FAA Medical Privileges: Classes, BasicMed, and Special Issuance

An FAA medical certificate is the health clearance most pilots need before flying, issued in three classes under 14 CFR Part 67 with validity periods ranging from 6 to 60 months depending on the class and your age.¹ Which class you need depends on the flying you plan to do, and a separate program called BasicMed lets some private pilots skip the traditional certificate entirely.

The Three Classes and How Long They Last

First-class is required to exercise airline transport pilot privileges. Under 40, it lasts 12 calendar months for ATP flying; at 40 or older, 6 months.¹ Second-class is required for commercial pilot privileges, including charter and flight engineer work, and lasts 12 months at any age. Third-class covers private, recreational, student, and sport pilots. Under 40, it lasts 60 months; at 40 or older, 24 months.

A higher class steps down as its top privileges expire, so you never need two certificates at once. A first-class certificate issued to a 35-year-old works for ATP flying for 12 months, then serves as a second-class for the rest of that year, and continues as a third-class certificate for the full five-year private-pilot window.

BasicMed as an Alternative

Since 2017, eligible pilots have been able to fly without a traditional medical certificate under BasicMed. You complete a physical exam with any state-licensed physician using the FAA’s Comprehensive Medical Examination Checklist every 48 months, and take an online medical education course every 24 months.²

BasicMed has operational limits. The aircraft’s maximum certificated takeoff weight cannot exceed 12,500 pounds, it must be authorized to carry no more than seven occupants, and you can carry no more than six passengers. Flights stay at or below 18,000 feet MSL and 250 knots, remain within the United States, and cannot be for compensation or hire.³

BasicMed is also not open to everyone. If you have ever been diagnosed with certain serious conditions, you must first obtain a Special Issuance through the traditional process before BasicMed becomes available. Those conditions include psychosis, bipolar disorder, severe personality disorders, substance dependence within the prior two years, epilepsy, unexplained loss of consciousness, myocardial infarction, coronary heart disease that required treatment, cardiac valve replacement, and heart replacement.² Pilots who have never held any FAA medical certificate also cannot use BasicMed, because it assumes prior certification.

How to Apply

The process starts online with FAA Form 8500-8, completed through the MedXPress portal. You enter your personal information and answer detailed questions about medical history, medications, and prior conditions. The system generates a confirmation number your AME uses to pull up the application.⁴ Once submitted, you have 60 days to complete the physical exam before the application is automatically deleted.⁵

Aviation Medical Examiners are physicians the FAA has authorized to conduct flight physicals. You can find one through the FAA’s Designee Locator.⁶ The FAA does not set fees, so prices vary by provider; expect a few hundred dollars for a standard exam.

During the visit, the AME pulls your MedXPress submission and performs the physical checks: vision, hearing, blood pressure, neurological screening, and a general assessment. If you meet all standards, the AME can issue the certificate on the spot. If something raises concern, the AME either denies the application or defers it to the FAA’s Aerospace Medical Certification Division for further review. Deferrals are common for anything outside the AME’s authority to clear, and they add weeks or months.

What the Exam Measures

Vision

First- and second-class certificates require distant visual acuity of 20/20 or better in each eye, corrected or uncorrected. If you need glasses or contacts to hit 20/20, the certificate is issued on the condition you wear them while flying.⁷ Third-class is more forgiving at 20/40 distant vision in each eye.⁸ Near vision is the same across all classes: 20/40 at 16 inches. First- and second-class applicants age 50 and older also need 20/40 near vision at 32 inches, closer to the reach of an instrument panel.

Hearing

You have three ways to pass the hearing test for any class. The common one is demonstrating that you can hear a conversational voice in a quiet room at six feet, with your back to the examiner, using both ears. Alternatively, you can pass a speech discrimination test with a score of at least 70 percent, or a pure tone audiometric test meeting FAA decibel thresholds.⁹ Only one needs to pass.

Blood Pressure

The AME measures seated blood pressure during the exam. For all classes, the guideline maximum is 155 mmHg systolic and 95 mmHg diastolic. An applicant below that threshold, who has not used blood pressure medication for at least 30 days, and who is otherwise qualified can be issued a certificate on the spot.¹⁰ Exceeding the threshold or currently using antihypertensive medication doesn’t necessarily mean denial, but it typically triggers a deferral for further review.

Conditions That Stop the AME From Issuing

Certain diagnoses prevent an AME from issuing a certificate outright and require FAA headquarters review, even when you’re managing the condition well.

Cardiovascular

Disqualifying cardiovascular conditions include history of myocardial infarction, angina, coronary heart disease that required treatment or was clinically significant, cardiac valve replacement, permanent pacemaker implantation, and heart replacement.¹¹ The list includes conditions you may have fully recovered from. A heart attack ten years ago with no current symptoms still counts.

Neurological

Epilepsy, any unexplained loss of consciousness, and any transient loss of nervous system function without a satisfactory medical explanation are all disqualifying.² The FAA treats unexplained episodes seriously because they can recur in the cockpit without warning.

Mental Health and Substance Use

Psychosis, bipolar disorder, and personality disorders severe enough to have produced repeated observable behavior problems are disqualifying. Substance dependence is also disqualifying, though the FAA allows an exception where there is clinical evidence of recovery with at least two consecutive years of total abstinence.¹²

Substance abuse within the past two years is separately disqualifying. That includes using a substance in a physically hazardous situation more than once, a verified positive drug test or an alcohol test result of 0.04 or greater, refusal to submit to DOT-required testing, or any misuse the Federal Air Surgeon determines affects your ability to fly safely.¹²

Sleep Apnea

Obstructive sleep apnea is disqualifying because of the cognitive impairment tied to poor sleep quality. If you’re already diagnosed and treated, you’ll need a Special Issuance and have 90 days to provide the required compliance data once the FAA requests it. If the AME observes symptoms severe enough to pose an immediate flight safety risk, the exam is deferred on the spot.¹³

Insulin-Treated Diabetes

Type 1 and Type 2 diabetes controlled with insulin are handled the same way. Expect a deferral at your first exam after starting insulin. The FAA requires proof that your condition has been clinically stable on current treatment for at least six months.¹⁴ First- and second-class applicants must submit Continuous Glucose Monitoring data along with documentation from a board-certified endocrinologist, an ophthalmologic evaluation, and a cardiac risk assessment. Applicants age 40 and over also need a maximal exercise stress test. Third-class applicants have a lighter path and can use either CGM data or recent glycosylated hemoglobin measurements.

Medications

Even if your condition is certifiable, the medication treating it might not be. Do Not Issue (DNI) drugs prevent the AME from issuing a certificate entirely. These include most psychiatric and psychotropic drugs, seizure medications, cancer treatments, and controlled substances in Schedules I through V. If you’re taking one, the exam is deferred.¹⁵

Do Not Fly (DNF) drugs have concerning safety profiles but don’t necessarily block certification. They can cause sedation or cognitive impairment even when you feel fine. Any medication with a label warning about drowsiness or operating machinery falls in this category, regardless of whether you’ve taken it before without side effects.

For any medication, the general rule is to wait five times the drug’s maximum half-life after your last dose before flying. If half-life data isn’t available, use five times the maximum dosing interval. A medication taken every four to six hours means a 30-hour wait. For diphenhydramine, the common antihistamine in Benadryl, the wait is 60 hours.

ADHD medications get their own treatment. The FAA has established specific evaluation pathways for applicants with an ADHD history or any prior use of ADHD medications, including a Fast Track and a Standard Track that involve neuropsychological testing and detailed documentation.¹⁶ You cannot fly while actively taking ADHD stimulants.

Getting Cleared With a Disqualifying Condition

A disqualifying condition doesn’t permanently ground you. The FAA has three mechanisms to restore medical privileges.

Special Issuance

Special Issuance is the main pathway for pilots with disqualifying conditions that are being treated or managed. The Federal Air Surgeon can grant one when you demonstrate that your condition is stable, your treatment is effective, and you can safely perform flight duties during the certificate period.¹⁷ Expect to submit extensive medical records, diagnostic results, and status reports from your treating physicians. Special Issuances are time-limited and require periodic renewal with updated documentation.

SODA

A Statement of Demonstrated Ability covers conditions that are permanent and stable rather than progressive, like the loss of a limb or color vision deficiency. The Federal Air Surgeon grants a SODA when the disqualifying condition is static and you’ve shown you can safely perform pilot duties despite it, usually through a practical medical flight test.¹⁸ A SODA doesn’t expire. It stays valid indefinitely unless the underlying condition worsens beyond what was originally cleared.¹⁹

CACI

Conditions AMEs Can Issue is the fastest route because your AME issues the certificate at the exam without deferring to FAA headquarters. If your condition appears on the CACI list and you meet the criteria on the condition-specific worksheet, the AME documents it and hands you the certificate.²⁰

The CACI list currently covers roughly two dozen conditions, including:

Asthma, arthritis, and essential tremor
Hypertension, hypothyroidism, and prediabetes
Glaucoma and migraine or chronic headache
Several cancers (bladder, breast, colon, prostate, renal, and testicular)
Chronic hepatitis C, chronic kidney disease, and chronic immune thrombocytopenia
Mitral valve repair, retained kidney stones, and polycystic ovarian syndrome
Low testosterone, psoriasis, and weight loss management

If you don’t meet the worksheet criteria, the AME defers to the FAA and you go through the standard Special Issuance process instead.

Reporting Obligations and Falsification

Any alcohol or drug-related motor vehicle conviction or administrative action must be reported to the FAA in writing within 60 calendar days. Administrative actions include license revocations, court-ordered alcohol classes, and community service tied to an alcohol offense. Even charges reduced to a lesser offense count.²¹ You also disclose the event on your next Form 8500-8. Missing the 60-day window gives the FAA grounds to deny any application for up to a year, or to suspend or revoke certificates you already hold.

Lying on the MedXPress application is both a federal crime and an independent administrative violation. Under 18 USC 1001, knowingly making false statements in a matter within government jurisdiction carries up to five years in prison and substantial fines.²² Separately, the FAA can revoke all of your airman and medical certificates based on the false statement alone, whether or not criminal charges are filed. The FAA cross-references applications against pharmacy records, VA records, and other databases, so undisclosed conditions and medications are discovered more often than applicants expect.

If You’re Denied

If the FAA issues a final denial, you can appeal to the National Transportation Safety Board. File a petition for review within 60 days of the date the FAA served the denial letter, identify the denial action, explain why you believe it was wrong, and include a copy of the letter.²³ The NTSB assigns a judge who schedules a prehearing conference and a formal hearing where both sides present evidence and cross-examine witnesses. You can represent yourself or hire an attorney. Before filing, most pilots are better served by working through the Special Issuance process or gathering stronger medical documentation to reapply. An NTSB appeal is a last resort, not a first move.

1
eCFR. 14 CFR 61.23 – Medical Certificates: Requirement and Duration
2
eCFR. 14 CFR Part 68 – Requirements for Operating Certain Small Aircraft
3
Federal Aviation Administration. BasicMed
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Federal Aviation Administration. Medical Certification
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Federal Aviation Administration. How Long Will My Application Remain in the MedXPress System?
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Federal Aviation Administration. Find an Aviation Medical Examiner (AME)
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eCFR. 14 CFR 67.203 – Eye
8
eCFR. 14 CFR 67.303 – Eye
9
eCFR. 14 CFR 67.105 – Ear, Nose, Throat, and Equilibrium
10
Federal Aviation Administration. Decision Considerations – Aerospace Medical Dispositions – Item 55. Blood Pressure
11
eCFR. 14 CFR 67.111 – Cardiovascular
12
eCFR. 14 CFR 67.107 – Mental
13
Federal Aviation Administration. Guide for Aviation Medical Examiners – Obstructive Sleep Apnea
14
Federal Aviation Administration. Guide for Aviation Medical Examiners – Insulin-Treated Diabetes Mellitus
15
Federal Aviation Administration. Do Not Issue and Do Not Fly Medications
16
Federal Aviation Administration. Guide for Aviation Medical Examiners – Attention Deficit/Hyperactivity Disorder
17
eCFR. 14 CFR 67.401 – Special Issuance of Medical Certificates
18
Federal Aviation Administration. Guide for Aviation Medical Examiners – Statement of Demonstrated Ability
19
Federal Aviation Administration. Guide for Aviation Medical Examiners – Items 23-24
20
Federal Aviation Administration. Guide for Aviation Medical Examiners – CACI Conditions
21
eCFR. 14 CFR 61.15 – Offenses Involving Alcohol or Drugs
22
Office of the Law Revision Counsel. 18 USC 1001 – Statements or Entries Generally
23
National Transportation Safety Board. How to File a Petition for Review of a Certificate Denial