ITEM 46. Neurologic

I. Code of Federal Regulations

All Classes: 14 CFR 67.109 (a)(b), 67.209 (a)(b), and 67.309 (a)(b)

II. Examination Techniques

A neurologic evaluation should consist of a thorough review of the applicant's history prior to the neurological examination. The AME should specifically inquire concerning a history of weakness or paralysis, disturbance of sensation, loss of coordination, or loss of bowel or bladder control. Certain laboratory studies, such as scans and imaging procedures of the head or spine, electroencephalograms, or spinal paracentesis may suggest significant medical history. The AME should note conditions identified in Item 60 on the application with facts, such as dates, frequency, and severity of occurrence.

A history of simple headaches without sequela is not disqualifying. Some require only temporary disqualification during periods when the headaches are likely to occur or require treatment. Other types of headaches may preclude certification by the AME and require special evaluation and consideration (e.g., migraine and cluster headaches).

One or two episodes of dizziness or even fainting may not be disqualifying. For example, dizziness upon suddenly arising when ill is not a true dysfunction. Likewise, the orthostatic faint associated with moderate anemia is no threat to aviation safety as long as the individual is temporarily disqualified until the anemia is corrected.

An unexplained disturbance of consciousness is disqualifying under the medical standards. Because a disturbance of consciousness may be expected to be totally incapacitating, individuals with such histories pose a high risk to safety and must be denied or deferred by the AME. If the cause of the disturbance is explained and a loss of consciousness is not likely to recur, then medical certification may be possible.

The basic neurological examination consists of an examination of the 12 cranial nerves, motor strength, superficial reflexes, deep tendon reflexes, sensation, coordination, mental status, and includes the Babinski reflex and Romberg sign. The AME should be aware of any asymmetry in responses because this may be evidence of mild or early abnormalities. The AME should evaluate the visual field by direct confrontation or, preferably, by one of the perimetry procedures, especially if there is a suggestion of neurological deficiency.

III. Aerospace Medical Dispositions (Updated 06/26/2024)

General Information:

A history or the presence of any neurological condition or disease that potentially may incapacitate an individual should be regarded as initially disqualifying.

Chronic conditions may be incompatible with safety in aircraft operation because of long-term unpredictability, severe neurologic deficit, or psychological impairment.

Prophylactic use of medications also may cause recurring spatial disorientation and affect pilot performance. In most instances, further neurological evaluation will be required to determine eligibility for medical certification.

For the majority of neurologic conditions, issuance should be denied or deferred. Refer to the specific condition disposition for guidance. Processing can be expedited by including the items listed under Evaluation Data for the corresponding condition.

If a neurological evaluation is required, it should meet all items on the FAA Specifications for Neurologic Evaluation.

Conditions:

(Updated 01/28/2026)

The following list of hyperlinks will take the user to the Web version of the AME Guide where the conditions are grouped together with any applicable, related documents. All the Neurologic dispositions are on the following pages of this document.

Injury)

• ALZHEIMER's DISEASE OR MILD COGNITIVE IMPAIRMENT (MCI) or DEMENTIA
• All Classes
• (Updated 02/22/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Alzheimer's diseaseORMild Cognitive Impairment (MCI)ORDementia from:• Creutzfeldt-Jakob disease;• Frontotemporal dementia;• Lewy body dementia;• Mixed dementia;• Normal Pressure Hydrocephalus;• Vascular dementia; or• Others	Submit the following for FAA review:The most recent detailed, Clinical Progress Note performed by the treating physician or neurologist. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.In most cases, this condition is incompatible with aviation safety.	DEFER Submit the information to the FAA.
B. Pre-clinical Alzheimer's condition	Submit the following for FAA review:1. A current, detailed neurological evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam in accordance with the FAA Specifications for Neurologic Evaluation.2. Neuropsychological evaluation in accordance with the FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment no more than 90 days before the AME exam. 3. Brain MRI. Magnetic Resonance Imaging (MRI) of the brain performed no more than 90 days prior to your AME exam. Submit the	DEFER Submit the information to the FAA for a possible Special Issuance.
	interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Other testing: Already performed by the treating neurologist.Note: Upon receipt and review of the above information, additional documentation may be required.

AMYOTROPHIC LATERAL SCLEROSIS (ALS) aka LOU GEHRIG'S DISEASE And Other MOTOR NEURON DISEASES

All Classes

(01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. All classes Any history	Submit the following for FAA review:1. A current, detailed neurological evaluation in accordance with the FAA Specifications for Neurologic Evaluation generated from a clinic visit from certified ALS clinic or associated clinic no more than 90 days before the AME exam.2. Any other testing deemed clinically necessary or already performed for this condition by the treating physician.	DEFER Submit the information to the FAA.

ARTERIOVENOUS MALFORMATION (AVM) – Neurological (Brain or Spinal Cord)

All Classes

(Updated 08/26/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Brain or Spinal CordNot requiring treatment	Submit to the FAA for review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Imaging studies:• MRI brain to include sequences sensitive to the presence of hemosiderin performed no more than 12 months before the AME exam.• CTA (preferred) or MRA head performed no more than 12 months before the AME exam.• Previous Imaging (such as CT, MRI, CTA, MRA, or cerebral catheter angiography/cath angio of the head) performed at any time after the symptoms occurred.• Submit BOTH the report and a copy of all images on compact disc (CD) in DICOM readable format. (There MUST be a 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain copies of all CDs or images as a safeguard if lost in the mail.3. Any other testing performed or deemed necessary by the treating physician.Note: If associated with a seizure – see that section. A recovery period may apply.	DEFERSubmit the information to the FAA for a possible Special Issuance
B. Brain or Spinal CordTreated with embolization procedureRuptured or repaired	Submit the following for FAA review:1. All items in Row A.2. Imaging studies. Performed after any procedure to verify the condition has been fully treated.3. Hospital records for each hospitalization related to this condition. It must include	DEFERSubmit the information to the FAA for a possible Special Issuance
	information on surgeries and procedures such as embolization.• Admission History and Physical (H&P).• Emergency Medical; Services (EMS)/ambulance run sheet (if applicable);• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) that can be printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.);• Lab report(s) including all drug or alcohol testing performed;• Operative/procedure report(s);• Pathology report(s); and• Radiology reports. The interpretive report(s) AND IMAGES of all diagnostic imaging (CT Scan, MRI, X-ray, ultrasound, or others) performed.• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records.Note: If the applicant has a large volume of records, it is recommended that they bring them to the exam so the AME can assist in determining what is miscellaneous and not needed by the FAA.
C. AVM - Peripheral (e.g. lungs, liver, or bone)	See that page: AVM - Peripheral (e.g. lungs, liver, or bone)

• BELL'S PALSY
• (Facial Nerve Palsy, Cranial Nerve Palsy)
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Single episodeCompletely resolved5 or more years ago	If the AME can determine the condition was a SINGLE EPISODE, fully resolved without sequelae with no symptoms or current problems that would interfere with flight duties:	ISSUE Annotate this information in Block 60.
B. Single episodeCompletely resolvedLess than 5 years ago	If the AME is able to determine ALL of the following are true:1. The condition/symptoms lasted more than 1 week, and fully resolved within 3 months. 2. There is no other history of a neurologic condition or neurologic symptoms (numbness, weakness, sensory disturbance, involvement outside the face, or the forehead not involved). 3. There are no current eye symptoms (e.g., dry eye, red eye, eye pain, vision disturbance, trouble closing eye, or persistent eyelid weakness). 4. No surgery was needed to correct the condition. If the AME is unable to determine above, request the treatment records or a current neurological, ENT, or ophthalmology evaluation.	ISSUEAnnotate Block 60 and submit any evaluation(s) to the FAA for retention in the pilot's file.If any underlying cause found, see that section.All others, go to Row C
C. All othersResolved in less than one (1) week,Lasted longer than three (3) months, ORContinued/persistent symptomsEye symptoms or required surgery to correct the conditionORTwo (2) or more	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the specialist (such as neurology, ENT, or ophthalmology) no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include if this was a single episode, if all symptoms have resolved, and if any other neurological conditions were identified.	DEFER Submit the information to the FAA for a possible Special Issuance.
episodes in a lifetimeAny additional neurological condition, neurological symptoms, or concern	3. MRI of the brain (Magnetic Resonance Imaging).• The most recent test from time of event or later.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Eye evaluation by a boardcertified ophthalmologist if any continued face or eye symptoms (e.g., dry eye, red eye, eye pain, vision disturbance, trouble closing eye, persistent eyelid weakness) OR any surgery needed to correct the condition. If no eye symptoms or surgery, this must be stated in the clinical progress note or AME notes.5. Copies of any treatment records such as ER, urgent care, or PCP notes describing events, diagnosis, and treatment.6. Any other testing performed by the treating physician for this condition.

• BRAIN ABSCESS
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. All classesAny history (current or ever in their lifetime)	After appropriate recovery period* Submit the following for FAA review1. A current, detailed neurological evaluation, in accordance with the FAA Specifications for Neurologic evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.3. The most recent MRI and/or CT imaging of the brain. (If not already performed, a current brain MRI is required.)• Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. The most recent electroencephalogram (EEG).• (If not already performed, a current EEG is required.)• The EEG recording should be sleep-deprived: awake, asleep, and with provocation (e.g., hyperventilation, photic/strobe light).• Include any previous EEG(s) available for comparison.• Submit BOTH the final interpretive report(s) and the actual tracings (ALL pages) for any EEGs on CD.	DEFER Submit the information to the FAA for a possible Special Issuance.
	• The CDs of EEG recordings must have proprietary opening software that is compatible with Windows 10.5. Other testing deemed clinically necessary by the treating physician.*Note: Applicants with prior brain abscess should have a minimum of 6 months observation following completion of treatment. If residual cortical lesion(s) are seen on MRI, a longer recovery period may be required. If surgery was performed (penetrating the dura), a minimum two (2)-year recovery period will apply. If associated with a seizure, refer to that section, as a longer recovery period may then apply.

Also see Encephalitis or Meningitis.

• BRAIN ANEURYSM
• (Intracranial aneurysm / Cerebral aneurysm) Not Ruptured
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
D.Existing Aneurysm which has not rupturedNote: If associated with a seizure – see that section. A recovery period may apply.If ruptured and/or repaired, refer to brain bleed/intracranial hemorrhage section.	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. CTA (preferred) or MRA head performed no more than 12 months before the AME exam.*3. Previous Imaging* (CT, MRI, CTA, MRA or cerebral catheter angiography/cath angio of the head) performed at any time after the symptoms occurred.Submit BOTH the report and a copy of the images on compact disc (CD) in DICOM readable format. (There MUST be a 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain copies of all CDs or images as a safeguard if lost in the mail.	DEFER Submit the information to the FAA for a possible Special Issuance

BRAIN BLEED

(Intracranial Hemorrhage, Cerebral Hemorrhage, Ruptured Aneurysm, Subarachnoid Hemorrhage, Subdural/Epidural Hemorrhage)

All Classes

(Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Any history of a Spontaneous intracranial hemorrhage not due to trauma*(Examples may include ruptured AVM,Subarachnoid hemorrhage [SAH],Subdural, or epidural hemorrhage)(*If due to TRAUMA, See - Traumatic Brain Injury section, subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.)	Required recovery periods:• If craniotomy performed: Two (2) years• Subarachnoid hemorrhage: One (1) yearAfter any required recovery period, submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist (vascular neurologist preferred) no more than 90 days before the AME exam.2. Brain imaging to verify bleed has resolved, performed no more than 12 months before the AME exam. If not already performed, a current test is required.3. MRI brain to include sequences sensitive to the presence of hemosiderin.4. CT angiography (CTA) or MRA or angiography. (Head required. Neck if clinically necessary)• Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.5. Hospital records for each hospitalization related to this condition. It must include information on surgeries and procedures.• Admission History and Physical (H&P);	DEFERSubmit information to the FAA for a possible Special Issuance
	• Emergency Medical Services (EMS)/ambulance run sheet (if applicable);• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) that can be printed from an electronic medical record are NOT sufficient for pilot medical certification purposes.);• Lab report(s) including all drug or alcohol testing performed;• Operative/procedure report(s);• Pathology report(s); and• Radiology reports. The interpretive report(s) AND IMAGES of all diagnostic imaging (CT Scan, MRI, X-ray, ultrasound, or others) performed.• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records.Note: After review of the submitted information, a Neuropsychological (NP) evaluation that meets that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist may be requiredIf the applicant has a large volume of records, it is recommended that they bring them to the exam so the AME can assist in determining what is miscellaneous and not needed by the FAA.If associated with a seizure – see that section. An additional recovery period and testing (such as EEG) may apply.If a shunt was placed – see the Hydrocephalus section.

BRAIN TUMOR (Intracranial Tumor) All Classes (Updated 05/29/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Benign Brain Tumor(meningioma, gliomas, etc.)NOT surgically treated	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. MRI brain performed no more than 12 months before the AME exam.• Submit both the report and a copy of the images on compact disc (CD) in DICOM readable format. (There MUST be a file name ‘DICOMDIR’ in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain copies of all CDs or image as a safeguard if lost in the mail.3. If hospitalized or radiation treatment was performed, submit copies of the following Hospital reports for each hospitalization related to this condition:• Admission History and Physical;• Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) that can be printed from an electronic medical record are NOT sufficient for pilot medical certification purposes.);• Emergency Medical Services (EMS)/ambulance run sheet (if applicable);• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Lab report(s) including all drug or alcohol testing performed;• Operative/procedure report(s);	DEFERSubmit the information to the FAA for a possible Special Issuance.
	• Pathology report(s); and• Radiology report(s). The interpretive report(s) of all diagnostic imaging (CT Scan, MRI, X-ray, ultrasound, or others) performed. Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, and medication administration records.4. After review of the information submitted, a neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluation for Potential Neurocognitive Impairment MAY be required.Note: If associated with a seizure also refer to the Seizure section. An additional recovery period may apply.If tumor type is Acoustic neuroma or Pituitary Tumor - see the corresponding section.
B. Benign Brain Tumor(meningioma, gliomas, etc.)Surgically treated/resected	After a two-year (2) recovery period, submit the following for FAA review:1. All information in Row A;2. Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment. (Due to surgical resection, NP testing is required.)Note: If associated with a seizure also refer to the Seizure section. An additional recovery period may apply.	DEFERSubmit the information to the FAA for a possible Special Issuance.
C. Malignant (cancerous) Brain TumorPrimary Tumor orSecondary metastatic tumor	After a five-year (5) recovery period following completion of chemotherapy, radiation, or surgery. (Maintenance biologic medication does not add to the above recovery time.)Submit the following for FAA review:1. All information in Row A; 2. The individual can submit the MOST RECENT detailed neurological evaluation (in lieu of one 90 days before the AME exam) that meets FAA Specifications for Neurologic Evaluation for initial case review.	DEFERSubmit the information to the FAA for a possible Special Issuance.

Note: A variety of intracranial tumors, both malignant and benign, are capable of causing incapacitation directly by neurologic deficit or indirectly through recurrent symptomatology. Potential neurologic deficits include weakness, loss of sensation, ataxia, visual deficit, or mental impairment. Recurrent symptomatology may interfere with flight performance through mechanisms such as seizure, headaches, vertigo, visual disturbances, or confusion. A history or diagnosis of an intracranial tumor necessitates a complete neurological evaluation before a determination of eligibility for medical certification can be established.

CAROTID or VERTEBRAL ARTERY DISEASE

(including carotid artery bruit; carotid artery stenosis; vertebral artery stenosis)

All Classes

(Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. 49% or less by ultrasound, CTA or angiogramANDNo history of TIA or CVA(use row for highest % stenosis from either left or right side)	The AME should review the following:Most recent vascular imaging and verify the testing was not performed for symptoms (TIA/CVA).If documentation verifies• 49% or less blockage (both sides)• no symptoms• no ongoing treatment with DOAC/NOAC or coumadin• no current problems that would interfere with flight duties:	ISSUEAnnotate this information in Block 60.
B. 50-79% stenosisANDNo history of TIA or CVAANDNOAC/DOAC/coumadin or surgery not recommended by treating physician at this time	See the CACI Carotid/Vertebral Artery Stenosis Worksheet.This will require a detailed Clinical Progress Note and vascular imaging (ultrasound, CTA, angiogram) performed within the previous one year.Note: Antiplatelet therapy (including dual Plavix + ASA) can be considered for CACI.Anticoagulation (NOAC/DOAC/coumadin/Jantoven) is not CACI. Go to row C.	ISSUEIf the pilot meets all CACI worksheet criteria and is otherwise qualified,ISSUEwith no time limitationAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.If no AME explanation, the individual may be asked to provide documentation.
C. All others including:80% stenosis or higherORTaking NOAC/DOAC/coumadinORSurgery is recommended,Note: if any neurologic symptoms or history of TIA or CVA, see that page.	Submit the following for FAA review:1. A detailed Clinical Progress Note performed within 90 days of exam from the treating physician (cardiologist, neurologist, or PCP). It should include a detailed summary of the history of the condition or diagnosis, treatments and outcomes, current medications, physical exam findings, all pertinent test results obtained, assessment, plan, and follow up. 2. It must specifically include if there has been any clinically significant increase in stenosis that would prompt a change in treatment or surveillance. 3. Vascular imaging (such as CTA, MRA, or angiogram) of head and neck performed no more than 90 days prior to AME exam. 4. MRI brain (with or without contrast) performed no more than 90 days prior to AME exam. 5. Other testing: Any deemed clinically necessary by the treating physician 6. Cardiovascular risk assessment to review risk factors and include testing indicated within the previous one year. [see Protocol for Cardiovascular Evaluation (CVE)].Note: Stress testing may be required in some cases or when clinically indicated.	DEFER Submit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

CACI – Carotid / Vertebral Artery Stenosis Worksheet

(Updated 01/28/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Carotid/Vertebral Artery Stenosis. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Carotid /Vertebral Artery Stenosis.

[ ] NOT CACI qualified Carotid/Vertebral Artery Stenosis. I have deferred. (Submit supporting documents.)

• CENTRAL SLEEP APNEA
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Central Sleep ApneaNoted on sleep study results ONLY	If the AME can determine:• The condition is NOT central sleep apnea;• The sleep study apnea/hypopnea indices show:o Less than 2 Central Apneas and/or Central Hypopnea episodes per hour occurANDo Less than 25% of total apnea and hypopnea episodes are listed as central;• The individual takes no medication for this condition; and• Individual has NO symptoms that would interfere with flight duties:	ISSUEUse the standard OSA protocol.Annotate Block 60 and submit the evaluation to the FAA for retention in the pilot's file.
B.Central Sleep Apnea Diagnosis	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating neurologist or sleep specialist no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis;	DEFERSubmit the information to the FAA for a possible Special Issuance.
	assessment and plan (prognosis); and follow-up.2. It must specifically include:• If there is excessive daytime sleepiness,• If treatment is successful, and• If the individual is compliant with treatment.3. Sleep study/ polysomnography (most recent test results). It must be an in-lab type 1 attended study.4. Any other testing performed or deemed necessary by the treating physician.

CEREBRAL PALSY

(All classes)

• CHIARI MALFORMATION
• All Classes
• (Updated 03/27/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Type I (aka low-lying tonsils)Incidental finding on imagingORChiari 1 decompression surgery 2+ years agoANDAsymptomatic	The AME should review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days prior to the AME exam. 2. It must specifically include the reason the imaging was performed.If review of documentation verifies the Chiari malformation is:• An incidental finding on imaging OR• Was surgically corrected 2 or more years ago;• Is asymptomatic;• No additional treatment recommended; and• No symptoms that would interfere with flight or safety related duties:(If an underlying condition is identified, e.g., headaches, see that page.)	ISSUEAnnotate Block 60 and submit the evaluation to the FAA for retention in the file.
B. Type 1 surgically corrected/decompressed within the past 2 years	No mandatory recovery period after decompression surgery. If no complications, can consider once the treating neurosurgeon has determined recovered, no symptoms and is stable.Submit the following for FAA review:1. Clinical records pertaining to condition (which identifies why surgery was performed); 2. Operative report; 3. Post-operative clinical notes from neurosurgeon; and 4. A current, detailed Clinical Progress Note generated from a clinic visit with the provider managing the Chiari I finding no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);	DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
	• Physical exam findings;• Results of any testing performed;• Diagnosis; assessment and plan; prognosis; and follow-up.It must specifically include:• If symptoms have resolved;• Any functional impact; and• Any abnormalities in the neurological exam.
C. Currently symptomaticORANY Chiari type (II, III, IV)	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days prior to the AME exam.It must specifically include:• Description of symptoms;• Consider syringomyelia and supply spinal cord imaging if deemed clinically necessary; and• Any follow-up or treatment needed2. Operative/procedure report(s); (if performed);3. MRI of the brain performed w/in previous 12 months the AME exam.;Note: Submit the interpretive report on paper and imaging on CD in DICOM readable format. (There must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Applicants may wish to retain a copy of all films as a safeguard if lost in the mail.4. Additional imaging studies (MRI spine, etc.) already performed or clinically indicated; and5. If Chiari Type II, submit copies of most recent spinal cord imaging for syringomyelia.	DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.

• COGNITIVE OR MENTAL IMPAIRMENT OR DYSFUNCTION
• COGNITIVE DISORDER)
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Neurological findingCognitive impairment/dysfunctionMental impairment/dysfunctionConfusionDeliriumEncephalopathyORWhen the cause of the neurological finding is unknown	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.3. Any other testing already performed or deemed necessary by the treating physician.Note: If the cause of the cognitive impairment is known (due to another condition - e.g., stroke, traumatic brain injury, substance abuse, multiple sclerosis, neurodegenerative disease, mood disorder, a specified medical illness, or specified medication effect) – see that section for any additional evaluation data requirements.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

• DEEP BRAIN STIMULATOR
• All Classes
• (Updated 02/22/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
Deep Brain Stimulator (DBS)	Submit the following for FAA review:1. Deep Brain Stimulator (DBS) Status Summary (see following page).2. Operative report.If applicant has two DBS devices, complete a status summary for each device.	DEFERSubmit the information to the FAA for a possible Special Issuance

Note: See underlying condition page for additional information requirements

• DEEP BRAIN STIMULATOR (DBS) STATUS SUMMARY
• (Updated 01/25/2023)
• Name _______________________________ Birthdate ________________

Applicant ID# _________________________ PI# _________________ Please have the treating neurologist complete this summary by entering the information in the space provided. Submit either this summary* or all supporting documentation (which addresses each item below) and a copy of the most recent device printout indicating the current device settings and status to your AME or to the FAA:

• Federal Aviation Administration
• Civil Aerospace Medical Institute, Building 13

Aerospace Medical Certification Division, AAM-300, PO Box 25082, Oklahoma City, OK 73125-9867 Lead stimulation site e.g., GPi, STN, ViM, CZi ____________________________________________________ (Use a separate page for each DBS stimulator lead to report the specific site and information for each lead).

……………….………………......……….____/____/____

in effectiveness.)…..…….……………………………………………………………………………………..Yes__ No__

_______________________________ _________

Neurologist signature Date *This DBS Status Summary is NOT required; however, it will help to streamline and significantly DECREASE FAA review time.

DYSTONIA (Including Torticollis) All Classes (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Any history of Dystonia at any timeThis includes cervical dystonia (spasmodic torticollis or torticollis)	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Any other testing performed or deemed necessary by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance.

EPILEPSY

(Seizure Disorder) All Classes (Updated 05/31/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Epilepsy by historySeizure-free for ten (10) yearsANDOff medication for the last 3 years	After a ten (10)-year seizure-free recovery period, obtain the following and submit for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist (epileptologist preferred), no more than 90 days before the AME exam.2. It must specifically include the date of last seizure activity and dates medication(s) discontinued.3. MRI brain performed at any time after the seizure activity started.• If not already performed, a current brain MRI is required. Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.3. Electroencephalogram (EEG) performed no more than 12 months before the AME exam. It must be sleep-deprived EEG: awake, asleep, and with provocation (hyperventilation, photic/strobe light). A 24-hour EEG study is preferred.• If not already performed, a current EEG is required.• Submit any previous EEG(s) available for comparison.	DEFERSubmit the information to the FAA for a possible Special Issuance.
	• Submit BOTH the interpretive report(s) on paper and a copy of the EEG recording(s) on CD with proprietary opening software that is compatible with Windows 10. You may wish to retain a copy of all films as a safeguard if lost in the mail.4. FAA Airman Seizure Questionnaire completed by the applicant.
B. SeLECTS(Self-limited Epilepsy with Centrotemporal Spikes).Seizure-free for four (4) yearsANDOff medication for the last two (2) yearsThis condition may also be called:• Rolandic Epilepsy,• Benign Rolandic Epilepsy (BRE),• BECTS (Benign Epilepsy with Central Temporal Spikes), or• CECTS (Childhood Epilepsy with Central Temporal Spikes)	After a four (4)-year seizure-free recovery period, obtain and submit for FAA review:• Evaluation Data Row A	DEFERSubmit the information to the FAA for a possible Special Issuance.

Also see Seizures.

• ENCEPHALITIS
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Current or historical diagnosisSingle episode	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include if this was a single episode, if the individual is immunocompromised, and if any seizure activity occurred.3. MRI and/or CT of the brain (the most recent test).• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. An electroencephalogram (EEG), if already performed, OR if any history of seizures.• The EEG recording should be sleep-deprived - awake, asleep, and with provocation (e.g., hyperventilation, photic/strobe light). Include any previous EEG(s) available for comparison. Submit BOTH the final interpretive report(s) and the actual tracings (ALL pages) for any EEGs on CD. The CDs of EEG recordings must have proprietary opening software that is compatible with Windows 10.Note: Neuropsychological (NP) evaluation will be required in some cases (such as	DEFERSubmit the information to the FAA for a possible Special Issuance.
	any residual lesions found on MRI or any neurocognitive concerns). When required, it must meet FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist.Seizure - if associated with a seizure, refer to that section. A recovery period may apply.
B. Current or historical diagnosiswith2 or more lifetime episodes,Immunocompromised, orseizure activity	All information required in Row APLUS• EEG is required if a history of seizures.• Additional information may be required after review of above information.	DEFERSubmit the information to the FAA for a possible Special Issuance.

Note: For Brain Abscess or Meningitis, see that page.

• GUILLAIN-BARRE SYNDROME
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Single episode,No complications,Fully resolved and recoveredwith a minimum of six (6) months stability	If the AME can determine this was a single episode, fully resolved with no complications or sequelae:Note: If the episode occurred within the previous 12 months, the AME must review documentation from the treating physician.If six (6) months of stability has not been met, go to Row B.	ISSUE Annotate Block 60 and submit any evaluations to the FAA for retention in the pilot's file.If any underlying cause found, see that section.
B. Less than six (6) months of stability after episode,Two or more episodes in a lifetime,Continued symptoms,ORComplications	Submit the following for FAA review:1. A current, detailed neurological evaluation, in accordance with the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam. 2. It must specifically include if there is any persisting deficit and period of stability without symptoms. 3. Other testing already performed or deemed necessary by the pilot's physician.Note: If associated with a seizure, refer to the Seizure section. A recovery period may apply.	DEFERSubmit the information to the FAA for a possible Special Issuance.

HEAD INJURY or BRAIN INJURY

Concussion, Closed Head Injury (CHI), Open Head Injury, Traumatic Brain Injury (TBI)

All Classes

(Updated 09/30/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Head injury ONLYThis means:• NO brain injury• NO concussion• NO neurological symptomsDO NOT use this row if the individual had any items listed in Row B, C, or D (e.g., brain injury, seizure, skull fracture.)	If the AME can determine the condition was• Head injury only (no brain injury) such as superficial scalp injury or globe (eyeball/eye injury) and/or musculoskeletal injuries (facial/maxilla/mandible fractures) that do not persist and do not rise to the level of even a mild concussion;• No neurological symptoms; and• No “mild concussion symptoms” such as headache, dizziness, nausea, or nonfocal neurological symptoms such as photo/phonophobia, tinnitus, irritability, mental fogginess, etc., as a result of the injury.• If imaging (CT/MRI) was performed, no evidence of brain trauma.• Has completely resolved and the individual has been released to full activity by the treating physician:Note: The AME should NOT use this row if any symptoms, concerns for concussion/brain injury, or any complications.If there are any concerns in history, the AME should review the most recent, detailed Clinical Progress Note describing the incident, recovery, and follow-up (if applicable).	ISSUEAnnotate this information Block 60 including approximate mechanism and date of injury.
B1. Brain injury four (4) or more years agoThis includes:• Concussion (a type of mild brain injury)• MILD brain InjuryAs long as NO seizure**Exception: An immediate impact seizure (within 24	The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL the questions on the Brain Injury Decision Tool for the AME.If all items on the decision tool are in the clear, “NO” column, the AME may:Note: For a remote injury with no concerns, the most recent progress note is acceptable.	ISSUESummarize this history, diagnosis, and annotate Block 60: “Discussed the history of BRAIN INJURY, no positives to screening questions, and no concerns.”
hours of injury) can be reviewed using Row B criteria.) Note: High impact/penetrating injuries (e.g., gunshot or severe trauma) may present with few or no concussive symptoms. For high impact injuries, see Row D.		If any “YES” answers, any AME concerns, or unable to verify history– DEFER
B2. Brain injury Within the past four (4) yearsThis includes:• Concussion• MILD brain Injury• Loss of Consciousness (LOC)• Alteration of Consciousness (AOC)• Post-Traumatic Amnesia (PTA)ALL less than 1 HOURAND• No seizure Exception: An immediate impact seizure (within 24 hours of injury) can be reviewed using Row B criteria.Note: High impact/penetrating injuries (e.g., gunshot or severe trauma) may present with few or no concussive symptoms. For high impact injuries, see Row D	After a 6-month recovery period obtain the following evaluation(s) and submit for FAA review:1. Acurrent, detailed Clinical Progress Notegenerated from a clinic visit with the treating physician or neurologist no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include:• Any evidence of seizure;• Any post-traumatic amnesia or mental fogginess (incomplete memory of the incident, does not recall the impact/crash, etc.)• Any post-concussive symptoms such as headaches, dizziness, irritability;• Any changes in vision;• Any focal deficit;• Any imaging performed and if (CT/MRI) was negative;• Any clinical indication for further brain imaging; initial CT head/face negative.3. Records from any hospitalization(s) for this condition to include:• Admission History and Physical;• Hospital discharge summary. (Typically, the patient portal notes or After Visit Summary [AVS] printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.);	DEFERSubmit the information to the FAA for a possible Special Issuance
Do NOT use this row if the individual had any items listed in Row C or D (e.g., brain injury, seizure, skull fracture)	• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Operative/procedure report(s);• Pathology report(s);• Radiology reports*. The interpretive report(s) of all diagnostic imaging performed (CT scan, MRI, X-ray, ultrasound, or others);• Lab report(s) including all drug or alcohol testing performed; and• Emergency Medical Services (EMS)/ambulance run sheet.• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.Note: If any abnormalities, go to Row C.
C. Moderate BRAIN InjuryThis includes:• LOC, AOC, or PTA 1 to 24 hours• Non-depressed skull fracture• Small parafalcine or tentorial subdural hematoma (resolved by MRI)• Small subarachnoid hemorrhage (resolved by MRI)	After a 12-month recovery period obtain the following evaluation(s) and submit for FAA review:1. A current, detailed neurological evaluation, in accordance with the FAA Specifications for Neurologic Evaluation, that is generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include if there is (or is NOT) any concern or history of seizure(s).3. EEG only if a seizure occurred and an EEG was obtained, submit results. EEG* Sleep-deprived and sleep awake state with activating procedures (with provocation) performed at the time of event or later.	DEFERSubmit the information to the FAA for a possible Special Issuance
Any hemorrhage must be resolved on MRI. If the MRI shows signs of hemosiderin deposition, go to Row D.	4. A Neuropsychological evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.5. MRI brain with hemosiderin-sensitive sequences (with contrast as clinically appropriate) performed any time after the event.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.6. Records from any hospitalization(s) for this condition to include:• Admission History and Physical.• Hospital discharge summary. (Typically, the patient portal notes or After Visit Summary [AVS] printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.).• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists).• Operative/procedure report(s).• Pathology report(s).• Radiology reports. The interpretive report(s) of all diagnostic imaging (CT scan, MRI, X-ray, ultrasound, or others) performed. For all imaging, submit the interpretive report(s) AND the actual images on CD in DICOM readable format.• Lab report(s) including all drug or alcohol testing performed.• Emergency Medical Services (EMS)/ambulance run sheet.
	• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records.7. Progress notes from ALL clinic follow-up visits related to this condition.8. Other tests already performed or clinically indicated.Note: Small parafalcine or tentorial Subdural Hematoma: If asymptomatic and MRI 3-6 months after the injury shows complete resolution, FAA may consider after a 6-month recovery period. Submit the Evaluation Data in this row after the recovery period.
D. Severe BRAIN InjuryThis includes:• Blood in the Brain: o Brain contusion o Intracranial bleed o Hematoma o Epidural hematoma o Subdural hematoma o Diffuse axonal injury• LOC, AOC, PTA: 24 hours or more• Depressed skull fracture• Penetrating head injury	After a four (4)-year recovery period submit for FAA review:• All items in Row CNote: MRI or MRA/CTA are required. If not performed during the initial management or monitoring of the condition, new testing must be obtained.For all imaging, submit the interpretive report(s) AND the actual images on CD in DICOM readable format.	DEFERSubmit the information to the FAA for a possible Special Issuance

LOC: Loss of Consciousness AOC: Alteration of Consciousness PTA: Post-Traumatic Amnesia

BRAIN INJURY DECISION TOOL FOR THE AME

Concussion, Closed Head Injury (CHI), Open Head Injury, Traumatic Brain Injury (TBI)

(Updated 09/30/2026) AME Instructions: Address each of the following items in your in-office exam and history review:

If head injury only, no brain injury, no concussion, no neurological symptoms: STOP. Go to the HEAD INJURY or BRAIN INJURY Concussion, Closed Head Injury (CHI), Open Head Injury, Traumatic Brain Injury (TBI) Disposition Table, Row A.

Date of most recent brain injury ___________________ (if multiple injuries^)

trauma) .................................................................................................................

If ALL items fall into the “NO”/CLEAR COLUMN, the AME may issue with notes in Block 60 which show you discussed the history of brain injury, found no positives to the screening questions, AND had no concerns.

If ANY SINGLE ITEM falls into the “YES”/SHADED COLUMN, the AME MUST DEFER. The AME should note which aspect caused the deferral and explain any YES answers from the shaded column. For any “YES*” items or concerns, upload the most recent detailed Clinical Progress Note and/or copies of any imaging reports (CT/MRI) that address these items.

ALL events must fall into the “No” column criteria.

This decision tool is for AME use; it does not have to be submitted to the FAA.

• HEADACHE or MIGRAINE
• (Cluster, Tension, Ocular, Acephalgic, Ophthalmic, or Retinal)
• All Classes
• (Updated 09/24/2025)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Stress HeadacheTension HeadacheControlled with OTC meds	If the AME can determine the condition is: mild and under control:• Average of less than two headache days per month;• Medications are acceptable (seldom requiring more than OTC analgesics);• Is not incapacitating (The individual has no symptoms that would interfere with flight duties.); and• Not associated with any neurological findings:	ISSUEAnnotate this information inBlock 60.
B. Migraine with aura (Classic migraine/Common Migraine)ORChronic tensionORChronic dailyORClusterOR(Older terms include acephalgic migraine, ocular migraine, ophthalmic migraineClassic migraine is now called migraine headache with aura.)	See the CACI-Migraine and Chronic Headache Worksheet.This will require a current, detailed Clinical Progress Note from the treating physician or neurologist.	If the pilot meets all CACI worksheet criteria and is otherwise qualifiedISSUE with no time limitationAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C.Any history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura)ORChronic daily,ORComplicated migraine,ORPost-traumatic headaches,ORRetinal migraine.(This type spreads across the retina and the concern is Amaurosis). Previously called ocular migraine.ORVestibular migraine	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. MRI* of the brain performed no more than one (1) year before the AME exam.• If an MRI is contraindicated or cannot be performed, the treating neurologist should discuss why. If CT is used, with or without contrast is per the treating neurologist.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.3. Number of headache days per month per the applicant.4. Other testing completed or deemed necessary by the treating physician.Note: If associated with a seizure – see seizure section. Chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in some instances, the use of such medications is disqualifying because they may interfere with the individual's alertness and functioning. In some conditions, pain may be incapacitating.	DEFERSubmit the information to the FAA for a possible Special Issuance.

Notes: Pain, in some conditions, may be acutely incapacitating. Chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in most instances, the use of such medications is disqualifying because they may interfere with a pilot's alertness and functioning.

Also see AASI Migraines.

CACI - Migraine and Chronic Headache Worksheet

(Updated 08/26/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam which explains all items below. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified migraine and chronic headaches. (Documents do not need to be submitted to the FAA.) [ ] Has current OR previous SI/AASI but now CACI qualified migraine and chronic headaches. [ ] NOT CACI qualified migraine and chronic headaches. I have deferred. (Submit supporting documents.)

• HUNTINGTON'S DISEASE
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Huntington's Disease	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.3. Any other testing deemed clinically necessary or already performed for this condition by the treating physician.Note: If the diagnosis is confirmed as symptomatic Huntington's, the individual may want to submit that information to AAM before obtaining the neuropsychological evaluation.	DEFERSubmit the information to the FAA for a possible Special Issuance.

HYDROCEPHALUS (With or Without Shunt) All Classes

(Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. With shunt placement	After a two (2) year symptomfree recovery period, submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include• the reason a shunt was placed and• if the shunt is functional or nonfunctional.3. Shunt series CT or MRI brain performed no more than 12 months before the AME exam.• Include both the report and a copy of the images on compact disc (CD) in DICOM readable format. (There MUST be a 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain copies of all CDs or image as a safeguard if lost in the mail.Note: After a review of the above information and due to the condition which caused the need for the shunt, a Neuropsychological (NP) evaluation in accordance with the FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment may be required.If associated with a seizure, brain tumor, or brain bleed – see the corresponding section. An additional recovery period may apply.	DEFERSubmit the information to the FAA for a possible Special Issuance.
B. Without shunt placement(such as normal pressure hydrocephalus)	Submit the following for FAA review:• A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than	DEFERSubmit the information to the FAA for a possible Special Issuance.
	90 days before the AME exam.• MRI and/or CT of the brain performed no more than 90 days before the AME exam.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.

• MENINGITIS
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Single episodeNo complications, fully resolved and recoveredANDNo hospitalizationORHospitalized 5 or more years ago	If the AME can determine the condition has resolved with no complications and the pilot has no symptoms that would interfere with flight duties:If within the past one year, the pilot should provide the AME with the most recent detailed, Clinical Progress Note from the treating physician describing the clinical course and resolution without complications.Note: If associated with a seizure or more than one episode, go to Row C.	ISSUEAnnotate this information in Block 60 including approximate date of single episode
B. Single episoderequiring hospitalizationless than 5 years ago	Submit the following for AME and FAA review:1. The most recent detailed, Clinical Progress Note performed from the treating physician or neurologist. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.2. It must specifically include if the condition has resolved and if any residual side effects remain.3. Hospital Discharge Summary. This is NOT the same as patient portal notes or After Visit Summary (AVS).4. MRI and/or CT brain imaging report (if already performed).5. EEG - electroencephalogram report (if already performed).Note: If the MRI or CT report verifies	If the AME can determine the condition has resolved with no residual symptoms, MRI, and EEG (if performed) are negative, and the pilot has no symptoms that would interfere with flight duties.ISSUEAnnotate Block 60 and submit the evaluation to the FAA for retention in the pilot’s file
	lesions or scarring on the brain; or the neurologic evaluation determines there is concern for cognitive impairment on clinical exam; or any history of seizure (a recovery period may apply), go to Row C.
C. More than one episode (ever)ORComplications such as meningoencephalitis, cortical involvement (stroke), seizureORAbnormal MRI or EEG findingsORNot fully resolved or recovered	Submit the following for FAA review1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Remember to also submit all items listed under "Prior Testing, Treatment, Or Other Records.”3. MRI and or CT of the brain performed no more than 90 days before the AME exam.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Hospital records (admission H&P, discharge summary, all consultant reports, copies of imaging reports, etc.).5. An electroencephalogram (EEG) if already performed OR if any history of seizures.• The EEG recording should be sleep-deprived: awake, asleep, and with provocation (e.g., hyperventilation, photic/strobe light).	DEFERSubmit the information to the FAA for a possible Special Issuance
	• Include any previous EEG(s) available for comparison.• Submit BOTH the final interpretive report(s) and the actual tracings (ALL pages) for any EEGs on CD.• The CDs of EEG recordings must have proprietary opening software compatible with Windows 10.Additional testing: If the CT/MRI report identifies lesions or scarring on the brain or the clinical neurologic evaluation has concern for cognitive impairment, a Neuropsychological (NP) evaluation will be required. When required, it must meet FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the treating neuropsychologist.Seizure: If associated with a seizure, refer to the Seizure section. A recovery period may apply.

Also see Brain Abscess and Encephalitis

• MYASTHENIA GRAVIS
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Generalized Myasthenia Gravis	Requires one (1)-year recovery period after diagnosis.After 1-year recovery, submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include: Medications prescribed for this condition including start and stop dates, dosages, and side effects (if any).• How long has the condition been stable;• Any periods of weakness, motor fluctuations, or fatigability;• Any history of myasthenic crisis; and• Any evidence of ocular myasthenia. If yes, also address: o Presence or absence of eye exam findings: o Any current finding of eye motility abnormality, symptoms of double vision; or o Any clinically significant ptosis.3. Lab studies already performed.4. CT Chest (performed at any time as a screening for Thymoma). Submit the report.5. Previous Imaging (e.g., CT, MRI, CTA, MRA, or catheter angiography of the head) performed at any time after the symptoms occurred.*	DEFERSubmit the information to the FAA for a possible Special Issuance.
	6. Other testing already performed such as an Electromyogram (EMG) or nerve conduction studies.*For all imaging, submit BOTH the report and a copy of the images on compact disc (CD) in DICOM readable format. (There MUST be a 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain copies of all CDs or images as a safeguard if lost in the mail.Note: If associated with a seizure see that page. An additional recovery period may apply.
B. Ocular Myasthenia Gravis	Submit the following for FAA review:1. All items listed in Row A above. 2. If ocular status is not addressed, an evaluation from an ophthalmologist may be required.	DEFERSubmit the information to the FAA for a possible Special Issuance.

• MULTIPLE SCLEROSIS (MS)
• All Classes
• (Updated 08/27/2025)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Multiple Sclerosis	After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. MRI brain with and without gadolinium performed no more than 90 days before the AME exam.3. MRI cervical and thoracic spine with and without gadolinium (most recent, if already performed).• For each MRI submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Eye evaluation. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ophthalmologist no more than 90 days before the AME exam. It must include a detailed summary of the history of any eye condition(s); current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.• It must specifically include an interpretation of the visual field testing;• Visual field testing (24-2 SITA standard) performed within the previous 90 days; and• Optical Coherence Tomography (OCT), if performed. Supply the color draft and printouts.5. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.6. Lab. The following testing, if already performed or clinically indicated:• Rheumatological antibody screening (ANA, RF, Lyme titer);• Cerebrospinal Fluid (CSF) testing;• All evoked potential testing; and	DEFERSubmit the information to the FAA for a possible Special Issuance.
	• NMO antibody panel (such as anti AQP4, anti MOG) in cases with spinal involvement, optic neuritis, or concerns for NMO-SD. (Submit most recent test result.)7. Any other testing already performed or deemed clinically necessary by the treating physician.
B. Neuromyelitis Optica Spectrum Disorder (NMOSD)ORMyelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD)	After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review:• All information listed above for MS Row A• On #6 Lab. NMO and anti-MOG antibody panel are required. (submit most recent test result).	DEFERSubmit the information to the FAA for a possible Special Issuance.
C. Clinically Isolated Syndrome (CIS)• any history of• no matter how long ago• include Transverse MyelitisIf optic neuritis see that page	After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review:• All information listed above for MS Row A• On #3 MRI cervical and thoracic spine-submit only if clinically indicated or already performed.	DEFERSubmit the information to the FAA for a possible Special Issuance.

NARCOLEPSY and IDIOPATHIC HYPERSOMNIA All Classes

(Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Current or historical diagnosisTreated or UntreatedNote: This condition is incompatible with aviation safety.	Submit the following for FAA review:1. The most recent detailed, Clinical Progress Note, generated from a clinic visit with the physician who treats or diagnosed this condition (narcolepsy or idiopathic hypersomnia). It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Copies of the most recent• Sleep study (sleep lab polysomnography);• Multiple Sleep Latency Test [MSLT]); and• Any other testing already performed for this condition.	DEFERSubmit the information to the FAA.
B. Current or historical diagnosis on medical recordsWITHNEW information which rescinds this diagnosis.Ex: Previously diagnosed with narcolepsy but additional evaluation determines cause is another condition.We require information for that condition and the following:	If additional testing, evaluation(s), or documentation verifies the diagnosis of Narcolepsy was rescinded, no longer requires treatment, or has resolved, submit the following for FAA review:1. A current, detailed neurological evaluation in accordance with the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with a Board-Certified neurologist or sleep specialist no more than 90 days before the AME exam.2. It must specifically include the current diagnosis, how the diagnosis of Narcolepsy was rescinded, and any occurrence(s) and frequency of cataplexy.3. A Type 1 or Type 2 Sleep Study (polysomnogram) performed within the previous 12 months.	DEFERSubmit the information to the FAA for a possible Special Issuance.

NEUROPATHY

(Peripheral Neuropathy) All Classes (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. NeuropathyWithout functional limitations	If the AME can determine the condition is:• Under control;• Medications are acceptable; and• The individual has no symptoms that would interfere with flight duties:	ISSUEAnnotate this information in Block 60.If no AME explanation, the pilot may be asked to provide documentation.
B. NeuropathyWith weakness/numbnessORFunctional limitations	Submit the following for FAA review: 1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam. It must include a detailed summary of the neuropathy (including etiology if known); current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include a description of any weakness, numbness, or functional limitations.3. Lab already performed for this condition.4. Any other testing or imaging deemed clinically necessary by the treating physician.Note: If the neuropathy is due to an underlying condition such as diabetes - see that section.	DEFERSubmit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.If not addressed in the progress note, the AME should describe any functional limitations that could affect the pilot's ability to operation aircraft controls.

• NEURALGIA
• (Trigeminal Neuralgia, Post Herpetic Neuralgia)
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A1. Post Herpetic Neuralgia,Occipital NeuralgiaFully resolvedANDoff medications	If the AME can determine that the Post herpetic or occipital neuralgia• Has fully resolved;• Medications have been discontinued; and• Individual has no symptoms that would interfere with flight or safety related duties:	ISSUEAnnotate this information in Block 60.If no AME explanation the individual may be asked to provide documentation.
A2. Trigeminal NeuralgiaSymptom free and treatment completed5 or more years agoANDdid NOT require surgery, gamma knife, or other procedure	If the AME can determine that the Trigeminal Neuralgia• Fully resolved 5 or more years ago;• Does not require any medication;• Was never treated with surgery; and• Individual has no symptoms that would interfere with flight or safety related duties:If the AME is unable to determine the above, request a current, detailed Clinical Progress Note from the treating physician. If medications are currently used, the AME should check with the Do Not Issue - Do Not Fly list.	ISSUEAnnotate this information in Block 60.If no AME explanation the individual may be asked to provide documentation.
B. Trigeminal NeuralgiaSymptomatic, unresolvedORrequiring treatment within the past 5 years	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include medications prescribed for this condition. Include start and stop dates; dosages, and side effects (if any). 3. Imaging performed at any time after symptoms started:• MRI brain• MRA head• Any other imaging (such as CT, MRI, CTA, MRA, or cerebral	DEFERSubmit the information to the FAA for a possible Special Issuance.
	catheter angiography/cath angio of the head) already performed.• Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.Note: If due to Multiple Sclerosis or other condition - see that section.
C. Trigeminal NeuralgiaTreated with surgery or gamma knife (ever)	Submit the following for FAA review:1. Row B evaluation data2. Brain imaging performed AFTER the procedure.3. Hospital records. Include these specific hospital records for any hospitalization, surgery, or procedures related to this condition.• Admission History and Physical (H&P);• Emergency Medical Services (EMS)/ambulance run sheet (if applicable);• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) that can be printed from an electronic medical record are NOT sufficient for pilot medical certification purposes.);• Lab report(s) including all drug or alcohol testing performed;• Operative/procedure report(s);• Pathology report(s); and• Radiology reports. The interpretive report(s) of all diagnostic imaging (CT, MRI, X-ray, ultrasound, or others) performed.• DO NOT submit miscellaneous hospital records such as	DEFERSubmit the information to the FAA for a possible Special Issuance.
	flowsheets, nursing notes, physician orders, or medication administration records.• For all imaging, submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.Note: If the applicant has a large volume of records, it is recommended that they bring them to the exam so the AME can assist in determining what is miscellaneous and not needed by the FAA.

NEUROFIBROMATOSIS

(Type 1/NF-1 von Recklinghausen Disease and Type 2/NF-2 Wishart Disease)

All Classes

(Updated 09/24/2025)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Neurofibromatosis Type 1 (NF1)von Recklinghausen disease	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Brain MRI with and without contrast performed no more than 90 days before the AME exam (reports and CD)*.3. Any other neuroimaging such as MRI spine, plexus, optic nerves, or other areas, most recent, if already performed (reports and CD)*.• For all images (CT/MRI), submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Eye evaluation from a board- certified ophthalmologist (NOT optometrist). Submit a current, detailed Clinical Progress Note, generated from a clinic visit with the treating ophthalmologist no more than 90 days before the AME exam. It must include a detailed summary of the any eye conditions; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.5. Threshold Visual field testing with good reliability (30-2 or 24-2) performed within the previous 90 days with an	DEFERSubmit the information to the FAA for a possible Special Issuance.
	interpretation of the visual field testing by the treating ophthalmologist.6. Neuropsychological (NP) evaluation is required in most cases. The type of evaluation may vary. The applicant may want to wait until FAA review of other items above before obtaining NP testing.• If a history of cognitive impairment, brain lesion, or brain surgery: FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment is required;• If there is a history or suspicion of learning disability or ADHD: FAA Specifications for Neuropsychological Evaluation for ADHD is required needed;• If no history: FAA may accept an abbreviated evaluation after review of the other neurologic evaluation items.7. Any other testing deemed clinically necessary by the treating physician.
B. Neurofibromatosis Type 2 (NF2)Wishart Disease	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Audiologic evaluation including pure tone and speech discrimination and speech audiometry with interpretation performed no more than 90 days before the AME exam.3. Brain MRI with and without contrast with fine cuts through the posterior fossa performed no more than 90 days before the AME exam (reports and CD)*.4. Any other neuroimaging such as MRI spine, plexus, optic nerves, or other	DEFERSubmit the information to the FAA for a possible Special Issuance.
	areas, most recent, if already performed (reports and CD)*.* For all images (CT/MRI). Submit BOTH the interpretive report and the actual images on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.6. Eye evaluation from a board-certified ophthalmologist (NOT optometrist). A current, detailed Clinical Progress Note generated from a clinic visit with the treating ophthalmologist no more than 90 days before the AME exam. It must include a detailed summary of the history of any eye conditions; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.7. Threshold Visual field testing with good reliability (30-2 or 24-2) performed within the previous 90 days with an interpretation of the visual field testing by the treating ophthalmologist.8. Neuropsychological (NP) evaluation is required in most cases. The type of evaluation may vary. The applicant may want to wait until FAA review of other items above before obtaining NP testing.• If a history of cognitive impairment, brain lesion, or history or brain surgery: FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment is required;• If there is a history or suspicion of learning disability or ADHD: FAA Specifications for
	Neuropsychological Evaluation for ADHD is required;• If no history - FAA may accept an abbreviated evaluation after review of the other neurologic evaluation items.9. Any other testing deemed clinically necessary by the treating physician.Note: Brain surgery including resection of benign tumors that requires dural penetration (except resection of vestibular Schwannomas) requires a 2-year recovery period.

Also see AASI for Neurofibromatosis.

• PARAPLEGIA
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Paraplegia	Submit the following for FAA review:1. A current, detailed neurological evaluation in accordance with the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically address:• Cause of paraplegia;• Medication use and side effects, if any;• Autonomic functions such as bowel, bladder, and blood pressure control;• Orthostatic episodes;• Hypotensive episodes on the ground. (This could be exacerbated with G-forces in flight.); and• Description of movement, strength, and tone (ability to get into and out of an airplane).Note: Most anticholinergic medications are not acceptable.If the neurology evaluation does not adequately describe movement, strength, and functional ability, the AME should describe any functional limitations that could affect the ability to operate aircraft controls. If not addressed, a PT/OT/PMR Functional Capacity Evaluation (FCE) may be required.In most cases, a Medical Flight Test (MFT) is required prior to medical certification and/or Special Issuance for all classes.	DEFERSubmit the information to the FAA for a possible Special Issuance or Medical Flight Test and SODA.

• PARKINSON'S DISEASE and PARKINSONISM (Secondary)
• All Classes
• (Updated 02/22/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Parkinson’s Disease or Secondary ParkinsonismCurrent or historical diagnosis	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include:• Unified Parkinson's UPDRS-III motor rating scale;• Medication*: Comment on medications, side effects, and effectiveness of medication or treatment;• Describe findings if/when an individual misses a dose of medication;• Must discuss stability of the condition: Fluctuations of motor and cognitive function; dyskinesia, in response to the medication; and what is the pattern of fluctuations throughout the day; and• Autonomic dysfunction such as blood pressure fluctuation or orthostasis;*Acceptable Medication(s): The only medication currently acceptable for aeromedical purposes is carbidopa + levodopa (in either long or short acting preparations).3. MRI brain (Magnetic Resonance Imaging) performed within the 12 months before the AME exam.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. A current Neuropsychological evaluation that meets FAA Specifications	DEFERSubmit the information to the FAA for a possible Special Issuance.
	for Neuropsychological Evaluations for Potential Neurocognitive Impairment, generated from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.
B. Parkinson's Treated with Deep Brain Stimulator (DBS)	Submit the following for FAA review:1. All Row A evaluation data 2. Operative report 3. DBS Status SummaryNote: DBS and lesioning therapy may carry a risk of cognitive impairment and are reviewed on a case-by-case basis.	DEFERSubmit the information to the FAA for a possible Special Issuance.

POLIO (Poliomyelitis) All Classes (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. PolioAny history including post-polio syndrome with NO functional limitation	If the AME can determine :• The condition is under control,• No medications are needed, AND• The individual has no functional limitations that could affect their ability to operation aircraft controls or perform safety related duties:	ISSUEAnnotate this information in Block 60.
B. PolioAny history including postpolio syndrome with functional limitation that could interfere with flight or safety related duties	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with a physical medicine and rehabilitation physician, physical therapist, or occupational therapist no more than 90 days before the AME exam. It should include a detailed history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must include the components of a Functional Capacity Evaluation (FCE).• It should evaluate items such as balance, strength, range of motion limitations, and pain.• It must describe any functional deficits or limitations for both large- and small-muscle groups as well as dexterity to operate an aircraft.3. If not addressed in the Clinical Progress Note, the AME should describe any functional limitations that could affect the pilot's ability to operate aircraft controls.Note: If functional capacity is limited, a Medical Flight Test (MFT) may be required. See that page.Specify on the exam the FSDO location the pilot wants to use for the MFT.	DEFERSubmit the information to the FAA for a possible Special Issuance or SODA.

• PSEUDOTUMOR CEREBRI
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
Pseudotumor CerebriIdiopathic intracranial hypertension(Previous name: Benign Intracranial Hypertension)	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. *MRI of the brain performed no more than 90 days before the AME exam.3. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ophthalmologist or neuro-ophthalmologist no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.4. Visual Field graphs (24-2 or 30-2) with narrative interpretation by the treating eye specialist.5. If surgery was performed, it should indicate follow-up results and note any complications.• If a shunt was placed as part of treatment, a minimum recovery period of two (2) years is required.6. Records from any hospitalization to include:• Admission History and Physical;• Hospital discharge summary. (Typically, the patient portal notes or after	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.
	visit summary (AVS) that can be printed from an electronic medical record are NOT sufficient for pilot medical certification purposes.);• Emergency Medical Services (EMS)/ ambulance run sheet (if applicable);• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Lab report(s) including all drug or alcohol testing performed;• Operative/procedure report(s); to include lumbar puncture(s); and• Pathology report(s)7. Radiology report(s). The interpretive report(s) of all diagnostic imaging (CT scan, MRI, MRA, MRV, X-ray, ultrasound, or others) performed.• For MRI or other diagnostic imaging: Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.

• SEIZURE
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Simple Febrile Seizureoccurring atAge 5 or younger(fever seizure/febrile seizure)	If the AME can determine all of the following apply:• A single seizure only;• Condition fully resolved age 5 or younger;• NO recurrence;• NO anticonvulsant medication given; AND• Condition has resolved without sequelae with NO symptoms or current problems that would interfere with flight duties:If the AME is unable to determine all of the above information, a detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist will be required.If the neurology evaluation verifies the condition was a simple febrile seizure:	ISSUEAnnotate this information in Block 60.All others, go to Row C
B. Single seizure even provoked by a known cause which has been correctedMay be due to:Electrolyte or severe metabolic imbalance;Medication use;orConvulsive syncope;If due to TBI or post concussive seizure - see that sectionIf due to drug or alcohol withdrawal - see D&A section	After a One (1)-year recovery period, submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. It must specifically include the date of last seizure activity and dates medication discontinued.3. *MRI brain performed at any time after the seizure activity started.• If not already performed, a current brain MRI is required.• Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory	DEFERSubmit the information to the FAA for a possible Special Issuance
	of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Electroencephalogram (EEG) performed no more than 12 months before the AME exam. It must be sleep-deprived EEG: Awake, asleep, and with provocation (hyperventilation, photic/strobe light).• If not already performed, a current EEG is required.• Submit any previous EEG(s) available for comparison.• Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.5. FAA Airman Seizure Questionnaire completed by the applicant.Note: In some cases, a longer recovery period will be required based on the underlying cause.
C. Single seizure event UNPROVOKED(No known cause)ORComplex febrile seizure;Atypical/complex febrile seizures; orfebrile seizures treated with medication as a child (usually age 5 or younger).Note: If 2 or more seizures in a lifetime, from any cause, go to the Epilepsy section.	After a four (4)-year recovery period and the last two (2) years must be without anticonvulsant medication, submit the following for FAA review:• All information in Row B.Upon review, additional information may be required.	DEFERSubmit the information to the FAA for a possible Special Issuance

FAA Pilot/ATCS Seizure Questionnaire (Updated 09/28/2022)

The following questions should be answered by the AIRMAN who should read through the entire questionnaire and complete all sections as appropriate. If the seizures occurred when the airman was a child, a parent or guardian familiar with the episodes should complete this questionnaire.

Circle, check, or fill in answers, as appropriate:

Airman Name (printed) _____________________________ MID#, PI#, or App D#_____________

Airman Name (printed) ____________________________ MID#, PI#, or App D#_____________

Signature ______________________________________ Date completed _______________

Airman Name (printed) ____________________________ MID#, PI#, or App D#_____________

• STROKE
• Cerebrovascular Accident (CVA) or Transient Ischemic Attack (TIA)
• All Classes
• (Updated 04/26/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. All typesEver in lifetimeORTIA	Required recovery period:• Cortical stroke or TIA: 2-year recovery• Sub-cortical stroke: 1-year recoveryNote: If the specific cause of a TIA or subcortical stroke is known and corrected (e.g., high-grade carotid stenosis fully treated or PFO with known acute venous clot fully treated), these may be considered on a case-by-case basis sooner than one year. Cortical strokes typically require a 2-year recovery period, regardless of cause.Once the required recovery period has been met, submit the following for FAA review: 1. A detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Brain MRI performed within the previous 12 months. New imaging may be required after FAA physician review.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.3. Hospital records from the event:• Admission History and Physical;• Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) printed from an electronic medical record are NOT sufficient for pilot medical certification purposes.);• Emergency Medical Services (EMS)/ambulance run sheet, if applicable;• Hospital consultant report(s) (e.g., neurology, cardiology, internal medicine, or other specialists);• Lab report(s);	DEFERSubmit the information to the FAA for a possible Special Issuance
	• Operative/procedure report(s), if applicable;• *Radiology report(s). The interpretive report(s) of all diagnostic imaging (CT Scan, MRI, X-ray, ultrasound, or others) performed.• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, and medication administration records.4. Cardiac Monitor• TIA - Results of a current 30-day cardiac event monitor such as a Zio patch or implanted loop recorder (ILR).• If an implanted cardiac monitor was placed, OR if a cryptogenic stroke, submit a minimum of six (6) months of device reports.• If ILR is currently implanted, submit data from implantation to the most recent interrogation.5. Any other testing below, if already performed. New testing should not be obtained for aeromedical purposes until requested by FAA physicians. (See note on next page regarding additional testing.)• *Imaging. Copies of all previous imaging such as CT, MRI, MRA, or other radiological tests;• Carotid ultrasound such as post procedure carotid endarterectomy. A carotid ultrasound is NOT acceptable in place of an MRA or CTA;• Transthoracic echocardiogram (TTE);• Cardiovascular Evaluation (CVE). (This may be found in hospital records as many are completed during the hospital stay.);• Stress test; and• Holter monitors performed since the event.

ADDITIONAL TESTING: Due to the complex etiology of strokes, once the initial information (Row A) is reviewed by the FAA, the items below may be required on a case-by-case basis. Additional testing should not be obtained until requested by FAA physicians.

Also see AASI Cerebrovascular Disease (CVA/Stroke/TIA).

G20210A gene mutation

• TRANSIENT GLOBAL AMNESIA (TGA)
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. TGASingle episode 5 or more years ago	Submit the following for FAA review:1. A current, detailed neurological evaluation, in accordance with the FAA Specifications for Neurologic Evaluation, that is generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam. 2. It must specifically include if there IS or IS NOT any concern for seizure. 3. MRI brain* (Prefer with contrast, if clinically appropriate.) Magnetic Resonance Imaging (MRI) of the brain performed no more than 90 days before the AME exam.• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail. 4. MR angiogram (MRA) or CT angiogram (CTA) of both the head and neck*.• Carotid Doppler may be acceptable on a case-by-case basis. Generally, this is not preferred because it does not evaluate intracranial circulation. (The pilot may still need an MRA). 5. EEG* Sleep deprived and sleep awake state with activating procedures (with provocation). 6. Echocardiogram (Echo), if already performed. 7. Prolonged ECG such as a Holter or loop recorder (or telemetry reading from hospital), if already performed. 8. Records from any hospitalization(s) for this condition to include:• Admission History and Physical;• Hospital Discharge Summary (Typically, the patient portal notes or after visit summary [AVS] that can be printed from the electronic medical record are NOT sufficient for pilot medical certification purposes.)	DEFERSubmit the information to the FAA for a possible Special Issuance.
	• Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists);• Operative/procedure report(s);• Pathology report(s);• Radiology reports. The interpretive report(s) of all diagnostic imaging (CT Scan, MRI, X-ray, ultrasound, or others) performed;• Lab report(s) including all drug or alcohol testing performed;• Emergency Medical Services (EMS)/ambulance run sheet;• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records.9. Progress notes from all clinic follow-up visits related to this condition; 10. Other tests already performed or as clinically indicated.Note: If imaging (MRI DWI brain) was performed in the acute period after the episode, it should be submitted (both reports and images). *Submit the reports and the actual images in DICOM format on CD.
B. TGASingle episode less than 5 years agoORIf 2 or more lifetime episodes, that should be stated.	After a 6-month recovery period obtain the following evaluation(s) and submit for FAA review:• All Evaluation Data items in Row ANote: *For all imaging, submit the interpretive report(s) AND the actual images on CD in DICOM readable format.MRI, MRA/CTA, or electroencephalogram (EEG) studies are required. If not performed during the initial management or monitoring of the condition, new testing must be obtained.If an MRI DWI brain was performed during the acute period after the episode, it should be submitted (both reports and images). If the MRI DWI shows classic TGA findings, the 6-month recovery period may be reduced. This waives the recovery period only. The evaluation items are still required.	DEFERSubmit the information to the FAA for a possible Special Issuance.

• TREMOR
• All Classes
• (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Physiologic tremor• Not requiring medication• Not progressing• No functional limitationsNote: This is not a disease. It can be a normal physiological finding for the situation.	If the AME can determine the pilot has no symptoms that would interfere with flight duties:	ISSUEAnnotate this information in Block 60
B. Essential Tremor Treated with an acceptable medication.Note: Previous term was “Benign Essential Tremor”	Follow the CACI – Essential Tremor Worksheet.This requires a current, detailed Clinical Progress Note from the treating physician.Acceptable medication for CACI is NONE or a beta-blocker.(All others go to Row C).If the pilot meets all CACI worksheet criteria and is otherwise qualified:	ISSUE with no time limitationAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. All othersThe diagnosis is suspect or uncertain;The individual is dependent on medication to be functional or requires a medication change;Assistive devices (such as weighted gloves, utensils) are used;Condition is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/ordependent on medication;Note: Most medication to treat tremor is not acceptable (e.g., gabapentin, mysoline [primadone]).	Submit the following to the FAA for review:☐ A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.☐ MRI and/or CT of the brain (the most recent test).• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.5. Electroencephalogram (EEG) performed no more than 12 months before the AME exam. It must be	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate elements or findings in Block 60.
	sleep-deprived EEG: awake, asleep, and with provocation (hyperventilation, photic/strobe light).• Include any previous EEG(s) available for comparison.• Submit BOTH the final interpretive report(s) and the actual tracings (ALL pages) for any EEGs on CD.• The CDs of EEG recordings must have proprietary opening software that is compatible with Windows 10.4. Other testing already performed the treating physician for this condition

CACI – Essential Tremor Worksheet

(Updated 07/26/2023) The AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND any supporting documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or secondclass must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Essential Tremor. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Essential Tremor.

[ ] NOT CACI qualified Essential Tremor. I have deferred. (Submit supporting documents.)

TOURETTE SYNDROME or TIC DISORDER All Classes

(Updated 02/22/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Tic disorder (Chronic motor or vocal tic)Present 5 or more yearsNot worsening	If the AME can determine:• The condition is under control,• No medications or treatment required, and• The individual has NO symptoms that would interfere with flight duties or communication:Note: Adult-onset tic disorder, go to Row B.	ISSUEAnnotate this information inBlock 60.
B. Tic disorder(Chronic motor or vocal Tic)Present less than 5 yearsUnknown causeORWorseningORAdult-onset tic	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. Due to the strong association with tic disorder and ADHD, a current neuropsychological and cognitive evaluation (Specifications for Neuropsychological Evaluations for ADHD) MAY be required after review of the initial neurological evaluation.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.
C. Tourette Syndrome	Submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam. 2. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for ADHD from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.Note: Tourette's syndrome and tics are commonly associated with Attention Deficit Hyperactivity Disorder (ADHD). Neuropsychological evaluation and testing is required.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

UNEXPLAINED LOSS OF CONSCIOUSNESS (ULOC)

(Unexplained Disturbance of Consciousness or Transient LOC Without Satisfactory Medical Explanation) All Classes

(Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. ULOCUnexplained Loss of Consciousnesscurrent or historical	After a 2-year, symptom-free recovery period, obtain and submit the following for FAA review:1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.2. The neurologic evaluation must specifically include:• A description of the event(s) and a summary of all testing or evaluation(s) performed to identify the cause;• If there has been any recurrence and the length of time without symptoms; and• If no cause was identified, that should be stated.3. Copies of any testing already performed such as lab, imaging, EEG, or other testing.4. Hospital or clinic records from this episode and follow-up. This may include History and Physical (H&P), operative notes, and hospital discharge summary (if applicable).If no neurological explanation is found, additional evaluations may be required on a case-by-case basis such as:• Cardiovascular evaluation from a cardiologist;• Exercise stress test;• Holter monitor; and/or• TTE Transthoracic echocardiogram (TTE)• If the above items have already been performed, they should be submitted to the FAA. If not yet performed, the applicant may want	DEFERSubmit the information to the FAA for a possible Special Issuance.
	to wait until FAA review of their case before undergoing additional testing.Note: Upon review of the above items, additional information or testing may be required.If a cause is identified - see that section.
B. Disturbance of consciousness without satisfactory medical explanation of the causeORTransient loss of control of nervous system function(s) without satisfactory medical explanation of the cause	See Row A.	DEFERSubmit the information to the FAA for a possible Special Issuance.

Note:

§ 67.109, 67.209, 67.309 Neurologic - Neurologic standards for an airman medical certificate are:

• OTHER NEUROLOGIC CONDITIONS
• All Classes
• (Updated 08/27/2025)