FAA Special Issuance Medical Certificates, Explained
A medical condition on your application does not automatically end your flying. The FAA issues thousands of special issuance medical certificates every year to pilots with conditions that would otherwise be disqualifying. Understanding the process — and starting it the right way — makes the difference between a manageable paperwork exercise and months of avoidable delay.
What a special issuance is
A special issuance (often shortened to “SI”) is a time-limited authorization, granted under 14 CFR 67.401, that lets the FAA issue a medical certificate to a pilot who does not meet the standard medical criteria. It typically comes with conditions: periodic status reports from your treating physician, specific testing, or follow-up evaluations.
Not every condition needs one. The FAA also maintains CACI (Conditions AMEs Can Issue) protocols covering dozens of common, well-controlled conditions — such as well-managed asthma, hypertension, or hypothyroidism — where the AME can issue your certificate at the exam if your documentation meets the worksheet criteria. Your AME determines whether your condition fits CACI or requires a special issuance.
Conditions that commonly require special issuance
- Coronary artery disease, heart attack, stents, or bypass surgery
- Diabetes treated with insulin or certain other medications
- Depression, anxiety, and other mental health conditions (including certain antidepressant use)
- Substance abuse or dependence history
- Seizure history and certain neurological conditions
- Cancer history, depending on type and treatment
- Sleep apnea, once diagnosed, requires documented effective treatment
How the process works
The path usually starts at a routine exam: the AME identifies a condition that cannot be issued under standard criteria or CACI and defers the application. The FAA then sends a letter listing exactly what it needs — records, test results, current status reports. You gather and submit; the FAA reviews and, when satisfied, grants the authorization. Your AME (or the FAA) then issues the certificate.
Timelines run from a few weeks to several months depending on the condition and how complete your submission is. The single biggest accelerator is sending everything the FAA asked for, in one complete package, the first time.
A practical tip: don’t walk into an exam with an undisclosed complex condition. Talk to an experienced AME first — many will do a consultation before you ever submit MedXPress, so the application goes in with the supporting evidence already assembled.
Where HIMS AMEs fit in
For substance-related and certain mental health cases, the FAA uses the HIMS program (Human Intervention Motivation Study) — a structured monitoring pathway built around specially trained HIMS AMEs. If your history involves alcohol or drug treatment, certain DUI circumstances, or SSRI use under the FAA’s protocols, you may need a HIMS AME to sponsor and monitor your case (a single low-BAC DUI with no dependence finding often does not require HIMS). They are a minority of all AMEs, so finding one near you is often the first step.
Find a HIMS AME near you
Filter the AME directory to examiners with the HIMS designation and read pilot reviews.
This guide is general information for pilots, not medical or legal advice. Requirements change — always confirm current FAA standards with your AME, your instructor, or the FAA directly.