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Special Issuance

The Federal Aviation Administration physicians are authorized to grant an Authorization for Special Issuance of a Medical Certificate (Authorization) in accordance with Title 14 of the Code of Federal Regulations § 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 applicable disease/condition, and the airman 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 RFS for the initial determination. An Examiner’s decision or determination is subject to review by the FAA.

Angina Pectoris

Bipolar Disorder

Cardiac Valve Replacement

Coronary Heart Disease

Diabetes Mellitus

Disturbance of Consciousness

Epilepsy

Heart Transplant

Myocardial Infarction

Permanent Cardiac Pacemaker

Personality Disorder

Psychosis

Substance Abuse

Substance Dependence

Transient Loss of control of nervous system function(s)

Angina Pectoris

Protocol to Re-issue Certification

A. Requirements are for consideration for any class of airman medical certification.
Recovery periods before consideration can be given for medical certification:

6 months: after angina, infarction, bypass surgery, angioplasty, stenting, rotoblation, or atherectomy

3 months: after ablation or valve replacement
None: after supraventricular tachycardia, atrial fibrillation, and syncope.
NOTE: if any of these conditions required any cardiac intervention that is listed in subparagraphs a and b above, then the applicable waiting periods do apply.

Hospital admission summary (history and physical), coronary catheterization report, and operative report regarding all cardiac events and procedures.

A current cardiovascular evaluation must include an assessment of personal and family medical history; a clinical cardiac and general physical examination; an assessment and statement regarding the applicant’s
medications, functional capacity, modifiable cardiovascular risk factors, motivation for any necessary change, prognosis for incapacitation; and blood chemistries (fasting blood sugar and current blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides).

A current maximal GXT – See GXT Protocol.

A SPECT myocardial perfusion exercise stress test using technetium agents and/or thallium may be required for consideration for any class if clinically indicated or the exercise stress test is abnormal by any of the usual parameters. The interpretive report and all SPECT images, preferably in black and white, must be submitted.

Note: If cardiac catheterization and/or coronary angiography have been performed, all reports and the actual films (if films are requested) must be submitted for review. Copies should be made of all films as a safeguard against loss. Films should be labeled with the name of the applicant and a return address.

B. Additional requirements for first or unlimited* second-class medical certification. The following should be
accomplished no sooner than 6-months post event:

Post-event coronary angiography. The application may be considered without post-event angiography but certification for first- and unlimited secondclass is unlikely without it.
A maximal thallium exercise stress test (See GXT Protocol).
FAA Form 8500-20, Medical Exemption Petition (Operational Questionnaire). The applicant should indicate if a lower class medical certificate is acceptable in the event ineligible for class sought.
• Limited second-class medical certificate refers to a second-class certificate with a functional limitation such as, Not Valid for Carrying Passengers for Compensation or Hire, Not Valid for Pilot in Command, Valid Only When Serving as a Pilot Member of a Fully Qualified Two-Pilot Crew, etc.

C. Certification.
Applicants found qualified for an airman medical certificate will be required to provide periodic follow-up cardiovascular evaluations including maximal stress testing. Additional diagnostic testing modalities, including radionuclide studies,
may be required if indicated.

No consideration will be given for an Authorization until all the required data have been received. The use of the applicant’s full name, date of birth, and social security number on all correspondence and reports will aid the agency in locating the proper file.

It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. In order to expedite processing, it is suggested that the information be sent in one mailing, when possible, to either:

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
Post Office Box 26080
Oklahoma City OK 73125-9914

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

Bipolar Disorder

A bipolar disorder may not reach the level of psychosis but can be so disruptive of judgment and functioning (especially mania) so as to interfere with aviation safety. All applicants with such a diagnosis must be denied or deferred. However, a number of these applicants, so diagnosed, may be
favorably considered for an Authorization when the symptoms do not constitute a threat to safe aviation operations.

Medical certificates may be issued only by an AAM-300 after review and a favorable recommendation by a consultant psychiatrist or by AAM-202.

Cardiac Valve Replacement

Applicants with tissue and mechanical valve replacement(s) are considered after the following:

1. A 6-month recovery period shall elapse after the valve replacement to ensure recovery and stabilization. First- and second-class initial applicants are reviewed by the Federal Air Surgeon’s cardiology panel;

2. Copies of hospital/medical records pertaining to the valve
replacement; include make, model, serial number and size,
admission/discharge summaries, operative report, and pathology report;

3. If applicable, a current evaluation from the attending physician regarding the use of Coumadin to confirm stability without complications, drug dose history and schedule, and International Normalized Ratio (INR) values (within acceptable range) accomplished at least monthly during the past 6-month period of observation;

4. A current report from the treating physician regarding the status of the cardiac valve replacement. This report should address your general cardiovascular condition, any symptoms of valve or heart failure, any related abnormal physical findings, and must substantiate satisfactory
recovery and cardiac function without evidence of embolic phenomena, significant arrhythmia, structural abnormality, or ischemic disease.

5. A current 24-hour Holter monitor evaluation to include select representative tracings;

6. Current M-mode, 2-dimensional echocardiogram with Doppler. Submit the video resulting from this study;

7. A current maximal GXT – See GXT Protocol;

8. If cardiac catheterization and coronary angiography have been performed, all reports and films must be submitted, if requested, for review by the agency. Copies should be made of all films as a safeguard against loss;

9. Following heart valve replacement, first- and second-class certificate holders shall be followed at 6-month intervals with clinical status reports and at 12-month intervals with a CVE, standard ECG, and Doppler echocardiogram. Holter monitoring and GXT’s may be required periodically if indicated clinically. For third-class certificate holders, the
above follow up testing will be required annually unless otherwise indicated.

10. Single, Mechanical and Valvuloplasty – See AASI for Cardiac Valve Replacement;

11. Multiple Heart Valve Replacement. Applicants who have received multiple heart valve replacements must be deferred, however, the AMCD may consider certification of all classes of applicants who have undergone a Ross procedure (pulmonic valve transplanted to the aortic
position and pulmonic valve replaced by a bioprosthesis).
It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. A medical release form may help in obtaining the necessary information.

All information shall be forwarded in one mailing to:

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
Post Office Box 26080
Oklahoma City OK 73125-9914
Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

No consideration can be given for Authorization for Special Issuance of a Medical Certificate until all the required data has been received.

Use your full name on any reports or correspondence will aid us in locating your file.

Coronary Heart Disease that has required treatment or if untreated has been symptomatic or clinically significant

A. Requirements are for consideration for any class of airman medical certification.

1. Recovery periods before consideration can be given for medical certification:
a. 6 months: after angina, infarction, bypass surgery, angioplasty, stenting, rotoblation, or atherectomy
b. 3 months: after ablation or valve replacement
c. None: after supraventricular tachycardia, atrial fibrillation, and syncope. NOTE: if any of these conditions required any cardiac intervention that is listed in subparagraphs a and b above, then the applicable waiting periods do apply.
Hospital admission summary (history and physical), coronary catheterization report, and operative report regarding all cardiac events and procedures.

A current cardiovascular evaluation must include an assessment of personal and family medical history; a clinical cardiac and general physical examination; an assessment and statement regarding the applicant’s medications, functional capacity, modifiable cardiovascular risk factors, motivation for any necessary change, prognosis for incapacitation; and blood chemistries (fasting blood sugar and current blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides).

A current maximal GXT – See GXT Protocol.

A SPECT myocardial perfusion exercise stress test using technetium agents and/or thallium may be required for consideration for any class if clinically indicated or the exercise stress test is abnormal by any of the usual parameters. The interpretive report and all SPECT images, preferably in black and white, must be submitted.

Note: If cardiac catheterization and/or coronary angiography have been performed, all reports and the actual films (if films are requested) must be submitted for review. Copies should be made of all films as a safeguard against loss. Films should be labeled with the name of the applicant and a return address.

B. Additional requirements for first or unlimited*
second-class medical certification. The following should be accomplished no sooner than 6-months post event:

1. Post-event coronary angiography. The application may be considered without post-event angiography but certification for first- and unlimited second-class is unlikely without it.
2. A maximal thallium exercise stress test (See GXT Protocol).
3. FAA Form 8500-20, Medical Exemption Petition (Operational Questionnaire). The applicant should indicate if a lower class medical certificate is acceptable in the event ineligible for class sought.

*Limited second-class medical certificate refers to a second-class certificate with a functional limitation such as, Not Valid for Carrying Passengers for Compensation or Hire, Not Valid for Pilot in Command, Valid Only When Serving as a Pilot Member of a Fully Qualified Two-Pilot Crew, etc.

C. Certification.
Applicants found qualified for an airman medical certificate will be required to provide periodic follow-up cardiovascular evaluations including maximal stress testing. Additional diagnostic testing modalities, including radionuclide
studies, may be required if indicated.

No consideration will be given for an Authorization until all the required data have been received. The use of the applicant’s full name, date of birth, and social security number on all correspondence and reports will aid the agency in locating the proper file.

It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. In order to expedite processing, it is suggested that the information be sent in
one mailing, when possible, to either:

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
Post Office Box 26080
Oklahoma City OK 73125-9914
Medical Appeals Section, AAM-313
Aerospace Medical Certification Division

Federal Aviation Administration
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

D. Coronary Intervention (CABG, Rotoblation, Atherectomy, PTCA, and STENT).

In addition, the applicant must provide the operative or post procedure report. If a STENT was placed, the report must include make of STENT, implant location(s), length and diameter of each STENT.

Diabetes Mellitus

Disease Protocols – Diabetes Mellitus – Type I or Type II, Insulin Treated The FAA has established a policy that permits the special issuance medical certification of insulin treated applicants for third class medical certification.
Consideration will be given only to those individuals who have been clinically stable on their current treatment regimen for a period of 6-months or more.
Consideration is not being given for first or second class certification. Individuals certificated under this policy will be required to provide substantial documentation regarding their history of treatment, accidents related to their disease, and current medical status. If certificated, they will
be required to adhere to stringent monitoring requirements and are prohibited from operating aircraft outside the United States. The following is a summary of the evaluation protocol and an outline of the conditions that the FAA will apply:

• Initial Certification
• Monitoring and Actions Required During Flight Operations
• Subsequent Medical Certification
(Note: Insulin pumps are acceptable.)

Initial Certification

1. The applicant must have had no recurrent (two or more) episodes of hypoglycemia in the past 5 years and none in the preceding 1 year which resulted in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring
without warning (hypoglycemia unawareness).
2. The applicant will be required to provide copies of all medical records as well as accident and incident records pertinent to their history of diabetes.
3. A report of a complete medical examination preferably by a physician who specializes in the treatment of diabetes will be required. The report must include, as a minimum:
a. Two measurements of glycosylated hemoglobin (total A1 or A1c concentration and the laboratory reference range), separated by at least 90 days. The most recent measurement must be no more than 90 days old.
b. Specific reference to the applicant’s insulin dosages and diet.
c. Specific reference to the presence or absence of cerebrovascular, cardiovascular, or peripheral vascular disease or neuropathy.
d. Confirmation by an eye specialist of the absence of clinically significant eye disease.
e. Verification that the applicant has been educated in diabetes and its control and understands the actions that should be taken if complications, especially hypoglycemia, should arise. The examining physician must also verify that the applicant has the ability and willingness to properly monitor and manage his or her diabetes.
f. If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded exercise stress test.
g. The applicant shall submit a statement from his/her treating physician, Examiner, or other knowledgeable person attesting to the applicant’s dexterity and ability to determine blood glucose levels using a recording glucometer.

Note: Student pilots may wish to ensure they are eligible for medical certification prior to beginning or resuming flight instruction or training. In order to serve as a pilot in command, you must have a valid medical certificate for the type of operation performed.

Monitoring and Actions Required During Flight Operations
To ensure safe flight, the insulin using diabetic airman must carry during flight a recording glucometer; adequate supplies to obtain blood samples; and an amount of rapidly absorbable glucose, in 10 gm portions, appropriate
to the planned duration of the flight. The following actions shall be taken in connection with flight operations:

1. One half hour prior to flight, the airman must measure the blood glucose concentration. If it is less than 100 mg/dl the individual must ingest an appropriate (not less than 10 gm) glucose snack and measure the glucose concentration one half hour later. If the concentration is within 100 — 300 mg/dl, flight operations may be undertaken. If less than 100, the process must be repeated; if over 300, the flight must be canceled.
2. One hour into the flight, at each successive hour of flight, and within one half hour prior to landing, the airman must measure their blood glucose concentration. If the concentration is less than 100 mg/dl, a 20 gm glucose snack shall be ingested. If the concentration is 100 — 300 mg/dl, no action is required. If the concentration is greater that 300 mg/dl, the airman must land at the nearest suitable airport and may not resume flight until the glucose concentration can be maintained in the 100 — 300 mg/dl range. In respect to determining blood glucose concentrations during flight, the airman must use judgment in deciding whether measuring concentrations or operational demands of the environment (e.g., adverse weather, etc.) should take priority. In cases where it is decided that operational demands take priority, the airman must ingest a 10 gm glucose snack and measure his or her blood glucose level 1 hour later. If measurement is not
practical at that time, the airman must ingest a 20 gm glucose snack and land at the nearest suitable airport so that a determination of the blood glucose concentration may be made.

Subsequent Medical Certification

1. For documentation of diabetes management, the applicant will be required to carry and use a whole blood glucose measuring device with memory and must report to the FAA immediately any hypoglycemic incidents, any involvement in accidents that result in serious injury
(whether or not related to hypoglycemia); and any evidence of loss of control of diabetes, change in treatment regimen, or significant diabetic complications. With any of these occurrences, the individual must cease flying until cleared by the FAA.
2. At 3-month intervals, the airman must be evaluated by the treating physician. This evaluation must include a general physical examination, review of the interval medical history, and the results of a test for glycosylated hemoglobin concentration. The physician must review the record of the airman’s daily blood glucose measurements and comment on the results. The results of these quarterly evaluations
must be accumulated and submitted annually unless there has been a change. (See No. 1 above – If there has been a change the individual must report the change(s) to the FAA and wait for an eligibility letter before resuming flight  duties).
3. On an annual basis, the reports from the examining physician must include confirmation by an eye specialist of the absence of significant eye disease.
4. At the first examination after age 40 and at 5 year intervals, the report, with ECG tracings, of a maximal graded exercise stress test must be included in consideration of continued medical certification.

Disturbance of Consciousness

Disturbance of consciousness without a satisfactory medical explanation of the cause. RFS’s may consider third-class applicants only. Any class certificate may be issued by AAM-300, except first and second class certificates may be issued only upon a favorable recommendation by an appropriate medical consultant.

1. No medical certificate should be issued unless a medical explanation can satisfactorily justify issuance of the appropriate class. Generally, a complete description of the event(s) and a comprehensive neurological examination with appropriate studies, e.g., CT or MRI scans and EEG’s and /or a comprehensive cardiovascular evaluation with echocardiograms vascular imaging, electrocardiograms, stress tests, and a 24-72 hour ambulatory electrocardiogram Holter may be indicated. If there has been no recurrence after 3 years, reconsideration may be given.

Epilepsy

Third class medical certificates may be issued to persons with history of idiopathic epilepsy (seizures). There must be no history of seizures for a period of at least 10 years, off anticonvulsant medication for at lease the preceding 3 years, with a current neurological examination and EEG. Such individuals shall be required to submit annual neurological evaluations with EEG’s until 15-years following the last event.

Heart Transplant

The Examiner must defer issuance. Issuance is considered for Third-class applicants only. FAA Cardiology Panel will review. Applicants found qualified will be required to provide annual followup evaluations. All studies must be performed within 30 days of application. Requirements for consideration:
• A 1 year recovery period shall elapse after the cardiac transplant before consideration
• A current report from the treating transplant cardiologist regarding the status of the cardiac transplant, including all pre- and post-operative reports. A statement regarding functional capacity, modifiable cardiovascular risk factors, and prognosis for incapacitation
• Current blood chemistries (fasting blood sugar, hemoglobin A1C concentration, and blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides), within 30 days
• Any tests performed or deemed necessary by all treating physicians (e.g., myocardial biopsy)
• Coronary Angiogram
• Graded Exercise Stress Test (see disease protocol) and stress echocardiogram
• A current 24-hour Holter monitor evaluation to include selective representative tracings
• Complete documentation of all rejection history, whether treated or not; include hospital records and reports of any tests done
• A complete history regarding any infectious process
• All complete history regarding any malignancy
• List of all present medications and dosages, including side effects It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. A medical release form may help in obtaining the necessary information.
Please ensure full name appears on any reports or correspondence. All information shall be forwarded in one mailing to either:

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
Post Office Box 26080
Oklahoma City OK 73125-9914

or

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

Myocardial Infarction

A. Requirements are for consideration for any class of airman medical certification.
1. Recovery periods before consideration can be given for medical certification:
a. 6 months: after angina, infarction, bypass surgery,
angioplasty, stenting, rotoblation, or atherectomy
b. 3 months: after ablation or valve replacement
c. None: after supraventricular tachycardia, atrial fibrillation, and syncope. NOTE: if any of these conditions required any cardiac intervention that is listed in subparagraphs a and b above, then the applicable waiting periods do apply. Hospital admission summary (history and physical), coronary catheterization report, and operative report regarding all cardiac events and procedures.
A current cardiovascular evaluation must include an assessment of personal and family medical history; a clinical cardiac and general physical examination; an assessment and statement regarding the applicant’s
medications, functional capacity, modifiable cardiovascular risk factors, motivation for any necessary change, prognosis for incapacitation; and blood chemistries (fasting blood sugar and current blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides). A current maximal GXT – See GXT Protocol. A SPECT myocardial perfusion exercise stress test using technetium agents and/or thallium may be required for consideration for any class if clinically indicated or the exercise stress test is abnormal by any of the usual parameters. The interpretive report and all SPECT images, preferably in black and white, must be submitted.

Note: If cardiac catheterization and/or coronary angiography have been performed, all reports and the actual films (if films are requested) must be submitted for review. Copies should be made of all films as a safeguard against loss. Films should be labeled with the name of the applicant and a return address.

B. Additional requirements for first or unlimited* second-class medical certification. The following should be accomplished no sooner than 6-months post event:

1. Post-event coronary angiography. The application may be considered without post-event angiography but certification for first- and unlimited second-class is unlikely without it.

2. A maximal thallium exercise stress test (See GXT Protocol).

3. FAA Form 8500-20, Medical Exemption Petition (Operational Questionnaire). The applicant should indicate if a lower class medical certificate is acceptable in the event ineligible for class sought.

*Limited second-class medical certificate refers to a second-class certificate with a functional limitation such as, Not Valid for Carrying Passengers for Compensation or Hire, Not Valid for Pilot in Command, Valid Only
When Serving as a Pilot Member of a Fully Qualified Two-Pilot Crew, etc.

C. Certification.
Applicants found qualified for an airman medical certificate will be required to provide periodic follow-up cardiovascular evaluations including maximal stress testing. Additional diagnostic testing modalities, including radionuclide
studies, may be required if indicated.

No consideration will be given for an Authorization until all the required data have been received. The use of the applicant’s full name, date of birth, and social security number on all correspondence and reports will aid the agency in locating the proper file.

It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical certification. In order to expedite processing, it is suggested that the information be sent in
one mailing, when possible, to either:

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
Post Office Box 26080
Oklahoma City OK 73125-9914
Medical Appeals Section, AAM-313
Aerospace Medical Certification Division

Federal Aviation Administration
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

D. Coronary Intervention (CABG, Rotoblation, Atherectomy, PTCA, and STENT). In addition, the applicant must provide the operative or post procedure report. If a STENT was placed, the report must include make of STENT, implant location(s), length and diameter of each STENT.

Permanent Cardiac Pacemaker

A 2-month recovery period must elapse after the pacemaker implantation to allow for recovery and stabilization. Submit the following:

1. Copies of hospital/medical records pertaining to the requirement for the pacemaker, make of the generator and leads, model and serial number, admission/discharge summaries, operative report, and all ECG tracings.

2. Evaluation of pacemaker function to include description and documentation of underlying rate and rhythm with the pacer turned “off” or at its lowest setting (pacemaker dependency), programmed pacemaker parameters, surveillance record, and exclusion of myopotential inhibition and pacemaker induced hypotension (pacemaker syndrome), Powerpack data including beginning of life
(BOL) and elective replacement indicator/end of life (ERI/EOL).

3. Readable samples of all electronic pacemaker surveillance records post surgery or over the past 6 months, or whichever is longer. It must include a sample strip with pacemaker in free running mode and unless contraindicated, a sample strip with the pacemaker in magnetic mode.

4. An assessment and statement from a physician regarding general physical and cardiac examination to include symptoms or treatment referable to the cardiovascular system; the airman’s interim and current cardiac condition, functional capacity, medical history, and medications.

5. A report of current fasting blood sugar and a current blood lipid profile to include: total cholesterol, HDL, LDL, and triglycerides.

6. A current Holter monitor evaluation for at least 24-consecutive hours, to include select representative tracings.

7. A current M-mode, 2-dimensional echocardiogram with Doppler.

8. A current Maximal Graded Exercise Stress Test Requirements

9. It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for airman medical
certification. A medical release form may help in obtaining the necessary information.

All information shall be forwarded in one mailing to:

Medical Appeals Section, AAM-313
Aerospace Medical Certification Division
Federal Aviation Administration
Post Office Box 26080
Oklahoma City OK 73125-9914
Medical Appeals Section, AAM-313

or

Aerospace Medical Certification Division
Federal Aviation Administration
6700 S MacArthur Blvd., Room B-13
Oklahoma City OK 73169

No consideration can be given for special issuance until all the required data has been received. The use of the airman’s full name and date of birth on all correspondence and reports will aid the agency in locating the proper file.

Personality Disorder

The category of personality disorders severe enough to have repeatedly manifested itself by overt acts refers to diagnosed personality disorders that involve what is called “acting out” behavior. These personality problems relate to poor social judgment, impulsivity, and disregard or antagonism toward authority, especially rules and regulations.

A history of long-standing behavioral problems, whether major (criminal) or relatively minor (truancy, military misbehavior, petty criminal and civil indiscretions, and social instability), usually occurs with these disorders. Driving infractions and previous failures to follow aviation regulations are critical examples of these acts.

Certain personality disorders and other mental disorders that include conditions of limited duration and/or widely varying severity may be disqualifying. Under this category, the FAA is especially concerned with significant depressive episodes requiring treatment, even outpatient therapy.
If these episodes have been severe enough to cause some disruption of vocational or educational activity, or if they have required medication or involved suicidal ideation, the application should be deferred or denied issuance.

Some personality disorders and situational dysphorias may be considered disqualifying for a limited time. These include such conditions as gross immaturity and some personality disorders not involving or manifested by overt acts.
Medical certificates may be issued by Regional Flight Surgeon’s and AAM-300 after review and a favorable recommendation by a consultant psychiatrist or
by AAM-202.

Psychosis

The category of psychosis includes schizophrenia and some bipolar and major depression, as well as some other rarer conditions. In addition, some conditions such as schizotypical and borderline personality disorders that
include psychotic symptoms at some time in their course may also be disqualifying.

Medical certificates may be issued only by AAM-300 after review and a favorable recommendation by a consultant psychiatrist or by AAM-202.

Substance Abuse

Third class medical certificates may be issued only by AAM-300 in accordance with the following:

1. After a period of documented abstinence of more than 1 year buy less than 2 years;

a. Records must be obtained which support the quality of
recovery. These must include any reports of treatment,
reports from psychiatrists and addictions specialists,
evidence of an acceptable ongoing support system,
employment and legal history (e.g., driving under the
influence convictions(s), etch.), medical history, and any
other evaluations performed.

b. If the current clinical evaluation including psychiatric and
psychological evaluations as indicated is favorable, the
applicant may be issued a medical certificate. A certificate
should be issued only under the provisions of 67.401 of the
CFR.

c. A monitoring system that includes periodic status reports by a physician competent in substance abuse or a substance abuse professional must be established for at least 2 years.

Substance Dependence

1. After a period of documented abstinence of more than 1 year buy less than 2 years;

a. Records must be obtained which support the quality of
recovery. These must include any reports of treatment,
reports from psychiatrists and addictions specialists,
evidence of an acceptable ongoing support system,
employment and legal history (e.g., driving under the
influence convictions(s), etch.), medical history, and any
other evaluations performed.

b. If the current clinical evaluation including psychiatric and
psychological evaluations as indicated is favorable, the
applicant may be issued a medical certificate. A certificate
should be issued only under the provisions of 67.401 of the
CFR.

c. A monitoring system that includes periodic status reports by a physician competent in substance abuse or a substance abuse professional must be established for at least 2 years.

Transient Loss of Control of Nervous System

Submit all pertinent medical records, current neurologic report, to include name and dosage of medication(s) and side effects

Requires FAA Decision