at risk for OSA but in the opinion of the AME the
applicant is at low risk for OSA , the AME must (Group/Box 4 of OSA
flow chart), select Group 4 on the AME Action Tab:
Discuss OSA risks with applicant;
Provide resource and educational information, as appropriate;
Issue, if otherwise qualified; and
Notate in Block 60
• If the applicant is at high risk for OSA, the AME must (Group/Box 5 of OSA
flow chart), select Group 5 on the AME Action Tab:
o Give the applicant Specification Sheet B and advise that a letter will be
sent from the Federal Air Surgeon requesting more information. The
letter will state that the applicant has 90 days to provide the information
to the FAA/AME
o Notate in Block 60; and
o Issue, if otherwise qualified
• If the AME observes or the applicant reports symptoms which are severe
enough to represent an immediate risk to aviation safety of the national
airspace (Group/Box 6 of OSA flow chart), select Group 6 on the AME
Action Tab.
o Notate in Block 60
o THE AME MUST DEFER
Your application for airman medical certification submitted this date indicates that you
have been treated or previously assessed for Obstructive Sleep Apnea (OSA).
You must provide the following information to the Aerospace Medical Certification
Division (AMCD) or your Regional Flight Surgeon within 90 days:
• All reports and records regarding your assessment for OSA by your primary care
physician and/or a sleep specialist.
• If you are currently being treated, also include:
o A signed Airman Compliance with Treatment form or equivalent;
o The results and interpretive report of your most recent sleep study; and
o A current status report from your treating physician indicating that OSA
treatment is still effective.
Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO BOX 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169
Due to your risk for Obstructive Sleep Apnea (OSA), and to review your eligibility to have a
medical certificate, you must provide the following information to the Aerospace Medical
Certification Division (AMCD) or your Regional Flight Surgeon’s Office for review within 90 days:
• In communities where a Level II HST is unavailable, the FAA will accept a level III HST.
If the HST is positive for OSA, no further testing is necessary and treatment in
accordance with the AASI must be followed. However, if the HST is equivocal, a higher
level test such as an in-lab sleep study will be needed unless a sleep medicine specialist
determines no further study is necessary and documents the rationale.
If your sleep study is positive for a sleep-related disorder, you may not exercise the
privileges of your medical certificate until you provide:
• The results and interpretive report of your most recent sleep study; and
• A current status report from your treating physician addressing compliance, tolerance of
treatment, and resolution of OSA symptoms.
If you are not diagnosed with a sleep-related disorder or the study was negative for a
sleep-related disorder, you may continue to exercise the privileges of your medical certificate,
but the evaluation report along with the results of any study, if conducted, must be sent to the
FAA at the address below. All information provided will be reviewed and is subject to further
FAA action.
In order to expedite the processing of your application, please submit the aforementioned
information in one mailing using your reference number (PI, MID, or APP ID).
Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO BOX 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169
An applicant with a history of an active ulcer within the past 3-months or a bleeding
ulcer within the past 6-months must provide evidence that the ulcer is healed if
consideration for medical certification is desired.
Evidence of healing must be verified by a report from the attending physician that
includes the following information:
• The name and dosage medication(s) used for treatment and/or prevention, along
with a statement describing side effects or removal
This information should be submitted to the AMCD. Under favorable circumstances, the
FAA may issue a certificate with special requirements. For example, an applicant with a
history of bleeding ulcer may be required to have the physician submit followup reports
every 6-months for 1 year following initial certification.
An applicant with a history of gastric resection for ulcer may be favorably considered if
free of sequela.
Will I need to provide any of my medical records? You should make records
available to the psychiatrist prior to their evaluations, to include:
• Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
• A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist by the Aerospace
Medical Certification Division (AMCD) in Oklahoma City, OK. For further
information regarding this process, please call (405) 954-4821, select the option
for “duplicate medical certificate or copies of medical records,” then select the
option for “certified copies of medical records.”
Will I need to provide any of my medical records? You should make records
available to both the psychiatrist and clinical psychologist prior to their evaluations, to
include:
• Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
• A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by the
Aerospace Medical Certification Division (AMCD) in Oklahoma City, OK. For
further information regarding this process, please call (405) 954-4821, select the
option for “duplicate medical certificate or copies of medical records,” then select
the option for “certified copies of medical records.”
What is required in the “core test battery?” The core test battery listed below
provides a standardized basis for the FAA’s review of cases, and must include:
a. Intellectual/Neurocognitive domain, to include both:
• The Wechsler Adult Intelligence Scale (recent edition; Processing Speed and
Working Memory Indexes must be scored).
• The Trail Making Test, Parts A & B (Reitan Trails A & B should be used since
aviation norms are available for the original Reitan Trails A & B, but not for
similar tests [e.g., Color Trails; Trails from Kaplan-Delis Executive Function,
etc.].)
c. For cases in which there are questions regarding reality testing/thought disorder
and/or defensive invalid profiles were produced on the self-report measure(s), the
Rorschach (Rorschach Performance Assessment System [R-PAS]) is preferred.
Exner’s Comprehensive System is also accepted.
e. Additional tests that the psychologist deems clinically necessary (based upon
presenting problem, clinical history and/or clinical presentation) to assure a
complete assessment.
What must be submitted? The neuropsychologist’s report as noted above, plus the
supporting documentation below.
• For self-report measures: Copies of all computer score reports (e.g., Pearson
MMPI-2 Extended Score Report, Pearson MCMI-III Profile Report with Grossman
Facet Scores),
• For performance measures: Copies of entire protocol (e.g., Rorschach response
sheets, location charts, and associated computer score reports,)
• For intellectual/neurocognitive measures: An appended score summary sheet
that includes all scores for all tests administered. When available, pilot norms
must be used. If pilot norms are not available for a particular test, then the
normative comparison group (e.g., general population, age/education-corrected)
must be specified. Also, when available, percentile scores must be included.
Will additional evaluations or testing be required in the future? If eligible for unrestricted
medical certification, no additional evaluations would be required. However, pilots
found eligible for Special Issuance will be required to undergo periodic re-evaluations.
The letter authorizing special issuance will outline the specific evaluations or testing
required.
Useful references for the psychologist:
• MOST COMPREHENSIVE SINGLE REFERENCE:
Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
• Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the Psychological
Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2), 227-245.
• Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace Psychiatry.
In J. R. Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.),
• Fundamentals of Aerospace Medicine (4th Ed.), (pp. 406-424). Philadelphia: Lippencott
Williams & Wilkins.
What is required in the “core test battery?” The core test battery listed below
provides a standardized basis for the FAA’s review of cases, and must include:
• CogScreen-Aeromedical Edition (CogScreen-AE).
• The complete Wechsler Adult Intelligence Scales (Processing Speed and
Working Memory Indexes must be scored).
• Trail Making Test, Parts A and B (Reitan Trails A & B should be used since
aviation norms are available for the original Reitan Trails A & B, but not for
similar tests [e.g., Color Trails; Trails from Kaplan-Delis Executive Function, etc.])
• Executive function tests to include:
(3) Category Test or Wisconsin Card Sorting Test, and
(4) Stroop Color-Word Test
• Paced Auditory Serial Addition Test (PASAT).
• A continuous performance test (i.e., Test of Variables of Attention [TOVA], or
Conners’ Continuous Performance Test [CPT-II], or Integrated Visual and
Auditory Continuous Performance Test [IVA+]), or Gordon Diagnostic System
[GDS].
• Test of verbal memory (WMS-IV subtests, Rey Auditory Verbal Learning Test, or
California Verbal Learning Test-II).
• Test of visual memory (WMS-IV subtests, Brief Visuospatial Memory Test-
Revised, or Rey Complex Figure Test).
• Tests of Language including Boston Naming Test and Verbal Fluency (COWAT
and a semantic fluency task).
• Psychomotor testing including Finger Tapping and Grooved Pegboard or Purdue
Pegboard.
• Personality testing, to include the Minnesota Multiphasic Personality Inventory
(MMPI-2). (The MMPI-2-RF is not an approved substitute. All scales, subscales,
content, and supplementary scales must be scored and provided. Computer
scoring is required. Abbreviated administrations are not acceptable.)
NOTES: (1) All tests administered must be the most current edition of the test unless
specified otherwise; (2) At the discretion of the examiner, additional tests may be
clinically necessary to assure a complete assessment.
An applicant with a history of renal transplant must submit the following if consideration
for medical certification is desired:
• The results of the following laboratory results: CBC, BUN, creatinine, and
electrolytes
• A personal statement attesting to the substance and amount, and date last used
NOTE: The applicant may be required to submit additional information before medical
disposition can be rendered. See Specifications on following pages.
Will I need to provide any of my medical records? You should make records
available to both the psychiatrist and clinical neuropsychologist prior to their
evaluations, to include:
• Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
• A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by the
Aerospace Medical Certification Division (AMCD) in Oklahoma City, OK. For
further information regarding this process, please call (405) 954-4821, select the
option for “duplicate medical certificate or copies of medical records,” then select
the option for “certified copies of medical records.”
aviation background and experience; medical conditions, and all medication use;
and behavioral observations during the interview.
• A mental status examination.
• An integrated summary of findings with an explicit diagnostic statement, and the
psychiatrist’s opinion(s) and recommendation(s) for treatment, medication,
therapy, counseling, rehabilitation, or monitoring should be explicitly stated.
Opinions regarding clinically or aeromedically significant findings and the
potential impact on aviation safety must be consistent with the Federal Aviation
Regulations.
What is required in the “core test battery?” The core test battery listed below
provides a standardized basis for the FAA’s review of cases, and must include:
• CogScreen-Aeromedical Edition (CogScreen-AE)
• The complete Wechsler Adult Intelligence Scales (Processing Speed and
Working Memory Indexes must be scored)
• Trail Making Test, Parts A and B (Reitan Trails A & B should be used since
aviation norms are available for the original Reitan Trails A & B, but not for
similar tests [e.g., Color Trails; Trails from Kaplan-Delis Executive Function, etc.])
• Executive function tests to include:
(5) Category Test or Wisconsin Card Sorting Test, AND
(6) Stroop Color-Word Test
• Paced Auditory Serial Addition Test (PASAT)
• A continuous performance test (i.e., Test of Variables of Attention [TOVA], or
Conners’ Continuous Performance Test [CPT-II], or Integrated Visual and
Auditory Continuous Performance Test [IVA+]), or Gordon Diagnostic System
[GDS].
• Test of verbal memory (WMS-IV subtests, Rey Auditory Verbal Learning Test, or
California Verbal Learning Test-II)
• Test of visual memory (WMS-IV subtests, Brief Visuospatial Memory Test-
Revised, or Rey Complex Figure Test)
• Tests of Language including Boston Naming Test and Verbal Fluency (COWAT
and a semantic fluency task)
• Psychomotor testing including Finger Tapping and Grooved Pegboard or Purdue
Pegboard
• Personality testing, to include the Minnesota Multiphasic Personality Inventory
(MMPI-2)
(The MMPI-2-RF is not an approved substitute. All scales, subscales, content, and
supplementary scales must be scored and provided. Computer scoring is
required. Abbreviated administrations are not acceptable.)
NOTES: (1) All tests administered must be the most current edition of the test
unless specified otherwise; (2) At the discretion of the examiner, additional tests may
be clinically necessary to assure a complete assessment.
What must be submitted? The neuropsychologist’s report as noted above, plus the
supporting documentation below:
• Copies of all computer score reports (e.g., CogScreen-AE score report, Pearson
MMPI-2 Extended Score Report, TOVA, CPT-II or IVA+ Report).
• An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test, then the normative comparison group (e.g.,
general population, age/education-corrected) must be specified. Also, when
available, percentile scores must be included.
For applicants who are just beginning warfarin (Coumadin) treatment the following is
required:
• Minimum observation time of 6 weeks after initiation of warfarin therapy;
• Must also meet any required observation time for the underlying condition; AND
• 6 INRs, no more frequently than 1 per week
• A 6-month recovery period shall elapse after the valve replacement to ensure
recovery and stabilization. First- and second-class initial applicants are reviewed
by the Federal Air Surgeon’s cardiology panel;
• Copies of hospital/medical records pertaining to the valve replacement; include
make, model, serial number and size, admission/discharge summaries, operative
report, and pathology report;
• If applicable, a current evaluation from the attending physician regarding the use
of Coumadin to confirm stability without complications, drug dose history and
schedule, and International Normalized Ratio (INR) values (within acceptable
range) accomplished at least monthly during the past 6-month period of
observation;
• A current report from the treating physician regarding the status of the cardiac
valve replacement. This report should address your general cardiovascular
condition, any symptoms of valve or heart failure, any related abnormal physical
findings, and must substantiate satisfactory recovery and cardiac function without
evidence of embolic phenomena, significant arrhythmia, structural abnormality, or
ischemic disease.
• A current 24-hour Holter monitor evaluation to include select representative
tracings;
• Current M-mode, 2-dimensional echocardiogram with Doppler. Submit the video
resulting from this study;
• A current maximal GXT – See GXT Protocol;
• If cardiac catheterization and coronary angiography have been performed, all
reports and films must be submitted, if requested, for review by the agency.
Copies should be made of all films as a safeguard against loss;.
• Following heart valve replacement, first- and second-class certificate holders
shall be followed at 6-month intervals with clinical status reports and at 12-month
intervals with a CVE, standard ECG, and Doppler echocardiogram. Holter
monitoring and GXT's may be required periodically if indicated clinically. For
third-class certificate holders, the above followup testing will be required annually
unless otherwise indicated.
• Single, Mechanical and Valvuloplasty - See AASI for Cardiac Valve
Replacement;
• Multiple Heart Valve Replacement. Applicants who have received multiple heart
valve replacements must be deferred, however, the AMCD may consider
certification of all classes of applicants who have undergone a Ross procedure
(pulmonic valve transplanted to the aortic position and pulmonic valve replaced
by a bioprosthesis).
Use your full name on any reports or correspondence will aid us in locating your file.
Table of Contents
1. Guidance
a. OSA Protocol and Decisions Consideration table
b. Quick-Start for AMEs
c. OSA Flow Chart
d. AASM Tables 2 and 3
e. AME Actions
f. Specification Sheet A
g. Specification Sheet B
2. AASI
a. AASI
b. Airman Compliance with Treatment form (signature document)
Decision Considerations
Disease Protocols – Obstructive Sleep Apnea
Sleep apnea has significant safety implications due to cognitive impairment secondary to the
lack of restorative sleep and is disqualifying for airman medical certification. The condition is
part of a group of sleep disorders with varied etiologies. Specifically, sleep apneas are
characterized by abnormal respiration during sleep. The etiology may be obstructive,
central or complex in nature. However, no matter the cause, the manifestations of this
disordered breathing present safety risks that include, but are not limited to, excessive
daytime sleepiness (daytime hypersomnolence), cardiac dysrhythmia, sudden cardiac
death, personality disturbances, refractory hypertension and, as mentioned above, cognitive
impairment. Certification may be considered once effective treatment is shown.
This protocol is designed to evaluate airmen who may be presently at risk for Obstructive
Sleep Apnea (OSA) and to outline the certification requirements for airmen diagnosed with
OSA. While this protocol focuses on OSA, the AME must also be mindful of other sleep-
related disorders such as insomnia, parasomnias, sleep-related movement disorders (e.g.
restless leg syndrome and periodic leg movement), central sleep apnea and other
hypersomnias, circadian rhythm sleep disorders, etc., that may also interfere with restorative
sleep. All sleep disorders are also potentially medically disqualifying if left untreated. If one
of these other sleep-related disorders is initially identified during the examination, the AME
must contact their RFS or AMCD for guidance.
Risk Information
The American Academy of Sleep Medicine has established the risk criteria (utilizing Tables
2 and 3) for OSA. When applying Table 2 and 3, the AME is expected to employ their
clinical judgment.
Educational information for airmen can be found in the FAA Pilot Safety Brochure on
Obstructive Sleep Apnea.
Persons with physical findings such as a retrograde mandible, large tongue or tonsils,
neuromuscular disorders, or connective tissue anomalies are at risk of OSA requiring
treatment despite a normal or low BMI. OSA is also associated with conditions such as
refractory hypertension requiring more than two medications for control, diabetes mellitus,
and atrial fibrillation. Over 90% of individuals with a BMI of 40 or greater have OSA
requiring treatment. Up to 30% of individuals with OSA have a BMI less than 30.
Guide for Aviation Medical Examiners
___________________________________________________________________________
Sleep Apnea
Followup
Special Issuance
See AASI
Periodic Limb All Submit all pertinent Requires FAA Decision
Movement, etc. medical information
and current status
report. Include sleep
study with a
polysomnogram, use
of medications and
titration study results,
along with a
statement regarding
Restless Leg
Syndrome
Guide for Aviation Medical Examiners
___________________________________________________________________________
The AME while performing the triage function must conclude one of six possible
determinations. The AME is not required to perform the assessment or to comment on the
presence or absence of OSA. For more information, view this instructional video on the
screening process.
In assessing airmen for groups 4 and 5, the AME is expected to use their own clinical
judgment, using AASM information, when making the triage decision.
Some AMEs have voiced the desire to perform the OSA assessment. While we do not
recommend it, the AME may perform the OSA assessment provided that it is in accordance
with the clinical practice guidelines established by the American Academy of Sleep
Medicine.*
AME Actions - On every exam, the Examiner must triage the applicant into one of 6 groups:
• If the applicant has had a prior OSA assessment (Group/Box 2 of OSA flow chart),
select Group 2 on the AME Action Tab:
o If the airman is under treatment, provide the requirements of the AASI and advise
the airman they must get the Authorization of Special Issuance;
o Give the applicant Specification Sheet A and advise that a letter will be sent from
the Federal Air Surgeon requesting more information. The letter will state that the
applicant has 90 days to provide the information to the FAA/AME;
o Notate in Box 60;
o Issue, if otherwise qualified
• If the applicant does not have an AASI/SI or has not had a previous assessment, the
AME must:
o Calculate BMI; and
o Consider AASM risk criteria Table 2 & 3
o If the AME determines the applicant is not currently at risk for OSA (Group/Box 3
of OSA flow chart), select Group 3 on the AME Action Tab:
Notate in Block 60; and
Issue, if otherwise qualified
o If the applicant is at risk for OSA but in the opinion of the AME the applicant is at
low risk for OSA , the AME must (Group/Box 4 of OSA flow chart), select Group
4 on the AME Action Tab:
• If the applicant is at high risk for OSA, the AME must (Group/Box 5 of OSA flow chart),
select Group 5 on the AME Action Tab:
o Give the applicant Specification Sheet B and advise that a letter will be sent from
the Federal Air Surgeon requesting more information. The letter will state that the
applicant has 90 days to provide the information to the FAA/AME
o Notate in Block 60; and
o Issue, if otherwise qualified
• If the AME observes or the applicant reports symptoms which are severe enough to
represent an immediate risk to aviation safety of the national airspace (Group/Box 6 of
OSA flow chart), select Group 6 on the AME Action Tab.
o Notate in Block 60
o THE AME MUST DEFER
Guide for Aviation Medical Examiners
___________________________________________________________________________
Your application for airman medical certification submitted this date indicates that you have
been treated or previously assessed for Obstructive Sleep Apnea (OSA).
You must provide the following information to the Aerospace Medical Certification Division
(AMCD) or your Regional Flight Surgeon within 90 days:
• All reports and records regarding your assessment for OSA by your primary care
physician and/or a sleep specialist.
• If you are currently being treated, also include:
o A signed Airman Compliance with Treatment form or equivalent;
o The results and interpretive report of your most recent sleep study; and
o A current status report from your treating physician indicating that OSA
treatment is still effective.
Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO BOX 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169
Guide for Aviation Medical Examiners
___________________________________________________________________________
Due to your risk for Obstructive Sleep Apnea (OSA), and to review your eligibility to have a
medical certificate, you must provide the following information to the Aerospace Medical
Certification Division (AMCD) or your Regional Flight Surgeon’s Office for review within 90
days:
If your sleep study is positive for a sleep-related disorder, you may not exercise the
privileges of your medical certificate until you provide:
• The results and interpretive report of your most recent sleep study; and
• A current status report from your treating physician addressing compliance, tolerance
of treatment, and resolution of OSA symptoms.
If you are not diagnosed with a sleep-related disorder or the study was negative for a
sleep-related disorder, you may continue to exercise the privileges of your medical
certificate, but the evaluation report along with the results of any study, if conducted, must
be sent to the FAA at the address below. All information provided will be reviewed and is
subject to further FAA action.
In order to expedite the processing of your application, please submit the aforementioned
information in one mailing using your reference number (PI, MID, or APP ID).
Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO BOX 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169
Guide for Aviation Medical Examiners
___________________________________________________________________________
Examiners may re-issue an airman medical certificate to airmen currently on an AASI for OSA if the
airman provides the following:
• An Authorization granted by the FAA;
• Signed Airman Compliance with Treatment form or equivalent from the airman attesting to
absence of OSA symptoms and continued daily use of prescribed therapy; and
• A current status report from the treating physician indicating that OSA treatment is still
effective.
o For Surgery:
For successfully treated surgical patients, a statement attesting to the continued
absence of OSA symptoms is required.
Note: The Examiner may request AMCD review to discontinue the AASI if there are indications that
the airman no longer has OSA (e.g., significant weight loss and a negative study or surgical
intervention followed by 3 years of symptom abatement and absence of significant weight
gain or co-morbid conditions). In most cases, a follow-up sleep study will be required to
remove the AASI.
Guide for Aviation Medical Examiners
___________________________________________________________________________
___ I have been using __________________ (CPAP/ Dental / or Positional Device) for OSA
as prescribed. I am tolerating the therapy well and have no symptoms of OSA (e.g. daytime
sleepiness or lack of mental attention or concentration).
___ I have been surgically treated for OSA and I have no symptoms of OSA (e.g. daytime
sleepiness or lack of mental attention or concentration).
I understand and acknowledge that I will receive the new requirements for continuation of
my special issuance of Obstructive Sleep Apnea and I will comply with the requirements at
my next FAA medical certificate renewal or reapplication.
GENERAL:
3. Does this process involve other sleep disorder conditions? (E.g. Period Limb
Movement Disorder, narcolepsy, central sleep apnea, etc.)
No. This process is for obstructive sleep apnea only. If it is clear that the airman suffers from
a different sleep disorder, DEFER and submit any supporting documentation for FAA
decision.
TRIAGE:
5. The airman was assessed 5 years ago for OSA but did not have a polysomnogram.
The evaluation was negative. Is he required to have an updated sleep evaluation or a
sleep study?
No. If there has been NO CHANGE in his/her risk factors, follow Group/Box 2 of the flow
chart and submit a copy of the previous assessment. However, if there has been a change in
risk factors (e.g. elevated BMI, new atrial fibrillation, refractory hypertension, etc.), triage
using the flow chart to determine if the airman needs a repeat assessment.
6. If I mark the radio button (1-6) and have no concerns, do I still need to put notes in
Block 60 regarding the OSA triage?
Yes. It is only required for Group/Box 4 to document that education was given. However, it
may be useful to document the rationale for triage decisions, especially for Group/Box 2, 5,
and 6.
9. Does the FAA require a specific type of sleep study if one is warranted?
Yes. The FAA requires that the test be either a Type I laboratory polysomnography or a Type
II (7 channel) unattended home sleep test (HST) that provides comparable data and
standards to laboratory diagnostic testing. It does not have to be a chain of custody study.
10. What if the doctor or insurance provider is only willing to do a level III Home Sleep
Test (HST)?
In communities where a Level II HST is unavailable, the FAA will accept a level III HST. If
the HST is positive for OSA, no further testing is necessary and treatment in accordance with
the AASI must be followed. However, if the HST is equivocal, a higher level test such as an
in-lab sleep study will be needed unless a sleep medicine specialist determines no further
study is necessary and documents the rationale.
11. If I do the sleep evaluation and determine the airman needs a sleep study, as the AME,
can I interpret the sleep study?
The AME may only interpret the sleep study if he/she is a sleep medicine specialist.
12. If an airman is in Group/Box 5 (at risk for OSA) they have 90 days to comply with
getting an evaluation. Does the AME issue a time-limited, 90 day certificate?
No. Issue a regular (not time limited) certificate, if the airman is otherwise qualified. The
AME MAY NOT issue a time-limited certificate without an authorization from the FAA.
13. I evaluated the airman and triaged him into Group/ Box 5. He had a sleep study and is
doing well on CPAP treatment. Does he have to wait for a time-limited certificate
before he can return to flight duties?
No. Once the airman is compliant with and doing well on treatment, he has met the
requirements for 14 CFR 61.53. The airman may return to flight status with the current
certificate issued by the AME, PROVIDED that ALL the required information regarding OSA
evaluation and treatment has been submitted to the FAA for review.
14. Once the AME issues a regular certificate, who is responsible for keeping track of the
90 days?
The FAA will keep track of the 90 days.
15. The airman has a prior SI/AASI for OSA that only asks for a current status report. Can I
issue this year if he does not bring in any other information on the OSA?
Yes. The AME may issue this year based on the previous SI/AASI if those requirements were
met.
16. Can the airman continue to submit only a current status report until his current AASI
expires?
No. An airman currently on an SI/AASI for OSA will receive a new SI/AASI letter this year. At
that point, he/she will have to comply with the new documentation requirements.
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18. If I give the airman Specification Sheet A or B and he does not submit the required
evaluation within 90 days and after the 30 day extension (if requested), what will
happen?
The airman will receive a failure to provide (FTP) denial.
19. How long does an airman have to be on CPAP with a new diagnosis of OSA before
they can return to flying?
The airman may submit the completed compliance statement and required documents to the
FAA for review as soon as they are tolerating the therapy without difficulty and have no
symptoms of OSA.
20. The airman has mild or moderate sleep apnea. Is he required to use CPAP?
In most cases an AHI of 15 or more will require CPAP.
21. If the airman has a sleep study and is diagnosed with OSA does he/she get a new
certificate?
Yes. Once a diagnosis of OSA is established, a Special Issuance is required. When the
airman submits the required supporting documents to the FAA, he/she will be evaluated for a
Special Issuance.
22. If an airman has a previously unreported history of OSA being treated with CPAP, can
the AME issue?
Yes. Issue a regular certificate (Group/Box 2), if the airman is otherwise qualified, and
submit the required information for FAA decision.
23. What if the airman is high risk and has had a previous sleep study that was positive,
but not one of the approved tests? He is currently on CPAP and doing well. Does he
have to get a new sleep study?
Follow Group/Box 2 and submit the required information for FAA decision.
24. The airman had a sleep study in the past and did not have sleep apnea. It was not an
approved test type. Will he have to get another sleep study?
The AME should follow the triage flow chart. If the airman is determined to be Group/Box 5
or 6, he/she will need a sleep evaluation. If a sleep study is warranted, it will need to be an
approved test type (see FAQ #9). Submit the required information for FAA decision.
25. The airman has OSA and was on CPAP in the past. He has now lost weight and is only
on a dental device. What do I do now?
Follow Group/Box 2 and submit the required information for FAA decision.
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Berlin Questionnaire©
Category 1 Category 2
3. How often do you snore? 8. Have you ever nodded off or fallen asleep
□ a. Almost every day while driving a vehicle?
□ b. 3-4 times per week □ a. Yes
□ c. 1-2 times per week □ b. No
□ d. 1-2 times per month
□ e. Rarely or never If you answered ‘yes’:
4. Has your snoring ever bothered 9. How often does this occur?
other people? □ a. Almost every day
□ a. Yes □ b. 3-4 times per week
□ b. No □ c. 1-2 times per week
□ c. Don’t know □ d. 1-2 times per month
□ e. Rarely or never
Category 3 is positive if the answer to item 10 is ‘Yes’ or if the BMI of the patient is
greater than 30kg/m2.
(BMI is defined as weight (kg) divided by height (m) squared, i.e.., kg/m2).
High Risk: if there are 2 or more categories where the score is positive.
Low Risk: if there is only 1 or no categories where the score is positive.
The original version of the ESS was first published in 1991. However, it soon became clear that
some people did not answer all the questions, for whatever reason. They may not have had much
experience in some of the situations described in ESS items, and they may not have been able to
provide an accurate assessment of their dozing behaviour in those situations. However, if one
question is not answered, the whole questionnaire is invalid. It is not possible to interpolate
answers, and hence item-scores, for individual items. This meant that up to about 5 % of ESS
scores were invalid in some series.
In 1997, an extra sentence of instructions was added to the ESS, as follows:
‘‘It is important that you answer each question as best you can’.
With this exhortation, nearly everyone was able to give an estimate of their dozing behaviour in all
ESS situations. As a result, the frequency of invalid ESS scores because of missed item-
responses was reduced to much less than 1%.
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The 1997 version of the ESS is now the standard one for use in English or any other language. It is
available in pdf here.
Guide for Aviation Medical Examiners
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1. Snoring
Do you snore loudly (louder than talking or loud enough to be heard
through closed doors)?
Yes No
2. Tired
Do you often feel tired, fatigued, or sleepy during daytime?
Yes No
3. Observed - Has anyone observed you stop breathing during your sleep?
Yes No
4. Blood pressure
Do you have or are you being treated for high blood pressure?
Yes No
8. Gender – Male?
Yes No
* Neck circumference is measured by staff
Evaluating the risk of Obstructive Sleep Apnea (OSA) requires clinical judgment based on an
integrated assessment of history, symptoms, AND physical/clinical findings. If an AME
elects to perform the assessment for OSA, he/she must follow the American Academy of Sleep
Medicine guidelines.
After completing the assessment, if the diagnosis of OSA is not made, the AME must sign and
submit the AME Assessment Statement - OSA. If the AME confirms the presence of OSA, then
full clinical note with test results, if performed, must be submitted.
_____ (initial) I have performed an OSA assessment in accordance with AASM guidelines
and have determined that there is no evidence of OSA requiring treatment at this time. (If a
sleep study was performed it must be attached).
____________________________________________________________________
____________________________________________________________________
Address: ____________________________________________________________
PHYSICIAN
SIGNATURE________________________________________DATE____________
Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO BOX 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169
Guide for Aviation Medical Examiners
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PHARMACEUTICALS
Guide for Aviation Medical Examiners
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PHARMACEUTICAL MEDICATIONS
As an Examiner you are required to be aware of the regulations and Agency policy and have
a responsibility to inform airmen of the potential adverse effects of medications and to
counsel airmen regarding their use. There are numerous conditions that require the chronic
use of medications that do not compromise aviation safety and, therefore, are permissible.
Airmen who develop short-term, self-limited illnesses are best advised to avoid performing
aviation duties while medications are used.
The lists of medications in this section are not meant to be all-inclusive or comprehensive,
but rather address the most common concerns.
Do Not Issue. AMEs should not issue airmen medical certificates to applicants who are
using these medications. If there are any questions, please call the Regional Flight
Surgeon’s office or the Aerospace Medicine Certification Division.
• Anticholinergics (oral)
• Antiseizure medications, even if used for non-seizure conditions
• Centrally acting antihypertensives, including but not limited to clonidine, reserpine,
guanethidine, guanadrel, guanabenz, and methyldopa
• Bromocriptine
• Dopamine agonists used for Parkinson’s disease or other medical indications:
Pramipexole (Mirapex), ropinirole (Requip) and rotigotine (NeuPro). All carry
warnings for suddenly falling asleep during activities of daily living
• Mefloquine (Lariam)
• Over-active bladder medications. Almost all of these medications are antimuscarinic.
Antimuscarinic medications carry strong warnings about potential for sedation and
impaired cognition
• Varenicline (Chantix)
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Do Not Fly. Airmen should not fly while using any of the medications in the Do Not Issue
section above or using any of the medications or classes/groups of medications listed
below. All of these medications below may cause sedation (drowsiness) or impair cognitive
function, seriously degrading pilot performance. This impairment can occur even when the
individual feels alert and is apparently functioning normally – in other words, the airman can
be “unaware of impair.”
For aviation safety, airmen should not fly following the last dose of any of the
medications below until a period of time has elapsed equal to:
• 5-times the maximum pharmacologic half-life of the medication; or
• 5-times the maximum hour dose interval if pharmacologic half-life information is
not available. For example, there is a 30-hour wait time for a medication that is
taken every 4 to 6 hours (5 times 6)
Sleep aids. All the currently available sleep aids, both prescription and over-the-counter
(OTC), can cause impairment of mental processes and reaction times, even when the
individual feels fully awake.
• See wait times for currently available prescription sleep aids
• Diphenhydramine (e.g., Benadryl) - Many OTC sleep aids contain
diphenhydramine as the active ingredient. The wait time after diphenhydramine is
60 hours (based on maximum pharmacologic half- life).
Guide for Aviation Medical Examiners
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Label warnings. Airmen should not fly while using any medication, prescription or OTC,
that carries a label precaution or warning that it may cause drowsiness or advises the
user “be careful when driving a motor vehicle or operating machinery.” This
applies even if label states “until you know how the medication affects you” and even if
the airman has used the medication before with no apparent adverse effect. Such
medications can cause impairment even when the airman feels alert and unimpaired
(see “unaware of impair” above).
Narcotic pain relievers. This includes but is not limited to morphine, codeine,
oxycodone (Percodan; Oxycontin), and hydrocodone (Vicodin, etc.).
Muscle relaxants. This includes but is not limited to carisoprodol (Soma) and
cyclobenzaprine (Flexeril).
The list of medications referenced below provides aeromedical guidance about specific
medications or classes of pharmaceutical preparations and is applied by using sound
aeromedical clinical judgment. This list is not meant to be totally inclusive or comprehensive.
No independent interpretation of the FAA's position with respect to a medication included or
excluded from the following should be assumed.
ACNE MEDICATIONS
ALLERGY – Antihistamines
ALLERGY – Immunotherapy
ANTACIDS
ANTICOAGULANTS
ANTIDEPRESSANTS
ANTIHYPERTENSIVE
MALARIA MEDICATION
SEDATIVES
SLEEP AIDS
Guide for Aviation Medical Examiners
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ACNE MEDICATIONS
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.113(c)
Second-Class Airman Medical Certificate: 67.213(c)
Third-Class Airman Medical Certificate: 67.313(c)
Topical acne medications, such as Retin A, and oral antibiotics, such as tetracycline,
used for acne are acceptable if the applicant is otherwise qualified.
For applicants using oral isotretinoin (Accutane), there is a mandatory 2-week waiting
period after starting isotretinoin prior to consideration. This medication can be
associated with vision and psychiatric side effects of aeromedical concern -
specifically decreased night vision/ night blindness and depression. These side-
effects can occur even after cessation of isotretinoin. A report must be provided with
detailed, specific comment on presence or absence of psychiatric and vision side-
effects. The AME must document these findings in Block 60, Comments on History
and Findings. Some applicants will have to be deferred. For applicants issued, there
must be a “NOT VALID FOR NIGHT FLYING” restriction on the medical certificate. A
waiting period and detailed information is required to remove this restriction. The
restriction cannot be removed until all the requirements are met. See Pharmaceutical
Considerations below.
V. PHARMACEUTICAL CONSIDERATIONS:
ALLERGY – ANTIHISTAMINES
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.105(b)(c)
Second-Class Airman Medical Certificate: 67.205(b)(c)
Third-Class Airman Medical Certificate: 67.305(b)(c)
Also, see Aerospace Medical Disposition table and Item 35, Lungs and Chest
V. PHARMACEUTICAL CONSIDERATIONS:
For hay fever requiring antihistamines:
• The nonsedating antihistamines loratadine, desloratadine, and fexofenadine may be
used while flying if, after an adequate initial “trial period,” symptoms are controlled
without adverse side effects.
• Applicants with seasonal allergies requiring any other antihistamine (oral and/or nasal)
may be certified by the examiner only as follows:
• With the stipulation that they do not exercise the privileges of airman
certificate while taking the medication, AND
• Wait after the last dose until either:
o At least five maximal dosing intervals* have passed. For example, if the
medication is taken every 4-6 hours, wait 30 hours (5x6) after the last dose
to fly, or,
o At least five times the maximum terminal elimination half-life has passed.
For example, if the medication half-life* is 6-8 hours, wait 40 hours (5x8)
after the last dose to fly.
• For hay fever controlled by Desensitization, AME must warn airman to not operate
aircraft until four hours after each injection.
• Airmen who are exhibiting symptoms, regardless of the treatment used, must not
fly.
In all situations, the examiner must notate the evaluation data in Block 60
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ALLERGY - IMMUNOTHERAPY
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.105(b)(c)
Second-Class Airman Medical Certificate: 67.205(b)(c)
Third-Class Airman Medical Certificate: 67.305(b)(c)
Also, see Aerospace Medical Disposition table and Item 35, Lungs and Chest
V. PHARMACEUTICAL CONSIDERATIONS
• For conditions controlled by desensitization, AME must warn the airman to not
operate aircraft until four hours after each injection.
• Sublingual immunotherapy (SLIT) used for allergic rhinitis is not acceptable
Guide for Aviation Medical Examiners
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ANTACIDS
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)
V. PHARMACEUTICAL CONSIDERATIONS
The prophylactic use of medications including simple antacids, H-2 inhibitors or
blockers, proton pump inhibitors, and/or sucralfates may not be disqualifying, if free
from side effects.
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ANTICOAGULANTS
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)
IV. PROTOCOL: As per the specific underlying condition(s), see Disease Protocols
V. PHARMACEUTICAL CONSIDERATIONS
For applicants who are just beginning warfarin (Coumadin) treatment the following is
required:
• Minimum observation time of 6 weeks after initiation of warfarin therapy;
• Must also meet any required observation time for the underlying condition; AND
• 6 INRs, no more frequently than 1 per week
For applicants who are on an established use of warfarin (Coumadin), status report
from the treating physician should address and include:
• Drug dose history and schedule;
• Comment regarding side effects; AND
• A minimum of monthly International Normalized Ratio (INRs) results for the
immediate prior 6 months.
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ANTIDEPRESSANTS
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.107
Second-Class Airman Medical Certificate: 67.207
Third-Class Airman Medical Certificate: 67.307
II. MEDICAL HISTORY: Item 18.m., Mental disorders of any sort; depression, anxiety,
etc.
V. PHARMACEUTICAL CONSIDERATIONS
The use of a psychotropic drug is disqualifying for aeromedical certification purposes –
this includes all antidepressant drugs, including selective serotonin reuptake inhibitors
(SSRIs). However, the FAA has determined that airmen requesting first, second, or
third class medical certificates while being treated with one of four specific SSRIs may
be considered (see Item 47., Psychiatric Conditions – Use of Antidepressant
Medications). The Authorization decision is made on a case-by-case basis. The
Examiner may not issue.
Guide for Aviation Medical Examiners
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ANTIHYPERTENSIVE
(Updated 10/28/15)
V. PHARMACEUTICAL CONSIDERATIONS
• Seven-day (7) no fly/ground trial is required when starting a new hypertension
(HTN) medication to verify no side effects.
• AME should issue (if otherwise qualified) if the airmen is on 3 or fewer
medications
• Uses of beta-adrenergic blockers ARE allowed with insulin, meglitinides, or
sulfonylureas.
CONTRACEPTIVES AND
HORMONE REPLACEMENT THERAPY
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)
V. PHARMACEUTICAL CONSIDERATIONS
• Insulin pumps are an acceptable form of treatment.
• Combinations of anti-diabetes medication (s): The chart of Acceptable
Combinations of Diabetes Medications (pdf) summarizes the acceptable
medications for both monotherapy and combination therapy. The chart
organizes medications into groups based on similarity of mechanisms of actions
and/or therapeutic effects.
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PRECAUTIONS
Biguanide
- Metformin (e.g. Glucophage, Group A
Fortamet, Glutetza, Riomet)
Thiazolidinediones (TZD)
- pioglitazone (Actos) Group B
- rosiglitazone (Avandia)
GLP-1 mimetics
- Dulaglutide (Trulicity)
- exenatide (Byetta)
- exenatide-ED (Bydureon)
- liraglutide (Victoza)
Group C Group C not allowed
with Meglitinides
DPP-4 inhibitors
- sitagliptin (Januvia)
- saxagliptin (Onglyza)
- linagliptin (Tradjenta)
- alogliptin (Nesina)
Alpha-glucosidase inhibitors
- acarbose (Precose) Group D
- miglitol (Glyset)
Sulfonylureas (SFU)
- chlorpropamide (Diabenase)
- glyburide (Diabeta)
- glimepiride (Amaryl)
- glipizide (Glucotrol)
- tolbutamide (Orinase)
- tolazamide (Tolinase)
Group E
Meglitinides
- repaglinide (Prandin)
Meglitinides not
- nateglinide (Starlix)
allowed with Group C
Insulin
- All forms
- Initial certification requires FAA
decision
Note: Amylinomimetics (e.g., pramlintide (Symlin) are not considered acceptable for medical certification.
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II. MEDICAL HISTORY: Use of medication for erectile dysfunction (ED) and/or benign
prostatic hyperplasia (BPH) may not be disqualifying for medical certification if there
are no side effects, the underlying condition is not aeromedically significant, and the
applicant is otherwise qualified. If the medication is used for any other condition, do
not issue – FAA approval is required.
If the medications below are used for any other non G-U condition (e.g.,
pulmonary arterial hypertension [PAH]) the examiner must defer issuance of a
medical certificate.
• Alpha blockers are allowed for daily use if there no side effects. No minimum wait time
is required after use once the airman has successfully passed the 7-day ground trial
period required for all hypertension medication.
• If alpha blockers are used in combination with PDE5 inhibitors (common examples are
listed below), the airman should not fly until verification that no hypotensive episodes or
other side effects are noted.
• Nitrates are not allowed.
GLAUCOMA MEDICATIONS
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213 (b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)
II. MEDICAL HISTORY: Item 18.,d, Medical History, Eye or vision trouble except
glasses.
The applicant should provide history and treatment, pertinent medical records, current
status report, and medication and dosage.
V. PHARMACEUTICAL CONSIDERATIONS
A few applicants have been certified following their demonstration of adequate control
with oral medication. Neither miotics nor mydriatics are necessarily medically
disqualifying. However, miotics such as pilocarpine cause pupillary constriction and
could conceivably interfere with night vision.
Although the FAA no longer routinely prohibits pilots who use such medications from
flying at night, it may be worthwhile for the Examiner to discuss this aspect of the use
of miotics with applicants. If considerable disturbance in night vision is documented,
the FAA may limit the medical certificate: NOT VALID FOR NIGHT FLYING.
Guide for Aviation Medical Examiners
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MALARIA MEDICATIONS
(Updated 4/27/16)
V. PHARMACEUTICAL CONSIDERATIONS:
• Use of mefloquine must be discontinued for at least 4 weeks prior to
consideration and:
• The airman must contact the FAA agency flight surgeon or their AME before
resuming pilot duties
• For return to pilot duties there must be no history of neurologic or psychiatric
symptoms during and or after mefloquine use
Guide for Aviation Medical Examiners
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SEDATIVES
I. CODE OF FEDERAL REGULATIONS
First-Class Airman Medical Certificate: 67.107
Second-Class Airman Medical Certificate: 67.207
Third-Class Airman Medical Certificate: 67.307
"Substance" includes alcohol and other drugs (e.g., PCP, sedatives and hypnotics,
anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other
psychoactive drugs or chemicals). For a "yes" answer to Item 18.n., the Examiner
should obtain a detailed description of the history. A history of substance dependence
or abuse is disqualifying. The Examiner must defer issuance of a certificate if there is
doubt concerning an applicant's substance use.
The events to be reported are specifically identified in Item 18.v. of FAA Form 8500-8.
If "yes" is checked, the applicant must describe the conviction(s) and/or administrative
action(s) in the EXPLANATIONS box. The description must include:
• The alcohol or drug offense for which the applicant was convicted or the type of
administrative action involved (e.g., attendance at an educational or
rehabilitation program in lieu of conviction; license denial, suspension,
cancellation, or revocation for refusal to be tested; educational safe driving
program for multiple speeding convictions; etc.);
• The name of the state or other jurisdiction involved; and
• The date of the conviction and/or administrative action
If there have been no new convictions or administrative actions since the last
application, the applicant may enter "PREVIOUSLY REPORTED, NO CHANGE."
Convictions and/or administrative actions affecting driving privileges may raise
questions about the applicant's fitness for certification and may be cause for
disqualification.
NOTE: The Examiner should advise the applicant that the reporting of alcohol or drug offenses
(i.e., motor vehicle violation) on the history part of the medical application does not relieve the
airman of responsibility to report each motor vehicle action to the FAA within 60 days of the
occurrence to the Civil Aviation Security Division, AAC-700; P.O. Box 25810; Oklahoma City,
OK 73125-0810.
V. PHARMACEUTICAL CONSIDERATIONS
SLEEP AIDS
(Updated 4/27/16)
II. MEDICAL HISTORY: Use of sleep aids is a potential risk to aviation safety due to
effects of the sleep aid itself or the underlying reason/condition for using the sleep aid.
All the currently available sleep aids, both prescription and over the counter, can cause
impairment of mental processes and reaction times, even when the individual feels fully
awake. (As examples, see the Food and Drug Administration drug safety
communications on zolpidem and eszopiclone)
Medical conditions that chronically interfere with sleep are disqualifying regardless of
whether a sleep aid is used or not. Examples may include primary sleep disorders
(e.g., insomnia, sleep apnea) or psychological disorders (e.g., anxiety, depression).
While sleep aids may be appropriate and effective for short term symptomatic relief,
the primary concern should be the diagnosis, treatment, and resolution of the
underlying condition before clearance for aviation duties.
Occasional or limited use of sleep aids, such as for circadian rhythm disruption in
commercial air operations, is allowable for pilots. Daily/nightly use of sleep aids is not
allowed regardless of the underlying cause or reason. See Pharmaceutical
Considerations below.
V. PHARMACEUTICAL CONSIDERATIONS:
Because of the potential for impairment, we require a minimum wait time between the
last dose of a sleep aid and performing pilot duties. This wait time is based on the
pharmacologic elimination half-life of the drug (half-life is the time it takes to clear half
of the absorbed dose from the body). The minimum required wait time after the last
dose of a sleep aid is 5-times the maximum elimination half-life.
The table on the following page lists several commonly prescribed sleep aids along
with the required minimum wait times for each.
Guide for Aviation Medical Examiners
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* NOTE: The different formulations of zolpidem have different half-lives, thus different wait times.
Guide for Aviation Medical Examiners
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SPECIAL ISSUANCES
AASI COVERSHEET
A. Special Issuance.
At his discretion, the Federal Air Surgeon may grant an Authorization for Special
Issuance of a Medical Certificate (Authorization), with a specified validity period, to an
applicant who does not meet the established medical standards. The applicant must
demonstrate to the satisfaction of the Federal Air Surgeon that the duties authorized by
the class of medical certificate applied for can be performed without endangering public
safety for the validity period of the Authorization. The Federal Air Surgeon may
authorize a special medical flight test, practical test, or medical evaluation for this
purpose. An airman medical certificate issued under the provisions of an Authorization
expires no later than the Authorization expiration date or upon its withdrawal. An
airman must again show to the satisfaction of the Federal Air Surgeon that the duties
authorized by the class of medical certificate applied for can be performed without
endangering public safety in order to obtain a new airman medical
certificate/Authorization under Title 14 of the Code of Federal Regulations (14 CFR)
§67.401.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. Examiners may re-issue an airman medical certificate
under the provisions of an Authorization, if the applicant provides the requisite medical
information required for determination. Examiners may not issue initial Authorizations.
An Examiner's decision or determination is subject to review by the FAA
The Guide refers to a number of selected medical conditions that are initially
disqualifying (if the applicant does not meet the issue criteria in the Aerospace
Medicine Dispositions Tables or the Certification Worksheets) and must be deferred to
the AMCD or RFS. If this is a first-time application for an AASI for a disqualifying
disease/condition, and the applicant has all of the requisite medical information
necessary for a determination, the Examiner must defer, and submit all of the
documentation to the AMCD or your RFS.
ASTHMA HEPATITIS C
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments which specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
If the applicant does not meet the above criteria, the Examiner must follow the AASI process.
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition
that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments
that specify the information that treating physician(s) must provide for the re-issuance
determination. If this is a first-time application for an AASI for the above disease/condition, and
the applicant has all the requisite medical information necessary for a determination, the
Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial
determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization,
if the applicant provides the following:
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability
to re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
AASI FOR
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability
to re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition and the applicant has all the required medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
• More than 20 percent of INR values are <2.0 or >3.0 for those being treated with
warfarin (Coumadin); or
• The applicant develops emboli, thrombosis, bleeding that required medical
intervention, or any other cardiac or neurologic condition previously not
diagnosed or reported.
An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that
specify the information that treating physician(s) must provide for the re-issuance determination.
If this is a first-time application for an AASI for the above disease/condition, and the applicant
has all the requisite medical information necessary for a determination, the Examiner must defer
and submit all of the documentation to the AMCD or RFS for the initial determination. The
information can be submitted using the DIABETES or HYPERGLYCEMIA ON ORAL
MEDICATIONS STATUS REPORT.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization,
provided that the applicant does not require insulin, remains on an acceptable oral
medication therapy according to the chart Acceptable Combinations of Diabetes
Medications, and if the applicant provides the following:
• An Authorization granted by the FAA AND either
• A DIABETES or HYPERGLYCEMIA ON ORAL MEDICATIONS STATUS
REPORT OR
• A current status report from the physician treating the airman’s diabetes,
including:
o A statement attesting that the airman is maintaining his or her diabetic
diet;
o A statement regarding any diabetic symptomatology; including any history
of hypoglycemic events and any cardiovascular, renal, neurologic, or
ophthalmologic complications; and
o The results of a current HgA1c level performed within last 30 days.
The Examiner must defer to the AMCD or Region if, since the applicant’s last exam:
• The applicant has been placed on insulin;
• The HgA1c level is greater than 9.0 mg%
• The applicant has experienced:
o Severe Hypoglycemia event(s) - requiring assistance of another person to
actively administer carbohydrates, glucagon, or take other corrective
actions (plasma glucose concentrations may not be available)*;
o Documented Symptomatic Hypoglycemia event(s) - typical symptoms of
hypoglycemia accompanied by a measured plasma glucose concentration
≤70 mg/dL (≤3.9 mmol/L)*;
o Asymptomatic Hypoglycemia – no reported symptoms but a measured
plasma glucose concentration ≤54 mg/dL (≤3.0 mmol/L)
• The applicant has developed evidence of any of the following:
o Cardiovascular disease,
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
• The FAA Form 8500-14 Glaucoma Eye Evaluation Form demonstrates visual
acuity incompatible with the medical standards; or
• There is a change in visual fields or adverse change in ocular pressure.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability
to re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
• The condition is not stable or has become uncontrolled (per the treating physician
note);
• The airman is taking a medication that is not acceptable (See Pharmaceuticals –
Antihypertensive);
• The airman has aeromedically significant side effects from the medication;
• There is a new co-morbid condition, complication, or end organ damage; or
• The end organ damage condition(s) do not meet FAA requirements. (See the
applicable section for the specific condition(s) in the AME guide)
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
• An Authorization granted by the FAA current statement of the condition since last
FAA medical examination;
• The name and dosage of medication(s) used for treatment and/or prevention with
comment regarding side effects; and
• Current thyroid function studies performed within last 90 days.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
Note:
• A Special Issuance or AASI is required for any metastatic melanoma regardless of Breslow
level.
• A Special Issuance or AASI is required for any melanoma which exhibits Breslow Level equal to
or deeper than 0.75 mm with or without metastasis.
• A melanoma that exhibits a Breslow Level of less than 0.75 mm and no evidence of metastasis
may be regular issued.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
• The frequency of headaches and/or other symptoms increase since the last
followup report; or
• The applicant is placed on medication(s), such as isometheptene mucate,
narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
• If the treating physician comments that the current stone has a likelihood of
becoming symptomatic;
• If the retained stone(s) has moved when compared to previous evaluations; or
• If the stone(s) has become larger when compared to previous evaluations.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
Examiners may re-issue an airman medical certificate to airmen currently on an AASI for OSA
if the airman provides the following:
o For Surgery:
For successfully treated surgical patients, a statement attesting to the continued
absence of OSA symptoms is required.
Note: The Examiner may request AMCD review to discontinue the AASI if there are
indications that the airman no longer has OSA (e.g., significant weight loss and a
negative study or surgical intervention followed by 3 years of symptom abatement and
absence of significant weight gain or co-morbid conditions). In most cases, a follow-
up sleep study will be required to remove the AASI.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.
The AASI’s listed below are presently restricted to the issue of a third-class airman
medical certificate.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI or the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the Examiner must defer and submit all of the documentation to
the AMCD or RFS for the initial determination.
For Third-class:
• Angina Pectoris
• Atherectomy
• Brachytherapy
• Coronary Bypass Grafting
• Myocardial Infarction
• Percutaneous Transluminal Angioplasty (PTCA)
• Rotoblation
• Stent Insertion
Valve Replacement
The FAA physicians provide the initial certification decision and grant the Authorization for
Special Issuance of a Medical Certificate (Authorization) in accordance with 14 CFR § 67.401.
The Authorization letter is accompanied by attachments that specify the information that
treating physician(s) must provide for the issuance determination. If this is first-time
application for an AASI for the above disease/condition, and the airman has all the requisite
medical information necessary for a determination, you must defer and submit all of the
documentation to the AMCD or your RFS for the initial determination.
Examiners may reissue an airman medical certificate if the applicant provides the following:
• The applicant complains of chest pain at any time (exclude chest pain with a firm
diagnosis of non-cardiac causes of chest pain);
• The applicant has another event (myocardial infarction, or restenosis requiring CABG,
atherectomy, brachytherapy, PTCA, or stent);
• The applicant for whatever reason is placed on a long acting nitrate;
• The applicant’s risk factors are inadequately controlled; or
• Has any reason for not renewing an AASI – See GXT Protocol; or
• The applicant develops bleeding that required medical intervention or other cardiac
condition not previously diagnosed or reported.
I have issued a -class medical certificate to the airman named below with all other limitations listed on the original
certificate. The certificate issued is timed limited by the restriction “NOT VALID FOR ANY CLASS AFTER ____________”
Date
Check all that apply:
Interim certificate issued for disease(s)/condition(s) below – No examination performed.
ALL AASI CONDITION ALL AASI CONDITION ALL AASI CONDITION
Arthritis Diabetes Mellitus – Type II Mitral and Aortic
Medication Controlled Insufficiency
Asthma Metabolic Syndrome, Glucose Paroxysmal Atrial
Intolerance, Impaired Glucose Tachycardia
Tolerance, Impaired Fasting
Glucose, Insulin Resistance, and
Pre-Diabetes
Atrial Fibrillation Glaucoma Prostate Cancer
Colitis Melanoma
(Ulcerative or Crohn’s)
Colon Cancer Migraine Headaches
THIRD AASI CONDITION THIRD
CLASS CLASS
ONLY ONLY
Coronary Heart Disease (CHD)
AIRMAN INFORMATION:
Name:
PI: DOB:
AME Signature:
SUBSTANCES OF DEPENDENCE/ABUSE
Substances of Dependence/Abuse
As an Examiner you are required to be aware of the regulations and Agency policy and have a
responsibility to inform airmen of the potential adverse effects of medications and to counsel airmen
regarding their use. There are numerous conditions that require the chronic use of medications that
do not compromise aviation safety and, therefore, are permissible. Airmen who develop short-term,
self-limited illnesses are best advised to avoid performing aviation duties while medications are
used.
Therefore, the list of medications referenced provides aeromedical guidance about specific
medications or classes of pharmaceutical preparations and is applied by using sound aeromedical
clinical judgment. This list is not meant to be totally inclusive or comprehensive. No independent
interpretation of the FAA's position with respect to a medication included or excluded from the
following should be assumed. See Aviation Industry Antidrug and Alcohol Misuse Prevention
Programs
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1. HIMS AME FACE-TO-FACE, IN OFFICE EVALUATION: Required EVERY 6 months for ALL CLASSES
No Yes
Any concerns that the airman is not successfully engaged in a continued abstinence-based recovery program
or is not working a good program based on your clinical interview/evaluation and review of reports? ……..…...
• Interval evaluations (every 3 months or as required by Authorization Letter) were unfavorable?........
• Any evidence or concern the airman has not remained abstinent?………………………………………
• Any positive drug or alcohol tests since last HIMS evaluation? ………………………………………….
• Any evidence of noncompliance or concern the airman is not working a good recovery program?.…
• Any NEW condition(s) that would require Special Issuance? (Do not include any new CACI
qualified condition.).…………………………………………………………………………………………....
Items 3 - 5: The AME should review. Do not submit these items (3-5) to the FAA unless concerns are noted.
st nd rd
3. AFTERCARE COUNSELOR REPORTS: For 1 and 2 class: Required every 3 months; 3 class: Per
Authorization Letter. N/A Yes No
• Show continued participation and abstinence-based sobriety? ………………………………......
4. CHIEF PILOT REPORT(S): Required monthly for commercial pilots holding first- or second-class N/A Yes No
certificates (N/A for third-class):
• Report(s) is/are favorable? ………………………………………………………………………......
5. PEER PILOT REPORTS: Required monthly for commercial pilots holding first- or second-class
certificates (N/A for third-class): N/A Yes No
• Report(s) is/are favorable with continued total abstinence? …………………………………….
6. ADDITIONAL REPORTS: Required ONLY when specified by the Authorization letter N/A Yes No
• HIMS related (AA attendance, therapy reports, etc.) are favorable and meet authorization
requirements…………………………………………………………………………………………..
• Reports required for other non-HIMS conditions all meet Authorization requirements……....
Yes No
7. I have no other concerns about this airman and recommend re-certification for Special Issuance. ………….
_________________________________________ ___________________________________
HIMS AME Signature Date of Evaluation
If ALL items fall into the clear column, the AME may issue with the time limitation specified in the Authorization letter.
If ANY SINGLE ITEM falls into the SHADED COLUMN, the AME MUST DEFER or contact the FAA for guidance AND EXPLAIN
in the HIMS evaluation report.
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The following information is to assist your treating physician/provider who may be unfamiliar with FAA medical
certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on
an airman medical certificate. You should strongly consider taking a copy to each evaluator so they understand what
specific information is needed in their report to the FAA. If each item is not addressed by the corresponding
provider there may be a delay in the processing of your medical certification until that information is submitted.
Additional information such as clinic notes or explanations should also be submitted as needed. All reports must be
CURRENT (within the last 90 days) for FAA purposes.
DRUG OR Every 6 months or per 1. Must be random, unannounced drug/alcohol testing. (Urine EtG/EtS, PEth testing or a mobile alcohol
ALCOHOL Authorization Letter monitoring system are preferred.)
TESTING 2. At a minimum, frequency must be 14 tests over a 12-month period (can be more frequent at AME
discretion).
3. Must state if the testing is performed by:
HIMS AME
Air Carrier testing program/office. Air Carrier must immediately notify the HIMS AME of any
positive test
HIMS AME may require additional testing to supplement the testing conducted by the Air
Carrier.
Other, such as return to duty testing from a substance abuse professional or a DOT/FAA drug
abatement program.
4. HIMS AME must immediately report any positive test to the FAA.
PSYCHIATRIST Every 12 months or per 1. Summarize clinical findings and status of how the airman is doing.
HISTORY Authorization Letter 2. Note any clinical concerns or changes in treatment plan.
REPORT 3. Recommendations for any additional treatment or monitoring, if applicable.
4. Agreement to immediately notify the FAA or AME (at 405-954-4821) if there are any changes in the
airman’s condition.
5. Interval treatment records if any, such as clinic or hospital notes, should also be submitted.
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The following information is to assist your treating physician/provider who may be unfamiliar with FAA medical
certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on
an airman medical certificate. You should strongly consider taking a copy to each evaluator so they understand what
specific information is needed in their report to the FAA. If each item is not addressed by the corresponding
provider there may be a delay in the processing of your medical certification until that information is submitted.
Additional information such as clinic notes or explanations should also be submitted as needed. All reports must be
CURRENT (within the last 90 days) for FAA purposes.
GROUP 1st and 2nd class: Every Progress report should include:
AFTERCARE 3 months or per 1. If the airman is continuing to participate in abstinence-based sobriety.
COUNSELOR Authorization Letter 2. How often the airman attends (weekly or per Authorization Letter).
3. Agreement to immediately notify the HIMS AME if there are any changes or deterioration in the airman’s
3rd class: As required condition.
(ex: AA meeting) per Authorization Letter
CHIEF PILOT, 1st and 2nd class: Every Monthly reports must address:
FLIGHT month (bring cumulative 1. The airman’s performance and competence.
OPERATION reports to HIMS AME 2. Crew interaction.
evaluation every 6 3. Mood (if available).
SUPERVISOR,
months.) 4. Presence or absence of any other concerns.
OR AIRLINE
MANAGEMENT 3rd class: Not applicable
DESIGNEE
If the airman is
1st or 2nd class
and employed
by an air carrier
PEER PILOT 1st and 2nd class: Every Must attest to the best of their knowledge, the airman’s continued total abstinence from drugs or alcohol.
month (bring cumulative
(Ex: from reports to HIMS AME
evaluation every 6
employer, ALPA, months.)
etc.)
3rd class: Not applicable
ADDITIONAL Every 6 months or per Varies. See the airman’s Authorization Letter. Include any applicable psychotherapy notes, therapist follow up
PROVIDERS Authorization Letter reports, social worker reports, AA sponsor contact, etc.
If the airman has other non-SSRI conditions that require a special issuance, those reports should also be
Additional
submitted according to the Authorization Letter.
reports for HIMS
or any other
condition noted
in Authorization
Letter
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Substances of Dependence/Abuse
Medical History: Item 18.n., Substance dependence; or failed a drug test ever; or substance abuse
or use of illegal substance in the last 2 years.
"Substance" includes alcohol and other drugs (e.g., PCP, sedatives and hypnotics, anxiolytics,
marijuana, cocaine, opioids, amphetamines, hallucinogens, and other psychoactive drugs or
chemicals). For a "yes" answer to Item 18.n., the Examiner should obtain a detailed description of
the history. A history of substance dependence or abuse is disqualifying. The Examiner must defer
issuance of a certificate if there is doubt concerning an applicant's substance use.
Convictions or Administrative Actions: Item 18.v., Conviction and/or Administrative Action History
The events to be reported are specifically identified in Item 18.v. of FAA Form 8500-8. If "yes" is
checked, the applicant must describe the conviction(s) and/or administrative action(s) in the
EXPLANATIONS box. The description must include:
• The alcohol or drug offense for which the applicant was convicted or the type of administrative
action involved (e.g., attendance at an educational or rehabilitation program in lieu of
conviction; license denial, suspension, cancellation, or revocation for refusal to be tested;
educational safe driving program for multiple speeding convictions; etc.);
• The name of the state or other jurisdiction involved; and
• The date of the conviction and/or administrative action
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If there have been no new convictions or administrative actions since the last application, the
applicant may enter "PREVIOUSLY REPORTED, NO CHANGE." Convictions and/or administrative
actions affecting driving privileges may raise questions about the applicant's fitness for certification
and may be cause for disqualification.
A single driving while intoxicated (DWI) conviction or administrative action usually is not cause for
denial if there are no other instances or indications of substance dependence or abuse. The
Examiner should inquire regarding the applicant's alcohol use history, the circumstances surrounding
the incident, and document those findings in Item 60.
NOTE: The Examiner should advise the applicant that the reporting of alcohol or drug offenses (i.e., motor
vehicle violation) on the history part of the medical application does not relieve the airman of responsibility to
report each motor vehicle action to the FAA within 60 days of the occurrence to the Civil Aviation Security
Division, AAC-700; P.O. Box 25810; Oklahoma City, OK 73125-0810.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 47., Psychiatric, Aerospace Medical
Disposition table.
IV. PROTOCOL: See Substances of Dependence/Abuse Protocol . For specification guidelines, see
Substance of Dependence/Abuse (Drugs and Alcohol) Specification Evaluation.
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Medical
Certificate First-Class Second-Class Third-Class
Pilot Type Airline Transport Pilot Commercial Pilot Private Pilot
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As of April 1, 2016, AMEs are no longer able to issue the combined FAA Medical Certificate and
Student Pilot Certificate. Student Pilots must have a separate Student Pilot Certificate and a separate
FAA Medical Certificate.
This change is due to a new Final Rule published on 01/12/16 [81 FR 1292]. It is in response to section
4012 of the Intelligence Reform and Terrorism Prevention Act and facilitates security vetting by the
Transportation Security Administration (TSA) of student pilot applicants prior to certificate issuance.
The airman, student pilot airman, and non-FAA Air Traffic Control Specialist will continue to require a
medical exam issued by an AME.
The student pilot will need a valid medical certificate prior to solo flight.
What has changed for the AME regarding the MEDICAL CERTIFICATE?
• Age Requirement:
There is no age requirement for a medical certificate. The exam should be timed so that the
medical certificate is valid at the time of solo flight.
• English Proficiency:
There is no language requirement for medical certification. However, if the AME has concerns
about the applicant’s English proficiency, they should contact their local FSDO and/or the RFS
and document this in Block 60. See General Information - Who May Be Certified, Language
Requirements.
• Transmittal time:
The AME has 14 days to transmit exams. The previous requirement to transmit student exams
within 7 days no longer applies.
The student pilot certificate will now be issued by a Flight Standards District Office (FSDO), an FAA-
designated pilot examiner, an airman certification representative associated with a part 141 flight
school, or a certificated flight instructor (CFI).
• See FAQs for AMEs. A description of the changes can be found in the Advisory Circular/AC 61-65F.
• Resident and US citizen student pilots follow Student Pilot’s Certificate Requirements.
• Foreign student pilots (non-resident) follow the Alien Flight Student Program.
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GLOSSARY
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GLOSSARY/ACRONYMS
AAM - Office of Aerospace Medicine
AASI - AME Assisted Special Issuance - Criteria under which an Examiner may reissue a
medical certificate for a third-class applicant with a medical history of a disqualifying condition,
who has already received a Special Issuance Authorization from the FAA, and criteria to defer
issuance to AMCD or RFS for these situations.
AMCD - Aerospace Medical Certification Division - located at the Civil Aerospace Medical
Institute in Oklahoma City, Oklahoma
AMCS - Airman Medical Certification System - allows the AME to electronically submit FAA
Form 8500-8, Application for Airman Medical Certificate to AMCD.
AME - Aviation Medical Examiner - a physician designated by the FAA and given the
authority to perform airman physical examinations for issuance of second- and third-
class medical certificates. (NOTE: Senior Examiners perform first-class airman
examinations).
AV - Atrioventricular
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ECG - Electrocardiogram
PT - Prothrombin Time
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US -Ultrasound
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(condition). I have
deferred.
3. Medical Policy In Disease Protocols,
Obstructive Sleep Apnea,
Reference Materials, revise
Specification Sheet B to include
bullet: “In communities where a
Level II HST is unavailable, the
FAA will accept a level III HST.
If the HST is positive for OSA,
no further testing is necessary
and treatment in accordance
with the AASI must be followed.
However, if the HST is
equivocal, a higher level test
such as an in-lab sleep study
will be needed unless a sleep
medicine specialist determines
no further study is necessary
and documents the rationale.”
4. Medical Policy In Disease Protocols, Protocol
for History of Diabetes Mellitus
Type II Medication – Controlled
(Non Insulin), Protocol for
Metabolic Syndrome, and CACI
– Pre Diabetes, revise to add
14 day wait period for use of
Metformin only. (Any other
single diabetes medication
requires a 60-day wait period.)
Protocols – Thromboembolic
Disease, revise to policy
include required wait time after
initial start of warfarin
(Coumadin) treatment.
2014 01/16/2014 1. Medical Policy In Equipment Requirements
and Item 52. Color Vision,
remove APT-5 Color Vision
Tester.
2 Medical Policy In Pharmaceuticals
(Therapeutic Medications), add
new “Do Not Issue-Do Not Fly”
section.
2014 01/01/2014 1. Administrative Revise cover page to reflect the
current calendar year.
2013 12/23/2013 1. Administrative In Pharmaceutical (Therapeutic
Medications), Sleep Aids, add a
link for FDA studies.
2. In Examination Techniques,
Item 43. Spine and Other
Musculoskeletal, revise
dispositions table for Arthritis.
Introduce Arthritis Worksheet
with certification criteria under
which the AME can regular
issue.
3. In Examination Techniques,
Item 41. G-U System –
Neoplastic Disorders, revise
dispositions table for Prostatic,
Renal, and Testicular
Carcinomas. Introduce Renal
Cancer Worksheet with
certification criteria under which
the AME can regular issue.
4. In Examination Techniques,
Items 31 - 34. Eye, revise
Examination techniques and
dispositions table for
Glaucoma. Introduce
Glaucoma Worksheet with
certification criteria under which
the AME can regular issue.
5. In Examination Techniques,
Items 38. Abdomen and
Viscera, revise dispositions
table for Hepatitis C - Chronic.
Introduce Hepatitis C – Chronic
Controlled.
13. In Disease Protocols, revise
title of Medication Controlled
Diabetes Mellitus - Type II.
Change name to Diabetes
Mellitus Type II – Medication
Controlled (Non Insulin). Also,
in Pharmaceuticals section,
revise name of protocol link to
reflect title change.
14. In Disease Protocols, revise
title of Insulin Treated Diabetes
Mellitus - Type I or Type II.
Change title to Diabetes
Mellitus Type I or Type II –
Insulin Treated. Also, in
Pharmaceuticals section, revise
name of protocol link to reflect
title change.
15. In Pharmaceuticals,
Antihypertensives, change
name of protocol link from
Hypertension Protocol to
Hypertension Worksheet.
16. In AME Assisted Special
Issuance (AASI), delete AASI
for Metabolic Syndrome,
Glucose Intolerance, Impaired
Glucose Tolerance, Impaired
Fasting Glucose, Insulin
Resistance, and Pre-Diabetes.
2013 03/05/13 1. Medical Policy In Disease Protocols, add
Specifications for
Neuropsychological
Evaluations for ADHD/ADD.
2. Medical Policy In Disease Protocols, add
Specifications for
Neuropsychological
Evaluations for Treatment with
SSRI Medications.
3. Medical Policy In Disease Protocols, add
Specifications for
Neuropsychological
Evaluations for Potential
Neurocognitive Impairment.
4. Medical Policy In Disease Protocols, add
Specifications for Psychiatric
Evaluations.
Equipment Requirements,
revise to include equipment to
measure height and weight.
2011 09/12/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions – Use of
Antidepressants, include SSRI
Specification Sheet for
guidance.
2. Medical Policy In Pharmaceuticals,
Antidepressants, revise to
clarify medical history, protocol,
and pharmaceutical
considerations.
3. Administrative In Table of Contents, renumber
entries listed on pages iii and
iv.
2011 08/12/11 1. Medical Policy In Special Issuances, Third-
Class AME Assisted – Valve
Replacement, revise to include
additional criteria for deferral
(“the applicant develops emboli,
thrombosis, etc.”).
2. Medical Policy In Special Issuances, AME
Assisted – All Classes – Atrial
Fibrillation, revise to include
additional criteria for deferral
(“bleeding that required medical
intervention”).
3. Medical Policy In Special Issuances, AME
Assisted – All Classes –
Warfarin (Coumadin) Therapy
for Deep Venous Thrombosis
(DVT), Pulmonary Embolism
(PE), and/ or
Hypercouagulopathies, revise
to include additional criteria for
deferral (“bleeding that required
medical intervention”).
4. Medical Policy In Special Issuances, Third-
Class AME Assisted –
Coronary Heart Disease, revise
to include additional criteria for
deferral (“bleeding that required
medical intervention”).
2011 08/09/11 1. Medical Policy In Disease Protocols, Coronary
Heart Disease, correct in item
A.1.b., “replacement” to
“repair.”
2. Administrative In Pharmaceuticals –
Antihypertensive, revise to
clarify unacceptable
medications.
3. Administrative In Examination Techniques,
Item 36., Heart, revise to clarify
unacceptable medications.
4. Administrative In Aerospace Medical
Dispositions, Item 55., revise to
clarify blood pressure limits.
5. Administrative In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions, revise
table to include information on
depression requiring the use of
antidepressant medications.
6. Administrative In Disease Protocols,
Hypertension, revise to clarify
unacceptable medications.
2011 05/25/11 1. Administrative In Examination Techniques,
Item 47., Psychiatric, revise
SSRI Follow Up Chart to clarify
procedure.
2011 05/08/11 1. Administrative In Pharmaceuticals, reorganize
and clarify the page content for
Acne Medications, Antacids,
Anticoagulants, Antihistaminic,
Antihypertensive,
Desensitization Injections,
Diabetes – Type II Medication
Controlled, Glaucoma
Medications, and Insulin.
2011 03/11/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions, clarify
policy verbiage on Bipolar
Disorder and Psychosis.
2011 03/02/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions, add
section titled “Use of
Antidepressant Medication,” to
state revised policy on use of
SSRIs.
2011 02/23/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 52., Color
Vision, clarify pass criterion for
OPTEC 900 Vision Tester.
2011 02/03/11 1. Medical Policy In Medical History, Item 18. v.,
History of Arrest(s),
Conviction(s), and/ or
Administrative Action(s),
reorder, revise, and clarify
deferral and issuance criteria.
2011 01/31/11 1. Errata Revise to correct transposed
words in title: Decision
Considerations, Disease
Protocols – “Graded Exercise
Stress Test – Bundle Branch
Block Requirements.”
2011 01/07/11 1. Administrative Revise cover page to reflect
current calendar year.
2010 11/23/10 1. Medical Policy In Exam Techniques, Item 26.
Nose and Item 35. Lungs and
Chest, revise and clarify criteria
for hay fever medications.
2. Medical Policy In Pharmaceuticals
(Therapeutic Medications) -
Desensitization Injections,
revise and clarify criteria for hay
fever medications.
2010 10/29/10 1. Medical Policy In Aerospace Medical
Dispositions, Item 52. Color
Vision, remove Titmus II Vision
Tester (Model Nos. TII and
TIIS) as an acceptable
substitute for color vision
testing.
2010 09/20/10 1. Medical Policy In AASI Protocol for Arthritis,
change title to “Arthritis and/ or
Psoriasis.” Clarify
authorization and deferral
criteria.
2010 09/03/10 1. Medical Policy In Exam Techniques, Item 21-
22 Height and Weight, add
Body Mass Index Chart and
Formula Table.
2010 06/15/10 1. Medical Policy In Aerospace Medical
Dispositions, Item 48, General
Systemic, clarify disposition for
Hyperthroydism and
Hypothyrodism. First Special
Issuance requires FAA
decision. Guidance for
Followup Special Issuance is
found in AASI Protocol.
2. Administrative In AASI Protocol for
Hyperthyroidism and Protocol
for Hypothyroidism, clarify
criteria for deferring and
issuing.