Guide for Aviation Medical ExaminersVersion 09/30/2026
Section 25
AME ASSISTED SPECIAL ISSUANCES (AASI)
43 pagesPages 689–730
AASIs for ALL CLASSES
- Authorization for Special Issuance of a Medical Certificate and
- AME Assisted Special Issuance (AASI)
- (Updated 08/28/2024)
A. Special Issuance.
At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a Medical Certificate (Authorization), with a specified validity period, may be granted to an applicant who does not meet the established medical standards. The applicant must demonstrate to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical certificate applied for can be performed without endangering public safety for the validity period of the Authorization. The Federal Air Surgeon may authorize a special medical flight test, practical test, or medical evaluation for this purpose. An airman medical certificate issued under the provisions of an Authorization expires no later than the Authorization expiration date or upon its withdrawal. An airman must again show to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical certificate applied for can be performed without endangering public safety in order to obtain a new airman medical certificate/Authorization under Title 14 of the Code of Federal Regulations (14 CFR) §67.401.
See Title 14 of the Code of Federal Regulations (14 CFR) §67.401.
B. AME Assisted Special Issuance (AASI).
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization to an applicant who has a medical condition that is disqualifying under 14 CFR Part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the requisite medical information required for determination. AMEs may not issue initial Authorizations. An AME's decision or determination is subject to review by the FAA. Please note that the Certificate Issuance Coversheet is no longer required when submitting information.
Continue Authorization Letter
As of May 2023:
If the AME issued an AASI correctly, AAM will no longer send a “continue authorization” letter, in accordance with the last paragraph of the authorization letter:
“Please be advised that as long as reports are submitted as outlined in your Authorization letter, certificates are issued correctly, and there have been no changes in your medical condition(s), no further correspondence will be sent from our office.”
AAM will continue to review AASI documents after an AME issues.
An individual may receive a Continue Authorization Letter when:
A third-class interim medical certificate is being issued; OR
If the AME made an error on the medical certificate and AAM needs to send a corrected certificate (e.g., forgot to put time limitation); OR
There was an interim condition where review was required, but no changes to the AASI are needed.
AME Assisted Special Issuance (AASI)
(Updated 07/29/2026) The following pages of the Guide for Aviation Medical Examiners introduce the AME Assisted Special Issuance (AASI) process.
The Guide refers to a number of selected medical conditions that are initially disqualifying (if the applicant does not meet the issue criteria in the Aerospace Medicine Dispositions Tables or the Certification Worksheets) and must be deferred to the AMCD or RFS. If this is a first-time application for an AASI for a disqualifying disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the AME must defer, and submit all of the documentation to the AMCD or your RFS.
Following the granting of an Authorization for Special Issuance of a Medical Certificate (Authorization) by the AMCD or RFS, an AME may reissue a medical certificate to an applicant with a medical history of an initially disqualifying condition once the AASI's specialized criteria is met and the applicant is otherwise qualified.
- ANXIETY, DEPRESSION, and RELATED
- CONDITIONS PATH
- AORTIC INSUFFICIENCY
- ARTHRITIS and/ or PSORIASIS
- ASTHMA
- ATRIAL FIBRILLATION
- BLADDER CANCER
- BREAST CANCER
- CARDIAC – SINGLE VALVE REPLACEMENT
- OR REPAIR
- CEREBROVASCULAR DISEASE
- (CVA/STROKE/TIA)
- CHRONIC KIDNEY DISEASE (CKD)
- CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)/
- SMALL LYMPHOCYTIC LYMPHOMA (SLL)
- CHRONIC OBSTRUCTIVE
- PULMONARY DISEASE (COPD)
- COLITIS (Ulcerative or Crohn’s Disease or
- Irritable Bowel Syndrome
- COLON CANCER/COLORECTAL CANCER
- CORONARY HEART DISEASE (CHD)
- VENOUS THROMBOEMBOLISM (VTE) -
DEEP VENOUS THROMBOSIS (DVT), PULMONARY EMBOLISM (PE), and/ or HYPERCOAGULOPATHIES
- DIABETES MELLITUS – TYPE II Medication
- Controlled (Not Insulin)
- GLAUCOMA
- HEPATITIS C
- HYPERTENSION (HTN)
- HYPERTHYROIDISM
- HYPOTHYROIDISM
- LYMPHOMA and HODGKIN’S DISEASE
- LOW TESTOSTERONE/ HYPOGONADISM
- MELANOMA
- MIGRAINE HEADACHES
MITRAL Valve Disease [Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Prolapse
- (MVP)]
- NEUROFIBROMATOSIS TYPE 1
- PAROXYSMAL ATRIAL TACHYCARDIA
- (PAT)
- PREDIABETES OR OVERWEIGHT/OBESITY
- TREATED WITH MEDICATION
- PROSTATE CANCER
- PSORIASIS
- RENAL CALCULI
- RENAL CANCER
- SLEEP APNEA/ OBSTRUCTIVE SLEEP
- APNEA (OSA)
- TESTICULAR CANCER
- THROMBOCYTOPENIA
AASI for Anxiety, Depression, and Related Conditions PATH
(Updated 08/26/2026) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that the treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides all the following:
An Authorization granted by the FAA which states that AASI PATH has been approved;
All interim Detailed Clinical Progress Notes (DCPN). At a MINIMUM, this must include:
EVERY 6 months (or more often as clinically indicated), progress notes from a clinic visit with a treating physician (MD/DO) or extender (PA-C/NP/midlevel);
At least one of these 6-month visits (and corresponding progress note) must come from a physician (MD/DO), such as a Primary Care Physician or Psychiatrist.
The most recent clinical progress note must be no more than 90 days before the AME exam;
Detailed Clinical Progress Notes must include a detailed interim summary; current medications, dosages, and side effects (if any); any changes in medication dose or type since last visit; physical exam findings; results of all testing performed; diagnosis; assessment and plan (prognosis); and follow-up; and 3. Anxiety, Depression, and Related Conditions PATH Status Summary completed by the treating physician and AME.
AME must defer and describe in Block 60 what item(s) caused the deferral if the psychiatrist, treating physician, or AME identifies any of the following:
Any NEW “Yes*” answers on the PATH Status Summary;
Any new (or not previously reported) psychiatric symptoms, signs, or diagnosis;
Any new history of substance use disorder or FAA substance dependence;
Any progression (change in symptoms that persist despite modifications to medication and/or therapy) of the disease; and/or
AME, treating physician, or treating provider has concerns.
The AME must notify the FAA Aeromedical Certification Division (405-954-4821) if there is a significant clinical deterioration in my client's cognition, judgment, emotional stability, or insight.
AASI for Aortic Insufficiency
(Updated 01/28/2026) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A summary of the applicant’s medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation; and
A current 2-D echocardiogram with Doppler performed within the last 90 days.
The AME must defer to the AMCD or Region if:
The mean gradient across the valve reaches 40 mm Hg;
New symptoms occur;
An arrhythmia develops; or
The treating physician or AME reports the murmur is now moderate to severe (Grade III or IV).
AASI for Arthritis and/or Psoriasis
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments which specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
The type of arthritis;
A general assessment of the condition and its effect on daily activities;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
Comments regarding range of motion of neck, upper and lower extremities, hands, etc.
The AME must defer to the AMCD or Region if:
The applicant has developed any associated systemic manifestations;
New joints have become involved;
The applicant required change in medication used for control of the disease; or
The applicant is taking steroid doses equivalent to more than 20 mg of prednisone per day (steroid conversion calculator)
AASI for Asthma
(Updated 08/26/2026) Note: If the applicant has mild symptoms that are infrequent, have not required hospitalization, or use of steroid medication, and no symptoms in flight, the AME may issue an airman medical certificate. See Item 35., Lungs and Chest Aerospace Medical Disposition.
If the applicant does not meet the above criteria, the AME must follow the AASI process.
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
☐ An Authorization granted by the FAA;
☐ Annual, current, detailed Clinical Progress Note generated from a clinic visit with the treating pulmonologist no more than 90 days before the AME exam. It must include a detailed interim summary; current medications, dosage, and side effects (if any); physical exam findings; results of all testing performed; diagnosis; assessment and plan (prognosis); and follow-up.
☐ It must specifically include if there has been any worsening in symptoms, hospitalizations, exacerbations, or inadequate compliance with treatment. ☐ Pulmonary function testing, if deemed necessary, performed no more than 90 days before the AME exam.
The AME must defer recertification if:
There is a worsening of the condition such as increased symptoms or an increase in the frequency of emergency room, hospital, or outpatient visits;
The FEV1 is less than 70% predicted value; or
The applicant is taking steroid doses equivalent to more than 20 mg of prednisone per day (steroid conversion calculator)
AASI for Atrial Fibrillation
(Updated 03/27/2024) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A report of a minimum 24-hour cardiac monitor performed within last 90 days. (Cardiac monitor report must be submitted, even if findings are normal, and should include 1-page computerized summary and the representative full-scale multi-lead ECG tracings);
A completed Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary and a cardiologist evaluation that addresses all items on the status report; and
The above data verifies:
o If all items on the Non-Valvular Atrial Fibrillation (AFib)/A-Flutter Status Summary are in the left-hand column OR reports verify:
No interval evidence or suspicion of stroke, TIA, or other thromboembolic event.
Heart rate is well controlled on cardiac monitor by cardiologist interpretation.
If symptom, rate, or rhythm control is indicated and, if so, a description of how it this is managed.
When CHA2DS2-VASc score ≥ 2, verify emboli mitigation is in place without side effects. See Pharmaceuticals – Anticoagulants - Emboli Mitigation.
The AME must defer to the AMCD or Region if:
Applicant had left atrial appendage (LAA) occlusion (Watchman)/excision or developed a new cardiac condition;
There has been an interval definitive or suspicious thromboembolic event;
Cardiology interpretation indicates questionable or poor rate control. Average heart rate is > 100, maximum (non-exercise) is >120, or a single pause is > 3 seconds;
Evidence that symptoms, rate, or rhythms are not well controlled;
CHA2DS2-VASc is ≥ 2 and emboli not mitigated; (Acceptable emboli mitigation under AASI authorization is anti-coagulation with either NOAC/DOAC/warfarin. When using warfarin/Jantoven, if more than 20% of INR values are less than 2.0 or greater than 3.); and/or
Interval bleeding that required medical intervention.
AASI for Bladder Cancer
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
A current status report performed within 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease
The AME must defer to the AMCD or Region if:
There has been any recurrence of the cancer; or
Any new treatment is initiated
AASI for Breast Cancer
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
A current status report performed within the last 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.
The AME must defer to the AMCD or Region if:
There has been any recurrence of the cancer; or
Any new treatment is initiated.
AASI for Cardiac - Single Valve Replacement or Repair
All Classes
(Updated 01/27/2021) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
☐ Authorization granted by the FAA ☐ ECG - Required annually.
☐ Echo - Current 2D echocardiogram performed within 90 days ☐ INRs for Mechanical Heart Values - A minimum of monthly International
Normalized Ratio (INR) results for the immediate prior six months ☐ Status report - performed within the past 90 days in accordance with the appropriate CHD Protocol (1st or 2nd Class; 3rd Class)
The AME must defer medical certification if the applicant has:
Additional valve procedure performed;
Any other disqualifying medical conditions or therapy not previously reported;
Any other reason for not renewing an AASI;
Arrhythmia, new onset, such as of atrial fibrillation/flutter, ventricular bigeminy, ventricular tachycardia, Mobitz Type II or greater AV block, complete heart block, RBBB, LBBB, or LVH
Bleeding that required medical intervention or other;
Echo reveals:
IF ANY OF THE FOLLOWING ARE NOTED ON ECHO, THE AME MAY NOT ISSUE.
| Any valve | Perivalvular leaking |
|---|---|
| Aortic Valve | Area post procedure is less than 1.0 cm2 |
| Aortic Valve | Peak gradient level is 60 mmHg or more |
| Aortic Valve | Mean gradient is 40 mmHg or more |
| Mitral Valve | Any evidence of worsening of mitral valve regurgitation or stenosis in narrative |
Emboli or thrombosis develop
INR - More than 20% of INR values are less than 2.5 or greater than 3.5. o In select cases of a Bileaflet (St. Jude) valve in the aortic position, INR values between 2.0 and 3.0 may be accepted (check with FAA)
New Event - Has another event, develops a new condition or identification of an additional cardiac condition not previously reported.
AASI for Cerebrovascular Disease (CVA/Stroke/TIA)
All classes
(Updated 01/25/2023) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
Annual, current, detailed Clinical Progress Note generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam. It must include a detailed interim summary; current medications, dosage, and side effects (if any); physical exam findings; results of all testing performed; diagnosis; assessment and plan (prognosis); and follow-up.
o It must specifically describe if there has been any change in symptoms, exam findings, or control of risk factors.
Brain MRI (report with comparison to prior studies) every 24-months.
AME must defer and describe in Block 60 what item(s) caused the deferral if the neurologist evaluation or AME exam identifies any of the following:
An interval change or worsening of the condition;
New neurologic symptom(s), diagnosis, or episode - focal or non-focal including a new CVA/Stroke/TIA based on symptoms or imaging;
Atrial fibrillation or atrial flutter - new onset or not previously reported;
Bleeding which required medical intervention;
New or not previously reported neurologic diagnosis or disqualifying medical condition or therapy;
Physical exam changes identified by either the neurologist or AME; and/or
Inadequate risk factor control - new risk factor identified OR inadequate control of known risk factors such as hypertension, hyperlipidemia, diabetes, smoking, hypercoagulable conditions, and/or obstructive sleep apnea.
AASI for Chronic Kidney Disease (CKD)
(Updated 11/25/2015) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A current, detailed status report from the treating physician detailing: o How long the condition has been stable and asymptomatic; o If there has been any significant change in eGFR or renal function; o Any interval development of other complications or abnormal physical exam findings (such as diabetes, uncontrolled HTN, or clinically significant proteinuria);
o Most recent lab results including eGFR, creatinine, hemoglobin, hematocrit and urine albumin or ACR;
o The name and dosage of medication(s) and presence or absence of any side effects; and o Statement from the treating physician if there is any evidence of cardiovascular disease
The AME must defer to the AMCD or Region if:
The condition is no longer stable (per the treating physician note);
Dialysis has been started or transplant has occurred;
The airman is taking a medication that is not acceptable (See Pharmaceuticals – Antihypertensive) or has aeromedically significant side effects from the medication;
Anemia with hemoglobin less than 10 gm/dL or hematocrit less than 30% is present; or
The eGFR is 29 or less; (if this occurs, the airman will need to submit additional testing to show stability [such as inulin clearance testing, creatinine clearance testing, or a 24-hour urine creatinine result] and the nephrologist’s clinical interpretation of results, prognosis, and plan for follow up).
AASI for Chronic Lymphocytic Leukemia (CLL)
Small Lymphocytic Lymphoma (SLL)
(Updated 05/31/2023) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A CLL/SLL Status Summary and a current, detailed Clinical Progress Note from the treating physician that includes all of the required information; and
The results of a complete blood count (CBC) performed no more than 90 days before the AME exam.
The AME must defer to the AMCD or Region if:
The condition worsens, individual becomes symptomatic, or new treatment is initiated;
The condition currently requires treatment with a chemotherapeutic agent;
Rai stage is 3 or higher or Binet stage is C;
Evidence of active disease;
The hemoglobin is less than 10, the platelet count is less than 100,000/microL, or the total or absolute lymphocytic count doubling time is less than 6 months.
AASI for Chronic Obstructive Pulmonary Disease (COPD)
(Updated 05/31/2023) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following (all performed no more than 90 days before the AME exam:
An Authorization granted by the FAA;
A completed COPD Status Summary verifying all items are “YES” or a current, detailed Clinical Progress Note which addresses each item;
A pulmonary Function Test (PFT); and
A 6-Minute Walk Test (6MWT).
The AME must defer to the AMCD or Region if:
Resting oxygen saturation is 95% or lower;
Pulmonary Function Tests show FEV1 is LESS than 60%;
6-Minute Walk Test (6MWT) shows 4% drop in SpO2 from baseline OR walked less than 400 meters; and
The individual is taking 4 or more medications for COPD OR is on daily oral steroid use.
Submit the COPD Status Summary or a current, detailed Clinical Progress Note; PFTs; and 6MWT results to the FAA for retention in the file.
AASI for Colitis (Ulcerative or Crohn’s Disease) or Irritable Bowel Syndrome (IBS)
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement regarding the extent of disease;
A statement regarding the frequency of exacerbation (the applicant should cease flying with any exacerbation as warned in § 61.53); and
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
The AME must defer to the AMCD or Region if:
There is a current exacerbation of the illness;
The applicant is taking medications such as Lomotil, steroid doses equivalent to more than 20 mg of prednisone per day (steroid conversion calculator), antispasmodics, and anticholinergics; or
The pattern of exacerbations is increasing in frequency or severity; or applicant underwent surgical intervention.
AASI for Colon Cancer/Colorectal Cancer
(Updated 10/27/2021) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
An update of the status of the malignancy since the last FAA medical examination, to include the results of a current (performed within the last 90 days) carcinoembryonic antigen (CEA), if a baseline value is available
The AME must defer to the AMCD or Region if:
There has been any progression of the disease or an increase in CEA or
Any new treatment is initiated
AASI for Coronary Heart Disease (CHD)
All Classes
(Updated 05/29/2024) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations, (14 CFR) part 67. This AASI is for an applicant with a history of Angina Pectoris; Atherectomy; Brachytherapy; Coronary Bypass Grafting; Myocardial Infarction; Percutaneous Transluminal Angioplasty (PTCA); Rotoblation; or Stent Insertion for any class.
The FAA physicians provide the initial certification decision and grant the Authorization for Special Issuance of a Medical Certificate (Authorization) in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the issuance determination. If this is first-time application for an AASI for the above disease/condition, and the airman has all the requisite medical information necessary for a determination, you must defer and submit all of the documentation to the AMCD or your RFS for the initial determination.
AMEs may reissue an airman medical certificate if the applicant provides the following:
☐ Authorization granted by the FAA;
☐ Coronary Heart Disease (CHD)/ Coronary Artery Disease (CAD) Recertification Status Summary – Completed within the past 90 days.
The AME must defer medical certification if:
Any item falls into the “NO*” column on the Coronary Heart Disease (CHD)/ Coronary Artery Disease (CAD) Recertification Status Summary;
Any other disqualifying medical conditions or therapy not previously reported;
Any other reason for not renewing an AASI
Bleeding that required medical intervention or other;
Chest pain - Complains of chest pain at any time (exclude chest pain with a firm diagnosis of non-cardiac causes of chest pain);
New Event - Has another event, develops a new condition, or identification of an additional cardiac condition not previously reported (such as myocardial infarction or restenosis requiring CABG, atherectomy, brachytherapy, PTCA, stent, or other procedure);
Nitrate - Is placed on a long acting nitrate for any reason; or
Risk factors - Inadequately controlled.
NOTE: As of 05/29/24 - For routine cases, follow-up stress test is no longer required provided ALL items on the CHD/CAD Recertification Status Summary are in the “YES” column. If risk factors are not controlled, any significant interval history change, or any concerns, the AME must defer.
AASI for Venous Thromboembolism (VTE) - Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE), and/or Hypercoagulopathies
(Updated 03/27/2024) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time issuance of an Authorization for the above disease/condition, and the applicant has requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance, if the applicant provides the following:
A valid Authorization for Special Issuance granted by the FAA;
A summary of the applicant’s medical condition since the last FAA medical examination, including a statement regarding any further episodes of VTE (DVT, PE) or other complication of hypercoagulopathy (see below*), future treatment plan, and prognosis;
The name and dosage of all medication(s) used for treatment and/or prevention with comment regarding side effects, if any; and
If using Jantoven (warfarin), obtain a minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months (see below*); and
If using other types of anticoagulants such as NOAC/DOAC (i.e. Xarelto, Eliquis, Pradaxa, Savaysa, etc.), the airman should obtain a statement from their treating/prescribing physician with details of the underlying condition, tolerance of the medication to include the presence or absence of side effects, any bleeding episodes requiring medical attention, and any occurrence/recurrence of deep vein thrombosis or pulmonary embolism.
*The AME must defer to the AMCD or Region if:
If using Jantoven (warfarin) and more than 20% of INR values are <2.0 or >3.0; or
If applicant experienced any side effects or bleeding episodes requiring medical attention; or
The applicant develops emboli, thrombosis, bleeding, or any other cardiac or neurologic condition previously not diagnosed or reported.
AASI for Diabetes Mellitus - Type II Medication Controlled (Not Insulin)
(Updated 01/28/2026) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination. The information can be submitted using the Diabetes or Hyperglycemia on Medications Status Report.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, provided that the applicant does not require insulin, remains on an acceptable oral medication therapy according to the chart Acceptable Combinations of Diabetes Medications, and if the applicant provides the following:
An Authorization granted by the FAA AND either
A Diabetes or Hyperglycemia on Medications Status Report OR
A current status report from the physician treating the airman’s diabetes, including:
o A statement attesting that the airman is maintaining his or her diabetic diet;
o A statement regarding any diabetic symptomatology; including any history of hypoglycemic events and any cardiovascular, renal, neurologic, or ophthalmologic complications; and o The results of a current HgA1c level performed within last 30 days.
The AME must defer to the AMCD or Region if, since the applicant’s last exam:
The applicant has been placed on insulin;
The HgA1c level is greater than 9.0 mg%
The applicant has experienced:
o Severe Hypoglycemia event(s) - requiring assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions (plasma glucose concentrations may not be available) * o Documented Symptomatic Hypoglycemia event(s) - typical symptoms of hypoglycemia accompanied by a measured plasma glucose concentration ≤70 mg/dL (≤3.9 mmol/L)*;
o Asymptomatic Hypoglycemia – no reported symptoms but a measured plasma glucose concentration ≤54 mg/dL (≤3.0 mmol/L)
The applicant has developed evidence of any of the following: o Cardiovascular disease;
o Neurologic disease, including any change in degree of peripheral neuropathy;
o Ophthalmologic disease; and/or o Renal disease (including a Creatinine over 2.0)
The airman has been placed on any amlynomimetics, such as pramlintide (Symlin)
The applicant is using any medication (single or in combination) that falls outside the framework of Acceptable Combinations of Diabetes Medications
The applicant has required treatment other than routine outpatient follow-up (e.g., emergency department, inpatient admission) for diabetes (e.g., hypoglycemia, ketoacidosis, non-ketotic hyperglycemia) or diabetes-related conditions.
The applicant has experienced any event suggesting hypoglycemia unawareness or hypoglycemia-associated autonomic failure.
* Reference: Hypoglycemia Workgroup of the ADA & The Endocrine Society.
AASI for Glaucoma
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
Certification only granted for open-angle-glaucoma and ocular hypertension;
The FAA Form 8500-14, Glaucoma Eye Evaluation Form is filled out by the treating eye specialist; and
A set of visual fields measurements is provided.
The AME must defer to the AMCD or Region if:
The FAA Form 8500-14 Glaucoma Eye Evaluation Form demonstrates visual acuity incompatible with the medical standards; or
There is a change in visual fields or adverse change in ocular pressure.
AASI for Hepatitis C
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
Any symptoms the applicant has developed;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
A current liver function profile performed within the last 90 days.
The AME must defer to the AMCD or Region if:
The applicant has developed symptoms;
There has been a change in treatment regimen, or the applicant has been placed on alpha-interferon;
Any side effects from required medication; or
An adverse change in liver function studies.
AASI for Hypertension (HTN)
(Updated 10/28/2015) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A current status report from the treating physician detailing: o If the is condition stable and, if so, for how long;
o Any secondary cause for the HTN;
o Any co-morbid condition (such as diabetes, obstructive sleep apnea); and o Any history of end organ damage (such as heart failure, myocardial infarction, cerebrovascular accident, kidney disease, eye disease); and o The name and dosage of medication(s) and presence or absence of any side effects.
The AME must defer to the AMCD or Region if:
The condition is not stable or has become uncontrolled (per the treating physician note);
The airman is taking a medication that is not acceptable (See Pharmaceuticals – Antihypertensive);
The airman has aeromedically significant side effects from the medication;
There is a new co-morbid condition, complication, or end organ damage; or
The end organ damage condition(s) do not meet FAA requirements. (See the applicable section for the specific condition(s) in the AME guide)
AASI for Hyperthyroidism
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA current statement of the condition since last FAA medical examination;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
Current thyroid function studies performed within last 90 days.
The AME must defer to the AMCD or Region if:
The applicant has developed hypothyroidism; or
The thyroid function studies are elevated, suggesting inadequate treatment; or
The applicant developed an associated illness, such as dysrhythmia.
AASI for Hypothyroidism
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects;
A statement regarding any other associated problems, such as cardiac or visual; and
A statement regarding the current thyroid stimulating hormone (TSH) level performed within the last 90 days.
The AME should defer to the AMCD or Region if:
The applicant develops a related problem in another system, such as cardiac; or
The TSH level is elevated.
AASI for Low Testosterone (Low T) Hypogonadism
All Classes
(Updated 09/25/2024) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations, (14 CFR) part 67. This AASI is for any class.
The FAA physicians provide the initial certification decision and grant the Authorization for Special Issuance of a Medical Certificate (Authorization) in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the issuance determination. If this is first-time application for an AASI for the above disease/condition, and the individual has all the requisite medical information necessary for a determination, you must defer and submit all of the documentation to AMCD or your RFS for the initial determination.
AMEs may reissue an airman medical certificate if the applicant provides the following:
☐ Authorization granted by the FAA;
☐ A Low Testosterone (Low T) Hypogonadism Status Summary OR a current, detailed Clinical Progress Note from an endocrinologist, urologist (preferred), or treating physician that includes all the required information; and ☐ The results of a complete blood count (CBC) performed no more than 90 days before the AME exam.
The AME must defer medical certification if:
Any new form of hypogonadism treatment is started;
Individual develops a new venous thromboembolic event (VTE) such as PE or DVT);
Hematocrit has risen to 55 or higher;
Development of any side effects, including visual (mild skin irritation and acne are acceptable);
Any other disqualifying medical conditions or therapy not previously reported; and/or
Any other reason for not renewing an AASI
AASI for Lymphoma and Hodgkin’s Disease
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
An update of the status of the disease from the last FAA medical examination and any testing deemed necessary by the treating physician.
The AME must defer to the AMCD or Region if:
There has been any recurrence or disease progression
Any new treatment is initiated
AASI for Melanoma
(Updated 08/26/2015) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA, and
A current status report performed within the last 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease
The AME must defer to the AMCD or Region if:
There has been any recurrence of the cancer, or
Any new treatment is initiated
Note:
A Special Issuance or AASI is required for any metastatic melanoma regardless of Breslow level.
A Special Issuance or AASI is required for any melanoma which exhibits Breslow Level equal to or deeper than 0.75 mm with or without metastasis.
A melanoma that exhibits a Breslow Level of less than 0.75 mm and no evidence of metastasis may be regular issued.
AASI for Migraines
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement regarding the frequency of headaches and/or other associated symptoms since last follow-up report;
A statement regarding if the characteristics of the headaches changed; and
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
The AME must defer to the AMCD or Region if:
The frequency of headaches and/or other symptoms increase since the last follow-up report; or
The applicant is placed on medication(s), such as isometheptene mucate, narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc.
AASI for Mitral Valve Disease
Mitral Regurgitation; Mitral Insufficiency; Mitral Valve Prolapse (MVP) (Updated 01/28/2026) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A detailed Clinical Progress Note from the treating cardiologist describing current clinical findings, any symptoms, new arrhythmia, develop of a severe murmur or any severe valve regurgitation, valve insufficiency or valve prolapse or if surgery is recommended; and
A current 2-D echocardiogram (Echo) with Doppler performed within the last 90 days.
The AME must defer to the AMCD or Region if:
New symptoms occur; OR
An arrhythmia develops; OR
The treating physician or AME reports a severe murmur; OR
Echo report identifies SEVERE Valve Regurgitation, Valve Insufficiency or Valve
Prolapse.
AASI for Neurofibromatosis Type 1 (NF1)
(Updated 01/28/2026) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
Annual current, detailed Clinical Progress Note generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam. It must include a detailed interim summary; current medications, dosage, and side effects (if any); physical exam findings; results of all testing performed; diagnosis; assessment and plan (prognosis); and follow-up.
AME must defer and describe in Block 60 what item(s) caused the deferral if the neurologist evaluation or AME exam identifies any of the following:
New (or not previously reported) neurologic symptoms, signs, or diagnosis;
Any progression of the disease; and/or
Any new treatment is initiated
AASI for Paroxysmal Atrial Tachycardia (PAT)
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement regarding any recurrences since the last FAA medical examination; and
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
The AME must defer to the AMCD or Region if:
There have been one or more recurrences; or
The applicant has received some treatment that was not reported in the past, such as radiofrequency ablation
AASI for Prediabetes or Overweight/Obesity Treated with Medication
Updated 09/27/2023)
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
A current, detailed clinical progress note performed no more than 90 days before the AME exam verifying:
o No interim development of diabetes; and/or o No hypoglycemia requiring intervention or significant side effects
Hemoglobin A1C is 6.4 or less (no more than 90 days before recertification).
The AME must defer to the AMCD or Region if:
Additional diabetes medications are added;
Development of diabetes; and/or
Any other reason for not renewing an AASI
If diagnosed with diabetes and taking medication other than insulin see: www.faa.gov/go/diabetic
If diagnosed with diabetes and taking insulin see: www.faa.gov/go/itdm
AASI for Prostate Cancer
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A current status of the medical condition to include any testing deemed necessary; and
A current PSA level performed within the last 90 days.
The AME must defer to the AMCD or Region if:
The PSA rises at a rate above 0.75 ng/ml per year;
A new treatment is initiated; or
Any metastasis has occurred.
AASI for Psoriasis
All Classes
(Updated 08/28/2024) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
A current, detailed Clinical Progress Note generated from a clinic visit with the treating Rheumatologist or Dermatologist no more than 90 days before the AME exam. It must include:
A detailed interim summary;
Current medications, dosage, and side effects (if any);
Physical exam findings;
Results of all testing performed;
Diagnosis;
Assessment and plan (prognosis); and
Follow-up.
It must specifically describe if co-morbid conditions are present, they are appropriately managed, and that the individual was counseled regarding guidelinedirected screening for co-morbid conditions.
AME must defer and describe in Block 60 what item(s) caused the deferral if the treating physician evaluation or AME exam identifies any of the following:
Any other disqualifying medical conditions or therapy not previously reported;
Development of symptoms or medication side effects incompatible with aviation safety; or
Guideline directed screening for co-morbid conditions are not addressed.
AASI for Renal Calculi
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement from your treating physician regarding the location of the retained stone(s), estimation as to size of stone, and likelihood of becoming symptomatic; and
A current report of appropriate imaging study (IVP, KUB, Ultrasound, or Spiral CT Scan) and provide a metabolic work-up, both performed within the last 90 days.
The AME must defer to the AMCD or Region if:
If the treating physician comments that the current stone has a likelihood of becoming symptomatic;
If the retained stone(s) has moved when compared to previous evaluations; or
If the stone(s) has become larger when compared to previous evaluations.
AASI for Renal Cancer
(Updated 04/25/2018) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
A current status report performed within the last 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.
The AME must defer to the AMCD or Region if:
There has been any recurrence of the cancer; or
Any new treatment is initiated.
AASI for Sleep Apnea/Obstructive Sleep Apnea (OSA)
(Updated 05/27/2026) AMEs may re-issue an airman medical certificate to airmen currently on an AASI for OSA if the individual provides the following:
An Authorization granted by the FAA; AND
A completed and signed OSA TREATED STATUS REPORT
OR
A current Detailed Clinical Progress Note from your treating physician indicating that OSA treatment is still effective AND
o For CPAP/ BIPAP/ APAP:
A copy of the cumulative annual PAP device report which shows actual time used (rather than a report typically generated for insurance providers which only shows if use is greater or less than 4 hours). Target goal should show use for at least 75% of sleep periods and an average minimum of 6 hours use per sleep period.
For persons with an established diagnosis of OSA who do not have a recording CPAP, a one-year exception will be allowed to provide a personal statement that they regularly use CPAP and use it before each shift when performing flight or safety duties. o For Dental Devices and/or for Positional Devices:
No conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc). Once Dental Devices with recording / monitoring capability are available, reports must be submitted.
o For Surgery:
For successfully treated surgical patients, a statement attesting to the continued absence of OSA symptoms is required.
Defer to the AMCD or the Region for further review if:
Concerns about adequacy of therapy or non-compliance;
Significant weight gain or development of conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension treated with more than two medications, atrial fibrillation, etc).
Note: The AME may request AMCD review to discontinue the AASI if there are indications that the airman no longer has OSA (e.g., significant weight loss and a negative study or surgical intervention followed by 3 years of symptom abatement and absence of significant weight gain or co-morbid conditions). In most cases, a follow-up sleep study will be required to remove the AASI.
AASI for Testicular Cancer
(Updated 04/25/2018) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA; and
A current status report performed within the last 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.
The AME must defer to the AMCD or Region if:
There has been any recurrence of the cancer; or
Any new treatment is initiated.
AASI for Thrombocytopenia
(Updated 10/27/2021) AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
An update of the status of the disease from the last FAA medical examination and any testing deemed necessary by the treating physician; and
CBC within the past 90 days.
The AME must defer to the AMCD or Region if:
There has been any recurrence or disease progression; or
There has been any bleeding that required treatment; or
Any new treatment is initiated such as IVIG, high dose steroids, platelet transfusion, splenectomy (as treatment, not traumatic), or others; and/or
Platelet count falls below 50,000/microL.
SUBSTANCES OF DEPENDENCE/ABUSE