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What happens if you fail FAA medical?

The FAA medical examination is required for all pilots who fly under FAA regulations. It is designed to ensure pilots are healthy and fit to operate an aircraft safely. Failing the FAA medical can have serious consequences for a pilot’s career. In this article, we will examine the FAA medical requirements, reasons for medical disqualification, the appeal process, and career options if you fail the exam.

FAA Medical Requirements

There are three classes of FAA medical certificates:

First Class

The First Class medical is required for airline transport pilots (ATP). It is valid for 12 months for pilots under age 40. Pilots over 40 need to renew it every 6 months. First Class standards are the most stringent, requiring excellent cardiovascular health, vision, hearing, mental health, and overall physical condition.

Second Class

The Second Class medical is required for commercial pilots. It is valid for 12 months. The standards are similar to First Class but allow for some additional conditions like mild hypertension when controlled by medication.

Third Class

The Third Class medical is required for private pilots. It is valid for 5 years for pilots under age 40. Pilots over 40 need to renew it every 2 years. It is the most lenient class but still requires meet minimum standards for vision, hearing, mental health, and general physical health.

To pass any class, you must demonstrate that you have no medical conditions that could impair your ability to fly safely. Even minor issues like migraines, antidepressant use, or alcohol dependence can be disqualifying if the FAA feels they aren’t adequately controlled.

Reasons for FAA Medical Disqualification

There are many medical conditions that can lead to FAA medical disqualification. Some of the most common are:

Cardiovascular Disease

Heart conditions like angina, heart attack, stent placement or bypass surgery trigger scrutiny. Arrhythmias, murmurs, and valve disorders may require extensive cardiac testing. Hypertension must be well controlled.

Neurological Disorders

Conditions including epilepsy, stroke, multiple sclerosis, Parkinson’s disease, and other disorders affecting the nervous system are disqualifying. This also includes cognitive disorders like dementia.

Psychiatric Illness

Major depressive disorder, bipolar disorder, psychotic disorders, personality disorders, drug or alcohol dependence, and suicide attempts often lead to denial. Use of antidepressants or anxiety medication requires detailed evaluation.


Diabetes is disqualifying unless you can prove stability with diet, exercise, or oral medication. Insulin use is prohibited except for very limited circumstances. Strict blood sugar control is required.


Active or recently treated cancer is disqualifying until you’ve been cancer-free for a period of time. Remission for 5+ years is often required.

Vision Loss

Distance visual acuity must be correctable to 20/20 with glasses or contacts. Near vision must be correctable to 20/40. Blindness in one eye is acceptable with restrictions.

Hearing Loss

Hearing must be adequate for safe operation, with or without hearing aids. Profound hearing loss in one ear may require special testing.

Musculoskeletal Issues

Problems like arthritis, back pain, joint replacement, or muscle disorders need evaluation to determine if strength and mobility are adequate despite limitations.

Medication Use

Many prescription and over-the-counter medications are not allowed, including opioids, benzodiazepines, stimulants, anticonvulsants, beta blockers, and others. All medication use must be reported.

Substance Abuse

Alcoholism or drug abuse requires documented sobriety for at least 2 years, often longer. This includes DUI history.

The Appeal Process

If you receive a denial from the FAA, you have a few options:


You can ask the FAA to reconsider their decision if you provide additional medical evidence and documentation that adequately explains or resolves the issue that led to denial. Success rates for reconsideration are low, but it’s worth trying.

Appeal to the FAA Federal Air Surgeon

If reconsideration fails, you can appeal to the Federal Air Surgeon for a formal review of your case. You may have to provide even more detailed medical records, testing, and statements from your doctors. The Federal Air Surgeon has the authority to overrule the initial denial. About 33% of appeals are ultimately approved this way.

Apply for a Special Issuance

If your medical condition requires an Authorization or Special Issuance, you can work with an Aviation Medical Examiner (AME) to gather documents needed to prove you can fly safely despite your diagnosis. This pathway has the highest approval rate but involves a thorough evaluation.

Fly Recreationally

You may still be eligible to fly recreationally using your valid state driver’s license as your medical certification under the Sport Pilot category, which allows uncertified flying of light sport aircraft. Restrictions apply, but it’s an option if you want to keep flying.

Career Options if Denied an FAA Medical

If your appeal and special issuance attempts ultimately fail, you may have to explore other aviation career paths if you want to stay in the industry:

Flight Instruction

You can provide flight instruction in light sport aircraft under the driver’s license option. This allows you to teach others to fly within light sport limits.

Ground Instructor

Use your experience and skills to teach ground school classes. Initial or recurrent training in systems, aerodynamics, regulations, procedures, navigation, weather, and other academics of aviation.

Aviation Education

Many aviation colleges and academies need seasoned pilots to train the next generation. You can teach in the classroom environment full or part-time.

Air Traffic Control

Leverage your aviation knowledge as an air traffic controller managing traffic in towers, approach/departure sectors, or enroute centers. ATC work is challenging but rewarding.

Aviation Management

Shift your focus to business administration of an airport, airline, or other aviation company. There are roles in safety, compliance, customer service, logistics, fleet management and more.

Aviation Sales

Use your expertise to sell aircraft, equipment or aviation services. A sales role allows you to remain connected to the industry.

Aviation Writing

Share your passion and knowledge through writing for aviation publications, textbooks, blogs, or other media channels.

UAS Remote Pilot

Pilot drones as a commercial operator once you obtain your FAA Remote Pilot certificate. This emerging field is rapidly expanding.

Aircraft Dispatch

While not flying the planes, aircraft dispatchers share in the flight’s responsibility, using experience and judgment to ensure efficient, safe operations.


Losing your FAA medical certification can be professionally and financially devastating if flying is your career. But it’s not necessarily the end of your aviation path. Whether through appeals, restrictions, or alternative roles, options exist to stay involved in the aviation community. Don’t give up hope. With determination and ingenuity, you may find a way to keep reaching for the skies.