FAA Special Issuance Medical Certificates, Explained
A medical condition that does not meet the unrestricted standards in 14 CFR part 67 does not automatically end the possibility of certification. The Federal Air Surgeon may grant an Authorization for Special Issuance when the applicant demonstrates that the authorized duties can be performed without endangering public safety during the authorization period.
Reviewed against FAA guidance: July 9, 2026
What a special issuance is
A special issuance is a time-limited FAA authorization under 14 CFR 67.401. The authorization may require periodic treating-provider reports, testing, monitoring, or follow-up evaluations. An FAA physician makes the initial special-issuance decision; an AME may later reissue under an AME Assisted Special Issuance when the authorization permits it and the required information is complete.
Not every medical-history item requires special issuance. Under CACI (Conditions AMEs Can Issue) protocols, an AME may issue for specified conditions when the applicant meets every criterion in the current FAA worksheet and is otherwise qualified. Cases outside those criteria follow the disposition specified by the FAA guide.
Conditions that commonly require special issuance
- Certain cardiovascular conditions or procedures, depending on the specific FAA protocol
- Diabetes treated with insulin and other cases identified by FAA disposition guidance
- Certain psychiatric diagnoses or treatment under the FAA Antidepressant Protocol
- Substance abuse or dependence requiring FAA evaluation or monitoring
- Seizure history and specified neurological conditions
- Cancer history, depending on diagnosis, treatment, and current status
- Obstructive sleep apnea cases that require an initial FAA decision or continued AASI documentation
How the process works
When a known condition may require FAA review, consult an experienced AME before the examination and collect the current records identified by the applicable FAA protocol. After the examination, the AME may issue if authorized by the guidance, defer the application, or deny it when the applicant is clearly ineligible.
For a deferred case, the FAA reviews the application and supporting evidence and may request additional information. Processing time varies with the condition, case complexity, workload, and completeness of the submission; no specific completion timeline should be assumed.
Preparation can reduce avoidable follow-up. Submit the records the current FAA protocol actually requests, including detailed clinical progress notes when required, rather than relying on a general physician letter or patient-portal summary.
Where HIMS AMEs fit in
The FAA may require a HIMS AME for drug or alcohol monitoring and for certain cases under its mental-health or Antidepressant Protocol guidance. The need for HIMS is case-specific; a DUI history, BAC result, diagnosis, or medication name should not be treated as a standalone determination. Confirm the applicable path with the FAA guidance and an appropriately qualified AME.
Official sources
Find a HIMS AME near you
Filter the AME directory to examiners with the HIMS designation and read pilot reviews.
This guide provides general educational information, not medical or legal advice. FAA requirements and medical-certification guidance can change. Confirm the current requirements for your circumstances with the FAA and an appropriately qualified AME.