Medical Certificate

Introduction:

  • Medical certificates aeromedically qualify aviation professionals to conduct their roles in the aviation system safely
  • Pilots must therefore meet medical requirements to be considered
  • All pilots, with some exceptions, must possess a valid medical certificate to exercise the privileges of their airman certificates
    • The Code of Federal Regulations (CFRs) prohibit a pilot who possesses a current medical certificate from performing crew-member duties while the pilot has a known medical condition or increase of a known medical condition that would make the pilot unable to meet the standards for the medical certificate
  • Initial, and periodic medical examinations thereafter, are conducted by designated Aviation Medical Examiners (AMEs), who are physicians with a special interest in aviation safety and training in aviation medicine
  • Anyone who meets the medical standards in this part (part 67) based on medical examination and evaluation of the person's history and condition, is entitled to an appropriate medical certificate
  • For certain pilots who qualify, relief from medical requirements is available through the BasicMed program
  • While not subject to the medical certificate process, even small unmanned aircraft systems (UAS) must be mindful of any medical considerations

Medical Certificate Requirements:

  • First-Class Medical Certificate:

    • A first class medical certificate is required when exercising the privileges of an airline transport pilot certificate;
    • If that person has reached his or her 60th birthday and serves as a pilot in 14 CFR part 121 operations
      • Notwithstanding the provisions of Sec. 61.23(d)(1)(iii), that person's first-class medical certificate expires, for 14 CFR part 121 operations, at the end of the last day of the 6th month after the month of the date of examination shown on the medical certificate

  • You must hold at least a second-class medical certificate:

    • When exercising the privileges of a commercial certificate

  • You must hold at least a third-class medical certificate:

    • When exercising the privileges of a private pilot certificate;
    • When exercising the privileges of a recreational pilot certificate;
    • When exercising the privileges of a student pilot certificate;
    • When exercising the privileges of a flight instructor certificate and acting as the pilot in command;
    • When exercising the privileges of a flight instructor certificate and serving as a required pilot flight crew-member;
    • When taking a practical test in an aircraft for a recreational pilot, private pilot, commercial pilot, or airline transport pilot certificate, or for a flight instructor certificate;
    • When performing the duties as an Examiner in an aircraft when administering a practical test or proficiency check for an airman certificate, rating, or authorization

Medical Application:

  • In order to apply for a medical you must schedule an appointment with an Aviation Medical Examiner and been examined in accordance with Part 183
  • An applicant may search for an AME online or by contacting the Manager of the Aerospace Medical Education Division, P.O. Box 26200, Oklahoma City, Oklahoma 73125
  • Before your appointment with your Aviation Medical Examiner (AME) simply go online to FAA MedXPress at https://medxpress.faa.gov/ and electronically complete FAA Form 8500-8
    • Information entered into MedXPress will be available to your AME to review prior to and at the time of your medical examination, if you provide a confirmation number
  • Must show proof of age and identity by presenting a government-issued photo identification (drivers license, military ID, passport)
    • If an applicant does not have government-issued identification, he or she may use non-photo, government-issued identification (such as a birth certificate or voter registration card) in conjunction with photo identification (such as a work identification card or a student identification card)
  • Each person who applies for a medical certificate shall execute an express consent form authorizing the Administrator to request information contained in the National Driver Register about the person to the Administrator
  • The administrator shall make information received from the National Driver Register, if any, available on request to the person for review and written comment
  • Any AME may grant a second or third class medical but only those AMEs specifically designated may grant first class

Medical Certificate Standards:



CERTIFICATE CLASS First-Class Second-Class Third-Class
PILOT TYPE Airline Transport Commercial Private
Distant vision 20/20 or better in each eye separately, with or without correction 20/40 or better in each eye separately, with or without correction

NOTE:
If corrected lenses are necessary for the required vision then they must be worn while exercising the privileges of the certificate
Near Vision 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
Color Vision Ability to perceive those colors necessary for safe performance of airmen duties
Other Vision
  • Normal fields 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
Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in fusion under conditions that may reasonably be expected to occur in performing airmen duties. Tests for these factors are not required except for persons found to have more than 1 prism diopter or pyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded, the Federal Air Surgeon may require the person to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate vergence-phoria relationship. If otherwise eligible, the person is issued a medical certificate pending the results of the examination N/A
Hearing
  • Demonstrate hearing of an average conversational voice in a quiet room, using both ears at 6 feet, with the back turned to the examiner, or;
  • Demonstrate an acceptable understanding of speech as determined by audiometric speech discrimination testing to a score of at least 70% obtained in one ear or in a sound field environment, or;
  • Provide acceptable results of 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 (11 West 42nd Street, New York, NY 10036)
Audiology Pure tone audiometric test: Unaided, with thresholds no worse than:
500Hz 1,000Hz 2,000Hz 3,000Hz
Better Ear(Db): 35 30 30 40
Poorer Ear (Db): 35 50 50 60
Ear, Nose, Throat
  • No disease or condition of the middle or internal ear, nose, oral cavity, pharynx, or larynx that:
    • Interferes with, or is aggravated by, flying or may reasonably be expected to do so; or
    • Interferes with, or may reasonably be expected to interfere with, clear and effective speech communication
  • No disease or condition manifested by, or that may reasonably be expected to be manifested by, vertigo or a disturbance of equilibrium
Cardiovascular

No established medical history or clinical diagnosis of:

  • Myocardial infarction
  • Angina pectoris
  • Coronary heart disease requiring treatment or if untreated, that has been symptomatic or clinically significant
  • Cardiac valve replacement
  • Permanent cardiac pacemaker implantation; or
  • Heart replacement;
Pulse Not disqualifying per se. Used to determine cardiac system status and responsiveness
Blood Pressure No specified values stated in the standards. Current guideline maximum is 155/95
Electro-Cardiogram At age 35 & annually after age 40 to demonstrate an absence of cardiovascular problems (test valid no earlier than 60 days before the date of the application) Not routinely required
Mental No established medical history of a personality disorder to have repeatedly manifested itself by overt acts, psychosis, or bipolar disorder. Further details available in FAR 67.107/207/307
Substance Dependence & Substance Abuse A diagnosis or medical history of substance dependence is disqualifying unless there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. A history of substance abuse within the preceding 2 years is disqualifying. Substance includes alcohol and other drugs (i.e., PCP, sedatives and hypnotics, anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other psychoactive drugs or chemicals)
Neurological No established medical history or clinical diagnosis of:
  • Epilepsy
  • Disturbance of consciousness
  • Transient loss of control of nervous system
Must have no other condition that the Federal Air Surgeon, based on the case history and appropriate qualified medical judgment relating to the condition involved finds:
  • Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
  • 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
Disqualifying Conditions

NOTE:
Airman with these conditions may still be eligible for “Special Issuance” medical certificate.
 Unless otherwise directed by the FAA, the Examiner must deny or defer if the applicant has a history of:
  1. Diabetes mellitus requiring hypoglycemic medication
  2. Angina pectoris
  3. Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant
  4. Myocardial infarction
  5. Cardiac valve replacement
  6. Permanent cardiac pacemaker
  7. Heart replacement
  8. Psychosis
  9. Bipolar disorder
  10. Personality disorder that is severe enough to have repeatedly manifested itself by overt acts
  11. Substance dependence
  12. Substance abuse
  13. Epilepsy
  14. Disturbance of consciousness and without satisfactory explanation of cause
  15. Transient loss of control of nervous system function(s) without satisfactory explanation of cause
  16. Any organic, functional, or structural disease, defect, or limitation that is found to:
    • Make a person unable or reasonably expected to be unable to safely perform the duties
  17. Any medication or other treatment that is found to:
    • Make a person unable or reasonably expected to be unable to safely perform the duties

A person who does not meet the above provisions may apply for the discretionary issuance of a certificate under 67.401

Medical Certificate Exceptions:

  • A medical certificate is not required when:
    • When exercising the privileges of a student pilot certificate while seeking:
      • A sport pilot certificate with glider or balloon privileges;
      • A pilot certificate with a glider category rating or balloon class rating;
    • When exercising the privileges of a sport pilot certificate with privileges in a glider or balloon;
    • When exercising the privileges of a pilot certificate with a glider category rating or balloon class rating in a glider or a balloon, as appropriate;
    • When exercising the privileges of a flight instructor certificate with:
      • A sport pilot rating in a glider or balloon;
      • A glider category rating;
    • When exercising the privileges of a flight instructor certificate if the person is not acting as pilot in command or serving as a required pilot flight crew-member;
    • When exercising the privileges of a ground instructor certificate;
    • When serving as an Examiner or check airman and administering a practical test or proficiency check for an airman certificate, rating, or authorization conducted in a glider, balloon, flight simulator, or flight training device;
    • When taking a practical test or a proficiency check for a certificate, rating, authorization or operating privilege conducted in a glider, balloon, flight simulator, or flight training device; or
    • When a military pilot of the U.S. Armed Forces can show evidence of an up-to-date medical examination authorizing pilot flight status issued by the U.S. Armed Forces and:
      • The flight does not require higher than a third-class medical certificate;
      • The flight conducted is a domestic flight operation within U.S. Airspace
  • A person must hold and possess either a medical certificate issued under part 67 of this chapter or a U.S. driver's license when:
    • Exercising the privileges of a student pilot certificate while seeking sport pilot privileges in a light-sport aircraft other than a glider or balloon;
    • Exercising the privileges of a sport pilot certificate in a light-sport aircraft other than a glider or balloon;
    • Exercising the privileges of a flight instructor certificate with a sport pilot rating while acting as pilot in command or serving as a required flight crew-member of a light-sport aircraft other than a glider or balloon;
    • Serving as an Examiner and administering a practical test for the issuance of a sport pilot certificate in a light-sport aircraft other than a glider or balloon

Duration of a Medical Certificate:

  • No matter how long you have a medical certificate, it never changes class, but the privileges which you can execute your license may

  • Third Class:

    • 40 or older: 24th month after the month of the date of examination shown on the medical certificate (2 years)
    • Under 40: 60th month after the month of the date of examination shown on the medical certificate (5 years)

  • Second Class:

    • Valid for the same as a third class (see above) however you can only execute the privileges of a Second Class for 12 months after the month of the date of the examination shown on the medical certificate

  • First Class:

    • 40 or older: 6th month after the month of the date of examination shown on the medical certificate before you can only execute the privileges of a Second-Class for the remaining 6 months and then drop to the privileges of a Third-Class
    • Under 40: 12th month after the month of the date of examination shown on the medical certificate before you can only execute the privileges of a Third-Class

Medical Deficiencies:

  • Operations that require a medical certificate:

    • No person who holds a medical certificate issued under part 67 may 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 meet the requirements for the medical certificate necessary for the pilot operation; or
      • 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

  • Operations that do not require a medical certificate:

    • 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

BasicMed:

  • Pilot Requirements:

    • Must hold a valid U.S. driver's license, comply with any restrictions, and consent to a National Driver Register check;
    • Have held a valid FAA medical certificate, regular or special issuance, on or after July 15, 2006; and not had their most recent medical revoked, suspended, or withdrawn, or most recent application denied
    • Pilots with a medical history or diagnosis of certain cardiac, neurological, or mental health conditions will need a one-time-only special issuance for each condition
    • Get a physical exam with a state-licensed physician (every four years (48 calendar months)), using the Comprehensive Medical Examination Checklist
    • Complete a BasicMed medical education course; (within the past 24 calendar months)

  • Aircraft Requirements:

    • Any aircraft authorized under federal law to carry not more than 6 occupants
    • Has a maximum certificated takeoff weight of not more than 6,000 pounds (no limitations on horsepower, number of engines, or gear type)

  • Operating Requirements:

    • Carries not more than five passengers Operates under VFR or IFR, within the United States (unless authorized), at less than 18,000 feet MSL, not exceeding 250 knots
    • Flight not operated for compensation or hire
    • Geographic Limitation: Within the United States (unless authorized)
  • The FAA guidance may be found on their website at: https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/
  • A list of frequency asked questions may be found at: https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/media/basicmed_faq.pdf

Small UAS Medical Considerations:

  • No person may manipulate the flight controls of a small unmanned aircraft system or act as a remote pilot in command, visual observer, or direct participant in the operation of the small unmanned aircraft if he or she knows or has reason to know that he or she has a physical or mental condition that would interfere with the safe operation of the small unmanned aircraft system
  • Essentially what this is saying is that the burden of medical certification or assessment of medical fitness falls entirely on you, the pilot. Reference Manned Requirements for fitness and emphasize see and avoid.

Medical Certificate Knowledge Quiz:

Conclusion:

  • Pilots who do not meet medical standards may still be qualified under special issuance provisions or the exemption process
    • This may require that either additional medical information be provided or practical flight tests be conducted
  • Student pilots should visit an Aviation Medical Examiner as soon as possible in their flight training in order to avoid unnecessary training expenses should they not meet the medical standards
    • For the same reason, the student pilot who plans to enter commercial aviation should apply for the highest class of medical certificate that might be necessary in the pilot's career
  • The CFRs prohibit a pilot who possesses a current medical certificate from performing crewmember duties while the pilot has a known medical condition or increase of a known medical condition that would make the pilot unable to meet the standards for the medical certificate
  • Note that a medical certificate is one of the required documents, if your operation requires one, to comply with FAR 61.3
  • Remember your medical readiness is not just at the time of your exam but before each flight
  • You can find more about how a medication impacts your ability to fly by visiting the FAA's Pilot Information - Over-the-Counter Medications
  • If you are worried about taking your medical, especially your first, check out the AOPA's guidance
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References: