[Federal Register Volume 61, Number 54 (Tuesday, March 19, 1996)]
[Rules and Regulations]
[Pages 11238-11263]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-6358]




[[Page 11237]]

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Part II





Department of Transportation





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Federal Aviation Administration



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14 CFR Parts 61 and 67



Revision of Airman Medical Standards and Certification Procedures and 
Duration of Medical Certificates; Final Rule

  Federal Register / Vol. 61, No. 54 / Tuesday, March 19, 1996 / Rules 
and Regulations  
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[[Page 11238]]


DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration

14 CFR Parts 61 and 67

[Docket No. 27940; Amendment Nos. 61-99 and 67-17]
RIN 2120-AA70


Revision of Airman Medical Standards and Certification Procedures 
and Duration of Medical Certificates

AGENCY: Federal Aviation Administration (FAA), DOT.

ACTION: Final rule.

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SUMMARY: This rule revises airman medical standards and medical 
certification procedures. The amendments implement a number of 
recommendations resulting from a comprehensive review of the medical 
standards announced in previous notices. This revision of the standards 
for airman medical certification and associated administrative 
procedures is necessary for aviation safety and reflects current 
medical knowledge, practice, and terminology. Also, this rule revises 
procedures for the special issuance of medical certificates 
(``waivers'') for those airmen who are otherwise not entitled to a 
medical certificate.
    This rule also changes the duration of third-class airman medical 
certificates, based on the age of the airman, for operations requiring 
a private, recreational, or student pilot certificate.
    Also, in this document, the FAA is announcing disposition of a 
number of petitions for rulemaking related to medical standards and 
duration of medical certificates.

EFFECTIVE DATE: September 16, 1996.

FOR FURTHER INFORMATION CONTACT: Dennis McEachen, Manager, Aeromedical 
Standards and Substance Abuse Branch, 800 Independence Avenue, SW., 
Washington, DC 20591; telephone (202) 493-4075.

SUPPLEMENTARY INFORMATION:

Background

Current Requirements--Airman Medical Certification

    Section 61.3(c) of Title 14 of the Code of Federal Regulations (14 
CFR part 61) provides, with some exceptions, that no person may serve 
as pilot in command or in any other capacity as a required pilot flight 
crewmember unless that person has in his or her personal possession an 
appropriate current airman medical certificate issued under 14 CFR part 
67. Part 67 provides for the issuance of three classes of medical 
certificates. A first-class medical certificate is required to exercise 
the privileges of an airline transport pilot certificate. Second- and 
third-class medical certificates are needed to exercise the privileges 
of commercial and private pilot certificates, respectively.
    A person who is found to meet the appropriate medical standards, 
based on a medical examination and an evaluation of the applicant's 
history and condition, is entitled to a medical certificate without 
restrictions or limitations other than the prescribed limitation as to 
its duration. These medical standards are currently set forth in 
Secs. 67.13, 67.15, and 67.17.

Special Issuance of Airman Medical Certificates

    An applicant for a medical certificate who is unable to meet the 
standards in Secs. 67.13, 67.15, or 67.17, and be entitled to a medical 
certificate, may nevertheless, be issued a medical certificate on a 
discretionary basis. Procedures for granting special issuances or 
exemptions have always been available, and, thus, failure to meet the 
standards has never been absolutely disqualifying. Historically, 
approximately 99 percent of all applicants ultimately receive a medical 
certificate.
    Under Sec. 67.19, Special issue of medical certificates, at the 
discretion of the Federal Air Surgeon, acting on behalf of the 
Administrator under Sec. 67.25, a special flight test, practical test, 
or medical evaluation may be conducted to determine that, 
notwithstanding the person's inability to meet the applicable medical 
standard, airman duties can be performed, with appropriate limitations 
or conditions, without endangering public safety. If this determination 
can be made, a medical certificate may be issued with appropriate 
safety limitations.

Duration of Airman Medical Certificates

    Section 61.23 identifies the duration of validity and privileges of 
each class of medical certificate. Currently, a first-class medical 
certificate is valid for 6 months for operations requiring an airline 
transport pilot certificate, 12 months for operations requiring a 
commercial pilot certificate or an air traffic control tower operator 
certificate (for non-FAA controllers), and 24 months for operations 
requiring only a private, recreational, or student pilot certificate. A 
second-class medical certificate is valid for 12 months for operations 
requiring a commercial pilot certificate or an air traffic control 
tower operator certificate (for non-FAA controllers) and for 24 months 
for operations requiring only a private, recreational, or student pilot 
certificate. A third-class medical certificate currently is valid for 
24 months for operations requiring a private, recreational, or student 
pilot certificate.

History

    On October 21, 1994, the FAA published a notice of proposed 
rulemaking (NPRM) (Notice No. 94-31, 59 FR 53226) proposing to amend 
parts 61 and 67. The proposed revisions to part 67 were based on an 
agency review of part 67 which was announced in the preamble to 
Amendment 67-11 (47 FR 16298; April 15, 1982) and on recommendations 
from a report prepared for the FAA by the American Medical Association 
(AMA). In the preamble to Amendment 67-11, the FAA announced that it 
intended to conduct an overall review of the medical standards in part 
67. A complete review of the regulations was needed to bring the 
standards and procedures for airman medical certification up to date 
with advances in medical knowledge, practice, and terminology. 
Amendment 67-11 was considered interim clarification until a 
comprehensive review of the medical standards contained in part 67 
could be concluded.
    The FAA began the review of the medical standards for airmen and of 
its certification practices and procedures by requesting public comment 
(47 FR 30795; July 15, 1982). In addition, the FAA initiated a contract 
with the AMA to provide professional and technical information. The AMA 
presented its report, ``Review of Part 67 of the Federal Air 
Regulations and the Medical Certification of Civilian Airmen'' (AMA 
Report), on March 26, 1986. The public was again invited to comment on 
part 67 in ``Announcement of the Availability of a Report'' (51 FR 
19040; May 23, 1986). The AMA Report detailed the results of a 
comprehensive review of the standards for airman medical certification 
and of their application. The AMA Report considered pertinent advances 
in the field of medicine since 1959, recommended changes in the FAA 
medical standards, and explained the rationale for such changes. The 
FAA considered public comments received on the AMA Report in developing 
Notice No. 94-31.
    In a separate but related issue, on May 11, 1979, the Aircraft 
Owners and Pilots Association (AOPA) petitioned to amend Sec. 61.23 to 
require medical examinations for private pilots at 36-month intervals 
rather than at 24-month

[[Page 11239]]
intervals. In response to the 1979 AOPA petition to amend Sec. 61.23, 
the FAA issued on October 29, 1982, NPRM No. 82-15 (47 FR 54414, 
December 2, 1982) proposing to amend part 61 to revise the duration of 
validity of third-class privileges of airman medical certificates for 
operations requiring a private or student pilot certificate. As 
proposed by Notice No. 82-15, the requirement for a third-class medical 
examination would have been changed to every 5 years for the youngest 
pilots then increasing in frequency to the existing 2-year interval for 
older pilots.
    On September 27, 1985, prior to the issuance of the AMA Report on 
its review of the airman medical standards and certification procedures 
in part 67, the notice proposing to amend part 61 to revise the 
duration of third-class airman medical certificates was withdrawn (50 
FR 39619). The proposal was withdrawn, in part, because of issues 
raised by the medical community. Given the then pending issuance of the 
AMA Report and the possibility that the report would provide better 
data on which to base an evaluation of the safety concerns raised by 
the medical community, the FAA decided that any future consideration of 
examination frequency would be within the context of the outcome of the 
comprehensive review of part 67.

Petitions for Rulemaking

    The FAA has received a number of other petitions for rulemaking 
that relate to airman medical certification and duration. These 
petitions are disposed of in this rulemaking. For each of these 
petitions a public docket was established, a notice of the petition was 
published in the Federal Register, and comments, if any, received on 
the petition were placed in the docket for public inspection.
    On July 30, 1981, the Civil Pilots for Regulatory Reform petitioned 
the FAA to revise the rules so that pilots who have incurred a 
myocardial infarction will not be automatically disqualified for life 
for airman medical certification. (Docket No. 22054) This petition was 
discussed in the preamble to the NPRM (59 FR 53243). Also, see the 
discussion in this preamble under ``Cardiovascular Secs. 67.111, 
67.211, and 67.311'' and the corresponding rule language. Comments 
received on the petition totaled 311; all of which generally supported 
the petition. After careful consideration of all the comments, both 
from this petition and the current rulemaking action (Docket No. 
27940), the FAA has determined that a diagnosis or medical history of 
myocardial infarction will continue to be disqualifying under part 67.
    On February 26, 1986, AOPA again petitioned the FAA to revise the 
duration of a third-class airman medical certificate to 36 calendar 
months for noncommercial operations requiring a private, recreational, 
or student pilot certificate. (Docket No. 24932) See preamble 
discussion under ``Discussion of Comments and Amendments to Part 61'' 
(Sec. 61.23) and the corresponding rule language. Comments received on 
this petition totaled two; both supported the petition. After careful 
consideration of all comments, both from this petition and the current 
rulemaking action (Docket No. 27940), the FAA has decided to deny this 
AOPA petition and adopt the proposal (Docket No. 27940) with the 
modifications discussed under ``Discussion of Comments and Amendments 
to Part 61.''
    On January 20, 1989, a petition was submitted to the FAA by Thomas 
J. Rush to provide a longer timeframe (60 or 90 days) for airmen to 
schedule medical examinations when they renew their special issuances 
of medical certificates. (Docket No. 25787) See the discussion in the 
preamble under ``Special Issuance Sec. 67.401;'' ``Discussion of 
Comments and Amendments to Part 61;'' and the corresponding rule 
language. The Federal Register notice of this petition received no 
comment. After careful consideration of the issues of this petition and 
of comments to the current rulemaking action (Docket No. 27940), the 
FAA has determined that the rule as it relates to this issue should 
remain unchanged.
    On February 12, 1990, AOPA petitioned the FAA to revise certain eye 
and cardiovascular standards to facilitate medical certificate issuance 
and better relate those standards to current medical knowledge and 
technology. Changes sought included the following: (1) Change the color 
vision standard for first-class medical certificates to the standard 
used for second-class medical certificates; and delete the color vision 
standard for third-class medical certificates; (2) Delete the 
uncorrected visual acuity standards; (3) Change the pathology of the 
eye standard for second-class medical certificates to the standard used 
for first-class medical certificates; and (4) For second- and third-
class medical certificates, relate cardiovascular conditions to their 
impact on the applicant's ability to operate safely. (Docket No. 26156) 
See the discussion in the preamble under the major heading ``Vision 
Secs. 67.103, 67.203, and 67.303'' (``Color Vision Secs. 67.103(c), 
67.203(c), and 67.303(c)''; ``Distant Visual Acuity''; ``Near Visual 
Acuity Standard''; and ``Intermediate Visual Acuity Standard''); and 
``Cardiovascular Secs. 67.111, 67.211, and 67.311''. Also see the 
corresponding rule language for these sections. Comments received on 
the petition totaled 80; 79 generally support the petition and 1 from 
the Air Line Pilots Association (now known as the Air Line Pilots 
Association International) (ALPA) opposed the petition. ALPA opposed 
the petition because they considered it premature in light of FAA's 
active rulemaking project to revise all of part 67. After careful 
consideration of all comments, both from this petition and the current 
rulemaking action (Docket No. 27940), the FAA has decided to adopt the 
vision and cardiovascular proposals of the current rulemaking action 
(Docket No. 27940) with the modifications discussed under ``Discussion 
of Comments and Final Rule for Part 67.''
    On June 25, 1990, AOPA petitioned the FAA to amend frequently 
waived medical standards as follows: (1) Add a provision for continued 
limited pilot privileges pending FAA action on an application for 
renewal of a medical certificate; (2) Permit applicants for all classes 
of medical certificates to meet revised hearing standards in either or 
both ears with or without a corrective device; (3) Change the 2-year 
period of abstinence from alcohol to a period ``reasonable to ensure 
abstinence''; and (4) Permit issuance of second- and third-class 
medical certificates to diabetics using hypoglycemic drugs other than 
insulin (with Federal Air Surgeon concurrence). (Docket No. 26281) See 
the discussion in the preamble under ``Discussion of Comments and 
Amendments to Part 61'' (Sec. 61.23); ``Hearing Secs. 67.105(a), 
67.205(a), and 67.305(a)''; under the major heading ``Mental Standards 
Secs. 67.107, 67.207, and 67.307'' (``Substance Dependence and 
Definitions'' and ``Substance Abuse''); and ``Diabetes Secs. 67.113(a), 
67.213(a), and 67.313(a)''. Also see the corresponding rule language 
for these sections. Comments received on the petition totaled 29; 28 
generally supported the petition, and one from ALPA opposed the 
petition. ALPA opposed the AOPA petition for the same reason it opposed 
the February 1990 AOPA petition; ALPA considered it premature in light 
of FAA's active rulemaking project to revise all of part 67. After 
careful consideration of all comments, both from this petition and the 
current rulemaking action (Docket No. 27940), the FAA has decided to 
adopt the duration, hearing, mental, and

[[Page 11240]]
general medical proposals with the modifications discussed under 
``Discussion of Comments and Amendments to Part 61'' and ``Discussion 
of Comments and Final Rule for Part 67.''
    On August 27, 1990, a petition was submitted to the FAA by Frank 
Goeddeke, Jr., to allow individuals with alcoholism problems to obtain 
a medical certificate after abstaining from alcohol for 90 days, rather 
than the 2-year time period stipulated in the rules. (Docket No. 26330) 
See the discussion in the preamble under the major heading ``Mental 
Standards Secs. 67.107, 67.207, and 67.307'' (``Substance Dependence 
and Definitions'' and ``Substance Abuse''). Also see the corresponding 
rule language for these sections. Comments received on the petition 
totaled three; all three supported the petition. After careful 
consideration of all comments, both from this petition and the current 
rulemaking action (Docket No. 27940), the FAA has decided to retain the 
2-year abstinence requirement related to alcoholism.
    In February 1991, the American Diabetes Association petitioned the 
FAA to amend the special issuance provisions of part 67 or, 
alternatively, amend the FAA special issuance policy to permit grants 
of special issuance of medical certificates to persons with insulin-
treated diabetes mellitus (ITDM) and permit grants of special issuance 
of medical certificates on a case-by-case basis. The ADA also requested 
the creation of an FAA-appointed medical task force to develop a 
medical protocol to permit meaningful case-by-case review. (Docket No. 
26493) The FAA referred to this petition in a request for comments on a 
proposed policy change concerning individuals with diabetes mellitus 
who require insulin that was published in the Federal Register on 
December 29, 1994. (See 59 FR 67246) See also the discussion in this 
preamble under ``Diabetes Secs. 67.113(a), 67.213(a), and 67.313(a)'' 
and the corresponding rule language. Comments received on the petition 
totaled 160; there was general support for the rulemaking part of the 
petition. Most commenters, however, strongly support special issuance 
of medical certificates for persons with ITDM. After careful 
consideration of all comments, both from this petition and the current 
rulemaking action (Docket No. 27940), the FAA is denying that part of 
the ADA petition that requested rulemaking; i.e., an amendment to 
Sec. 67.19. The FAA will respond to the ADA request for a policy change 
and to the comments received to both dockets when it publishes in a 
separate notice its disposition of the December 29, 1994, notice on 
that subject (Docket No. 26493).
    On September 24, 1993, AOPA once again petitioned the FAA to revise 
the duration of a third-class airman medical certificate to 48 calendar 
months for a specific trial period for noncommercial operations 
requiring a private or student pilot certificate. Docket No. 27473) See 
the preamble discussion under ``Discussion of Comments and Amendments 
to Part 61'' (Sec. 61.23) and the corresponding rule language. Comments 
received on the petition totaled 140; 137 generally supported the 
petition and 3 opposed it. After careful consideration of all comments, 
both from this petition and the current rulemaking action (Docket No. 
27940), the FAA has decided to deny this AOPA petition and adopt the 
current rulemaking action's duration proposal (Docket No. 27940) with 
the modifications discussed under ``Discussion of Comments and 
Amendments to Part 61.''
    The FAA considered each of these petitions for rulemaking and the 
public comments on the petitions in preparing the NPRM and this final 
rule. The FAA believes that the actions requested in the petitions are 
addressed and resolved in this rulemaking action. Therefore, action in 
each of the referenced petitions is considered completed by publication 
of this final rule.
    The FAA is also addressing two other petitions for rulemaking 
relating to part 67. On August 14, 1991, a petition was submitted to 
the FAA by Charles Webber and on June 20, 1992, a petition was 
submitted to the FAA by Robert H. Monson. Both of these petitioners 
request that the FAA eliminate Sec. 67.3 in its entirety. The 
petitioners state that this rule allows the FAA to obtain a copy of an 
applicant's automobile driving record before an airman medical 
certificate can be issued and that this violates individual privacy 
rights (under the Privacy Act, 5 United States Code (U.S.C.) 552a). 
(Docket No. 26782 and Docket No. 26913) Section 67.3 was added to part 
67 in 1990 after the National Driver Register (NDR) Act of 1982 was 
amended to specifically authorize the FAA to receive information from 
the NDR regarding motor vehicle actions that pertain to any individual 
who has applied for an airman medical certificate. In the NPRM and in 
this final rule Sec. 67.3 has been recodified as Sec. 67.7. The 
substance of this section was not discussed in the NPRM for this 
rulemaking because the background, issues, and public comments had been 
thoroughly covered in the final rule for Sec. 67.3 (August 1, 1990; 55 
FR 31300). Since Sec. 67.3 went into effect, the FAA has found access 
to the NDR useful in making medical certification determinations. 
Comments received to the Webber petition totaled 24; all generally 
supported the petition. The Monson petition received no comment. After 
careful consideration of both petitions and all the comments, both from 
the petitions and the current rulemaking action (Docket No. 27940), the 
FAA has determined it will take no further action on the referenced 
petitions after publication of this final rule.
    In accordance with the above discussion and after consideration of 
comments received on the NPRM, the FAA is revising part 67 and 
Secs. 61.23 and 61.39 of part 61.

Summary of Amendments to Part 67

    The following is a summary of the substantive revisions made by 
this rulemaking. Because this rulemaking completely recodifies part 67, 
this summary states both the current and new section/paragraph numbers.
    1. Distant visual acuity requirements for first- and second-class 
medical certification are changed to delete the uncorrected acuity 
standards. However, each eye must be corrected to 20/20 or better, as 
in the current standard. [Current Secs. 67.13(b) and 67.15(b); Final 
Secs. 67.103(a) and 67.203(a)]
    2. For third-class medical certification, the current 20/50, 
uncorrected, or 20/30, corrected, distant visual acuity standard is 
changed to 20/40 or better, in each eye, with or without correction. 
[Current Sec. 67.17(b); Final Sec. 67.303(a)]
    3. For first- and second-class medical certification, minimum near 
visual acuity requirements are specified in terms of Snellen equivalent 
(20/40), corrected or uncorrected, each eye, at 16 inches. This 
replaces the current standard of v=1.00 at 18 inches for first-class 
only. An intermediate visual acuity standard (near vision at 32 inches) 
of 20/40 or better at 32 inches Snellen equivalent, corrected or 
uncorrected, is added to the first- and second-class visual 
requirements for persons over age 50. [Current Secs. 67.13(b) and 
67.15(b); Final Secs. 67.103(b), 67.203(b), and 67.303(b)]
    4. A near visual acuity standard of 20/40 or better, Snellen 
equivalent (20/40), corrected or uncorrected, each eye, at 16 inches is 
added to the third-class visual requirements. [Current (None); Final 
Sec. 67.303(b)]
    5. Color vision requirements are amended to read: ``ability to 
perceive those colors necessary for safe performance of airman 
duties,'' and are the same for all classes. Current

[[Page 11241]]
standards require ``normal color vision'' for first-class and the 
ability to distinguish aviation signal colors for second- and third-
class applicants. [Current Secs. 67.13(b), 67.15(b), and 67.17(b); 
Final Secs. 67.103(c), 67.203(c), and 67.303(c)]
    6. The current first-class standard pertaining to pathological 
conditions of the eye or adnexa that interfere or that may reasonably 
be expected to interfere with proper function of an eye is substituted 
in both the second- and third-class standards for the current standards 
which specify, respectively, ``no pathology of the eye'' and ``no 
serious pathology of the eye.'' [Current Secs. 67.15(b) and 67.17(b); 
Final Secs. 67.203(e) and 67.303(d)]
    7. The ``whispered voice test'' for hearing is replaced for all 
classes by a conversational voice test using both ears at 6 feet; an 
audiometric word (speech) discrimination test to a score of at least 70 
percent obtained in one ear or in a sound field environment; or pure 
tone audiometry according to a table of acceptable thresholds (American 
National Standards Institute (ANSI), 1969). [Current Secs. 67.13(c), 
67.15(c), and 67.17(c); Final Secs. 67.105(a), 67.205(a), and 
67.305(a)]
    8. The standards pertaining to the ear, nose, mouth, pharynx, and 
larynx are revised to more general terms and related to flying and 
speech communication. Specific references to the mastoid and eardrum 
are deleted. The current standard, ``No disturbance in equilibrium,'' 
is changed to, ``No ear disease or condition manifested by, or that may 
reasonably be expected to be manifested by, vertigo or a disturbance of 
equilibrium.'' The amended standards are the same for all classes. 
[Current Secs. 67.13(c), 67.15(c), and 67.17(c); Final Secs. 67.105(b), 
67.205(b), and 67.305(b)]
    9. ``Psychosis,'' as used in the final rule, refers to a mental 
disorder in which the individual has delusions, hallucinations, grossly 
bizarre or disorganized behavior, or other commonly accepted symptoms 
of this condition, or may reasonably be expected to manifest such 
symptoms. [Current Secs. 67.13(d), 67.15(d), and 67.17(d); Final 
Secs. 67.107(a), 67.207(a), and 67.307(a)]
    10. Substance dependence and substance abuse are defined and 
specified as disqualifying medical conditions. Substance dependence is 
disqualifying unless there is clinical evidence, satisfactory to the 
Federal Air Surgeon, of recovery, including sustained total abstinence 
from the substance for not less than the preceding 2 years. Substance 
abuse is disqualifying if use of a substance was physically hazardous 
and if there has been at any other time an instance of the use of a 
substance also in a situation in which that use was physically 
hazardous; or if a person has received a verified positive drug test 
result under an anti-drug program of the Department of Transportation 
or one of its administrations within the preceding 2 years. Alcohol 
dependence and alcohol abuse are included in the terms ``substance 
dependence'' and ``substance abuse'', respectively. [Current 
Secs. 67.13(d), 67.15(d), and 67.17(d); Final Secs. 67.107(a) and (b), 
67.207(a) and (b), and 67.307(a) and (b)]
    11. ``Bipolar disorder'' is added as a specifically disqualifying 
condition. This addresses an issue created by a change in nomenclature 
contained in the Diagnostic and Statistical Manual of Mental Disorders, 
Third Edition (DSM III), and continued in the DSM IV. [Current (None); 
Final Secs. 67.107(a), 67.207(a), and 67.307(a)]
    12. The general mental standard is amended to add the word 
``other'' before ``mental.'' The final revised standard reads, ``No 
other personality disorder, neurosis, or other mental condition * * 
*.'' [Current Secs. 67.13(d), 67.15(d), and 67.17(d); Final 
Secs. 67.107(c), 67.207(c), and 67.307(c)]
    13. ``A transient loss of control of nervous system function(s) 
without satisfactory medical explanation of the cause,'' is added as a 
specifically disqualifying neurologic condition. [Current (None); Final 
Secs. 67.109(a), 67.209(a), and 67.309(a)]
    14. The word ``seizure,'' is substituted for ``convulsive.'' 
[Current Secs. 67.13(d), 67.15(d), and 67.17(d); Final Secs. 67.109(b), 
67.209(b), and 67.309(b)]
    15. ``Cardiac valve replacement,'' ``permanent cardiac pacemaker 
implantation,'' and ``heart replacement'' are added as specifically 
disqualifying cardiovascular conditions for all classes of 
certification. [Current Secs. 67.13(e), 67.15(e), and 67.17(e); Final 
Secs. 67.111(a); 67.211 (d), (e), and (f); and 67.311 (d), (e), and 
(f)]
    16. The time period for which an electrocardiogram may be used to 
satisfy the requirements of the first-class medical certificate is 
revised to 60 days from the current 90 days. [Current Sec. 67.13(e); 
Final Secs. 67.111(c)]
    17. The current table of age-related maximum blood pressure 
readings for applicants for first-class medical certificates and the 
reference to ``circulatory efficiency'' are deleted. Blood pressure 
will continue to be assessed for all three classes but will be 
evaluated under the appropriate general medical standards. [Current 
Sec. 67.13(e); Final Secs. 67.113(b), 67.213(b), and 67.313(b)]
    18. Current Sec. 67.19, Special issue of medical certificates, is 
rewritten [Final Sec. 67.401(a)] to provide for, at the discretion of 
the Federal Air Surgeon, an ``Authorization for a Special Issuance of 
Medical Certificate'' (Authorization), valid for a specified period of 
time. An individual who does not meet the published standards of part 
67 may be issued a medical certificate of the appropriate class if he 
or she possesses a valid Authorization. The duration of any medical 
certificate issued in accordance with proposed Sec. 67.401 is for the 
period specified at the time of its issuance or until withdrawal of an 
Authorization upon which the certificate is based. A new Authorization 
is required after expiration, and the applicant must again apply for a 
special issuance of a medical certificate.
    19. Final Sec. 67.401(b) provides for a Statement of Demonstrated 
Ability (SODA) instead of an Authorization. A SODA will be issued with 
no expiration date to applicants whose disqualifying conditions are 
static or nonprogressive and who have been found capable of performing 
airman duties without endangering public safety. A SODA authorizes an 
aviation medical examiner to issue a medical certificate if the 
applicant is otherwise eligible.
    20. Final Sec. 67.401(e) retains the language of current 
Sec. 67.19(c) regarding consideration of the freedom of a private pilot 
to accept reasonable risks to his or her own person or property that 
are not acceptable in the exercise of commercial or airline transport 
pilot privileges, and consideration at the same time of the need to 
protect the safety of persons and property in other aircraft and on the 
ground.
    21. Final Sec. 67.401(f) adds language that explicitly provides 
that the Federal Air Surgeon may withdraw the Authorization or SODA. An 
Authorization or SODA may be withdrawn at any time for (1) adverse 
change in medical condition, (2) failure to comply with its provisions, 
(3) potential endangerment of public safety, (4) failure to provide 
medical information, or (5) the making or causing to be made of a 
statement that is covered by Sec. 67.403.
    22. Final Sec. 67.401(i) permits a person to request that the 
Federal Air Surgeon review a decision to withdraw an Authorization or 
SODA. The request for a review must be made within 60 days of the 
service of the letter that withdrew the Authorization or SODA. The 
review procedures will be on an expedited basis and will provide the 
affected

[[Page 11242]]
holder of an Authorization or SODA a full opportunity to respond to a 
withdrawal by submitting supporting appropriate evidence.
    23. Final Sec. 67.403 differs from current Sec. 67.20 by providing 
for denial of an airman medical certificate if the application for an 
airman medical certificate is falsified. Though this consequence is 
implied, the current regulation specifically provides only for 
revocation or suspension of certificates. Additionally, Sec. 67.403 
provides for denial or withdrawal of any Authorization or SODA if the 
information provided to obtain it is false, whether the statement was 
knowingly false or unknowingly incorrect. Finally, Sec. 67.403(c) makes 
an unknowingly incorrect statement that the FAA relied upon in making 
its decisions regarding an application for an airman medical 
certificate or a request for an Authorization or SODA, a basis for 
denial, revocation, or suspension of an airman medical certificate and 
the denial or withdrawal of an Authorization or SODA.
    24. A new Sec. 67.415 provides that the holder of any medical 
certificate that is suspended or revoked shall, upon the 
Administrator's request, return it to the Administrator. The FAA 
practice always has been to request return of the certificate in such 
circumstances to avoid any misunderstanding as to the validity of the 
certificate.
    25. Where appropriate, changes are made to eliminate gender-
specific pronouns, to replace ``applicant'' with ``person,'' to use 
current position titles and addresses, to correct spelling and improve 
syntax, and to adjust section and paragraph references.

General Discussion of Public Comments

    In response to the NPRM, the FAA received over 5,200 written 
comments from the public. In addition, in January of 1995, the FAA held 
three public meetings on the proposal, at which approximately 50 
individuals and organizations participated. One was held in Washington, 
D.C., one in Orlando, Florida, and one in Seattle, Washington. 
Information from both the written comments to the docket and the 
presentations at these public meetings was considered in the final rule 
decisions along with the petitions for rulemaking and the comments 
received to those dockets discussed above.
    Commenters include approximately 30 trade associations, over 20 FAA 
aviation medical examiners (AME's), and over 5,100 members of the 
general public. Air transport pilots and other commercial pilots, 
private and recreational pilots, flight schools, and flight instructors 
were among the public commenters.
    A substantial number of commenters oppose the proposed changes on 
the basis that these changes would be a financial burden, that there is 
a lack of accident data to support stricter standards, and that the 
stricter standards would not produce discernible safety benefits. There 
was little or no opposition, however, to proposed changes that relaxed 
standards or reduced the regulatory burden.
    The FAA carefully considered each comment and all presentations 
made at the public meetings in determining this final rule. Comments 
that address specific proposed requirements relevant to the proposed 
rule are summarized and responded to in the following sections of this 
preamble. To the extent possible, all comments relevant to the adopted 
standards and regulatory changes are addressed; issues not relevant to 
this rulemaking raised in the written comments or at the public 
meetings are not addressed in this document.
    The FAA has determined that several of the proposed stricter 
standards are not required at this time. The withdrawal of these 
proposed stricter standards are fully discussed in the relevant 
sections of this document.

Overall Justification and Authority for This Rulemaking

    AOPA, which represents the interests of 330,000 pilots and aircraft 
owners, states in its comment that there is not sufficient 
justification to warrant this rulemaking since more than 98 percent of 
all general aviation accidents do not involve medical factors. AOPA 
also asserts that the FAA's statutory authority for regulating medical 
standards does not justify the medical certification program currently 
in place, especially with respect to persons who exercise only private 
or recreational flying privileges. AOPA states that it is unable to 
identify a grant of authority to the Administrator to deny a medical 
certificate to a pilot based, not on the pilot's present physical 
ability but on the finding that a condition may reasonably be expected 
within 2 years after the finding to make the pilot unable to perform 
the required duties. AOPA believes that the FAA should reconsider 
whether the proposal goes beyond the intent of the Federal Aviation Act 
of 1958 and beyond what is necessary to safety in air commerce.
    In a related comment, the Independent Pilots Association (IPA) 
states that ``nowhere is the FAA or the Federal Air Surgeon charged 
with the duty to practice preventive medicine.''
    FAA Response: The FAA has not gone beyond the intent of its 
authority in this rulemaking action. As stated previously in this 
notice, the purpose of this rulemaking is to update the medical 
standards to reflect current medical knowledge, practice, and 
terminology. The FAA is authorized under 49 U.S.C. 44703 to find that 
an applicant for an airman certificate is physically able to perform 
duties pertaining to the position for which the certificate is sought. 
The FAA is to issue such a certificate ``containing such terms, 
conditions, and limitations as to duration thereof, periodic or special 
examinations, tests of physical fitness, and other matters'' necessary 
to assure aviation safety.
    It is reasonable that airmen, sharing the same air space and flying 
over the same populated areas, whether engaged in air transportation or 
in private operations, must meet certain standards in skills and 
medical fitness to assure aviation safety. That some distinction in the 
degree of standards is permissible is reflected in the distinction 
between types of pilot certificates and classes of medical certificates 
as required by law. While the FAA is not charged with the duty to 
practice preventive medicine, determining the medical fitness of airmen 
requires making an assessment of the risks involved in certain medical 
conditions and denying medical certification in instances in which the 
person is, or may be, unable to safely perform aviation activities.
    On reconsideration of the proposal and after careful consideration 
of all the comments and presentations received, the FAA is withdrawing 
certain proposed requirements. Among the withdrawals are (1) the 
proposal to shorten the duration of third-class medical certificates 
for pilots 70 and older, (2) the requirement for a test to determine 
total blood cholesterol, and (3) electrocardiogram requirements for 
second-class medical certificates. A more complete discussion of the 
withdrawal of the requirements occurs in the following sections of the 
preamble.
    One of the FAA's primary concerns is the need to ensure that its 
regulations maintain the proper balance between cost and benefits. The 
FAA will only issue a final rule when there is clear evidence that it 
will enhance safety, and that it will do so at a reasonable cost. This 
is a longstanding FAA commitment, and a requirement of DOT policies and 
procedures. In this context, after review of the comments, the FAA is 
not persuaded that there is yet adequate evidence to show that those 
costs of the proposals are justified by

[[Page 11243]]
the safety benefits that can reasonably be expected.
    However, the FAA will continue to monitor accident and health data 
as part of our responsibility to help ensure that adequate safety is 
maintained. Consistent with the principles of the Clinton 
administration's National Performance Review, the FAA will, in the 
coming months, explore alternative nonregulatory means to reduce 
medically-related accidents. These alternative administrative actions 
will not impose the same costs on airmen as the proposals contained in 
the NPRM, but will assist pilots and aviation medical examiners in 
identifying and reducing potential medical risks.

National Transportation Safety Board (NTSB) and Judicial Review

    Several associations and individuals comment that this rulemaking 
appears to be an effort by the FAA to change decisions by the NTSB and 
the courts. Several individuals at the hearings held in conjunction 
with this rulemaking also expressed this opinion.
    FAA Response: The FAA agrees that in some cases these comments are 
accurate. The FAA promulgates rules and policies when the FAA 
determines that a substantial public safety interest requires such 
action. In some circumstances, the NTSB or the courts have determined 
that the rule language adopted by the FAA does not achieve the FAA's 
intent. The FAA views the circumstances in which review authorities 
have disagreed with the FAA's interpretation of its rules as a 
reflection of regulatory defects and not a reflection of policy 
defects. This rule corrects the regulatory defects by clarifying or 
more accurately stating in the regulatory language those policies that 
the FAA believes are necessary to protect substantial public safety 
interests.

Discussion of Comments and Amendments to Part 61

    Proposed Sec. 61.23 lengthens the current 2-year third-class 
medical certification period to a 3-tier system: a 3-year period for 
pilots under age 40, a 2-year period for those age 40 to 69, and annual 
certification for pilots age 70 and over.
    Comments: Most individual commenters expressed support for the 
increased duration (from 2 years to 3 years) for third-class medical 
certificates for pilots under age 40. Several AME's comment that it is 
appropriate to differentiate for age, although opinions of AME's and 
other commenters vary as to the age at which the frequency of 
examinations should change. Commenters suggest duration periods for 
third-class medical certificates ranging from 1 to 5 years.
    Several associations, several AME's, and a majority of the 
individuals who commented on this issue strongly oppose the proposal to 
increase the frequency of medical examinations for pilots age 70 and 
over for reasons including the following: the proposal may be illegal 
under federal age discrimination laws; more frequent examinations will 
not predict sudden incapacitation; the benefits have not been 
demonstrated; accident rates are lower for older pilots; and the 
statistical analysis the FAA used to confirm that incidence of 
accidents increases with age is supported by an insufficient sample 
size. The Experimental Aircraft Association (EAA), AOPA, and the 
Colorado Pilots Association believe all airmen should have a 3-year 
standard regardless of age because, until medical technology reaches a 
point where the onset of a heart attack can be accurately predicted, 
there is no justification for more frequent or different examinations 
for pilots age 70 or over.
    Some commenters say that the requirement will be particularly 
burdensome to older pilots, many of whom are on a fixed income. One 
commenter suggests that the FAA pay for annual examinations if they 
will be required. Several commenters note that such examinations are 
generally not covered by insurance.
    FAA Response: The FAA has decided to lengthen the current 2-year 
third-class medical certification period to a 2-tier system. For airmen 
under age 40, medical certificates must be renewed every 3 years. For 
airmen age 40 and over, the current 2-year duration will remain.
    As stated in the NPRM, extending the length of time between 
examinations for third-class medical certificates of persons under age 
40 should result in no significant increase in undetected pathology 
between required examinations. The FAA, after careful consideration of 
all comments and testimony received as well as the petitions and 
comments received to Docket Nos. 24932, 26281, and 27473, has 
determined that extending the duration between medical examinations can 
be done with no detriment to safety in the case of younger airmen who 
are much less likely to suffer medical incapacitation. As with all age 
groups, those individuals under age 40 manifesting conditions that 
represent a risk to safety will be denied certification or, if they 
apply for and receive a special issuance of a medical certificate, will 
be restricted in their flying activities or examined more thoroughly 
and frequently, or both.
    The final rule will provide for maximum regulatory relief without a 
decrement to public safety.
    The proposal to shorten the duration of third-class medical 
certificates of airmen over the age of 70 is being withdrawn because on 
reexamination insufficient data exist to support the revision at this 
time. Several aviation associations, AME's, and individuals commented 
that the data used in the proposal did not support the conclusion that 
decreased accidents would result if the duration of third-class medical 
certificates for airmen over the age of 70 was shortened. The FAA has 
determined that the possible reduction of a very few known general 
aviation accidents that are medically-related cannot be justified when 
compared with the cost of the proposal. This is in contrast to 
accidents of airline transport and commercial carriers where a single 
accident may have significant loss of life and property.
    All third-class medical certificates or third-class privileges of a 
first- or second-class medical certificate issued prior to the 
effective date of this final rule will remain valid for 2 years from 
the date of issuance of the certificate unless the validity period has 
been otherwise limited by the FAA. The period of validity for all 
third-class airman medical certificates or third-class privileges of a 
first- or second-class medical certificate issued on or after the 
effective date of this final rule will be calculated according to the 
provisions of the final rule unless the validity period is otherwise 
limited by the FAA.
    Section 61.53 provides that: ``No person may act as pilot in 
command, or in any other capacity as a required pilot flight crewmember 
while he [or she] has a known medical deficiency, or increase of a 
known medical deficiency, that would make him [or her] unable to meet 
the requirements for his [or her] current medical certificate.'' This 
amendment does not change Sec. 61.53, and the FAA continues to require 
airmen to comply with that rule. In reducing the frequency of required 
periodic contacts with knowledgeable health professionals, self-
monitoring and personal attention to health become a more important 
part of the individual airman's responsibility for flight safety.
    Consistent with the changes above, the final rule amends Sec. 61.39 
to coincide with the duration change in Sec. 61.23. Section 61.39 
requires that applicants must possess at least a third-class medical 
certificate or the third-class privileges of a first- or second-class 
medical certificate valid under Sec. 61.23

[[Page 11244]]
in order to be eligible for a flight test for a certificate, or an 
aircraft or instrument rating.

Discussion of Comments and Final Rule for Part 67

    The following discussion generally addresses comments received and 
the FAA's response to those comments on the specific standards or 
requirements in the rule. As noted above, over 5,200 comments were 
received concerning this rulemaking. The comments addressed by the FAA 
are broadly representative of these many thousands of comments. Other 
matters and issues raised by the commenters, such as additional tests 
and examinations that are performed under the special issuance 
procedures, are not addressed in this document. The FAA is responding 
only to comments that are within the scope of this rulemaking.

Lists of Medical Standards

General

    ``Include, but are not limited to.'' The proposal uses the word 
``includes'' rather than the word ``are'' in each section of the 
medical standards because the proposed medical standards are not, and 
never have been, meant to be exhaustive in naming all medical 
conditions that are disqualifying.
    Comments: AOPA, EAA, National Air Transportation Association 
(NATA), and most individual commenters say this provision gives FAA 
absolute discretion without proper promulgation of regulations; the 
language is too open-ended and provides no standard at all. AOPA states 
that because the disqualifying conditions are not enumerated, 
applicants cannot know if they have a deficiency for which the FAA 
would disqualify them. One AME says that the proposal gives the FAA too 
much leeway, and should read ``are limited to.'' A majority of the 
individual commenters strongly oppose use of the term ``include, but 
are not limited to,'' saying that it would allow FAA too much unchecked 
authority over an applicant.
    FAA Response: The final rule will not contain the proposed language 
``include, but are not limited to.'' Medical conditions identified 
during an evaluation that are not specifically listed as disqualifying 
but do not meet the general medical standard regarding safe performance 
of duties and exercise of privileges, would continue to be 
disqualifying under general medical standards. The intent of the 
proposal was to alert individuals of this long-standing FAA practice 
and not to expand the scope of the regulations.

Vision (Sections 67.103, 67.203, 67.303)

    Distant Visual Acuity. The proposal deletes the uncorrected vision 
standard for first- and second-class medical certificates and requires 
a distant visual acuity of 20/20 or better, in each eye, with or 
without correction. For third-class medical certificates, a distant 
visual acuity of 20/40 or better with or without correction, is 
required for each eye.
    Comments: Comments on the proposal for distant visual acuity were 
in favor of the changes; one AME notes that the proposal is less 
stringent than the present standards.
    FAA Response: The final rule is the same as proposed in the NPRM. 
As stated in the NPRM, the FAA practice for many years has been to 
grant any class medical certificate requested, regardless of 
uncorrected distant acuity, if the required minimum vision is present 
or achieved through conventional corrective lenses, there is no 
evidence of significant eye pathology, and the person is otherwise 
eligible. Thousands of airmen have demonstrated their ability to safely 
perform their jobs while using corrective lenses for distant visual 
acuity that is poorer than 20/100 in each eye. The FAA, after careful 
consideration of the comments and presentations received as well as the 
petition and comments received to Docket No. 26156, has determined that 
the requirements for distant visual acuity may be relaxed. The revision 
will streamline the process of medical certification by not requiring 
special issuance for persons who cannot meet an uncorrected distant 
acuity standard.
    Near visual acuity standard. The proposed rule replaces the 
outdated standards for near visual acuity by requiring for all three 
classes a near visual acuity of 20/40 or better, Snellen equivalent, at 
16 inches in each eye separately, with or without corrective lenses.
    Comments: United States Pilots Association (USPA) states that the 
FAA presented no evidence to justify the addition of a near-vision 
standard. Joint Aviation Authorities (JAA) also notes the lack of 
accident-supported data, but states that the European opinion is that 
the pilot should have enough visual capacity to read the aircraft 
instruments if his or her glasses or lenses are lost in flight. The EAA 
suggests changing 16 inches to ``ability to read an instrument panel,'' 
which would preserve the intent of the rule, but would not require any 
additional equipment or training of AME's.
    Three AME's approve and one disapproves of the proposed near visual 
acuity standards. One AME doubts that a pilot with 20/40 vision can 
read small print (such as on instrument approach plates) in dim light, 
but notes that a nearsighted person can compensate by looking around 
one's spectacle lenses. Farsighted persons with 20/40 vision, however, 
may not be able to read small print at 16 inches. This commenter 
suggests (1) supplying AME's with specimen aeronautical charts and 
plates and requiring that the items be read in normal room light with 
or without correcting lenses, or (2) raising the near vision standard 
to at least 20/25.
    FAA Response: The FAA agrees with the AMA Report recommendation 
that all three classes of medical certificates should have the same 
near visual acuity standards. The final rule is the same as proposed. 
It eliminates the antiquated terminology in the current standards for 
first-class medical certification, corrects the inconsistency between 
standards and practice for second-class medical certification, and 
establishes a standard for third-class medical certificates. After 
careful consideration of all comments and presentations received as 
well as the petition and comments received to Docket No. 26156, the FAA 
has determined that the near visual acuity standard proposed in the 
NPRM establishes an objective requirement that is necessary for safety 
and can be best accomplished by the final rule.
    Intermediate visual acuity standard. The NPRM proposed to add a new 
intermediate visual acuity standard (near vision at 32 inches) for 
first- and second-class medical certificates for pilots age 50 or older 
of 20/40, Snellen equivalent, at 32 inches in each eye separately, with 
or without corrective lenses.
    Comments: The AMA states that all pilot applicants older than 50 
should have 20/40 visual acuity at 32 inches because they need this 
degree for proper sight and use of instruments, switches, and other 
controls.
    Regarding intermediate visual acuity, AOPA says that 20/40 at 32 
inches over age 50 is unjustified, and that the age criteria is 
arbitrary. One AME says there are no data or operational experience to 
suggest that an additional middle vision standard for older pilots is 
needed. According to one AME, the 32-inch intermediate vision standard 
is too strict for pilots over 50 and will add to the cost without 
adding any discernible benefit. According to this commenter, those who 
need trifocals already have them.
    FAA Response: The final rule includes a requirement for 
intermediate

[[Page 11245]]
visual acuity for first- and second-class medical certificates for 
pilots age 50 or older. This standard is consistent with the 
International Civil Aviation Organization (ICAO) standards. The AMA 
Report recommended this intermediate vision standard in light of the 
eye's diminished ability with age to accommodate intermediate viewing 
distances. Also, the NTSB has recommended that an intermediate vision 
standard be established. The FAA, after careful consideration of the 
comments received as well as the petition and comments received to 
Docket No. 26156, has determined to adopt the rule proposed in the 
NPRM; airline transport and commercial pilots need adequate 
intermediate vision to monitor aircraft instruments and other cockpit 
equipment. This standard is also necessary to safeguard the public 
safety.

Color Vision (Sections 67.103(c), 67.203(c), 67.303(c))

    The proposed color vision standard for all classes is the ``ability 
to perceive those colors necessary for safe performance of airman 
duties.'' Current standards require ``normal color vision'' for first-
class applicants and the ability to distinguish aviation signal colors 
for second- and third-class applicants.
    Comments: The USPA, NATA, and National Agricultural Aviation 
Association (NAAA) support the proposed simplification of the color 
vision standard.
    One AME states that the current system is adequate to identify the 
individual with a color vision problem and should be left intact. This 
commenter states that the proposed NPRM advances no new or improved 
method of determining color vision abilities.
    AOPA and the AMA say that the regulations as proposed leave too 
much room for inconsistent interpretation; the rule should precisely 
state what colors are ``necessary for the safe performance of airman 
duties'' and what tests should be done. An individual suggests using 
visual flight rule (VFR) charts and runway and taxi light colors as 
discriminants for realistic and practical color vision tests. EAA says 
that the FAA should change the wording ``safe performance of airman 
duties'' to ``read and understand a sectional aeronautical chart.'' EAA 
believes this would ensure the intent of the rule, give the AME a 
simple inexpensive test, and better define what is necessary for safe 
performance of duties.
    Aerospace Medical Association (ASMA) and Air Transport Association 
(ATA) oppose the proposed changes. ASMA suggests that the FAA 
discontinue the color blindness test; the standard should be based on 
an individual's ability to perform safely.
    FAA Response: The final rule for color vision is the same as 
proposed. As stated in the NPRM, in current practice applicants for 
certification are tested by use of standard pseudoisochromatic plates 
or by other approved devices. A passing score defines the applicant as 
not color deficient. Failure indicates a color deficiency and requires 
that any medical certificate issued be limited, prohibiting flight at 
night or by color signal control. The limitation can be removed by 
successful completion of a practical signal light test or of a medical 
flight test, as appropriate for the class medical certificate sought 
and the level of aviation experience of the applicant. This final rule 
would allow, for all three classes of medical certificates, an 
individual who fails the test using pseudoisochromatic plates or other 
approved devices to still obtain a medical certificate without 
obtaining a waiver as long as the individual can demonstrate an ability 
to perceive those colors necessary for the safe performance of airman 
duties. The FAA will provide guidance to AME's to assist in these 
tests.
    The FAA, after careful consideration of the comments and 
presentations received as well as the petition and comments received to 
Docket No. 26156, has determined that the color vision standard in the 
final rule should remain as proposed.

Hearing (Sections 67.105(a), 67.205(a), 67.305(a))

    In the proposed rule, the ``whispered voice test'' for hearing is 
deleted for all classes and replaced with three alternatives: (1) A 
conversational voice test using both ears at 6 feet; (2) an audiometric 
word (speech) discrimination test to a score of at least 70 percent 
obtained in one ear or in a sound field environment; or (3) pure tone 
audiometry according to a table of acceptable thresholds (ANSI, 1969).
    Comments: Some AME's generally support the proposed hearing 
standards. ASMA states, however, that the rule language could be 
interpreted to require audiograms and that the FAA should state in the 
preamble that it intends for the basic screening test to be the spoken-
voice test. ASMA also says that the rule should state that audiometric 
tests are only used as alternatives for further evaluation of 
individuals who show reduced hearing acuity.
    Many commenters support the ``conversational voice'' recognition 
standard as operationally relevant. AOPA and USPA support the proposed 
standard that allows both ears to be used simultaneously to hear 
conversational voice spoken at 6 feet.
    ATA says a pure tone audiogram followed by a speech discrimination 
test based upon an audiometric standard guideline would be a far more 
accurate and objective measurement of hearing than the highly 
subjective conversational and whispered voice tests.
    -ATA says that a 70 percent score on an audiometric word 
discrimination test is too low to support speech comprehension during 
critical phases of flight; the standard should be 95 percent. Another 
individual suggests that 85 percent would allow for accurate 
communication in more cockpit environments. ATA and one AME also 
believe that the rule is vague, should be more descriptive, and should 
cite a decibel reading for administering the test.
    - One AME says that possibly a screening cut-off level for pure-
tone audiometry would be appropriate.
    -AOPA says that the same screening test should apply for those 
without ``normal hearing'' and users of hearing aids. According to 
AOPA, there appears to be no clinical reason for excluding the use of 
hearing aids within the medical standards.
    -Several commenters question whether an ``and'' or an ``or'' is 
appropriate between subparagraphs (a)(1) and (a)(2) of Secs. 67.105, 
67.205, and 67.305. Most think the rule should say ``or.''
    -A commenter notes that the standard for 2000 Hz in the chart in 
Sec. 67.205(c) is 30 for the poorer ear, which is more stringent than 
the standard of 50 for first-class medical certificate. The commenter 
believes that this must be a typographical error.
    FAA Response: The final rule is the same as proposed, except that 
the typographical error in the chart in Sec. 67.205(c) is corrected to 
50 and the lead-in for paragraph (a) in all three sections reads: ``The 
person shall demonstrate acceptable hearing by at least one of the 
following tests:'' and a period is placed at the end of each 
subparagraph. These editorial corrections to paragraph (a) are intended 
to eliminate any confusion or ambiguity. Passing any one of the tests, 
as required, is acceptable for certification. The FAA anticipates that 
the conversational voice test will be the most commonly used; however, 
passing any one of the tests will suffice even if the applicant has 
failed the other two. While there is some subjectivity to a 
conversational voice test, it is the simplest and least expensive form 
of testing. The FAA, after careful consideration of the

[[Page 11246]]
comments and presentations received as well as the petition and 
comments received to Docket No. 26281, has determined that the hearing 
standards in the final rule should remain as proposed.
    -The FAA is following the AMA Report recommendations in requiring a 
70 percent score in an audiometric word discrimination test. The FAA 
considers a 95 percent score too restrictive.
    -As with current policy, if a hearing aid is necessary to meet the 
standard, an Authorization or SODA is required. In most cases, however, 
a person using a hearing aid can be issued a medical certificate.

Equilibrium (Sections 67.105(c), 67.205(c), 67.305(c))

    -The proposal revises the current standard, ``No disturbance in 
equilibrium,'' to, ``No ear disease or condition manifested by, or that 
may reasonably be expected to be manifested by, vertigo or a 
disturbance of equilibrium.'' The proposed standards are the same for 
all classes.
    Comments: One commenter states that the ear, nose, throat, and 
equilibrium revisions are appropriate and realistic for addressing 
safety.
    -AOPA and other commenters say that the language relating to 
vertigo or disturbance of equilibrium is too broad; instead the rule 
should qualify that an applicant shall have ``no disturbance of 
equilibrium that is severe enough to make piloting an aircraft 
unsafe.'' AOPA asserts that vertigo is a common and normal occurrence 
and disqualification should not be based on a symptom. According to 
AOPA an episode of in-flight vertigo is not necessarily attributable to 
an underlying medical condition that is disqualifying. AOPA notes that 
the FAA intentionally induces vertigo at safety seminars using a 
``vertigon'' chair.
    FAA Response: The final rule is the same as proposed. The final 
rule is more precise than the current rule since it specifies that the 
vertigo or disturbance of equilibrium be a manifestation of a condition 
or disease of the ear. It appears commenters are confusing pilot 
vertigo or spatial disorientation that can occur in flight with vertigo 
that is a manifestation of a medical condition or disease. In-flight 
pilot vertigo or spatial disorientation is not related to this medical 
standard. The FAA has determined, after careful consideration of the 
comments and presentations received, that the equilibrium standards in 
the final rule should remain as proposed.

Mental Standards (Sections 67.107, 67.207, 67.307)

    -Definition of Psychosis. The proposed rule states that 
``psychosis'' refers to ``a mental disorder in which the individual has 
manifested psychotic symptoms or to a mental disorder in which the 
individual may reasonably be expected to manifest psychotic symptoms.'' 
This language change was proposed to be consistent with the diagnostic 
terminology and classification of mental disorders, published in the 
DSM III and its successor DSM IV.
    Comments: ATA suggests identifying the underlying disorders that 
FAA considers psychoses, e.g., schizophrenia, paranoid states, or 
depression. ATA suggests defining psychosis as ``an alteration in 
either thought content or process, or both, to such an extent that the 
individual suffers from hallucinations, delusions, or other 
manifestations.'' One AME states that ``psychotic reaction'' needs 
further definition in the rule. IPA suggests that the FAA refrain from 
referring to a specific edition of the DSM since DSM-IV is the current 
psychiatric diagnostic standard, not the 15-year old DSM-III referenced 
in the NPRM. JAA says its Manual of Civil Aviation Medicine gives much 
more detailed interpretation of its psychiatric and psychological 
requirements.
    FAA Response: On reconsideration and after careful consideration of 
the comments received, the FAA has changed the final rule language 
regarding psychosis to be more specific. Paragraph (a)(2) of 
Secs. 67.107, 67.207, and 67.307 reads as follows:
    ``(2) A psychosis. As used in this section, `psychosis' refers to a 
mental disorder in which:
    -``(i) The individual has manifested delusions, hallucinations, 
grossly bizarre or disorganized behavior or other commonly accepted 
symptoms of this condition; or
    -``(ii) The individual may reasonably be expected to manifest 
delusions, hallucinations, grossly bizarre or disorganized behavior, or 
other commonly accepted symptoms of this condition.''
    -At the time of the AMA Report and the FAA review of part 67, the 
most current DSM was DSM III. Since then, the DSM has been revised and 
the most current version is DSM IV. The FAA has determined that the 
revisions between DSM III and DSM IV do not necessitate any substantive 
changes between the proposed rule and the final rule.
    -Bipolar disorder. The proposed rule adds bipolar disorder 
(formerly ``manic depressive psychosis'') as a specifically 
disqualifying mental condition because the American Psychiatric 
Association's nomenclature in DSM III and DSM IV no longer includes 
bipolar disorder within the category of psychoses.
    Comments: One AME and a few individuals support the proposal to 
make bipolar disorders disqualifying.
    AOPA believes bipolar disorder should not be singled out as a 
disqualifying mental condition, and that applicants should be evaluated 
on a case-by-case basis. AOPA asserts that bipolar disorders vary in 
severity and symptoms from one individual to another; some never 
exhibit the manic symptoms which appear to be the primary concern of 
the FAA.
    FAA Response: The FAA, after careful consideration of the comments 
and presentations received, has determined that the final rule be the 
same as proposed. However, since the proposed rule was issued, DSM IV 
was developed which refers to more than one bipolar disorder and to 
separate criteria that apply to the different types of bipolar 
disorders. Although the DSM IV contains a change in classification of 
this disorder, there is no change in the rule language from the 
proposed rule language because the disorder, whatever its 
classification, is considered disqualifying.
    The FAA believes these conditions are of concern in the context of 
airman medical certification and flight safety, and that the agency 
must amend the mental standards since in accordance with the DSM III 
and its successor DSM IV, psychoses no longer include bipolar 
disorders. In consideration of potential risk to flight safety, 
individuals with this diagnosis are rarely granted certification. Those 
few individuals who are determined to be eligible for certification 
through the special issuance provisions must be followed closely for 
relapse and recurrence of symptoms. By including the new terminology, 
the standards will clearly reflect the agency's concern about this 
disorder. Specifically listing bipolar disorders as disqualifying is 
not a substantive change in FAA policy or practice.
    -Substance Dependence and Definitions. The proposal updates the 
standards for alcoholism and drug dependence to make them consistent 
with DSM III (and subsequently DSM IV) nomenclature which eliminates 
the term ``alcoholism'' and substitutes the diagnoses of ``substance 
dependence'' and ``substance abuse.'' The proposed revision defines 
``substance dependence,'' ``substance abuse,'' and ``substance.'' The 
proposed revision identifies disqualifying substances or

[[Page 11247]]
groups of substances (e.g., alcohol, cocaine, opioids, hallucinogens, 
cannabis, etc.) and would make dependence on or abuse of them 
disqualifying. The proposal also makes substance dependence 
disqualifying unless there is clinical evidence of recovery, including 
sustained total abstinence for not less than the preceding 2 years in 
the case of alcohol dependence, and the preceding 5 years in the case 
of other substance dependence.
    Comments: Two AME's generally support the proposed changes 
regarding substance dependence. AOPA, National Air Traffic Controllers 
Association (NATCA), EAA, and two other AME's suggest a minimum 2-year 
abstinence for all substances because they believe the extended period 
of decertification for substance dependency is without statistical 
justification. According to these commenters, the AMA data on which the 
5-year restriction is based are dated; there are many new treatments 
and research that indicate a required 5-year abstinence is too strict; 
and the 5-year rule may reflect some public hysteria concerning drug 
use. In addition, according to these commenters, there are six times as 
many alcohol-related accidents as drug-related accidents, bringing into 
question why the FAA is proposing stricter standards on other 
substances when alcohol is a greater problem.
    Two AME's say the FAA should not broaden the substances and should 
leave the regulation as is. Another AME says FAA needs to further 
define ``substance'' by identifying particular drugs.
    EAA says that the FAA should limit the disqualification for muscle 
relaxants to users of ``muscle relaxants with habit-forming potential'' 
because many muscle relaxants have no habit-forming potential.
    FAA Response: The FAA, after careful consideration of the comments 
and presentations received as well as the petitions and comments 
received to Docket Nos. 26281 and 26330, has decided to make the 
minimum period of abstinence from alcohol and other substances 2 years 
because longer term experience with recovery from dependence on drugs 
or alcohol now suggest that 2 years is adequate for both alcohol and 
drugs. In many cases, the FAA has granted special issuance to air 
transport and commercial pilots and has waived the 2-year abstinence 
period when it was satisfied that certain stringent criteria are met. 
The criteria can be summarized as follows: (1) A full commitment and 
partnership of the aviation employer and employee to ensure the 
employee's continued sobriety through monitoring; (2) full commitment 
and partnership of the recovering employee with a fellow employee to 
ensure continued sobriety through monitoring; and (3) frequent 
evaluations, testing, and attendance at professional aftercare 
treatment.
    Also, the FAA has decided to delete ``muscle relaxants'' from the 
list of substances in Secs. 67.107(a)(4)(i), 67.207(a)(4)(i), and 
67.307(a)(4)(i) in part because the FAA agrees with the EAA comment, 
but also because muscle relaxants are not included as a substance in 
DSM III and its successor DSM IV.
    To conform with DSM IV terminology, the FAA has changed the 
reference to ``volatile solvents and gases'' to ``inhalants,'' a term 
the FAA considers to be equivalent.
    Otherwise the final rule is the same as proposed. The standards are 
consistent with the AMA Report and address the national concerns about 
substance dependence.
    -Substance abuse. As proposed, substance abuse is one of the 
following:
    (1) Use of alcohol within the preceding 2 years in a situation in 
which that use is physically hazardous, if there has been at any other 
time an instance of the use of alcohol or another substance also in a 
situation in which that use was physically hazardous; or
    (2) Use of a substance other than alcohol within the preceding 5 
years in a situation in which that use is physically hazardous, if 
there has been at any other time an instance of the use of that 
substance, alcohol, or another substance also in a situation in which 
that use was physically hazardous; -
    (3) Use of a prohibited drug defined in appendix I of part 121 of 
this chapter within the preceding 5 years; or -
    (4) Misuse of a substance within the preceding 2 years if alcohol 
or within the preceding 5 years if another substance, that the Federal 
Air Surgeon based on case history and appropriate qualified medical 
judgment, finds-- -
    (i) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held 
or -
    (ii) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    Comments: Two AME's and other commenters generally support the 
proposed changes to the substance abuse standard. -
    The JAA states that the proposed recommendations are similar to 
those in the JAA proposals except that a shorter recertification period 
following alcohol abuse is allowed and the JAA Manual of Civil Aviation 
Medicine gives much more detailed interpretation of the psychiatric and 
psychological requirements. -
    EAA says the broad FAA list of ``substances,'' combined with the 
definition of ``abuse'' and the extremely vague issue of ``physical 
hazard'' makes it conceivable that abuse could be held as a single 
misapplication of prescription medication (e.g., amphetamines, 
tranquilizers, sedatives, and muscle relaxants).
    FAA Response: The FAA has decided to make the time periods related 
to substance abuse of alcohol or other substances 2 years to be 
consistent with substance dependence abstinence time requirements of 
this section and for the reasons already given. Otherwise the final 
rule is the same as proposed, except that Secs. 67.107(b)(2), 
67.207(b)(2), and 67.307(b)(2) are modified. Instead of prohibiting the 
``use of a prohibited drug defined in Appendix I of part 121,'' the 
final rule language reads ``A verified positive drug test result 
acquired under any anti-drug program or internal program of the U.S. 
Department of Transportation or any other Administration of the U.S. 
Department of Transportation.'' The modified language clarifies the 
FAA's intention in referencing Appendix I in the proposed rule. The FAA 
stated in the NPRM preamble that it considers a positive drug test 
conducted under any rule or internal program of the Department of 
Transportation to be compelling proof of the use of a prohibited drug 
for which the drug test was positive. -
    The changes are intended to provide specific regulatory medical 
standards and enhance the agency's ability to examine and exclude from 
aviation a person who, though not substance dependent, manifests 
recurrent abuse of alcohol or other legal or illegal substances, or has 
a single violation of DOT drug testing programs within the preceding 2 
years. These standards are consistent with the AMA Report and address 
national concerns about substance abuse. -
    In referring to use of a substance when ``physically hazardous,'' 
the standard generally refers to instances such as driving or flying 
while intoxicated or under the influence of alcohol or drugs, but could 
also refer to other physically hazardous situations that occurred while 
a person was under the influence of alcohol or legal or illegal drugs. 
This term is also used in DSM III and its successor DSM IV. The FAA, 
after careful consideration of the comments and presentations 
concerning

[[Page 11248]]
substance abuse as well as the petitions and comments received to 
Dockets Nos. 26281 and 26330, has determined that the rule as modified 
provides adequate notice to airmen of the required medical standards 
and is necessary to protect the public safety.

Neurological (Sections 67.109, 67.209, and 67.309) -

    The FAA proposed three changes to the neurological standards, 
adding ``a single seizure'' to the list of disqualifying conditions; 
using ``seizure'' rather than ``convulsive'' to describe potentially 
disqualifying conditions; and adding a ``transient loss of control of 
nervous system functions'' standard.
    Comments: ATA, AOPA, and three AME's assert that the proposed 
requirement that focuses on a single seizure is burdensome and not 
necessary; a single mild seizure should not be the sole cause for 
disqualification. ATA notes that a single febrile seizure during 
childhood, associated with a normal electroencephalogram (EEG), 
neurological examination, and imaging study, does not increase the risk 
for further seizure activity over time. EAA suggests rather than 
disqualifying applicants who have had seizures, AME's be given a 
checklist and evaluation guide for pilots with a history of a 
disturbance of consciousness or neurologic function. AOPA cites common 
causes of single seizure events including low sodium in the blood, heat 
exhaustion, head injury from which the applicant entirely recovers, and 
eclampsia during pregnancy. -
    One AME asserts that the frequency of in-flight incapacitation 
following seizure episodes is so low as to render this change 
unnecessary. According to the AME, febrile seizures are common, and the 
amount of increased paperwork to request special issuance of a medical 
certificate for individuals who have had these is simply not worth it. 
-
    USPA and AOPA say the neurological loss of control definition is 
too broad and is open to abuse and misinterpretation. -
    In response to the FAA's statement in the NPRM preamble that 
neither the AMA-recommended test nor the test by Folstein provides a 
``useful screening device, alone or in combination, for airman 
neurological status,'' the AMA emphasizes the extreme importance of a 
test of mental fitness in attempting to ensure aviation safety and 
strongly recommends that the FAA designate or develop a sensitive and 
more specific test of mental capacity if those proposed by the AMA 
report are unsatisfactory.
    FAA Response: The FAA, after careful consideration of all the 
comments and presentations received, has decided to withdraw the 
proposal that specifies that a single seizure is disqualifying. The 
proposed standard at paragraph (a)(2) will not be added to the first-, 
second-, or third-class medical certificate requirements. This part of 
the proposal is being withdrawn because the FAA agrees with commenters 
that a single febrile seizure in childhood should not in most instances 
be disqualifying. However, any seizure that has occurred must be 
reported by the applicant as part of the medical history and could be 
found to be disqualifying under the general neurological standards of 
Secs. 67.109(b), 67.209(b), and 67.309(b). Also, a single seizure that 
constitutes a disturbance of consciousness or a transient loss of 
control of nervous system function(s) without satisfactory medical 
explanation of the cause would be disqualifying under 
Secs. 67.109(a)(2) or (3), 67.209(a)(2) or (3), and 67.309(a)(2) or 3). 
Under Sec. 61.53, Operations during medical deficiency, such an 
occurrence would require an airman to cease exercising the privileges 
of any airman certificate held until medically evaluated and cleared 
for airman duties by the FAA. -
    The proposed change from ``convulsive disorder'' to ``seizure 
disorder'' at paragraph (b) remains in the final rule.-
    The FAA has determined that the addition of ``transient loss of 
control of nervous system functions'' should remain in the final rule. 
It clarifies the agency's aeromedical concern about such events whether 
or not they are characterized as disturbances of consciousness and 
allows for the identification and individual evaluation of persons with 
this history. -
    As to mental screening tests, neither the AMA report nor the 
American Academy of Neurology/American Association of Neurological 
Surgeons report proposes detailed, objective criteria and tests that 
could be included in the standards and by which medical certification 
could be determined. Neither the AMA-recommended test nor the Folstein 
test provides a useful screening device, alone or in combination, for 
airman neurological status. Also, neither screening test, alone or in 
combination, provides predictors of skills relevant to piloting.

Cardiovascular (Sections 67.111, 67.211, and 67.311) -

    List of Disqualifying Conditions. The proposed rule adds to the 
list of disqualifying cardiovascular conditions for first-, second-, 
and third-class airman medical certificates an established medical 
history of cardiac valve replacement, permanent cardiac pacemaker 
implantation, and heart replacement.
    Comments: None of the commenters specifically object to the 
disqualification for heart replacement. -
    Two associations, one AME, and several individuals do not support 
the proposal to specifically disqualify applicants with cardiac valve 
replacements or permanent cardiac pacemakers. One association states 
that the current list of disqualifying conditions is adequate. Many of 
these commenters say medical technology for valve replacements and 
pacemakers is excellent and improving, so it would be premature for the 
FAA to disqualify these heart conditions. -
    EAA says that for bioprosthetic cardiac valve patients with no 
signs of heart failure, arrhythmia, or atrial fibrillation, and with a 
normal functional capacity on stress testing, the FAA should not 
require the applicant to go through the special issuance process to 
obtain a medical certificate. According to the commenter, these 
individuals are at very low risk for sudden incapacitation and can 
perform normal activities including piloting an aircraft without undue 
risk. One AME believes that disqualifications for heart valve 
replacements should be evaluated on an individual basis. -
    EAA maintains that standby pacemakers or well-functioning permanent 
pacemakers should be allowed with a satisfactory cardiovascular 
evaluation and monitoring. Another commenter believes it is appropriate 
to deny pacemaker users first- and second-class medical certificates, 
but a pacemaker should not disqualify a person from a third-class 
medical certificate.
    FAA Response: The FAA, after careful consideration of the comments 
and presentations received as well as the petitions and comments 
received to Docket Nos. 22054 and 26156, has determined that 
disqualifying cardiovascular conditions remain in the final rule as 
proposed. Further, the FAA has determined that these are serious 
conditions that give rise to safety concerns in the aviation 
environment specifically with regard to valve failure, pacemaker 
malfunction, progression of the underlying disease that required

[[Page 11249]]
artificial cardiac pacing, organ rejection, or the complications of 
immunosuppression. As stated in the NPRM preamble, the FAA will 
continue to consider special issuance of medical certification on a 
case-by-case basis after specialized medical evaluations to confirm 
adequate recovery and function and the absence of significant risk in 
terms of the aviation environment. -
    These regulations clarify long-standing FAA policy. Previously, the 
FAA has denied medical certification to airmen with cardiac valve 
replacement, pacemaker implantation, or heart transplant under the 
current general medical standards. In the final rule, a medical history 
of cardiac valve replacement, pacemaker implantation, or heart 
transplant is disqualifying. A person with such a medical history, 
however, may apply for and possibly receive, a special issuance of a 
medical certificate. The FAA will continue to monitor medical 
technology in this area and will reassess these rules as developments 
warrant. -
    Blood Pressure (Proposed Secs. 67.111(b), 67.211(b), and 
67.311(b)). The proposed rule revises the blood pressure standards 
established in 1959 applicable to first-class medical certificates. The 
current table of age-related maximum blood pressure readings for 
applicants for first-class medical certificates and the reference to 
``circulatory efficiency'' are deleted, and a requirement that average 
blood pressure while sitting not exceed 150/95 millimeters of mercury 
is added for applicants of all classes. A medical assessment is 
specified for all applicants who need or use antihypertensive 
medication to control blood pressure.
    Comments: Four AME's support the proposed blood pressure standard, 
but one requests that the AME make some notation as to whether this is 
achieved by approved antihypertensive medication. JAA suggests further 
assessment of applicants whose blood pressure level is not 
``consistently 160/95'' or lower. -
    The Boeing Employees Soaring Club, ALPA, USPA, NATA, GAPA, NAAA, 
three AME's, and many individual commenters do not support the proposed 
blood pressure standard. They say that it would increase the cost of 
medical care, would require costly cardiovascular work-ups for people 
who would not otherwise require therapy, and is not supported by 
medical data or accident information. Many commenters and one AME do 
not support the proposal because, according to these commenters, blood 
pressure naturally increases with age. -
    ALPA and Boeing Employees Soaring Club say a blood pressure reading 
could be affected by many factors, including time of day, daily stress, 
or fear of a visit to their physician, and that the FAA should not have 
a set blood pressure level in the rule. -
    AOPA, EAA, and several commenters, including doctors, say that the 
FAA should not disqualify persons whose blood pressure is stabilized at 
a lower level with therapy. According to commenters, in the NPRM the 
FAA implies that treated hypertension is more of a risk than the 
condition of high blood pressure.
    FAA Response: After careful consideration of all the comments and 
testimony, the FAA has decided to eliminate specific blood pressure 
requirements in the final rule. For all classes, the final rule makes 
no specific reference to blood pressure but, rather, requires that the 
appropriate general medical standard in Secs. 67.113(b), 67.213(b), and 
67.313(b) be met.
    The FAA has determined that a blood pressure standard is 
unnecessary. Each person's medical condition and treatment regimen, if 
any, will continue to be evaluated on an individual basis. While the 
use of an antihypertensive medication is not made specifically 
disqualifying, a person may be required to undergo further medical 
assessment.
    Electrocardiograms (Proposed Sec. Sec. 67.111 (c) and (d) and 
67.211(d)); Final Sec. Sec. 67.111 (b) and (c)). The NPRM proposed to 
add a new requirement for routine resting electrocardiograms (ECG) for 
second-class medical certification. Applicants would have an ECG after 
reaching age 35 and every 2 years after reaching age 40. An ECG 
requirement currently exists for first-class applicants; however, 
first-class applicants must have an initial ECG after the 35th birthday 
and annually after reaching age 40. The NPRM did not propose to add an 
ECG requirement for third-class applicants. The NPRM also proposed to 
change the validity period for an ECG to meet the requirements of a 
medical examination. Currently, an ECG made within 90 days before a 
medical examination can be used to satisfy the first-class application 
requirement. The proposal was to change to this to 60 days.
    Comments: The AMA, ATA, JAA, and two AME's support the proposal.
    ASMA, NATA, NAAA, EAA, GAPA, and ALPA do not support the proposal 
to require ECG's for second-class applicants. National Business 
Aircraft Association (NBAA), ASMA, AOPA, and EAA cite the lack of 
cardiac incapacitation as a causal factor in aviation accidents. Many 
commenters, including doctors, do not support the requirement to 
administer ECG tests to asymptomatic persons. Six AME's say that the 
ECG does not predict sudden incapacitation.
    A majority of commenters stress the financial burden that ECG 
testing would create on those who need second-class medical 
certificates. According to commenters, the FAA's cost estimate for 
ECG's does not account for the cost to AME's of purchasing the 
equipment and modems to transmit the readings to the Civil Aeromedical 
Institute. The ECG test would also increase the amount of time an AME 
would spend on each pilot. AOPA notes that the FAA anticipates 1,800 
applicants will not meet ECG standards, and would have to undergo the 
cost of additional evaluation to determine eligibility for a medical 
certificate. AOPA also noted that the FAA's regulatory evaluation 
estimated that 90 percent of these applicants would ultimately be 
granted medical certificates. AOPA believes the ECG requirement and 
follow-up testing is a waste of time and money. The Soaring Society of 
America suggests that an applicant's regular medical facility could 
perform this test and certify it to the AME, which would prevent 
redundant tests and lower the cost and complexity of obtaining the 
second-class medical certificate.
    FAA Response: After careful consideration of the comments and 
testimony received, the FAA has decided to withdraw the proposal for an 
ECG requirement for second-class medical certification. There was 
limited support for the proposal within the medical community; and 
several aviation associations (including an aeromedical association), 
AME's, and individuals commented that the cost of implementing this 
proposal cannot be justified when compared with the current, limited-
prognostic capabilities of the routine resting ECG.
    The existing ECG requirement for first-class medical certification, 
an initial ECG after the 35th birthday and annual ECG's after reaching 
age 40, remains in the final rule. The change from 90 to 60 days for 
using an ECG to satisfy the first-class medical certification 
requirement also remains in the final rule. The FAA has determined that 
the ECG requirement for first-class medical certification, normally 
held by airline transport pilots, is consistent with the highest level 
of safety and is cost effective when coupled with the semi-annual 
examination required for that certificate. An airman holding a first-
class medical certificate receives the highest level of medical 
scrutiny (i.e., semi-annual

[[Page 11250]]
examination) because of the nature of his or her employment; the annual 
ECG is one element of this frequent, multi-factorial, medical 
surveillance.
    Most commercial ``commuter'' operations (e.g., passenger operations 
of a turbojet airplane, passenger operations of an airplane having a 
passenger seating configuration of 10 seats or more, or passenger 
operations of a multiengine airplane being operated by a commuter air 
carrier) require pilots to have first-class medical certificates. The 
remaining population of commercial pilots (e.g., pilots of commuter 
passenger operations with airplane passenger seating configuration of 9 
seats or less; flight instructors; pilots of crop dusting, banner 
towing, powerline, pipeline inspection operations) is required to hold 
a second-class medical certificate. As previously stated, the FAA has 
determined that biennial ECG's for these commercial pilots are not cost 
effective and that these pilots do not require the same level of 
medical scrutiny, given their employment, as pilots who are required to 
have a first-class medical certificate. The FAA, however, will continue 
to monitor and evaluate the medical/flying histories of those pilots 
required to have a second-class medical certficate and will, if 
appropriate, impose an ECG requirement in the future.
    Finally, the public should be aware that the FAA uses the ECG to 
evaluate the medical fitness of second-class medical certificate 
applicants when sound medical judgment indicates that the test would be 
reasonable and useful. The FAA routinely requests an ECG when an 
individual has or may have a medical history or clinical diagnosis of a 
variety of medical conditions, including cardiovascular disease, 
hypertension, dysrhythmia, diabetes, peripheral vascular disease, 
cerebral vascular disease, cardiomyopathy, valvular heart disease, 
congenital heart disease, or a previously abnormal ECG. The FAA will 
continue to use the ECG as a diagnostic tool in appropriate situations.
    Anticoagulant  medications  (Proposed  Secs. 67.111(c),  67.211(c), 
 and  67.311(c)).  The  proposed  rule  adds  the  provision that 
persons applying for first-, second-, or third-class medical 
certificates must not use anticoagulant medication.
    Comments: EAA, AOPA, two AME's, and several individuals state that 
the proposed rule is subject to interpretation and could, for example, 
include aspirin. The two AME's say that the FAA needs to differentiate 
between anticoagulant and antiplatelet medications regarding which are 
disqualifying. AOPA says disqualification should be based on the 
applicant's disease, not on the medicine taken, unless there are 
specific side effects that directly affect the safety of flight.
    EAA supports the prohibition of heparin. AOPA says coumadin use 
should not be disqualifying, since its track record is well 
established.
    FAA Response: The FAA did not intend for antiplatelet medications 
(e.g., aspirin) to be included as anticoagulants. After careful 
consideration of the comments and testimony received, the FAA has 
decided to withdraw the proposal to add anticoagulant use as a 
specifically disqualifying medication since the use of these 
medications could be found disqualifying in this final rule under 
paragraph (c) of the general medical condition section (see 
Secs. 67.113(c), 67.213(c), and 67.313(c)), of part 67.
Cholesterol Testing (Proposed Section 67.111(f))
    The current rule contains no cholesterol standards. The proposed 
rule adds a new total blood cholesterol testing requirement for first-
class applicants after they reach age 50, and annually thereafter. A 
blood cholesterol level of 300 milligrams per deciliter or more 
requires applicants to undergo further evaluation. If otherwise 
eligible, the applicant would be issued a medical certificate pending 
results of the evaluation.
    Comments: The vast majority of individual commenters, as well as 
NBAA, AOPA, ASMA, and EAA, do not support the proposed requirement for 
total blood cholesterol determination for first-class medical 
certification. AOPA, NATA, and ALPA say some individuals believe that 
the test is invasive and a personal health matter to be discussed with 
a private physician, not with the FAA. AOPA, EAA, two AME's, and 
several individuals say factors other than total cholesterol contribute 
to coronary artery disease. Since the AMA study, Allied Pilots 
Association (APA), EAA, two AME's and several others note, high density 
lipoprotein (HDL) and low density lipoprotein (LDL) have been found to 
better correlate with coronary artery disease (CAD) than total 
cholesterol.
    Nearly half of the AME commenters state that cholesterol testing is 
not needed because it does not predict an applicant's ability to 
perform safely. One AME notes that 50 percent of all myocardial 
infarctions occur in people with cholesterol ranging between 180 and 
220, levels well below the FAA's proposed evaluation threshold of 300. 
NBAA and APA say the link between incidence of high serum cholesterol 
and aircraft accidents caused by pilot incapacitation is tenuous at 
best. APA suggests that the FAA consider reviewing cardiovascular risk 
factors every 3-5 years to develop other, more appropriate measures of 
cardiovascular risk.
    FAA Response: After careful consideration of the comments and 
testimony received, the FAA has decided to withdraw the proposal to 
measure the total cholesterol of applicants for first-class medical 
certification. Several aviation associations, AME's, and individuals 
commented that there is no scientific evidence that demonstrates the 
relationship between a specific cholesterol value and the existence of 
identifiable pathology that represents a threat to aviation safety. 
Commenters pointed out that a different understanding exists today 
about total cholesterol level, per se, and pathology compared to when 
the data that supported the original proposal were compiled. 
Cholesterol testing, as proposed, is not cost effective. The FAA 
encourages airmen to have their lipid levels checked as a health 
measure but is not requiring airmen to do so in the final rule.
Diabetes (Sections 67.113(a), 67.213(a), and 67.313(a))
    No change is proposed to the standards concerning airmen with 
diabetes, currently set forth in paragraph (f)(1) of Secs. 67.13, 
67.15, and 67.17. In the preamble to the proposed rule, however, FAA 
states that it has determined that persons who do not meet the medical 
standard because their diabetes requires oral hypoglycemic drugs would 
no longer be categorically denied special issuance of airman medical 
certification. This policy would apply to individuals whose diabetes is 
without complications and acceptably controlled by diet and oral drugs 
with appropriate monitoring and other conditions. However, this policy 
change does not affect the long-standing FAA policy and practice that a 
diabetic using insulin for control is not eligible for unrestricted or 
restricted medical certification.
    Comments: Two AME's believe that insulin-dependent diabetics should 
not be allowed any type of pilot's license.
    USPA says insulin-dependent diabetics should be acceptable on a 
case-by-case basis. One commenter believes that diabetic private or 
recreational pilots should be certificated if their diabetes is under 
good control.
    EAA, two other AME's, and many individuals support permitting
    
[[Page 11251]]

noninsulin-dependent diabetics to obtain special issuance.
    A few commenters state that it is unrealistic to exclude all users 
of hypoglycemic drugs, as proposed in the NPRM. One diabetic noted that 
50 percent of men over 65 have ``Diabetes II,'' which does not require 
insulin or anything other than a mild drug.
    FAA Response: After careful consideration of the comments and 
testimony received as well as the petitions and comments received to 
docket Nos. 26281 and 26493, the FAA has determined that the current 
consensus of the medical community supports the FAA position. Many 
individuals who are not insulin-treated diabetics can, with appropriate 
monitoring and other conditions, receive a special issuance of their 
medical certificates to perform the duties authorized by their class of 
medical certificate without endangering public safety. The final rule 
is the same as the current rule.
    Also, the FAA has determined that, rather than engaging in 
rulemaking concerning diabetes, it is more appropriate to reexamine its 
policy on special issuance of medical certificates to persons with 
insulin-treated diabetes mellitus. On December 29, 1994, subsequent to 
publication of the NPRM, the Federal Air Surgeon requested comments on 
a possible policy change with respect to individuals who have a 
clinical diagnosis of insulin-treated diabetes mellitus (59 FR 67246, 
December 29, 1994). The docket for this notice closed on March 29, 
1995. The FAA will review the comments and testimony received in 
dockets Nos. 26493 and 27940 concerning diabetes and will publish in a 
separate notice the agency's determination concerning its policy on 
special issuance of medical certificates to persons with insulin-
treated diabetes mellitus.

Special Issuance (Section 67.401)

    Proposed Sec. 67.401(a) limits the duration of any medical 
certificate issued under the special issuance procedures of this 
section to the duration of an Authorization for special issuance. When 
the Authorization expires, or if the FAA withdraws the Authorization, 
the medical certificate issued pursuant to that Authorization also 
expires.
    Comments: AOPA and IPA say that the extra requirements for special 
issuance procedures should be withdrawn because they will increase the 
burden on FAA to write exceptions (especially in a time of government 
budget cutting and staff reductions), and because applicants will have 
to pay more and bet their livelihood with each reaffirmation request.
    FAA Response: The FAA, after careful consideration of all the 
comments and testimony received as well as the petitions and comments 
received to Docket No. 25787, has decided to retain the requirement 
limiting duration of any class medical certificate to the duration of 
an Authorization. This will ensure that the medical justification for 
the special issuance remains valid and the holder of the special 
issuance undergoes appropriate periodic reevaluation. This change 
explicitly connects the duration of any special issuance medical 
certificate to the validity of the document upon which it is based and 
requires periodic requests for reissuance. The FAA foresees no 
significant additional administrative burden on the FAA.
    The FAA has included specific requirements for an Authorization in 
the rule language in order to provide procedures for legal 
documentation and control of validity periods, followup requirements, 
withdrawals, and functional or operational limitations.

Incorrect Statements by Applicants (Sections 67.401(f)(5) and 
67.403(c))

    The proposed rule broadens the regulatory basis for action when an 
applicant or airman provides incorrect information when applying for 
medical certification. Proposed Secs. 67.401(f)(5) and 67.403(c) would 
allow the FAA the option of denying, suspending, or revoking an airman 
medical certificate and denying or withdrawing an Authorization or 
SODA, not only when the holder makes a fraudulent or intentionally 
false statement, but also when the holder makes an incorrect statement 
in support of a request for a medical certificate, an Authorization, or 
SODA or in an entry in any logbook, record, or report that is kept, 
made, or used to show compliance with the medical certificate, 
Authorization, or SODA. A suspension, revocation, or withdrawal could 
occur even if the person did not knowingly make the incorrect statement 
or entry.
    Comments: One AME supports the Authorization and SODA withdrawal 
proposals.
    EAA says the proposed Sec. 67.403(c) statement concerning 
unknowingly false statements should only call for a review of the 
medical certificate and possible revocation, if warranted by the 
corrected information. AOPA notes that the Federal Aviation Act says 
applicants denied issuance or renewal of a certificate may have an NTSB 
hearing.
    NATCA, IPA, APA, four AME's, and a large number of individual 
commenters are concerned about what they view as the lack of due 
process in the decision to withdraw the Authorization. According to 
these commenters, many innocent errors are made on the applications due 
to the applicant's unclear memory or misunderstanding of terms on the 
application. These commenters suggest that the FAA require the AME to 
contact the pilot and provide a chance to explain and correct the 
incorrect statements. Commenters say that the wording creates too 
ambiguous an authority for the FAA and creates the potential for action 
by the FAA against almost any pilot. Some associations are concerned 
that individuals whose applications or certificates are denied may 
actually lose their jobs without benefit of an opportunity to clarify 
unintentional discrepancies.
    FAA Response: The FAA noted in the preamble to the NPRM its concern 
that medical certification based on incorrect medical data may be 
inappropriate in the light of the true data. The current regulations do 
not explicitly provide for withdrawal of an Authorization or SODA or 
suspension or revocation of a medical certificate when unknowingly 
incorrect statements are relied upon in the FAA's decision to issue an 
Authorization, SODA, or medical certificate. The FAA's intent in 
including language on incorrect statements is to provide a basis for 
appropriate action when a person provides such unknowingly incorrect 
information that is relied on by the agency in its decision. The 
withdrawal, suspension, or revocation in this case is not meant to be 
punitive, but rather corrects the inappropriate granting of an 
Authorization, SODA, or medical certificate. The final rule clarifies 
the FAA's intent by including language in Sec. 67.403(c) that limits 
the reference to ``incorrect statements'' to those ``upon which the FAA 
relied.''

Return of Medical Certificate Sections 67.401(i)(4) and 67.415

    Proposed Sec. 67.401(i)(4) requires surrender to the Administrator 
of a medical certificate rendered invalid pursuant to a withdrawal in 
accordance with Sec. 67.401(a). The proposal also adds a requirement in 
Sec. 67.415 to specify that the holder of a medical certificate that is 
suspended or revoked must return the medical certificate to the 
Administrator.
    Comments: EAA says that presently airmen are not required to return 
their medical certificates without a hearing before the NTSB; 
procedures now exist for emergency suspension or revocation of a 
certificate based on false information. Therefore, EAA believes

[[Page 11252]]
there is no need for this requirement. Three AME's believe that the 
added requirement for mandatory return of a medical certificate at the 
request of the Administrator would open the whole process of medical 
certification to potential abuse by the FAA and should be deleted. 
Several individuals state that this provision is unnecessary and should 
be withdrawn; the current rules are sufficient to ensure that pilots 
fly only with a valid medical certificate.
    FAA Response: Current Sec. 67.27(g) provides that the holder of a 
medical certificate shall surrender it, upon request of the FAA, if its 
issuance is wholly or partly reversed upon reconsideration. After 
careful consideration of all the comments and testimony received, the 
FAA has determined that the language, as proposed, codifies existing 
practice, parallels the procedures with airman certificates, and 
clarifies the FAA's intent to require the return of medical 
certificates that have become invalid. The retention by an airman of an 
invalid medical certificate is not consistent with proper and efficient 
enforcement of safety regulations because of the apparent authority of 
these documents. Inclusion of this requirement, however, does not in 
any way affect the certificate holder's administrative review or appeal 
rights.

Regulatory Evaluation Summary

Introduction

    Changes to Federal regulations must undergo several economic 
analyses. First, Executive Order 12866 directs Federal agencies to 
promulgate new regulations or modify existing regulations only if the 
potential benefits to society justify its costs. Second, the Regulatory 
Flexibility Act of 1980 requires agencies to analyze the economic 
impact of regulatory changes on small entities. Finally, the Office of 
Management and Budget directs agencies to assess the effects of 
regulatory changes on international trade. In conducting these 
assessments, the FAA has determined that this rule: (1) Will generate 
benefits exceeding its costs and is not ``significant'' as defined in 
Executive Order 12866; (2) is not ``significant'' as defined in DOT's 
Policies and Procedures; (3) will not have a significant impact on a 
substantial number of small entities; and (4) will not constitute a 
barrier to international trade. These analyses, available in the 
docket, are summarized below.
    The majority of the amendments will have insignificant attributable 
costs and benefits. This evaluation does not address the minor 
amendments such as changes in syntax, technical corrections, 
reorganization, updating medical terminology, or adjustments to cross 
references for conformance purposes.
    Furthermore, the evaluation attributes no significant costs or 
benefits to several other amendments that add a specific disease or 
medical condition to the list of medical standards. Such additions do 
not necessarily constitute a change in the standards. Existing 
regulations include three open-ended (general) medical standards that 
cover:

    (1) any other personality disorder, neurosis, or mental 
condition * * *, (2) any other organic, functional, or structural 
disease, defect, or limitation * * *, and (3) no medication or other 
treatment * * *.

that the Federal Air Surgeon finds would make, or may reasonably be 
expected to make, the applicant unable to perform the duties associated 
with the airman certificate. Thus, the applicable medical standards are 
not limited to those actually listed in the regulation. As medical 
knowledge and experience progress, the Federal Air Surgeon may find a 
previously unlisted disease or condition to be grounds for withholding 
or restricting a medical certificate, so long as that finding is based 
on qualified medical judgment.
    The addition of specifically disqualifying medical conditions under 
the amended standards could cause a small number of airmen, who 
currently hold medical certificates as a result of an order of the 
National Transportation Safety Board (NTSB) to be disqualified from 
further medical certification. These airmen were denied medical 
certification by the FAA under the current general medical standards. 
For example, the FAA has denied medical certification to airmen who 
have had cardiac valve replacement and the NTSB has ordered medical 
certification in some of these cases. Under the amended standards a 
medical history of cardiac valve replacement is specifically 
disqualifying and those airmen will no longer be entitled to medical 
certification. It is expected, however, that medical certification of 
the affected individuals will continue under the Federal Air Surgeon's 
special issuance authority once the FAA evaluates the case and is 
satisfied that the airman's condition has not worsened since the NTSB 
ordered medical certification. As such, the expected economic impact of 
the specifically disqualifying medical conditions will be minor.

Discussion of Comments Addressing Economic Evaluation

    This section of the summary responds to comments concerning the 
economic evaluation of the NPRM. The NPRM for this rule included five 
significant proposals that were withdrawn after careful consideration 
of the comments received. This section notes, but does not address 
comments concerning the regulatory evaluation of the withdrawn 
proposals, since such comments are no longer pertinent.
    Comment: The U.S. Small Business Administration (SBA) states in it 
comment that the FAA's regulatory flexibility analysis for the NPRM 
does not conform to the Regulatory Flexibility Act (RFA), and that a 
proper regulatory flexibility analysis must be performed prior to 
issuing a final rule.
    FAA Response: The FAA does not agree. Federal agencies are required 
to prepare a regulatory flexibility analysis only if the proposed rule 
would have a significant economic impact on a substantial number of 
small entities.\1\ The NPRM would not have had such impact and this was 
stated. The SBA also notes that no explanation was provided to support 
that determination. The FAA agrees and provides the following table of 
explanation.

    \1\ A Guide to Federal Agency Rulemaking, 2nd edition, 
Administrative Conference of the United States; 1991; p. 162.

[[Page 11253]]


----------------------------------------------------------------------------------------------------------------
                                                                                                       Average  
                                                                             NPRM                      cost per 
            Medical certification category               NPRM 10-year     annualized       Active      year per 
                                                         present value       costs         airmen       active  
                                                                                                        airman  
----------------------------------------------------------------------------------------------------------------
First-class...........................................      $5,700,000        $811,551      147,676        $5.50
Second-class..........................................      22,700,000       3,231,969      173,435        18.64
Third-class...........................................       5,600,000         797,314      325,996         2.45
----------------------------------------------------------------------------------------------------------------

    As shown above, the average annualized cost impact of the proposed 
rule would have ranged from $2.45 to $18.64 per person subject to 
medical certification requirements. It would be statistically 
impossible for the impact of the proposed rule to exceed these averages 
to such an extent as to have a significant impact (multiple thousands 
of dollars annually depending on the entity type) on a substantial 
number (at least one-third) of small entities; even if the rule only 
affected small entities. Similarly, since the costs of the final rule 
are approximately 20 percent of the NPRM costs, it follows that the 
final rule also will not have a significant economic impact on a 
substantial number of small entities.
    Comments: Several associations and numerous individual commenters 
find it illogical to draw inferences for pilots from the air traffic 
controllers who were monitored in the Johns Hopkins study. The reasons 
cited by the commenters include air traffic control (ATC) work is 
inherently stressful, ATC work is sedentary, controllers are exposed to 
cathode ray tube monitors and indoor air, controllers have a history of 
strife between labor and management, and they work on varying shifts.
    FAA Response: The FAA disagrees. The Hopkins study was expressly 
used to quantify the relative differences of primary pathology 
incidence across age cohorts. The Hopkins results are conclusively 
supported by other general medical investigation as well as the FAA's 
own medical certification data for pathology incidence and application 
denials.
    Comments: Four national aviation associations strongly disagree 
with the NPRM proposal to reduce the duration of third-class medical 
certificates for persons age 70 and older. The commenters assert that 
the benefits have not been demonstrated and that the statistical 
analysis FAA used to confirm that the incidence of pathology related 
accidents increases with age is supported by an insufficient sample 
size.
    FAA Response: After careful consideration of the testimony and 
comments received, the FAA has withdrawn this proposed provision.
    Comments: Numerous individual commenters stated that the proposed 
higher standards for blood pressure would prove costly to pilots with 
borderline pressure measurements and that the affected individuals 
would be required to take extensive additional testing.
    FAA Response: After careful consideration of the testimony and 
comments received, the FAA has withdrawn this proposed provision.
    Comments: Six major associations disagree with the provision for 
electrocardiograms, second class and assert that the frequency of 
medically related aviation accidents, the majority of which are not 
predictable, does not support the administrative and economic burdens 
that would be imposed on the affected applicants. Two associations 
assert that the 40-percent effectiveness level that was assumed in the 
evaluation is questionable and is a significant error in the cost-
benefit analysis. Five associations, two AME's, and numerous individual 
commenters state that the FAA's cost estimate does not account for the 
cost for AME's to purchase the necessary medical equipment and modems. 
They warn that some AME's may withdraw their participation rather than 
incur the additional costs.
    FAA Response: After careful consideration of the testimony and 
comments received, the FAA has withdrawn this proposed provision.
    Comments: Several associations assert that requiring a cholesterol 
test would be a significant administrative and cost burden. One 
association stated that the regulatory evaluation employed an average 
laboratory test cost of $10, but that costs range between $15 and $16 
in the Washington, D.C. area. One individual commenter asserts that the 
cost-benefit analysis is flawed because it based cost savings on a 
cholesterol level lower than 300, and because the analysis assumed that 
all heart attacks studied represented individuals with critically high 
cholesterol.
    FAA Response: After careful consideration of the testimony and 
comments received, the FAA has withdrawn this proposed provision.
    Comments: One major association states that the addition of the 
intermediate vision, first and second class is unnecessary and 
unwarranted, and that it would add costs with no significant safety 
benefit.
    FAA Response: The FAA does not agree. The evaluation estimated that 
the direct testing costs, including applicant time, would range from 
$1.30 to $3.86 per year per applicant age 50 and older. Additional 
costs (for glasses and examinations) would only be incurred by those 
persons whose intermediate vision was, in fact, deficient, and who 
could not satisfactorily read their flight instruments. The FAA 
maintains that these costs are not unreasonable, and that the benefits 
of commercial pilots being able to read flight instruments are 
conclusive.

Costs and Benefits That Are Not Quantified

    Prior to summarizing the evaluation of the substantive provisions, 
it is important to note one category of costs and one category of 
benefits that have not been quantified in this analysis. The evaluation 
does not explicitly quantify the economic consequences to those 
individuals who could lose their pilot medical certificate privileges 
as a result of the additional medical tests or standards. Where such 
consequences are expected, the evaluation estimates the numbers of 
persons who may be denied but does not attribute a cost to those 
actions.
    -It is recognized that the denial of pilot privileges could mean 
the loss of a highly valued avocation for some individuals. For others, 
it could actually result in the loss of primary livelihood. An accurate 
assessment of the economic valuation of the denials that are projected 
under the rule is beyond the scope of the evaluation.
    -At the same time, the evaluation also does not quantify the 
overwhelming personal health benefits, external to flight safety, that 
will be afforded to those individuals whose medical conditions will be 
detected and whose treatment will be enabled by the new tests and 
standards. On average, third-class medical certificate holders spend 
only 0.7 percent of their time flying. The evaluation only quantifies 
the direct benefits of the rule to reduced aviation accidents.

[[Page 11254]]

    -Under existing regulations, the Federal Air Surgeon is charged to 
deny a medical certificate in those cases where a disease or other 
physical or mental condition would make, or may be reasonably be 
expected to make, the applicant unable to perform the duties associated 
with the medical certificate. Such findings are not capricious, but 
instead, are based on the case history of the individual and on 
appropriate, qualified medical judgment. The FAA holds that the 
severity of a disease or medical condition necessary to warrant a 
denial is such that the aviation safety and personal health benefits of 
that action will always exceed the costs associated with the loss of 
pilot privilege.

Summary of Quantified Costs and Benefits

    Vision Amendments, All Classes. The final rule institutes 
additional vision tests and standards for all three classes. For first- 
and second-class medical certificate applicants age 50 and older, it 
adds a new standard (20/40 or better, Snellen equivalent) and a new 
test for intermediate vision (near vision at 32 inches). Applicants for 
third-class medical certificates will be subject to a new standard (20/
40 or better) and a new test for near vision (16 inches).
    The projected 10-year costs of the intermediate vision amendment 
for first-class medical certificate applicants are: (1) $1.4 million in 
primary testing costs, (2) $2.1 million in follow-up compliance costs 
(examinations and glasses) for those persons who would not meet the 
standard, and (3) $6,147 in direct processing costs for the expected 15 
additional persons who could be denied under the provision. In total, 
it is expected that the intermediate vision amendment for first-class 
medical certificate applicants would impose an incremental 10-year cost 
of $3.5 million, with a 1995 present value of $2.5 million.
    The projected 10-year costs of the intermediate vision amendment 
for second-class medical certificate applicants are: (1) $442,224 in 
primary testing costs, (2) $2.0 million in follow-up compliance costs 
(examinations and glasses) for those persons who would not meet the 
standard, and (3) $6,626 in direct processing costs for the expected 17 
additional persons who would be denied under the provision. In total, 
it is expected that the intermediate vision amendment for second-class 
medical certificate applicants would impose an incremental 10-year cost 
of $2.4 million, with a 1995 present value of $1.7 million.
    The projected 10-year costs of the near vision amendment for third-
class medical certificate applicants are: (1) $2.3 million in primary 
testing costs, (2) $1.1 million in follow-up compliance costs 
(examinations and glasses) for those persons who would not meet the 
standard, and (3) $129,690 in direct processing costs for the expected 
330 additional persons who would be denied under the provision. In 
total, it is expected that the near vision amendment for third-class 
medical certificate applicants would impose an incremental 10-year cost 
of $3.5 million, with a 1995 present value of $2.5 million. It is 
emphasized that the denials and costs associated with the near vision 
requirement are not wholly attributable to the amendment. Although this 
requirement does not exist in current regulations, the requirement has 
been in place administratively for some time. Thus, the associated 
costs are being and would continue to be incurred without this 
amendment. The economic evaluation of this requirement is provided as 
information to assess the fact the requirement would explicitly be 
added to the regulations.
    In assessing the benefits of the vision amendments, NTSB accident 
records were investigated for the periods from 1962 through 1989 for 
commercial flights and from 1982 through 1989 for general aviation. For 
these periods, no accident was found where intermediate or near vision 
deficiency was specifically determined to be the cause. As such, the 
FAA is not able to quantitatively ascribe the benefits of the three 
vision amendments based solely on historical accident analysis.
    Notwithstanding the absence of documented accidents related to 
these three provisions, the FAA maintains that such accidents may well 
have occurred and would continue to occur in the absence of the 
amendments. The NTSB accident analysis system may not document those 
cases where a near or intermediate vision problem caused or contributed 
to accidents. Examples would include deviations from course or 
altitude, inaccurate monitoring of gauges and other avionics displays, 
and incorrect setting of aeronautical parameters such as headings or 
radio frequencies.
    While the extent to which intermediate or near vision problems have 
caused such accidents is unknown, it is the FAA's position that: (1) 
general aviation pilots require adequate near vision to read charts and 
checklists, and (2) commercial pilots require adequate intermediate 
vision to properly monitor aircraft instruments. Although this 
evaluation is not able to quantify the benefits of the vision 
amendments, the FAA holds that the benefits will be significant and 
will exceed the expected costs.
    Part 61, Medical Certificate Validity Period, Third-Class. Under 
the final rule, persons under age 40 will generally only be required to 
undergo a physical examination every 3 years. Medical certificates for 
persons age 40 and older will continue to be valid for 2 years.
    Other than minor administrative costs to effect the new procedure, 
there will be no direct expenditures associated with the amendment. In 
addition, careful consideration of all comments and testimony received, 
as well as the petitions and comments received to Docket Nos. 24932, 
26281, and 27473, leads the FAA to conclude that extending the duration 
between medical examinations can be done with no detriment to safety in 
the case of younger airmen, who are much less likely to suffer medical 
incapacitation.
    The FAA has investigated the relative primary pathology incidence 
rates for persons under and over 40 years of age. As a group, persons 
under age 40 exhibit 1/27 of the pathology incidence rate of persons 40 
and older. Even weighting these rates, by the numbers of pilots by age 
class, results in an ``under age 40'' incidence equal to 1/6 that of 
third-class medical certificate applicants age 40 and older.
    The FAA's position on this issue is further supported by a review 
of the pertinent accident data. National Transportation Safety Board 
(NTSB) data were reviewed for the period 1982 through 1989. During that 
period, 259 pathology related, general aviation accidents occurred. 
Only two of those accidents, however, involved private pilots under age 
40 with a potentially detectable primary pathology. One case involved a 
37-year-old pilot with a valid medical certificate who suffered a heart 
attack that had not been predicted. The second accident involved a 25-
year-old with a vasovagal syncope who was flying without a medical 
certificate.
    As with all age groups, those individuals under age 40 manifesting 
conditions that represent a risk to safety will be denied medical 
certification or, if they apply for and receive a special issuance of a 
medical certificate, will be restricted in their flying activities and/
or examined more thoroughly and frequently.
    The primary benefits of this amended provision will derive from the 
annual reduction in third-class medical certificate applications. FAA 
compared the projected numbers of applications

[[Page 11255]]
under the existing 2 year duration for all ages, against the 
applications that are expected under the final rule provision extending 
the duration for persons under age 40 to 3 years. Applications under 
the final rule were computed by reducing the projected applications for 
persons under age 40 by a factor of two-thirds. Over the 10-year study 
period, the part 61 provision is expected to reduce applications by 
268,000.
    Each avoided examination is valued at $89, consisting of $50 in 
direct testing costs, and one and one-half hours of the applicant's 
time valued at $29 per hour. This produces an expected 10-year savings 
of $23.9 million, with a 1995 present value of $16.7 million, not 
counting FAA processing costs

Regulatory Flexibility Determination

    The Regulatory Flexibility Act of 1980 (RFA) was enacted by 
Congress to ensure that small entities are not unnecessarily or 
disproportionately burdened by Government regulations. The RFA requires 
a Regulatory Flexibility Analysis if a rule would have a significant 
economic impact, either detrimental or beneficial, on a substantial 
number of small entities. FAA Order 2100.14A, Regulatory Flexibility 
Criteria and Guidance, provides threshold cost and small entity size 
standards for complying with RFA review requirements in FAA rulemaking 
actions.
    The rule is estimated to have a 10 year, 1995 present value cost of 
$6.6 million, which equates to an annualized cost of $940,000 to the 
approximately 647,100 active airmen. The average annualized effect per 
airman is projected to equal $1.45. In light of this information, the 
FAA finds that the amendment will not have a significant economic 
impact on a substantial number of small entities.

International Trade Impact Assessment

    The final rule will have little or no impact on trade for both U.S. 
firms doing business in foreign countries and foreign firms doing 
business in the United States.

Federalism Implications

    The regulations herein would not have substantial direct effects on 
the states, on the relationship between the national government and the 
states, or on the distribution of power and responsibilities among the 
various levels of government. Therefore, in accordance with Executive 
Order 12866, it is determined that this rule does not have sufficient 
federalism implications to warrant the preparation of a Federalism 
Assessment.

Conclusion

    For the reasons discussed in the preamble, and based on the 
findings in the Regulatory Evaluation and the International Trade 
Impact Analysis, the FAA has determined that this rule is not major 
under Executive Order 12866. In addition, the FAA certifies that this 
rule will not have a significant economic impact, positive or negative, 
on a substantial number of small entities under the criteria of the 
Regulatory Flexibility Act. This rule is considered significant under 
DOT Regulatory Policies and Procedures (44 FR 11034; February 26, 
1979). A regulatory evaluation of the rule, including a Regulatory 
Flexibility Determination and Trade Impact Analysis, has been placed in 
the docket. A copy may be obtained by contacting the person identified 
under FOR FURTHER INFORMATION CONTACT.

Paperwork Reduction Act

    The paperwork burden associated with part 67 is currently approved 
under OMB number 2120-0034. There is small reduction in paperwork 
associated with this final rule.

Derivation and Distribution Tables

    The Derivation Table below shows the source in current part 67 on 
which each paragraph of each section of revised part 67 is based. The 
Distribution Table below shows where each current part 67 section and 
paragraph can be found in the revised part 67.

                            Derivation Table                            
                                                                        
           Revised section                          Based On            
                                                                        
                                                                        
                                Subpart A                               
Section                                                                 
  67.1...............................  Current Secs.  67.1 and 67.21.   
  67.3...............................  Current Sec.  67.11.             
  67.5...............................  Current Sec.  67.12.             
  67.7...............................  Current Sec.  67.3.              
                                                                        
                                Subpart B                               
Section                                                                 
  67.101.............................  Current Sec.  67.13(a) and new   
                                        language.                       
  67.103(a)..........................  Current Sec.  67.13(b)(1).       
  67.103(b)..........................  Current Sec.  67.13(b)(2) and new
                                        language.                       
  67.103(c)..........................  Current Sec.  67.13(b)(3) and new
                                        language.                       
  67.103(d)..........................  Current Sec.  67.13(b)(4).       
  67.103(e)..........................  Current Sec.  67.13(b)(5).       
  67.103(f)..........................  Current Sec.  67.13(b)(6) and    
                                        flush paragraph.                
  67.105(a)..........................  Current Sec.  67.13(c)(1) and new
                                        language.                       
  67.105(b)..........................  Current Sec.  67.13(c)(2),       
                                        (c)(3), (c)(4), (c)(5), and new 
                                        language.                       
  67.105(c)..........................  Current Sec.  67.13(c)(6) and new
                                        language.                       
  67.107(a)..........................  Current Sec.  67.13(d)(1)(i) and 
                                        new language.                   
  67.107(b)..........................  New language.                    
  67.107(c)..........................  Current Sec.  67.13(d)(1)(ii)    
                                        reordered.                      
  67.109(a)..........................  Current Sec.  67.13(d)(2)(i) and 
                                        new language.                   
  67.109(b)..........................  Current Sec.  67.13(d)(2)(ii).   
  67.111(a)..........................  Current Sec.  67.13(e)(1) and new
                                        language.                       
  67.111(b)..........................  Current Sec.  67.13(e)(2) and (3)
                                        and new language.               
  67.111(c)..........................  Flush paragraph after current    
                                        Sec.  67.13(e)(5) as modified.  
  67.113(a)..........................  Current Sec.  67.13(f)(1).       
  67.113(b)..........................  Current Sec.  67.13(f)(2).       
  67.113(c)..........................  Current Sec.  67.13(f)(3), added 
                                        September 9, 1994.              
  67.115.............................  Current Sec.  67.13(g).          
                                                                        
                                Subpart C                               
Section                                                                 
  67.201.............................  Current Sec.  67.15(a) and new   
                                        language.                       
  67.203(a)..........................  Current Sec.  67.15(b)(1).       
  67.203(b)..........................  Current Sec.  67.15(b)(2) and new
                                        language.                       
  67.203(c)..........................  Current Sec.  67.15(b)(5) and new
                                        language.                       
  67.203(d)..........................  Current Sec.  67.15(b)(3).       
  67.203(e)..........................  Current Sec.  67.15(b)(4) and new
                                        language.                       
  67.203(f)..........................  Current Sec.  67.15(b)(6) and    
                                        flush paragraph.                
  67.205(a)..........................  Current Sec.  67.15(c)(1) and new
                                        language.                       
  67.205(b)..........................  Current Sec.  67.15(c)(2),       
                                        (c)(3), (c)(4), (c)(5), and new 
                                        language.                       
  67.205(c)..........................  Current Sec.  67.15(c)(6) and new
                                        language.                       
  67.207(a)..........................  Current Sec.  67.15(d)(1)(i) and 
                                        new language.                   
  67.207(b)..........................  New language.                    
  67.207(c)..........................  Current Sec.  67.15(d)(1)(ii)    
                                        reordered.                      
  67.209(a)..........................  Current Sec.  67.15(d)(2)(i) and 
                                        new language.                   
  67.209(b)..........................  Current Sec.  67.15(d)(2)(ii) and
                                        new language.                   
  67.211.............................  Current Sec.  67.15(e)(1) and new
                                        language.                       
  67.213(a)..........................  Current Sec.  67.15(f)(1).       
  67.213(b)..........................  Current Sec.  67.15(f)(2).       
  67.213(c)..........................  Current Sec.  67.15(f)(3), added 
                                        September 9, 1994.              
  67.215.............................  Current Sec.  67.15(g).          
                                                                        
                                Subpart D                               
Section                                                                 
  67.301.............................  Current Sec.  67.17(a) and new   
                                        language.                       
  67.303(a)..........................  Current Sec.  67.17(b)(1) and new
                                        language.                       
  67.303(b)..........................  New language.                    
  67.303(c)..........................  Current Sec.  67.17(b)(3) and new
                                        language.                       
  67.303(d)..........................  Current Sec.  67.17(b)(2) and new
                                        language.                       
  67.305(a)..........................  Current Sec.  67.17(c)(1) and new
                                        language.                       
  67.305(b)..........................  Current Sec.  67.17(c)(2) and    
                                        (3), and new language.          
  67.305(c)..........................  Current Sec.  67.17(c)(4) and new
                                        language.                       
  67.307(a)..........................  Current Sec.  67.17(d)(1)(i) and 
                                        new language.                   
  67.307(b)..........................  New language.                    
  67.307(c)..........................  Current Sec.  67.17(d)(1)(ii)    
                                        reordered.                      
  67.309(a)..........................  Current Sec.  67.17(d)(2)(i) and 
                                        new language.                   
  67.309(b)..........................  Current Sec.  67.17(d)(2)(ii) and
                                        new language.                   

[[Page 11256]]
                                                                        
  67.311.............................  Current Sec.  67.17(e)(1) and new
                                        language.                       
  67.313(a)..........................  Current Sec.  67.17(f)(1).       
  67.313(b)..........................  Current Sec.  67.17(f)(2).       
  67.313(c)..........................  Current Sec.  67.17(f)(3), added 
                                        September 9, 1994.              
  67.315.............................  Current Sec.  67.17(g).          
                                                                        
                                Subpart E                               
Section                                                                 
  67.401(a)..........................  Current Sec.  67.19(a) and new   
                                        language.                       
  67.401(b)..........................  New language.                    
  67.401(c)..........................  Current Sec.  67.19(b).          
  67.401(d)..........................  Current Sec.  67.19(d) and new   
                                        language.                       
  67.401(e)..........................  Current Sec.  67.19(c).          
  67.401(f)..........................  New language.                    
  67.401(g)..........................  Current Sec.  67.19(e) and new   
                                        language.                       
  67.401(h)..........................  Current Sec.  67.19(f) and new   
                                        language.                       
  67.401(i)..........................  New language.                    
  67.401(j)..........................  New language.                    
  67.403(a)..........................  Current Sec.  67.20(a) and new   
                                        language.                       
  67.403(b)..........................  Current Sec.  67.20(b) and new   
                                        language.                       
  67.403(c)..........................  New language.                    
  67.405(a)..........................  Current Sec.  67.23(a).          
  67.405(b)..........................  Current Sec.  67.23(b).          
  67.407(a)..........................  Current Sec.  67.25(a) and new   
                                        language.                       
  67.407(b)..........................  Current Sec.  67.25(a) flush     
                                        paragraph and new language.     
  67.407(c)..........................  Current Sec.  67.25(b), as       
                                        amended September 9, 1994, and  
                                        new language.                   
  67.407(d)..........................  Current Sec.  67.25(c).          
  67.409(a)..........................  Current Sec.  67.27(a).          
  67.409(b)..........................  Current Sec.  67.27(b), as       
                                        amended September 9, 1994.      
  67.409(c)..........................  Current Sec.  67.27(c).          
  67.409(d)..........................  Current Sec.  67.27(d).          
  67.411(a)..........................  Current Sec.  67.29(a).          
  67.411(b)..........................  Current Sec.  67.29(b).          
  67.411(c)..........................  Current Sec.  67.29(c).          
  67.413(a)..........................  Current Sec.  67.31.             
  67.413(b)..........................  New language.                    
  67.415.............................  New language.                    
                                                                        



                           Distribution Table                           
                                                                        
           Current Section                      Revised Section         
                                                                        
                                                                        
                                Subpart A                               
Section                                                                 
  67.1...............................  Sec.  67.1.                      
  67.3...............................  Sec.  67.7.                      
  67.11..............................  Sec.  67.3.                      
  67.12..............................  Sec.  67.5.                      
  67.13(a)...........................  Sec.  67.101.                    
  67.13(b)...........................  Sec.  67.103.                    
  67.13(c)...........................  Sec.  67.105.                    
  67.13(d)...........................  Sec.  67.107 and Sec.  67.109.   
  67.13(e)...........................  Sec.  67.111 and Sec.  67.113(b).
  67.13(f)...........................  Sec.  67.113.                    
  67.13(g)...........................  Sec.  67.115.                    
  67.15(a)...........................  Sec.  67.201.                    
  67.15(b)...........................  Sec.  67.203.                    
  67.15(c)...........................  Sec.  67.205.                    
  67.15(d)...........................  Sec.  67.207 and Sec.  67.209.   
  67.15(e)...........................  Sec.  67.211.                    
  67.15(f)...........................  Sec.  67.213.                    
  67.15(g)...........................  Sec.  67.215.                    
  67.17(a)...........................  Sec.  67.301.                    
  67.17(b)...........................  Sec.  67.303.                    
  67.17(c)...........................  Sec.  67.305.                    
  67.17(d)...........................  Sec.  67.307 and Sec.  67.309.   
  67.17(e)...........................  Sec.  67.311.                    
  67.17(f)...........................  Sec.  67.313.                    
  67.17(g)...........................  Sec.  67.315.                    
  67.19..............................  Sec.  67.401.                    
  67.20..............................  Sec.  67.403.                    
                                                                        
                                Subpart B                               
Section                                                                 
  67.21..............................  Sec.  67.1.                      
  67.23..............................  Sec.  67.405.                    
  67.25..............................  Sec.  67.407.                    
  67.27..............................  Sec.  67.409.                    
  67.29..............................  Sec.  67.411.                    
  67.31..............................  Sec.  67.413.                    
                                                                        

List of Subjects

14 CFR Part 61

    Aircraft, Airmen, Alcohol abuse, Drug abuse, Recreation and 
recreation areas, Reporting and recordkeeping requirements.

14 CFR Part 67

    Airmen, Delegations of authority (Government agencies), Health, 
Medical standards and certification procedures, Reporting and 
recordkeeping requirements.

The Amendments

    In consideration of the foregoing, the Federal Aviation 
Administration amends parts 61 and 67 of Title 14 Code of Federal 
Regulations (14 CFR parts 61 and 67) as follows:

PART 61--CERTIFICATION: PILOTS AND FLIGHT INSTRUCTORS

    1. The authority citation for part 61 continues to read as follows:

    Authority: 49 U.S.C. 106(g), 40113, 44701-44703, 44707, 44709-
44711, 45102-45103, 45301-45302.

    2. Section 61.23 is amended by revising paragraphs (a)(3), (b)(2), 
and (c) to read as follows:


Sec. 61.23  Duration of medical certificates.

    (a)-* * *
    (3) The period specified in paragraph (c) of this section for 
operations requiring only a private, recreational, or student pilot 
certificate.
    (b)-* * *
    (2) The period specified in paragraph (c) of this section for 
operations requiring only a private, recreational, or student pilot 
certificate.
    (c) A third-class medical certificate for operations requiring a 
private, recreational, or student pilot certificate issued--
    (1) Before September 16, 1996, expires at the end of the 24th month 
after the month of the date of examination shown on the certificate.
    (2) On or after September 16, 1996, expires at the end of the:
    (i) 36th month after the month of the date of the examination shown 
on the certificate if the person has not reached his or her 40th 
birthday on or before the date of the examination; or
    (ii) 24th month after the month of the date of the examination 
shown on the certificate if the person has reached his or her 40th 
birthday on or before the date of the examination.
    3. Section 61.39 is amended by revising paragraph (a)(3) to read as 
follows:


Sec. 61.39  Prerequisites for flight tests.

    (a)-* * *
    (3) Hold a current medical certificate appropriate to the 
certificate the applicant seeks or, in the case of a rating to be added 
to the applicant's pilot certificate, at least a current third-class 
medical certificate issued under part 67 of this chapter;
* * * * *
    4. Part 67 is revised to read as follows:

PART 67--MEDICAL STANDARDS AND CERTIFICATION

Subpart A--General

Sec.
67.1  Applicability.
67.3  Issue.
67.5  Certification of foreign airmen.
67.7  Access to the National Driver Register.

Subpart B--First-Class Airman Medical Certificate

67.101  Eligibility.
67.103  Eye.
67.105  Ear, nose, throat, and equilibrium.
67.107  Mental.
67.109  Neurologic.
67.111  Cardiovascular.
67.113  General medical condition.
67.115  Discretionary issuance.

Subpart C--Second-Class Airman Medical Certificate

67.201  Eligibility.
67.203  Eye.
67.205  Ear, nose, throat, and equilibrium.
67.207  Mental.
67.209  Neurologic.
67.211  Cardiovascular.
67.213  General medical condition.
67.215  Discretionary issuance.

Subpart D--Third-Class Airman Medical Certificate

67.301  Eligibility.
67.303  Eye.
67.305  Ear, nose, throat, and equilibrium.
67.307  Mental.
67.309  Neurologic.
67.311  Cardiovascular.
67.313  General medical condition.
67.315  Discretionary issuance.

[[Page 11257]]


Subpart E--Certification Procedures

67.401  Special issuance of medical certificates.
67.403  Applications, certificates, logbooks, reports, and - 
records: Falsification, reproduction, or alteration; incorrect 
statements.
67.405  Medical examinations: Who may give.
67.407  Delegation of authority.
67.409  Denial of medical certificate.
67.411  Medical certificates by flight surgeons of Armed Forces.
67.413  Medical records.
67.415  Return of medical certificate after suspension or 
revocation.

    Authority: 49 U.S.C. 106(g), 40113, 44701-44703, 44707, 44709-
44711, 45102-45103, 45301-45303.

Subpart A--General


Sec. 67.1  Applicability. -

    This part prescribes the medical standards and certification 
procedures for issuing medical certificates for airmen and for 
remaining eligible for a medical certificate.


Sec. 67.3  Issue. -

    Except as provided in Sec. 67.5, a person who meets the medical 
standards prescribed in this part, based on medical examination and 
evaluation of the person's history and condition, is entitled to an 
appropriate medical certificate.


Sec. 67.5  Certification of foreign airmen. -

    A person who is neither a United States citizen nor a resident 
alien is issued a certificate under this part, outside the United 
States, only when the Administrator finds that the certificate is 
needed for operation of a U.S.-registered aircraft.


Sec. 67.7  Access to the National Driver Register. -

    At the time of application for a certificate issued under this 
part, each person who applies for a medical certificate shall execute 
an express consent form authorizing the Administrator to request the 
chief driver licensing official of any state designated by the 
Administrator to transmit information contained in the National Driver 
Register about the person to the Administrator. The Administrator shall 
make information received from the National Driver Register, if any, 
available on request to the person for review and written comment.

Subpart B -- First-Class Airman Medical Certificate


Sec. 67.101  Eligibility. -

    To be eligible for a first-class airman medical certificate, and to 
remain eligible for a first-class airman medical certificate, a person 
must meet the requirements of this subpart.


Sec. 67.103  Eye. -

    Eye standards for a first-class airman medical certificate are: -
    (a) Distant visual acuity of 20/20 or better in each eye 
separately, with or without corrective lenses. If corrective lenses 
(spectacles or contact lenses) are necessary for 20/20 vision, the 
person may be eligible only on the condition that corrective lenses are 
worn while exercising the privileges of an airman certificate. -
    (b) Near vision of 20/40 or better, Snellen equivalent, at 16 
inches in each eye separately, with or without corrective lenses. If 
age 50 or older, near vision of 20/40 or better, Snellen equivalent, at 
both 16 inches and 32 inches in each eye separately, with or without 
corrective lenses. -
    (c) Ability to perceive those colors necessary for the safe 
performance of airman duties. -
    (d) Normal fields of vision. -
    (e) No acute or chronic pathological condition of either eye or 
adnexa that interferes with the proper function of an eye, that may 
reasonably be expected to progress to that degree, or that may 
reasonably be expected to be aggravated by flying. -
    (f) Bifoveal fixation and vergence-phoria relationship sufficient 
to prevent a break in fusion under conditions that may reasonably be 
expected to occur in performing airman duties. Tests for the factors 
named in this paragraph are not required except for persons found to 
have more than 1 prism diopter of hyperphoria, 6 prism diopters of 
esophoria, or 6 prism diopters of exophoria. If any of these values are 
exceeded, the Federal Air Surgeon may require the person to be examined 
by a qualified eye specialist to determine if there is bifoveal 
fixation and an adequate vergence-phoria relationship. However, if 
otherwise eligible, the person is issued a medical certificate pending 
the results of the examination.


 67.105  Ear, nose, throat, and equilibrium. -

    Ear, nose, throat, and equilibrium standards for a first-class 
airman medical certificate are:
    (a) The person shall demonstrate acceptable hearing by at least one 
of the following tests:
    (1) Demonstrate an ability to hear an average conversational voice 
in a quiet room, using both ears, at a distance of 6 feet from the 
examiner, with the back turned to the examiner.
    (2) Demonstrate an acceptable understanding of speech as determined 
by audiometric speech discrimination testing to a score of at least 70 
percent obtained in one ear or in a sound field environment.
    (3) Provide acceptable results of pure tone audiometric testing of 
unaided hearing acuity according to the following table of worst 
acceptable thresholds, using the calibration standards of the American 
National Standards Institute, 1969 (11 West 42d Street, New York, NY 
10036):

------------------------------------------------------------------------
                                                500   1000   2000   3000
                Frequency (Hz)                   Hz    Hz     Hz     Hz 
------------------------------------------------------------------------
Better ear (Db)...............................   35     30     30     40
Poorer ear (Db)...............................   35     50     50     60
------------------------------------------------------------------------

    (b) No disease or condition of the middle or internal ear, nose, 
oral cavity, pharynx, or larynx that--
    (1) Interferes with, or is aggravated by, flying or may reasonably 
be expected to do so; or
    (2) Interferes with, or may reasonably be expected to interfere 
with, clear and effective speech communication.
    (c) No disease or condition manifested by, or that may reasonably 
be expected to be manifested by, vertigo or a disturbance of 
equilibrium.


Sec. 67.107  Mental.

    Mental standards for a first-class airman medical certificate are:
    (a) No established medical history or clinical diagnosis of any of 
the following:
    (1) A personality disorder that is severe enough to have repeatedly 
manifested itself by overt acts.
    (2) A psychosis. As used in this section, ``psychosis'' refers to a 
mental disorder in which:
    (i) The individual has manifested delusions, hallucinations, 
grossly bizarre or disorganized behavior, or other commonly accepted 
symptoms of this condition; or
    (ii) The individual may reasonably be expected to manifest 
delusions, hallucinations, grossly bizarre or disorganized behavior, or 
other commonly accepted symptoms of this condition.
    (3) A bipolar disorder.
    (4) Substance dependence, except where there is established 
clinical evidence, satisfactory to the Federal Air Surgeon, of 
recovery, including sustained total abstinence from the substance(s) 
for not less than the preceding 2 years. As used in this section-- --
    (i) ``Substance'' includes: Alcohol; other sedatives and hypnotics; 
anxiolytics; opioids; central nervous system stimulants such as 
cocaine, amphetamines, and similarly acting sympathomimetics; 
hallucinogens;

[[Page 11258]]
phencyclidine or similarly acting arylcyclohexylamines; cannabis; 
inhalants; and other psychoactive drugs and chemicals; and
    (ii) ``Substance dependence'' means a condition in which a person 
is dependent on a substance, other than tobacco or ordinary xanthine-
containing (e.g., caffeine) beverages, as evidenced by--
    (A) Increased tolerance;
    (B) Manifestation of withdrawal symptoms;
    (C) Impaired control of use; or
    (D) Continued use despite damage to physical health or impairment 
of social, personal, or occupational functioning.
    (b) No substance abuse within the preceding 2 years defined as:
    (1) Use of a substance in a situation in which that use was 
physically hazardous, if there has been at any other time an instance 
of the use of a substance also in a situation in which that use was 
physically hazardous;
    (2) A verified positive drug test result acquired under an anti-
drug program or internal program of the U.S. Department of 
Transportation or any other Administration within the U.S. Department 
of Transportation; or
    (3) Misuse of a substance that the Federal Air Surgeon, based on 
case history and appropriate, qualified medical judgment relating to 
the substance involved, finds--
    (i) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (ii) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    (c) No other personality disorder, neurosis, or other mental 
condition that the Federal Air Surgeon, based on the case history and 
appropriate, qualified medical judgment relating to the condition 
involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.109  Neurologic.

    Neurologic standards for a first-class airman medical certificate 
are:
    (a) No established medical history or clinical diagnosis of any of 
the following:
    (1) Epilepsy;
    (2) A disturbance of consciousness without satisfactory medical 
explanation of the cause; or
    (3) A transient loss of control of nervous system function(s) 
without satisfactory medical explanation of the cause.
    (b) No other seizure disorder, disturbance of consciousness, or 
neurologic condition that the Federal Air Surgeon, based on the case 
history and appropriate, qualified medical judgment relating to the 
condition involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.111  Cardiovascular.

    Cardiovascular standards for a first-class airman medical 
certificate are:
    (a) No established medical history or clinical diagnosis of any of 
the following:
    (1) Myocardial infarction;
    (2) Angina pectoris;
    (3) Coronary heart disease that has required treatment or, if 
untreated, that has been symptomatic or clinically significant;
    (4) Cardiac valve replacement;
    (5) Permanent cardiac pacemaker implantation; or
    (6) Heart replacement;
    (b) A person applying for first-class medical certification must 
demonstrate an absence of myocardial infarction and other clinically 
significant abnormality on electrocardiographic examination:
    (1) At the first application after reaching the 35th birthday; and
    (2) On an annual basis after reaching the 40th birthday.
    (c) An electrocardiogram will satisfy a requirement of paragraph 
(b) of this section if it is dated no earlier than 60 days before the 
date of the application it is to accompany and was performed and 
transmitted according to acceptable standards and techniques.


Sec. 67.113  General medical condition.

    The general medical standards for a first-class airman medical 
certificate are:
    (a) No established medical history or clinical diagnosis of 
diabetes mellitus that requires insulin or any other hypoglycemic drug 
for control.
    (b) No other organic, functional, or structural disease, defect, or 
limitation that the Federal Air Surgeon, based on the case history and 
appropriate, qualified medical judgment relating to the condition 
involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    (c) No medication or other treatment that the Federal Air Surgeon, 
based on the case history and appropriate, qualified medical judgment 
relating to the medication or other treatment involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.115  Discretionary issuance.

    A person who does not meet the provisions of Secs. 67.103 through 
67.113 may apply for the discretionary issuance of a certificate under 
Sec. 67.401.

Subpart C--Second-Class Airman Medical Certificate


Sec. 67.201  Eligibility.

    To be eligible for a second-class airman medical certificate, and 
to remain eligible for a second-class airman medical certificate, a 
person must meet the requirements of this subpart.


Sec. 67.203  Eye.

    Eye standards for a second-class airman medical certificate are:
    (a) Distant visual acuity of 20/20 or better in each eye 
separately, with or without corrective lenses. If corrective lenses 
(spectacles or contact lenses) are necessary for 20/20 vision, the 
person may be eligible only on the condition that corrective lenses are 
worn while exercising the privileges of an airman certificate.
    (b) Near vision of 20/40 or better, Snellen equivalent, at 16 
inches in each eye separately, with or without corrective lenses. If 
age 50 or older, near vision of 20/40 or better, Snellen equivalent, at 
both 16 inches and 32 inches in each eye separately, with or without 
corrective lenses.
    (c) Ability to perceive those colors necessary for the safe 
performance of airman duties.
    (d) Normal fields of vision.
    (e) No acute or chronic pathological condition of either eye or 
adnexa that

[[Page 11259]]

interferes with the proper function of an eye, that may reasonably be 
expected to progress to that degree, or that may reasonably be expected 
to be aggravated by flying.
    (f) Bifoveal fixation and vergence-phoria relationship sufficient 
to prevent a break in fusion under conditions that may reasonably be 
expected to occur in performing airman duties. Tests for the factors 
named in this paragraph are not required except for persons found to 
have more than 1 prism diopter of hyperphoria, 6 prism diopters of 
esophoria, or 6 prism diopters of exophoria. If any of these values are 
exceeded, the Federal Air Surgeon may require the person to be examined 
by a qualified eye specialist to determine if there is bifoveal 
fixation and an adequate vergence-phoria relationship. However, if 
otherwise eligible, the person is issued a medical certificate pending 
the results of the examination.


Sec. 67.205  Ear, nose, throat, and equilibrium.

    Ear, nose, throat, and equilibrium standards for a second-class 
airman medical certificate are:
    (a) The person shall demonstrate acceptable hearing by at least one 
of the following tests:
    (1) Demonstrate an ability to hear an average conversational voice 
in a quiet room, using both ears, at a distance of 6 feet from the 
examiner, with the back turned to the examiner.
    (2) Demonstrate an acceptable understanding of speech as determined 
by audiometric speech discrimination testing to a score of at least 70 
percent obtained in one ear or in a sound field environment.
    (3) Provide acceptable results of pure tone audiometric testing of 
unaided hearing acuity according to the following table of worst 
acceptable thresholds, using the calibration standards of the American 
National Standards Institute, 1969:

------------------------------------------------------------------------
                                                500   1000   2000   3000
                Frequency (Hz)                   Hz    Hz     Hz     Hz 
------------------------------------------------------------------------
Better ear (Db)-..............................   35   30 -     30     40
Poorer ear (Db)-..............................   35     50     50     60
------------------------------------------------------------------------

    (b) No disease or condition of the middle or internal ear, nose, 
oral cavity, pharynx, or larynx that--
    (1) Interferes with, or is aggravated by, flying or may reasonably 
be expected to do so; or
    (2) Interferes with, or may reasonably be expected to interfere 
with, clear and effective speech communication.
    (c) No disease or condition manifested by, or that may reasonably 
be expected to be manifested by, vertigo or a disturbance of 
equilibrium.


Sec. 67.207  Mental.

    Mental standards for a second-class airman medical certificate are:
    (a) No established medical history or clinical diagnosis of any of 
the following:
    (1) A personality disorder that is severe enough to have repeatedly 
manifested itself by overt acts.
    (2) A psychosis. As used in this section, ``psychosis'' refers to a 
mental disorder in which:
    (i) The individual has manifested delusions, hallucinations, 
grossly bizarre or disorganized behavior, or other commonly accepted 
symptoms of this condition; or
    (ii) The individual may reasonably be expected to manifest 
delusions, hallucinations, grossly bizarre or disorganized behavior, or 
other commonly accepted symptoms of this condition.
    (3) A bipolar disorder.
    (4) Substance dependence, except where there is established 
clinical evidence, satisfactory to the Federal Air Surgeon, of 
recovery, including sustained total abstinence from the substance(s) 
for not less than the preceding 2 years. As used in this section-- ---
    (i) ``Substance'' includes: Alcohol; other sedatives and hypnotics; 
anxiolytics; opioids; central nervous system stimulants such as 
cocaine, amphetamines, and similarly acting sympathomimetics; 
hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; 
cannabis; inhalants; and other psychoactive drugs and chemicals; and
    (ii) ``Substance dependence'' means a condition in which a person 
is dependent on a substance, other than tobacco or ordinary xanthine-
containing (e.g., caffeine) beverages, as evidenced by--
    (A) Increased tolerance;
    (B) Manifestation of withdrawal symptoms;
    (C) Impaired control of use; or
    (D) Continued use despite damage to physical health or impairment 
of social, personal, or occupational functioning.
    (b) No substance abuse within the preceding 2 years defined as:
    (1) Use of a substance in a situation in which that use was 
physically hazardous, if there has been at any other time an instance 
of the use of a substance also in a situation in which that use was 
physically hazardous;
    (2) A verified positive drug test result acquired under an anti-
drug program or internal program of the U.S. Department of 
Transportation or any other Administration within the U.S. Department 
of Transportation; or
    (3) Misuse of a substance that the Federal Air Surgeon, based on 
case history and appropriate, qualified medical judgment relating to 
the substance involved, finds--
    (i) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (ii) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    (c) No other personality disorder, neurosis, or other mental 
condition that the Federal Air Surgeon, based on the case history and 
appropriate, qualified medical judgment relating to the condition 
involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


67.209  Neurologic.

    Neurologic standards for a second-class airman medical certificate 
are:
    (a) No established medical history or clinical diagnosis of any of 
the following:
    (1) Epilepsy;
    (2) A disturbance of consciousness without satisfactory medical 
explanation of the cause; or
    (3) A transient loss of control of nervous system function(s) 
without satisfactory medical explanation of the cause;
    (b) No other seizure disorder, disturbance of consciousness, or 
neurologic condition that the Federal Air Surgeon, based on the case 
history and appropriate, qualified medical judgment relating to the 
condition involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


67.211  Cardiovascular.

    Cardiovascular standards for a second-class medical certificate are 
no established medical history or clinical diagnosis of any of the 
following:
    (a) Myocardial infarction;
    (b) Angina pectoris;
    (c) Coronary heart disease that has required treatment or, if 
untreated, that

[[Page 11260]]
has been symptomatic or clinically significant;
    (d) Cardiac valve replacement;
    (e) Permanent cardiac pacemaker implantation; or
    (f) Heart replacement.


67.213  General medical condition.

    The general medical standards for a second-class airman medical 
certificate are:
    (a) No established medical history or clinical diagnosis of 
diabetes mellitus that requires insulin or any other hypoglycemic drug 
for control.
    (b) No other organic, functional, or structural disease, defect, or 
limitation that the Federal Air Surgeon, based on the case history and 
appropriate, qualified medical judgment relating to the condition 
involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    (c) No medication or other treatment that the Federal Air Surgeon, 
based on the case history and appropriate, qualified medical judgment 
relating to the medication or other treatment involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    -(2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.215  Discretionary issuance.

    - A person who does not meet the provisions of Secs. 67.203 through 
67.213 may apply for the discretionary issuance of a certificate under 
Sec. 67.401.

Subpart D--Third-Class Airman Medical Certificate


Sec. 67.301  Eligibility.

    -To be eligible for a third-class airman medical certificate, or to 
remain eligible for a third-class airman medical certificate, a person 
must meet the requirements of this subpart.


Sec. 67.303  Eye.

    -Eye standards for a third-class airman medical certificate are:
    -(a) Distant visual acuity of 20/40 or better in each eye 
separately, with or without corrective lenses. If corrective lenses 
(spectacles or contact lenses) are necessary for 20/40 vision, the 
person may be eligible only on the condition that corrective lenses are 
worn while exercising the privileges of an airman certificate.
    -(b) Near vision of 20/40 or better, Snellen equivalent, at 16 
inches in each eye separately, with or without corrective lenses.
    -(c) Ability to perceive those colors necessary for the safe 
performance of airman duties.
    -(d) No acute or chronic pathological condition of either eye or 
adnexa that interferes with the proper function of an eye, that may 
reasonably be expected to progress to that degree, or that may 
reasonably be expected to be aggravated by flying.


Sec. 67.305  Ear, nose, throat, and equilibrium.

    -Ear, nose, throat, and equilibrium standards for a third-class 
airman medical certificate are:
    -(a) The person shall demonstrate acceptable hearing by at least 
one of the following tests:
    -(1) Demonstrate an ability to hear an average conversational voice 
in a quiet room, using both ears, at a distance of 6 feet from the 
examiner, with the back turned to the examiner.
    -(2) Demonstrate an acceptable understanding of speech as 
determined by audiometric speech discrimination testing to a score of 
at least 70 percent obtained in one ear or in a sound field 
environment.
    -(3) Provide acceptable results of pure tone audiometric testing of 
unaided hearing acuity according to the following table of worst 
acceptable thresholds, using the calibration standards of the American 
National Standards Institute, 1969:

------------------------------------------------------------------------
                                                500   1000   2000   3000
                Frequency (Hz)                   Hz    Hz     Hz     Hz 
------------------------------------------------------------------------
Better ear (Db)-..............................   35     30     30     40
Poorer ear (Db)-..............................   35     50     50     60
------------------------------------------------------------------------

    -(b) No disease or condition of the middle or internal ear, nose, 
oral cavity, pharynx, or larynx that--
    -(1) Interferes with, or is aggravated by, flying or may reasonably 
be expected to do so; or
    -(2) Interferes with clear and effective speech communication.
    -(c) No disease or condition manifested by, or that may reasonably 
be expected to be manifested by, vertigo or a disturbance of 
equilibrium.


Sec. 67.307  Mental.

    -Mental standards for a third-class airman medical certificate are:
    -(a) No established medical history or clinical diagnosis of any of 
the following:
    -(1) A personality disorder that is severe enough to have 
repeatedly manifested itself by overt acts.
    -(2) A psychosis. As used in this section, ``psychosis'' refers to 
a mental disorder in which--
    -(i) The individual has manifested delusions, hallucinations, 
grossly bizarre or disorganized behavior, or other commonly accepted 
symptoms of this condition; or
    -(ii) The individual may reasonably be expected to manifest 
delusions, hallucinations, grossly bizarre or disorganized behavior, or 
other commonly accepted symptoms of this condition.
    -(3) A bipolar disorder.
    -(4) Substance dependence, except where there is established 
clinical evidence, satisfactory to the Federal Air Surgeon, of 
recovery, including sustained total abstinence from the substance(s) 
for not less than the preceding 2 years. As used in this section-- -
    -(i) ``Substance'' includes: alcohol; other sedatives and 
hypnotics; anxiolytics; opioids; central nervous system stimulants such 
as cocaine, amphetamines, and similarly acting sympathomimetics; 
hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; 
cannabis; inhalants; and other psychoactive drugs and chemicals; and
    -(ii) ``Substance dependence'' means a condition in which a person 
is dependent on a substance, other than tobacco or ordinary xanthine-
containing (e.g., caffeine) beverages, as evidenced by--
    -(A) Increased tolerance;
    -(B) Manifestation of withdrawal symptoms;
    -(C) Impaired control of use; or
    -(D) Continued use despite damage to physical health or impairment 
of social, personal, or occupational functioning.
    -(b) No substance abuse within the preceding 2 years defined as:
    -(1) Use of a substance in a situation in which that use was 
physically hazardous, if there has been at any other time an instance 
of the use of a substance also in a situation in which that use was 
physically hazardous;
    -(2) A verified positive drug test result conducted under an anti-
drug rule or internal program of the U.S. Department of Transportation 
or any other Administration within the U.S. Department of 
Transportation; or
    -(3) Misuse of a substance that the Federal Air Surgeon, based on 
case history and appropriate, qualified medical judgment relating to 
the substance involved, finds--
    -(i) Makes the person unable to safely perform the duties or 
exercise the

[[Page 11261]]
privileges of the airman certificate applied for or held; or
    -(ii) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    -(c) No other personality disorder, neurosis, or other mental 
condition that the Federal Air Surgeon, based on the case history and 
appropriate, qualified medical judgment relating to the condition 
involved, finds--
    -(1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    -(2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.309  Neurologic.

    -Neurologic standards for a third-class airman medical certificate 
are:
    -(a) No established medical history or clinical diagnosis of any of 
the following:
    -(1) Epilepsy;
    -(2) A disturbance of consciousness without satisfactory medical 
explanation of the cause; or
    -(3) A transient loss of control of nervous system function(s) 
without satisfactory medical explanation of the cause.
    -(b) No other seizure disorder, disturbance of consciousness, or 
neurologic condition that the Federal Air Surgeon, based on the case 
history and appropriate, qualified medical judgment relating to the 
condition involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.311  Cardiovascular.

    Cardiovascular standards for a third-class airman medical 
certificate are no established medical history or clinical diagnosis of 
any of the following:
    (a) Myocardial infarction;
    (b) Angina pectoris;
    (c) Coronary heart disease that has required treatment or, if 
untreated, that has been symptomatic or clinically significant;
    (d) Cardiac valve replacement;
    (e) Permanent cardiac pacemaker implantation; or
    (f) Heart replacement.


Sec. 67.313  General medical condition.

    The general medical standards for a third-class airman medical 
certificate are:
    (a) No established medical history or clinical diagnosis of 
diabetes mellitus that requires insulin or any other hypoglycemic drug 
for control.
    (b) No other organic, functional, or structural disease, defect, or 
limitation that the Federal Air Surgeon, based on the case history and 
appropriate, qualified medical judgment relating to the condition 
involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.
    (c) No medication or other treatment that the Federal Air Surgeon, 
based on the case history and appropriate, qualified medical judgment 
relating to the medication or other treatment involved, finds--
    (1) Makes the person unable to safely perform the duties or 
exercise the privileges of the airman certificate applied for or held; 
or
    (2) May reasonably be expected, for the maximum duration of the 
airman medical certificate applied for or held, to make the person 
unable to perform those duties or exercise those privileges.


Sec. 67.315  Discretionary issuance.

    A person who does not meet the provisions of Secs. 67.303 through 
67.313 may apply for the discretionary issuance of a certificate under 
Sec. 67.401.

Subpart E--Certification Procedures


Sec. 67.401  Special issuance of medical certificates.

    (a) At the discretion of the Federal Air Surgeon, an Authorization 
for Special Issuance of a Medical Certificate (Authorization), valid 
for a specified period, may be granted to a person who does not meet 
the provisions of subparts B, C, or D of this part if the person shows 
to the satisfaction of the Federal Air Surgeon that the duties 
authorized by the class of medical certificate applied for can be 
performed without endangering public safety during the period in which 
the Authorization would be in force. The Federal Air Surgeon may 
authorize a special medical flight test, practical test, or medical 
evaluation for this purpose. A medical certificate of the appropriate 
class may be issued to a person who does not meet the provisions of 
subparts B, C, or D of this part if that person possesses a valid 
Authorization and is otherwise eligible. An airman medical certificate 
issued in accordance with this section shall expire no later than the 
end of the validity period or upon the withdrawal of the Authorization 
upon which it is based. At the end of its specified validity period, 
for grant of a new Authorization, the person must again show to the 
satisfaction of the Federal Air Surgeon that the duties authorized by 
the class of medical certificate applied for can be performed without 
endangering public safety during the period in which the Authorization 
would be in force.
    (b) At the discretion of the Federal Air Surgeon, a Statement of 
Demonstrated Ability (SODA) may be granted, instead of an 
Authorization, to a person whose disqualifying condition is static or 
nonprogressive and who has been found capable of performing airman 
duties without endangering public safety. A SODA does not expire and 
authorizes a designated aviation medical examiner to issue a medical 
certificate of a specified class if the examiner finds that the 
condition described on its face has not adversely changed.
    (c) In granting an Authorization or SODA, the Federal Air Surgeon 
may consider the person's operational experience and any medical facts 
that may affect the ability of the person to perform airman duties 
including--
    (1) The combined effect on the person of failure to meet more than 
one requirement of this part; and
    (2) The prognosis derived from professional consideration of all 
available information regarding the person.
    (d) In granting an Authorization or SODA under this section, the 
Federal Air Surgeon specifies the class of medical certificate 
authorized to be issued and may do any or all of the following:
    (1) Limit the duration of an Authorization;
    (2) Condition the granting of a new Authorization on the results of 
subsequent medical tests, examinations, or evaluations;
    (3) State on the Authorization or SODA, and any medical certificate 
based upon it, any operational limitation needed for safety; or
    (4) Condition the continued effect of an Authorization or SODA, and 
any second- or third-class medical certificate based upon it, on 
compliance with a statement of functional limitations issued to the 
person in coordination with the Director of Flight Standards or the 
Director's designee.

[[Page 11262]]

    (e) In determining whether an Authorization or SODA should be 
granted to an applicant for a third-class medical certificate, the 
Federal Air Surgeon considers the freedom of an airman, exercising the 
privileges of a private pilot certificate, to accept reasonable risks 
to his or her person and property that are not acceptable in the 
exercise of commercial or airline transport pilot privileges, and, at 
the same time, considers the need to protect the safety of persons and 
property in other aircraft and on the ground.
    (f) An Authorization or SODA granted under the provisions of this 
section to a person who does not meet the applicable provisions of 
subparts B, C, or D of this part may be withdrawn, at the discretion of 
the Federal Air Surgeon, at any time if--
    (1) There is adverse change in the holder's medical condition;
    (2) The holder fails to comply with a statement of functional 
limitations or operational limitations issued as a condition of 
certification under this section;
    (3) Public safety would be endangered by the holder's exercise of 
airman privileges;
    (4) The holder fails to provide medical information reasonably 
needed by the Federal Air Surgeon for certification under this section; 
or
    (5) The holder makes or causes to be made a statement or entry that 
is the basis for withdrawal of an Authorization or SODA under 
Sec. 67.403.
    (g) A person who has been granted an Authorization or SODA under 
this section based on a special medical flight or practical test need 
not take the test again during later physical examinations unless the 
Federal Air Surgeon determines or has reason to believe that the 
physical deficiency has or may have degraded to a degree to require 
another special medical flight test or practical test.
    (h) The authority of the Federal Air Surgeon under this section is 
also exercised by the Manager, Aeromedical Certification Division, and 
each Regional Flight Surgeon.
    (i) If an Authorization or SODA is withdrawn under paragraph (f) of 
this section the following procedures apply:
    (1) The holder of the Authorization or SODA will be served a letter 
of withdrawal, stating the reason for the action;
    (2) By not later than 60 days after the service of the letter of 
withdrawal, the holder of the Authorization or SODA may request, in 
writing, that the Federal Air Surgeon provide for review of the 
decision to withdraw. The request for review may be accompanied by 
supporting medical evidence;
    (3) Within 60 days of receipt of a request for review, a written 
final decision either affirming or reversing the decision to withdraw 
will be issued; and
    (4) A medical certificate rendered invalid pursuant to a 
withdrawal, in accordance with paragraph (a) of this section, shall be 
surrendered to the Administrator upon request.
    (j) No grant of a special issuance made prior to September 16, 
1996, may be used to obtain a medical certificate after the earlier of 
the following dates:
    (1) September 16, 1997; or
    (2) The date on which the holder of such special issuance is 
required to provide additional information to the FAA as a condition 
for continued medical certification.


Sec. 67.403  Applications, certificates, logbooks, reports, and 
records: Falsification, reproduction, or alteration; incorrect 
statements.

    (a) No person may make or cause to be made--
    (1) A fraudulent or intentionally false statement on any 
application for a medical certificate or on a request for any 
Authorization for Special Issuance of a Medical Certificate 
(Authorization) or Statement of Demonstrated Ability (SODA) under this 
part;
    (2) A fraudulent or intentionally false entry in any logbook, 
record, or report that is kept, made, or used, to show compliance with 
any requirement for any medical certificate or for any Authorization or 
SODA under this part;
    (3) A reproduction, for fraudulent purposes, of any medical 
certificate under this part; or
    (4) An alteration of any medical certificate under this part.
    (b) The commission by any person of an act prohibited under 
paragraph (a) of this section is a basis for--
    (1) Suspending or revoking all airman, ground instructor, and 
medical certificates and ratings held by that person;
    (2) Withdrawing all Authorizations or SODA's held by that person; 
and
    (3) Denying all applications for medical certification and requests 
for Authorizations or SODA's.
    (c) The following may serve as a basis for suspending or revoking a 
medical certificate; withdrawing an Authorization or SODA; or denying 
an application for a medical certificate or request for an 
authorization or SODA:
    (1) An incorrect statement, upon which the FAA relied, made in 
support of an application for a medical certificate or request for an 
Authorization or SODA.-
    (2) An incorrect entry, upon which the FAA relied, made in any 
logbook, record, or report that is kept, made, or used to show 
compliance with any requirement for a medical certificate or an 
Authorization or SODA.


Sec. 67.405  Medical examinations: Who may give. -

    (a) First-class. Any aviation medical examiner who is specifically 
designated for the purpose may give the examination for the first-class 
medical certificate. Any interested person may obtain a list of these 
aviation medical examiners, in any area, from the FAA Regional Flight 
Surgeon of the region in which the area is located. -
    (b) Second- and third-class. Any aviation medical examiner may give 
the examination for the second- or third-class medical certificate. Any 
interested person may obtain a list of aviation medical examiners, in 
any area, from the FAA Regional Flight Surgeon of the region in which 
the area is located.


Sec. 67.407  Delegation of authority. -

    (a) The authority of the Administrator under 49 U.S.C. 44703 to 
issue or deny medical certificates is delegated to the Federal Air 
Surgeon to the extent necessary to-- -
    (1) Examine applicants for and holders of medical certificates to 
determine whether they meet applicable medical standards; and -
    (2) Issue, renew, and deny medical certificates, and issue, renew, 
deny, and withdraw Authorizations for Special Issuance of a Medical 
Certificate and Statements of Demonstrated Ability to a person based 
upon meeting or failing to meet applicable medical standards. -
    (b) Subject to limitations in this chapter, the delegated functions 
of the Federal Air Surgeon to examine applicants for and holders of 
medical certificates for compliance with applicable medical standards 
and to issue, renew, and deny medical certificates are also delegated 
to aviation medical examiners and to authorized representatives of the 
Federal Air Surgeon within the FAA. -
    (c) The authority of the Administrator under 49 U.S.C. 44702, to 
reconsider the action of an aviation medical examiner is delegated to 
the Federal Air Surgeon; the Manager, Aeromedical Certification 
Division; and each Regional Flight Surgeon. Where the person does not 
meet the standards of Secs. 67.107(b)(3) and (c), 67.109(b), 67.113(b) 
and (c), 67.207(b)(3) and (c), 67.209(b), 67.213(b) and (c), 
67.307(b)(3) and (c), 67.309(b), or 67.313(b) and (c), any action taken 
under this paragraph other than by the Federal Air Surgeon is subject 
to

[[Page 11263]]
reconsideration by the Federal Air Surgeon. A certificate issued by an 
aviation medical examiner is considered to be affirmed as issued unless 
an FAA official named in this paragraph (authorized official) reverses 
that issuance within 60 days after the date of issuance. However, if 
within 60 days after the date of issuance an authorized official 
requests the certificate holder to submit additional medical 
information, an authorized official may reverse the issuance within 60 
days after receipt of the requested information. -
    (d) The authority of the Administrator under 49 U.S.C. 44709 to re-
examine any civil airman to the extent necessary to determine an 
airman's qualification to continue to hold an airman medical 
certificate, is delegated to the Federal Air Surgeon and his or her 
authorized representatives within the FAA.


Sec. 67.409  Denial of medical certificate. -

    (a) Any person who is denied a medical certificate by an aviation 
medical examiner may, within 30 days after the date of the denial, 
apply in writing and in duplicate to the Federal Air Surgeon, 
Attention: Manager, Aeromedical Certification Division, AAM-300, 
Federal Aviation Administration, P.O. Box 26080, Oklahoma City, 
Oklahoma 73126, for reconsideration of that denial. If the person does 
not ask for reconsideration during the 30-day period after the date of 
the denial, he or she is considered to have withdrawn the application 
for a medical certificate. -
    (b) The denial of a medical certificate---
    (1) By an aviation medical examiner is not a denial by the 
Administrator under 49 U.S.C. 44703.-
    (2) By the Federal Air Surgeon is considered to be a denial by the 
Administrator under 49 U.S.C. 44703. -
    (3) By the Manager, Aeromedical Certification Division, or a 
Regional Flight Surgeon is considered to be a denial by the 
Administrator under 49 U.S.C. 44703 except where the person does not 
meet the standards of Secs. 67.107(b)(3) and (c), 67.109(b), or 
67.113(b) and (c); 67.207(b)(3) and (c), 67.209(b), or 67.213(b) and 
(c); or 67.307(b)(3) and (c), 67.309(b), or 67.313(b) and (c). -
    (c) Any action taken under Sec. 67.407(c) that wholly or partly 
reverses the issue of a medical certificate by an aviation medical 
examiner is the denial of a medical certificate under paragraph (b) of 
this section. -
    (d) If the issue of a medical certificate is wholly or partly 
reversed by the Federal Air Surgeon; the Manager, Aeromedical 
Certification Division; or a Regional Flight Surgeon, the person 
holding that certificate shall surrender it, upon request of the FAA.


Sec. 67.411  Medical certificates by flight surgeons of Armed Forces. -

    (a) The FAA has designated flight surgeons of the Armed Forces on 
specified military posts, stations, and facilities, as aviation medical 
examiners. -
    (b) An aviation medical examiner described in paragraph (a) of this 
section may give physical examinations for the FAA medical certificates 
to persons who are on active duty or who are, under Department of 
Defense medical programs, eligible for FAA medical certification as 
civil airmen. In addition, such an examiner may issue or deny an 
appropriate FAA medical certificate in accordance with the regulations 
of this chapter and the policies of the FAA. -
    (c) Any interested person may obtain a list of the military posts, 
stations, and facilities at which a flight surgeon has been designated 
as an aviation medical examiner from the Surgeon General of the Armed 
Force concerned or from the Manager, Aeromedical Education Division, 
AAM-400, Federal Aviation Administration, P.O. Box 26082, Oklahoma 
City, Oklahoma 73125.


Sec. 67.413  Medical records. -

    (a) Whenever the Administrator finds that additional medical 
information or history is necessary to determine whether an applicant 
for or the holder of a medical certificate meets the medical standards 
for it, the Administrator requests that person to furnish that 
information or to authorize any clinic, hospital, physician, or other 
person to release to the Administrator all available information or 
records concerning that history. If the applicant or holder fails to 
provide the requested medical information or history or to authorize 
the release so requested, the Administrator may suspend, modify, or 
revoke all medical certificates the airman holds or may, in the case of 
an applicant, deny the application for an airman medical certificate. -
    (b) If an airman medical certificate is suspended or modified under 
paragraph (a) of this section, that suspension or modification remains 
in effect until the requested information, history, or authorization is 
provided to the FAA and until the Federal Air Surgeon determines 
whether the person meets the medical standards under this part.


Sec. 67.415  Return of medical certificate after suspension or 
revocation. -

    The holder of any medical certificate issued under this part that 
is suspended or revoked shall, upon the Administrator's request, return 
it to the Administrator.

    Issued in Washington, D.C. on March 12, 1996.
David R. Hinson,
Administrator.
[FR Doc. 96-6358 Filed 3-13-96; 1:34 pm]
BILLING CODE 4910-13-P