Hiatal hernia
What the FAA's documents say about hiatal hernia, in plain words, with the FAA's own words one press away.
FAA term: Hiatal Hernia (Sliding or Paraesophageal)Covers: All classes
Show the FAA's words: which classes the FAA's table covers
HIATAL HERNIA (Sliding or Paraesophageal) All Classes
Short version
The Hiatal Hernia disposition table has three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ASimple hiatal hernia, controlled, with no alarm features | Examiner issues | Examiner can issue |
| Row BParaesophageal hernia, surgically repaired 2 or more years ago | Examiner issues | Examiner can issue |
| Row CUnrepaired paraesophageal, or repaired less than 2 years ago | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Hiatal hernia
- Row A · Examiner can issue
An asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication, or treated surgically with full recovery, and with no alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting). If the examiner can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable, the table says ISSUE, and the examiner summarizes the findings in Item 60. The row's note says medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.
A. Asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication OR treated surgically, with full recovery AND No alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting) … If the AME can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable: Note: Medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects. ISSUE Summarize findings in Item 60.
- Row B · Examiner can issue
A paraesophageal hernia, surgically repaired 2 or more years ago. The examiner should review a current, detailed progress note, a current CBC, and the results of any other testing already performed. If the examiner can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed, the table says ISSUE. The examiner summarizes the findings in Item 60 and submits the evaluation to the FAA for retention in the file.
B. Paraesophageal hernia, surgically repaired 2 or more years ago … The AME should review: … If the AME can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed: ISSUE Summarize findings in Item 60 and submit the evaluation to the FAA for retention in the file.
- Row C · Special Issuance
All others (complicated), an unrepaired paraesophageal hernia, or a hernia surgically repaired less than 2 years ago. The table lists what to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
C. All others (Complicated) Unrepaired paraesophageal hernia OR Surgically repaired less than 2 years ago. … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Summarize findings in Item 60.
The FAA pathways for hiatal hernia
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: What the examiner determines for row A
Control, alarm features, and medications.Row A is an asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication, or treated surgically with full recovery, and no alarm features. Your AME determines the things the row lists.
Your AME determines
- The condition is stable and well controlled
- No aeromedical concerns
- Medications are acceptable
Row A: no alarm features, for example
- Not: Dysphagia
- Not: Odynophagia
- Not: Weight loss
- Not: GI bleeding
- Not: Anemia
- Not: Recurrent vomiting
Medications
Antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.
Your AME's summary in Item 60
- The findings
Show the FAA's words: What the examiner determines for row A
If the AME can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable:
FAA source: Hiatal Hernia Disposition Table. FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
A. Asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication OR treated surgically, with full recovery AND No alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting)
FAA source: Hiatal Hernia Disposition Table. FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
Note: Medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.
FAA source: Hiatal Hernia Disposition Table. FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
acceptable if there are no side effects. ISSUE Summarize findings in Item 60.
FAA source: Hiatal Hernia Disposition Table. FAA date 30 September 2026; checked by Crosscheck 14 October 2026.
Step 2: See your AME
If the examiner can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable, the table says ISSUE, and the examiner summarizes the findings in Item 60. The row's note says medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.Exam day- If the examiner can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable, the table says ISSUE, and the examiner summarizes the findings in Item 60. The row's note says medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.
Show the FAA's words: See your AME
A. Asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication OR treated surgically, with full recovery AND No alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting)
If the AME can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable: Note: Medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects. ISSUE Summarize findings in Item 60.
FAA source: Hiatal Hernia Disposition Table. 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 is stable, well controlled, with no aeromedical concerns, and medications are acceptable, the table says ISSUE, and the examiner summarizes the findings in Item 60. The row's note says medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.
Row BExaminer issuesExaminer can issue
The examiner should review a current, detailed progress note, a current CBC, and the results of any other testing already performed. If the examiner can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed, the table says ISSUE. The examiner summarizes the findings in Item 60 and submits the evaluation to the FAA for retention in the file.
Row CDefers to the FAASpecial Issuance
The table lists what to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
An asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication, or treated surgically with full recovery, and with no alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting). If the examiner can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable, the table says ISSUE, and the examiner summarizes the findings in Item 60. The row's note says medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects.
A. Asymptomatic simple hiatal hernia with typical reflux symptoms adequately controlled with or without medication OR treated surgically, with full recovery AND No alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting) … If the AME can determine the condition is stable, well controlled, with no aeromedical concerns, and medications are acceptable: Note: Medication such as antacids, proton pump inhibitors (PPIs), or H2 blockers are acceptable if there are no side effects. ISSUE Summarize findings in Item 60.
- Row B · Examiner can issue
A paraesophageal hernia, surgically repaired 2 or more years ago. The examiner should review a current, detailed progress note, a current CBC, and the results of any other testing already performed. If the examiner can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed, the table says ISSUE. The examiner summarizes the findings in Item 60 and submits the evaluation to the FAA for retention in the file.
B. Paraesophageal hernia, surgically repaired 2 or more years ago … The AME should review: … If the AME can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed: ISSUE Summarize findings in Item 60 and submit the evaluation to the FAA for retention in the file.
- Row C · Special Issuance
All others (complicated), an unrepaired paraesophageal hernia, or a hernia surgically repaired less than 2 years ago. The table lists what to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and summarizes the findings in Item 60.
C. All others (Complicated) Unrepaired paraesophageal hernia OR Surgically repaired less than 2 years ago. … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Summarize findings in Item 60.
If the examiner defersSpecial Issuance
The table marks row C, all others (complicated), an unrepaired paraesophageal hernia or a hernia surgically repaired less than 2 years ago, DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note generated from a clinic visit with the treating physician or surgeon no more than 90 days before the exam, including what the table lists.
- Item 2. A current CBC (lab).
- Item 3. Results of any other testing already performed by the treating physician.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks row C, all others (complicated), an unrepaired paraesophageal hernia or a hernia surgically repaired less than 2 years ago, DEFER.
C. All others (Complicated) Unrepaired paraesophageal hernia OR Surgically repaired less than 2 years ago. … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A current, detailed clinical progress note generated from a clinic visit with the treating physician or surgeon no more than 90 days before the exam, including what the table lists.
Submit the following for FAA review: 1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician or surgeon no more than 90 days before the AME exam. It should include
- Item 2
A current CBC (lab).
Submit the following for FAA review: … 2. Current CBC (lab). … 3. Results of any other testing already performed by the treating physician. DEFER
- Item 3
Results of any other testing already performed by the treating physician.
Submit the following for FAA review: … 3. Results of any other testing already performed by the treating physician. DEFER
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.
Two years after repair is the line
The table puts a paraesophageal hernia surgically repaired 2 or more years ago in row B, marked ISSUE, and a hernia surgically repaired less than 2 years ago in row C, marked DEFER, with an unrepaired paraesophageal hernia.
Show the FAA's words: good to know, 2
B. Paraesophageal hernia, surgically repaired 2 or more years ago … ISSUE Summarize findings in Item 60 and submit the evaluation to the FAA for retention in the file. … C. All others (Complicated) Unrepaired paraesophageal hernia OR Surgically repaired less than 2 years ago. … DEFER Submit the information to the FAA for a possible Special Issuance.
Row B's evaluation still goes to the FAA
Row B is marked ISSUE, and the table also says to submit the evaluation to the FAA for retention in the file.
Show the FAA's words: good to know, 3
ISSUE Summarize findings in Item 60 and submit the evaluation to the FAA for retention in the file.
The table's alarm features
Row A includes no alarm features, which the table gives as e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting.
Show the FAA's words: good to know, 4
AND No alarm features (e.g., dysphagia, odynophagia, weight loss, GI bleeding, anemia, or recurrent vomiting)
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.
Related conditions
Each has its own page, with what the FAA's documents say about it.
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.