Behind the Scenes of a Deferred Medical Application

Caitlin LoRusso is a managing partner of LoRusso & LoRusso, Ltd., a boutique aviation law firm based at KBJC in Broomfield, Colorado.  Her practice focuses on aircraft transactions, pilot and aircraft certificate defense, crash litigation, FAA regulation consulting, drone consulting and litigation, and aviation tax consulting.  When Caitlin is not in the office, she can be found in the kitchen baking pastries or flying in airshows up and down the Front Range with her husband and law partner, Joseph LoRusso, in a 1943 Boeing Stearman 450 biplane.

As an AOPA Panel Attorney with a busy certificate defense practice, I see pilots on a daily basis struggle as they wait to hear if they'll be able to fly again.  This propelled me to contact the staff at the Civil Aerospace Medical Institute (CAMI) to get an idea of what exactly is going on in Oklahoma City.  What I learned is that they are just as busy as you would expect an office to be that processes virtually every FAA airman medical certificate application in the world.  As of 2018, there are 560,162 medically certified airmen, ages 16 and up.  Of that number, 36.8% have a first class medical, 19.8% have a second class, and 43.5% have a third class.[1]  Each and every one of those medical applications eventually made its way to the Mike Monroney Aeronautical Center in Oklahoma City where they are overseen or reviewed in some capacity by CAMI.

While the majority of medical applications are approved and issued by an AME on the spot, some certifications, particularly those disclosing a condition listed in Box 18 on FAA Form 8500-8, are deferred and then require secondary review by the staff doctors and Legal Instrument Examiners at CAMI.  This means that the examining AME determined that the airman did not meet the standards required for a medical certificate to be issued, or there was an unresolved question regarding the pilot's medical history or condition.  This secondary review typically leads to an issuance of a medical certificate or a request for additional information.  If further information, such as supplemental medical records, is required, the pilot will be contacted by letter.  After the pilot submits the requested information, the doctors at CAMI review the file again and will issue an approval or a denial. 

For the pilots who are grounded while their medical file is in the review queue, it can seem like the FAA machine is intentionally geared to move slowly just to aggravate and dishearten airmen.  After all, the FAA's unofficial motto is "We're not happy until you're not happy."  However, what the pilot community doesn't know is that, while they report wait times anywhere between 2 weeks and a year (the longest we’ve seen in our office is 14 months), the hard-working staff at CAMI is cranking out between 15,000 and 20,000 certifications per month.  In addition, they field 500-600 calls per day from pilots, attorneys, and AMEs - yet still manage to sound pleasant when they answer the phone. 

So, my best advice is, if you know you're going into your AME’s office with an issue that could trigger a deferral, consult with AOPA’s Medical Certification Staff and/or an AOPA Panel Attorney beforehand and make sure that you provide exactly what is asked for by the FAA (and nothing more) in a timely manner.  Then prepare to be patient.  Everyone at CAMI works diligently and with every intention of issuing medical certificates.  While we all love to hate the FAA, their purpose is to make the skies safe for all of us, and the folks at CAMI provide an important service to airmen everywhere.  For information about the medical certification process, go to 

[1] VJ Skaggs, Norris, AI, 2016 Aerospace Medical Certification Statistical Handbook, DOT/FAA/AM-18/4, May 2018, at i, available at

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