Aviation medicals—myths versus realities

image: © iStock Photo | VisualField

Whether you fly an A380 or a Jabiru J160, if you’re in the air it’s your responsibility to be medically certified.

You’re just about to be issued with your pilot’s licence but there’s just one thing standing in the way between you and soaring through the bright blue sky—your aviation medical.

As a pilot (or aircrew member) it’s your duty to truthfully self-report about any potential medical conditions—but we know many don’t.

‘Aeromedical decision making can be a difficult, emotive, controversial and exposed process,’ says Pooshan Navathe, CASA’s Principal Medical Officer.

‘We have an honesty-based system. If pilots don’t tell us about their medical conditions it’s their lives—and possibly the lives of passengers—which are in potential danger.’

As outlined in Part 67 of the Civil Aviation Safety Regulations 1998 (CASR), CASA has the responsibility to ensure that it is making an informed decision and to ensure that the safety of air navigation is not jeopardised.

‘Australia has got very different attitudes about a lot of things including occupational health and safety,’ says Navathe.

‘Any medical decisions made by CASA have to align with general Australian legal principles and we shouldn’t necessarily compare ourselves to overseas safety laws which could be and often are, entirely different.’

Types of aviation medical certificates

CASA issues three types of medical certificates. Each class of medical certificate also has a medical standard set out in tables in Part 67 of the CASR, but here’s a short summary:

Medical certificate-—Class 1

This medical standard applies to holders of an air transport pilot licence, commercial pilot licence (other than balloons), multi-crew pilot (aeroplane) licence, and flight engineer licence. Class 1 certificates are valid for one year.

Medical certificate—Class 2

This medical applies to holders of a private pilot licence, commercial pilot (balloon) licence and flight radio operator licence. A Class 2 medical certificate is valid for four years for applicants less than 40 years of age on the day of issue, and in all other cases for two years.

Medical certificate—Class 3

This medical standard applies to holders of an air traffic control licence or flight service officers. The Class 3 medical certificate is valid for two years.

Then there is the recreational aviation medical practitioner’s certificate. This allows appropriately licensed pilots to hold a recreational pilot’s licence (RPL) without needing to have a class 2 medical. The RPL is based on a modified unconditional driver’s licence medical certificate for a private motor vheicle.

Who makes CASA’s medical decisions?

CASA employs over 700 designated aviation medical examiners (DAMEs) spread throughout Australia and overseas to assist the medical staff of the CASA Office of Aviation Medicine with the Australian medical certification system.

DAMEs have a duty to CASA to carry out a focused examination, and provide information to CASA. CASA’s medical officers review the information received from the DAMEs and make a regulatory decision as to whether—on the evidence available—an applicant is entitled to the issue of a medical certificate under Part 67 of the CASR.

CASA’s medical certification system also utilises the opinions of a wide variety of clinical medical specialists such as psychiatrists, neurologists and cardiologists. CASA’s aeromedical decision-making is collegial and evidence-based.

‘Every decision is very individual and made on a case-by-case basis—we are completely transparent about what we do,’ says Navathe.

But the temptation for a pilot to skip the necessary processes to gain medical certification is often evident.

According to a study into deceased pilots’ medical history and medications1:

14/223 using psychotropic medications declared a psychiatric problem
1/14 declared medications
69/149 using cardiovascular medications declared cardiovascular disease
29/149 declared medications
1/15 declared neurological medications


Navathe admits that there are problems with non-disclosure in Australia too.

‘In just six weeks we tracked 13 non-serious non-disclosures and 18 serious non-disclosures.

‘The thing that a pilot or aircrew member may not realise is that if they have an undisclosed medical condition and an event occurs, it doesn’t matter what the reason is for the event, their insurance pay out is at risk.

‘However, once a condition is disclosed and a certificate issued, this is much less likely.’

Information about specific medical conditions and DAME Clinical Practical Guidelines is outlined on the CASA website.

Ageing aviation population

Just like Australia’s general ageing population, aviation medicals become a more pointed issue as the aviation population ages.

‘People are getting older in the aviation community. And as people get older medical conditions increase,’ says Pooshan Navathe.

However, a serious medical condition doesn’t necessarily mean you’ll be grounded.

‘We have people with cancer, metastatic cancer who are flying,’ says Navathe. ‘And we may say, “You need to get a PET scan every three months and a blood test every month,” and there may be limitations, but it doesn’t necessarily stop them from flying.

‘Another example is pilots with depression. In America they are required to sit on the ground for nine months after they’re in remission. In Australia, if you’re in remission and on medication, you can go flying tomorrow morning.

‘We understand it may not be cheap, as the pilot will still have to see their GP every three months and they’ll get asked a whole stack of questions. But they can fly in the interim—even commercially.

‘The only single condition that is a show stopper is epilepsy, but even then this is not necessarily permanent. If a pilot comes back to us in 10 years after they’re off medication and they haven’t had a fit, then we’ll let them fly. But 10 years is a long time to wait for certification.’

Percentage of certificate holders by age group and certificate issue year

How CASA is evolving

The aviation medical can be a frustrating process, but CASA is invested in making this procedure easier.

‘Just recently we have extended the period of certification for many conditions for an extra year (from one year to two years),’ says Navathe.

‘By next year a new system will be in place where pilots complete the medical questionnaire online. They submit that to their DAME, who then assesses it, carries out an examination, and hits the submit button.

‘We expect about 10,000 medical certificates out of 26,000 will be issued on the spot. ‘CASA’s philosophy is that if you’re truthful with us, we will do all we can to keep you in the air—if it is safe to do so.’

For more information about aviation medicals, call CASA’s dedicated assessor helpline on 1300 4 AVMED (1300 4 28633), or go to the Aviation Medicals section on the CASA website.

Canfield DV, Salazar GJ, Lewis RJ, Whinnery JE.Pilot medical history and medications found in post mortem specimens from aviation accidents. Aviat Space Environ Med. 2006 Nov;77(11):1171-3.


  1. I am 81yrs old and want to try and renew my CPLs with the required “medicals”. I have 2 knee replacements so stopped doing renewals as I did not like the stress test on the treadmill putting so much wear-and-tear on my replacements. Do I still have to do a stress test and is there some alternative. I did hear of an injection? I am on NO medication, nor do I have any medical condition other than worn out joints! Apart from an appointment with a DAME I know I have to do an eye examination, too. Can you please enlighten me as to the requirements for renewal of CPL and PPL standard? I would appreciate this very much. I have no plan to go back “full-time” into the work-force but am seeking my options. Thank you.

  2. Thank you, yes CASA contacted me. Meantime, I fronted up to the only DAME’s surgery in my area (Warrnambool, Vic) for an appointment within 2-3months only to be told he was not taking any more patients. I am faced with a 10hr round-trip to Melbourne ! Then after that DAME’s results I would have to do a STRESS Test at some other location, yet to be found. Stress? Bit much to expect in my opinion who has been flying since 1962 and got my 2 CPL’s in 1967. There has got to be a better way! If I am going to go for an AvMed I may as well aim for the “top” for I may want to do some more helicopter charity joyrides some day. It is just the Stress Test options that I don’t seem to be able to ascertain. I hate that treadmill.

  3. Hi Rosemary
    There is a test for persons on certain medication or with dicky knees and joints. Have an injection, wait an hour have sort of MRI, wait an hour or so for the injection to dissipate and have another MRI type. I did it after havinmg a pacemaker implant. I did mine at Cabrini.

  4. Hi if a pilot fails a psychiatric test to fly with the RAAF also with QANTAS , would it possible for a pilot who failed both these test,s be able to fly with Virgin Airways , if so are there test of a lower standard.
    Kind regards


    • Can’t say regards the RAAF, but Qantas uses the Myers-Briggs personality ‘test’ which is completely bogus in my opinion (I have BSc and MSc in Psychology). The test was concocted back in the 1940’s by a house wife with no formal qualifications who was a fan of Carl Jung – himself famous as the psychodynamic therapist that had sexual intercourse with the majority of his female patients. That a company like Qantas still uses such a test is absurd at the very least. If you ‘failed’ the test, wear it as a badge of honour!

      • And yes, you could fly for a different company. Different companies have different screening procedures for applicants – not all employ the same or any of the tests. It’s not a question of lower standards, it’s a question of what a company feels is the best way to judge a new hire candidate. Personally, I think companies that use the so called personality tests have been sold a bill of goods – bad science and good marketing! I know several pilots at Virgin and Qantas and they are all excellent aviators – those in Qantas got hired in spite of the personality tests! You can get interview preparation and practice the sort of ‘tests’ involved as well – people do better on the tests with practice.

  5. Thanks for the article, in easy English! A quick question I cannot find the answer to. After my CPL licence medical I have to do an opthalmic exam. The local Opthalmic DAME is away for three weeks, so how long am I allowed to leave between the main medical and the opthalmic one? Will I have to do another full medical if the eye exam is made a month or so after the main medical? Thanks for you time.

  6. Few years ago I had pain down my left arm. I was referred to a Cardio Specialist by my GP. This Specialist noted I fly planes. The cardio specialist recommended I do a Graded stress test especially orientated to aviation standard. At the testing area I walk in a standby old cardio defibulator activated. During the Graded stress test on being exhausted I was laid on an examination bench while a doctor full body pressure and pressed into my diaphragm an ultrasound lazier in the direction of my heart and asked me to exhale all my air. My heart went into palpitations and corrected itself once the unit was removed.
    Was this an essential part of Graded Stress Test?

  7. My eyesight is not 6/6.
    I use spectacle -2.0
    Can I still clear the class 1 medical.
    Where do lasik and spectacle stand in CASA?

  8. The table of certificate holders by age group used in the article says all you need to know about the inbuilt bias of our regulator. The use of symbols which show pilots beginning to stoop from age 40 onwards is thoughtless and offensive. Being one of the 2.6% of pilots of 70+ years I can reassure Dr.Navathe that I look nothing like the symbol he has chosen and indeed I have not observed any of my cohort to look remotely like the symbol.
    Although in very good health, thankfully, I have given up applying for a class one and reverted to class two simply because of the cost of all the CASA required tests many of which are uniquely Australian.
    Get with the times Australians are living longer and sadly CASA medical requirements are still firmly rooted in the biplane era.

  9. I have been taking pain medicine for many years after a car accident left me with issues with nerve damage. It has been years now and the medication has been slowly been increased to morphine and a relatively high dose of morphine for anyone who is not taking it regularly but because of tolerance over time for me it is not high. My doctor agrees that it is not affecting me in a adverse way but I am worried I won’t pass cert2. I know that defence aviation rules say that this type of medication is not allowed full stop but I do not know if it is the same for a UAV/sUAS pilot on class 2 cert. Does anyone know if this medication will stop me getting the class 2 cert? I am good health otherwise.

  10. if you are taking any medication is that on your medical certificate for employers to see or is it confidential

  11. If a 16 year old gets a mental health plan regarding bullying and social issues at school, and has a desire to be a pilot, will the fact that he has a mental health plan impact his ability to become a pilot?

  12. I sustained a head injury 6 years ago in a accident. I have a very mild form of Ataxia, will this affect me getting a class 1 medical certificate?

  13. I have had multiple grand mal seizures in the past. On an MRI my doctor found a cavernous malformation and I had brain surgery over 5 years ago to correct the problem. I have been seizure free since the surgery and have had follow up MRI showing no issues. Will I qualify for a first class medical to fly commercially? Or do I still need to wait out the 10years?

  14. I have only ever found Avmed to be difficult and obstructive. It’s as though the more people are grounded the better their KPIs. I have never been given advice, only threats for non compliance.

  15. My mate is trying to obtain his commercial helicopter license and suffers from migraines from time to time, is this a condition that will affect his license test???? Cheers


Please enter your comment!
Please enter your name here