FAA Streamlines "Special" Medicals

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The FAA recently expanded its special issuance program for pilots with medical problems; now the program includes First- and Second-Class medical certificates as well as Third-Class medicals. The change promises to streamline the FAA's approval process for pilots who require the higher certificates. Senior FAA Aviation Medical Examiner Brent Blue, M.D., explains all.


After a tremendously successful Aviation Medical Examiner (AME) Assisted Special Issuance (AASI) program for Third-Class medical certificates, the FAA's chief physician, Federal Air Surgeon Jon Jordan, M.D., recently decided to expand the program to include Second- and First-Class medicals. This is great news, both for AMEs who have spent a lot of time with their patients ensuring the correct paperwork gets filed and for the pilots themselves. The expansion to the AASI program became effective September 7, 2004, but its announcement was only in the quarterly Federal Air Surgeon's Medical Bulletin mailed to AMEs at the end of November. The announcement means that approvals for airmen who require the more stringent medical certificates won't be unnecessarily delayed.

What Is A "Special-Issuance" Medical?

The so-called "special issuance medical" certificates are those involving a pilot with a medical problem that disqualifies him or her from receiving a "standard" medical. The specific medical conditions considered under the AASI program are listed below. Note that applicants for a medical certificate whose medical history includes one or more of these conditions are not automatically granted a certificate. Instead, the applicant must meet the specific certification decision-making criteria for the condition or conditions and must be otherwise qualified to receive a medical certificate. The Federal Air Surgeon retains the sole authority to issue a "special issuance" medical as specified in the Federal Aviation Regulations (FARs).

Also, this program does not allow special-issuance medicals to be issued in this streamlined fashion by the AME for first-time applicants. Instead, the AASI program only speeds up renewals for the 19 specific conditions listed below, presuming they are stable.

If this is a first-time issuance for this disease/condition, and the airman has all of the requisite medical information necessary for a determination, AMEs must submit all of the documentation to the Aerospace Medical Certification Division, or contact the regional flight surgeon in your area for the initial determination. Your AME will know how to do all of this.

How The AASI Program Works

The AASI program is a direct result of two developments: better medical monitoring tools available to AMEs and the FAA, plus a real emphasis on customer service by the Civil Aviation Medical Institute's Aerospace Medical Certification division in Oklahoma City. The special issuance program, which was implemented in 2002, is basically designed to reduce the amount of time and effort necessary for all parties to process well known and understood medical problems that fall outside the parameters established in the FARs.

Under the program, the FAA's staff physicians provide the initial certification decision and grant the authorization, via a letter, in accordance with FAR 67.401. The authorization letter is accompanied by attachments specifying the information the treating physician(s) must provide for the FAA to make a determination on re-issuing the medical certificate.

Subsequently, medical certificate renewals are much easier to obtain. Once the airman has an authorization letter from the FAA, the AASI program allows AMEs to renew special issuance medicals on the spot instead of forcing the pilot to wait 10-12 weeks for consideration. However, the authorization letters are generally for six years.

The pilot still has to comply with scheduled testing and monitoring for the medical conditions considered under the AASI. The tests can be presented to the AME and a certificate issued based on the stability of the medical problem or problems. The data is submitted to the FAA but there is no lag time for the issuance of the certificate.

Pilots seeking a Third Class medical do not always need to have an annual AME exam but do have to submit medical information annually. AMEs will issue a certificate for the second year without having to do the standard medical exam but may charge for their time to review and process the material.

AASI-Eligible Conditions

There are 19 conditions that fall under this program. They are:

  • arthritis
  • asthma
  • atrial fibrillation
  • chronic lymphocytic leukemia
  • chronic obstructive pulmonary disease (COPD)
  • colitis (ulcerative or Crohn's)
  • colon cancer
  • diabetes on oral medications
  • glaucoma
  • hepatitis C
  • hyperthyroidism
  • hypothyroidism
  • lymphoma and Hodgkin's disease
  • migraine syndrome
  • mitral and aortic insufficiency
  • paroxysmal atrial tachycardia
  • prostate cancer
  • renal calculi (kidney stones)
  • sleep apnea

Reducing The Backlog

Dr. Warren Silberman, manager of the Aeromedical Certification Division, has led the AASI initiative, one that has been responsible for dramatically reduced the backlog of cases. The recently announced expansion to First- and Second-Class medicals will further reduce the backlog and speed up the time required for special issuances for the non-AASI conditions.

For those who might be wondering why this information has just made it to the AMEs since it became effective in early September, the answer is fairly governmental. The best way to disseminate information to the AME community is electronically, especially since all AMEs have to submit the information required by the FAA for medical certificates via the Internet. However, the FAA's privacy concerns preclude broadcast e-mails to the AME community.

What Should You Do?

If you have been diagnosed with one or more of the listed conditions and your flying requires a Second- or First-Class medical certificate, you should consult with your AME about whether you can benefit from the AASI program. Have that consultation well before your medical certificate comes up for renewal. You'll need to assemble the medical records and data necessary for your AME to submit to the FAA doing so may require some extra time and effort from both your AME and the physician treating you for the condition.

Once the materials your AME needs are assembled, they get transmitted to Oklahoma City for review. Presuming your condition meets the requirements for the AASI program, your AME will soon receive an authorization letter specifying the information the FAA will require to be submitted along with the renewal application. Your AME can then issue your renewed certificate at the same time the application and the additional information is sent to Oklahoma City.

Expanding the AASI program to encompass Second- and First-Class medical certificates is one of the best things that could happen in the FAA's Aeromedical branch. Hats off to all who worked together to make it happen.

More about aviation medicine is available in AVweb's Aeromedical section.