When a pilot hears “deferred” or “denied,” the mind goes straight to worst-case scenarios. In reality, those two outcomes mean very different things. One is the FAA saying, “We need more information.” The other is the FAA saying, “Not eligible right now.”
At Kansas Aviation Medicine, Dr. Harrison performs FAA Class 1, 2, and 3 exams for pilots ranging from GA to ATP. His focus is on clean documentation and predictable outcomes working hard to prevent avoidable deferrals and keep pilots out of the denial lane. Here is what each outcome means, what typically happens next, and how to keep your medical from becoming the weak link in your flying plans.
THE THREE POSSIBLE OUTCOMES AT YOUR EXAM
At the end of an FAA medical exam, an AME has three basic options:
- Issue the certificate on the spot
- Defer the application to the FAA for review
- Deny the application if you clearly do not meet medical standards
Most pilots are used to “issue,” because it is common. The confusion usually starts when an AME cannot legally issue that day, even if the pilot feels fine.
WHAT A DEFERRAL ACTUALLY MEANS
A deferral means the AME is not allowed to issue at the exam, so the application is sent to the FAA for a decision. The AME defers when the FAA’s disposition tables or an authorization letter requires deferral, when more information or evaluation is needed, or when there is uncertainty about the significance of findings. The FAA also instructs AMEs not to hold an exam beyond 14 days while waiting for documents, so missing records often trigger deferral.
A deferral is not a final “no.” It is a handoff. The FAA, usually Aerospace Medical Certification Division in Oklahoma City or a Regional Flight Surgeon, becomes the decision-maker.
Common reasons for deferral include:
- A condition that requires FAA review or special issuance
- A medication history that needs documentation
- A new diagnosis that is not fully documented
- Missing specialist notes, labs, imaging, or treatment summaries
- A history item that was disclosed but not explained well
In pilot terms, a deferral is often a paperwork and documentation problem, not a health emergency.
If your situation involves alcohol or other high-scrutiny issues, our HIMS evaluations and consults can help you map the correct path before you submit anything to the FAA.
WHAT A DENIAL MEANS
A denial is a formal decision that you do not currently meet the medical standards for the class applied for. Denials are less common than deferrals, and they are higher stakes because they start formal appeal timelines.
Denial can happen in two ways:
- An AME issues a denial at the exam because the pilot clearly does not meet standards at that moment, or
- The FAA denies the application after review of a deferred file
The important point is this: A denial is not “we need more information,” but rather “not eligible right now.”
A NOTE ON “DENIAL” AT KANSAS AVIATION MEDICINE
One point that helps reduce a lot of anxiety: In Dr. Harrison’s entire career as an AME, he has never denied a pilot’s medical certificate in the exam room. His approach is straightforward. If a pilot clearly meets the standards, he issues. If something requires additional review, records, or FAA input, he defers the application and let’s the FAA make the decision.
That matters for two reasons. First, it keeps the process fair and consistent, especially in borderline cases where a denial would create unnecessary damage and timelines. Second, it gives the pilot the best chance to submit the right documentation and have the file evaluated by the FAA medical certification team, which is exactly what the regulations are built for.
If there is a concern that could change the outcome, Dr. Harrison would rather slow down, get the right information, and submit it correctly than force a snap decision in a single appointment.
WHAT HAPPENS AFTER A DEFERRAL
After deferral, the FAA reviews the submitted application and any supporting documents. If the FAA needs more information, they will send a request specifying what they want and where to send it.
This is where most delays occur. Not because the condition is automatically disqualifying, but because pilots submit incomplete records, the wrong tests, or a specialist letter that does not answer the FAA’s actual questions.
Practical steps after a deferral:
- Read the FAA letter carefully and respond to the exact request, not what you think they meant.
- Send complete packets, not one page at a time.
- Label everything with your identifying information and any case reference numbers the FAA provides.
- Keep copies of everything you send.
- If you cannot meet a deadline, request an extension in writing before the deadline passes.
If you are working with Kansas Aviation Medicine, we will help you interpret the request and build a clean submission plan. The FAA is not looking for volume. They are looking for specific answers from qualified sources.
WHAT HAPPENS AFTER A DENIAL
If you receive a denial, you have two key pathways inside the FAA system:
- Reconsideration within the FAA
- Review by the NTSB after a final FAA denial
The FAA’s own guidance states that you may apply for reconsideration within 30 days after the date of denial, under 14 CFR 67.409, by writing to the Federal Air Surgeon through Aerospace Medical Certification Division.
If the denial becomes final, FAA guidance explains that an airman may petition the NTSB for review within 60 days after a final denial of an unrestricted medical certificate.
Those are hard timelines. The “right” move depends on why the denial occurred, what documentation exists, and whether the issue is correctable with treatment, time, or a better medical narrative.
This is also where it becomes important to avoid internet shortcuts. Denial management is case-specific, and it is worth getting competent aeromedical guidance early.
HOW TO PROTECT YOUR CERTIFICATE BEFORE YOU EVER SIT DOWN FOR THE EXAM
Most pilots can avoid the worst outcomes with a simple rule.
Do not walk into an FAA medical unprepared if you have any complexity.
Here is what that looks like in practice.
1) Do a pre-exam consult when you have any red flags
If you have a history of cardiac workups, sleep apnea, diabetes, psychiatric treatment, DUI, substance-related history, or prior FAA correspondence, do not “just show up and see what happens.” That is how pilots get boxed into deferral or denial.
A pre-exam consult lets us decide whether to proceed with a formal exam or do a consult-first strategy that protects your options.
2) Bring the right documentation, not just a diagnosis list
The FAA generally cares about stability, treatment, follow-up, and risk. A diagnosis with no treatment summary is rarely enough.
A strong packet often includes:
- A concise treating physician summary
- Relevant testing results, with dates
- Current medication list and dosing
- Compliance documentation when required
- Clear statement of functional status and symptom control
3) Treat MedXPress like a legal document
It is. You should save a copy of your application for your records, and complete the AME exam within 60 days of submitting it.
Most trouble starts when pilots rush MedXPress, omit details, or answer in a way that creates confusion later.
If something is complicated, do not guess. Ask your AME team how to present it accurately.
4) Stay with an AME who knows your file
Switching AMEs is not automatically wrong, but it increases the odds of inconsistent history, incomplete context, and unnecessary back-and-forth. Continuity reduces surprises.
DEFERRAL IS COMMON, DENIAL IS AVOIDABLE
A deferral is often a solvable process problem. A denial is a decision that triggers formal timelines and usually indicates something significant was missed, misunderstood, or unmanaged.
If you’re due for an exam, you can schedule an FAA medical online. If you are worried about a deferral or what the FAA may ask for, start with a confidential consultation. You will leave with a clear plan and the right documentation targets.
