A second class medical certificate is an FAA-issued health clearance required for commercial pilots, flight engineers, flight navigators, and air traffic control tower operators. It sits between the first class certificate (needed for airline transport pilots) and the third class certificate (for private and recreational pilots). If you plan to fly commercially for compensation or hire, this is the medical standard you need to meet.
Who Needs a Second Class Medical
You need at least a second class medical certificate to exercise the privileges of a commercial pilot certificate in any aircraft other than a balloon or glider. That includes crop dusting, banner towing, aerial photography, charter flights, and any other paid flying work that falls under commercial pilot authority. As of May 2023, balloon pilots exercising commercial privileges (other than instructional flights) also need one.
Air traffic control tower operators who are not FAA employees also fall under this requirement. Flight engineers and flight navigators, though increasingly rare roles, are included as well. If you hold a commercial certificate but only fly as a private pilot, a third class medical is sufficient. The certificate class is tied to the privileges you’re actively using, not just the ratings on your pilot certificate.
How It Differs From First and Third Class
All three classes share the same disqualifying conditions and many of the same physical standards. The practical differences come down to what you’re allowed to do and how long the certificate lasts. A first class medical is required for airline transport pilot duties and includes an EKG at certain ages. A second class medical does not require an EKG and has no intermediate vision requirement, while first class certificates do. A third class medical allows only private pilot privileges.
Think of the three classes as a ladder: holding a higher class always covers the privileges below it. A pilot with a valid first class medical can do everything a second or third class allows. When a first class certificate expires for airline transport purposes, it typically downgrades to second class privileges for a period before eventually dropping to third class.
Vision Standards
The vision bar for a second class medical is straightforward. You need 20/40 or better in each eye separately for distant vision, with or without corrective lenses. Near vision must also be 20/40 or better in each eye, measured at 16 inches. There is no intermediate vision requirement for second class, which is one area where it’s less demanding than first class.
If you wear glasses or contacts to meet these thresholds, your certificate will carry a limitation requiring you to have corrective lenses available while flying. Color vision is also tested during the exam, typically using standard plate tests.
Hearing Standards
The hearing test starts simple: you need to hear a normal conversational voice in a quiet room at 6 feet with your back turned to the examiner. If you can’t pass that, the examiner moves to a pure tone audiometry test. The passing thresholds at key frequencies are 35 decibels at 500 Hz, 30 dB at 1,000 Hz, 30 dB at 2,000 Hz, and 40 dB at 3,000 Hz in your better ear. The poorer ear gets more leeway, with thresholds of 35, 50, 50, and 60 dB at those same frequencies.
If you fail both the voice test and the audiometry, there’s one more option: a speech discrimination test, usually administered by an audiologist. You need to score at least 70 percent in one ear at no more than 65 dB intensity.
Blood Pressure and Cardiovascular Requirements
Your blood pressure must not exceed 155/95 mmHg. If you’ve used blood pressure medication, you need to have been off it for at least 30 days before the exam to receive an immediate issuance. Pilots who manage hypertension with certain approved medications can still qualify, but the process involves additional review.
Several cardiovascular conditions are automatically disqualifying: heart attack, angina, coronary heart disease that has required treatment or caused symptoms, heart valve replacement, permanent pacemaker implantation, and heart replacement. These don’t necessarily mean you can never fly commercially, but they require a special issuance process rather than a routine exam.
Disqualifying Medical Conditions
Beyond cardiovascular issues, the FAA lists specific neurological and mental health conditions that prevent standard certification. Epilepsy is disqualifying, as is any unexplained loss of consciousness or unexplained loss of nervous system function. On the mental health side, a diagnosis of psychosis, bipolar disorder, or a severe personality disorder that has manifested in repeated overt acts will block certification.
Substance dependence is also disqualifying, but with a clear path back. If you have clinical evidence of recovery, including at least two years of sustained total abstinence, the Federal Air Surgeon can approve certification. The key word is “dependence,” not occasional use, though any substance issue disclosed or discovered during the process will receive scrutiny.
How Long It Lasts
A second class medical certificate is valid for 12 months for commercial pilot privileges. After that 12-month window, it doesn’t disappear entirely. It downgrades to third class privileges, which remain valid for an additional period depending on your age: 60 months total from the date of examination if you’re under 40, or 24 months total if you’re 40 or older. So a 35-year-old commercial pilot who lets the certificate lapse after 12 months can still fly as a private pilot for several more years on the same exam.
The Application and Exam Process
Getting a second class medical starts online through the FAA’s MedXPress system. You create an account, answer a series of medical history questions, and submit the application electronically. Once submitted, you have 60 days to complete your in-person exam before the application expires from the system.
Next, you find an Aviation Medical Examiner using the FAA’s online directory at designee.faa.gov. AMEs are physicians with specialized FAA training, and their fees vary by location and practice. Expect to pay roughly $100 to $200 for a second class exam, though prices differ. Flight schools and local pilot groups can often recommend AMEs who are experienced and efficient.
On exam day, bring your MedXPress confirmation number, a government-issued ID, and copies of any relevant medical records. If you have a current or past medical condition, research the AME Guide beforehand so you know what documentation to bring. Having the right paperwork at your appointment can mean the difference between walking out with a certificate that day and waiting weeks for additional review. The exam itself covers vitals, vision (acuity, depth perception, color vision), hearing, a urine sample, and a physical examination performed by the AME.
What Happens if You Don’t Qualify
Failing to meet a standard doesn’t always end the conversation. The FAA offers a Special Issuance process for pilots with conditions that are initially disqualifying. This involves submitting additional medical documentation to the FAA’s Aerospace Medical Certification Division, which reviews your case individually. If approved, you receive an Authorization for Special Issuance, and your AME can reissue your medical certificate at future exams as long as you continue to meet the specialized criteria.
For certain static conditions like the loss of an eye or a limb, a Statement of Demonstrated Ability (SODA) may apply instead. This is a one-time practical test showing you can safely operate an aircraft despite the condition. Once granted, it typically doesn’t need to be repeated at each renewal. The special issuance and SODA processes add time and paperwork, but they keep commercial flying accessible to pilots managing a wide range of health conditions.