First-Class Medical Mental Standards

FAR 67.107 First-Class Medical Mental Standards

FAR 67.107 sets the mental health standards for a first-class airman medical certificate, covering psychosis, bipolar disorder, substance dependence, and abuse.

In Plain English

FAR 67.107 lists the mental health conditions that disqualify an applicant from a first-class airman medical certificate — the certificate required for ATP privileges. The Federal Air Surgeon uses these standards to decide who can safely fly at the highest commercial level.

You cannot have a history or clinical diagnosis of:

  • A personality disorder severe enough to have repeatedly shown itself through overt acts
  • A psychosis — including delusions, hallucinations, or grossly disorganized behavior, either present or reasonably expected
  • A bipolar disorder
  • Substance dependence, unless you can prove recovery with at least 2 years of total abstinence acceptable to the Federal Air Surgeon

You also cannot have substance abuse within the preceding 2 years, which includes a verified positive drug test, a BAC of 0.04 or greater, refusing a DOT-required test, or hazardous use of a substance.

Finally, any other neurosis or mental condition that the Federal Air Surgeon judges unsafe is disqualifying. This matters because mental fitness directly affects judgment, decision-making, and crew performance — the core of safe airline flying.

Regulation Text
14 CFR § 67.107
§ 67.107 Mental. Mental standards for a first-class airman medical certificate are: (a) No established medical history or clinical diagnosis of any of the following: (1) A personality disorder that is severe enough to have repeatedly manifested itself by overt acts. (2) A psychosis. As used in this section, “psychosis” refers to a mental disorder in which: (i) The individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition; or (ii) The individual may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition. (3) A bipolar disorder. (4) Substance dependence, except where there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. As used in this section— (i) “Substance” includes: Alcohol; other sedatives and hypnotics; anxiolytics; opioids; central nervous system stimulants such as cocaine, amphetamines, and similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and chemicals; and (ii) “Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by— (A) Increased tolerance; (B) Manifestation of withdrawal symptoms; (C) Impaired control of use; or (D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning. (b) No substance abuse within the preceding 2 years defined as: (1) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous; (2) A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or (3) Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds— (i) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. (c) No other personality disorder, neurosis, or other mental condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds— (1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. [Docket 27940, 61 FR 11256, Mar. 19, 1996, as amended by Amdt. 67-19, 71 FR 35764, June 21, 2006]
Oral Exam Questions a DPE Might Ask
Q1What mental conditions are automatically disqualifying for a first-class medical certificate?
Per FAR 67.107(a), an established history or diagnosis of a severe personality disorder with overt acts, psychosis, bipolar disorder, or substance dependence is disqualifying.
Q2How does FAR 67.107 define substance abuse, and how recently does it matter?
FAR 67.107(b) disqualifies an applicant for substance abuse within the preceding 2 years, including a verified positive drug test, an alcohol test of 0.04 or greater, refusal to test, or hazardous misuse the Federal Air Surgeon finds unsafe.
Q3Can a pilot with a past substance dependence diagnosis ever qualify for a first-class medical?
Yes. Under FAR 67.107(a)(4), an applicant may qualify with established clinical evidence of recovery satisfactory to the Federal Air Surgeon, including sustained total abstinence for at least the preceding 2 years.
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FAR 67.107 — First-Class Medical Mental Standards