Faa Guide For Aviation Medical Examiners
Faa Guide For Aviation Medical Examiners
Faa Guide For Aviation Medical Examiners
Welcome 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, disposition, and protocols, necessary for completion of the
FAA Form 8500-8, Application for Airman Medical Certificate or Airman Medical and
Student Pilot Certificate.
To navigate through the Guide 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. Likewise, click on the + button again to collapse any of the
expanding files.
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/
TABLE OF CONTENTS
Introduction .......................................................................................................i
GENERAL INFORMATION
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Guide for Aviation Medical Examiners
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APPLICANT HISTORY
Items 1-2. Application For; Class of Medical Certificate Applied For.. ............21
Items 3-10. Identification............................................... ...................................23
Items 11-12. Occupation; Employer....................................…............................26
Item 13. Has Your FAA Airman Medical Certificate Ever Been Denied,
Suspended, or Revoked?..............................................................26
Items 14-15. Total Pilot Time..............................................................................27
Item 16. Date of Last FAA Medical Examination............ .............................27
Item 17.a. Do You Currently Use Any Medication (Prescription or
Nonprescription)? ..........................................................................27
Item 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying?.....28
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Application Review
DECISION CONSIDERATIONS:
Disease Protocols……………………………………………….157
Pharmaceuticals…………………………………………………186
Special Issuances………………………………………..……….199
AASIs for All Classes………………………………………….202
AASIs for Third-Class……………………………………………… 227
AME Assisted Special Issuance Coversheet………………..230
Substances of Dependence/Abuse…………………………….…231
RESOURCES:
Glossary…………………………………………………………………………….237
Archives…………………………………………………………………………….241
Forms: http://www.faa.gov/library/forms
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Guide for Aviation Medical Examiners
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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/icaonet/arch/doc/7300/7300_9ed.pdf
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GENERAL INFORMATION
This section provides input to assist an Aviation Medical Examiners (AME), otherwise known
as an Examiner, in performing his or her duties in an efficient and effective manner. It also
describes Examiner responsibilities as the Federal Aviation Administration's (FAA)
representative in medical certification matters and as the link between airmen and the FAA.
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
Guide for Aviation Medical Examiners
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representations, or entry, may be fined up to $250,000 or imprisoned not more than
5 years, or both" (Title 18 U.S. Code. Secs. 1001; 3571).
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 certificated. The request for this medical information must not be
misconstrued as the FAA ordering or mandating that the applicant undergo testing,
where clinically inappropriate or contraindicated. The risk of the study based upon the
disease state and test conditions must be balanced by the applicant’s desire for
certification and determined by the applicant and their healthcare provider(s).
• 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;
• Heart replacement;
• 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
§ 67.401), shall expire no later than the end of the validity period or upon the withdrawal
of the Authorization upon which it is based. 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 medical certificate and/or a Re-Authorization.
• 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
Individuals granted an Authorization (or SODA) must carry that documentation with
them when exercising pilot privileges.
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.
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. In order to ensure that
release of information is proper, whenever a court order or subpoena is received by the
Examiner, the appropriate RFS, or the AMCD, should be contacted. Similarly, unless
the applicant's written consent for release is of a routine nature; e.g., accompanying a
standard insurance company request, advice should be sought from the FAA 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-331
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.
a. Age Requirements
There is no age restriction or aviation experience requirement for medical certification. Any
applicant who qualifies medically may be issued a Medical Certificate, FAA Form 8500-9
(white), regardless of age. Examiners also have been delegated authority to issue the
combined Medical Certificate and Student Pilot Certificate, FAA Form 8420-2 (yellow), which is
age restricted because it is an airman medical and student pilot certificate (student license and
medical certificate). For issuance of the combined certificate, the applicant must have reached
his or her 16th birthday.
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:
b. Language Requirements
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
LAST UPDATE: September 21, 2009 9
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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 for an “Airman Medical and Student Pilot Certificate” 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 read, write, and
converse in English. This may be accomplished by observing the applicant read FAA
Form 8500-8 instructions and questions, writing answers, 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 the applicant. Errors may occur, particularly in unusual or unexpected circumstances, but
rarely interfere with meaning.
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.
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.
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
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.
• Only use standard limitations as contained within this document or on the
Aerospace Medical Certification System (AMCS).
• Both the AME and applicant must sign the medical certificate in ink. The
applicant must sign before leaving the AME’s office.
• AMEs are required to use the electronic transmission capability of AMCS and
must forward the FAA/Orginal Copy to the FAA in Oklahoma (see address
below). The AME Work Copy must be retained as the file copy.
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; 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.
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.
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. This includes international AME’s.
MANAGER
AEROSPACE MEDICALCERTIFICATION DIVISION, AAM-300
CIVIL AEROSPACE MEDICAL INSTITUTE
FEDERAL AVIATION ADMINISTRATION
POST OFFICE BOX 26080
OKLAHOMA CITY, OK 73125-0080
These may be batch mailed at monthly intervals. All incomplete applications and
medical examinations must be mailed immediately to the above address.
The Applicant's Copy of the FAA Form 8500-8 (last page) must be given to the applicant
along with the information for Applicant and the instruction sheet.
Examiners are cautioned to provide adequate security for blank medical application and
certificate forms to ensure that they do not become available for illegal use. When the
FAA issues new or revised medical forms and certificates, the FAA will advise
Examiners of the disposition of the old forms and certificates. The serial numbers of
FAA Form 8500-8 assigned to each Examiner are recorded at the Civil Aerospace
Medical Institute in Oklahoma City. If asked, the Examiner should be prepared to
account for the forms. The Examiners are responsible making provisions to return of all
unused FAA forms at such time they leave (resign, retire, terminated, or death) the AME
Program:
MANAGER
AEROSPACE MEDICAL EDUCATION DIVISION, AAM-400
CIVIL AEROSPACE MEDICAL INSTITUTE
FEDERAL AVIATION ADMINISTRATION
POST OFFICE BOX 26080
OKLAHOMA CITY, OK 73125-0080
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 of receipt of a request for review, a written final decision either
affirming or reversing the decision to withdraw will be issued; and
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 or Airman Medical and
Student Pilot 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, page 24. Record the type of
identification(s) provided and identifying number(s) under Item 61, page 154.
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.
Both the yellow and white certificates and their instructions must be removed before the
application is given to the applicant. The Information for Applicant and Instructions for
Completion of the Application pages must also be given to the applicant.
On the general information and medical history page of the application, the applicant is
to fill in Items 1-20 in his or her handwriting using a ballpoint pen, exerting sufficient
pressure for all copies, to make legible imprints upon the Examiner's and airman’s
copies of the form.
The Examiner must ensure completeness and review all items 1 through 20. A medical
certificate must never be issued to an applicant who refuses to answer Item 13, page
26; Items 16 and 17, page 27; Item 18, page 29; or Item 19, page 34; or to an applicant
who refuses to sign the form (Item 20, front side of the examination form). 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. (See Item 16, page 27).
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, page 24). 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.
The applicant must personally enter all data and make all corrections on the application
form. The applicant should initial all corrections. The application constitutes a legal
document and must be completed in the applicant's handwriting. If for any reason
someone other than the applicant enters information in Items 1-20, the person should
initial beside that item (including any check marks), and the Examiner should add a note
explaining in Item 60, page 153, the person's inability to enter the data.
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 whether the application is for an Airman Medical Certificate
(white) or an Airman Medical and Student Pilot Certificate (yellow), and 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, a student pilot may ask for a
first-class medical certificate to see if he or she qualifies medically before entry into an
aviation career.
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.
The applicant's last, first, and middle name (or initial if appropriate) must be printed. All
applicants without a middle name should enter "NMN" or "NONE". Nicknames and
abbreviated names must not be used. 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.
Although applicants are asked to complete all questions on the application, the FAA
Form 8500-8, they are not legally required to complete Item 4. The FAA requests the
SSN for identification purposes and record control. Its use as a unique identifier may
eliminate a mistake in identification.
The applicant must print a permanent mailing address, including country, and the
zip code (full nine digits if known). The person must also provide a current daytime
area code and telephone number.
The applicant must enter the numbers for the month, day, and year of birth in order
(e.g., 04/29/2000 for April 29, 2000). Name, date of birth, and SSN are the basic
identifiers of airmen. When an Examiner wishes to communicate with the FAA
concerning an applicant, the Examiner must give the applicant's full name, date of birth,
and SSN if at all possible. The applicant should indicate citizenship; e.g., U.S.A.
If the applicant wishes to be issued an Airman Medical and Student Pilot Certificate
(FAA Form 8420-2), the Examiner should check the date of birth to ensure that the
applicant is at least 16 years old. Unless the applicant is at least 16 years old, a
combined Airman Medical and Student Pilot Certificate may not be issued, even if the
applicant will become 16 years old before the certificate expires (except as noted
below).
The FAA will not confirm a certificate issued by an Examiner to a person who is less
than 16 years old. The applicant must be at least 16 years old at the time of
application to be eligible for a student pilot certificate for flight of powered aircraft. This
minimum age requirement applies only to the issuance of the yellow FAA Form 8420-2,
and never to the issuance of the white medical certificate (FAA Form 8500-9).
An alternative procedure for this situation is for the Examiner to issue the Airman
Medical and Student Pilot Certificate, FAA Form 8420-2 (yellow), with the following
statement in the limitations block of the student pilot certificate:
This procedure should not be used if the applicant's 16th birthday will occur more than
30 days from the date of application.
Although nonmedical regulations allow an airman to solo a glider or balloon at age 14, a
medical certificate is not required for glider or balloon operations. These airmen are
required to certify to the FAA that they have no known physical defects that make them
unable to pilot a glider or balloon. This certification is made at the FAA FSDO’s.
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.
Color of hair should be entered as "brown," "black," "blonde," "gray," or "red." Lack of
hair should be entered as "bald." No abbreviations or other colors should be used. This
information is for identification only.
Color of eyes should be entered as "brown," "black," "blue," "hazel," "gray," or "green."
No abbreviations or other colors should be used. This information is for identification
only.
Item 9. Sex
Occupational data are principally used for statistical purposes. This information, along
with information obtained from Items 10, page 25, Items 14 and 15, page 27, 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?
13. Has Your FAA Airman Certificate Ever Been Denied, Suspended, or Revoked?
Yes No If yes, give date _____________________
MM / DD / YYYY
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,
page 29.
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
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 yes, list below medication(s) used and check appropriate box).
No Yes
Previously Reported
Yes No
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.
During periods in which the foregoing medications are being used for treatment of acute
illnesses, the airman is under obligation to refrain from exercising the privileges of
his/her airman medical certificate unless cleared by the FAA.
ITEM 17.b. DO YOU EVER USE NEAR VISION CONTACT LENS(ES) WHILE
FLYING?
17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying? Yes No
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/are inappropriate for flying.
18. Medical History -HAVE YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH, HAD, OR DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING? Answer “yes” or “no”
for every condition listed below. In the EXPLANATIONS box below, you may note ‘PREVIOUSLY REPORTED, NO CHANGE” only if the explanation of the condition
was reported on a previous application for an airman medical certificate and there has been no change in your condition. See Instructions Page
b. Dizziness or fainting spell High or low blood pressure n. Substance dependence or failed a drug
h. s. Medical rejection by military service
test ever; or substance abuse or use
of illegal substance in the last 2 years
c. Unconsciousness for any reason Stomach, liver, or intestinal t. Rejection for life or health insurance
i.
trouble
Yes No History of (1) any arrest(s) and/or conviction(s) involving driving while intoxicated by, while impaired by, or while under the influence Yes No
of alcohol or a drug; or (2) history of any arrest(s), conviction(s), or administrative action(s) involving an offense(s) which History of nontraffic
v.
resulted in the denial, suspension, cancellation, or revocation of driving privileges or which resulted in attendance w. conviction(s)(misdemeanors
at an educational or a rehabilitation program. or felonies).
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.
Of particular importance are conditions that have developed since the last FAA medical
examination. If more space is needed, a plain sheet of paper bearing the applicant's full
printed name, date of birth, signature, and the date should be used.
The Examiner must take the time to review the applicant's responses on FAA
Form 8500-8 before starting the applicant's medical examination.
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.
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.a. Frequent or severe headaches. The applicant should report frequency, duration,
characteristics, severity of symptoms, neurologic manifestations, and whether they have
been incapacitating, treatment and side effects, if any. (See Item 46, page 103).
18.b. Dizziness or fainting spells. The applicant should describe characteristics of the
episode; e.g., spinning or lightheadedness, frequency, factors leading up to and
surrounding the episode, associated neurologic symptoms; e.g., headache, nausea,
LOC, or paresthesias. Include diagnostic workup and treatment if any.
(See Items 25-30, page 39; and Item 46, page 103).
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
to imply that the applicant can be certificated if the etiology is identified, because the
etiology may also be disqualifying in and of itself. (See Item 46, page 103).
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
18.e. Hay fever or allergy. The applicant should report frequency and duration of
symptoms, and whether they have been incapacitating by the condition. Mention
should also be made of treatment and side effects. The Examiner should inquire
whether the applicant has ever experienced any “ear block”, barotitis, or any other
symptoms that could interfere with aviation safety? Barosinusitis is of concern and
should also be ruled out. (See Item 26, page 42).
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, page 57).
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, page 63).
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, page 63, and Item 55, page 146).
18.i. Stomach, liver, or intestinal trouble. The applicant should provide history and
treatment, pertinent medical records, current status report, and medication. If a surgical
procedure was done, the applicant must provide operative and pathology reports.
(See Item 38 page 77).
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, page 85).
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
18.l. Neurological disorders; epilepsy, seizures, stroke, paralysis, etc. The applicant
should provide history and treatment, pertinent medical records, current status report
and medication. The Examiner should obtain details about such a history and report the
results. An established diagnosis of epilepsy, a transient loss of control of nervous
system function(s), or a disturbance of consciousness is a basis for denial no matter
how remote the history. Like all other conditions of aeromedical concern, the history
surrounding the event is crucial. Certification is possible if a satisfactory explanation
can be established. (See Item 46, page 103).
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 46, page 103; and Item 47, page 115).
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.
(See Item 47, page 115).
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, page 44).
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
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, page 153. It is
of great assistance to the applicant and the FAA if the Examiner can help obtain copies
of military documents for attachment to the FAA Form 8500-8. 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 under separate
cover.
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,
page 153. 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.
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 arrest(s), 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 arrested, 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 arrest, conviction, and/or administrative action
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
• 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:
• 3 arrest(s), conviction(s), and/or administrative action(s) within a lifetime
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
• 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 applicant
must name the charge for which convicted and the date of the conviction(s), and copies
of court documents (if available). (See Item 47, page 115).
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
19. Visits to Health Professional Within Last 3 Yes NO See Instructions Page
Years (Explain Below)
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, page 153 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, page 153 as follows:
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
M M D D YYY Y
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
or Airman Medical and Student Pilot 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, page 153 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 the
Manager of the AMCD.
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.
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 condition 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, page 153 the
0H1
(b) No disease or condition of the middle or internal ear, nose, oral cavity,
pharynx, or larynx that -
1. The head and neck should be examined to determine the presence of any
significant defects such as:
b. Gross deformities
c. Fistulas
f. Surgical scars
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 such an applicant initially applies for medical certification, if
otherwise qualified, the AMCD may issue a combination medical/student pilot certificate
with the limitation “Valid for Student Pilot Purposes Only.” This will allow the student to
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 contact AMCD
or the RFS for authorization to take a medical flight test (MFT). 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.
7. The nose should be examined for the presence of polyps, blood, or signs of
infection, allergy, or substance abuse. The Examiner should determine if there is a
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.
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. 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 and
acquired, including current status report
tracheostomy
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
1
Hay fever controlled solely by desensitization without requiring antihistamines or other medications is
not disqualifying. 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 antihistamines . The
Examiner should document this in Item 60, page 153. However, non-sedating antihistamines loratadine
or fexofenadine may be used while flying, after adequate individual experience has determined that the
medication is well tolerated without significant side effects.
Nose
Sinus Tumor
Inner Ear
Mastoids
Middle Ear
Outer Ear
Ear Drums
Otologic Surgery. A history of otologic surgery is not necessarily disqualifying for medical
certification. The FAA evaluates each case on an individual basis following review of the
otologist's report of surgery. The type of prosthesis used, the person's adaptability and
progress following surgery, and the extent of hearing acuity attained are all major factors
to be considered. Examiners should defer issuance to an applicant presenting a history of
otologic surgery for the first time, sending the completed report of medical examination,
with all available supplementary information, to the AMCD.
Some conditions may have several possible causes or exhibit multiple symptomatology.
Episodic disorders of dizziness or disequilibrium require careful evaluation and
consideration by the FAA. Transient processes, such as those associated with acute
labyrinthitis or benign positional vertigo may not disqualify an applicant when fully
recovered. (Also see Item 46, page 103 for a discussion of syncope and vertigo).
(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 Items 50-54, beginning on page 133.
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? (Also see Item 53, page 142; and Item 54,
page 144).
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. (See Item 50, for further
2H
consideration of nystagmus).
4. Monocular Vision. An applicant will be considered monocular when there is only one
eye or when the best corrected distant visual acuity in the poorer eye is no better than
20/200. An individual with one eye, or effective visual acuity equivalent to monocular,
may be considered for medical certification, any class, through the special issuance
section of part 67 (14 CFR 67.401).
In amblyopia ex anopsia, the visual acuity loss is simply recorded in Item 50 of FAA
3H
Form 8500-8, and visual standards are applied as usual. If the standards are not met, a
Report of Eye Evaluation, FAA Form 8500-7, should be submitted for consideration.
Although it has been repeatedly demonstrated that binocular vision is not a prerequisite
for flying, some aspects of depth perception, either by stereopsis or by monocular cues,
are necessary. It takes time for the monocular airman to develop the techniques to
interpret the monocular cues that substitute for stereopsis; such as, the interposition of
objects, convergence, geometrical perspective, distribution of light and shade, size of
known objects, aerial perspective, and motion parallax.
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 can facilitate FAA review by
obtaining a report of Ophthalmological Evaluation for Glaucoma (FAA Form 8500-14)
from a treating or evaluating eye specialist (optometrist or ophthmologist), also see
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 iridencleisis 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
by the FAA.
An applicant with unilateral or bilateral open angle glaucoma may be certified by the
FAA (with follow-up required) when a current ophthalmological report substantiates that
pressures are under adequate control, there is little or no visual field loss or other
complications, and the person tolerates small to moderate doses of allowable
medications. Individuals who have had filter surgery for their glaucoma, or combined
glaucoma/cataract surgery, can be considered when stable and without complications.
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
9. Sunglasses. Sunglasses are not acceptable as the only means of correction to meet
visual standards, but may be used for backup purposes if they provide the necessary
correction. Airmen should be encouraged to use sunglasses in bright daylight but must
be cautioned that, under conditions of low illumination, they may compromise vision.
Mention should be made that sunglasses do not protect the eyes from the effects of
ultra violet radiation without special glass or coatings and that photosensitive lenses are
unsuitable for aviation purposes because they respond to changes in light intensity too
slowly. The so-called "blue blockers" may not be suitable since they block the blue light
used in many current panel displays. Polarized sunglasses are unacceptable if the
windscreen is also polarized.
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 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, the applicant may resume airman
duties, after consultation and review by an Examiner, 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)
indicate that the applicant meets the standards, the FAA may delegate authority to the
Examiner to issue subsequent certificates.
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
2
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, General
Pterygium All Document findings in If less than 50% of the
Item 60 cornea and not effecting
central vision
- Issue
Otherwise - Requires
FAA Decision
3
Whether acute or chronic, of either eye or adnexa, that may interfere with visual functions, may progress
to that degree, or may be aggravated by flying (tumors and ptosis obscuring the pupil, acute inflammatory
disease of the eyes and lids, cataracts, or orthokeratology).
Eyes - Procedures
Ophthalmoscopic
Followup
Special Issuance’s -
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
Pupils
Pupils
Ocular Motility
4
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.
(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
5H
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
5
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 page 153.
6
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.
7
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
8
If the applicant otherwise meets the medical standards and currently requires no treatment, the
Examiner may Issue. However, a history of frequent severe attacks is disqualifying. Certificate issuance
may be possible in other cases. If additional information is obtained, it must be submitted to the FAA.
9
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.
10
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
(3) Coronary heart disease that has required treatment or, if untreated,
that has been symptomatic or clinically significant
(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
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,
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.
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.
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 in accordance with FAA specifications.
C. Medication.
2. The Examiner may submit for the Federal Air Surgeon's review requests for
Authorization under the special issuance section of part 67 (14 CFR 67.401) in
8H
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
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
Arrhythmias
Followup
Special Issuance’s -
See AASI Protocol
Atrial Fibrillation
Followup
Special Issuance’s -
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;
Bracytherapy; 3rd Initial Special
Coronary Bypass Issuance - Requires
Grafting; FAA Decision
Myocardial Infarction;
PTCA; Followup
Rotoblation; and Special Issuance’s -
Stent Insertion See AASI Protocol
Hypertension
Otherwise - Requires
FAA Decision
Syncope
Valvular Disease
Followup
Special Issuance’s -
See AASI Protocol
Single Valve 1st & 2nd See Cardiac Valve
10H Requires FAA Decision
Replacement (Tissue, 3rd Replacement Initial Special
Mechanical or Issuance - Requires
Valvuloplasty) FAA Decision
Followup
Special Issuance’s -
See AASI Protocol
8. With the possible exceptions of aspirin and dipyridamole taken for their effect on
blood platelets, the use of anticoagulants or other drugs for treatment or prophylaxis of
fibrillation may preclude medical certification.
9. A history of cardioversion or drug treatment, per se, does not rule out certification.
A current, complete cardiovascular evaluation will be required. A 3-month observation
period must elapse after the procedure before consideration for certification.
10. Any other cardiac disorder not otherwise covered in this section.
11. For all classes, certification decisions will be based on the applicant's medical
history and current clinical findings. Certification is unlikely unless the information is
highly favorable to the applicant. Evidence of extensive multi-vessel disease, impaired
cardiac functioning, precarious coronary circulation, etc., will preclude certification.
Before an applicant undergoes coronary angiography, it is recommended that all
records and the report of a current cardiovascular evaluation, including a maximal
electrocardiographic exercise stress test, be submitted to the FAA for preliminary
review. Based upon this information, it may be possible to advise an applicant of the
likelihood of favorable consideration.
12. A history of low blood pressure requires elaboration. If the Examiner is in doubt, it is
usually better to defer issuance rather than to deny certification for such a history.
(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
st
Phlebothrombosis or 1 & 2nd See Thrombophlebitis Requires FAA Decision
Thrombophlebitis 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.
The Examiner should not issue a medical certificate if the applicant has a recent history
of bleeding ulcers or hemorrhagic colitis. Otherwise, ulcers must not have been active
within the past 3 months.
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.
Otherwise - Issue
Liver Transplant All Submit all pertinent Requires FAA Decision
medical information
and current status
report, include
duration of
symptoms, name and
dosage of drugs and
side effects
Peptic Ulcer All See Peptic Ulcer Requires FAA Decision
Protocol
Splenomegaly All Provide hematologic Requires FAA Decision
workup
Malignancies
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.
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.
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.
Cutaneous
*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
• 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
Malignant Melanoma
Urticarial Eruptions
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.
12H
(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
13H
Form 8500-8. Disorders such as sterility and menstrual irregularity are not usually of
importance in qualification for medical certification.
2. Dribbling or Incontinence
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, page 123, for details concerning diabetes and Item 57, page 148, 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
Otherwise –
Requires FAA
Decision
General Disorders
Inflammatory Conditions
Otherwise - Requires
FAA Decision
Chronic (Nephritis) All Submit all pertinent Requires FAA Decision
medical information
and status report
Nephrosis All Submit all pertinent Requires FAA Decision
medical information
and status report
Neoplastic Disorders
Neoplastic Disorders
Nephritis
Otherwise - Requires
FAA Decision
Pyelitis or All Submit all pertinent If asymptomatic
Pyelonephritis medical information - Issue
and status report Otherwise - Requires
FAA Decision
Nephritis
Urinary System
Otherwise - Requires
FAA Decision
11
Calculus 8F All Submit current If there is no residual
metabolic evaluation calculi and the
Renal - Single episode and status report metabolic workup is
negative
- Issue
Otherwise - Requires
FAA Decision
11
Complete studies to determine the possible etiology and prognosis are essential to favorable FAA
consideration. Determining factors include site and location of the stones, complications such as
compromise in renal function, repeated bouts of kidney infection, and need for therapy. Any underlying
disease will be considered. The likelihood of sudden incapacitating symptoms is of primary concern.
Report of imaging studies (KUB, IVP, or spiral CT) must be submitted in order to conclude that there are
no residual or retained calculi.
Urinary System
Followup
Special Issuance’s -
See AASI Protocol
Ureteral or Vesical All Single episode and If metabolic workup is
no retained calculi, negative and there is
submit current no sequela or retained
metabolic evaluation calculi - Issue
and status report
(Ureteral stent is
acceptable if
functioning without Otherwise - Requires
sequela) FAA Decision
GENITAL/REPRODUCTIVE SYSTEM
Gender dysphoria and gender reassignment are not disqualifying, however, a complete
review of the medical history and records is indicated to determine that there is no
medical, psychiatric, or psychological condition that is considered disqualifying. Medical
disqualification is considered appropriate during the time of hormonal manipulation until
such time where there is a stabilization of the dose administered and the physiologic
response. Defer and submit a current status report and all pertinent medical reports to
AMCD or RFS.
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
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.
12
Essential tremor is not disqualifying unless it is disabling.
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. A medical certificate and SODA, without
the student limitation, may be provided to the inspector for issuance to the applicant, or
the inspector may be required to send the report to the FAA medical officer who
authorized the test.
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.
Arthritis
13
Osteoarthritis 10F All Submit a current status If mild and controlled
report to include with small doses of
functional status nonprescription
(degree of impairment agents - Issue
as measured by
strength, range of If symptomatic or
motion, pain), requires medication
medications with side - Requires FAA
effects and all pertinent Decision
medical reports
13
Arthritis (if it is symptomatic or requires medication, other than small doses of nonprescription anti-
inflammatory agents), is disqualifying unless the applicant holds a letter from the FAA specifically
authorizing the Examiner to issue the certificate when the applicant is found otherwise qualified. Although
the use of many medications on a continuing basis ordinarily contraindicates the performance of pilot
duties, under certain circumstances, certification is possible for an applicant who is taking aspirin,
ibuprofen, naproxen, similar nonsteroidal anti-inflammatory drugs (NSAID), or COX-2 inhibitors. If the
applicant presents evidence documenting that the underlying condition for which the medicine is being
taken is not in itself disabling and the applicant has been on therapy (NSAID) long enough to have
established that the medication is well tolerated and has not produced adverse side effects, the Examiner
may issue a certificate.
Arthritis
Collagen Disease
Active disease of bones All Submit a current status Requires FAA Decision
and joints report to include
functional status
(degree of impairment
as measured by
strength, range of
motion, pain),
medications with side
effects and all pertinent
medical reports
Ankylosis, curvature, or All Submit a current status Requires FAA Decision
other marked report to include
deformity of the spinal functional status
column sufficient to (degree of impairment
interfere with the as measured by
performance of airman strength, range of
duties motion, pain),
medications with side
effects and all pertinent
medical reports
14
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 further FAA consideration. The applicant may be authorized to take a MFT along with the private
pilot certificate flight test. If successful, the limitation VALID FOR STUDENT PILOT PURPOSES ONLY is
removed from the medical certificate, but operational limitations may be added. A statement of
demonstrated ability is issued.
Other neuromuscular conditions are covered in more detail in Item 46, page 103.
(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
14H
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.
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 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.
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.
15
Complete neurological evaluations supplemented with appropriate laboratory and imaging studies are
required of applicants with the above conditions. Cerebral arteriography may be necessary for review in
cases of subarachnoid hemorrhage.
Cerebrovascular Disease
Intracranial Aneurysm All Submit all pertinent Requires FAA Decision
or Arteriovenous medical records,
Malformation current neurologic
report, name and
dosage of
medication(s) and
side effects
Intracranial Tumor 16 13F All Submit all pertinent Requires FAA Decision
medical records,
current neurologic
report, name and
dosage of
medication(s) and
side effects
Pseudotumor Cerebri All Submit all pertinent Requires FAA Decision
(benign intracranial medical records,
hypertension) current neurologic
report, name and
dosage of
medication(s) and
side effects
16
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.
Multiple Sclerosis
17
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.
18
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 19 16F
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
Chronic Tension or All Submit all pertinent Requires FAA Decision
Cluster Headaches medical records,
current neurologic
report, to include
characteristics,
frequency, severity,
associated with
neurologic
phenomena, name
and dosage of
medication(s) and
side effects
19
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.
Headaches 19 17F
19
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.
Neurologic Conditions
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
20
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.
21
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).
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
Unconsciousness or
disorientation of more
than 1 hour following
injury
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
Nonfunctioning
Labyrinths;
or
Orthostatic
Hypotension
22
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.
(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-
(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 related to age, pilot time, and class of certificate for
which applied. Information about the present occupation and employer also may be
helpful. If any psychotropic drugs are or have been used, followup questions are
appropriate. Previous medical denials or aircraft accidents may be related to psychiatric
problems.
Psychiatric information can be derived from the individual items in medical history
(Item 18; page 32). 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:
Significant observations during this part of the medical examination should be recorded
in Item 60, of the application form. The Examiner, upon identifying any significant
16H7
problems, should defer issuance of the medical certificate and report findings to the
FAA. This could be accomplished by contacting a RFS or the Manager of the AMCD.
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 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 (listed below)
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.
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.
Psychiatric Conditions
Otherwise - Requires
FAA Decision
Attention Deficit All Submit all pertinent Requires FAA Decision
Disorder medical information
and clinical status
report to include
documenting the
period of use, name
and dosage of any
medication(s) and
side-effects
Psychiatric Conditions
b). No use of
psychotropic
medication(s) - Issue
Otherwise - Requires
FAA Decision
Personality Disorders All See 1. below Requires FAA Decision
Psychosis All See 2. below Requires FAA Decision
Pyschotropic All Document period of If medication(s)
medications for use, name and discontinued for at least
Smoking Cessation dosage of 30 days and w/o side-
medication(s) and effects - Issue
side-effects
Otherwise – Requires
FAA Decision
Substance Abuse All See 6. below Requires FAA Decision
Substance All See 5. below Requires FAA Decision
Dependence
Suicide Attempt All Submit all pertinent Requires FAA Decision
medical information
required
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.
3. A bipolar disorder may not reach the level of psychosis but can be so
disruptive of judgment and functioning (especially mania) so as to interfere with
aviation safety. All applicants with such a diagnosis must be denied or deferred.
However, a number of these applicants, so diagnosed, may be favorably
considered for an Authorization when the symptoms do not constitute a threat to
safe aviation operations.
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) 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 been performed in conjunction with examinations made under other
items, and to determine the relevance of any positive or abnormal 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
18H
Endocrine Disorders
Endocrine Disorders
Neoplasms
Acoustic Neuroma
Colon/ Rectal Cancer and
other Abdominal
Malignancies
G-U System Cancers
Kaposi’s Sarcoma
Leukemias and
Lymphomas
Malignant Melanomas
Eye Tumors
(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:
C. Equipment
*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.
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 meets the standard with the use of hearing aids, the
certificate may be issued 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 recommendations in
Chapter 3. Items 31-34, Eye, Section II, #5,
23H
f. Common errors:
2. Acceptable Substitutes for Distant Vision Testing: any commercial 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:
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)24.
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. While waiting to complete a MFT, an
applicant who is otherwise qualified for certification may be issued a medical
certificate, which must contain the limitation “Valid for Student Pilot Privileges
Only.”
24
In obtaining special eye evaluations in respect to the airman medical certification program or the air
traffic controller health 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:
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:
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:
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.
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. Farnsworth Lantern test: an average of more than one error per series of nine color pairs
in series 2 and 3. (See instruction booklet.)
7. Titmus Vision Tester, Titmus II Vision Tester, Titmus 2 Vision Tester, Titmus i400,
OPTEC 2000 Vision Tester, OPTEC 900 Vision Tester, Keystone Orthoscope, or
Keystone Telebinocular: any errors in the six plates.
8. LKC Technologies, Inc., APT-5 Color Vision Tester: The letter must be correctly
identified in at least two of the three presentations of each test condition. (See APT-5
screening chart for FAA-related testing in instruction booklet.)
9. Richmond-HRR, 4th edition: two or more errors on plates 5-24. Plates 1-4 are for
demonstration only; plates 5-10 are screening plates; and plates 11-24 are diagnostic
plates.
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).
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.
Normal Abnormal
1. Fifty-inch square black matte surface wall target with center white fixation
point; 2 millimeter white test object on black-handled holder:
c. The applicant should be instructed to keep the left eye focused on the
fixation point.
d. 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.
f. 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. 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
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
54. Heterophoria 20’ (in prism diopters) Esophoria Exophoria Right Hyperphoria Left Hyperphoria
Third-Class: No Standards
Equipment:
2. Horizontal prism bar with graduated prisms beginning with one prism
diopter and increasing in power to at least eight prism diopters.
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.
24H
(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 -
A. Examining Options
1. An applicant whose pressures are within the above limits, who has not used
antihypertensives for 30 days, and who is otherwise qualified should be issued a
medical certificate by the Examiner.
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
(1) Makes the person unable to safely perform the duties or exercise
the privileges of the airman certificate applied for or held; or
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.
See General System, Item 48, page 123 for more details.
(1) At the first application after reaching the 35th birthday; and
Note: All applicants for certification may be required to provide ECG's 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.
B. Currency
C. Interpretation
The method for recording and transmitting ECG's 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 ECG's should use the following format for
preparation and submission:
b. Applicant and Examiner identification must be complete and the tracing must
be dated.
2. Such hard-copy ECG’s 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.
______________________________________________________________________
APPLICATION REVIEW
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.
After all routine evaluations and tests are completed, the Examiner should make a
complete review of FAA Form 8500-8. If the form is complete and accurate, the
Examiner should add final comments, make qualification decision statements, and sign
the declaration. The medical history page of FAA Form 8500-8 must be completed in
the handwriting of and signed and dated by the applicant. Upon completion of the
physical examination, the entire FAA Form 8500-8, Items 1 through 64, must be
electronically transmitted to the FAA.
(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.
______________________________________________________________________
II. Examination Techniques
60. Comments on History and Findings: AME shall comment on all "YES" answers in the Medical History section and for
abnormal findings of the examination. (Attach all consultation reports, ECG's, X-rays, etc., to this report before mailing).
If possible, all ancillary reports such as consultations, ECG's, 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,
If there are no significant medical history items or abnormal physical findings, the
Examiner should indicate this by checking the appropriate block.
Item 62. Has Been Issued Medical Certificate Medical & Student Pilot Certificate
The Examiner must check the proper box to indicate if the Medical Certificate, FAA
Form 8500-9 (white), or Medical Certificate and Student Pilot Certificate, FAA
Form 8420-2 (yellow), has been issued. If neither form 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 completed FAA
Form 8500-8 should be transmitted to the AMCD with a note stating that additional
information will follow. 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 on FAA
Form 8500-8 and the application transmitted to the AMCD for further consideration.
If the applicant decides at this point to abandon the application for a medical certificate,
the Examiner should also note this on FAA Form 8500-8 and mail the incomplete form
to the AMCD. An incomplete FAA Form 8500-8 should not be transmitted 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,
page 4).
List all disqualifying defects, diagnoses, or conditions by ITEM NUMBER that serve as
the basis for denial or deferral in Item 63. Comments or discussion of specific
observations or findings may be reported in Item 60, page 153 or submitted on a
separate sheet of paper.
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.
Item 64. Medical Examiner’s Declaration - I hereby certify that I have personally reviewed the medical history and
personally examined the applicant named on this medical examination report. This report with any attachment
embodies my findings completely and correctly.
Date of Examination Aviation Medical Examiner’s Name Aviation Medical Examiner’s Signature
If the application is not transmitted electronically, the date of examination and the
Examiner's name and complete address must be typed. The Examiner must personally
sign the completed form. The Examiner's serial number and telephone number should
be entered in the blocks provided.
The FAA designates specific individuals as Examiners, and this status may not be
further delegated to a physician who may be covering the designee's practice.
Although the FAA does not require that the Examiner sign the Examiner's copy of FAA
Form 8500-8, the Examiner should at least personally initial this form.
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Guide for Aviation Medical Examiners
________________________________________________________________
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.
x SEVERE ALLERGIES
x BINOCULAR MULTIFOCAL AND ACCOMMODATING DEVICES
x CARDIAC TRANSPLANT
x CARDIOVASCULAR EVALUATION
x CONDUCTIVE KERATOPLASTY
x CORONARY HEART DISEASE
x DIABETES MELLITUS - Type I or Type II, Insulin Treated
x DIABETES MELLITUS - Type II, Medication Controlled
x DIABETES MELLITUS - Diet Controlled
x GRADED EXERCISE STRESS TEST REQUIREMENTS
x HUMAN IMMUNODEFICIENCY VIRUS (HIV)
x HYPERTENSION
x IMPLANTED PACEMAKER
x MUSCULOSKELETAL EVALUATION
x PEPTIC ULCER
x RENAL TRANSPLANT
x SUBSTANCES of DEPENDENCE/ABUSE (Drugs and Alcohol)
x THROMBOEMBOLIC DISEASE
x VALVE REPLACEMENT
________________________________________________________________
This Protocol establishes the authority for the Examiner to issue an airman
medical certificate to binocular applicants using multifocal or accommodating
ophthalmic devices.
• 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.
_______________________________________________________________________
The Examiner must defer issuance. Issuance is considered for Third-class applicants only. FAA
Cardiology Panel will review. Applicants found qualified will be required to provide annual
followup evaluations. All studies must be performed within 30 days of application.
x A 1 year recovery period shall elapse after the cardiac transplant before consideration
x 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
x Current blood chemistries (fasting blood sugar, hemoglobin A1C concentration, and blood
lipid profile to include total cholesterol, HDL, LDL, and triglycerides), within 30 days
x Any tests performed or deemed necessary by all treating physicians (e.g., myocardial
biopsy)
x Coronary Angiogram
x Graded Exercise Stress Test (see disease protocol) and stress echocardiogram
x 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.
________________________________________________________________
x Blood chemistries (fasting blood sugar, current blood lipid profile to include
total cholesterol, HDL, LDL, and triglycerides) performed within the last 90
days
________________________________________________________________
x The airman must provide all medical records related to the procedure
x 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
________________________________________________________________
Myocardial infarction, angina pectoris, or other evidence of coronary heart disease are
covered in this protocol. Reports and test results relating to the diagnosis in accordance
with the attached protocol must be obtained and forwarded to the AMCD.
A. Requirements are for consideration for any class of airman medical certification.
________________________________________________________________
In addition, the applicant must provide the operative or procedure report if a STENT was
implanted. The report must include make, manufacturer, and type of STENT, implant
location(s), and length and diameter of each STENT.
________________________________________________________________
The FAA has established a policy that permits the special issuance medical
certification of insulin-treated applicants for third-class medical certification.
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.
Consideration is not being given for first- or second-class certification.
Individuals certificated under this policy will be required to provide substantial
documentation regarding their history of treatment, accidents related to their
disease, and current medical status. If certificated, they will be required to adhere
to stringent 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:
A. Initial Certification
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.
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 that 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 airman must use judgment in deciding whether measuring
concentrations or operational demands of the environment (e.g.,
adverse weather, etc.) should take priority. In cases where it is
decided that operational demands take priority, the airman must
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Guide for Aviation Medical Examiners
________________________________________________________________
This protocol is used for all diabetic applicants treated with oral agents or incretin
mimetic medications (exenatide), herein referred to as medication(s).
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. 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 diabetes. 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:
x under control;
x stable;
x presents no risk to aviation safety; and
x consults with the Examiner who issued the certificate, AMCD or RFS.
An applicant who uses insulin for the treatment of his or her diabetes may only
be considered for an Authorization for a third-class airman medical certificate.
A blood glucose determination is not a routine part of the FAA medical evaluation
for any class of medical certificate. However, the examination does include a
routine urine test. A medical history or clinical diagnosis of diabetes mellitus may
be considered previously established when the diagnosis has been or clearly
could be made because of supporting laboratory findings and/or clinical signs
and symptoms. When an applicant with a history of diabetes is examined for the
first time, the Examiner should explain the procedures involved and assist in
obtaining prior records and current special testing.
________________________________________________________________
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.
________________________________________________________________
If the Bundle Block Branch (BBB) has been previously documented and
evaluated, no further evaluation is required. A medical certificate should not be
issued to any class if the applicant has a new onset of a bundle branch block. A
right BBB in an otherwise healthy person 30 years of age or younger should not
require a CVE. All other individuals who do have a right BBB require a CVE but
a radionuclide study should not be required unless the standard exercise stress
test cannot be interpreted. A stress echocardiogram may be sufficient in most
cases. A left BBB in a person of any age should have a CVE and should include
a radionuclide perfusion study. Those individuals who have a negative work-
up may be issued the appropriate class of medical certificate. No followup
is required. If any future changes occur, a new current CVE will be required.
16
Guide for Aviation Medical Examiners
________________________________________________________________
17
Guide for Aviation Medical Examiners
________________________________________________________________
Initial: The Examiner may issue first-, second-, or third-class medical certificates
to otherwise qualified airmen whose hypertension is adequately controlled with
acceptable medications without significant adverse effects. In such cases, the
Examiner shall:
________________________________________________________________
Medications:
2. The Examiner may submit for the Federal Air Surgeon's review
requests for Authorization under the special issuance section of
part 67 (14 CFR § 67.401) in cases in which these or other usually
unacceptable medications are used. Specialty evaluations are
required in such cases and must provide information on why the
specific drug is required. The Examiner's own recommendation
should be included. The Examiner must defer issuance of a
medical certificate to any applicant whose hypertension is being
treated with unacceptable medications.
Duration of Certificates: The duration of the certificate will be valid until the time
of normal expiration, unless otherwise specified by the FAA.
A 2-month recovery period must elapse after the pacemaker implantation to allow
for recovery and stabilization. Submit the following:
________________________________________________________________
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.
21
Guide for Aviation Medical Examiners
________________________________________________________________
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), without the student limitation, may be provided to
the inspector for issuance to the applicant, or the inspector may be required to
send the report to the FAA medical officer who authorized the test.
22
Guide for Aviation Medical Examiners
________________________________________________________________
Evidence of healing must be verified by a report from the attending physician that
includes the following information:
23
Guide for Aviation Medical Examiners
________________________________________________________________
x The results of the following laboratory results: CBC, BUN, creatinine, and
electrolytes
PROTOCOL FOR
SUBSTANCES OF DEPENDENCE/ABUSE
(DRUGS - ALCOHOL)
• A personal statement attesting to the substance and amount, and date last
used
________________________________________________________________
x PT/PTT
x Protein S & C
x Leiden Factor V
x If still anticoagulated, submit all (no less than monthly) INR from time of
hospital discharge to present
26
Guide for Aviation Medical Examiners
________________________________________________________________
PROTOCOL FOR CARDIAC VALVE REPLACEMENT
Applicants with tissue and mechanical valve replacement(s) are considered after the
following:
x 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;
x 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;
x 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 accomplished at least
monthly during the past 6-month period of observation;
x 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.
x A current 24-hour Holter monitor evaluation to include select representative
tracings;
x Current M-mode, 2-dimensional echocardiogram with Doppler. Submit the video
resulting from this study;
x A current maximal GXT – See GXT Protocol;
x 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;.
x 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.
x Single, Mechanical and Valvuloplasty - See AASI for Cardiac Valve Replacement;
x 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.
28
PHARMACEUTICALS
186
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.
ANTIDEPRESSANTS INSULIN
ANTIHYPERTENSIVE SEDATIVES
SUBSTANCES OF DEPENDENCE/ABUSE
See page 231
PHARMACEUTICALS
ACNE MEDICATIONS
I. CODE OF FEDERAL REGULATIONS
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 40, page 83, Skin,
Aerospace Medical Disposition table.
V. PHARMACEUTICAL CONSIDERATIONS:
PHARMACEUTICALS
ANTACIDS
II. MEDICAL HISTORY: Item 18.i., page 31, Stomach, liver, or intestinal trouble.
The applicant should provide history and treatment, pertinent medical records, current
status report, and medication. If a surgical procedure was done, the applicant must
provide operative and pathology reports.
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
ANTICOAGULANTS
II. MEDICAL HISTORY: Item Item 18.g., page 31, 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.
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
ANTIDEPRESSANTS
Medical History: Item 18.n., page 32, 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.
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.
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, page
153.
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
PHARMACEUTICALS
ANTIHISTAMINIC
II. MEDICAL HISTORY: Item 18.e., page 31, Hay fever or allergy.
The applicant should report frequency and duration of symptoms, and whether
they have been incapacitating by the condition. Mention should also be made of
treatment and side effects. The Examiner should inquire whether the applicant has
ever experienced any “ear block,” barotitis, or any other symptoms that could
interfere with aviation safety. Barosinusitis is of concern and should also be ruled
out.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 26, page 42, Nose,
Aerospace Medical Disposition table.
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
ANTIHYPERTENSIVE
II. MEDICAL HISTORY: Item 18.h., page 31, High or low blood pressure.
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
DESENSITIZATION INJECTIONS
I. CODE OF FEDERAL REGULATIONS
II. MEDICAL HISTORY: Item 18.e., page 31, Hay fever or allergy.
The applicant should report frequency and duration of symptoms, and whether
they have been incapacitating by the condition. Mention should also be made of
treatment and side effects. The Examiner should inquire whether the applicant has
ever experienced any “ear block”, barotitis, or any other symptoms that could
interfere with aviation safety. Barosinusitis is of concern and should also be ruled
out.
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
DIABETES MELLITUS – TYPE II
MEDICATION CONTROLLED
I. CODE OF FEDERAL REGULATIONS
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
GLAUCOMA MEDICATIONS
II. MEDICAL HISTORY: See specific history items in Exam Techniques, Item 31-34.,
page 49, Eye – Glaucoma
The applicant should provide history and treatment, pertinent medical records, current
status report, and medication and dosage.
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
INSULIN
I. CODE OF FEDERAL REGULATIONS
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.
IV. PROTOCOL: See Diabetes Mellitus - Type I or Type II, Insulin Treated
Protocol
V. PHARMACEUTICAL CONSIDERATIONS
PHARMACEUTICALS
MALARIA MEDICATIONS
I. CODE OF FEDERAL REGULATIONS
PHARMACEUTICALS
SEDATIVES
Medical History: Item 18.n. page 32, 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.
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.
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, page
153.
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
AASI COVERSHEET
199
Authorization for Special Issuance of a Medical Certificate and
AME Assisted Special Issuance (AASI)
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.
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.
Guide for Aviation Medical Examiners
________________________________________________________________
The Guide refers to a number of selected medical conditions that are initially
disqualifying and must be deferred to the AMCD or RFS. Following the granting
of an Authorization for Special Issuance of a Medical Certificate (Authorization)
by the AMCD or RFS. Each AASI has their own specialized clinical criteria, by
which an Examiner may reissue a medical certificate to an applicant with a
medical history of an initially disqualifying condition, if otherwise qualified.
ARTHRITIS HYPOTHYROIDISM
HEPATITIS C
HYERTHYROIDISM
________________________________________________________________
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
issuance of an Authorization for the above 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 RFS
for the initial determination.
3
Guide for Aviation Medical Examiners
________________________________________________________________
Note: If the applicant has mild symptoms that are infrequent, have not required hospitalization, or
use of steroid medication, and no symptoms in flight, the Examiner may issue an airman medical
certificate. See Item 35., Lungs and Chest Aerospace Medical Disposition, page 59.
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 issuance of an Authorization for the above 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 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:
________________________________________________________________
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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 RFS
for the initial determination.
7
Guide for Aviation Medical Examiners
________________________________________________________________
AASI FOR CHRONIC LYMPHOCYTIC LEUKEMIA
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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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 issuance of an Authorization for the
above disease/condition, and the applicant has provided all of 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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 issuance of an Authorization for the
above 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 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 issuance of an Authorization for the above 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 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:
• The name and dosage of medication(s) used for treatment and/or prevention with
comment regarding side effects;
• A statement regarding any other associated problems, such as cardiac or visual; and
• A statement regarding the current thyroid stimulating hormone (TSH) level performed
within the last 90 days.
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
issuance of an Authorization for the above 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 RFS
for the initial determination.
• An update of the status of the disease from the last FAA medical
examination and any testing deemed necessary by the treating
physician.
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
issuance of an Authorization for the above 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 RFS
for the initial determination.
Note:
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 issuance of an Authorization for the
above disease/condition, and the applicant has provided all of 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 RFS
for the initial determination.
x An arrhythmia develops; or
________________________________________________________________
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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 RFS
for the initial determination.
22
Guide for Aviation Medical Examiners
________________________________________________________________
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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 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
issuance of an Authorization for the above 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 RFS
for the initial determination.
26
Guide for Aviation Medical Examiners
________________________________________________________________
AASI FOR WARFARIN (COUMADIN) THERAPY FOR DEEP VENOUS THROMBOSIS (DVT),
PULMONARY EMBOLISM (PE), AND/ OR HYPERCOAGULOPATHIES
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 issuance of an Authorization for the
above disease/condition and the applicant has all of 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.
________________________________________________________________
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.
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
issuance of an Authorization for the above 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 RFS
for the initial determination.
For Third-class:
Angina Pectoris
Atherectomy
Brachytherapy
Myocardial Infarction
Rotoblation
Stent Insertion
Valve Replacement
________________________________________________________________
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.
This AASI is presently restricted to the issue of a third-class airman medical certificate
for an applicant with a history of Angina Pectoris; Atherectomy; Brachytherapy; Coronary
Bypass Grafting; Myocardial Infarction; Percutaneous Transluminal Angioplasty (PTCA);
Rotoblation; or Stent Insertion. First- and second-class applicants must be deferred to
the FAA.
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 issuance of an Authorization for the
above 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 RFS for the initial determination.
x The applicant complains of chest pain at any time (exclude chest pain
with a firm diagnosis of non-cardiac causes of chest pain);
x The applicant has another event (myocardial infarction, or restenosis
requiring CABG, atherectomy, brachytherapy, PTCA, or stent);
x The applicant for whatever reason is placed on a long acting nitrate;
x The applicant’s risk factors are inadequately controlled; or
x Has any reason for not renewing an AASI – See GXT Protocol.
________________________________________________________________
AASI FOR SINGLE VALVE REPLACEMENT
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.
This AASI is presently restricted to the issue of a third-class airman medical certificate.
First- and second-class applicants must be deferred to the FAA.
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 issuance of an Authorization for the
above 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 RFS for the initial determination.
x More than 20% of INR values are less than 2.5 or greater than 3.5
In select cases of a Bileaflet (St. Jude) valve in the aortic position, INR
values between 2.0 and 3.0 may be accepted (check with FAA)
I have reviewed the enclosed medical report(s) and have determined that the report(s) is in accordance with this applicant’s
Authorization for Special Issuance of a Medical Certificate and the AASI Protocol established for certificate issuance.
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.
AIRMAN INFORMATION:
Name:
PI: DOB:
AME Signature:
231
Substances of Dependence/Abuse
AMPHETAMINES NARCOTICS
COCAINE PS YCHOTROPIC
HYPNOTICS STIMULANTS
HALLUCINOGENS TRANQUILIZERS
Medical History: Item 18.n., page 32, 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.
2
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.
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,
See page 153.
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.
http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/drug_alcohol
3
SYNOPSIS OF MEDICAL STANDARDS
235
SUMMARY OF MEDICAL STANDARDS – Revised April 3, 2006
Medical
Certificate
Pilot Type First-Class Second-Class Third-Class
Airline Transport Pilot Commercial Pilot Private Pilot
237
______________________________________________________________
GLOSSARY/ACRONYMS
AASI - AME Assisted Special Issuance - Criteria under which an Examiner may
Authorization from the FAA, and criteria to defer issuance to AMCD or RFS for
these situations.
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 and student pilot certificates. (NOTE: Senior Examiners
perform first-class airman examinations).
AV - Atrioventricular
ECG - Electrocardiogram
US -Ultrasound
9. Administrative In Pharmaceuticals,
Antihistaminic, V.
Pharmaceutical
Considerations – add
“C. Aerospace Medical
Dispositions, Item 35. Lungs
and Chest.”
10. Medical Policy Revise Disease Protocols,
Coronary Heart Disease to
clarify requirements for
consideration for any class
of airman medical
certification.
11. Errata Revise Disease Protocols,
Coronary Heart Disease to
remove “Limited to Flight
Engineer Duties.”
V. 04/25/2007 1. Administrative Move Leukemia, Acute and
Chronic from Aerospace
Medical Dispositions Item
48. General Systemic to
Item 48. General Systemic,
Blood and Blood-Forming
Tissue Disease.
1. Revise Cover page. Remove 2009 title. Guide updated to reflect current
calendar year.
4. In Applicant History, Item 17b, revise and clarify criteria regarding use of
types of contact lenses.
5. In Exam Techniques, Items 31-34 Eye – Contact Lenses, revise and clarify
criteria.
1. Revise Cover page. Remove 2008 title. Guide updated to reflect current
calendar year.
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. See
Aerospace Medical Dispositions, Item 40. Skin below. \
11. In AME Assisted Special Issuance, All Classes – added entry and criteria
for Metabolic Syndrome (Glucose Intolerance, Impaired Glucose Tolerance, Impaired
Fasting Glucose, Insulin Resistance, and Pre-Diabetes). Also added entry on AASI
Certificate Issuance sheet.
19. In Examination Techniques, Item 52. Color Vision, add note to Agency-
Designated AMEs: “Not all tests approved for pilots are acceptable for FAA
ATCSs. Contact RFS for current list.”
6. Revise entire Guide. Remove any use of the term Urinalysis. Change term
to “Urine Test(s).”
9. In Examination Techniques, Item 52., Color Vision, add Richmond HRR 4th
Edition as acceptable vision tester.
10. In Aerospace Medical Dispositions, Item 52., Color Vision, add testing
standards for Richmond HRR 4th Edition.
This section provides guidance for the initial Authorization for Special Issuance of
a Medical Certificate (Authorization) in accordance with Title 14 of the Code of
Federal Regulations (14 CFR) §67.401, AME Assisted Special Issuances (AASI),
and AASI’s for Third-Class only.
7. Revise Atrial Fibrillation AME Assisted Special Issuance. This AASI was
updated as a result of the advancement of medical technology.
8. Revise the Asthma AME Assisted Special Issuance (AASI). Insert the
following provision into the Asthma AASI:
Note: If the applicant has mild symptoms that are infrequent, have not required
hospitalization, or use of steroid medication, and no symptoms in flight, the
Examiner may issue an airman medical certificate. See Item 35., Lungs and
Chest, Aerospace Medical Disposition, page 59.
If the applicant does not meet the above criteria, the Examiner must follow the
AASI process.
NOTE:
• The Examiner may issue an airman medical certificate if the applicant has
demonstrated is now euthyroid, stable, and without other organ system
involvement. See Item 48., General Systemic, Aerospace Medical Disposition,
page 127.
If Applicant does not meet the above criteria, the Examiner must follow the AASI process.
13. Item 35. Lungs and Chest. Revise Asthma, Aerospace Medical Disposition
table, page 59 as follows:
Atrial Fibrillation
Followup
Special Issuance’s -
See AASI Protocol
Resolved History of 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
15. Item 36. Heart. Revise Coronary Heart Disease Aerospace Medical
Disposition table, page 71 as follows:
Coronary Heart 1st & 2nd See CHD Protocol Requires FAA Decision
Disease:
Angina Pectoris
Atherectomy;
Bracytherapy; 3rd Initial Special
Coronary Bypass Issuance - Requires
Grafting; FAA Decision
Myocardial Infarction;
PTCA; Followup
Rotoblation; and Special Issuance’s -
Stent Insertion See AASI Protocol
Valvular Disease
Single Valve 1st & 2nd See Valve Requires FAA Decision
Replacement (Tissue, 3rd Replacement Initial Special
Mechanical or Issuance - Requires
Valvuloplasty) FAA Decision
Followup
Special Issuance’s -
See AASI Protocol
Multiple Valve All Document history Requires FAA Decision
Replacement and findings, CVE
Protocol, and submit
any tests deemed
appropriate
Endocrine Disorders
19. Revise FAA Form 8500-7, Report of Eye Evaluation. Update Form to
reflect latest vision procedures.
20. Revise AASI for Single Valve Placement. Correct to show INR values for
mechanical valve should read 2.5 and 3.5, except for certain types of bileaflet
valves in the aortic position.
21. Revise Protocol for Hypertension. Clarify regarding initiation and change
of medication and the suspension of pilot duties.
23
If the applicant was previously deferred for either hyperthyroidism or hypothyroidism and was granted an
Authorization for Special Issuance of a Medical Certificate, see AASI for Hyperthyroidism and/or
AASI for Hypothyroidism.
“Bifocal contact lenses or contact lenses that correct for near and/or intermediate
vision only are not considered acceptable for aviation duties.”
24. Item 46. Neurologic. Revise Neurologic Conditions Disposition Table and
Footnote #21 to include guidance on Rolandic Seizure:
“Rolandic Seizure may be eligible for certification if the applicant is seizure free
for 4 years and has a normal EEG. Consultation with FAA required.”
“For issuance of the combined “Medical Certificate and Student Pilot Certificate,” the
applicant must have reached his or her 16th birthday. If the applicant has not reached age
16 before the examination date, see Item 6. Date of Birth for alternate procedures.
26. Cardiac Transplant Disease Protocol. Insert into Disease Protocols section as
follows:
28. Item 48. General Systemic. Move Leukemia, Acute and Chronic to Item
48. General Systemic, Blood and Blood-Forming Tissue Disease.
Neoplasms
Accoustic Neuroma
Kaposi’s Sarcoma
Leukemias and
Lymphomas
Malignant Melanomas
Eye Tumors
30. Item 38. Abdomen and Viscera Malignancies. Move Breast Cancer to
Item 48. General Systemic, Neoplasms; move Colitis (Ulcerative, Regional
Enteritis or Crohn's disease) and Peptic Ulcer to Item 38. Abdomen and Viscera
and Anus Conditions.
34. Policy Update. Add policy regarding the use of isotretinoin (Accutane) to
Pharmaceutical Medications; Examination Techniques and Criteria for
Evaluation, Item 40. Skin; and Aerospace Medical Dispositions, Item 40. Skin.
36. Item 36. Heart – Atrial Fibrillation. Change link in Dispositions table to
read CVE Protocol with EST, ECHO, and 24-hour.
Followup Special
Issuance’s - See
AASI Protocol
NOTE: Syncope, recurrent or not satisfactorily explained, requires deferral (even though
the syncope episode may be medically explained, an aeromedical certification decision
may still be precluded). Syncope may involve cardiovascular, neurological, and
psychiatric factors.
“Examiner must defer to the AMCD or Region if the treating physician or Examiner
reports the murmur is moderate to severe (Grade III or IV).”
47. Examination Techniques, Item 51. Near and Intermediate Vision. Revise
to include Keystone Orthoscope and Keystone Telebinocular.
55. General Information, Who May Be Certified. Add guidance for ICAO
standard for English Proficiency, Operational Level 4.
57. Exam Techniques, Item 50, Distant Vision. Revise equipment list of
acceptable substitutes.
66. In Exam Techniques, Item 52, Color Vision. Revise language to specify
that AME-administered aviation Signal Light Gun test is prohibited.
The following changes are made to Version IV. of the Guide for
Aviation Medical Examiners:
1. The Guide for Aviation Medical Examiner’s “MAKEOVER.”
The Office of Aerospace Medicine was tasked to redesign the Guide’s website to
conform with the DOT and the FAA’s National Policy concerning Web
Management.
Eyes, General
6. Item 37. Vascular System. Insert Deep Vein Thrombosis and Pulmonary
Embolism into the aerospace medical disposition table, page 76, as follows:
Vascular Conditions
Bifocal contact lenses or contact lenses that correct for near and/or
intermediate vision only are not considered acceptable for aviation duties.
This Protocol establishes the authority for the Examiner to issue an airman
medical certificate to binocular applicants using multifocal or accommodating
ophthalmic devices.
11. AME Assisted Special Issuance. Insert into this section a new Bladder,
Breast, Melanoma and Renal Carcinoma AASI.
1. Search Engine. Installed a Search Engine at the top of the Navigation Bar of
the 2004 Guide for Aviation Medical Examiner’s (Guide).
2. WHAT’S NEW. A "What's New" link is inserted in the Navigation Bar of the
2004 Guide. This link provides important airmen medical certification decision-
making revisions or items of significance.
3. Instructions site. The "Instructions” site located in the Navigation Bar of the
2003 Guide is deleted and incorporated into the “Introduction” and the newly
developed “Available Downloads” sites of the 2004 Guide.
5. Insert a Table of Contents and an Index into the pdf version of the
2004 Guide. In the printable version of the 2004 Guide, insert a Table of
Contents and an Index for easier access to pertinent regulations, examination
procedures, case disposition guidelines, and disease protocol necessary to
obtain medical certification information and guidance.
7. Items 31-34. Eye. Insert Section 6. Orthokeratology into Items 31-34, Eye,
located on page 48, as follows:
Psychiatric Conditions
If the Examiner denies the applicant, the Examiner must issue a Letter of Denial,
FAA Form 8500-2 to the applicant, and report the issuance of the denial in
Item 60.
12. AME Assisted Special Issuance (AASI). In the AASI section, delete AASI
for History of Monocularity
13. Archives. Insert in the 2004 Guide an Archive site, which delineates each
modification, its effective date, a description, and the reason for modification.
14. Item 37. Vascular Conditions. In Item 37, Vascular System aerospace
medical disposition table, Arteriosclerotic Vascular Disease/Condition, page 74
of Version II. of the Guide, insert CAD US if applicable as follows:
Vascular Conditions