Could you ELI5? I was just looking into this question but I’m not familiar with the various medical examinations. What are the differences between regular, special and basic?
Traditionally to fly a plane in the US you need A class 1, 2, or 3 medical. 1 and 2 are required for airline and general commercial ops respectively and they have various rates of renewal based on class and your age ranging from 1 to 5 years. This is an FAA rule but flows down from ICAO, the international version of the FAA. They have to get all the government bodies to allow flights into each other's airspace so they standardize things like licensing, airspace rules and routes, runway layout and markings, etc. This means Saudi Arabia, China, etc, all get a say in whether your mental health condition means you can't fly a Cessna in upstate NY.
Within these rules, there is a carve out for edge cases as one would expect. If you have one of a variety of issues that are well understood but would otherwise prevent you from getting a regular medical, you can petition for a special issuance. Usually stuff like past alcohol abuse, mild depression, various physical disabilities (frequently mild types of colorblindness), etc. Ultimately these are class 1, 2, or 3 medicals with an asterisk requiring more documentation. Notably however, they do not approve them for ADHD while medicated. Typically to get one you need enough psych assessments to show it was a misdiagnosis or is extremely mild, but you can shop around until you find a psychologist who will write whatever you want.
Somewhat more recently (2016) congress passed a bill adding a 4th type of medical called BasicMed. It's a program where you complete an online web powerpoint, take a document to your doctor to fill out, and then everything after that is a conversation between you and your doctor. It is not internationally recognized so breaks the ICAO dependence stated above, but means you can't fly outside the US, even to Canada/Mexico/Caribbean islands etc, among other restrictions. It also has an extremely random requirement to have held a class 3 or higher medical after July 14th, 2006. That ended up really neutering the bill from this perspective as ADHD isn't really a late onset disorder and most people who would want to use this with ADHD have already been denied or are incapable of obtaining a class 3 without some significant effort.
> Typically to get one you need enough psych assessments to show it was a misdiagnosis or is extremely mild, but you can shop around until you find a psychologist who will write whatever you want.
Just want to clarify something on this point. Doctor shopping doesn't really work well here. The FAA has a list of doctors it listens to, and anyone else's opinion is as good as useless.
Within these rules, there is a carve out for edge cases as one would expect. If you have one of a variety of issues that are well understood but would otherwise prevent you from getting a regular medical, you can petition for a special issuance. Usually stuff like past alcohol abuse, mild depression, various physical disabilities (frequently mild types of colorblindness), etc. Ultimately these are class 1, 2, or 3 medicals with an asterisk requiring more documentation. Notably however, they do not approve them for ADHD while medicated. Typically to get one you need enough psych assessments to show it was a misdiagnosis or is extremely mild, but you can shop around until you find a psychologist who will write whatever you want.
Somewhat more recently (2016) congress passed a bill adding a 4th type of medical called BasicMed. It's a program where you complete an online web powerpoint, take a document to your doctor to fill out, and then everything after that is a conversation between you and your doctor. It is not internationally recognized so breaks the ICAO dependence stated above, but means you can't fly outside the US, even to Canada/Mexico/Caribbean islands etc, among other restrictions. It also has an extremely random requirement to have held a class 3 or higher medical after July 14th, 2006. That ended up really neutering the bill from this perspective as ADHD isn't really a late onset disorder and most people who would want to use this with ADHD have already been denied or are incapable of obtaining a class 3 without some significant effort.