Eye
First and second class visual acuity standards are identical and require that you be able to see 20/20 or better in each eye, with or without correction for distance. For near vision, the standard is 20/40 (at 16 inches), and for pilots age 50 and over, a 20/40 intermediate vision (at 32 inches) is also required.
There is no uncorrected distant vision requirement. Your aviation medical examiner (AME) will probably check your uncorrected vision just to see if there have been any significant changes since your last exam. Waivers for uncorrected visual acuity are no longer valid since there is no standard, so when you renew your next medical, ask the AME to include a note requesting that the waiver be removed from your records.
If you wear eyeglasses or contact lenses that correct you to 20/20 or better, you meet the standards. Your certificate will include a limitation that you wear corrective lenses while exercising privileges. For third class, you need to be able to see 20/40 or better in each eye, with or without correction for distant and near vision.
Refractive corrective procedures
There are several procedures for correcting distant visual acuity now available, the most popular being LASIK. LASIK and other similar procedures use a specialized laser to reshape the cornea to improve visual acuity. All Food and Drug Administration (FDA)-approved procedures are acceptable to the FAA to meet the vision standards for any class of medical certificate. There is some documentation required, though, when you have any refractive correction procedure performed.
Color vision standards now apply equally to all classes of medical certificates. The new rule requires that an applicant have "...the ability to perceive those colors necessary for safe performance of airman duties." The regulation doesn't tell us exactly what colors are necessary for performing airman duties, but we can assume red, green, and white for aircraft position and anticollision lighting, white/blue combinations for runway and taxiway lighting, and airport tower identification lighting.
To demonstrate that you meet the standard, it's still necessary to identify characters on a field of colored dots using, most commonly, the Ishihara pseudoisochromatic color plates. Pilots who have mild color deficiency and don't do well with color plates in the AME's office can still be issued a medical certificate that will limit them to no night flying or use of tower color signal controls until the restriction is removed through additional testing.
The FAA authorizes several alternative color perception tests. If you can pass one of these tests, you will be issued a medical certificate without the night-flying restrictions. If you can't pass any of the alternative tests, it's still possible to take the color signal light test at an FAA air traffic control tower.
There is some paperwork required, and you will be dealing with your local flight standards district office (FSDO) as well as the Aerospace Medical Certification Division. Complete details for having the color restriction removed are available online.
Ear, nose, throat, and equilibrium
The hearing standards for any class medical require that you be able to hear a conversational voice at 6 feet, with your back turned to the examiner. If you can't meet the conversational voice test, additional testing may be needed, including audiometric speech discrimination testing or pure tone audiometric testing. If you can meet the standard while wearing a hearing aid, the AME can issue your certificate. The FAA will later issue a waiver when your application is processed.
Obviously, any condition that results in vertigo or any type of disequilibrium is disqualifying until the condition is diagnosed and the likelihood of recurrence of symptoms established. Ear problems that are at least temporarily disqualifying include serious infections such as those caused by labyrinthitis. Acoustic neuromas, benign tumors that grow in the inner ear that can cause hearing loss, ringing in the ears (tinnitus), and disequilibrium similar to vertigo, also are disqualifying until reviewed by the FAA. Meniere's disease is a particular problem for pilots because of the quick onset and severity of symptoms. Vertigo can come on quickly and last for up to 24 hours. Symptoms may disappear, only to recur unexpectedly months or even years later.
Mental
The mental standards include several of the 15 specific disqualifying conditions, including:
A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
Substance dependence/abuse (defined within the regulation and includes prescription drugs, illicit drugs, and alcohol) or a verified positive DOT-mandated drug test.
Psychosis;
Bipolar disorder.
Personality disorders and psychoses pose substantial challenges for certification. These diagnoses often require the use of disqualifying medications, and individuals on these drugs don't always respond well to therapy. Substance dependence usually requires at least 24 months of documented abstinence and recovery. Applicants with substance abuse histories may be considered for certification with evidence of at least 12 months of recovery and continued abstinence. Complete information can be found online. Remember, too, that any alcohol-related motor vehicle action must be reported to the FAA Civil Aviation Security Division within 60 days of the action.
Neurologic
Neurologic cases, too, pose some of the more difficult certification decisions for the FAA. Epilepsy and disturbances of consciousness or transient loss of control of nervous system function without satisfactory medical explanation of the cause are disqualifying. A one-time-only seizure with an otherwise normal neurological evaluation can be favorably reconsidered if at least four years have passed since the seizure and there has been no anticonvulsant drug therapy for at least two years.
A history of multiple seizures, but no diagnosis of epilepsy, may be considered for certification only if there has been at least a 10-year period since the last seizure and at least three years have passed since anticonvulsant medication was used. A history of epilepsy may be considered only after there have been no seizures and no anticonvulsant medication usage for the last 10 years.
Some "disturbances of consciousness" may be directly related to a neurologic problem but may also be associated with an underlying cardiac problem, or a combination of both neurologic and cardiac pathology. These cases require extensive testing to determine the true origin of the problem. Sometimes a firm diagnosis cannot be made. When that happens, the FAA usually requires a period of at least one year of observation with no recurrence of symptoms before a medical issuance will be considered.
Strokes and transient ischemic attacks, sometimes referred to as "ministrokes", fall in the category of "transient loss of control of nervous system function without evidence of the cause" and usually require two years of observation and recovery. Neurological conditions almost always require a specialist evaluation.
Cardiovascular
Heart disease and related vascular problems ground more pilots than any other disease process. Prior to the development of coronary artery bypass surgery in the 1980s, there was little medical intervention available to enable the FAA to recertify pilots who had histories of heart attacks or significant heart disease. Now, thanks to significant advances in the treatment of heart disease and a large database of persons who have been treated, the FAA has granted thousands of special issuance medical certificates. The regulations currently disqualify a history of:
Myocardial infarction (heart attack);
Angina pectoris (chest pain associated with heart disease);
Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant;
Cardiac valve replacement;
Permanent cardiac pacemaker implantation;
Heart replacement.
The regulation also requires applicants for a first class medical, at the first examination after age 35 and annually after age 40, to have an electrocardiogram showing no evidence of myocardial infarction or other significant abnormality.
Clinically significant heart disease isn't defined in the regulation. The term refers to an abnormal treadmill stress test, sometimes characterized by a change of greater than one millimeter in what cardiologists call the "ST" segment of the electrocardiogram, an abnormal radionuclide myocardial perfusion scan (thallium or sestamibi are commonly used radioisotopes), or an angiogram indicating 50% or greater blockage of any coronary artery.
Additional specific tests may also be needed, depending on the findings of earlier studies. Rhythm disturbances, for example, may require a 24-hour ambulatory Holter monitor or a signal-averaged ECG. A heart murmur that might indicate a defective valve is usually studied with an echocardiogram.
General medical condition
This is the "catch-all" section of the regulations that covers all the other medical conditions that aren't associated with regulatory standards. Diabetes that requires medication treatment is a disqualifying condition and requires a special issuance. If you take oral medications to control blood glucose, the reporting information is straightforward.
For insulin-controlled diabetes, though, the process is more complicated. The FAA will ask for a comprehensive medical history and current testing). The FAA is only issuing third class medical certificates under the current policy, and that is not likely to be expanded to higher classes anytime soon. There are now about 400 pilots flying with a special issuance for insulin-treated diabetes.
"No other organic, functional, or structural disease, defect, or limitation..." rounds out this section of the regulation. High blood pressure (hypertension) is included as an "organic condition" and is a good example of how the FAA uses policy to enforce a medical standard. If there was a regulation that mandated the maximum allowable blood pressure limits, the only way pilots with high blood pressure could be legally certificated would be with a special issuance authorization. A special issuance is a costly and time-consuming way to achieve a medical, so the FAA did us a favor (if you want to call it that) by addressing hypertension by policy rather than by regulatory standard.
Unfortunately, some medical examiners still aren't aware of this longstanding policy and will send your application in to the FAA (defer) even if you have the required evaluation at the time of examination. A deferral is not a good thing to have happen because the review process in Oklahoma City may take up to 120 days before you get a response. That isn't good news for any pilot, but if you fly professionally or use your airplane in business, it's really bad news.
The hypertension policy sets a maximum allowable blood pressure of 155 systolic over 95 diastolic. This is still considerably higher than the recognized desired readings of less than 120/80. You'll need to have a report of a resting electrocardiogram. Blood plasma levels for glucose, cholesterol, triglycerides, potassium, and creatinine, and a summary report from your treating physician including three blood pressure reports demonstrating good control will also be needed. The FAA approves virtually all anti-hypertension medications, including alpha-adrenergic blockers, beta-adrenergic blockers, ACE-inhibitors, calcium channel blockers, direct vasodilators, and diuretics. These groups of drugs make up the majority of blood pressure medications available. As long as your doctor prescribes a drug from one of the approved categories and the medication does the job of keeping your pressure down, you'll be able to get any class of medical.
Special Issuance
We've alluded to some disqualifying conditions that are embedded in the medical regulations. There are actually 15 that are specifically disqualifying, and if you report having had any of them on your medical application, your AME cannot issue a medical certificate until it is cleared by the FAA under what's known as a special issuance authorization. A special issuance is a two-sided coin. It's great that the regulations offer a mechanism to offset the disqualifying conditions. The downside is that it's a discretionary issuance granted by the Federal Air Surgeon and comes with requirements for periodic interim medical reports and time limitations (usually 12 months) on the duration of the certificate, and it can be withdrawn anytime the FAA sees evidence of an "adverse" change in your condition. You may hold a certificate that appears to be valid for up to 36 calendar months in accordance with FAR 61.23. In reality, though, the certificate is valid for only as long as the authorization is in force, and that's determined by the type of medical condition and the perceived risk of incapacitation that could result from the condition.
In addition to the time limitation, reissuance of the certificate will be based on additional testing that must be submitted to the FAA prior to the expiration date of the authorization. This might be a simple status report from your treating physician or a complete reexamination with comprehensive (and expensive) diagnostic testing. Additional limitations may be placed on the operational privileges of the certificate, such as limiting a second class medical holder to carrying passengers for hire only when part of a qualified two-pilot crew.
A special issuance is different from a waiver or Statement of Demonstrated Ability (SODA). Waivers are issued for static defects that are not likely to change. Useful vision in only one eye (monocular vision) is one condition for which a medical flight test might be used. There are several hundred pilots flying with monocular vision waivers. Upper or lower limb amputees can also qualify for a SODA with a flight test. Medical flight tests are sometimes conducted to demonstrate that an applicant can safely operate the aircraft. The waiver becomes part of your medical certificate and shows that, although you don't necessarily meet the minimum standards to hold a medical certificate, you have satisfied the FAA that you can safely exercise the privileges of the certificate(s) you hold.
For special issuance consideration, the FAA will ask for medical information specific to the type of condition you had. Often, that first round of records will be sufficient for the FAA to make a decision. Sometimes, though, additional information is needed, especially if the first records you sent are incomplete or inconclusive, or if there are abnormal results indicated. You may get several letters over a period of months asking for more information before finally getting a decision. That's another reason why TurboMedical® is a valuable tool. You will know exactly what information the FAA requires before you start the process. The doctors in Oklahoma City don't want to ask you for any more information than is necessary, but they also won't issue a certificate until they have a complete medical profile on you. Just be patient and expect a few bumps in the road along the way. The process can be frustrating and time consuming. The hassles notwithstanding, more than 25,000 pilots have been certified under special issuance.
Medications
Medication usage is one of the most commonly asked about questions. The regulations don't include specific reference to disqualifying drugs, although FAR §61.53 mentions the circumstances under which certain medications would not be allowed. Further, FAR §91.17 prohibits the use of any drug that "affects the person's faculties in any way contrary to safety."
Once again, FAA policy determines the acceptability of a medication based upon the potential side effects and the symptoms for which the drug is being taken. If you report the current use of a "disqualifying" drug on item 17a of the medical application, the medical examiner will have to defer the application, and there's that long delay again. That's one of the problems of not knowing the status of a particular drug and a very good reason to check AOPA's list of acceptable medications or give the AOPA medical certification specialists a call.
If you receive a denial letter based upon disqualifying medication usage, it's still possible to get the certificate issued, but you will need a report from your treating doctor summarizing your history requiring the use of the medication, and confirmation that you have discontinued the medication for at least 90 days and have remained symptom free during that time. Generally, the FAA prohibits the use of any drug that acts on the central nervous system. Stimulants, barbiturates, antidepressants (yes, Prozac and Paxil are currently disqualifying), hypnotics, muscle relaxants, sedatives, tranquilizers, and sleep aids are a few that aren't allowed.
Drugs affect people differently, and the side effects can range from none at all to profound. Over-the-counter antihistamines or decongestants taken a half hour before a flight may seem innocuous until you're airborne. That's when altitude and pressure changes can cause uncomfortable side effects that could render you "unable to safely perform the duties." Drowsiness is not uncommon in many of the OTCs, yet over-the-counter remedies are frequently misused by unsuspecting flight crewmembers. Remember, too, that the condition for which a drug is being taken may be disqualifying under FAR 61.53. A "medical deficiency" requires that you ground yourself, so a really bad cold and sore throat, combined with self-dispensed medications, may prompt you to have second thoughts about flying today. If you decide to fly anyway, a good rule of thumb for any medication usage is double the last dosage interval before flying. For example, if the prescription instructs you to take the medication every four hours, wait eight hours after the last dose before leaving the ground. Your pharmacist can probably answer any questions about proper usage of a medication and possible adverse side effects or drug interactions.
Contrary to popular belief, the FAA really wants to certify as many pilots as possible. Less than 1 percent of people who apply for a medical receive a final denial, and some of those just give up without pursuing reconsideration.
The Aeromedical Certification Division is a labor-intensive part of the federal bureaucracy and always has a backlog of several months. The best way to work with the FAA is to get started on the right foot. Even when you do everything absolutely right, it will still take some time to get a response to your application. If you understand how the system works, use TurboMedical® and all the other medical certification resources available to you as an AOPA member, and remain patient and persistent, chances are good that you will be issued a medical.
AOPA is the best source of medical certification information outside the FAA and can provide advice to members that isn't available through any other aviation source. Members can access the Aviation Services Pilot Information Center at 800/USA AOPA (872-2672).
FAA Medical Certification Frequently Asked Questions
General Information
I'm ready to start flight training, but my instructor has suggested that I get my medical before getting too involved in training. Can my family doctor give me an FAA medical?
No. The FAA designates physicians (M.D.'s or D.O.'s) around the country to administer flight physicals. These doctors attend initial and recurrent training seminars to maintain their eligibility to conduct FAA medical examinations. Most aviation medical examiners are family practitioners, but many other medical specialties are also represented. Your flight instructor can probably recommend a doctor who can do your physical. AOPA's Medical Certification department can refer you to doctors in your city or county, or you can find the list on AOPA's Web site.
What kinds of certificates are there? How do I know the appropriate one for me?
The FAA issues three classes of medical certificates:
A first class is required for pilots who exercise airline transport pilot (ATP) privileges; that is, those flying scheduled airliners and other pilots whose employers require this level of certification. A first class medical is valid for ATP privileges for six months.
Second class is required for pilots who fly commercially — in operations such as crop dusting, delivering canceled checks, or carrying passengers or cargo for hire. The second class medical is valid for commercial privileges for 12 months.
Third class is appropriate for student pilots and private pilots who fly for pleasure or personal business (but not for hire). Student pilots need only a third class/student pilot certificate that serves as a combination pilot and medical certificate. A third class medical is valid for 24 months (36 months for applicants who have not reached age 40). A third class medical is valid for student, recreational, and private pilot privileges.
Does a third class medical examination include any type of drug testing?
No. Your AME will not be testing for illicit drugs during a flight physical. A routine part of the FAA medical exam is a urinalysis to check for sugar or protein, indicators of possible diabetes or kidney disease. Even as a commercial pilot participating in the DOT/FAA drug testing program, a drug test is done independent of an aviation medical examination. Your AME may also be a medical review officer for a drug testing company, but when conducting a flight physical, he/she will not test you for illicit drugs.
Some of the information asked for on the application is a little confusing, especially the medical history section. Can the examiner help me check answers to those questions?
You should accurately complete the front side of the form. Your signature at the bottom makes the form a legal document and tells the FAA that all information provided is correct to your best knowledge. The application asks you to report use of medications, past medical history, and visits to health professionals. These are important items that the examiner and the FAA use to identify any potential problems that could delay the issuance of your medical. Read the instruction sheet carefully before completing the application and refer to it as you fill out the form. Better yet, before you see the aviation medical examiner, use AOPA's interactive medical application, TurboMedical® to familiarize yourself with the application. The medical examiner can give you some general guidance, but if the FAA has any questions, they will contact you for clarification.
Does the FAA set a standard fee for a medical examination?
The FAA does not set the fees that examiners can charge. The doctors are encouraged to keep their charges for pilot physical exams within the range of fees that other patients would be charged for similar services. A third class medical will cost approximately $60-$100, depending on the area of the country where the exam is taken.
If I see an aviation medical examiner every two years for a third class medical, can I postpone regular physicals with my family doctor?
The FAA aviation medical is not intended to be a comprehensive physical checkup. It is intended to be a screening exam to determine if you meet the minimum medical standards required by the regulations. You should continue to see your family physician for routine periodic checkups.
If I have a change in my medical status after the certificate is issued, may I still fly?
That depends upon whether or not you are in compliance with FAR 61.53. This regulation prohibits the exercising of pilot-in-command privileges while you have a known medical deficiency that prevents you from meeting the requirements of your medical certificate. The regulation does not define medical "deficiency," however. If your treating physician feels that your condition allows you to meet the medical standards and does not jeopardize aviation safety, you may continue flying and report the condition on your next medical application.
My medical was denied. Can I still fly?
Sure you can. You can't legally act as pilot in command or as a required flight crewmember, but you can sit in the left seat and manipulate the controls, as long as you have a qualified pilot on board who is appropriately rated, current, and knowingly acting as pilot in command. In fact, you can LOG as pilot in command all that time that you are sole manipulator of the controls. You just can't act as PIC.
What happens if I get caught flying without a medical?
That depends. If you hold a valid medical and just didn't have it in your possession when you flew and can provide it to the inspector who ramp-checked you, a fine and/or civil penalty will likely result. If you have been denied a medical because of a disqualifying medical condition and are caught flying, the penalty will probably be revocation of all your airman certificates and ratings. If they catch you a second time, jail time is a possibility, though a stiff fine is more likely if your certificates were revoked after the previous offense.
Special Circumstances
Although most pilots are certified without complications, there are some conditions that require extra effort before approval can be granted. Here are some situations frequently discussed with AOPA's Medical Certification department staff.
Alcohol Use and Alcohol-Related Legal Actions
I have a "driving under the influence" (DUI) in my driving record. Is that going to be a problem?
Item 18v of the medical application asks you to report any alcohol- or drug-related motor vehicle actions. If there is only one prior DUI on your record, the FAA will not be too concerned.
If you have had two alcohol-related actions within three years, or more than three in any time period, the FAA has a basis to deny your medical. You will be asked to provide copies of your driving record and any court records resulting from the driving infractions. Additional information concerning your past and current use of alcohol may also be required before your eligibility for medical certification can be determined.
*Please note: Under FAR 61.15, it's required that you report alcohol-related incidents to the Civil Aviation Security Division within 60 days of each administrative action and/or conviction. This report is separate from the report on the medical application. Because each case is unique, members with questions regarding alcohol-related driving offenses are encouraged to call AOPA for information and assistance.
What happens if I don't report alcohol-related convictions on the application?
Alcohol problems are serious business to the FAA. By signing the application, you are authorizing the FAA to access the National Driver Register to cross-match your driving record against the information provided on the application. Alcohol convictions and other offenses resulting in suspension, denial, cancellation, or revocation of drivers' licenses will appear on the NDR. Omitting information on the medical application can result in suspension or revocation of your airman and/or medical certificate.
Cardiovascular Problems
I fly under a special issuance medical because I had a heart valve replaced six years ago. The FAA tells me in the letters to send my records in at least 60 days prior to the expiration date to avoid a lapse. I do that, and it takes three or four months to get a new medical. What can I do to get a full year on my special issuance?
Special issuances cause a lot of delays right now because there is such a backlog in the review of these cases. Even though the letter doesn't say so, you can do your follow-up examination and testing up to 90 days before your current medical expires. Count back on the calendar 90 days from the expiration date and schedule your cardiology exam and testing as close to that day as possible. Once your doctor gets the reports to you, get them in the mail (preferably overnight or express mail) as soon as possible.
Vision Problems
I didn't pass the color vision test at the examiner's office. He put a restriction on my medical that prevents me from flying at night or with color signal control. Can I get this removed?
Most aviation medical examiners use the Ishihara pseudoisochromatic color plates. People with even mild color deficiencies usually have problems passing this test. The FAA authorizes several alternative color plate tests that will substitute for the Ishihara. If you can pass one of these other tests, you meet the color vision standards and will be issued a medical certificate without any night-flying restriction. Another option is to take a color signal light test at an FAA control tower. Upon successful completion of the signal light test, the FAA will issue you a waiver that will allow night flying.
My ophthalmologist has recommended a lens implant following removal of a cataract. Will I lose my certificate?
Not if the surgery enables you to again meet the vision standards for your class of medical. After the surgery, ground yourself until the ophthalmologist releases you to resume normal activities and you again meet the vision standard. Then you may return to flying. At your next medical examination, report the surgery and present a completed Report of Eye Evaluation to the AME.
My eye doctor assures me that a surgical procedure called "LASIK" will enable me to throw away my "Coke bottle" lenses. What will it do to my medical?
The FAA approves refractive surgical procedures provided you have no serious complications and your visual acuity meets the medical standards for the class of medical you hold. When you are released from your doctor's care (usually within a few days or weeks), ask your physician to complete an FAA "Report of Eye Evaluation" Form 8500-7. Take the completed form to your aviation medical examiner at your next medical exam.
Cancer
Since my last medical, I was diagnosed with cancer. How will this affect my next FAA physical?
All treatment must be completed and you should be free of any evidence of metastatic disease or in remission before attempting certification. When you go for your examination, take copies of your hospitalization records, surgical report, and discharge summary, along with a current status report from your treating physician. There are many types of cancer, and each type requires close review, but a good status report and prognosis can often result in certificate issuance.
Kidney Stones
I had a kidney stone since my last FAA exam. Will I have any problem?
The presence of a kidney stone is disqualifying for the issuance of a medical certificate. You will need a status report from your urologist. The report should summarize your medical history, including a comment about your recent treatment for the stones. Also, a current report of either an IVP, KUB, or ultrasound indicating the absence of stones will be needed. With a favorable report, the AME may issue your certificate.
FAA Terminology
What is the difference between a "deferral" and a "denial"?
The medical examiner has two options if he decides not to issue your medical. If you clearly don't meet the medical standards, he can issue a denial, although most examiners prefer not to because of the paperwork required. More likely, the doctor will defer the application to Oklahoma City. The FAA will eventually issue a certificate, ask you for more information, or deny your application. If you are finally denied a medical, you should ask for reconsideration under FAR 67.409.
The FAA sent me a letter stating it is "unable to establish my eligibility to hold a medical certificate." The examiner had issued my medical, so may I still use it?
The FAA is questioning something about your medical history, medications, or visits to health professionals that requires further explanation. Your medical remains valid until the FAA tells you otherwise, but you do need to provide the information requested in the letter.
The FAA has denied my application because it claims I have a "history" of angina. However, I experienced this condition only once, and that was a year ago. How can I convince the FAA that I have no "history"?
The FAA uses the term "history" to refer to any medical situation on record, regardless of the number of times experienced or the length of time since the episode(s) occurred. For example, if you check the "yes" box on the medical application because you recall one incident of "fainting" in the tenth grade, the FAA will want information about your "history" of fainting.
2006-08-23 06:18:55
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