How ‘letters of conditions’ keep pilots in the sky – and safe.

Many pilots worry that declaring a medical condition to the CAA might put an end to their flying.

“The reality is more reassuring,” says Claude Preitner, CAA Senior Medical Officer. “The CAA’s medical system is designed to help pilots continue to fly safely, not stop them from flying.”

Pilots can stay in the air if their risks are properly managed through endorsements, conditions, and restrictions on their medical certificate, and monitoring requirements.

This is the Accredited Medical Conclusion (AMC) process. A favourable AMC allows the CAA to issue a medical certificate to a pilot when they don’t meet the standard, but can safely operate under defined conditions (for example, ‘extra follow-up’ or ‘limited operational privileges’).

When the CAA applies conditions

The CAA or your medical examiner may apply conditions to your medical certificate because of the following issues:

• A health issue could affect safe flying. This includes anything that might impair alertness, judgement or physical functioning – for example, an asthmatic pilot may be required to carry an inhaler.
• A pilot doesn’t fully meet Part 67 standards. Part 67 sets criteria for impairments, including vision, hearing, neurological function, and cardiovascular health. The CAA may still issue a medical certificate with conditions to manage risk when the pilot flies.
• The CAA requires more detailed periodic monitoring for some conditions that, although stable, need regular check-ins (for example, annual cardiology reports, blood tests, medication reviews).

How these conditions appear on a medical certificate

Endorsements printed on the certificate

These fall into two groups:

• Operational endorsements apply directly to how you fly (for example, ‘corrective lenses must be worn’ or ‘not valid for night flying’).
• Non-operational endorsements are requirements you must meet during the certificate’s validity period, such as medical surveillance or specialist follow-up. These are generally referred to on the certificate and detailed in a separate letter.

Shortened medical certificate validity

The CAA can issue a pilot with a medical certificate lasting for a shorter period than the maximum permitted, with specific notes or conditions on it. The pilot’s health can be checked again sooner to make sure they remain stable and safe to fly.

Compliance considerations

“A pilot must comply with all the conditions, restrictions, and endorsements on their medical certificate,” Claude says.

“If any of the conditions attached to the medical certificate aren’t met, the pilot can’t legally fly – even if the certificate is still within its validity period.”

Pilots must also tell the CAA about any change in their medical condition that may affect safety, and they must pause flying until the matter is resolved. This requirement applies if they know or suspect they have a ‘new’ condition, or notice a change to an existing condition, such as new symptoms or an increase in their severity or frequency.

The only exceptions are medical conditions that clearly fit one of the specific exemptions in the CAA’s General Directions Exceptions for Temporary Medical Conditions. These are minor, short-term issues that meet all the listed ‘acceptable characteristics for non-reporting’ for that condition.

For example, mild hay fever – causing only occasional sneezing, no eye irritation, sinus or ear blockage, and no breathing problems – doesn’t need to be reported.

Other common examples*

Diabetes

John is diabetic, the side effects of which can impair him if he doesn’t manage his condition, presenting a risk when he pilots an aircraft. He manages his condition without using insulin.

His medical certificate may still be issued for 12 months, but a certificate of surveillance is also issued requiring specific three-monthly checks to make sure his diabetes remains stable through the certification period.

Sleep disorder

Andrew has moderately severe obstructive sleep apnoea (his breathing repeatedly stops and starts when he sleeps). This results in fatigue that is a significant risk to aviation safety.

Certification is only possible if he regularly sleeps using a medical device that delivers a steady stream of pressurised air through a mask to keep his airways open.

He must also demonstrate compliance by supplying the CAA with regular data downloads from the device (usually every three months).

Heart condition

Maia suffered a heart attack and she has a residual risky heart impairment. This creates an unacceptable level of risk for solo pilot operations.

The CAA may mitigate this by applying a multi-crew restriction when she carries passengers, meaning she may fly only as part of a crew, so there are always two pilots at the controls.

A restriction ‘not valid for air operations carrying passengers’ may be imposed on the Class 1 certificate, allowing her to return to restricted flying operations.

Challenging a medical decision

If you want a review of a CAA medical decision, you can:

• within 20 working days of the decision to decline, or impose a condition or restriction on a medical certificate, seek a free review by the convener of certain decisions. The convener is an independent specialist appointed by the Minister of Transport.
• provide new medical evidence (for example, specialist reports) to satisfy the specific concern – this is the basis on which AMCs and endorsements can be adjusted. 

Contact med@caa.govt.nz if you have questions.

More information

Download Medical matters GAP booklet [PDF 3 MB] or request a printed copy.

Also read A new way to report health conditions - Introducing Safe Haven (Vector, Summer 2024).

Go to the Safe Haven website(external link) to learn more about this new programme.