Concussion and head injury
What the FAA's documents say about concussion and head injury, in plain words, with the FAA's own words one press away.
FAA term: Head Injury or Brain Injury (Concussion, Closed Head Injury (CHI), Open Head Injury, Traumatic Brain Injury (TBI))Covers: All classes
Show the FAA's words: which classes the FAA's table covers
HEAD INJURY or BRAIN INJURY Concussion, Closed Head Injury (CHI), Open Head Injury, Traumatic Brain Injury (TBI) All Classes
Short version
The disposition table has five rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AHead injury only: no brain injury, no concussion | Examiner issues | Examiner can issue |
| B1Brain injury four (4) or more years ago, as long as no seizure | Examiner issues | Examiner can issue |
| B2Brain injury, past 4 years: LOC, AOC, PTA under 1 hour, no seizure | Defers to the FAA | Special Issuance |
| Row CModerate brain injury, such as LOC, AOC or PTA of 1 to 24 hours | Defers to the FAA | Special Issuance |
| Row DSevere brain injury, such as LOC, AOC or PTA of 24 hours or more | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Concussion and head injury
- Row A · Examiner can issue
Head injury only, meaning no brain injury, no concussion and no neurological symptoms. The row says not to use it if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.). If the examiner can determine the condition was head injury only, as the row lists, the table says ISSUE, and the examiner annotates the information in Block 60, including the approximate mechanism and date of injury.
A. Head injury ONLY This means: • NO brain injury • NO concussion • NO neurological symptoms DO NOT use this row if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.) … If the AME can determine the condition was … ISSUE Annotate this information Block 60 including approximate mechanism and date of injury.
- B1 · Examiner can issue
A brain injury four or more years ago, including a concussion (a type of mild brain injury) or a mild brain injury, as long as there was no seizure. The row's exception is an immediate impact seizure, within 24 hours of injury. For high impact injuries, the row says see Row D. The examiner gathers information and addresses all the questions on the Brain Injury Decision Tool for the AME. If all items are in the clear, NO column, the table says the examiner may issue, and summarizes the history and diagnosis in Block 60. On any YES answer, any examiner concern, or a history that cannot be verified, the examiner defers.
B1. Brain injury four (4) or more years ago This includes: • Concussion (a type of mild brain injury) • MILD brain Injury As long as NO seizure* … If all items on the decision tool are in the clear, “NO” column, the AME may: … ISSUE Summarize this history, diagnosis, and annotate Block 60: … If any “YES” answers, any AME concerns, or unable to verify history – DEFER
- B2 · Special Issuance
A brain injury within the past four years, including a concussion or a mild brain injury, with loss of consciousness (LOC), alteration of consciousness (AOC) and post-traumatic amnesia (PTA) all less than 1 hour, and no seizure. The row's exception is an immediate impact seizure, within 24 hours of injury. For high impact injuries, the row says see Row D. After a 6-month recovery period, the table lists what to obtain and submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
B2. Brain injury Within the past four (4) years This includes: • Concussion • MILD brain Injury • Loss of Consciousness (LOC) • Alteration of Consciousness (AOC) • Post-Traumatic Amnesia (PTA) ALL less than 1 HOUR AND • No seizure … After a 6-month recovery period obtain the following evaluation(s) and submit for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
- Row C · Special Issuance
A moderate brain injury, including LOC, AOC, or PTA of 1 to 24 hours; a non-depressed skull fracture; a small parafalcine or tentorial subdural hematoma (resolved by MRI); or a small subarachnoid hemorrhage (resolved by MRI). After a 12-month recovery period, the table lists what to obtain and submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
C. Moderate BRAIN Injury This includes: • LOC, AOC, or PTA 1 to 24 hours • Non-depressed skull fracture • Small parafalcine or tentorial subdural hematoma (resolved by MRI) • Small subarachnoid hemorrhage (resolved by MRI) … After a 12-month recovery period obtain the following evaluation(s) and submit for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
- Row D · Special Issuance
A severe brain injury, including blood in the brain (brain contusion, intracranial bleed, hematoma, epidural hematoma, subdural hematoma, diffuse axonal injury); LOC, AOC, PTA of 24 hours or more; a depressed skull fracture; or a penetrating head injury. After a four-year recovery period, the table asks for all items in Row C to be submitted for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
D. Severe BRAIN Injury This includes: • Blood in the Brain: o Brain contusion o Intracranial bleed o Hematoma o Epidural hematoma o Subdural hematoma o Diffuse axonal injury • LOC, AOC, PTA: 24 hours or more • Depressed skull fracture • Penetrating head injury … After a four (4)-year recovery period submit for FAA review: • All items in Row C … DEFER Submit the information to the FAA for a possible Special Issuance
- A note on the table, 1
The table spells out its three abbreviations at its foot.
LOC: Loss of Consciousness AOC: Alteration of Consciousness PTA: Post-Traumatic Amnesia
- A note on the table, 2
Rows B1 and B2 each note that high impact or penetrating injuries (e.g., gunshot or severe trauma) may present with few or no concussive symptoms, and for high impact injuries say see Row D.
Note: High impact/penetrating injuries (e.g., gunshot or severe trauma) may present with few or no concussive symptoms. For high impact injuries, see Row D
The FAA pathways for concussion and head injury
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: Head injury only
For Row A, what the examiner determines at the exam.If there are any concerns in history.
If there are any concerns in history.
If there are any concerns in your history, your AME should review the most recent, detailed progress note describing the incident, recovery, and follow-up.
Show the FAA's words: Head injury only
If there are any concerns in history, the AME should review the most recent, detailed Clinical Progress Note describing the incident, recovery, and follow-up (if applicable).
FAA source: Head Injury (Concussion). FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
If the AME can determine the condition was • Head injury only (no brain injury) such as superficial scalp injury or globe (eyeball/eye injury) and/or musculoskeletal injuries (facial/maxilla/ mandible fractures) that do not persist and do not rise to the level of even a mild concussion; • No neurological symptoms; and • No “mild concussion symptoms” such as headache, dizziness, nausea, or non-focal neurological symptoms such as photo/phonophobia, tinnitus, irritability, mental fogginess, etc., as a result of the injury. • If imaging (CT/MRI) was performed, no evidence of brain trauma. • Has completely resolved and the individual has been released to full activity by the treating physician:
FAA source: Head Injury (Concussion). FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
DO NOT use this row if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.)
Note: The AME should NOT use this row if any symptoms, concerns for concussion/brain injury, or any complications.
FAA source: Head Injury (Concussion). FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
ISSUE Annotate this information Block 60 including approximate mechanism and date of injury.
FAA source: Head Injury (Concussion). FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
Step 2: See your AME
If the examiner can determine the condition was head injury only, as the row lists, the table says ISSUE, and the examiner annotates the information in Block 60, including the approximate mechanism and date of injury.Exam day- If the examiner can determine the condition was head injury only, as the row lists, the table says ISSUE, and the examiner annotates the information in Block 60, including the approximate mechanism and date of injury.
Show the FAA's words: See your AME
A. Head injury ONLY This means: • NO brain injury • NO concussion • NO neurological symptoms DO NOT use this row if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.)
If the AME can determine the condition was
ISSUE Annotate this information Block 60 including approximate mechanism and date of injury.
FAA source: Head Injury (Concussion). FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
If the examiner can determine the condition was head injury only, as the row lists, the table says ISSUE, and the examiner annotates the information in Block 60, including the approximate mechanism and date of injury.
B1Examiner issuesExaminer can issue
The examiner gathers information and addresses all the questions on the Brain Injury Decision Tool for the AME. If all items are in the clear, NO column, the table says the examiner may issue, and summarizes the history and diagnosis in Block 60. On any YES answer, any examiner concern, or a history that cannot be verified, the examiner defers.
B2Defers to the FAASpecial Issuance
After a 6-month recovery period, the table lists what to obtain and submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defersRow CDefers to the FAASpecial Issuance
After a 12-month recovery period, the table lists what to obtain and submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defersRow DDefers to the FAASpecial Issuance
After a four-year recovery period, the table asks for all items in Row C to be submitted for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Head injury only, meaning no brain injury, no concussion and no neurological symptoms. The row says not to use it if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.). If the examiner can determine the condition was head injury only, as the row lists, the table says ISSUE, and the examiner annotates the information in Block 60, including the approximate mechanism and date of injury.
A. Head injury ONLY This means: • NO brain injury • NO concussion • NO neurological symptoms DO NOT use this row if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.) … If the AME can determine the condition was … ISSUE Annotate this information Block 60 including approximate mechanism and date of injury.
- B1 · Examiner can issue
A brain injury four or more years ago, including a concussion (a type of mild brain injury) or a mild brain injury, as long as there was no seizure. The row's exception is an immediate impact seizure, within 24 hours of injury. For high impact injuries, the row says see Row D. The examiner gathers information and addresses all the questions on the Brain Injury Decision Tool for the AME. If all items are in the clear, NO column, the table says the examiner may issue, and summarizes the history and diagnosis in Block 60. On any YES answer, any examiner concern, or a history that cannot be verified, the examiner defers.
B1. Brain injury four (4) or more years ago This includes: • Concussion (a type of mild brain injury) • MILD brain Injury As long as NO seizure* … If all items on the decision tool are in the clear, “NO” column, the AME may: … ISSUE Summarize this history, diagnosis, and annotate Block 60: … If any “YES” answers, any AME concerns, or unable to verify history – DEFER
- B2 · Special Issuance
A brain injury within the past four years, including a concussion or a mild brain injury, with loss of consciousness (LOC), alteration of consciousness (AOC) and post-traumatic amnesia (PTA) all less than 1 hour, and no seizure. The row's exception is an immediate impact seizure, within 24 hours of injury. For high impact injuries, the row says see Row D. After a 6-month recovery period, the table lists what to obtain and submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
B2. Brain injury Within the past four (4) years This includes: • Concussion • MILD brain Injury • Loss of Consciousness (LOC) • Alteration of Consciousness (AOC) • Post-Traumatic Amnesia (PTA) ALL less than 1 HOUR AND • No seizure … After a 6-month recovery period obtain the following evaluation(s) and submit for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
- Row C · Special Issuance
A moderate brain injury, including LOC, AOC, or PTA of 1 to 24 hours; a non-depressed skull fracture; a small parafalcine or tentorial subdural hematoma (resolved by MRI); or a small subarachnoid hemorrhage (resolved by MRI). After a 12-month recovery period, the table lists what to obtain and submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
C. Moderate BRAIN Injury This includes: • LOC, AOC, or PTA 1 to 24 hours • Non-depressed skull fracture • Small parafalcine or tentorial subdural hematoma (resolved by MRI) • Small subarachnoid hemorrhage (resolved by MRI) … After a 12-month recovery period obtain the following evaluation(s) and submit for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
- Row D · Special Issuance
A severe brain injury, including blood in the brain (brain contusion, intracranial bleed, hematoma, epidural hematoma, subdural hematoma, diffuse axonal injury); LOC, AOC, PTA of 24 hours or more; a depressed skull fracture; or a penetrating head injury. After a four-year recovery period, the table asks for all items in Row C to be submitted for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
D. Severe BRAIN Injury This includes: • Blood in the Brain: o Brain contusion o Intracranial bleed o Hematoma o Epidural hematoma o Subdural hematoma o Diffuse axonal injury • LOC, AOC, PTA: 24 hours or more • Depressed skull fracture • Penetrating head injury … After a four (4)-year recovery period submit for FAA review: • All items in Row C … DEFER Submit the information to the FAA for a possible Special Issuance
If the examiner defersSpecial Issuance
For Row B1, on any YES answers, any examiner concerns, or a history the examiner is unable to verify, the table says DEFER.
The table marks Row B2, a brain injury within the past four years, DEFER.
The table marks Row C, a moderate brain injury, DEFER.
The table marks Row D, a severe brain injury, DEFER.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
For Row B1, on any YES answers, any examiner concerns, or a history the examiner is unable to verify, the table says DEFER.
If any “YES” answers, any AME concerns, or unable to verify history – DEFER
- Reason 2
The table marks Row B2, a brain injury within the past four years, DEFER.
B2. Brain injury Within the past four (4) years … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 3
The table marks Row C, a moderate brain injury, DEFER.
C. Moderate BRAIN Injury … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 4
The table marks Row D, a severe brain injury, DEFER.
D. Severe BRAIN Injury … DEFER Submit the information to the FAA for a possible Special Issuance
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workGood to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
High impact injuries go to Row D
Rows B1 and B2 each note that high impact or penetrating injuries (e.g., gunshot or severe trauma) may present with few or no concussive symptoms, and for high impact injuries say see Row D. Row D is marked DEFER.
Show the FAA's words: good to know, 2
Note: High impact/penetrating injuries (e.g., gunshot or severe trauma) may present with few or no concussive symptoms. For high impact injuries, see Row D … D. Severe BRAIN Injury … DEFER Submit the information to the FAA for a possible Special Issuance
A seizure within 24 hours of the injury
Rows B1 and B2 are for no seizure, with one exception in each. An immediate impact seizure (within 24 hours of injury) can be reviewed using Row B criteria.
Show the FAA's words: good to know, 3
Exception: An immediate impact seizure (within 24 hours of injury) can be reviewed using Row B criteria.
Portal notes and visit summaries from the hospital
For the hospital discharge summary, the table says that typically, the patient portal notes or After Visit Summary [AVS] printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.
Show the FAA's words: good to know, 4
(Typically, the patient portal notes or After Visit Summary [AVS] printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.)
Hemosiderin on the MRI moves the case to Row D
For Row C the table says any hemorrhage must be resolved on MRI, and if the MRI shows signs of hemosiderin deposition, go to Row D.
Show the FAA's words: good to know, 5
Any hemorrhage must be resolved on MRI. If the MRI shows signs of hemosiderin deposition, go to Row D.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.