Self-grounding for Medical Deficiency

FAR 61.53--Self-grounding for Medical DeficiencyPerhaps one of the most important operational regulations in the Federal Aviation Regulations, FAR 61.53 sets forth the legality and appropriateness of exercising pilot privileges when there is a known medical condition that could be considered disqualifying under FAA Part 67 Medical Standards.

FAR 61.53: Prohibition on Operations During Medical Deficiency

  • Operations that require a medical certificate. Except as provided for in paragraph (b) of this section, a person who holds a current medical certificate issued under part 67 of this chapter shall not act as pilot in command, or in any other capacity as a required flight crewmember while that person:
    • Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation; or
    • Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation.
  • Operations that do not require a medical certificate. For operations provided for in FAR 61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required flight crew member, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

You may notice some ambiguity in the language of this regulation. There is no reference to any specific medical conditions. Vagueness is not unusual for the FARs, and in this case, it's a good thing, although it does make understanding and complying with the regulation a little more difficult. Hopefully, we can shed some light on the several ways FAR 61.53 can be interpreted.

Part 67 of the Federal Aviation Regulations specifically mentions 15 medical conditions that are disqualifying by "history or clinical diagnosis." These include:

  • A personality disorder that is severe enough to have repeatedly manifested itself by overt acts
  • A psychosis
  • Bipolar disorder
  • Substance dependence (including alcohol)
  • Substance abuse
  • Epilepsy
  • Disturbance of consciousness without satisfactory explanation of the cause
  • Transient loss of nervous system function without satisfactory explanation of the cause
  • Diabetes requiring oral hypoglycemic medications or insulin
  • Myocardial infarction
  • Angina pectoris
  • Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant
  • Cardiac valve replacement
  • Permanent cardiac pacemaker
  • Heart replacement

When a diagnosis or history of one of these conditions can be established, any medical certificate held at the time may not be "current and appropriate" for operating an aircraft in accordance with FAR 61.3(c). For these cases, the only regulatory mechanism for regaining medical certification is through the discretionary "special issuance authorization." The special issuance (SI) procedure is explained in Subpart E, or FAR 67.401 of the medical regulations. An SI can be granted for a disqualifying medical condition when (a) sufficient time has passed since the medical event that the likelihood of recurrence is minimal, and (b) when appropriate medical testing has been done that demonstrates to the satisfaction of the FAA that the likelihood for recurrence or incapacitation is at an acceptably low level. "Acceptably low" risk is a vague term in itself but, for civil aviation medical certification purposes, translates to about 1%.

But what if you have an illness or medical condition other than one of those 15 specific disqualifiers? Now it gets a little more complicated, and a more thorough review of the language of FAR 61.53 may be necessary. What general medical conditions are grounding under the regulation, and for how long? And do you have to notify the FAA when the deficiency is discovered or when it no longer exists, and can you simply resume flying when the condition resolves?

FAR 61.53 and, in fact, the entire FAA medical certification regulatory philosophy, seems to make an important assumption: Pilots don't fly when they aren't feeling well. This assumption seems to have merit, considering that medical incapacitation is a causal factor in less than 0.3% of general aviation accidents. Another assumption is that the readers of the regulations, we pilots who fly in the National Airspace System, are reasonable people who will exercise conservative judgment in interpreting the regulations and exercising piloting privileges. The FAA acknowledges "the language is subjective and [that the system] is relying on pilots to use reasonable judgment."

The first part of FAR 61.53, the "...knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation" section, leaves it to the pilot to make the determination that a medical condition requires "self-grounding." Realistically, though, depending upon the condition, that decision is often made with the professional advice of the treating health care professional. Two heads are better than one, right? Most of the time, yes, but not always.

Your treating physician may not be as knowledgeable of the FAA's medical standards as the FAA doctors who review your case. Therefore, in the opinion of the treating physician and his/her discussions with you as the patient/pilot, if the condition does not render you "unable to meet the requirements" of FAR Part 67, you may continue operating on your current medical until the normal date of expiration. However, the FAA sometimes disagrees with the treating physician, and on appeal to the National Transportation Safety Board, the board often agrees that the FAA's judgment prevails over the treating physician.

Just remember that §61.53 is the “escape clause” of sorts for both the FAA and the pilot, and it places the burden on the pilot in command to make the determination that he/she is indeed medically qualified to fly.  The regulation provides an understanding between the FAA and the pilot that applies from the time you walk out of the aviation medical examiner’s office with a new medical certificate until your next renewal date, be that six months or five years, depending upon your age and class of medical certificate held.

Under normal circumstances, at no time during your voluntary grounding are you required to notify the FAA. Notification is made at the time of your next scheduled FAA physical examination. Once the condition that grounded you has resolved, (and it isn't one of the 15 specific disqualifying conditions) and you determine that you're again in compliance with the regulations, you may resume exercising the privileges of your existing medical certificate. The FAA's Chief Counsel, for the most part, agrees with this understanding but differs slightly by suggesting that, as a matter of policy, the pilot is "encouraged" to notify the FAA of a medical deficiency before exercising flying privileges.

The reporting procedures are different if you are certificated under a time-limited special issuance authorization issued under FAR 67.401. The FAA authorization letter that comes with your medical certificate will state that you should notify the Aerospace Medical Certification Division any time there is a change in your medical condition or medication usage is begun or changed.

The second part of the regulation, "…is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements for the medical certificate necessary for the pilot operation," introduces another interesting question. What medications does the FAA consider acceptable to use while flying? The same question emerges with respect to FAR 61.53, and again, the pilot is responsible for determining the safety of flight while using medications.

To muddy the waters a bit further, FAR 91.17 states, in part, that no pilot may exercise privileges "...while using any drug that affects the person's faculties in any way contrary to safety...." Again, the regulations place the burden on the pilot to make a determination about medication usage prior to flying. The doctor who prescribes a medication may tell you that it is perfectly safe to use while flying, yet it may not be allowed by the FAA.

If you don't do your homework first, there's a risk that your aviation medical examiner will defer the application and that the FAA will then deny your medical if that medication is considered unacceptable for flying. When your application is deferred, the medical examiner sends your medical information to the FAA and you wait for a letter to arrive. If the FAA determines the medication is unacceptable and issues a denial, you will have to discontinue the use of the medication for 90 days and provide a report from your treating physician as to why you were on it in the first place, that you're no longer using it, and that there has been no recurrence of symptoms that would require you to go back on the medication. More information about the FAA's medication usage policy can be found online.

The FAA doesn't publish a "list" of allowed medications, and that's a good thing. There is no practical way the FAA could accurately maintain such a list. However, the most commonly prescribed medications that are allowed by the FAA can be found online.

If you have any questions about how a medical condition might affect your current or future medical certification eligibility, contact AOPA's Medical Certification staff at 800/872-2672, or you can e-mail your questions.

Updated October 27, 2009