FAA First-Class Medical: What Disqualifies You, What Doesn't, and Why to Take It First

 

If you're planning to fly for a living, the first-class medical certificate is the only step in the process that can stop you cold. It is also the cheapest and fastest step, and it is the one people put off the longest.

That order is backwards, and it costs people money.

Here is what the FAA disqualifies, what it doesn't, and how to find out where you stand before you sign an enrollment agreement.

The FAA's list of specifically disqualifying conditions is shorter than you think. Almost everything else is a documentation process, not a wall. Here's the full list, the standards, and the order to do this in.

ON THIS PAGE

1. The short version
2. What is specifically disqualifying
3. The standards you have to meet
4. What is not disqualifying, the CACI list
5. Depression, anxiety, and antidepressants
6. How long a first-class medical lasts
7. How to get one, step by step
8. Why this goes first
9. Frequently asked questions

Direct answer:

Under 14 CFR Part 67, the conditions that specifically disqualify you from a first-class medical certificate are: epilepsy, a disturbance of consciousness without satisfactory medical explanation, bipolar disorder, a psychosis, a severe personality disorder, substance dependence without two years of documented recovery, diabetes requiring insulin, and six cardiac conditions including myocardial infarction, angina, valve replacement, a permanent pacemaker, and heart replacement.

Conditions outside that list are generally a documentation process. Many common conditions can be issued by your Aviation Medical Examiner at the exam under the FAA's CACI list. Several disqualifying conditions still have a path through special issuance under 14 CFR 67.401.

The short version

Under 14 CFR Part 67, the FAA names a specific, closed list of conditions that disqualify an applicant for a first-class medical certificate. It is shorter than people expect.

Everything outside that list is not a wall. It is a documentation requirement. It may take months and it may be irritating, but it has a path.

The mistake is not having a complicated medical history. The mistake is discovering it in month eight of flight training instead of month zero.

What is specifically disqualifying

These are the conditions the regulation names by name. If you have an established medical history or clinical diagnosis of one of these, an Aviation Medical Examiner cannot issue you a certificate at the exam.

Even here, "disqualifying" does not always mean permanently ineligible. Several of these conditions have established paths back through special issuance under 14 CFR 67.401, which lets the Federal Air Surgeon issue a certificate under conditions and monitoring. Pilots fly after heart attacks. It is a longer road with more paperwork, not a closed door.

The standards you have to meet

Separate from the disqualifying list, a first-class medical has objective standards to pass.

Vision (14 CFR 67.103)

• Distant vision: 20/20 or better in each eye separately, with or without corrective lenses
• Near vision: 20/40 or better at 16 inches
• If you're 50 or older, near vision is also tested at 32 inches

Glasses and contacts are fine. Corrected to 20/20 is the standard, not uncorrected.

Hearing (14 CFR 67.105)

Demonstrated by one of three methods: hearing a conversational voice at six feet with your back turned, scoring at least 70 percent on a speech discrimination test, or passing pure tone audiometry.

Electrocardiogram (14 CFR 67.111)

Required on your first application after age 35, and annually after age 40. The EKG must be dated within 60 days of your application.

What is not disqualifying (and what people wrongly assume is)

This is the part that changes people's plans.

The FAA maintains a list called CACI, which stands for Conditions AMEs Can Issue. These are conditions that used to require a full FAA review and can now be issued by your AME on the spot, at the exam, provided you bring the right documentation. The list currently covers roughly twenty common conditions, including:

• Hypertension
• Asthma
• Hypothyroidism
• Migraine and chronic headache
• Glaucoma
• Pre-diabetes
• Arthritis
• Chronic kidney disease
• Colitis
• Several treated cancers, including prostate, colon, breast, bladder, renal, and testicular
• Chronic hepatitis C
• Mitral valve repair
• Retained kidney stone

If your condition is on the CACI list and you show up with current clinical notes from your treating physician, you can often walk out of the appointment with a certificate in hand. Show up without the paperwork and the same condition turns into a deferral and a wait.

Bring the documentation. That is the entire difference.

Is your condition on the list, or not?

If you're reading this because of something specific in your history, you don't have to guess in private. Tell Paul what it is.

He'll tell you whether it's a CACI item, a special issuance conversation, or a non-issue, and whether you need a regular AME or a specialist.

Tell Paul What I'm Worried About

Depression, anxiety, and antidepressants

This is the single most searched question on this topic, and the answer is more open than it was a decade ago.

If you are currently taking an antidepressant: the FAA has an established protocol. The medication has to be one of the conditionally acceptable antidepressants, used alone rather than in combination. You must have been clinically stable, on a stable dose, with no aeromedically significant side effects, for at least three continuous months. Certification requires evaluation by a HIMS Aviation Medical Examiner, a specially trained AME, and a neuropsychological evaluation.

If you took one in the past and stopped: you must be off the medication for at least 60 days with a favorable report from your treating physician showing stable mood and no significant side effects.

What rules you out of this protocol: psychosis, suicidal ideation, or treatment with multiple psychiatric medications at once.

The takeaway is not "you'll be fine." It's that a history of depression or anxiety, on its own, is a process, one with a defined protocol, defined timelines, and a defined specialist. It is not the end of the conversation, and you should find out where you stand from an AME rather than from a forum.

How long a first-class medical lasts

This surprises people, so it's worth being precise. Validity depends on your age at the exam.

The certificate doesn't expire all at once, it steps down. A first-class medical that has aged past its first-class window still carries second- and third-class privileges for the periods above.

How to get one

1. Create an account at FAA MedXPress and complete the application online. Answer the medical history questions honestly and completely. This is a federal form, and inconsistencies between what you report and what's in your records cause far more problems than the underlying conditions do.
2. Find an Aviation Medical Examiner through the FAA's Designee Locator. If any part of your history is complicated, look specifically for an AME with experience in your issue, and for psychiatric history, a HIMS AME.
3. Schedule within 60 days. Your MedXPress application expires if the exam isn't completed in that window.
4. Bring documentation. Current clinical progress notes from your treating physician, generally dated within 90 days, plus your MedXPress confirmation number and government-issued photo ID.
5. Understand the three outcomes. The AME can issue, defer, or deny. A deferral means the file goes to the FAA for review and you wait. A denial can still be worked through special issuance.

Why this goes first

Every other decision in this process, which school, which financing, which start date, is reversible. This one isn't.

An exam and a few hours of your time tells you whether the career you're planning is available to you. Do it before you compare tuition, before you talk to a lender, and before you give notice at work.

If the answer is clean, you've bought yourself confidence. If it's complicated, you've started the clock on a process that takes months, and you've started it while it costs you nothing but time.

This article explains FAA regulations and process. It is not medical advice, and it is not an aeromedical determination. Only an Aviation Medical Examiner can tell you where you stand.

8. FAQ

What disqualifies you from an FAA first-class medical?

14 CFR Part 67 names a specific list: epilepsy, a disturbance of consciousness without satisfactory explanation, bipolar disorder, a psychosis, a severe personality disorder, substance dependence without two years of documented recovery, insulin-treated diabetes, and several cardiac conditions including myocardial infarction, angina, cardiac valve replacement, a permanent pacemaker, and heart replacement. Conditions outside that list are generally a documentation process, not a disqualification.

Can you get a first-class medical if you take antidepressants?

Yes, under the FAA's antidepressant protocol. You must be on a single conditionally acceptable medication, clinically stable on a stable dose for at least three continuous months, evaluated by a HIMS AME, and complete a neuropsychological evaluation.

How long is a first-class medical certificate valid?

For first-class privileges: 12 calendar months if you were under 40 at the exam, 6 calendar months if you were 40 or older. It then steps down to second-class and third-class privileges for additional periods.

Do I need 20/20 vision to be an airline pilot?

You need 20/20 or better in each eye separately, with or without corrective lenses. Glasses and contact lenses are acceptable.

What is CACI?

Conditions AMEs Can Issue: an FAA list of roughly twenty common conditions, including hypertension, asthma, migraine, hypothyroidism and several treated cancers, that your AME can certify at the exam if you bring current documentation from your treating physician.

What happens if my AME defers my application?

Your file goes to the FAA for review and you'll receive a letter requesting additional medical documentation. This is not a denial. It is a wait, and it is why applying early matters.

Should I get a first-class or third-class medical if I'm just starting?

If your goal is a career, take the first-class exam. A third-class certificate tells you nothing about whether you can hold the certificate a career requires, and finding out later is the expensive version.

Can I still become a pilot after a denial?

Often, yes, through special issuance under 14 CFR 67.401. It requires more documentation and ongoing monitoring, but it is an established path rather than an exception.

Take the medical first. Then we'll talk about everything else.

If there's something in your history you're worried about, get on Paul's calendar before you spend a dollar on training. Tell him what it is.

He'll tell you whether it's a CACI item, a special issuance conversation, or a non-issue, whether you should be looking for a HIMS AME specifically, and how to sequence the medical against a realistic start date so you're not paying for airplanes while you wait on a file.

Some histories are genuinely hard. If yours is one of them, he'll tell you that before you've committed anything.

Tell Paul What I'm Worried About

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