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Aviation Medical Examiner (AME) Assisted Special Issuance ALL CLASSES

If this is a first-time issuance for a disqualifying condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer, and submit all of the documentation to the AMCD or your RFS.

The Guide refers to a number of selected medical conditions that are initially disqualifying and must be deferred to the AMCD or RFS. Following the granting of an Authorization for Special Issuance of a Medical Certificate (Authorization) by the AMCD or RFS’s office. Each AASI has their own specialized clinical criteria, by which an Examiner may reissue a medical certificate to an applicant with a medical history of an initially disqualifying condition, if otherwise qualified.

Arthritis and/or Psoriasis

Asthma

Atrial Fibrillation

Bladder Cancer

Breast Cancer

Chronic Lymphocytic Leukemia

Chronic Obstructive Pulmonary Disease (COPD)

Colitis

Colon Cancer

Deep Venous Thrombosis/Pulmonary Embolism Warfarin (Coumidin Therapy)

Diabetes Melitus Type II, Medication Controlled

Glaucoma

Hepatitis C

Hyperthyroidism

Hypothyroidism

Lymphoma and Hodgkin’s Disease

Melanoma

Metabolic Syndrome, Glucose Intolerance, Impaired Glucose Tolerance, Insulin Resistance, and Pre-Diabetes

Migraine Headaches

Mitral and Aortic Insufficiency

Paroxysmal Atrial Tachycardia

Prostate Cancer

Renal Calculi

Renal Carcinoma

Testicular Carcinoma

Arthritis and/or Psoriasis

Airmen’s Medical Certification may be re-issued under the provisions of Authorization provided the applicant meets the following conditions:
– A copy of the Authorization granted by the FAA.
– A current status report from your treating physician to include:
a. the type of arthritis or psoriasis;
b. a general assessment of the condition and effect on
daily activities;
c. the name and dosage of the medication used in treating
and /or in preventing your condition with comments
regarding any side effects
d. for arthritis: the report must include comments
regarding range of motion of neck, upper and lower
extremities, hands, etc.

Medical certification can not be issued by the AME and must be deferred to the AMCD or Region if:
– for arthritis; new joints have become affected
– if you require a change in medication used for control of the disease
– you are taking more than 20mg prednisone or the equivalent daily

Asthma

Airmen’s Medical Certification may be re-issued under the provisions of Authorization provided the applicant meets the following conditions:
– A copy of the Authorization granted by the FAA.
– A current status report from your treating physician to include:
– current medical status that addresses frequency of attacks and whether the attacks have resulted in emergency room visits or hospitalizations;
– caution the applicant to cease flying with any exacerbation
as warned in § 61.53
– results of pulmonary function testing, if deemed necessary, performed with last 90 days

Medical certification can not be issued by the AME and must be deferred to the AMCD or Region if:
– the symptoms worsen;
– there has been an increase in frequency of emergency
room, hospital, or outpatient visits;
– the FEV1 is less than 70% predicted value;
– the applicant requires 3 or more medications for
stabilization;
– you are taking more than 20mg prednisone or the
equivalent daily

Atrial Fibrillation

Examiners 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;
– The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects;
– A report of a current 24-hour Holter Monitor performed within last 90 days; and
– A minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months. The Examiner must defer to the AMCD or Region if:
– Holter Monitor demonstrates: HR >120 BPM or Pauses >3
seconds;
– More than 20% of INR values are <2.0 or >3.0; or
– The applicant develops emboli, thrombosis, bleeding, or any other cardiac condition previously not diagnosed or reported.

Bladder Cancer

Examiners 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 Examiner must defer to the AMCD or Region if:
– There has been any recurrence of the cancer; or
– Any new treatment is initiated.

Breast Cancer

Examiners 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 Examiner must defer to the AMCD or Region if:
– There has been any recurrence of the cancer; or
– Any new treatment is initiated.

Chronic Lymphocytic Leukemia

Examiners 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 clinical follow up report from the treating physician that includes an update of the condition of the applicant since the last examination;
– The results of any applicable laboratory results, including a complete blood count performed within the last 90 days.

The Examiner must defer to the AMCD or Region if:
– The condition currently requires treatment with a
chemotherapeutic agent; or
– The white blood cell count has risen above 80,000; or
– Any new treatment is initiated.

Chronic Obstructive Pulmonary Disease

Examiners 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 symptomatology of the condition;
– A statement addressing any associated illnesses, such as heart failure;
– The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
– A pulmonary specialist evaluation that includes the results of a current pulmonary function test, performed within last 90 days.

The Examiner must defer to the AMCD or Region if:
– The FEV1 or FEV1/FVC is less than 70%;
– The applicant has been placed on a steroid dose equivalent to greater than 20mg of Prednisone per day; or
– The applicant has developed an associated cardiac condition.

Colitis

Examiners 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 Examiner 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 20mg of Prednisone per day, antispasmodics, and anticholinergics; or
– The pattern of exacerbations are increasing in frequency or severity; or applicant underwent surgical intervention.

Colon Cancer

Examiners 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 last 90 days) carcinoembryonic antigen (CEA), if a baseline value is available.

The Examiner must defer to the AMCD or Region if:
– There has been any progression of the disease or an increase in CEA
– Any new treatment is initiated

Deep Venous Thrombosis/Pulmonary Embolism Warfarin (Coumidin Therapy)

Examiners 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 DVT, PE or other complication of hypercoagulopathy (see below *);
– The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
– A minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months (see below *).

The Examiner must defer to the AMCD or Region if:
– More than 20 percent of INR values are <2.0 or >3.0; or
– The applicant develops emboli, thrombosis, bleeding, or any other cardiac or neurologic condition previously not diagnosed or reported.

Diabetes Melitus Type II, Medication Controlled

Examiners 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 physician treating the airman’s
diabetes, including:
– A statement attesting that the airman is maintaining his
or her diabetic diet;
– A statement regarding any diabetic symptomatology,
including any history of hypoglycemic events and any cardiovascular, renal, neurologic, or ophthalmologic complications; and
– The results of a current HgA1c level performed within last 30 days.

The Examiner must defer to the AMCD or Region if:
– The applicant has been placed on insulin
– The HgA1c level is greater than 9.0 mg%
– Any hypoglycemic event
– The applicant has developed evidence of any of the following:
– Cardiovascular disease,
– Neurologic disease, including any change in degree of
peripheral neuropathy,
– Ophthalmologic disease,
– Renal disease (including a Creatinine over 2.0)
– The airman has been placed on any amlynomimetic, such as pramlintide (Symlin)
– There is a change in oral hypoglycemic medication
– The airman has been placed on beta-blockers AND his/her oral diabetes medications include any sulfonlyurea and/or any meglitinide. Commonly used meglitinides include repaglinide (Prandin) and nateglinide (Starlix). Commonly used sulfonylureas include: acetohexamide (Dymelor);
chloropropamide (Diabinese); tolazamide (Tolinase);
tolbutamide (Orinase); glimepiride (Amaryl); glipizide
(Glucotrol, Glucotrol XL); glyburide (DiaBeta, Micronase,
Glynase); glyburide plus metformin (Glucovance); glipizide plus metformin (Metaglip). Any new treatment is initiated

Glaucoma

Examiners 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 Examiner 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 initiated

Hepatitis C

Examiners 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 last 90 days.

The Examiner 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.

Hyperthyroidism

Examiners 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 Examiner 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.

Hypothyroidism

Examiners 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 last 90 days.

The Examiner must 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.

Lymphoma and Hodgkin’s Disease

Examiners 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 Examiner must defer to the AMCD or Region if:
– There has been any recurrence or disease progression
– Any new treatment is initiated

Melanoma

Examiners 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 Examiner 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 > .75 mm with or without metastasis
– A melanoma that exhibits a Breslow Level < .75 mm which has no evidence of metastasis may be regular issued

Metabolic Syndrome, Glucose Intolerance, Impaired Glucose Tolerance, Insulin Resistance, and Pre-Diabetes

Examiners 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 attesting that the airman is maintaining his or her diabetic diet;
– A statement regarding any diabetic symptomology; and
– The results of a current HgA1c level performed within last 90 days.

The Examiner must defer to the AMCD or Region if:
– The applicant has been placed on insulin
– The HgA1c level is greater than 9.0 mg%
– Any hypoglycemic event
– The applicant has developed evidence of any of the following:
– Cardiovascular disease,
– Neurologic disease, including any change in
degree peripheral neuropathy,
– Ophthalmologic disease,
– Renal disease (including a Creatinine over 2.0)
– The airman has been placed on any amlynomimetic, such
as pramlintide (Symlin)
– There is a change in oral hypoglycemic medication
– The airman has been placed on beta-blockers AND his/her oral diabetes medications include any sulfonlyurea and/or
any meglitinide. Commonly used meglitinides include
repaglinide (Prandin) and nateglinide (Starlix).
Commonly used sulfonylureas include: acetohexamide
(Dymelor); chloropropamide (Diabinese); tolazamide
(Tolinase); tolbutamide (Orinase); glimepiride (Amaryl);
glipizide (Glucotrol, Glucotrol XL); glyburide (DiaBeta,
Micronase, Glynase); glyburide plus metformin
(Glucovance); glipizide plus metformin (Metaglip).

Migraine Headaches

Examiners 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 followup 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 Examiner should defer to the AMCD or Region if:
– The frequency of headaches and/or other symptoms increase since the last followup report; or
– The applicant is placed on medication(s), such as isometheptene mucate, narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc.

Mitral and Aortic Insufficiency

Examiners 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 last 90 days.

The Examiner 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 Examiner reports the murmur is now moderate to severe (Grade III or IV).

Paroxysmal Atrial Tachycardia

Examiners 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 Examiner 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.

Prostate Cancer

Examiners 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 last 90 days.

The Examiner 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

Renal Calculi

Examiners 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 last 90 days.

The Examiner 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.

Renal Carcinoma

Examiners 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 Examiner must defer to the AMCD or Region if:
– There has been any recurrence of the cancer; or
– Any new treatment is initiated.

Sleep Apnea

Examiners 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 report (performed within last 90 days) from the treating physician that references the present treatment, whether this has eliminated any symptoms and with specific comments regarding daytime sleepiness. If there is any question about response to or compliance with treatment, then a Maintenance of Wakefulness Test (MWT) will be required.

The Examiner must defer to the AMCD or Region if:
– There is any question concerning the adequacy of therapy;
– The applicant appears to be non-compliant with therapy;
– The MWT demonstrates sleep deficiency; or
– The applicant has developed some associated illness, such as right-sided heart failure.

Testicular Carcinoma

Examiners 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 Examiner must defer to the AMCD or Region if:
 – There has been any recurrence of the cancer; or
 – Any new treatment is initiated