The rigorous First-Class Medical examination is mandated for those operating as commercial airline pilots or as pilots-in-command of certain aircraft and serves to assess an individual’s physical and mental fitness to undertake the responsibilities inherent in aviation. The FAA’s stringent criteria encompass a thorough evaluation of various health parameters, including cardiovascular health, vision, and psychological well-being. Beyond mere regulatory compliance, obtaining and maintaining a first-class medical certificate signifies a commitment to professional excellence and safety in aviation.
Operations Requiring First-Class Medical Certificates
Must hold a first-class medical certificate:
- When exercising the pilot-in-command privileges of an airline transport pilot certificate;
- When exercising the second-in-command privileges of an airline transport pilot certificate in a flag or supplemental operation in part 121 that requires three or more pilots; or
- When serving as a required pilot flightcrew member in an operation conducted under part 121 if the pilot has reached his or her 60th birthday.
Duration of First Class Medical Certificate
A first-class medical certificate is valid for a specified duration, depending on the age of the pilot:
- Under 40 years old: A first-class medical certificate is valid for 12 months, then to third-class privileges for 48 months
- 40 years old and over: A first-class medical certificate is valid for 6 months, then second-class privileges for an additional 6 months, and third-class privileges for another 12 months.
Application Process For First Class Medical Certificate
The application process for a third-class medical certificate involves several steps:
- MedXpress: Pilots are required to complete FAA Form 8500-8, also known as the Application for Airman Medical Certificate. This form collects personal and medical history information. You can complete this form online through the FAA’s MedXpress website.
- Locate an Aviation Medical Examiner (AME): Pilots must schedule an appointment with an FAA-designated Aviation Medical Examiner (AME) to undergo the medical examination. The cost of the exam is not set by the FAA, so it may be anywhere from $280- $395 depending on where you live.
- Medical Examination: During the medical examination, the AME will assess various aspects of the pilot’s health, including vision, hearing, cardiovascular health, and overall fitness.
- Submission and Review: Once the examination is complete, the AME will submit the medical certificate application to the FAA for review. With you potentially leaving the doctor’s office with your medical certificate in hand barring any underlying medical issues.
MedXpress
The FAA MedXPress system allows anyone requiring an FAA Medical Clearance or Medical Certificate to electronically complete the FAA Form 8500-8. Information entered into MedXPress will be available for your FAA-designated Aviation Medical Examiner (AME) to review at the time of your medical examination.
First-Class Airman Medical Certificate Eligibility
To be eligible for a first-class airman medical certificate, and to remain eligible for a first-class airman medical certificate, a person must meet the requirements of this subpart.
Eye
Eye standards for a first-class airman medical certificate are:
- 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.
- 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.
- Ability to perceive those colors necessary for the safe performance of airman duties.
- Normal fields of vision.
- No acute or chronic pathological condition of either eye or adnexa that interferes with the proper function of an eye, that may reasonably be expected to progress to that degree, or that may reasonably be expected to be aggravated by flying.
- Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in fusion under conditions that may reasonably be expected to occur in performing airman duties. Tests for the factors named in this paragraph are not required except for persons found to have more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded, the Federal Air Surgeon may require the person to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate vergence-phoria relationship. However, if otherwise eligible, the person is issued a medical certificate pending the results of the examination.
Ear, nose, throat, and equilibrium
Ear, nose, throat, and equilibrium standards for a first-class airman medical certificate are:
- The person shall demonstrate acceptable hearing by at least one of the following tests:
- Demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the examiner, with the back turned to the examiner.
- Demonstrate an acceptable understanding of speech as determined by audiometric speech discrimination testing to a score of at least 70 percent obtained in one ear or in a sound field environment.
- Provide acceptable results of pure tone audiometric testing of unaided hearing acuity according to the following table of worst acceptable thresholds, using the calibration standards of the American National Standards Institute, 1969:
| Frequency (Hz) | 500 Hz | 1000 Hz | 2000 Hz | 3000 Hz |
|---|---|---|---|---|
| Better ear (Db) | 35 | 30 | 30 | 40 |
| Poorer ear (Db) | 35 | 50 | 50 | 60 |
- No disease or condition of the middle or internal ear, nose, oral cavity, pharynx, or larynx that—
- Interferes with, or is aggravated by, flying or may reasonably be expected to do so; or
- Interferes with, or may reasonably be expected to interfere with clear and effective speech communication.
- No disease or condition manifested by or that may reasonably be expected to be manifested by, vertigo or a disturbance of equilibrium.
Mental
Mental standards for a first-class airman medical certificate are:
- No established medical history or clinical diagnosis of any of the following:
- A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.
- A psychosis. As used in this section, “psychosis” refers to a mental disorder in which:
- The individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition; or
- The individual may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition.
- A bipolar disorder.
- Substance dependence, except where there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. As used in this section—
- “Substance” includes: Alcohol; other sedatives and hypnotics; anxiolytics; opioids; central nervous system stimulants such as cocaine, amphetamines, and similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and chemicals; and
- “Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by—
- Increased tolerance;
- Manifestation of withdrawal symptoms;
- Impaired control of use; or
- Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.
- No substance abuse within the preceding 2 years is defined as:
- Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous
- 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
- Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds—
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
- 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—
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
Neurologic
Neurologic standards for a first-class airman medical certificate are:
- No established medical history or clinical diagnosis of any of the following:
- Epilepsy;
- A disturbance of consciousness without a satisfactory medical explanation of the cause; or
- A transient loss of control of nervous system function(s) without a satisfactory medical explanation of the cause.
- No other seizure disorder, disturbance of consciousness, or neurologic condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
Cardiovascular
Cardiovascular standards for a first-class airman medical certificate are:
- No established medical history or clinical diagnosis of any of the following:
- Myocardial infarction;
- Angina pectoris;
- Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant;
- Cardiac valve replacement;
- Permanent cardiac pacemaker implantation; or
- Heart replacement;
- A person applying for first-class medical certification must demonstrate an absence of myocardial infarction and other clinically significant abnormality on electrocardiographic examination:
- At the first application after reaching the 35th birthday; and
- On an annual basis after reaching the 40th birthday.
- An electrocardiogram will satisfy the requirement if it is dated no earlier than 60 days before the date of the application it is to accompany and was performed and transmitted according to acceptable standards and techniques.
General medical condition
The general medical standards for a first-class airman medical certificate are:
- No established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control.
- 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—
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
- 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—
- Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
- May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
Special Issuances
Pilots seeking special issuance for any disqualifying factors must undergo thorough medical evaluations, provide documentation from their treating physicians, and sometimes fulfill additional requirements to demonstrate their ability to safely operate aircraft despite their medical condition. If approved, they receive a medical certificate with specific limitations and conditions tailored to their situation.
While the stringent requirements may pose challenges, they ultimately serve as a safeguard against potential risks inherent in aviation operations. Through comprehensive medical evaluations and adherence to regulatory standards, pilots uphold the fundamental principles of prioritizing safety above all else. As aviation continues to evolve and face new challenges, the FAA’s commitment to maintaining rigorous medical standards ensures that the skies remain safe for all who travel within them.