2.11.2.6 CLASS 1 MEDICAL CERTIFICATE
(a) Certificate issue and renewal
(1) The level of medical fitness to be met for the renewal of a medical certificate shall be the same as that for the initial assessment except where otherwise specifically stated.
(2) An applicant for a CPL or ATPL shall undergo an initial medical examination for the issue of a Class 1 Medical Certificate.
(3) Except where otherwise stated in this subpart, holders of CPL or ATPL shall have their Class 1 medical certificate renewed at intervals not exceeding those specified below.
(4) In alternate years, for Class 1 applicants under 40 years of age, [the AUTHORITY] may, at its discretion, allow medical examiners to omit certain routine examination items related to the assessment of physical fitness, while increasing the emphasis on health education and prevention of ill health.
Note. Guidance for Licensing Authorities wishing to reduce the emphasis on detection of physical disease, while increasing the emphasis on health education and prevention of ill health, in applicants under 40 years of age, is contained in the Manual Civil Aviation Medicine (Doc 8984).
(5) A Class 1 medical certificate will be issued when the applicant complies with the requirements of this Part.
ICAO Annex 1: 6.1.1(a);6.3.1.1, 6.3.1.2, 6.3.1.3,
(b) Physical and mental requirements
(1) The applicant shall not suffer from any disease or disability which could render that applicant likely to become suddenly unable either to operate an aircraft safely or to perform assigned duties safely.
(2) The applicant shall have no established medical history or clinical diagnosis of any of the following such as might render the applicant unable to safely exercise the privileges of the licence applied for or held:
(i) An organic mental disorder;
(ii) A mental or behavioural disorder due to use of psychoactive substances; this induces dependence syndrome induced by alcohol or other psychoactive substances;
(iii) Schizophrenia or a schizotypal or delusional disorder;
(iv) A mood (affective) disorder;
(v) A neurotic, stress-related or somatoform disorder;
(vi) A disorder of adult personality or behaviour, particularly if manifested by repeated overt acts;
(vii) Mental retardation;
(viii) A disorder of psychological development;
(ix) A behavioural or emotional disorder, with onset in childhood or adolescence; or
(x) A mental disorder not otherwise specified.
(3) The applicant shall have no established medical history or clinical diagnosis of any of the following:
(i) A progressive or non-progressive disease of the nervous system, the effects of which, according to accredited medical conclusion, are likely to interfere with the safe exercise of the applicant’s licence and rating privileges;
(ii) Epilepsy; or
(iii) Any disturbance of consciousness without satisfactory medical explanation of cause.
(4) The applicant shall not have suffered any head injury, the effects of which, according to accredited medical conclusion, are likely to interfere with the safe exercise of the applicant’s licence and rating privileges shall be assessed as unfit.
(5) The applicant shall not possess any abnormality of the heart, congenital or acquired, which is likely to interfere with the safe exercise of the applicant’s licence and rating privileges. A history of proven myocardial infarction shall be disqualifying.
(6) An applicant who has undergone coronary by-pass grafting or angioplasty (with or without stenting) or other cardiac intervention or who has a history of myocardial infarction or who suffers from any other potentially incapacitating cardiac condition shall be assessed as unfit unless the applicant’s cardiac condition has been investigated and evaluated in accordance with best medical practice and is assessed not likely to interfere with the safe exercise of the applicant’s licence or rating privileges.
(7) An applicant with an abnormal cardiac rhythm shall be assessed as unfit unless the cardiac arrhythmia has been investigated and evaluated in accordance with the safe exercise of the applicant’s licence or rating privileges.
(8) Electrocardiography shall form part of the heart examination for the first issue of a medical certificate.
(9) Electrocardiography shall be included in re-examination of applicants over the age of 50 at least annually.
Note 1: The purpose of routine electrocardiography is case finding. It does not provide sufficient evidence to justify disqualification without further thorough cardiovascular investigation.
Note 2: Guidance on resting and exercise electrocardiography is published in the Manual of Civil Aviation Medicine (Doc 8984).
(10) The systolic and diastolic blood pressures shall be within normal limits.
(11) The use of drugs for control of high blood pressure is disqualifying except for those drugs, the use of which, according to accredited medical conclusion is compatible with the safe exercise of the applicant’s licence and rating privileges.
Note: Extensive guidance on the subject is published in the Manual of Civil Aviation Medicine (Doc 8984).
(12) There shall be no significant functional or structural abnormality of the circulatory system.
(13) There shall be no acute disability of the lungs or any active disease of the structures of the lungs, mediastinum or pleura likely to result in incapacitating symptoms during normal or emergency operations.
(14) Radiography should form a part of the initial chest examination.
Note:  Periodic chest radiography is usually not necessary but may be a necessity in situations where asymptomatic pulmonary disease can be expected.
(15) Applicant’s with chronic obstructive pulmonary disease shall be assessed as unfit unless the applicant’s condition has been investigated and evaluated in accordance with best medical practice and is assessed not likely to interfere with the safe exercise of the applicant’s licence or rating privileges.
(16) Applicant’s with asthma causing significant symptoms or likely to cause incapacitating symptoms during normal or emergency operations shall be assessed as unfit.
(17) The use of drugs for control of asthma shall be disqualifying except for those drugs, the use of which is compatible with the safe exercise of the applicant’s licence and rating privileges.
Note: Guidance material on hazards of the medications is published in the Manual of Civil Aviation Medicine (Doc 8984).
(18) Applicants with active pulmonary tuberculosis shall be assessed as unfit.
(19) Applicants with quiescent or healed lesions which are known to be tuberculous, or are presumably tuberculous in origin, may be assessed as fit.
Note: Guidance material on assessment of respiratory diseases is published in the Manual of Civil Aviation Medicine (Doc 8984).
(20) Applicants with significant impairment of the function of the gastrointestinal tract or its adnexa shall be assessed as unfit.
(21) The applicant shall be completely free from those hernias that might give rise to incapacitating symptoms.
(22) Applicants with sequela of disease of, or surgical intervention on any part of the digestive tract or its adnexa, likely to cause incapacity in flight, in particular any obstructions due to stricture or compression shall be assessed as unfit.
(23) An applicant who has undergone a major surgical operation on the biliary passages or the digestive tract or its adnexa, with a total or partial excision or a diversion of any of these organs should be assessed as unfit until such time as the medical Authority designated for the purpose by [STATE] and having access to the details of the operation concerned considers that the effects of the operation are not likely to cause incapacity in flight.
(24) Applicants with metabolic, nutritional or endocrine disorders that are likely to interfere with the safe exercise of the applicant’s licence and rating privileges shall be assessed as unfit.
(25) Applicants with insulin-treated diabetes mellitus shall be assessed as unfit.
Note: Guidance material on assessment of Type 2 insulin treated diabetic applicants, under the provisions of 2.11.1.5, is contained in the Manual of Civil Aviation Medicine (Doc 8984).
(26) Applicants with non-insulin-treated diabetes mellitus shall be assessed as unfit unless the condition is shown to be satisfactorily controlled by diet alone or by diet combined with oral anti-diabetic medication, the use of which is compatible with the safe exercise of the applicant’s licence and rating privileges.
(27) Applicants with disease of the blood and/or the lymphatic system shall be assessed as unfit unless adequately investigated and their condition found unlikely to interfere with the safe exercise of the applicant’s licence and rating privileges.
Note:  Sickle cell trait or other haemoglobinopathic traits are usually compatible with a fit assessment.
(28) Applicants with renal or genitourinary disease shall be assessed as unfit, unless adequately investigated and their condition found unlikely to interfere with the safe exercise of the applicant’s licence and rating privileges.
(29) Urine examination shall form part of the medical examination and abnormalities shall be adequately investigated.
Note: Guidance material on assessment of diabetic applicants is contained in the Manual of Civil Aviation Medicine (Doc 8984).
(30) Applicants with sequelae of disease or surgical procedures on the kidneys or the genitourinary tract, in particular any obstructions due to stricture or compression, shall be assessed as unfit unless the applicant’s condition has been investigated and evaluated in accordance with the best medical practice and is assessed not likely to interfere with the safe exercise of the applicant’s licence or rating privileges.