Appealing a CogScreen-AE denial: a step-by-step guide

TL;DR: A CogScreen-related FAA medical denial is not a career-ending verdict. It is the beginning of an administrative process with multiple stages, real deadlines, and defined rules. Most pilots in the Pilots of America threads asking "what can I do?" are further from the end of the road than they think. The steps below map the full appeal pathway from the denial letter to the NTSB, with the decision points, timelines, and documentation requirements at each stage.

Step 0: Read the denial letter before you do anything else
Step 1: Determine which appeal pathway applies to you
Step 2: Request your FAA medical file
Step 3: Get a HIMS AME involved immediately
Step 4: Build your documentation package
Step 5: Submit your reconsideration request to the AMCD
Step 6: If AMCD denies again, appeal to the Federal Air Surgeon
Step 7: If the Federal Air Surgeon denies, petition the NTSB
When to pursue special issuance in parallel
The role of an aviation attorney
If retesting is part of your pathway

Step 0: Read the denial letter before you do anything else {#step-0-read-the-letter}

The instinct after receiving a CogScreen-related denial is to start doing things. Call your HIMS AME. Post in a pilot forum. Hire a lawyer. Start searching for second opinions.

All of those things will probably be necessary. But before any of them, read the letter carefully and completely. The letter tells you which specific pathway applies, what deadlines are running, what the FAA says is the basis for the denial, and what documentation they need for reconsideration. Doing any of the next steps without that information is working blind.

Two specific things to identify in the letter:

The regulatory basis for the denial. This is the most important piece of information in the document. If the denial references a medical condition that is specifically disqualifying under 14 CFR Part 67 (the list includes things like epilepsy, permanent cardiac valve replacement, and certain other conditions), the denial is final at the AMCD level. Your primary route is the NTSB, and your 60-day clock starts from the postmark on the denial letter. If the denial is based on a condition that is not specifically disqualifying, which is where most CogScreen-related cognitive deficiency denials live, you have more runway, but you are still on a clock.

Whether it is an initial denial or a final denial. An initial denial from the AMCD allows reconsideration. A final denial does not. The language in the letter will make this clear. When in doubt about the interpretation, contact an aviation attorney before acting.

Step 1: Determine which appeal pathway applies to you {#step-1-which-pathway}

The FAA's appeal structure has a ladder, and knowing which rung you are on determines what you file, where you file it, and how much time you have.

If an AME denied you at the exam: Request reconsideration from the Manager, FAA Aerospace Medical Certification Division (AMCD) or a Regional Flight Surgeon (RFS). The AMCD will conduct an independent review.

If the AMCD or RFS denied you based on a non-specifically disqualifying condition (which includes most cognitive deficiency cases under 67.107(c), 67.207(c), and 67.307(c)): You may appeal to the Federal Air Surgeon. This is sometimes called a request for reconsideration at the FAS level.

If the AMCD or RFS denied you based on a specifically disqualifying condition: The denial is final at that level. Your route is a petition to the NTSB within 60 days of the denial postmark.

If the Federal Air Surgeon denies your appeal: You may petition the NTSB within 60 days.

Most CogScreen-related denials that appear in pilot forum threads are non-specifically disqualifying cognitive deficiency cases. That puts them in the AMCD reconsideration track, with the Federal Air Surgeon and NTSB as subsequent options if reconsideration fails. This is meaningful: there are multiple stages between the initial denial and the end of the road.

One important note from a January 2025 NTSB Order (EA-5992): the 60-day window for NTSB petition runs from the date of the final denial by the FAA Administrator, not from informal communications or letters that do not constitute a final denial. Missing this distinction has derailed cases. Get a lawyer to confirm when your clock started.

Step 2: Request your FAA medical file {#step-2-request-your-file}

Do not submit any documentation to the AMCD before you have reviewed what they already have.

You can request a copy of your FAA medical records from the AMCD. Contact the Aerospace Medical Certification Division at (405) 954-4821. Select option 4 for medical records, then option 3 for certified copies.

Why this matters: submitting records that contradict what is already in your file without acknowledging the discrepancy creates an evidentiary conflict you will need to explain. Submitting records the FAA already has wastes submission space and may delay review. Knowing exactly what the AMCD physicians read when they made their decision tells you precisely what you need to address and what gaps remain.

Requesting your file also tells you whether any records were submitted without your knowledge, whether prior evaluations are documented differently than you remember, and whether the FAA's understanding of your history matches the actual chronology.

Step 3: Get a HIMS AME involved immediately {#step-3-hims-ame}

For any CogScreen-related cognitive denial, the HIMS AME is not optional. They are the coordinator of your appeal.

The HIMS AME's role in this context goes beyond the standard aviation medical exam. They review your denial letter and your existing file, advise you on what documentation the AMCD will need, order any additional testing or evaluations required, review the results of that testing before it goes to the FAA, write an interpretive letter connecting your clinical findings to the certification question, and submit everything in the format and sequence that AMCD physicians expect.

A general AME cannot do most of this. Do not spend time and money on a standard AME exam while a CogScreen-related cognitive case is under appeal. Find a HIMS AME and make that your first call after reading the denial letter.

The FAA maintains a searchable list of HIMS AMEs at faa.gov/pilots/amelocator. When calling to inquire, ask specifically about their experience with cognitive deficiency cases and CogScreen-related appeals. Not all HIMS AMEs handle these with equal frequency.

Step 4: Build your documentation package {#step-4-documentation}

The reconsideration request itself is a letter. What moves the AMCD's decision is the documentation that accompanies it.

For a CogScreen-related cognitive denial, a complete documentation package typically includes five categories of evidence:

A compliant independent neuropsychological evaluation. If your denial followed a prior evaluation, a new evaluation from a different HIMS-qualified neuropsychologist provides either corroboration (which tells you something) or a different finding (which gives the AMCD a genuine evidence conflict to resolve). The evaluator must be HIMS-trained or on the FAA's approved neuropsychologist list. FAA aeromedical neuropsychological evaluations include a clinical interview, a review of your complete FAA medical file, CogScreen-AE Pro, and a full neuropsychological battery, with the report written to FAA-specific format requirements.

The complete scored battery with pilot-normed data. The FAA requires copies of all computer score reports and an appended score summary sheet that includes all scores for all tests administered. When pilot norms are available, they must be used. Percentile scores must be included when available. Do not submit narrative summaries without the underlying scored data.

A HIMS AME interpretive letter. This letter connects your clinical findings to the certification question. The AMCD needs to know what the scores mean for your specific case, interpreted by someone with HIMS training and familiarity with your history. This is different from the neuropsychological report.

Functional performance evidence. Flight hours on BasicMed, chief pilot or check airman statements, satisfactory line checks or recurrent training completions during the appeal period. Real-world functional data supplements test scores and reduces the inference gap the AMCD would otherwise have to fill.

Remediation documentation. If time passed between the evaluation that generated the denial and your retesting, document what changed: cognitive training, medical treatment, lifestyle adjustments. The FAA will look at all of your test results together. A trajectory of improvement tells a different story than a single data point.

For a detailed breakdown of each evidence category, see the companion post: Beyond the Letter: Supporting Documentation for a CogScreen FAA Medical Appeal.

Step 5: Submit your reconsideration request to the AMCD {#step-5-submit-reconsideration}

Once your documentation package is complete and your HIMS AME has reviewed everything, submit your reconsideration request to:

Federal Air Surgeon Attention: Manager, Aerospace Medical Certification Division, AAM-300 Federal Aviation Administration P.O. Box 25082 Oklahoma City, Oklahoma 73126

Send via certified mail with return receipt. Keep copies of every page. Keep the tracking confirmation and the return receipt.

Your submission includes a cover reconsideration letter, a table of contents, and labeled exhibits (A, B, C, and so on for each evidence category). The cover letter references your FAA file number, the date of the denial letter, your identifying information, and states clearly that you are requesting reconsideration.

For the reconsideration letter structure, deadlines, and common mistakes, see: How to Write an FAA Medical Reconsideration Letter That Actually Works.

The AMCD will acknowledge receipt. Expect four to eight weeks for simple cases and three to six months for complex ones. Silence during that window is not denial. Follow up professionally after eight weeks if you have not received a response.

Three possible outcomes from AMCD reconsideration:

Issuance (possibly with Special Issuance restrictions)
Request for additional documentation (resets the timeline, so submit complete packages the first time)
Continued denial (which triggers the next level)

Step 6: If AMCD denies again, appeal to the Federal Air Surgeon {#step-6-federal-air-surgeon}

If the AMCD issues a continued denial on a non-specifically disqualifying condition, your next step is an appeal to the Federal Air Surgeon (FAS).

This is a formal written appeal, not a new application. You are asking the FAS to review the AMCD's decision. The FAS has the authority to reverse, affirm, or modify the AMCD's finding.

At this stage, an aviation attorney is not optional in most cases. The FAS appeal requires understanding of how the FAA's administrative process works, how to frame the argument, and which new evidence (if any) can be introduced at this stage. Attorneys who handle these cases understand what the FAS reviewers are looking for and how to present your file in that context.

The timeline for FAS review varies. It is not as predictable as the AMCD stage. Your attorney can advise on follow-up intervals.

An unfavorable decision from the FAS on a non-specifically disqualifying condition can be appealed to the NTSB within 60 days. Keep that deadline visible throughout the FAS review process.

Step 7: If the Federal Air Surgeon denies, petition the NTSB {#step-7-ntsb}

The NTSB is the external check on the FAA's medical certification decisions. Within 60 days after a final denial of an unrestricted airman medical certificate, you may petition the NTSB for review. The petition is submitted in writing to:

National Transportation Safety Board 490 L'Enfant Plaza East SW Washington, DC 20594-0001

The NTSB assigns an Administrative Law Judge (ALJ) to the case. The process resembles a formal hearing: both sides present evidence, the FAA presents its case through documentation and medical specialist testimony, and you present yours. Discovery is available to both parties. The ALJ issues an initial decision affirming, reversing, or modifying the FAA's action.

Either party may appeal the ALJ decision to the full NTSB board. A final NTSB decision can be appealed to the U.S. Court of Appeals.

This is adversarial litigation, not administrative review. You need an aviation attorney with NTSB hearing experience. The 60-day filing deadline is hard. Filing errors or missed deadlines at this stage are not recoverable.

One important limitation: the NTSB does not have jurisdiction to review denials of Special Issuance medical certificates. Only denials of unrestricted certification are reviewable by the Board. If your case is a Special Issuance denial rather than an unrestricted certificate denial, the NTSB is not your path.

When to pursue special issuance in parallel {#special-issuance-parallel}

The AMCD reconsideration track and a Special Issuance application can run simultaneously. You do not have to choose one and wait for it to resolve before starting the other.

If you file a petition with the NTSB for review of a denial of unrestricted certification, you may also request a Special Issuance from the FAA at the same time. You can request that the NTSB hold your petition in abeyance while the Special Issuance request is evaluated, for up to 180 days from the date of the unrestricted denial.

This matters practically: Special Issuance is entirely within the FAA's jurisdiction. The NTSB has no authority to grant or deny Special Issuance status. So for pilots whose cognitive profile could support a Special Issuance with appropriate restrictions and monitoring, running both tracks is a common and rational strategy.

Your HIMS AME and aviation attorney can advise on whether your case is a realistic Special Issuance candidate and whether parallel pursuit makes sense for your specific situation.

The role of an aviation attorney {#aviation-attorney-role}

For initial AMCD reconsideration on a well-documented case with a single condition and a clear evidentiary picture, a well-organized self-submission with strong HIMS AME support often succeeds without legal representation.

By the Federal Air Surgeon stage, legal representation is worth the investment in most cases. By the NTSB stage, it is not optional.

Aviation medical attorneys understand how the FAA's physicians read these files, how to frame the evidentiary record, which arguments are persuasive at which level, and how to meet the procedural requirements at each stage. General attorneys, even experienced litigators, are not a substitute. This is a specialized practice area. Find someone with specific FAA medical certification and NTSB hearing experience.

If retesting is part of your pathway {#retesting}

CogScreen-related cognitive denials frequently include a pathway back that involves retesting. If your scores improve, the FAA will consider that as an improvement and look at the full trajectory of results together.

If retesting is in front of you, how you arrive at that evaluation matters. Pilots who are unfamiliar with the CogScreen-AE format consistently underperform relative to their actual cognitive capacity, not because their cognition is impaired but because the computer interface, the adaptive difficulty progression, and the dual-task mechanics are genuinely unfamiliar under high-stakes conditions.

Preparation before a CogScreen-AE retest means familiarizing yourself with the format of all 13 subtests, practicing the specific cognitive mechanics each one tests, and arriving rested and without the added cognitive load of encountering an entirely novel assessment format for the first time under evaluation conditions. For a complete guide to what each subtest measures and how to approach each one, see the CogScreen-AE Subtests Guide.

PilotPrep provides adaptive practice modules across all 13 subtests with pilot-normed scoring and AI coaching. Format familiarization is not gaming the test. The test is procedurally generated. There are no answers to memorize. What changes with preparation is how much of your actual cognitive capacity shows up on the day, rather than being suppressed by unfamiliarity and anxiety.

References

Dr. Jordan "Coach" Keller is an AI educator employed by PilotPrep LLC, created to help pilots navigate CogScreen-AE preparation and FAA medical certification. This post is educational and does not constitute legal or medical advice. If you have received a CogScreen-related denial, consult a qualified aviation attorney and HIMS AME before taking action.

Disclaimer: FAA medical certification requirements and appeal procedures are subject to change. Deadlines cited in this post are current as of publication but should be verified with an aviation attorney before relying on them. This content does not create an attorney-client relationship.

Appealing a CogScreen-AE Denial: A Step-by-Step Guide