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PHD. MBA. MHS. Type rated on A350, A330, B777, B747-400, B747-200, B757, B767, B737, B727. International Airline Pilot / Author / Speaker. Dedicated to giving the gift of wings to anyone following their dreams. Supporting Aviation Safety through training, writing, and inspiration. Fighting for Aviation Safety and Airline Employee Advocacy. Safety Culture and SMS change agent.

Wednesday, August 24, 2011

Loss of License

"Off the Record Q & A with a Local A.M.E."

DR. Larry

Dr. Larry,

I think one of the greatest concerns for pilots, and a major reason for their not disclosing everything they should to their AME, is their fear of loss of license.

Can you tell us what events will cause a pilot to permanently lose their medical?

On the other side of that coin, if a pilot fails an item on the test—high blood pressure, eye-site, ECG, etc.,—what happens?

Do you report the event to the FAA? Or do you enable the pilot to do what it takes to pass the medical?


Pilots are the most passionate of anyone having control of a motorized vehicle, so of course their great fear is loss of license. Commercial pilots are also at risk for loss of income. Even though far less than 1% of all medical exams result in a denial, everyone seems to have heard a story about the pilot who went in feeling fine and ended up losing their license. In reality, the majority of those who have their license denied are due to “failure to provide” requested information.

Per our Regional Flight Surgeon, most pilots are surprised that over 90% of all airman walk out of their FAA exam with their medical certificate. This is compatible with my 30 plus years of experience although more than 95% leave with certificate in hand.

While few, the medical problems which can cause loss of license are significant. Examples include a stroke with or without a significant neurologic deficit, or a diabetic requiring insulin who requests a First or Second class medical. (Third class applicants however can fly with insulin under a Special Issuance). There is also a short list of other disorders which may result in denials. Even within this group, many have the possibility for Special Issuance, such as returning to flight status following a heart attack.

A bigger issue for both pilot and examiner occurs when something presents during the exam, such as an abnormal ECG, failing of the visual exam, or a medication is listed which is not compatible with flying. At these times, the AME has some decisions to make, and these should be made in concert with the airman.

Most problems that come up typically require further explanation and perhaps a medical report from the treating physician (eg, hypertension, hypothyroidism, kidney stones, and DUI). One option open to the AME is the ability to put “on-hold” an application while the airman gathers the necessary records. The AME has only a limited number of days before they must submit the completed form; between 7 to 10 days maximum. During this time an airman is not typically grounded. If the pilot is proactive and has the reports when they come in for their exam, these health concerns can often be dealt with on the spot by a knowledgeable AME or by the AME contacting the Regional Flight Surgeon for clearance. The proactive pilot will then be in the best position for not losing any time in the air due to lack of or delay in certification.

There likely will be times in a pilot’s career when they are faced with health issues that can potentially ground them. A broken leg or gallbladder surgery are examples. The Guide for Aviation Medical Examiners holds nearly all the protocols and dispositions the AME must follow. However, a trusted and knowledgeable AME has the ability and leeway to help a pilot navigate unforeseen turbulence, especially when the airman is willing to be proactive in their approach to their medical exams. For this reason, we advise all our pilots to call or email with flight related health questions anytime and especially before presenting for their medicals.
To your good health,

Dr. Larry
Advanced Senior AME
Heart Attack and Stroke Prevention
Family and Sports Medicine

Thank you Dr. Larry!

Please continue to send me your questions. Everything you wanted to know, but were afraid to ask.

Enjoy the Journey!

~ Karlene


  1. Cheers.... can Larry cover the following...

    Anti-histamines (I find Cetirizine works better than Lisinopril, but can only fly when on one - neither give me any side effects...)

    Malaria - prophylaxis and treatments. (Remember the malaria parasite buggers the red blood cells - now, I can fly whilst on Doxy or Vibramycin, but Larium is not good... when I get a start up malaria, I can take Artemesia and Lumenfantin for the 3 days... and be fit enough to fly the whole time... but if I wait 24 hours and may be 'self-grounded' for a week during treatment and recovery..

    Hope that gives something to chew on for a couple of weeks!

  2. Thank you for the information.

    MY QUESTION: What are the minimum examination requirements for someone who requires visual correction?

    I was once informed that I might have issues becoming an international pilot with the need to wear glasses.

    Thank you for your time.
    - Jeremy

  3. Capt. Yaw... I will be chewing on this until Dr. Larry responds. I'll check with him and see if your question is an answer here type... or save for next week. I will keep you posted! Thanks for the great question. (I think ;))

  4. Hi Jeremy, I'm going to let Dr. Larry give you the details, but let me tell you... I'm flying with many pilots wearing glasses. What's worse than a pilot who is wearing glasses? One that needs to. Thanks for the great comment! We'll get you an answer.

  5. This comment has been removed by the author.

  6. Hi Jeremy,
    Visual standards vary by Class. For First and Second Class, one needs visual acuity of 20/20 or better in each eye independently and together, with or without correction. For Third Class, it's 20/40, which is more lenient. A form 8500-7, filled out by an eye specialist, verifying the airman’s ability to meet the requirements may be used in lieu of the exam in the AME’s office.
    Here’s a link the regulations and good luck!

  7. Just thought I would ask a question about Lauren. She has very slight spastic diplegia that hardly affects her in any way (ankles slightly stiff.) Would she pass a medical in order to fly solo? She has never had any blood pressure problems, or fits or seizures, and is fit and works out hard. Putting off getting her a medical in case she is not allowed to fly solo, that would wreck her dream.

  8. Jo, Thanks for the great question. I'll send this to Dr. Larry right now.

  9. Hi Joanne,
    Allow me to answer your question regarding Lauren's spastic diplegia and certification in next Wednesday's post. This query deserves an expanded response since it applies to many disorders considered for medical certification by the FAA. Here’s a little preview: you’ll like the answer!

  10. Hello Doctor,
    I'm Drishya,studying aeronautical engineering .I wish to become a pilot but I had an open cholecystectomy in 2017 .is iam eligible to became a pilot

    1. Hello Drishya, I am so sorry for your medical issues. What you need to do is contact an AME, Aviation Medical Examiner, and then ask him. You could probably contact the FAA. I am not your doctor, and cannot give medical advice. But, the FAA doctors will advise. Best of luck!

  11. Hi! Please if you could answer my question I would really appreciate it. I have recently been diagnosed with a polyp in my gallbladder (11 mm) without any symptoms as it was found during and eco while looking for kidney stones.

    I have yet to see a general surgeon and my medical class 1 is due for a renewal. I’m curious about the possible outcomes. Wether the general surgeon decides to remove it or to wait and check again in 6 months, how could it affect my classe 1 medical licence?


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