Navigating the First Class Medical

When beginning your transition to the airlines usually you will compare several different R-ATP programs, map out domiciles with the various regionals, and have a good understanding of the steps involved. However, a largely overlooked part of this planning is getting a FAA first class medical certificate.

I’m in my 26th year of Naval service and I’ve had my share of health issues, but nothing I would consider abnormal for someone in their 40’s. Even if you are in great health, you probably still have some small issues or take daily medication. Medical issues can be big, small or somewhere in-between. I unfortunately fell into the big issue category. Late last year, while sitting in my office, I experienced a complex medical episode. All of my symptoms lasted only a few minutes and I didn’t think much of it, but after urging from my wife and a phone call to my flight surgeon, I reluctantly ended up at my local ER.

I was almost 45 and in pretty good health. I passed my last Navy flight physical and scored high on my last physical readiness test. As I sat in the ER hearing what the doctors were telling me, I could see my plan of flying for the airlines taking off without me, but I knew my #1 priority was my health. I was transported to the Navy hospital for further testing. After getting an official diagnosis I was at a loss of where to go from there. I have a flight surgeon in my squadron, but he is not an FAA Aviation Medical Examiner (AME). I turned to some networking sites I’m a member of for guidance and was able to track down a highly recommended AME. I had some time on my hands since I was grounded by both the Navy and the FAA for 6 months.

Getting your first class medical can be completed with just one trip to your local AME. A quick eye exam, EKG, some lab tests, and you are walking out with a class first class medical. Mine was nowhere this easy or cheap. So where do you start if you have a complex case? If you don’t have any major issues, then I would start here and read through the various links. If you consider yourself a complex case, then do some research to find the best doctor that has experience specifically in your issues. Navigating the waiver process can be difficult and requires certain language. Your local AME might be proficient at basic flight physicals, but you should ask questions about their familiarization with your issues and their experience level of getting complex cases through the system.

I initially touched base with my soon-to-be AME via email. I provided my background and he said he could probably get me a first class medical, but he would make no promises. He would not review any medical documents until I was ready to start the official paperwork and provide the associated fees. Since I was in the 6 month no fly window the AME suggested I wait 3 months to officially became one of his clients. I was glad I started at the 3-month mark because he had a lot of tasks for me to complete.

Over the next 90 days I had a lot to accomplish. First was getting copies of all my records, starting with the ER trip and all tests. Since I started at my local hospital and was transported to the military facility later that night, I had to get copies of everything from each facility. There were lots of tests and various specialists I encountered not only during my visit to both hospitals, but for all the follow up appointments. Neurology, Cardiology, MRI, MRA, CT scans, and lots of other fun things that happen when you are at the hospital. I compiled all the doctors’ notes and test results and sent them off to the AME.

Then I had to start working on the “To Do” list provided to me. This included several follow up trips to various specialists. My AME gave me very specific wording that he wanted to see entered officially in my medical record. The wording used in your medical records can be critical. This back and forth went on for several months and included my Navy doctors filling out FAA forms that they were unfamiliar with. I found that doctors don’t like being told what to do or what to write in a medical record.

After 6 months (actually at day 183 which is a FAA requirement), I finished up with one last appointment and booked a visit with my AME in person. Hilton is currently giving transitioning veterans 100K Hilton Honor points to assist in job hunting, and I used some of those points to pay for my room.

The physical itself was pretty routine, until I discovered a disconnect between the military and FAA: prescription medicines that I was taking and were approved for use by the Navy were not necessarily approved for use while flying by the FAA. This proved to be a bigger problem than I thought, as I had to do my own research to find an allowable FAA medicine. You can find a list on or

Once I found a, FAA allowable medicine, I had to get my current Navy doctor to prescribe it and put in my medical record that I was no longer on the old medicine, then I had to get my AME copies of the doctor’s note. Not long afterward, I was able to get a first class medical certificate, although mine came with stipulations that have to be accomplished as part of my yearly exam.

I’m still a year away from retiring, but I feel much better knowing that I have my medical clearance. I feel that if I did not have the right doctor then I would not have been given the clearance. Get started early in your research and don’t let your medical clearance expire.

Good luck, and I hope to see you on the line someday.

By Scott "Smoke" Moak

Scott Moak is an Active Duty Navy Commander with over 26 years of service. He is a CFI/CFII and type rated in the
S61 and S70 with over 2400 flight hours. He hopes to start RTP training with PSA Airlines early next year.
Follow him on Instagram at @scottmoak

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