Federal aviation regulations list a specific set of disqualifying medical conditions for pilots under 14 CFR Part 67, and a diagnosis in any of these categories triggers an automatic denial of your medical certificate unless you qualify for a special issuance or an alternative pathway. The categories are cardiovascular disease, four named psychiatric disorders, certain neurological events, substance dependence and abuse, and insulin-treated diabetes. A general medical catch-all lets the Federal Air Surgeon deny certification for anything else that would make flying unsafe.
Disqualifying Cardiovascular Conditions
Heart problems are the most common reason pilots lose their certificates. The cardiovascular standards apply identically to first-, second-, and third-class certificates, and a documented history is enough. You do not have to be symptomatic at the time of your exam.
- Myocardial infarction (any history of a heart attack, regardless of how long ago)
- Angina pectoris
- Symptomatic or treated coronary heart disease
- Cardiac valve replacement
- Permanent cardiac pacemaker implantation
- Heart replacement
These appear in 14 CFR 67.111 (first class), 67.211 (second class), and 67.311 (third class), and the list is identical across all three.1eCFR. 14 CFR 67.111 – Cardiovascular
A disqualification is not always permanent. Many cardiovascular conditions can be revisited through the special issuance process, where pilots submit stress tests, echocardiograms, and detailed physician reports to prove stability. Well-controlled high blood pressure sits in a different category: your AME can issue the certificate on the spot under the Conditions AMEs Can Issue program if your reading is at or below 155/95, you take no more than three approved medications, and you have no side effects. Centrally acting antihypertensives like clonidine are not acceptable.2Federal Aviation Administration. CACI – Hypertension Worksheet
The Four Disqualifying Mental Health Diagnoses
Four psychiatric diagnoses automatically block certification. Pilots and flight surgeons sometimes call them the “big four.”
- Psychosis, meaning any disorder involving delusions, hallucinations, or significantly disorganized behavior. The regulation also covers cases where a person may reasonably be expected to develop those symptoms.
- Bipolar disorder, disqualifying in all cases regardless of current stability or treatment.
- Severe personality disorder, specifically one serious enough to have repeatedly shown itself through observable behavior.
- Substance dependence on any substance.
These standards appear at 14 CFR 67.107, 67.207, and 67.307.3eCFR. 14 CFR 67.107 – Mental Substance dependence is the only one of the four with a built-in path back: the Federal Air Surgeon has authority to reconsider after at least two years of sustained total abstinence with clinical evidence of recovery.
Depression itself is not on this list, but the medications used to treat it create their own regulatory layer. The FAA will consider only a short list of antidepressants under special issuance. As of August 2025, the approved options are four SSRIs (citalopram, escitalopram, fluoxetine, and sertraline), three SNRIs (desvenlafaxine, duloxetine, and venlafaxine), sustained-release bupropion, and vilazodone, each used as a single agent.4Federal Aviation Administration. Antidepressant Medications Paroxetine (Paxil), fluvoxamine (Luvox), all tricyclic antidepressants, all MAO inhibitors, immediate-release bupropion, and esketamine (Spravato) are flatly unacceptable.
Disqualifying Neurological Conditions
The neurological standards are the most unforgiving in Part 67. Sudden loss of consciousness at altitude is one of the most dangerous scenarios in aviation, and the regulation reflects that. Three categories of neurological findings are specifically disqualifying under 14 CFR 67.109, 67.209, and 67.309:
- Epilepsy, meaning any established history or clinical diagnosis, with no exceptions written into the regulation itself.
- An unexplained disturbance of consciousness, such as a fainting episode or blackout with no identified satisfactory cause.
- An unexplained transient loss of nervous system function, meaning temporary neurological symptoms like sudden weakness, numbness, or loss of coordination that lack a medical explanation.
The word “unexplained” carries real weight. A fainting episode with a confirmed cause like dehydration is treated differently from a blackout with no identifiable trigger, because the FAA presumes an unexplained episode carries a high risk of recurring.5eCFR. 14 CFR 67.109 – Neurologic Beyond those three, the Federal Air Surgeon has discretionary authority to deny certification for any other seizure disorder, disturbance of consciousness, or neurological condition that could impair safe flight.
Concussions and traumatic brain injuries are not on the specifically disqualifying list, but they trigger a mandatory hold. For a brain injury within the past five years where the loss of consciousness, altered consciousness, or post-traumatic amnesia lasted less than one hour, you cannot even begin the recertification process for six months. After that period, your AME must defer the application and forward detailed neurological evaluations to the FAA for possible special issuance.6Federal Aviation Administration. Head Injury or Brain Injury More severe injuries face longer waits and more extensive review.
Substance Abuse and DUI Reporting
Substance issues appear twice in Part 67. Clinical dependence is one of the four disqualifying psychiatric diagnoses. Substance abuse, treated separately, is broader and covers use in a physically hazardous situation on more than one occasion, a positive DOT-required drug or alcohol test (or a refusal), or any substance misuse the Federal Air Surgeon finds incompatible with safe flying.3eCFR. 14 CFR 67.107 – Mental The alcohol testing threshold is 0.04 concentration or greater.
DUI convictions and similar motor vehicle actions carry a separate reporting requirement. You must submit a written report to the FAA within 60 days of any alcohol- or drug-related motor vehicle action, including license suspensions, revocations, and convictions. The report goes to the Civil Aviation Security Division and must include your airman certificate number, the type of violation, the date, and the state that holds the record.7eCFR. 14 CFR 61.15 – Offenses Involving Alcohol or Drugs Failing to report can result in suspension or revocation of your pilot certificate for up to one year, on top of what the underlying offense does to your medical.
Lying about any of this on your medical application is a federal crime. Falsifying information on a government form is punishable under 18 U.S.C. 1001 by up to five years in federal prison and fines up to $250,000.8Office of the Law Revision Counsel. 18 USC 1001 – Statements or Entries Generally9Office of the Law Revision Counsel. 18 USC 3571 – Sentence of Fine The FAA cross-references medical records, driving records, and DOT databases.
Diabetes and the General Medical Catch-All
Beyond the named categories, 14 CFR 67.113, 67.213, and 67.313 disqualify any disease, defect, or limitation that the Federal Air Surgeon finds makes a person unable to fly safely, even if it is not on any specific list. The one metabolic condition singled out by name is diabetes that requires insulin or other hypoglycemic drugs, because of the risk that hypoglycemia will cause confusion or loss of consciousness in flight.10eCFR. 14 CFR 67.113 – General Medical Condition The FAA does have a protocol for insulin-treated diabetes mellitus that allows some pilots to obtain special issuance, but the requirements are demanding: endocrinologist reports, continuous glucose monitoring data, and ongoing compliance monitoring.
Sleep apnea is a good illustration of how the catch-all works. It is not listed as a specifically disqualifying condition, but untreated apnea causes daytime sleepiness and impaired cognition, so it falls squarely within the Federal Air Surgeon’s discretionary authority. The FAA’s own guidance notes that over 90% of individuals with a BMI of 40 or greater have obstructive sleep apnea requiring treatment, though up to 30% of people with the condition have a BMI under 30.11Federal Aviation Administration. Guide for Aviation Medical Examiners: Obstructive Sleep Apnea If you are diagnosed, certification depends on demonstrating effective treatment, usually through CPAP compliance data.
Medications That Can Block Your Certificate
You can pass every diagnostic bar in Part 67 and still be grounded by what is in your medicine cabinet. The general medical standard gives the Federal Air Surgeon authority to deny a certificate based on any medication that impairs safe flight.10eCFR. 14 CFR 67.113 – General Medical Condition
Sedating antihistamines are a common trap. Products containing diphenhydramine, found in many allergy and sleep aids, require a waiting period of five maximum dosing intervals after your last dose before you can fly. If the label directs dosing every four to six hours, that is at least 30 hours on the ground after your last dose.12Federal Aviation Administration. Flight After Use of Medications with Sedating Effects A Benadryl the night before a morning flight can put you in violation. Most sedatives, opioid pain medications, all tricyclic antidepressants, and all MAO inhibitors are categorically unacceptable. When in doubt, check with your AME before starting anything new.
Special Issuance and SODA: Getting Back in the Cockpit
A disqualifying condition rarely means the end of flying. Two mechanisms let pilots return, and the difference between them matters.
A Special Issuance, formally an Authorization for Special Issuance of a Medical Certificate, is a time-limited authorization granted at the discretion of the Federal Air Surgeon. You have to demonstrate that you can safely perform pilot duties despite the condition for the duration of the certificate. The FAA can require special medical flight tests, practical tests, or additional evaluations.13eCFR. 14 CFR 67.401 – Special Issuance of Medical Certificates The certificate expires and must be renewed, often with fresh medical documentation each cycle. The Federal Air Surgeon can attach operational limitations and condition renewal on follow-up testing.
A Statement of Demonstrated Ability (SODA) is different. It applies when your disqualifying condition is static or nonprogressive and you have proven you can fly safely despite it. A SODA does not expire. Once granted, it authorizes any AME to issue your medical certificate going forward, as long as the condition described has not worsened.13eCFR. 14 CFR 67.401 – Special Issuance of Medical Certificates SODAs are common for stable conditions like the loss of an eye or a limb.
The special issuance process is slow. Expect months of back-and-forth with the Aeromedical Certification Division in Oklahoma City, and budget for the medical testing the FAA requires. Incomplete submissions are the most common reason for delays.
Does BasicMed Get You Around These Rules?
BasicMed under 14 CFR Part 68 lets some pilots skip the AME exam entirely. You see a state-licensed physician who runs a Comprehensive Medical Examination using an FAA checklist, and you complete an online medical education course every two years.14eCFR. 14 CFR Part 68 – Requirements for Operating Certain Small Aircraft Without a Medical Certificate BasicMed carries operational limits: aircraft with no more than seven seats and a maximum takeoff weight of 12,500 pounds, no more than six passengers, altitudes at or below 18,000 feet MSL, speeds not exceeding 250 knots, flights within the United States, and no compensation or hire.15Federal Aviation Administration. BasicMed
Here is the catch, and it is the reason BasicMed is not a shortcut around Part 67. If you have a history of psychosis, bipolar disorder, severe personality disorder, substance dependence, epilepsy, unexplained loss of consciousness, myocardial infarction, treated coronary heart disease, cardiac valve replacement, or heart replacement, you must have successfully completed the special issuance process for that condition before you can use BasicMed.14eCFR. 14 CFR Part 68 – Requirements for Operating Certain Small Aircraft Without a Medical Certificate BasicMed is a simpler route for pilots whose issues fall outside the specifically disqualifying categories, not an escape hatch from them.
Your Duty to Self-Ground
Holding a valid medical certificate does not authorize you to fly regardless of your current health. Under 14 CFR 61.53, you cannot act as pilot in command or as a required crew member if you know or have reason to know of any medical condition that would keep you from meeting the requirements of your medical certificate. The same rule applies to any medication or treatment causing such impairment.16eCFR. 14 CFR 61.53 – Prohibition on Operations During Medical Deficiency
This obligation reaches BasicMed pilots too, even without a traditional medical certificate. The standard is whether you know or have reason to know of a condition that would make you unable to fly safely. Flying with a known disqualifying condition exposes you to certificate action, potential criminal liability, and severe civil consequences if something goes wrong.