Part 67 Series — Your Heart, Brain & Mental Health: The FAA’s Medical Standards Explained

If the eye chart feels straightforward, this is where things get serious.

When you sit down with an Aviation Medical Examiner (AME), the vision test is usually quick. The deeper questions come next:

• Have you ever had chest pain?

• Any history of seizures?

• Ever been treated for depression or anxiety?

• Any neurologic events?

For many private pilots, this is the part of the exam that feels the most intimidating.

Under FAR Part 67, the FAA outlines specific cardiovascular, neurologic, and mental health standards for medical certification. These aren’t vague “we’ll see how you’re doing” guidelines — they’re structured regulatory criteria.

In this third article of our five-part Part 67 series, we’ll break down how the FAA evaluates:

• Heart conditions

• Neurologic disorders

• Psychiatric and mental health history

And we’ll do it in plain English — without turning this into a medical textbook.

Let’s look at what the FAA is really evaluating.

Third-Class Cardiovascular, Neurologic & Mental Health Standards

For private pilots flying small aircraft under a Third-Class medical, the applicable standards are found in:

• §67.303 — Third-Class medical standards

This section identifies disqualifying medical conditions within several major body systems, including cardiovascular, neurologic, and psychiatric categories.

Cardiovascular Standards (Third-Class)

Under §67.303, a history or clinical diagnosis of certain cardiovascular conditions can be disqualifying unless evaluated and cleared by the FAA.

These include:

• Myocardial infarction (heart attack)

• Angina pectoris

• Coronary heart disease requiring treatment

• Cardiac valve replacement

• Permanent cardiac pacemaker

• Heart transplant

The FAA’s concern is not the diagnosis alone — it’s the risk of sudden incapacitation.

For small-aircraft operations, even brief incapacitation in flight can pose serious risk, especially during takeoff, landing, or single-pilot IFR.

However, many cardiovascular conditions are eligible for special issuance under §67.401 if properly treated and stable.

Neurologic Standards (Third-Class)

Neurologic conditions are evaluated carefully due to their potential unpredictability.

Disqualifying conditions include:

• Epilepsy

• Disturbance of consciousness without satisfactory explanation

• Transient loss of nervous system function

• Stroke (cerebrovascular accident)

Again, the FAA’s primary concern is in-flight incapacitation or impaired cognitive function.

A single unexplained blackout event, for example, typically triggers FAA review.

Mental Health Standards (Third-Class)

Under §67.303, certain psychiatric conditions may be disqualifying, including:

• Psychosis

• Bipolar disorder

• Personality disorders that are severe enough to have repeatedly manifested in overt acts

• Substance dependence

The FAA evaluates whether a condition:

• Impairs judgment,

• Affects cognition,

• Interferes with safe performance of pilot duties.

Importantly, not all mental health diagnoses are permanently disqualifying. Treatment history, stability, and medication use are considered carefully.

At this level, you now understand the categories of conditions that draw FAA attention under Part 67.

But how these standards are applied in practice is where many pilots have questions.

Special Issuance, Stability & What Actually Triggers Deferral

Let’s look deeper at how these regulations are implemented.

A Diagnosis Is Not Automatically the End

Many private pilots assume:

“Heart condition = grounded forever.”

That’s not necessarily true.

Under §67.401, the FAA may grant a Special Issuance Authorization if:

• The condition is stable,

• Treatment is effective,

• Risk of incapacitation is acceptably low,

• Ongoing monitoring is possible.

For example:

• Pilots with treated coronary artery disease

• Pilots with certain controlled arrhythmias

• Pilots post-stent placement

…may receive time-limited medical certificates with reporting requirements.

Mental Health & Medication

Mental health treatment does not automatically disqualify an applicant.

However:

• Certain psychiatric diagnoses listed in Part 67 require FAA review.

• Some medications are disqualifying.

• Others may be permitted under structured evaluation pathways.

The FAA looks at:

• Stability of condition

• History of symptoms

• Duration of treatment

• Functional performance

Honest reporting is critical. Failing to disclose treatment history can create far greater problems than the diagnosis itself.

“Disturbance of Consciousness”

One of the most commonly misunderstood phrases in §67.303 is:

“Disturbance of consciousness without satisfactory medical explanation.”

This includes:

• Unexplained fainting episodes

• Blackouts

• Seizure-like events

Even a single unexplained episode often triggers deferral until evaluated.

The FAA’s concern is unpredictability.

The FAA’s Core Medical Principle

Across cardiovascular, neurologic, and psychiatric standards, one principle remains consistent:

Risk of sudden incapacitation or impaired judgment.

The FAA is not evaluating perfection.

It is evaluating operational safety in a single-pilot cockpit environment.

Why This Matters for Private Pilots

Small-aircraft operations often involve:

• Single-pilot responsibility

• Limited automation

• Rapid workload changes

• No backup crew

Part 67’s medical standards reflect that reality.

They are structured to minimize the likelihood of:

• Sudden loss of consciousness

• Cognitive impairment

• Decision-making degradation

The standards may feel strict — but they are risk-based.

Coming Up Next

In Article 4, we’ll examine:

• Substance abuse and dependence standards

• General medical conditions

• Diabetes and metabolic disorders

• The meaning of “established medical history”

Because Part 67 doesn’t just look at dramatic events.

It also evaluates ongoing health conditions that may affect safe flight.

Until then:

Be informed.
Be honest.
And remember — the FAA is evaluating risk, not perfection. 🛩️