FAA Special Issuance Medical Certificate: How It Works

Most pilots pass their FAA medical exam and walk out with a certificate the same day. Some do not. If you have a condition that does not meet the FAA medical standards, the FAA can still certify you through a process called Special Issuance. This post explains how Special Issuance works, what the AME Assisted Special Issuance (AASI) and Conditions AMEs Can Issue (CACI) programs change, and what you can do now if you are facing a deferral.

What Special Issuance Means

A Special Issuance is a medical certificate the FAA grants to a pilot who does not meet the standard medical requirements. The authority comes from 14 CFR 67.401. The FAA issues the certificate with conditions attached. Those conditions usually include a time limit and a set of follow-up items, such as doctor visits, tests, or reports.

The FAA sends an Authorization for Special Issuance, often called an SI letter. The letter lists what you must do to keep the certificate valid. It may say things like "submit a status report from your treating physician every year" or "submit a current ECG." Read the letter carefully. The dates and documents in it are not suggestions.

A Special Issuance is not permanent. It is time limited. If you miss a required report, the authorization can end. That means your medical certificate can stop being valid even if you feel fine.

How the Process Starts

The process starts with an exam from an FAA-designated Aviation Medical Examiner (AME). Only an AME can issue an FAA medical certificate. Before the exam, you fill out FAA Form 8500-8 in MedXPress and bring the confirmation number. The MedXPress application stays valid for 60 days. Answer every question honestly. A false answer is a federal offense.

At the exam, the AME reviews your history and your condition. If everything meets the standards, the AME issues your certificate on the spot. If not, the AME has two choices: deny or defer.

A denial means the AME believes you do not qualify.
A deferral sends your file to the FAA Aerospace Medical Certification Division in Oklahoma City or to a Regional Flight Surgeon.

Reviews can take weeks or months. Plan for that timeline if you have a job or a checkride coming up.

AASI: When Your AME Can Reissue

The AME Assisted Special Issuance program, or AASI, lets an AME reissue your Special Issuance without sending your file back to the FAA. This only works if you already hold a Special Issuance and you meet the rules in your SI letter.

Under AASI, the AME reviews the same items the FAA would review. If your paperwork is complete and your condition is stable, the AME can issue your new certificate at the visit. This saves weeks or months of waiting.

AASI is not automatic. The AME must follow the FAA's rules for your specific condition. If something in your file is missing or has changed, the AME may still need to defer. Ask your AME before the visit whether your case qualifies for AASI. Bring every document your SI letter asks for.

CACI: Conditions AMEs Can Issue

The Conditions AMEs Can Issue program, or CACI, covers a list of specific conditions. For these conditions, the AME can issue your certificate on the spot using an FAA worksheet. No Special Issuance letter is needed if you meet the worksheet requirements.

CACI does not mean the condition is ignored. It means the AME has a clear checklist to follow. If you meet the checklist, you leave with a certificate. If you do not, the AME may defer.

The CACI list and the worksheets can change. Check the FAA Guide for Aviation Medical Examiners or ask your AME about the current list before you schedule.

Conditions That Often Need Special Issuance

Some conditions commonly lead to a deferral or a Special Issuance. The FAA may still certify you, but usually with extra steps.

Heart conditions. Many first-class exams for pilots age 35 and over need an ECG at age 35 and then each year after age 40. A history of heart disease often needs more testing and a Special Issuance.
Diabetes. Certification depends on the type and how it is treated. Expect the FAA to ask for reports from your treating physician.
Obstructive sleep apnea. The FAA can certify sleep apnea when it is treated, for example with CPAP and compliance reports.
ADHD. A history of ADHD or ADHD medicine often needs extra review, sometimes with neuropsychological testing. Stimulant medicines are not allowed while flying.
Antidepressants. The FAA allows some antidepressants with a Special Issuance after a stable period, including fluoxetine, sertraline, citalopram, and escitalopram. HIMS AMEs handle many of these cases.

This is not a complete list. If your condition is not here, ask your AME how the FAA treats it.

What the FAA Looks For

The FAA wants to see that your condition is stable and that you can fly safely. In most cases, the file needs:

A current status report from your treating physician.
Test results or reports named in the FAA's request.
Proof that you are following your treatment plan.
A clear statement that your condition does not impair your ability to fly.

The exact items depend on your condition. The FAA Guide for Aviation Medical Examiners lists the requirements for many conditions. Your AME can also tell you what the FAA usually asks for.

Do not send records the FAA did not ask for. Extra paperwork can slow the review. Send what the letter requests, on time, and keep a copy.

What Happens If You Are Deferred

A deferral is not a denial. It means the FAA will make the decision. The FAA reviews your file and may ask for more information. During a typical year the FAA processes a large number of records and considers many Special Issuance requests, so the queue can be long.

While you wait, do not fly if your certificate has expired or if you do not meet the conditions of your last certificate. If you are unsure about your status, call the FAA or your AME before you fly.

If the FAA grants a Special Issuance, read the letter the day it arrives. Put the due dates on your calendar. Set reminders 60 days before each deadline. Most problems with Special Issuances come from missed reports, not from the condition itself.

BasicMed Is a Different Path

BasicMed lets some private pilots fly without a current medical certificate. You must have held a valid FAA medical certificate at some point after July 14, 2006, take an approved online medical course every 24 months, and get an exam from any state-licensed physician every 48 months using the FAA Comprehensive Medical Examination Checklist.

Flights must be below 18,000 feet MSL, at 250 knots or less, and not for compensation or hire. The FAA Reauthorization Act of 2024 raised the aircraft and passenger limits, so check the current FAA BasicMed page before you rely on it. BasicMed is not a fix for every case. It does not apply to commercial flying, and some pilots with serious conditions still need to work through the FAA.

Steps You Can Take Today

Gather your records. Get the latest reports from your treating physician.
Check your SI letter or your last certificate for due dates.
Find an AME who handles your condition. You can find an AME near you or browse by state, such as Aviation Medical Examiners in Texas or Aviation Medical Examiners in Florida.
Call the office before you book. Ask whether they handle AASI or CACI cases for your condition and what the visit costs. AMEs set their own fees, so prices vary by city and class.
Fill out MedXPress before the visit and bring the confirmation number.

If you are new to the medical process, start with FAA medical classes explained and what to expect at your exam. For a deeper walkthrough of the Special Issuance process, see our Special Issuance guide. Rules can change, so confirm the details with the FAA Guide for Aviation Medical Examiners or your AME.

Key takeaways

A Special Issuance is a time-limited certificate the FAA grants when you do not meet the standard medical requirements. It comes with conditions you must follow.
AASI lets your AME reissue a Special Issuance at the visit if you meet the rules in your SI letter. CACI lets the AME issue for certain conditions using an FAA worksheet.
A deferral sends your file to the FAA in Oklahoma City or a Regional Flight Surgeon. Reviews can take weeks or months, so plan ahead.
Missed reports are the most common reason a Special Issuance ends. Put the due dates on your calendar and send documents on time.
AMEs set their own fees. Call the office to confirm the price and whether they handle your condition before you book.

Common questions

Does a special issuance medical expire?

Yes, a special issuance often has an expiration date. The FAA may set a shorter validity period than a standard certificate. You may need to send follow-up reports or get re-examined before it expires. Always check the date on your certificate and confirm renewal requirements with your AME or the FAA.

Can I be a CFI with a BasicMed certification?

BasicMed lets some private pilots fly without a current medical certificate, but it has limits. Flights must be below 18,000 feet MSL, at 250 knots or less, and not for compensation or hire. Being a CFI usually involves compensation, so BasicMed may not apply. Check the current FAA BasicMed page or ask the FAA.

How do I check my FAA medical?

You can check your FAA medical certificate status by contacting the FAA Aerospace Medical Certification Division or using the FAA MedXPress system. Your AME may also help. For official confirmation, always refer to the FAA. Do not rely on third-party sources for your official medical status.

What is a medical certificate for a pilot?

A pilot medical certificate is a document issued by an FAA-designated Aviation Medical Examiner (AME) that shows you meet the health standards to fly. There are three classes: first, second, and third. Each class has different requirements and validity periods. You must have the right class for your flying privileges.

This guide is general information, not medical or legal advice. FAA rules change. Check the FAA Guide for Aviation Medical Examiners or ask your AME about your own case. Read our editorial policy.