Any pilot who wants to exercise the privileges of an airline transport pilot license, so they can act as pilot in command of scheduled air carriers’ aircraft must be issued a first-class medical certificate.

Compared to second-class and third-class medical certificates, more stringent requirements must be met.

First Class Medical Requirements


  • Distant Vision: Distant vision must be correctable to 20/20 or better in each eye
  • Near Vision: Near vision must be correctable to 20/40 or better in each eye, as measured at 16 inches
  • Intermediate Vision: If aged 50 or over, intermediate vision must be correctable to 20/40 or better in each year, as measured at 32 inches
  • Color Vision: The FAA state that it is necessary to possess the “ability to perceive those colors necessary for safe performance of airman duties”


You must “demonstrate hearing of an average conversational voice in a quiet room, using both ears at 6 feet, with the back turned to the examiner or pass one of the audiometric tests”.

This test can either be an audiometric speech discrimination test (a score of at least 70% reception in one ear is required), or a pure tone audiometric test.

ENT, Pulse, and Blood Pressure

  • ENT: You must not suffer from any ear, nose, or throat condition that interferes with, or could be aggravated by flying, including the interference of clear communication, or is manifested by vertigo or a disturbance of equilibrium
  • Pulse: Not disqualifying per se. Used to determine cardiac system status and responsiveness
  • Blood Pressure: While no specified values are stated in the standards, the current guideline maximum value is 155/95


An Electro-Cardiogram (EKG) is required at age 35 and annually after age 40.

Mental Health

You must not have a diagnosis of psychosis, bipolar disorder, or severe personality disorders.

Substance Dependence and Abuse

A diagnosis or medical history of substance dependence is disqualifying unless there is established clinical evidence of recovery, including abstinence of at least 2 years. A history of substance abuse within the past 2 years is disqualifying.

Disqualifying Conditions

Besides substance use and dependence, and the mental health conditions listed above, medical disqualifying conditions include:

  • Angina pectoris
  • Bipolar disease
  • Cardiac valve replacement
  • Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant
  • Diabetes mellitus requiring hypoglycemic medications
  • Disturbance of consciousness without satisfactory explanation of the cause
  • Epilepsy
  • Heart replacement
  • Myocardial infarction
  • Permanent cardiac pacemaker
  • Transient loss of control of nervous system function(s) without a satisfactory explanation of the cause

How Long is a First Class Medical Certificate Valid For?

If aged 40 or older, you will need to renew your first-class medical certificate every 6 months. If not renewed after 6 months, privileges will change to that of a second-class medical certificate for a further 6 months until being downgraded to the privileges of a third-class medical certificate.

If younger than 40, a first class medical certificate is good for 12 months. After 12 months, first-class medical lapses to a third class medical.

Note that the duration is calculated according to the month of the examination, not the day of the examination – i.e. if you are younger than 40 and are issued with a medical on January 1st, it needs to be renewed by January 31st of the following year.

Helen Krasner holds a PPL(A), with 15 years experience flying fixed-wing aircraft; a PPL(H), with 13 years experience flying helicopters; and a CPL(H), Helicopter Instructor Rating, with 12 years working as a helicopter instructor.

Helen is an accomplished aviation writer with 12 years of experience, having authored several books and published numerous articles while also serving as the Editor of the BWPA (British Women Pilots Association) newsletter, with her excellent work having been recognized with her nomination of the “Aviation Journalist of the Year” award.

Helen has won the “Dawn to Dusk” International Flying Competition, along with the best all-female competitors, three times with her copilot.