Home/Federal/Federal Register/2026-18162

Proposed Rule2026-18162

Modernizing Medical Standards for Non-Insulin Dependent Diabetes Mellitus Cases

Primary source

Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.

Published

September 4, 2026

Issuing agencies

Transportation DepartmentFederal Aviation Administration

Abstract

FAA proposes to amend its regulations to allow applicants with non-insulin dependent diabetes mellitus to apply for airman medical certification that may be issued at the time of their medical examination instead of requiring Special Issuance review by FAA. This action would reduce the burden associated with the process of review for Authorization for Special Issuance while recognizing that modern medical advancements have significantly improved the manageability of certain forms of diabetes.

Full Text

<html>
<head>
<title>Federal Register, Volume 91 Issue 171 (Friday, September 4, 2026)</title>
</head>
<body><pre>
[Federal Register Volume 91, Number 171 (Friday, September 4, 2026)]
[Proposed Rules]
[Pages 56798-56809]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-18162]

========================================================================
Proposed Rules
Federal Register
________________________________________________________________________

This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.

========================================================================

Federal Register / Vol. 91, No. 171 / Friday, September 4, 2026 /
Proposed Rules

[[Page 56798]]

DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration

14 CFR Part 67

[Docket No. FAA-2026-10990; Notice No. 26-15]
RIN 2120-AM25

Modernizing Medical Standards for Non-Insulin Dependent Diabetes
Mellitus Cases

AGENCY: Federal Aviation Administration (FAA), Department of
Transportation (DOT).

ACTION: Notice of proposed rulemaking.

-----------------------------------------------------------------------

SUMMARY: FAA proposes to amend its regulations to allow applicants with
non-insulin dependent diabetes mellitus to apply for airman medical
certification that may be issued at the time of their medical
examination instead of requiring Special Issuance review by FAA. This
action would reduce the burden associated with the process of review
for Authorization for Special Issuance while recognizing that modern
medical advancements have significantly improved the manageability of
certain forms of diabetes.

DATES: Send comments on or before October 5, 2026.

ADDRESSES: Send comments identified by docket number FAA-2026-10990
using any of the following methods:
<bullet> Federal eRulemaking Portal: Go to <a href="http://www.regulations.gov">www.regulations.gov</a> and
follow the online instructions for sending your comments
electronically.
<bullet> Mail: Send comments to Docket Operations, U.S. Department
of Transportation (DOT), 1200 New Jersey Avenue SE, West Building 5th
Floor (W58-213), Washington, DC 20590.
<bullet> Hand Delivery or Courier: Take comments to Docket
Operations in Room W58-213 of the West Building 5th Floor at 1200 New
Jersey Avenue SE, Washington, DC 20590 between 9 a.m. and 5 p.m.,
Monday through Friday, except Federal holidays.
<bullet> Fax: Fax comments to Docket Operations at (202) 493-2251.
Docket: Background documents or comments received may be read at
<a href="http://www.regulations.gov">www.regulations.gov</a> at any time. Follow the online instructions for
accessing the docket or go to the Docket Operations in Room W58-213 of
the West Building 5th Floor at 1200 New Jersey Avenue SE, Washington,
DC 20590 between 9 a.m. and 5 p.m., Monday through Friday, except
Federal holidays.

FOR FURTHER INFORMATION CONTACT: Dr. Charles Mathers, Office of
Aerospace Medicine, Federal Aviation Administration, 800 Independence
Avenue SW, Washington, DC 20591; telephone (405) 954-4821; email <a href="/cdn-cgi/l/email-protection#c5fce8849396e8848488e897b0a9a0a8a4aeacaba2e886aaa8a8a0abb1b685a3a4a4eba2aab3"><span class="__cf_email__" data-cfemail="8ab3a7cbdcd9a7cbcbc7a7d8ffe6efe7ebe1e3e4eda7c9e5e7e7efe4fef9caecebeba4ede5fc">[email&#160;protected]</span></a>.

SUPPLEMENTARY INFORMATION:

I. Executive Summary

A. Overview of Proposed Rule

Under current regulations in 14 CFR part 67, an applicant for
medical certification who has an established medical history or
clinical diagnosis of diabetes mellitus (commonly referred to as
diabetes) that requires insulin or any other hypoglycemic drug for
control has a specifically disqualifying medical condition. These
applicants must go through the FAA Authorization for Special Issuance
of a Medical Certificate (hereafter referred to as ``SI'' process)
under Sec. 67.401, Special issuance of medical certificates. FAA
proposes to amend Sec. Sec. 67.113(a), 67.213(a), and 67.313(a), which
provide the general medical standards for a first-class, second-class,
or third-class airman medical certificate, to remove the phrase ``or
any other hypoglycemic drug'' from these sections, thereby allowing
persons with diabetes that can be controlled through the use of non-
insulin medications who meet all other applicable medical
qualifications to receive a medical certificate without having to go
through the SI process.
Non-insulin dependent diabetes mellitus (NIDDM) is routinely
managed by primary care physicians today using a variety of treatments
that may include one or a combination of oral or injectable
medication(s). The availability of numerous new diabetes medication
classes and other non-insulin treatments has substantially improved
disease management. Diabetes is now more effectively controlled,
resulting in a reduction in severe complications, including
cardiovascular events, hypoglycemia, and other adverse outcomes. This
level of disease management did not exist when the current regulatory
language was adopted in 1959 and through the many ensuing years.
This rulemaking would allow medical certificate applicants with
NIDDM to be evaluated by an Aviation Medical Examiner (AME) instead of
being deferred to FAA for consideration of an SI from the Federal Air
Surgeon.

B. Summary of the Costs and Benefits

The proposed rule would replace the existing NIDDM certification
process, which requires application deferral and FAA review for an SI,
with a more efficient process under the general medical standards for
applicants with NIDDM. The proposed rule would reduce NIDDM medical
certification wait times and FAA processing time, resulting in cost
savings to both industry and FAA. Processing all NIDDM cases via the SI
process places a burden on applicants and FAA. Reducing time, steps,
and number of people required to issue medical certificates in new or
recertification cases would provide relief to airmen whose NIDDM is
well controlled with approved treatments. Applicant wait times and FAA
backlogs would lessen, assuming current resources remain available.
FAA estimates industry cost savings over five years, providing both
low and high-case scenarios, based on cost savings per applicant and
the estimated total number of applicants during that timeframe. In the
low-case scenario, FAA estimates the proposed rule would save industry
$39.70 million ($34.78 million at a seven percent discount rate, $37.43
million at a three percent discount rate) in labor hours during the
period of analysis. In the high-case scenario, FAA estimates the
proposed rule would save industry $80.19 million ($70.24 million at a
seven percent discount rate, $75.60 million at a three percent discount
rate) in labor hours during the period of analysis.

[[Page 56799]]

II. Authority for This Rulemaking

FAA's authority to issue rules on aviation safety is found in title
49 of the United States Code (49 U.S.C.). Subtitle I, section 106,
describes the authority of the FAA Administrator. Subtitle VII,
Aviation Programs, describes in more detail the scope of the agency's
authority.
This rulemaking is issued under the authority described in subtitle
VII, part A, subpart III, sections 44701, 44702, and 44703. Under
section 44701, FAA is charged with prescribing regulations and minimum
standards for practices, methods, and procedures the Administrator
finds necessary for safety in air commerce. Pursuant to 49 U.S.C.
44701(a)(5), the Administrator is required to promote safe flight of
civil aircraft in air commerce by prescribing regulations and minimum
standards for cybersecurity and other, methods, and procedures the
Administrator finds necessary for safety in air commerce and national
security. Under sections 44702 and 44703, the Administrator may issue
medical certificates to individuals who are qualified for, and
physically able to perform the duties related to, the position to be
authorized by the certificate.
This proposed rule is within the scope of those authorities because
it would amend the regulations pertaining to airman medical standards
and certification to allow applicants with NIDDM potentially to be
issued unrestricted medical certificates after ensuring the individuals
are qualified and physically able to perform the duties related to
their medical certificate, but without the need to go through the SI
process.

III. Background

A. Overview of Medical Certificate Process

FAA issues a medical certificate to an applicant who has met
specific medical standards required to qualify for, or otherwise
perform the duties related to, the applicant's position. There are
three classes of medical certificates, each with different requirements
and privileges with respect to pilots: first-class medical certificates
are required for most airline transport pilots; \1\ second-class
medical certificates are required for most commercial pilots;
<SUP>2 3</SUP> and third-class medical certificates are required for
private pilots, student pilots, and recreational pilots, as well as
flight instructors and examiners under certain circumstances.\4\ The
duration of each class of medical certificate is determined by the age
of the applicant on the date of the medical examination and the type of
operation being conducted, as set forth in Sec. 61.23(d).
---------------------------------------------------------------------------

\1\ Specifically, a first-class medical certificate is required
when exercising pilot-in-command privileges of an airline transport
pilot (ATP) certificate; when exercising second-in-command
privileges of an ATP certificate in a flag or supplemental operation
under 14 CFR part 121 that requires three or more pilots; or when
serving as a required pilot in a part 121 operation if the pilot is
60 years or older. See Sec. 61.23(a)(1).
\2\ Specifically, a person must hold at least a second-class
medical certificate: when exercising second-in-command privileges of
an ATP certificate in part 121 operations other than in a flag or
supplemental operation that requires three or more pilots; when
exercising the privileges of a commercial pilot certificate in an
aircraft other than a balloon or glider; or when exercising the
privileges of a commercial pilot certificate with a balloon class
rating, except if the person is providing flight training in a
balloon in accordance with Sec. 61.133(a)(2)(ii). See Sec.
61.23(a)(2).
\3\ In addition to pilots, FAA notes that flight engineers,
flight navigators, and certain air traffic control tower operators
are required to obtain a second-class medical certificate pursuant
to 14 CFR 63.31(c), 63.51(c), and 65.31(c), respectively. The
changes proposed in this rule would apply equally to medical
certificates issued to flight engineers, flight navigators, and
certain air traffic control tower operators as they would to pilots.
\4\ Specifically a person must hold at least a third-class
medical certificate: when exercising the privileges of a private
pilot certificate, recreational pilot certificate, or student pilot
certificate, except when operating under the conditions and
limitations of BasicMed; when exercising the privileges of a flight
instructor certificate and acting as the pilot in command or as a
required flightcrew member, except when operating under the
conditions and limitations of BasicMed; when taking a practical test
in an aircraft for a recreational pilot, private pilot, commercial
pilot, or airline transport pilot certificate, or for a flight
instructor certificate, except when operating under the conditions
and limitations of BasicMed; or when performing the duties as an
Examiner in an aircraft when administering a practical test or
proficiency check for an airman certificate, rating, or
authorization, except when meeting the requirements to operate under
the conditions and limitations of BasicMed. See Sec. 61.23(a)(3).
---------------------------------------------------------------------------

The regulations governing medical standards and certification are
contained in 14 CFR part 67, Medical standards and certification.
Subparts B, C, and D of part 67 detail the medical eligibility
requirements of first-, second-, and third-class medical certificates,
respectively. These eligibility requirements include specific standards
for vision, hearing, psychological, neurologic, and cardiovascular
symptoms, including listing disqualifying conditions for each medical
category. Sections 67.113, 67.213, and 67.313 provide the general
medical standards that apply to other, unspecified medical conditions,
and detail disqualifying conditions that do not fit into the other
categories, including diabetes mellitus.
To obtain a medical certificate, an applicant without a
specifically disqualifying medical condition described in subparts B,
C, and D of part 67 (for first-class, second-class, and third-class
medical certificates, respectively) must undergo a medical examination
conducted by an FAA-authorized AME. An applicant who is found to meet
the appropriate medical standards, based on the medical examination and
an evaluation of the applicant's history and condition, is entitled to
a medical certificate.
For applicants who are unable to meet the medical standards, such
as those with a disqualifying condition like diabetes mellitus, the
regulations provide for the ability to grant issuance of a certificate
under Sec. 67.401.\5\ Section 67.401, Special issuance of medical
certificates, details the ability of the Federal Air Surgeon to grant
an Authorization for Special Issuance of a Medical Certificate or a
Statement of Demonstrated Ability (SODA) \6\ to applicants who do not
meet the provisions of subparts B, C, or D of part 67 if the person
shows to the satisfaction of the Federal Air Surgeon that the duties
authorized by the class of medical certificate applied for can be
performed without endangering public safety.
---------------------------------------------------------------------------

\5\ See Sec. Sec. 67.115, 67.215, and 67.315.
\6\ The primary difference between an SI and a SODA is that an
SI is valid for a period set by the Federal Air Surgeon based on the
conditions of the SI while a SODA has no expiration date. SODAs are
generally issued to an applicant whose disqualifying condition is
static or nonprogressive and who has been found capable of
performing airman duties without endangering public safety.
---------------------------------------------------------------------------

B. Regulatory History of Diabetes Medical Standards

In 1959, the Federal Aviation Agency \7\ promulgated the standard
to disqualify applicants for medical certificates who have an
established history or clinical diagnosis of diabetes mellitus
requiring insulin or other hypoglycemic drug for control.\8\ For years
after the standard was adopted, FAA did not provide any exemption or
special issuances from the diabetes standard. FAA policy was that a
medical history or diagnosis of diabetes was disqualifying for all
classes of medical certification because of concerns about
unpredictable hypoglycemia and the risk it posed to aviation safety.
---------------------------------------------------------------------------

\7\ From its inception in 1958 through 1967, FAA was known as
the Federal Aviation Agency.
\8\ Amendment of Medical Standards, 24 FR 7309 (Sep. 11, 1959).
---------------------------------------------------------------------------

Since then, however, FAA has incrementally updated the special
issuance medical certification protocol for applicants with diabetes.
In 1982, FAA published a final rule on special

[[Page 56800]]

issuance of airman medical certificates.\9\ In the discussion of that
final rule, FAA explained that it would continue its existing policy of
denying medical certification to individuals with diabetes, regardless
of whether the condition was controlled with insulin or other
hypoglycemic medications. FAA indicated, however, that if future
medical advances should make certification possible, FAA would consider
those factors in its review of medical standards.
---------------------------------------------------------------------------

\9\ Special Issuance of Airman Medical Certificates and Revision
of Cardiovascular and Alcoholism Standards final rule, 47 FR 16298
(Apr. 15, 1982).
---------------------------------------------------------------------------

Shortly after the 1982 final rule, FAA initiated a contract with
the American Medical Association (AMA) to assist in a review of the
medical standards for airmen and FAA's medical certification practices
and procedures. The AMA presented its report (AMA report) on March 26,
1986, and FAA invited the public to comment in its announcement of that
report.\10\
---------------------------------------------------------------------------

\10\ Review of Medical Standards and Certification Procedures;
Availability of Report and Request for Comments notice, 51 FR 19040
(May 23, 1986).
---------------------------------------------------------------------------

In the late 1980s, FAA began to grant special issuance of medical
certificates to individuals who controlled their diabetes with diet and
oral hypoglycemic drugs. In 1994, FAA issued an NPRM \11\ to revise a
number of the medical standards in part 67 substantially based largely
on the findings of the AMA report. In the discussion of that NPRM, FAA
noted that ``(t)he AMA report recommended that persons whose diabetes
is adequately controlled with oral hypoglycemic drugs and who show
evidence of stability and freedom from adverse effects be considered
for medical certification with proper medical monitoring.'' In the
final rule issued in 1996,\12\ while no changes were made to the text
of the diabetes standards, FAA formally adopted a policy of no longer
categorically denying medical certification applications of persons
with diabetes requiring oral hypoglycemic drugs.\13\ Instead, as
adopted in the final rule and continued under current regulations and
procedures, applicants with NIDDM are issued medical certificates
through the SI process.
---------------------------------------------------------------------------

\11\ Revision of Airman Medical Standards and Certification
Procedures and Duration of Medical Certificates NPRM, 59 FR 53226
(Oct. 21, 1994).
\12\ Revision of Airman Medical Standards and Certification
Procedures and Duration of Medical Certificates final rule, 61 FR
11238 (Mar. 19, 1996).
\13\ In 1996, FAA issued a policy statement regarding the
issuance of third-class airmen medical certificates to applicants
with insulin-treated diabetes mellitus (ITDM) (Special Issuance of
Third-Class Airman Medical Certificates to Insulin-Treated Diabetic
Airman Applicants, 61 FR 59282, Nov. 21, 1996). In that policy
statement, FAA determined selected individuals with ITDM could be
considered for special issuance of a third-class airman medical
certificate under certain conditions and monitoring protocols. In
2019, FAA announced that it would also issue first and second-class
certificates to pilots with ITDM under the special issuance process
(Special-Issuance Medical Certification: Diabetes Protocol for
Applicants Seeking to Exercise Airline Transport, Commercial, or
Private Pilot Privileges, 84 FR 60137, Nov. 7, 2019). This proposed
rule would only extend to applicants with NIDDM, and applicants with
ITDM would continue to be required to utilize the special issuance
process.
---------------------------------------------------------------------------

IV. Discussion of the Proposed Rule

A. Removal of NIDDM as a Disqualifying Medical Condition

FAA proposes to no longer classify NIDDM as a specifically
disqualifying medical condition under part 67. The proposed amendment
would remove the phrase ``or any other hypoglycemic drug'' from
Sec. Sec. 67.113(a), 67.213(a), and 67.313(a). If finalized as
proposed, this change would allow applicants with NIDDM to be
potentially issued first-, second-, and third-class medical
certificates by AMEs at the time of the medical examination, as opposed
to deferral to FAA for the SI process required under current
regulations.
Because NIDDM would no longer be a specifically disqualifying
condition, NIDDM applicants would be evaluated under the general
medical standards contained in paragraphs (b) and (c) of Sec. Sec.
67.113, 67.213, and 67.313. Under these provisions, an NIDDM applicant
may nonetheless be denied a medical certificate, on a case-by-case
basis, if the Federal Air Surgeon or designated AME finds that the
diabetes or non-insulin hypoglycemic treatment makes, or may reasonably
be expected to make, the applicant unable to perform the duties or
exercise the privileges of the airman certificate held or for which
application has been sought safely.
Under the proposed amendment, Sec. Sec. 67.113(a), 67.213(a), and
67.313(a) would continue to disqualify applicants with insulin-treated
diabetes mellitus (ITDM) from receiving an unrestricted medical
certificate at the time of examination. Applicants with ITDM would
still be required to go through the SI process, and individual
circumstances would determine what requirements the Federal Air Surgeon
would put in place in terms of regular testing and monitoring, and the
duration of any authorization issued.

B. Aviation Safety Impact

FAA conducted an analysis of fatal accidents involving airmen using
non-insulin diabetes medications from 2008-2025. Data sources included
the FAA ToxDB databases, which include both MANTRA and ToxFlo.\14\
Fifty-one cases were found where non-insulin diabetes medications were
reported. The Office of Aerospace Medicine examined the available
records, including autopsy, toxicology, accident, and National
Transportation Safety Board determinations, to determine the
possibility of diabetes-related incapacitation in the accident. Of
these, it was deemed improbable that diabetes, diabetes complications,
or diabetes medications contributed to the accident in 50 cases. One
case remains under investigation and, therefore, FAA could not make
determinations on this case at this time.
---------------------------------------------------------------------------

\14\ The FAA ToxDB databases are internal data sources used by
FAA as part of its accident investigation responsibilities and are
not available to the public. More information can be found at
<a href="https://www.transportation.gov/individuals/privacy/toxicology-database-toxdb">https://www.transportation.gov/individuals/privacy/toxicology-database-toxdb</a>.
---------------------------------------------------------------------------

Advancements in medical science have significantly reduced the risk
associated with diabetic complications in those with NIDDM. Population-
level data from the United States reveal dramatic improvements in
complication rates among adults with diabetes between 1990 and 2010,
with acute myocardial infarction rates declining by approximately two-
thirds, and substantial reductions in stroke, lower extremity
amputation, and death from hyperglycemic crisis.\15\ The Steno-2 study
demonstrated that multifactorial intervention targeting glycemic
control, blood pressure, and lipids reduced both microvascular and
macrovascular complications more effectively than glucose-lowering
alone, which has become the cornerstone of modern diabetes
management.\16\ In addition, newer glucose-lowering agents have
produced a paradigm shift in preventing cardiovascular and renal
complications. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and
glucagon-like peptide-1 (GLP-1) receptor agonists reduce mortality and
major cardiovascular events compared to usual care.\17\ SGLT2
inhibitors specifically reduce progression to chronic kidney disease,
heart failure hospitalizations, and severe hypoglycemia, while GLP-1
receptor agonists demonstrate particular efficacy

[[Page 56801]]

in reducing stroke and achieving weight loss.\18\
---------------------------------------------------------------------------

\15\ Gregg, E.W., et al., Changes in diabetes-related
complications in the United States, 1990-2010, N Engl J Med.,
370(16): 1514-23 (Apr. 17, 2014).
\16\ Ahmad, E., et al., Type 2 diabetes, Lancet, 400(10365):
1803-1820 (Nov. 19, 2022).
\17\ Drake, T., et al., Newer Pharmacologic Treatments in Adults
With Type 2 Diabetes: A Systematic Review and Network Meta-analysis
for the American College of Physicians, Ann Intern Med., 177(5):
618-632 (May 2024).
\18\ Management of Type 2 Diabetes Mellitus Work Group, VA/DoD
CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 2 DIABETES
MELLITUS (2023), Available at: <a href="https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/CD/diabetes/VADOD-Diabetes-CPG_Final_508.pdf">https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/CD/diabetes/VADOD-Diabetes-CPG_Final_508.pdf</a> (last accessed Sep. 1, 2026).
---------------------------------------------------------------------------

In addition to the risk reductions associated with medical
advancements, the current SI process required for those with NIDDM
presents a significant burden to medical professionals within FAA's
Office of Aerospace Medicine who must devote time and resources to
reviewing these lower-risk cases at the expense of more complex and
potentially higher-risk cases. If this rule is finalized as proposed,
FAA medical staff would be able to focus on these higher-risk cases and
provide more expeditious review, reducing overall risk in the national
airspace.

C. Medical Evaluation of NIDDM Cases

If this rule is finalized as proposed, NIDDM cases would be
evaluated by an AME under paragraphs (b) and (c) of Sec. Sec. 67.113,
67.213, and 67.313, the general medical standards, instead of by FAA
medical personnel under the SI process. The applicant must have no
other organic, functional, or structural disease or limitation nor any
medication or treatment that the AME finds--based on the applicant's
case history and appropriate, qualified medical judgment relating to
the condition or treatment--makes, or may reasonably be expected to
make, the applicant unable to perform the duties safely or exercise the
privileges of the airman certificate sought. As such, while NIDDM would
no longer be disqualifying specifically, an applicant with NIDDM must
still undergo medical evaluation for the condition to ensure the
applicant can safely perform his or her airman duties.
If this rule is finalized as proposed, FAA would notify the public
and its AMEs of the regulatory change. Applicants currently pending
review by FAA could choose to remain in the review process for their
currently pending application or return to their AME and reinitiate the
medical certificate application process.
Applicants with NIDDM would continue to provide their medical case
history of NIDDM for evaluation, typically to include a clinical
progress note, status report, or similar documentation from their
treating physician, as well as an acceptable Hemoglobin A1C (A1C) test.
NIDDM cases would be evaluated on a case-by-case basis by an AME to
determine an applicant's medical qualification. The AME would consider
multiple factors, such as the stability of the applicant's diabetes
mellitus, any recommendations made by the treating physician, and the
types of medication or treatment being used. Notwithstanding the
proposed rule, in higher-risk NIDDM cases, the AME may still defer the
applicant to FAA medical personnel for further evaluation and, if the
applicant is ultimately determined to be medically fit, issuance of an
unrestricted or limited medical certificate using the established SI
process. Deferral to FAA would be appropriate, for example, in NIDDM
cases involving recent episodes of clinical hypoglycemia requiring
intervention, medication side effects that could potentially interfere
with the performance of airman duties, evidence of any diabetes-induced
end organ disease, or high A1C levels.

D. Cost Savings and Burden Reduction

Cost savings are expected upon finalization of this proposal. FAA
estimates that allowing AMEs to evaluate applicants with controlled
NIDDM using the general medical standards in paragraphs (b) and (c) of
Sec. Sec. 67.113, 67.213, and 67.313 would potentially enable them to
issue medical certificates at the time of the applicant medical exam in
roughly 3,000 cases annually. Therefore, about 3,000 applicants would
receive their medical certificates much more quickly each year because
their cases would avoid the current time-consuming AME-deferral to FAA.
The proposed change would also allow an estimated 1,200 total cases
currently followed under SI to be transitioned, so that AMEs--rather
than FAA--would be able to handle recertification. As of September
2025, 1,300 initial applications are in the specific FAA Medical
Appeals queue for review. Of these, 300 would potentially qualify for
AME-issuance under the general medical standards that would be allowed
if this rule is finalized as proposed. Approximately 50 percent of
these cases are applicants for first- or second-class medical
certificates. For the recertification cases currently awaiting the same
FAA review, approximately 1,200 applicants (about 75 percent are
applying for a first- or second-class medical certificate) would
potentially qualify for AME issuance rather than FAA review under the
proposed change.

V. Regulatory Notices and Analyses

A. Regulatory Impact Analysis (RIA)

Executive Order (E.O.) 12866 (``Regulatory Planning and Review'')
and E.O. 13563 (``Improving Regulation and Regulatory Review'') require
agencies to regulate in the ``most cost-effective manner,'' to make a
``reasoned determination that the benefits of the intended regulation
justify its costs,'' and to develop regulations that ``impose the least
burden on society.'' The Office of Management and Budget (OMB) has
determined this proposed rule is not a significant regulatory action as
defined in section (3)(f) of E.O. 12866. In conducting this analysis,
FAA has determined the proposed rule has benefits that justify its
costs.
1. Baseline and Population
The existing regulatory framework and practices for prospective
applicants with NIDDM constitute the baseline for this analysis.
Current airmen with NIDDM or those with NIDDM seeking a medical
certification would be impacted. In addition, all applicants with
deferred medical applications under review for SI would have faster
processing times. FAA uses a five-year period of analysis for the
proposed rule. Five years encompasses the longest period a medical
certification remains valid before needing re-certification.\19\
Therefore, the analysis period encompasses at least one cycle of
initial and recurrent costs for all active pilots initially
certificated under an SI within or prior to year zero.\20\
---------------------------------------------------------------------------

\19\ See Sec. 61.23(d).
\20\ FAA notes that, while flight engineers, flight navigators,
and certain air traffic control tower operators are required to
obtain at least a second-class medical certificate, FAA considered
only pilots for this analysis because the volume of non-pilot
certificates is small and would not significantly impact the
proposed rule's analysis. In 2024, for example, 0.8 percent of new
second-class medical certificates issued were for non-pilot
positions (See: U.S. Civil Airmen Statistics, Table 17, available
at: <a href="https://www.faa.gov/media/90441">https://www.faa.gov/media/90441</a>.
---------------------------------------------------------------------------

FAA used internal data and airman growth rates to estimate the
number of initial and recurrent medical certifications for affected
airmen with NIDDM and all deferred applicants throughout the five-year
period of analysis. FAA estimated the number of certifications and the
share of certifications by class of medical certificate using internal
data, and FAA estimated the annual growth rate in first-, second-, and
third-class pilot medical certifications using the growth in active
pilot certificates from 2015 to 2024.\21\ Table 1 displays FAA's growth
rate and certification assumptions by pilot class.
---------------------------------------------------------------------------

\21\ 2024 Active Civil Airmen Statistics, FAA (2025), available
at: <a href="https://www.faa.gov/data_research/aviation_data_statistics/civil_airmen_statistics">https://www.faa.gov/data_research/aviation_data_statistics/civil_airmen_statistics</a>.

[[Page 56802]]

Table 1--Certification Assumptions by Medical Certificate Class
------------------------------------------------------------------------
Share of initial Certification
Class certifications growth rate \2\
\1\ (%) (%)
------------------------------------------------------------------------
First-Class....................... 25 1.50
Second-Class...................... 16 0.70
Third-Class....................... 60 5.70
------------------------------------------------------------------------
Note: Numbers may not add due to rounding.
\1\ Source: Internal FAA data, 2025.
\2\ FAA used the change in active pilots from 2014 to 2025 to estimate
the annualized growth rate in certifications by medical class (See:
U.S. Civil Airmen Statistics, Table 4, available at: <a href="https://www.faa.gov/media/90441">https://www.faa.gov/media/90441</a>).

Using growth rate and historical certification data, FAA estimates
there would be 44,176 unrestricted NIDDM certifications (7,595 initial
and 36,581 recurrent) and 169,085 Authorizations for SI (49,967 initial
and 119,118 recurrent) in the analysis period. The estimated initial
and recurrent NIDDM certifications include only applicants with NIDDM
who would be issued an unrestricted medical certificate after FAA
examination under the proposed rule. All applicants with NIDDM who
would not receive an unrestricted medical certificate after FAA review
are estimated within Authorization for SI projections. Table 2 displays
the estimated initial and recurrent unrestricted NIDDM certifications,
and Table 3 displays the initial and recurrent SI Authorizations
throughout the analysis period.\22\
---------------------------------------------------------------------------

\22\ Pilots are not impacted by the same deferred certification
process upon recertification, and the recertification process does
not impact pilot cost savings. However, FAA will experience cost
savings when reviewing pilot recertifications, regardless of pilot
class. Therefore, FAA estimated the number of recertifications but
did not separate these recertifications by pilot class.

Table 2--Initial and Recurrent Unrestricted NIDDM Certifications
----------------------------------------------------------------------------------------------------------------
Initial certifications
------------------------------------------------ Recurrent Total
Year First- Second- Third- certifications certifications
Total class class class \1\
----------------------------------------------------------------------------------------------------------------
0............................... 1,403 329 207 867 6,988 8,391
1............................... 1,458 334 208 916 7,146 8,604
2............................... 1,516 339 209 968 7,310 8,826
3............................... 1,577 344 210 1,023 7,480 9,057
4............................... 1,641 349 211 1,081 7,657 9,298
-------------------------------------------------------------------------------
Total....................... 7,595 1,695 1,045 4,855 36,581 44,176
----------------------------------------------------------------------------------------------------------------
Note: The estimated initial and recurrent NIDDM certifications include only NIDDM applicants that would be
issued an unrestricted medical certificate after FAA examination under the proposed rule.
\1\ The number of recurrent certifications includes all first-, second-, and third-class pilot recertifications.
FAA did not separate recertifications by class, as the recertification class does not impact the proposed
rule's cost savings.

Table 3--Initial SI Authorizations and Recurrent Restricted Certifications
----------------------------------------------------------------------------------------------------------------
Initial SI authorizations
------------------------------------------------ Recurrent Total
Year First- Second- Third- certification certifications
Total class class class \1\
----------------------------------------------------------------------------------------------------------------
0............................... 9,230 2,164 1,362 5,704 22,755 31,985
1............................... 9,592 2,197 1,368 6,026 23,269 32,861
2............................... 9,974 2,230 1,375 6,368 23,803 33,777
3............................... 10,375 2,263 1,382 6,730 24,357 34,732
4............................... 10,796 2,296 1,388 7,112 24,933 35,729
-------------------------------------------------------------------------------
Total....................... 49,967 11,151 6,875 31,941 119,118 169,085
----------------------------------------------------------------------------------------------------------------
Note: The estimated SI authorizations exclude any deferred applications denied an SI authorization in a given
year.
\1\ The number of recurrent certifications includes all first-, second-, and third-class pilot recertifications.
FAA did not separate recertifications by class, as the recertification class does not impact the proposed
rule's cost savings.

2. Costs
FAA does not anticipate any new costs from the proposed rule's
changes to the NIDDM medical certification. To receive a medical
certificate, a prospective applicant with NIDDM currently provides (1)
a ``Diabetes or Hyperglycemia on Oral Medications Status Report'' or a
clinical progress note from their treating physician and (2) an A1C
test performed no more than 90 days prior to their AME exam.\23\ For
recertifications, applicants with NIDDM provide (1) an Authorization
for SI granted by FAA and (2) a ``Diabetes or Hyperglycemia on Oral
Medications Status Report'' or a current status report (including an
A1C test) from their
---------------------------------------------------------------------------

\23\ Guide for Aviation Medical Examiners: Protocol for Diabetes
Mellitus Treated with Any Medication Other Than Insulin, FAA (2025),
available at: <a href="https://www.faa.gov/ame_guide/dec_cons/disease_prot/diabetes_med">https://www.faa.gov/ame_guide/dec_cons/disease_prot/diabetes_med</a>.

---------------------------------------------------------------------------

[[Page 56803]]

treating physician.\24\ FAA anticipates the proposed process would not
impose any new cost burdens to applicants with NIDDM relative to the
existing application process. Applicants would provide the same or
similar documentation to their AME for review.
---------------------------------------------------------------------------

\24\ Guide for Aviation Medical Examiners: Special Issuances AME
Assisted--All Classes--Diabetes Mellitus--Type II, Medication
Controlled (Not Insulin), FAA (2025), <a href="https://www.faa.gov/ame_guide/special_iss/all_classes/diabetes">https://www.faa.gov/ame_guide/special_iss/all_classes/diabetes</a>.
---------------------------------------------------------------------------

FAA does not anticipate any additional risk from streamlining the
NIDDM medical certification process. In an analysis of 51 fatal
accidents from 2008 to 2025 in which the use of NIDDM medications was
identified, FAA deemed it improbable that diabetes, diabetes
complications, or diabetes medications contributed to the accident in
50 cases. One case remains under investigation. In addition,
advancements in medical technology have reduced the risk associated
with diabetic complications in those with NIDDM. Under the proposed
rule, applicants with NIDDM would be evaluated by an AME for stability
and control similar to what is currently performed for such deferred
applications. The proposed process does not incur an additional cost to
initial or recurrent medical certification for applicants with NIDDM,
and FAA does not anticipate new safety risks from the streamlining of
the NIDDM certification process.
i. Industry Cost Savings
Transitioning a portion of medical certification applications from
the special issuance process to the proposed process would reduce
initial certification delays for airmen with NIDDM and airmen requiring
an SI Authorization. FAA estimates initial applications deferred for an
SI Authorization currently take an average of 64 days for FAA to
process.\25\ Pilots cannot perform flight duties during this processing
time, resulting in a cost to both pilots and industry in lost labor
hours. The proposed rule's process would significantly reduce
processing delays for pilots with NIDDM. FAA would also receive fewer
deferred applications, leading to faster processing for all deferred
applicants.
---------------------------------------------------------------------------

\25\ Special Issuance recertifications can be processed by an
AME, resulting in zero grounding time. However, FAA Legal
Instruments Examiners and Physicians still review and verify
recertifications.
---------------------------------------------------------------------------

FAA estimates the reduction in lost flight hours from processing
delays to estimate pilots' and industry cost savings because of the
proposed rule. Using Bureau of Labor Statistics data, FAA estimates the
fully-loaded hourly wage of a pilot holding a first-class medical
certificate is $108.85, and the fully-loaded hourly wage of a pilot
holding a second-class medical certificate is $58.93.\26\ To estimate
the lost labor hours recovered for both initial applicants with NIDDM
who would be eligible for an unrestricted medical certificate and all
deferred initial applicants because of the proposed rule, FAA estimates
the per-applicant reduction in medical certification delays. FAA
assumes that a pilot with NIDDM who would be eligible for an
unrestricted medical certificate under the proposed rule will see a 64-
day (2.10 month) reduction in certification delays. For all deferred
initial applicants, FAA estimates the reduction in delays based upon
the reduction in total deferred application backlogs. Based upon
internal FAA data, 15.2 percent of the current deferred applicant
backlog would transition to the proposed rule's NIDDM unrestricted
medical certification process. A 15.2 percent reduction in the 64-day
certification delay would result in a 10-day (0.33 month) reduction in
processing delays for all other applicants in FAA's deferred backlog.
---------------------------------------------------------------------------

\26\ Based upon Bureau of Labor Statistics (BLS) data, a pilot
with an airline transport pilot certificate and a first-class
medical certificate has a median salary of $226,600 annually; a
pilot holding a commercial certificate and a second-class medical
certificate has a median salary of $122,670 annually; and both pilot
classes work approximately 2,700 labor hours annually (900 flight
hours and 1,800 non-flight hours) (See: Airline and Commercial
Pilots, BLS OOH (2025), available at: <a href="https://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm">https://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm</a>). BLS also estimated the fringe benefit factor for a
private industry worker is 1.297 (See: Employer Costs for Employee
Compensation, BLS (June 2024), available at: <a href="https://www.bls.gov/news.release/archives/ecec_09102024.pdf">https://www.bls.gov/news.release/archives/ecec_09102024.pdf</a>). FAA multiplied the median
salaries by the fringe benefit factor and divided the fully-loaded
salaries by 2,700 labor hours.
---------------------------------------------------------------------------

Reducing these processing delays would shorten a pilot's grounded
time and, therefore, recover flight hours for pilots with NIDDM who
would be eligible for an unrestricted medical certificate and all
deferred applicants. FAA estimates the average pilot holding a first-
or second-class medical certificate flies 75 hours monthly based upon
BLS's estimation of monthly flight hours for airline pilots.\27\ FAA
anticipates that, while a pilot is grounded because of a deferred
application, a pilot could take on additional non-flying labor
activities to offset lost labor hours. Based upon this inference, FAA
created a low-case and high-case estimation of the number of flight
hours reclaimed. In the low-case scenario, FAA assumes that half of a
pilot's lost flight hours are replaced with additional non-flying labor
hours when grounded. In the high-case scenario, FAA assumes that none
of a pilot's lost flight hours are replaced with additional non-flying
labor hours when grounded. FAA requests comment on how certification
delays impact pilot labor hours, including what labor activities pilots
undertake while grounded and the low-case and high-case labor hour
assumptions. Table 4 displays the low-case and high-case labor hour
scenarios.
---------------------------------------------------------------------------

\27\ Airline and Commercial Pilots, BLS OOH (2025), available
at: <a href="https://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm">https://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm</a>.

Table 4--Low-Case and High-Case Labor Hours Lost per Month
----------------------------------------------------------------------------------------------------------------
Additional non-
Scenario Flight hours flying labor Monthly labor
lost \1\ hours hours lost
----------------------------------------------------------------------------------------------------------------
Low-Case........................................................ 75 37.5 37.5
High-Case....................................................... 75 0 75
----------------------------------------------------------------------------------------------------------------
\1\ From BLS's monthly airline pilot flight hours estimate (See: Airline and Commercial Pilots, BLS OOH (2025),
available at: <a href="https://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm">https://www.bls.gov/ooh/transportation-and-material-moving/airline-and-commercial-pilots.htm</a>.).

FAA uses these estimated delay reductions, pilot wages, and monthly
flight hours to estimate the cost savings per application in both the
low-case and high-case scenario. Table 5 displays the calculations used
to estimate per-applicant cost savings in both scenarios.

[[Page 56804]]

Table 5--Initial Application Delay Per-Applicant Cost Savings
----------------------------------------------------------------------------------------------------------------
Processing
Fully- loaded Monthly labor delay Flight hours Per- applicant
Applicant type wage \1\ hours lost reduction lost cost savings
(months) \2\
----------------------------------------------------------------------------------------------------------------
Low-Case Scenario
----------------------------------------------------------------------------------------------------------------
NIDDM First-Class............... $108.85 37.5 2.10 79 8,599
NIDDM Second-Class.............. 58.93 37.5 2.10 79 4,655
Deferred First-Class............ 108.85 37.5 0.33 12 1,306
Deferred Second-Class........... 58.93 37.5 0.33 12 707
----------------------------------------------------------------------------------------------------------------
High-Case Scenario
----------------------------------------------------------------------------------------------------------------
NIDDM First-Class............... 108.85 75 2.10 158 17,199
NIDDM Second-Class.............. 58.93 75 2.10 158 9,310
Deferred First-Class............ 108.85 75 0.33 25 2,721
Deferred Second-Class........... 58.93 75 0.33 25 1,473
----------------------------------------------------------------------------------------------------------------
Note: Numbers may not add due to rounding.
\1\ The fully-loaded wage is calculated as follows: Fully-Loaded Wage = (Median Salary * 1.297 Fringe Benefit
Factor) /2,700 Annual Labor Hours.
\2\ The Per-Applicant Cost Savings is calculated as follows: Cost Savings = Fully Loaded Wage * Flight Hours
Lost.

FAA estimates the industry low-case and high-case cost savings from
per-applicant cost savings and total number of estimated applicants
throughout the period of analysis. In the low-case scenario, FAA
estimates the proposed rule would save industry $38.87 million ($34.05
million at a seven percent discount rate, $36.64 million at a three
percent discount rate) in labor hours during the period of analysis. In
the high-case scenario, FAA estimates the proposed rule would save
industry $79.36 million ($69.51 million at a seven percent discount
rate, $74.81 million at a three percent discount rate) in labor hours
during the period of analysis. Table 6 displays the estimated low-case
industry cost savings, and Table 7 displays the high-case industry cost
savings.

Table 6--Low-Case Initial Application Delay Cost Savings
--------------------------------------------------------------------------------------------------------------------------------------------------------
Initial applicants Delay reduction cost savings ($M)
------------------------------------------------------------------------------------------------ Total cost
Year NIDDM NIDDM Deferred Deferred NIDDM NIDDM Deferred Deferred savings
first- second- first- second- first- second- first- second- ($M)
class class class class class class class class
--------------------------------------------------------------------------------------------------------------------------------------------------------
0........................................... 329 207 2,164 1,362 $2.83 $0.96 $2.83 $0.96 $7.58
1........................................... 334 208 2,197 1,368 2.87 0.97 2.87 0.97 7.68
2........................................... 339 209 2,230 1,375 2.92 0.97 2.91 0.97 7.77
3........................................... 344 210 2,263 1,382 2.96 0.98 2.96 0.98 7.87
4........................................... 349 211 2,296 1,388 3.00 0.98 3.00 0.98 7.96
-----------------------------------------------------------------------------------------------------------
Total................................... 1,695 1,045 11,151 6,875 14.58 4.86 14.57 4.86 38.87
--------------------------------------------------------------------------------------------------------------------------------------------------------

Table 7--High-Case Initial Application Delay Cost Savings
--------------------------------------------------------------------------------------------------------------------------------------------------------
Initial applicants Delay reduction cost savings ($M)
------------------------------------------------------------------------------------------------ Total cost
Year NIDDM NIDDM Deferred Deferred NIDDM NIDDM Deferred Deferred savings
first- second- first- second- first- second- first- second- ($M)
class class class class class class class class
--------------------------------------------------------------------------------------------------------------------------------------------------------
0........................................... 329 207 2,164 1,362 $5.66 $1.93 $5.89 $2.01 $15.48
1........................................... 334 208 2,197 1,368 5.74 1.94 5.98 2.02 15.68
2........................................... 339 209 2,230 1,375 5.83 1.95 6.07 2.03 15.87
3........................................... 344 210 2,263 1,382 5.92 1.96 6.16 2.04 16.07
4........................................... 349 211 2,296 1,388 6.00 1.96 6.25 2.05 16.26
-----------------------------------------------------------------------------------------------------------
Total................................... 1,695 1,045 11,151 6,875 29.15 9.73 30.35 10.13 79.36
--------------------------------------------------------------------------------------------------------------------------------------------------------

ii. FAA Cost Savings
FAA estimates the proposed certification process would reduce FAA
labor hours spent processing NIDDM applications. Currently, an AME must
defer all initial and recurrent NIDDM applications. These applications
then go to an FAA Legal Instruments Examiner for processing. FAA
estimates it takes 15 minutes for a Legal Instruments Examiner to
process an NIDDM application. In approximately 10 percent of NIDDM
applications, the Legal Instruments Examiner defers the application to
an FAA Physician who spends an additional 15 minutes processing that
NIDDM application for authorization of a special issuance. Based upon
the fully-loaded hourly wage for Legal Instruments Examiners and
Physicians,\28\ FAA estimates

[[Page 56805]]

NIDDM applications incur an $18.91 processing cost. Table 8 displays
the wage and labor hours used to calculate the per-unit processing
cost.
---------------------------------------------------------------------------

\28\ To estimate the fully-loaded labor hours of a Legal
Instruments Examiners and Physicians, FAA used the average salary of
an FAA employee located in the ``rest of the U.S.'' locality (an H-
band salary for Examiners and an M-band salary for Physicians) (See:
Pay & Benefits, FAA (2025), available at: <a href="https://www.faa.gov/jobs/working_here/benefits">https://www.faa.gov/jobs/working_here/benefits</a>) and multiplied that salary by a fringe
benefit cost factor of 1.3625. A fringe benefit factor estimates the
additional monetary benefits, such as healthcare and retirement
benefits (See: OMB Memo M-08-13). Lastly, FAA estimated the hourly
wage for by dividing the annual salary by 2,080 annual labor hours.

Table 8--Per-Unit FAA Processing Cost of Initial and Recurrent Applications
----------------------------------------------------------------------------------------------------------------
Weighted
Fully-loaded Share of average
Occupation Salary \1\ hourly wage Labor hours applicants (%) processing
\2\ cost \3\
----------------------------------------------------------------------------------------------------------------
Legal Instruments Examiner...... $95,033 $62.25 0.25 100 $15.56
Physician....................... 204,386 133.88 0.25 10 3.35
-------------------------------------------------------------------------------
Total Cost.................. .............. .............. .............. .............. 18.91
----------------------------------------------------------------------------------------------------------------
Note: Numbers may not add due to rounding.
\1\ Source: FAA's Core Compensation salary table (<a href="https://www.faa.gov/jobs/working_here/benefits">https://www.faa.gov/jobs/working_here/benefits</a>).
\2\ To calculate the hourly wage, FAA assumed employees would work 2,080 hours annually and multiplied this wage
by a fringe benefit factor of 1.3625 (See: OMB Memo M-08-13).
\3\ The weighted average processing cost accounts for the probability that a given NIDDM application incurs that
labor cost. Because only 10% of NIDDM applications incur a physician cost, the weighted average cost for all
NIDDM applications is 10% of the physician process cost.

Through the proposed rule's certification process, FAA would avoid
all Legal Instruments Examiner and Physician processing costs for NIDDM
applications issued an unrestricted medical certificate. FAA estimates
the proposed rule would save the Agency $835,366 ($730,488 at a seven
percent discount rate, $786,906 at a three percent discount rate) in
labor hours throughout the period of analysis. Table 9 displays the
estimated FAA cost savings.

Table 9--FAA Processing Cost Savings
[2024$]
----------------------------------------------------------------------------------------------------------------
Per-unit cost
Year NIDDM applications savings Cost savings
----------------------------------------------------------------------------------------------------------------
0....................................... 8,391..................... $18.91 $158,673
1....................................... 8,604..................... 18.91 162,701
2....................................... 8,826..................... 18.91 166,899
3....................................... 9,057..................... 18.91 171,267
4....................................... 9,298..................... 18.91 175,825
-----------------------------------------------------------------------
Total Cost Savings.............. .......................... .............. 835,366
7% Discount Rate................ .......................... .............. 740,448
3% Discount Rate................ .......................... .............. 786,448
----------------------------------------------------------------------------------------------------------------

iii. Unquantified Cost Savings
FAA did not quantify the cost savings from reduced third-class
medical certificate processing delays or from non-pilot second-class
medical certificate processing delays. Private, student, and
recreational pilots must generally have a third-class medical
certificate. As with pilots holding or applying for first- and second-
class medical certificates, pilots holding or applying for third-class
medical certificates would receive their NIDDM medical certification
and deferred application review faster, resulting in reclaimed flight
hours. Pilots with a third-class medical certificate could experience
cost savings from private, student, or recreational operations.
However, private, student, and recreational activities are difficult to
quantify and monetize. FAA requests comment on the proposed rule's cost
savings impact on affected pilots applying for a third-class medical
certificate. The impacts of the proposed rule were not quantified for
flight engineers, flight navigators, and certain air traffic control
tower operators due to the small size of these populations. Although
this can provide a cost saving, FAA has not quantified the cost savings
for pilots with third-class medical certificates or for non-pilots with
second-class medical certificates from faster processing under the
proposed rule.
3. Benefits
FAA has not quantified the estimated benefit of an increase in
NIDDM pilot applications. The proposed rule may entice more prospective
applicants with NIDDM to acquire a pilot certificate through the
simplified medical certification process under the general medical
standards. An increase in the number of prospective pilots would be a
benefit to both prospective pilots and to air carriers seeking to hire
new pilots. An influx of pilots would allow air carriers to expand
service opportunities and offerings, while prospective pilots
themselves could gain benefits through the salary and benefits of a
pilot career. However, FAA has not quantified the number of prospective
pilots who would acquire a certificate because of the proposed rule.
FAA requests comment on the quantitative and qualitative impacts the
proposed rule would have on certificate applications received from
prospective pilots with NIDDM.
4. Summary
The proposed rule would replace the existing medical certification
process, which requires deferral and review for authorization of a
special issuance, with a more efficient certification process for
airmen with NIDDM. The revised process would provide cost savings for
both FAA and industry by reducing FAA processing time for unrestricted
NIDDM pilot medical certifications and eliminating delays for pilots
with

[[Page 56806]]

NIDDM to receive their medical certifications. It would also decrease
the processing time for deferred applications by reducing the total
deferred application backlog. Table 10 below provides a summary of the
annual and total cost savings to both industry operators and FAA.

Table 10--Summary of Costs
[Millions 2024$]
----------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------
Qualitative Cost Savings
----------------------------------------------------------------------------------------------------------------
<bullet> Reduced delay in initial third-class NIDDM certifications and initial third-class deferred initial
authorization processing.
----------------------------------------------------------------------------------------------------------------
Cost Savings ($M)
----------------------------------------------------------------------------------------------------------------
2024$ 7% 3% 7% 3%
----------------------------------------------------------------------------------------------------------------
Industry Cost Savings
----------------------------------------------------------------------------------------------------------------
Present value
Annualized
----------------------------------------------------------------------------------------------------------------
Low-Case $38.87 $34.05 $36.64 $8.30 $8.00
High-Case 79.36 69.51 74.81 16.95 16.34
FAA Cost Savings
----------------------------------------------------------------------------------------------------------------
Total Cost Savings 0.84 0.73 0.79 0.18 0.17
----------------------------------------------------------------------------------------------------------------
Total Cost Savings
----------------------------------------------------------------------------------------------------------------
Low-Case 39.70 34.78 37.43 8.48 8.17
High-Case 80.19 70.24 75.60 17.13 16.51
----------------------------------------------------------------------------------------------------------------

B. Regulatory Flexibility Act

The Regulatory Flexibility Act (RFA) of 1980, (Pub. L. 96-354) (5
U.S.C. 601-612), as amended by the Small Business Regulatory
Enforcement Fairness Act of 1996 (Pub. L. 104-121) and the Small
Business Jobs Act of 2010 (Pub. L. 111-240), requires Federal agencies
to consider the effects of the regulatory action on small business and
other small entities and to minimize any significant economic impact.
The term ``small entities'' comprises small businesses and not-for-
profit organizations that are independently owned and operated and are
not dominant in their fields, and governmental jurisdictions with
populations of less than 50,000.
FAA used the definition of small entities in the RFA for this
analysis. The RFA defines small entities as small businesses, small
governmental jurisdictions, or small organizations. In 5 U.S.C. 601(3),
the RFA defines ``small business'' to have the same meaning as ``small
business concern'' under section 3 of the Small Business Act. The Small
Business Act authorizes the Small Business Administration (SBA) to
define ``small business'' by issuing regulations. SBA (2023) has
established size standards for various types of economic activities, or
industries under the North American Industry Classification System
(NAICS). These size standards generally define small businesses based
on the number of employees or annual receipts.
There are ten affected NAICS codes for air transportation services
based on the type of activity conducted. Table 11 shows the SBA size
standards for these transportation activities. Note that the SBA
definition of a small business applies to the parent company and all
affiliates as a single entity.

Table 11--Small Business Size Standards
------------------------------------------------------------------------
NAICS code Description Size standard
------------------------------------------------------------------------
481111........................ Scheduled Passenger 1,500 Employees.
Air Transportation.
481112........................ Scheduled Freight Air 1,500 Employees.
Transportation.
481211........................ Nonscheduled Chartered 1,500 Employees.
Passenger Air
Transportation.
481219........................ Other Nonscheduled Air $25.0 Million.
Transportation.
487990........................ Scenic and Sightseeing $14.0 Million.
Transportation, Other.
115112........................ Soil Preparation, $9.0 Million.
Planting, and
Cultivating.
541370........................ Surveying and Mapping $19.0 Million.
(except Geophysical)
Services.
488190........................ Other Support $40.0 Million.
Activities for Air
Transportation.
611512........................ Flight Training....... $34.0 Million.
488111........................ Air Traffic Control... $40.0 Million.
------------------------------------------------------------------------
Source: SBA (2023).
NAICS = North American Industrial Classification System.
SBA = Small Business Administration.

To identify small entities impacted by the proposed rule, FAA
analyzed data from various sources, including company annual reports
and the Bureau of Transportation Statistics. Of the 4,840 total
entities identified, FAA concludes the majority are small. The small
entities include approximately 32 of 56 part 121 operators (NAICS codes
481111 and 481112), the majority of the 525 part 141 flight schools,
and the majority of the 45 part 142 training centers

[[Page 56807]]

(NAICS code 611512). Although the proposed rule also impacts four air
traffic control (NAICS code 488111) entities, FAA estimates only one is
a small business. The remaining affected entities are either part 135,
part 91, or part 137 operators (NAICS codes 481211, 481219, 487990,
115112, 541370, and 488190). There were approximately 1,750 part 135
operators, 900 part 91 operators, and 1,560 part 137 (crop dusting)
operators at the time of this proposed rule. FAA infers that most of
these 4,210 operators are small. Therefore, FAA has determined that
this proposed rule would impact a substantial number of small entities.
Although a substantial number of small entities would be affected
by the proposed rule, it would not have a significant impact. Affected
entities, including small entities, would experience cost savings from
a more streamlined certification process for some applicants with
NIDDM. Therefore, FAA certifies that the proposed rule would not have a
significant economic impact on a substantial number of small entities.

C. International Trade Impact Assessment

The Trade Agreements Act of 1979 (Pub. L. 96-39), as amended by the
Uruguay Round Agreements Act (Pub. L. 103-465), prohibits Federal
agencies from establishing standards or engaging in related activities
that create unnecessary obstacles to the foreign commerce of the United
States. Pursuant to these Acts, the establishment of standards is not
considered an unnecessary obstacle to the foreign commerce of the
United States, so long as the standard has a legitimate domestic
objective, such as the protection of safety and does not operate in a
manner that excludes imports that meet this objective. The statute also
requires consideration of international standards and, where
appropriate, that they be the basis for U.S. standards.
FAA has assessed the potential effect of this proposed rule and
determined it ensures the safety of the American public and does not
exclude imports that meet this objective. As a result, FAA does not
consider this proposed rule as creating an unnecessary obstacle to
foreign commerce.

D. Unfunded Mandates Assessment

The Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1531-1538)
governs the issuance of Federal regulations that require unfunded
mandates. An unfunded mandate is a regulation that requires a State,
local, or Tribal Government or the private sector to incur direct costs
without the Federal Government having first provided the funds to pay
those costs. FAA determined the proposed rule would not result in the
expenditure of $187,000,000 or more ($100,000,000 adjusted for
inflation using the most current Implicit Price Deflator for the Gross
Domestic Product) by State, local, or Tribal Governments, in the
aggregate, or the private sector, in any one year.

E. Paperwork Reduction Act

The Paperwork Reduction Act of 1995 (44 U.S.C. 3507(d)) requires
FAA to consider the impact of paperwork and other information
collection burdens imposed on the public. Although the process of
applying for an FAA medical certificate does involve an information
collection, the proposed rule will not affect that process for
individual applicants.
All applicants for an FAA medical certificate are currently
required to complete a form 8500-8 using the FAA MedXPress system.\29\
The applicant's submitted information is made available to the selected
AME at the time of the required medical examination. The proposed rule
would only remove the need to request an SI and would have no impact on
the requirement for applicants to complete form 8500-8, and there would
be no change in individual information collection burden as a result of
this proposed rule.
---------------------------------------------------------------------------

\29\ This information collection has been approved by the OMB
under OMB Control Number 2120-0036.
---------------------------------------------------------------------------

F. International Compatibility

In keeping with U.S. obligations under the Convention on
International Civil Aviation, it is FAA policy to conform to
International Civil Aviation Organization (ICAO) Standards and
Recommended Practices to the maximum extent practicable. ICAO publishes
medical standards regarding diabetes in Annex 1, Personnel Licensing.
These standards are less strict than current FAA regulatory
requirements. Adjustments to existing differences filed with ICAO would
be needed to reflect the proposed change, once implemented. The
proposed change would bring FAA closer into alignment with ICAO
standards and will provide a path to manage the risk associated with
issuing medical certificates to airmen with non-insulin-dependent
diabetes into the future, as medical technologies affecting diagnosis
and treatment continue to evolve.

G. Environmental Analysis

FAA has analyzed the environmental impacts of this proposed rule
pursuant to the National Environmental Policy Act of 1969 (NEPA) (42
U.S.C. 4321 et seq.). FAA has determined this rule is categorically
excluded pursuant to Paragraph B-2.6(f) of Appendix B to FAA Order
1050.1G, FAA National Environmental Policy Act Implementing
Procedures.\30\ Categorical exclusions are categories of actions the
agency has determined normally do not significantly affect the quality
of the human environment and therefore do not require either an
environmental assessment (EA) or environmental impact statement
(EIS).\31\ In analyzing the applicability of a categorical exclusion,
the agency must also consider whether extraordinary circumstances are
present that would warrant the preparation of an EA or EIS.\32\ This
rulemaking, which proposes to amend FAA regulations regarding the
issuance of medical certificates to applicants with NIDDM, is
categorically excluded pursuant to Paragraph B-2.6(f) of FAA Order
1050.1G: ``Regulations, standards, and exemptions (excluding those that
if implemented may cause a significant impact on the human
environment).'' FAA does not anticipate any environmental impacts, and
there are no extraordinary circumstances present in connection with
this rulemaking.
---------------------------------------------------------------------------

\30\ 90 FR 29615 (Jul. 3, 2025).
\31\ See DOT Order 5610.1D Sec. 9.
\32\ Id. Sec. 9(b).
---------------------------------------------------------------------------

VI. Executive Order Determinations

A. Executive Order 13132, Federalism

FAA has analyzed this proposed rule under the principles and
criteria of E.O. 13132, Federalism. FAA has determined this action
would not have a substantial direct effect on the States, or the
relationship between the Federal Government and the States, or on the
distribution of power and responsibilities among the various levels of
government, and, therefore, would not have federalism implications.

B. Executive Order 13211, Regulations That Significantly Affect Energy
Supply, Distribution, or Use

FAA analyzed this proposed rule under E.O. 13211, Actions
Concerning Regulations that Significantly Affect Energy Supply,
Distribution, or Use. FAA has determined it would not be a
``significant energy action'' under the Executive order and would not
be likely to have a significant adverse effect on

[[Page 56808]]

the supply, distribution, or use of energy.

C. Executive Order 13609, Promoting International Regulatory
Cooperation

E.O. 13609, Promoting International Regulatory Cooperation,
promotes international regulatory cooperation to meet shared challenges
involving health, safety, labor, security, environmental, and other
issues and to reduce, eliminate, or prevent unnecessary differences in
regulatory requirements. FAA has analyzed this action under the
policies and agency responsibilities of E.O. 13609 and has determined
that no action is required under this E.O., and that the proposed rule
would bring FAA into closer alignment with ICAO.

D. Executive Order 14192, Unleashing Prosperity Through Deregulation

This proposed rule, if finalized as proposed, is expected to be an
E.O. 14192 deregulatory action.

VII. Additional Information

A. Comments Invited

FAA invites interested persons to participate in this rulemaking by
submitting written comments, data, or views. FAA also invites comments
relating to the economic, environmental, energy, or federalism impacts
that might result from adopting the proposals in this document. The
most helpful comments reference a specific portion of the proposal,
explain the reason for any recommended change, and include supporting
data. To ensure the docket does not contain duplicate comments,
commenters should submit only one time if comments are filed
electronically, or commenters should send only one copy of written
comments if comments are filed in writing.
FAA will file in the docket all comments it receives, as well as a
report summarizing each substantive public contact with FAA personnel
concerning this proposed rule. Before acting on this proposal, FAA will
consider all comments it receives on or before the closing date for
comments. FAA will consider comments filed after the comment period has
closed if it is possible to do so without incurring expense or delay.
FAA may change this proposal in light of the comments it receives.
Privacy: In accordance with 5 U.S.C. 553(c), FAA solicits comments
from the public to inform its rulemaking process better. FAA posts
these comments, without edit, including any personal information the
commenter provides, to <a href="http://www.regulations.gov">www.regulations.gov</a>, as described in the system
of records notice (DOT/ALL-14 FDMS), which can be reviewed at
<a href="http://www.dot.gov/privacy">www.dot.gov/privacy</a>.

B. Confidential Business Information

Confidential Business Information (CBI) is commercial or financial
information that is both customarily and actually treated as private by
its owner. Under the Freedom of Information Act (FOIA) (5 U.S.C. 552),
CBI is exempt from public disclosure. If your comments responsive to
this NPRM contain commercial or financial information that is
customarily treated as private, that you actually treat as private, and
that is relevant or responsive to this NPRM, it is important that you
clearly designate the submitted comments as CBI. Please mark each page
of your submission containing CBI as ``PROPIN.'' FAA will treat such
marked submissions as confidential under the FOIA, and they will not be
placed in the public docket of this NPRM. Submissions containing CBI
should be sent to the person in the FOR FURTHER INFORMATION CONTACT
section of this document. Any commentary that FAA receives which is not
specifically designated as CBI will be placed in the public docket for
this rulemaking.

C. Electronic Access and Filing

A copy of this NPRM, all comments received, any final rule, and all
background material may be viewed online at <a href="http://www.regulations.gov">www.regulations.gov</a> using
the docket number listed above. Electronic retrieval help and
guidelines are available on the website. It is available 24 hours each
day, 365 days each year. An electronic copy of this document may also
be downloaded from the Office of the Federal Register's website at
<a href="http://www.federalregister.gov">www.federalregister.gov</a> and the Government Publishing Office's website
at <a href="http://www.govinfo.gov">www.govinfo.gov</a>. A copy may also be found at FAA's Regulations and
Policies website at <a href="http://www.faa.gov/regulations_policies">www.faa.gov/regulations_policies</a>.
Copies may also be obtained by sending a request to the Federal
Aviation Administration, Office of Rulemaking, ARM-1, 800 Independence
Avenue SW, Washington, DC 20591, or by calling (202) 267-9677.
Commenters must identify the docket or notice number of this
rulemaking.
All documents FAA considered in developing this proposed rule,
including economic analyses and technical reports, may be accessed in
the electronic docket for this rulemaking.

D. Small Business Regulatory Enforcement Fairness Act

The Small Business Regulatory Enforcement Fairness Act (SBREFA) of
1996 requires FAA to comply with small entity requests for information
or advice about compliance with statutes and regulations within its
jurisdiction. A small entity with questions regarding this document may
contact its local FAA official or the person listed under the FOR
FURTHER INFORMATION CONTACT heading at the beginning of the preamble.
To find out more about SBREFA on the internet, visit <a href="http://www.faa.gov/regulations_policies/rulemaking/sbre_act/">www.faa.gov/regulations_policies/rulemaking/sbre_act/</a>.

List of Subjects in 14 CFR Part 67

Airmen, Authority delegations (Government agencies), Health,
Reporting and recordkeeping requirements.

The Proposed Amendment

For the reasons discussed in the preamble, the Federal Aviation
Administration proposes to amend chapter I of title 14, Code of Federal
Regulations as follows:

PART 67--MEDICAL STANDARDS AND CERTIFICATION

0
1. The authority citation for part 67 continues to read as follows:

Authority: 49 U.S.C. 106(f), 40113, 44701-44703, 44707, 44709-
44711, 45102-45103, 45301-45303.

0
2. Amend Sec. 67.113 by revising paragraph (a) to read as follows:

Sec. 67.113 General medical condition.

* * * * *
(a) No established medical history or clinical diagnosis of
diabetes mellitus that requires insulin for control.
* * * * *
0
3. Amend Sec. 67.213 by revising paragraph (a) to read as follows:

Sec. 67.213 General medical condition.

* * * * *
(a) No established medical history or clinical diagnosis of
diabetes mellitus that requires insulin for control.
* * * * *
0
4. Amend Sec. 67.313 by revising paragraph (a) to read as follows:

Sec. 67.313 General medical condition.

* * * * *
(a) No established medical history or clinical diagnosis of
diabetes mellitus that requires insulin for control.
* * * * *

[[Page 56809]]

Issued under authority provided by 49 U.S.C. 106(f), 44701,
44702, and 44703 in Washington, DC.
Susan Northrup,
Federal Air Surgeon, Office of Aerospace Medicine.
[FR Doc. 2026-18162 Filed 9-3-26; 8:45 am]
BILLING CODE 4910-13-P

</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>

View on FederalRegister.gov →Plain-text source

Indexed from Federal Register on September 4, 2026.

This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.