Has the FAA Really Shortened the Brain Injury Wait?
Key Takeaways: Yes. In the FAA AME Guide "Head Injury or Brain Injury" table (Version 09/30/2026), the FAA cut its brain injury timelines from 5 years to 4 years. If your concussion or mild brain injury happened 4 or more years ago and you answer "no" to every Brain Injury Decision Tool question, your AME may now be able to issue your certificate in the office without a deferral. A severe TBI now has a 4-year recovery period before FAA review. Moderate and severe cases still require a deferral, neurological and neuropsychological evaluations, and imaging. Send the right records: actual clinical records, imaging on CD in DICOM format with a DICOMDIR file, and evaluations dated within 90 days of your AME exam. Careful preparation can help you avoid delays, but no one can speed up FAA review.
Yes. The FAA shortened its brain injury timelines in its latest AME Guide update. If you had a concussion years ago, your AME may now be able to issue your certificate in the office without a deferral. If you are recovering from a severe traumatic brain injury (TBI), the FAA may now review your case one year sooner. Both changes come from the FAA AME Guide "Head Injury or Brain Injury" table, Version 09/30/2026. Many websites still list the old 5-year numbers, so check the date on any source you use.
Reach out to the Ison Law Firm today for help. Call us at 855-598-7338 or contact us online. The Ison Law Firm is based in Florida and represents pilots nationwide.
How Does the FAA Classify Head and Brain Injuries Now?
The FAA sorts injuries by severity, and each category has its own recovery period and record requirements. The table below simplifies the 09/30/2026 FAA table, so check the full table for every requirement. LOC means loss of consciousness, AOC means alteration of consciousness, and PTA means post-traumatic amnesia.
| Category | Examples | Recovery Period | Required Documents | AME Action |
|---|---|---|---|---|
| Head injury only | Scalp, eye, or facial fractures; no concussion or neurological symptoms; no brain trauma on imaging, if imaging was done; fully resolved; released to full activity | None stated | Records showing full resolution | AME may issue; annotate Block 60 |
| Mild (within 4 years) | LOC, AOC, or PTA all under 1 hour; no seizure (an impact seizure within 24 hours can still be reviewed in this row) | 6 months | Current, detailed clinical progress note from within 90 days of the AME exam, plus hospital records and any other items the table lists | Defer for possible special issuance |
| Moderate | LOC/AOC/PTA 1 to 24 hours; non-depressed skull fracture; small parafalcine or tentorial subdural hematoma resolved on MRI; small subarachnoid hemorrhage | 12 months | Neurological eval to FAA specs and neuropsychological eval (both within 90 days of the exam), MRI with hemosiderin-sensitive sequences, EEG only if a seizure occurred, full hospital records | Defer |
| Severe | Brain contusion, intracranial bleed, hematoma, epidural or subdural hematoma, diffuse axonal injury, LOC/AOC/PTA 24+ hours, depressed skull fracture, penetrating injury | 4 years | Everything required for moderate; the FAA may ask for more imaging or testing | Defer |
Note one exception in the moderate category. If a small parafalcine or tentorial subdural hematoma caused no symptoms and an MRI 3 to 6 months after the injury shows it fully resolved, the FAA may consider the case after 6 months instead of 12. Whether your injury fits depends on your imaging and records, so have someone review them carefully.
Does an Old Concussion Still Require a Deferral?
In many cases, no. If your concussion or mild brain injury happened 4 or more years ago, involved no seizure other than an impact seizure within 24 hours, and you can answer "no" to every Brain Injury Decision Tool question, your AME may issue the certificate in the office after reviewing your records. Before this update, you generally had to wait 5 years.
A single "yes" answer can change the outcome. If you answer "yes" to any Decision Tool question, the AME would generally need to defer your application to the FAA. Symptoms that never fully cleared or gaps in your records could send an otherwise simple case to FAA review. To learn how the FAA treats older injuries, see our guide on getting an FAA medical after a brain injury.
What Is the Path to a Special Issuance After a Recent or Severe TBI?
Pilots with a mild injury within 4 years, or any moderate or severe injury, should plan for a deferral and a possible special issuance. Under 14 CFR § 67.401, the Federal Air Surgeon may issue a medical certificate (an Authorization for Special Issuance) if the applicant shows that the duties of the class applied for "can be performed without endangering public safety" while the Authorization is in effect. Special issuance is up to the FAA, often limited in time, and may require follow-up reports. The FAA explains who may authorize these certificates on its special issuance authorization page.
Why Recovery Periods Matter
The recovery period is the minimum wait before the FAA will review your case, not a promise of approval. A pilot with a severe TBI generally must wait 4 years, then submit everything required for moderate injuries, plus any added imaging or testing the FAA asks for. Submitting early does not speed anything up, and the firm cannot expedite FAA review.
What the Neuropsychological Evaluation Covers
FAA neuropsychological evaluations are central to moderate and severe cases. You generally must complete the evaluation within 90 days of your AME exam, along with a neurological evaluation done to FAA specifications. Results that raise questions about cognitive function can lead to more review or a denial, so the quality and timing of this testing matter.
Where Seizures Fit In
A seizure after a head injury adds another layer to the review. In moderate and severe cases, the table requires an EEG only if a seizure occurred. The neurologic standards in 14 CFR §§ 67.109, 67.209, and 67.309 cover epilepsy, unexplained disturbances of consciousness, and other neurologic conditions. The mental standards in 14 CFR §§ 67.107, 67.207, and 67.307 may also apply when cognitive or psychiatric symptoms follow an injury.
Can You Be a Pilot With Epilepsy or Post-Traumatic Seizures?
Many pilots ask, "Can you be a pilot with epilepsy?" after a TBI that caused a seizure. The answer depends on the facts. Under Part 67, an established history or diagnosis of epilepsy is disqualifying for all classes. The FAA may still consider special issuance in limited cases, usually after a long seizure-free period off medication. The FAA table treats an impact seizure within 24 hours of a mild injury differently and allows review within the mild row.
An impact seizure and ongoing seizure risk are very different. The FAA generally views a single seizure at the moment of injury differently than seizures 24 hours or more after the injury, repeat seizures, or seizures diagnosed as epilepsy. If you had a seizure after a head injury, the records describing its timing and nature will likely shape how the FAA views your risk. You can read the full rules in 14 CFR Part 67.
What Records Will the FAA Actually Accept?
The format of your records can matter as much as what they say. Under the FAA table, patient portal notes and After Visit Summaries are generally not enough. The FAA wants the actual clinical records.
- Submit imaging on CD in DICOM format with a DICOMDIR file.
- Include full hospital records where the table requires them.
- Do not submit nursing notes, flowsheets, orders, or medication administration records.
- Make sure progress notes and evaluations fall within the 90-day window before your AME exam.
Sending the wrong records often leads to FAA letters asking for more information. Each request can add months to a case. Pilots often send stacks of unneeded paperwork while missing the one report the FAA needs.
💡 Pro Tip: Request your imaging disc from the hospital’s radiology department early. Confirm it includes the DICOMDIR file, since some discs contain only viewer software.
What Should You Do Before Your AME Exam?
Prepare before you see your AME, not after. Once you submit FAA Form 8500-8 through MedXPress, your answers become part of your record, and false or incomplete answers can have serious consequences. Gather records, review the Decision Tool questions, and confirm your timeline first.
Past testing may make some new testing unnecessary. If you already have imaging or evaluations from your treatment, a careful review may show they meet part of the FAA’s requirements. Evaluations must still fall within the 90-day window where the table requires it. The Ison Law Firm’s attorneys are pilots, and the firm has a physician on staff, Alexander S. Ison, who can help review what you already have. An aviation medical certification attorney can help you put together a submission that answers the FAA’s questions the first time.
💡 Pro Tip: If you reported a head injury incorrectly on an older application, address it before your next exam instead of hoping no one notices.
Frequently Asked Questions
1. Does the 4-year rule apply to all brain injuries?
No. In-office issuance at 4 years applies only to a concussion or mild brain injury with no disqualifying seizure and all Decision Tool questions answered "no." For severe injuries, 4 years is the recovery period before FAA review, and a deferral is still required.
2. Will my AME defer a moderate TBI?
Yes. AMEs defer moderate injuries to the FAA, which reviews them after a 12-month recovery period. The exception is a small parafalcine or tentorial subdural hematoma that caused no symptoms and shows as fully resolved on MRI, which the FAA may consider after 6 months.
3. Can an impact seizure disqualify me?
Not automatically. The FAA can still review an impact seizure within 24 hours of a mild injury in the mild row. Seizures 24 hours or more after the injury, repeat seizures, or an epilepsy diagnosis raise more serious issues under 14 CFR §§ 67.109, 67.209, and 67.309.
4. Can a lawyer speed up FAA review?
No. The Ison Law Firm cannot expedite the FAA’s process. We can help make sure your submission is complete and in the right format, which may help you avoid needless delays.
Is Now the Time to Revisit Your Medical?
For many pilots with an old concussion or a past severe TBI, the 09/30/2026 update may open a new path. The shorter timelines may move your eligibility date forward, but the record requirements remain strict, and outcomes depend on your facts. Planning your submission carefully gives you the best chance of getting a medical certificate after a head injury.
If you face a deferral, a pending special issuance, or questions about an old injury, request a confidential case review with the Ison Law Firm. Call (855) 598-7338 or schedule your review online. The Ison Law Firm is based in Florida and represents pilots nationwide.
Disclaimer: This content is for informational purposes only and is not legal advice. Every case is unique, and results may vary. Consult an attorney about your specific circumstances.
