PPPD (persistent postural perceptual dizziness)
What the FAA's documents say about PPPD (persistent postural perceptual dizziness), in plain words, with the FAA's own words one press away.
FAA term: Persistent Postural Perceptual Dizziness (PPPD or 3PD)Covers: All classes
Short version
The disposition table has one row, any history.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AAny history | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for PPPD (persistent postural perceptual dizziness)
- Row A · Special Issuance
Any history. The row says that after the condition has fully resolved, no symptoms remain, and medication is no longer needed for suppression of the vertigo, the following is submitted for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance, and the table says follow-up issuance will be per the Authorization letter.
A. Any history • After the condition has fully resolved; • No symptoms remain; and • Medication is no longer needed for suppression of the vertigo: Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the Authorization Letter
The FAA pathways for PPPD (persistent postural perceptual dizziness)
Which exam
Your step-by-step plan
Step 1: After the condition has fully resolved
What the row says before its list.The row says that after the lines below, the list that follows is submitted for FAA review.
After
- The condition has fully resolved
- No symptoms remain
- Medication is no longer needed for suppression of the vertigo
Show the FAA's words: After the condition has fully resolved
• After the condition has fully resolved; • No symptoms remain; and • Medication is no longer needed for suppression of the vertigo: Submit the following for FAA review:
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
Step 2: The progress note from your ENT or neurotologist
From your treating otolaryngologist (ENT) or neurotologist.Progress note
Within 90 days before the examA current, detailed progress note from a clinic visit with your treating otolaryngologist (ENT) or neurotologist, no more than 90 days before the exam.
It must include
- A detailed summary of the history of the condition
- Current medications, dosage, and side effects, if any
- Physical exam findings
- Results of any testing performed
- Diagnosis
- Assessment and plan (prognosis)
- Follow-up
Points your physician specifically addresses
The table's second item: it must specifically include if active disease exists, and if in remission, when remission commenced.
It must specifically include
- If active disease exists
- If in remission, when remission commenced
Show the FAA's words: The progress note from your ENT or neurotologist
1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days prior to the AME exam. It must include: • A detailed summary of the history of the condition; • Current medications, dosage, and side effects (if any); • Physical exam findings; • Results of any testing performed; • Diagnosis; • Assessment and plan (prognosis); and • Follow-up
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
2. It must specifically include: • If active disease exists. • If in remission, when did remission commence.
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
“IT MUST SPECIFICALLY INCLUDE” If this language is in your letter, it is to highlight SPECIFIC items (that may or may not be part of a standard current, detailed Clinical Progress Note). Make sure your physician addresses these specific items important for medical certification or clearance.
FAA source: Pilot Information – What a Detailed Clinical Progress Note must contain. FAA date 25 September 2024; checked by Crosscheck 14 October 2026.
Step 3: Tests and records
The rest of the table's list.Clinical audiogram
A current clinical audiogram, performed within the past 90 days.
With
- Air-conduction/bone-conduction (AC/BC)
- Speech discrimination (SD)
Additional tests
As clinically indicated.
As clinically indicated.
Additional tests, such as ECOG, VEMP or an MRI with gadolinium of the cerebellopontine angle (CPA), performed as clinically indicated.
Office treatment records
All office treatment records.
Pharmacy records
Pharmacy records for the last 3 years from all pharmacies used.
Vestibular rehab progress notes
If performed.
If performed.
Copies of any vestibular rehab progress notes, if performed.
Show the FAA's words: Tests and records
3. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discriminat ion (SD) (performed within the past 90 days).
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
4. Additional tests such as [ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle (CPA), etc.] performed as clinically indicated.
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
5. All Office treatment records.
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
6. Pharmacy Records for the last 3 years from all Pharmacies used.
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
7. Copies of any Vestibular Rehab progress notes (if performed).
FAA source: Persistent Postural Perceptual Dizziness (PPPD or 3PD). FAA date 29 November 2023; checked by Crosscheck 14 October 2026.
What the examiner checks
Row ADefers to the FAASpecial Issuance
The row says that after the condition has fully resolved, no symptoms remain, and medication is no longer needed for suppression of the vertigo, the following is submitted for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance, and the table says follow-up issuance will be per the Authorization letter.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Special Issuance
Any history. The row says that after the condition has fully resolved, no symptoms remain, and medication is no longer needed for suppression of the vertigo, the following is submitted for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance, and the table says follow-up issuance will be per the Authorization letter.
A. Any history • After the condition has fully resolved; • No symptoms remain; and • Medication is no longer needed for suppression of the vertigo: Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance. Follow up Issuance Will be per the Authorization Letter
If the examiner defersSpecial Issuance
The table marks its one row, any history, DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days before the exam, with what the table says it must include.
- Item 2. Items the physician specifically addresses: if active disease exists and, if in remission, when remission commenced. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
- Item 3. A current clinical audiogram with air-conduction/bone-conduction (AC/BC) and speech discrimination (SD), performed within the past 90 days.
- Item 4. Additional tests such as ECOG, VEMP, or an MRI with gadolinium of the cerebellopontine angle (CPA), performed as clinically indicated.
- Item 5. All office treatment records.
- Item 6. Pharmacy records for the last 3 years from all pharmacies used.
- Item 7. Copies of any vestibular rehab progress notes (if performed).
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks its one row, any history, DEFER.
A. Any history … 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 from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days before the exam, with what the table says it must include.
1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating otolaryngologist (ENT) or neurotologist no more than 90 days prior to the AME exam. It must include:
- Item 2
Items the physician specifically addresses: if active disease exists and, if in remission, when remission commenced. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
2. It must specifically include: • If active disease exists. • If in remission, when did remission commence.
“IT MUST SPECIFICALLY INCLUDE” If this language is in your letter, it is to highlight SPECIFIC items (that may or may not be part of a standard current, detailed Clinical Progress Note). Make sure your physician addresses these specific items important for medical certification or clearance.
- Item 3
A current clinical audiogram with air-conduction/bone-conduction (AC/BC) and speech discrimination (SD), performed within the past 90 days.
3. Current clinical audiogram with Air-Conduction/Bone-Conduction (AC/BC) and Speech Discriminat ion (SD) (performed within the past 90 days).
- Item 4
Additional tests such as ECOG, VEMP, or an MRI with gadolinium of the cerebellopontine angle (CPA), performed as clinically indicated.
4. Additional tests such as [ECOG, VEMP, MRI with Gadolinium of the cerebellopontine angle (CPA), etc.] performed as clinically indicated.
- Item 5
All office treatment records.
5. All Office treatment records.
- Item 6
Pharmacy records for the last 3 years from all pharmacies used.
6. Pharmacy Records for the last 3 years from all Pharmacies used.
- Item 7
Copies of any vestibular rehab progress notes (if performed).
7. Copies of any Vestibular Rehab progress notes (if performed).
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 workAt later examsSpecial Issuance
The disposition table is headed All Classes.
Show the FAA's words: how often the FAA asks again
PERSISTENT POSTURAL PERCEPTUAL DIZZINESS (PPPD OR 3PD) All Classes
The table says follow-up issuance will be per the Authorization letter.
Show the FAA's words: at later exams
Follow up Issuance Will be per the Authorization Letter
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 workFollow-up issuance per the Authorization letter
The table says follow-up issuance will be per the Authorization letter.
Show the FAA's words: Follow-up issuance per the Authorization letter
Follow up Issuance Will be per the Authorization Letter
Good 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.
The row covers any history
The table's one row is any history, and it is marked DEFER.
Show the FAA's words: good to know, 2
A. Any history … DEFER Submit the information to the FAA for a possible Special Issuance.
The list follows full resolution
The row says that after the condition has fully resolved, no symptoms remain, and medication is no longer needed for suppression of the vertigo, the list that follows is submitted for FAA review.
Show the FAA's words: good to know, 3
• After the condition has fully resolved; • No symptoms remain; and • Medication is no longer needed for suppression of the vertigo: Submit the following for FAA review:
Pharmacy records for the last 3 years
The list asks for pharmacy records for the last 3 years from all pharmacies used.
Show the FAA's words: good to know, 4
6. Pharmacy Records for the last 3 years from all Pharmacies used.
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.