Guide for Aviation Medical ExaminersVersion 09/30/2026
Section 08
ITEM 37. Vascular System
7 pagesPages 203–209
CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal
Vascular System
I. Code of Federal Regulations
All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)
(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds –
Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges;
No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment involved, finds -
Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
II. Examination Techniques
Inspection. Observe and report any thoracic deformity (e.g., pectus excavatum), signs of surgery or other trauma, and clues to ventricular hypertrophy. Check the hematopoietic and vascular system by observing for pallor, edema, varicosities, stasis ulcers, venous distention, nail beds for capillary pulsation, and color.
Palpation. Check for thrills and the vascular system for arteriosclerotic changes, shunts or AV anastomoses. The pulses should be examined to determine their character, to note if they are diminished or absent, and to observe for synchronicity.
Percussion. N/A.
Auscultation. Check for bruits and thrills.
III. Aerospace Medical Disposition
The following table lists the most common conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.
- VASCULAR CONDITIONS
- All Classes
- (Updated 08/26/2026)
| DISEASE/CONDITION | EVALUATION DATA | DISPOSITION |
|---|---|---|
| Aneurysm (Abdominal or Thoracic) | Submit all available medical documentation | Requires FAA Decision |
| Aneurysm (Status Post Repair) | Submit all documentation in accordance with CVE Protocol, and include a GXT | Requires FAA Decision |
| Arteriosclerotic Vascular disease with evidence of circulatory obstruction | Submit all documentation in accordance with CVE Protocol, and include a GXT, and CAD ultrasound if applicable | Requires FAA Decision |
| Peripheral Edema | The underlying medical condition must not be disqualifying | If findings can be explained by normal physiologic response or secondary to medication(s)- IssueOtherwise - Requires FAA Decision |
| DISEASE/CONDITION | CLASS | EVALUATION DATA | DISPOSITION |
|---|---|---|---|
| Phlebothrombosis or Thrombophlebitis | 1st & 2nd | See Thrombophlebitis Protocol | Requires FAA Decision |
| Phlebothrombosis or Thrombophlebitis | 3rd | Document history and findingsSee Thrombophlebitis Protocol | A single episode resolved, not currently treated with anticoagulants, and a negative evaluation- IssueIf history of multiple episodes- Requires FAA Decision |
VASCULAR CONDITIONS
ARTERIOVENOUS MALFORMATION (AVM) - Peripheral (lungs, liver, bone)
- All Classes
- Updated 08/26/2026
| DISEASE/CONDITION | EVALUATION DATA | DISPOSITION |
|---|---|---|
| A. Peripheral AVM (lungs, liver, bone, etc.)Incidental finding on imaging | If the AME can determine this is an incidental finding or does not require clinical surveillance, and there are no symptoms that would interfere with flight or safety-related duties: |  ISSUESummarize findings in Item 60. |
| B. Peripheral AVM (lungs, liver, bone, etc.)SymptomaticOR requires clinical surveillanceOR treatment is recommended | Submit the following for FAA review:9. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.10. Copies of any testing already performed (e.g. X-ray, MRI, CT, or MRA).11. If surgery has been performed, submit: a. Admission History & Physical (H&P) b. Hospital Discharge Summary c. Operative report(s). |  DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60. |
| C. Nervous system (brain or spinal cord) | See that page: AVM - Neurological (brain or spinal cord) |
Buerger Disease or Thromboangiitis Obliterans (TAO)
All Classes
(Updated 08/26/2026)
| DISEASE/CONDITION | EVALUATION DATA | DISPOSITION |
|---|---|---|
| A. Current or Historical DiagnosisWith NO complicationsAND NOT smoking | If the AME can determine the condition is under control, no medications are needed, no symptoms that would interfere with flight duties, AND not smoking: | ISSUESummarize findings in Item 60. |
| B. Current or Historical DiagnosisWITH complicationsOR continued SMOKING | Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their cardiologist or treating physician no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Personal Statement (typed) describing your history of tobacco use in any form (e.g. cigarettes, cigars, pipes, vapes, or chewing tobacco) or tobacco cessation aids (e.g., vapes, gum, patches, lozenges, Chantix).• Include start and stop dates (MM/YYYY), daily amount used, and whether you currently use tobacco.• If currently using any form of tobacco, list the type, how much, and how often.3. Results of any other testing already performed by the treating physician. | DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize findings in Item 60. |
POSTURAL TACHYCARDIA SYNDROME (POTS)
- All Classes
- Updated 08/26/2026
| DISEASE/CONDITION | EVALUATION DATA | DISPOSITION |
|---|---|---|
| A. Any historyNote: In most cases, a diagnosis of POTS is not acceptable for medical certification/clearance. | Submit the following for FAA review:12. A current, detailed Clinical Progress Note generated from a clinic visit with the treating cardiologist or neurologist performed no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.13. It must specifically include if the diagnosis of POTS is:• Confirmed;• Equivocal; or• Not confirmed14. Copies of any other treatment records or testing already performed by any providers for this or any similar condition by the treating physician.• Doctor's office notes;• Consultant notes;• Results from any testing already performed for the condition; and• Hospital records: History and Physical (H&P), operative notes, and discharge summary (if applicable).Note: To rescind the diagnosis of POTS, submit an evaluation performed by:• POTS center of excellence;• A neurologist specializing in autonomic nervous system disorders; OR• A researcher with extensive experience in POTS. |  DEFERSubmit the information to the FAA. |
- RAYNAUD'S SYNDROME
- (Primary Raynaud’s/Raynaud’s Disease or Secondary Raynaud’s/Raynaud’s
- Phenomenon)
- All Classes
- (Updated 05/31/2023)
| DISEASE/CONDITION | EVALUATION DATA | DISPOSITION |
|---|---|---|
| A. Primary Raynaud'sORRaynaud's disease | If the AME is able to determine through history and physical exam, there is no underlying cause, illness, or injury, the symptoms do not impede flight duties, and medication used to treat this condition is acceptable (see HTN meds): |  ISSUEAnnotate (elements or findings) in Item 60 |
| B. Secondary Raynaud'sORRaynaud's phenomenonORwith any impairment or disability due to the condition.If due to a known cause - see that section (Ex: systemic lupus erythematosus, Rheumatoid arthritis) | Submit the following: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 should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.Any other testing already performed or deemed clinically necessary by the treating physician. |  DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60 |
Note: The names Raynaud's disease, Raynaud's phenomenon, or Raynaud's syndrome are often used interchangeably.
If the AME has any concerns regarding the type or severity of the condition, request a current, detailed Clinical Progress Note from the treating physician.