If you’ve ever worried about what might happen if your FAA medical exam doesn’t go as planned — you’re not alone. One of the most common questions I hear from pilots is: 

“What happens if something gets flagged during my medical?”

Let’s break down what deferrals and denials really mean — and what steps you can take if either comes up.

✅ First Things First: Most Exams End in Issuance

For the vast majority of airmen, the FAA medical exam ends with a certificate in hand — no surprises. Here’s a confidence boost:
Less than 1% of applicants are truly denied. And of those, half are simply due to not submitting requested documentation.

That means most issues are manageable — especially if you know what to expect.

🔄 What’s a Deferral?

A deferral means your AME isn’t authorized to issue your certificate at the time of your exam. Instead, they submit your application and supporting documents to the FAA for further review.

This is not a denial — it’s a pause while the FAA evaluates your case more closely.

Some medical conditions fall into categories where AMEs can issue directly:

• CACIs (Conditions AMEs Can Issue)

• AASIs (Authorization for AMEs to Issue after one FAA review)

But if your condition doesn’t fall into one of these, or you’re requesting a first-time special issuance, it usually requires deferral.

Why does the FAA defer? Typically, it’s due to conditions that could impact flight safety, such as:

• Impaired ability to control limbs (e.g., for flight controls or emergency egress)

• Risk of sudden incapacitation (e.g., cardiac, neurological conditions)

• Significant vision changes

• Concerns about cognitive function or judgment

In these cases, the FAA may ask for more testing, specialist evaluations, or HIMS involvement (for substance use or certain mental health diagnoses) before making a final decision.

❌ What’s a Denial?

A denial means the FAA has formally reviewed your case and determined that you do not currently meet the medical standards for certification.

This happens in fewer than 1% of applications. And even then — it’s not always permanent.

Many pilots regain certification after addressing FAA concerns, gathering supporting documentation, or completing required monitoring programs such as HIMS.

✈️ How to Avoid a Deferral or Denial

The FAA wants healthy, safe pilots — not perfect ones. So if you’ve had a medical issue, the key is to get it properly treated and bring the appropriate documentation to your exam.

A few tips to improve your chances of same-day issuance:

• Schedule a pre-exam consult if you’ve been diagnosed with something new or are unsure what to disclose.

• Review the Guide to see what you records to bring from recent medical evaluations (within 90 days)

Being prepared can significantly reduce FAA processing time and keep you flying without long interruptions.

We’re Here to Help

As a Senior HIMS AME, my role is to support aviation safety and help you navigate the certification process with clarity and confidence.

If you’ve been deferred, denied, or just want to make sure your exam goes smoothly, don’t hesitate to reach out. We’ll help you gather the right documentation, build a plan, and communicate with the FAA effectively — so you can get back in the air.

As Always, 

Smooth skies and steady pulses,

— HIMS AME of Houston

Disclaimer

This blog post is intended for general informational purposes only and does not constitute as medical advice, diagnosis, or treatment. It is not a substitute for consulting with your healthcare provider for case-specific assessment. Always seek the advice of your physician for any concerns or questions regarding medical conditions. Following the suggestions in this post does not guarantee a specific medical outcome or certification outcome. HIMS AME of Houston is not a representative of the Federal Aviation Administration.