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after consultation with flight operations experts. An applicant may be found fit to operate an aircraft as a
pilot under supervision or as a co-pilot but not as a pilot-in-command. In cases where prognosis cannot be
given with the necessary degree of certainty, any potential risk to flight safety may, in general aviation
where two pilots are not normally required, be mitigated by a restriction to fly without passengers or
outside controlled airspace only or neutralized by the carriage of a “safety pilot”. Such a pilot should
receive adequate information about the medical condition which has led to the restriction “with safety
pilot only”. In addition, he must be capable of acting as pilot-in-command in case of an emergency. In
commercial aviation, a restriction to multi-crew operations only may serve a similar purpose. In such a
manner it is often possible to fit individuals into aviation by restricting their licence or limiting their
duties and thus mitigating the risk to flight safety while retaining the experience of individuals who would
otherwise be denied a licence.
1.2.5.2.1 The period of validity of a Medical Assessment may be reduced when clinically indicated.
Annex 1, 1.2.5.2, sets out a table listing the normal maximum time intervals between medical
examinations for continued validity of a range of licences. The following Standard 1.2.5.2.1 allows the
Licensing Authority to require an individual to be medically re-examined at more frequent intervals. In
many cases, however, progress reports on an individual at intervals during the period of validity of his
licence will suffice, thus making a complete medical certification examination unnecessary. Sometimes it
may be relevant to observe the applicant on the flight deck or in a synthetic flight trainer. In such cases, it
is important to obtain the co-operation of operators and qualified flying instructors. It is entirely possible,
by utilizing advice from experienced specialists and/or accredited medical conclusion, to introduce some
flexibility into the process without degrading the intent of the medical standards in Annex 1. While this
would require an additional effort from the Licensing Authority, it could provide a continuing and critical
analysis of the existing medical requirements and could show whether they achieve their purpose.
Moreover, it will extend the careers of those who are professionally employed and enable an increasing
number of motivated individuals to achieve their ambition to fly while, at the same time, avoiding any
compromise of flight safety.
ICAO Preliminary Unedited Version — October 2008 I-3-13
SAMPLE PROCEDURES FOR EVALUATION
OF BORDERLINE CERTIFICATION CASES
Sample medical flight tests
Borderline medical conditions should first be referred to a specialist for a thorough investigation as
outlined in the following chapters of this manual. This should include an evaluation of whether or not the
condition is progressive, to what extent function is impaired, and whether there is any risk of future
deterioration or sudden incapacitation. If the applicant fails to meet the medical requirements but the
condition, in the examiner’s opinion, does not affect the regular and safe performance of duties, the
Licensing Authority might wish additionally to assess any skill and experience demonstrated during
practical flight tests, in order to make certain that the applicant is capable of performing duties without
endangering flight safety.
Special medical flight testing, appropriate to the applicant’s deficiencies, is conducted to help the
Licensing Authority estimate the applicant’s ability to perform under normal as well as adverse flight
conditions. Therefore, testing of the applicant could include marginal or simulated marginal conditions
such as might be encountered in emergency operations, in adverse weather, in twilight or at night, in haze
or cloudiness, and in flight towards the sun as appropriate to the condition being assessed.
The flight test report should comment on the conditions under which tests were given.
Reasonable simultaneous tasks should be introduced during medical flight testing (such as map reading
and navigation, operation of flight equipment, maintenance of communications, and even equipment or
engine malfunction) to estimate the applicant’s ability to perform more than one task simultaneously.
Specifications for such special medical flight tests provide guidelines to help in determining the
applicant’s abilities and limitations. Where the applicant’s abilities are compared to those of the flight
examiner, it is assumed that the relevant flight examiner’s physical attributes are normal. If not, the
applicant should be reassigned to another flight examiner.
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Manual of Civil Aviation Medicine 1(25)
