A federal agency’s authority to issue new regulations originates from the laws (statutes) enacted by Congress. These laws grant an agency general authority to regulate the activity of a certain area of society. The FAA, for example, is tasked with regulating all aviation-related activity in the United States. The aviation regulations are housed in Title 14 of the Code of Federal Regulations (C.F.R.) and are referred to as the Federal Aviation Regulations or “FARs.” The FARs cover everything from airworthiness standards, charter operations, pilot certification, and more.
Agencies cannot go beyond their statutory authority and must stay within the confines of the U.S. Constitution when promulgating new regulations. An agency must also adhere to the framework of the Administrative Procedure Act (APA). This is primarily done through a “notice and comment” rulemaking procedure.
In general, the notice and comment process starts with a notice of the proposed rule. This notice is published in the Federal Register[i] and includes, among other information, the initial draft of the rule and instructions on how the public can participate. The next step is a public comment period, typically lasting 30 days, wherein the public can submit written comments or feedback on the proposed rule. After the comment period, the agency will review and consider any comments and make edits as needed. The final rule is then implemented. This notice and comment process is fundamental to ensuring individuals, groups, and communities affected by a federal agency’s proposed rule can be heard.
The AME Guide
Pilots are expected to know the FARs. While the FARs themselves may not change consistently, many of the FAA’s underlying policies implemented to enforce the FARs do. A major example is with airman medical certification. The medical standard FARs are codified in 14 C.F.R. Part 67. The standards are sorted into six categories (mental, cardiovascular, etc.) and organized by the class of medical certificate. These FARs offer little detail and mostly outline generalized standards that formalize the FAA’s role in deciding an applicant’s aeromedical fitness. For specificity on how the FAA assesses medical conditions, one must look beyond the FARs and consult the FAA’s Guide for Aviation Medical Examiners (or “AME Guide”).
Per the FAA’s website, the AME Guide “provides pertinent information and guidance needed to perform the duties and responsibilities of an Aviation Medical Examiner.”[ii] The information and guidance include explicit instructions on how AMEs should evaluate certain medical conditions. The AME Guide offers details on medical decisions that are not outlined in the FARs. The information in the AME Guide is directly published by the FAA and thus provides a unique insight into how the FAA internally assesses specific medical conditions. No other publicly facing information of its kind is available.
The AME Guide is supposed to update the last Wednesday of every month. The updates may be administrative or affect FAA medical policy. The content of the monthly updates is at the medical division’s discretion and has been inconsistent in 2025. Prior to August 27, 2025, the last medical policy update was on December 12, 2024. After eight months of no movement, the FAA’s last update had 39 revisions, six administrative and 33 medical policy changes.[iii] The current iteration of the AME Guide is now 854 pages.
Unlike the notice and comment process that would be required to edit or add a medical standard in the FARs (14 C.F.R. Part 67), the AME Guide’s medical policies can change without notice and public comment. The AME Guide is essentially a living document that evolves at the will of the FAA and requires consistent monitoring to ensure compliance with medical standards. Many pilots simply do not have the bandwidth to keep up to date with the shifting medical landscape and their fluctuating health circumstances. AMEs may also have difficult times, particularly those who are not primarily practicing in aviation. The result is a moving goal post for compliance that will ground pilots for extended periods of time if completed incorrectly. It is another wrinkle in the already delicate balance of reporting that pilots deal with each time they renew their medical certificate.
Options Moving Forward
Transferring the AME Guide policies into the regulations and subjecting all aeromedical standard changes to the default notice and comment rulemaking would be overburdensome. However, maintaining status quo, wherein significant amendments to the underlying medical policies in the AME Guide are simply published by the FAA, would continue to subject pilots to sporadic updates. Finding a balance, whether via other established rulemaking options (hybrid, informal, etc.) or via new methods, is needed. Including industry leaders, aviation organizations, and other interested groups in the FAA’s determinations would create a joint commitment to stay at the forefront of aeromedical safety while at the same time fostering greater trust in the process and reasoning behind aeromedical changes. In the interim, it is recommended that pilots get as familiar with the AME Guide and/or contact legal counsel to assist with compliance and advocacy.
[i] https://www.federalregister.gov/
[ii] See https://www.faa.gov/ame_guide
[iii] See the following link for specific update information: https://www.faa.gov/ame_guide/media/archives.pdf
