Background: Aviation medical examination has a primary role to assess an airman’s flight eligibility and to detect any illness or disease beforehand that might cause incapacitation during flight. This study is to analyze the total issuances in 2009, and to understand what the causative diseases and illnesses of the major waiver and denial cases. Methods: This study was done by statistical analysis of the total issuance of Airman’s Medical Certificate reviewed by the Aerospace Medical Association of Korea from Jan. 1st to Dec. 31st in 2009. Results: The Aerospace Medical Association of Korea reviews more than 5,000 issuances every year, and the most of them are first class Airman’s Medical Certificate for airline transport pilot license or commercial pilot license holders (91.5%). Also most of the applicants are the airline pilots (71.0%). In Korea, first class medical certificates are for airline transport pilot, commercial pilot, or first officer, second class are for private pilot, commercial glider pilot, student pilot, pilot of light aircraft, flight engineers, or flight navigator, and third class are for aviation traffic controllers. In 2009 the total application forms that the consultant committee were 725 (13.6%). Since an applicant can have more than one reason for waiver, pending, or denial, the total numbers of reasons were 920. The committee determined 825 cases as waiver, 36 cases as pending, and 29 cases as denial. The 825 waiver cases were sorted into 270 cardiovascular disease cases (30%), 196 ophthalmologic disease cases (21%), 151 otorhinolaryngologic disease cases (16%), 79 endocrinologic disease cases (9%), 58 genitourinary & renal disease (7%), 57 gastrointestinal disease (7%), and etc. 30 cases of denial were 8 ophthalmologic disease cases (26.7%), 6 cardiovascular disease cases (20%), 3 neurologic disease cases (10%), 3 endocrinologic disease cases (10%), and etc. Among these denial cases included the cases which were lack of observation period after initiation of pharmacological treatment for diabetes, after stent insertion due to coronary artery occlusive disease, after the termination of malignant melanoma, and after the completion of depression treatment with medicine. Also there were cases which was submitted with not-enough medical data. In conclusion, among total 5,342 applicants in 2009, 4,642 were fit (86.9%), 670 were waiver (12.5%), 30 were denial (0.6%). The annual denial rate based on airman applicants is 5.6 per 1,000. Conclusion: In 2009, for a year, the denial cases due to the diseases under treatment, not completed were 19 cases; 6 cases of ophthalmologic disease, 3 cases of cardiovascular disease, 3 cases of neurologic disease, 2 cases of endocrinologic disease, and 1 psychiatric/gastrointestinal/respiratory/hematologic diseases respectively. The rest 11 denials were due to lack of observation period before issuance, or not-enough medical data. This statistics are compatible with other statistics regarding medical certificate issuance. And the reasons of denial also show almost similar aspects. For the cases of lack of observation period and not-enough data, the aviation medical examiners should draw more close attention and have comprehensive measurements preparation. Furthermore, the government needs to strengthen aviation medical examiners education.