FAA Medical | Special Issuance

Pilots with disqualifying medical conditions are often eligible for FAA medical certification waivers through Special Issuance medical certification. The medical certificate typically provides the same authorization but can carry certain limitations such as the date of expiration. Typically this requires extensive documentation and decisions are made on a case by case basis.

The FAA also requires Special Issuance for many medical conditions not specifically listed as disqualifying in the FAR’s.  Some conditions require immediate grounding while others do not.

The conditions listed below are specifically listed in the FAR’s as disqualifying, yet most of these conditions still permit Special Issuance medical certification.  Contact us to determine eligibility.

  • Coronary heart disease
  • Angina
  • Myocardial infarction
  • Heart replacement
  • Cardiac valve replacement
  • Permanent cardiac pacemakers
  • Diabetes
  • Psychosis
  • Bipolar disorder
  • Severe personality disorder
  • Substance dependence or abuse
  • Epilepsy
  • Disturbance of consciousness
  • Transient loss of nervous system function

Aviation Medical Examiners (AME’s) generally are NOT authorized to grant the initial authorization for Special Issuance certification.  Some pilot membership groups have issued statements which many airmen have interpreted incorrectly.  Many pilots only hear or see the statement AME’s authorized…..special issuance medicals” and don’t notice that it is only for certain types of special issuance waiver renewals which have been previously approved by the actual FAA vs. a private physician who is designated to perform FAA medical examinations.  Special Issuance waivers typically must be issued by an FAA government employee versus an AME who is designated by the FAA to perform flight physicals or FAA medical examinations. 

Some consider it logical to have an AME coordinate the Special Issuance process.  While one-stop-shopping may be an attractive option, this arrangement may forfeits confidentiality and can put the pilot in a defensive posture.  Many find themselves frustrated when their AME ends up deferring the case to the Aeromedical Branch in Oklahoma.  This means the pilot does not walk out of the AME’s office with a medical in-hand and in many of these cases, the pilot waits several months only to receive a letter from the FAA asking the pilot for more records or information.

While Aviation Medical Examiners are permitted to renew certain Special Issuance waivers, in most cases the initial waiver authorization must be granted from the Federal Air Surgeon first.  This is typically authorized by a letter to the pilot from the Aeromedical Certification Branch of the FAA in Oklahoma City.

Those who are authorized must have that letter permitting them to see their AME for Special Issuance renewal. Interestingly many AME’s will still defer these cases due to the complexity of the issue, their lack of comfort or familiarity with the condition or certification criteria.

AGAIN, the AME assisted program was not designed for first-time Special Issuance applicants.

In most cases the FAA must grant the initial medical certification Special Issuance waiver.  The airman must have a letter from the FAA which authorizes AME Special Issuance renewal.

Currently, Special Issuance may be renewed by AME’s (when authorized by the aforementioned FAA letter) for the following medical conditions:

  • Asthma
  • Arthritis
  • Brachytherapy
  • Cancer: Breast, Bladder, Colon, Hodgkin’s Lymphoma, Lymphoma, Melanoma, Prostate, Renal
  • Chronic Lymphocytic Leukemia
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Crohn’s Disease
  • Diabetes Type II (Diet controlled or Oral Medication Only)
  • Glaucoma or Ocular Hypertension
  • Hepatitis C
  • Hyperthyroidism
  • Hypothyroidism
  • Kidney Stones ( Urolithiasis)
  • Migraine Syndrome
  • Sleep Apnea
  • Ulcerative Colitis
  • Cardiovascular / Heart: Angina Pectoris (chest pain), Atherectomy, Atrial Fibrillation, Coronary Artery Disease, Coronary Bypass Grafting (CABG), Mitral & Aortic Insufficiency, Murmur, Myocardial Infarction, Paroxysmal Atrial Tachycardia, Percutaneous Transluminal Coronary Angioplasty (PTCA), Stent Implantation, Valve Replacement Valvuloplasty,

Pilot Medical Solutions provides confidential collaboration with your private physician to assure all records and documentation phraseology meets the FAA’s requirements.  Pilot Medical Solutions has helped thousands of pilots with FAA Special Issuance medical certification.

We work directly with your physicians and the FAA to resolve complex aeromedical certification issues quickly.

Contact us at 800-699-4457 or via E-Mail to confidentially discuss the details of your case and to establish your eligibility for FAA medical certification.

There is no charge for an initial consultation.

MEDICAL FAR’s (Part 67)   |  Special Issuance Stats   |   FAA Protocols  |  Checklist

54 replies
  1. Thomas J Bonnes
    Thomas J Bonnes says:

    Anyone hear off waivers being made in the case of epilepsy in teen years? I am 37 now and take medication for epilepsy but I have not had a seizure since my late teens. My neurologist started they wouldn’t be opposed to me getting a PPL (not an FAA doctor). I don’t want to apply if I’ll get turned down.

    • admin
      admin says:


      Unfortunately the FAA will not approve anyone on antiseizure medications. The first step towards the possibility of FAA medical certification would be if your doctor finds that you no longer need the medication.

  2. Andy A
    Andy A says:

    I am on a special issuance for a myocardial infarction and stent placement. Last year was the initial application for the special issuance and this year I had my first renewal. I was under the impression that the AME could issue the medical this time around. He deferred the application/renewal to the FAA. I have not had any symptoms or setbacks since this initial occurance so I am not sure why he defferred to the FAA. He also charged a fee to mail the paperwork for me. I was told I could expect my certificate to come from the FAA at some point. I am an airline pilot and my medical expires in a couple weeks. It looks like next months schedule is shot and possibly more waiting on the FAA. I’ve learned that the special issuance renewal is really no different than the intial and could take months. I guess my question is can I submit paperwork to the FAA myself 2 or 3 months ahead of seeing the AME?

    • admin
      admin says:

      Without reviewing your records it’s not possible to provide a thorough reply but there are a few general things we can tell you.
      (1) Renewing Special Issuance should be a much shorter process and generally the AME is authorized to renew the certificate unless there are new conditions or changes in your treatment.
      (2) It is possible to submit your paperwork directly to the FAA 2 or 3 months prior to your renewal date.
      (3) It is ALWAYS best to have someone who is familiar with FAA requirements to review your case prior to renewal because even the slightest change in your medical history can derail an otherwise fit application. You can call the medical hot-line at 888-LEFTSEAT to discuss the details of this situation, even now.

  3. Alejandro
    Alejandro says:

    Today I went to my first medical exam, class three and they denied mucho exam saying that my migraines were disquialifying the doctor charged me an extra fee for the extra paperwork my problem here is that I am a foreigner with a m1 visa and I need to start studying aviation in my school as soon as possible, how long will it take for the procedure to arrive? Also my doctor did not explain me well how the procedure would be, I send my diagnosis to his mail and then a letter from the FAA will arrive at my address? After the letter arrives what should O do?

    • admin
      admin says:


      The FAA will send you a letter in one or two months asking for additional information.
      You don’t have to wait. You can contact our office today to discuss the details of your case and what they will be requesting. Call 888-LEFTSEAT (405-787-0303).

  4. Johnny Marquez
    Johnny Marquez says:

    My son, 17, wants to become a pilot and is looking to go to college and study aviation. He has Hemophilia and ADD. Due to these conditions he was denied his medical. Is there anything that can be done?
    He went on his own without consultation and summited a reconsideration a that came back denied as well.
    I was reading about the option of having him undergo a Pycological re’evaluation of his condition after more that 90 days of bing off his ADD meds. Any thought on that?
    How about his hemophilia, we know of other hemophilia which that are pilots. Is there anything in particular that can be done regarding this condition

    • admin
      admin says:

      Mr. Marquez,

      These conditions (ADD and hemophilia) are conditions which can be approved by the FAA on a case by case basis. This cannot be approved by a designated Aviation Medical Examiner (AME) and requires approval by the FAA itself.

      If medications are required to treat the ADD/ADHD this is one thing which will prevent approval. Having favorable neuropsychological testing is essential to FAA acceptance of ADD/ADHD. For many people, testing result will indicate one or more areas of weaknesses. Areas of weakness may be shored-up with cognitive fitness programming.

      On the hemophilia, the frequency which infusions are required is generally a key element.
      A complete history and current status narrative will be required.
      The FAA will require all pertinent medical reports and lab work. This includes but is not limited to frequency, severity and location of bleeding sites.

      Pilot Medical Solutions has successfully assisted several pilots with this process for 24 years.
      Contact us at 800-699-4457 (405-787-0303) to confidentially discuss your case.

  5. Roberto A.
    Roberto A. says:

    Good afternoon, today I recived my special issuance medical certificate and it was approved, my problem is that if I need a 1st class certificate will I need to do all the paperwork I did for my 3rd class but asking for a 1st class certificate, and will I need to wait another 2-3 months, or my AME could give me the first class if the FAA authorized me the 3rd class certificate? Great day

    • admin
      admin says:

      Typically if you qualify for a Special Issuance, you can qualify for all classes, provided you take the FAA examination for the desired class. There are several conditions/issues which have differing standards and requirements for each particular FAA medical class. One example is that if your issue is cardiovascular, the FAA will normally require more invasive and more expensive testing for a class 1 or 2 authorization, such as a radionuclide treadmill stress test verses a standard exercise stress test. We can give you more information if you wish to reply here or you can confidentially phone us at 405-787-0303 to discuss your particular case.

  6. Cody
    Cody says:

    I had a complicated migraine with TIA symptoms March 2018 (under specific circumstances as noted in my package sent to the FAA). TIA symptoms freaked the FAA out and they took my medical. Never had this happen before and have not had it happen since (1 year ago). I spent 5 years in the Marines with no problems, so its not like I’m not healthy. Every doctor I’ve spoken to said I am fine and the test results reflect that. How can doctors (ER doctors, neurologists, etc) in Atlanta say I am healthy to fly and doctors working for the FAA say I am not? I get the FAA has a “no-no” list, but they are literally judging the situation off of a piece of paper. When was the last time anyone emailed their doctor asking if their leg was broken and gotten an accurate response?

    This is my senior year of college and now I do not have a career.

    • admin
      admin says:


      If the evidence from your physicians supports a migraine event it is possible to obtain certification soon. If your doctors are calling it a TIA this indicates they don’t fully know what caused it. If they don’t know what caused the event, the FAA’s position is that you are statistically more likely than the general population to have another event. Call Pilot Medical at 405-787-0303 to discuss your options in greater detail.

    • admin
      admin says:


      While the FAA approved a few bipolar cases in the distant past, they are not certifying these cases now. If you believe this diagnosis may be incorrect and that your physician may find that you don’t need medication there is a possibility for FAA acceptance. Contact Pilot Medical at 405-787-0303 to discuss in greater detail.

  7. Debra L Liptrap
    Debra L Liptrap says:

    I am wondering if anyone else thinks this is really strange and or has any insight. Pardon the lengthy note. I had a kidney stone in February of 2018 (my first). The FAA requested that I see a nephrologist and gave a list of required testing. A CT at the time of the stone showed two very small retained stones. All information was submitted to the FAA. In June of 2018 they granted a special issuance saying I need to see the nephrologist in one year and if there was no change, the local AME may grant the medical. I saw my nephrologist and had all the requested testing. He gave me a very positive report to take to the AME. On July 17, I saw the AME and gave him all the records and testing. He gave me the medical for one year as directed in a letter from the FAA. I got a voice mail yesterday at 4:30 pm from the AME saying he had been reviewing my records and probably should not have granted the medical until the issue of the retained stones had been cleared up! This is not a new issue and was included in the information sent to the FAA last year prior to getting the medical. My nephrologist had addressed this in the note that I gave him stating the stones were too small and there was minimal risk of incapacitation. I have a history of unexplained unusual kidney labs but again, the nephrologist evaluated everything and feels I am very healthy and in his professional opinion am safe to fly. I didn’t hear the message until 6pm yesterday so of course could not reach the AME. So now I have to wonder all weekend what the heck is going on for him to call almost a month later with this news!

    • admin
      admin says:

      If the FAA authorized future certification with the provision that your stone status remain the same and nothing had changed, then it’s difficult to see any reason for FAA concern. If, on the other hand, something did change then the AME should have deferred you and you should expect to be asked by the actual FAA in OKC for current favorable information.
      Hope this is not too late. If you need further discussion, please call the medical certification hotline at 888-LEFTSEAT.

  8. Dan
    Dan says:

    Started getting migraines with scintillating scotoma (which is partial visual disturbance). I have a class 1 medical and was doing commercial training but have grounded myself. I know these are migraines because they run in the family, should I talk to the AME first or try to get prophylactic medications from a GP first?

    • admin
      admin says:


      In most cases, the AME will defer this issue. This is especially true if you don’t have favorable documentation.
      There are several elements which are important with migraines. These include but is not limited to:
      (1) How often they occur
      (2) Severity of the headache
      (3) The interval of time between visual disturbances and the headache
      (4) How are they treated

      For a free consult, contact us at 800-699-4457 or 888-LEFTSEAT.
      You can also email info@leftseat.com.

  9. StevAb
    StevAb says:

    The FAA website has no information about the medication which I am taking. Can you tell me if Valtrex (Valacyclovir) is approved?


    • admin
      admin says:

      The FAA does not provide a list of approved drugs. Valtrex (Valacyclovir) has been acceptable to the FAA. Pilot Medical Solutions has the largest list of FAA accepted medications. This list is constantly being updated, and while not an official list, it provides detailed information to help pilots. The list can be found at: https://www.leftseat.com/faa-accepted-medications/. The list of FAA-accepted medications is the most accurate and complete information available to Pilot Medical on the listed date. This “master list” was developed by Pilot Medical Solutions through communication with the FAA over the last 25 years.

  10. Cody
    Cody says:

    I submitted my waiver application for a third class medical certificate last December. (2018) I have yet to receive an answer as of September 2019. The waiver was for an SSRI I take which is on the approved medication list. My HIMS AME submitted my application saying he did not believe I needed the neurocognitive testing. I was examined by a psychiatrist and this report was submitted. My HIMS AME said we should submit without the neurocognitive testing to see if it could get approved. I am very stable and only take the medicine for anxiety. I have been on the same dose for over 6 years. No other health issues whatsoever. Are they not replying because they don’t have enough info? I was told they would send me a letter asking for more info if they needed it. I have called the airmen’s medical number several times. They said my application was sent to the Federal Air Surgeon in Washington. Why haven’t I received an answer yet?

    • admin
      admin says:

      I am sorry to inform you that while your AME is probably correct not to submit neuropsychological testing, the submission which you describe is unlikely to gain FAA acceptance. While the FAA lists several SSRI’s which they approve, in reality they approve very few applications(about 30%). Specifically, “anxiety” treated with an SSRI is even less likely to be approved.
      As for how long it takes, all cases where airmen are taking SSRI’s are forwarded to Washington, DC for consideration by the FAA Chief of Psychiatry. It is not unusual for these cases to take 6 month to a year. You can call our office for a free consultation. We can tell you what to do now and what to expect later.
      Pilot Medical Solutions 800-699-4457.

  11. Andrew
    Andrew says:

    Hello, I am 25 years old and up until 5 years ago I had never had an issue regarding my mental status. However, when I was 19 I made a poor choice and took Alprazolam with a couple of friends. I had an adverse reaction to the Alprazolam and it caused me to have a manic episode. Because of this manic episode I was subsequently diagnosed with Bipolar Disorder. Up until this incident I had not ever had any of the symptoms of Bipolar Disorder and as of now I am currently not prescribed any medications and do not exhibit any symptoms of Bipolar Disorder. I have spent hours searching for a definitive answer as to whether or not I would have a chance of being granted a Medical Certificate and I have found numerous conflicting answers. It seems that one option may be to have my medical record amended to reverse the diagnosis and another would be to apply for third class, get deferred, submit all the medical documents they request and cross my fingers and pray. I am willing to take my time and be patient if attempting the amendment is the best option. But I am simply not sure if I even have a shot. Any advice or suggestions would be greatly appreciated. Thank you in advance for any help.

    • admin
      admin says:


      The diagnosis you cited is of course problematic and, although the FAA used to allow mild cases, a confirmed diagnosis is now permanently disqualifying. That said, if the diagnosis was poorly formed, as your narrative depicts, it is possible to refute this. Part of the challenge will be that Bipolar disorder typically presents oscillatory manifestations which can be difficult to accurately and objectively chart. For favorable consideration, the goal should be to obtain overwhelming empirical evidence that you do not have a Bipolar disorder. Contact Pilot Medical Solutions at 405-787-0303 to discuss your case in detail.

  12. DonS
    DonS says:

    The FAA denied me for heart disease and the use of prozac. My attorney said I should appeal this decision. Then I read about Special Issuance. Are they different or the same thing?

    • admin
      admin says:

      Generally, there are two types of FAA medical appeals. Special Issuance is normally a result of a medical appeal vs a legal one.
      (1) Legal appeals generally are a disagreement of facts. Legal appeals generally are utilized by an airmen when they wish to demonstrate they do not have a particular medical condition despite the FAA’s assertion to the contrary.
      (2) Medical appeals are typically based upon undisputed facts concerning the fitness of the applicant.

      Special Issuance is an authorization which may be granted by the FAA responsive to a medical appeal under FAR 67.401. It provides discretionary approval if the FAA finds that you are safe to exercise your pilot privileges even though you may have a medical issue that in some other airman could jeopardize safety. Special Issuance is often generated by a medical appeal.

  13. Christie Rose
    Christie Rose says:

    Thanks to leftseat I have my Special Issuance. I was also wanting to know if I can fly internationally with this authorization.

    • admin
      admin says:


      While each country can restrict these authorization, in general flying in other countries is authorized for pilots on Special Issuance. There are certain exceptions such as with the condition diabetes. The date of expiration can also be a factor as foreign countries do not want the airman to expire in their country. Contact Pilot Medical at 405-787-0303 to discuss your case in detail.

  14. Bill Prevost
    Bill Prevost says:

    Thanks for sharing your thoughts and guidance. It is clear that your organization has a well honed FAA certification strategy.

    • admin
      admin says:

      The FAA has agreed to extend deadlines and timelines for some FAA medical approval and renewal functions. They have stated they will look away from a violations such as flying on recently expired medical certificates. Leftseat.com has dedicated a page to the Coronavirus (COVID 19) where you can find the DOT/FAA announcement concerning the FAA’s suspension of medical certification enforcement. The page is http://www.leftseat.com/coronavirus-COVID19/.

  15. Ahmed
    Ahmed says:

    i’m wondering if my mild deviated nose septum and varicocele grade 1 are disqualifying for class 1 medical certification thanks

    • admin
      admin says:


      Both conditions should be fairly straightforward FAA approvals, however, depending upon the treatment and severity either could pose obstacles to FAA medical certification. There is a high probability that the Aviation Medical Examiner will defer the case to the actual FAA. It is important that you have all the essential records required for FAA acceptance. Call 405-787-0303 to discuss the details further.


  16. blogman
    blogman says:

    Good info. Lucky me I recently found your site by accident (stumbled upon).
    I need to find a way to extend my Special Issuance. Calling you now.

  17. LesJ
    LesJ says:

    You provide a wealth of information here. It is clear that your organization would be able to guide and assist me with FAA medical certification. Please contact me at the email listed above.
    Les Jones

  18. JHill
    JHill says:

    Really appreciate seeing this blog post. FAA medical certification has given me great stress and frustration but this seems to open a window for me to fly again.
    Thank you

  19. FredC
    FredC says:

    Excellent post. I continually check this blog. Extremely useful information. Many thanks and best of luck.

  20. Kim S
    Kim S says:

    When a “special issuance” is given, does this mean when I get my medical certificate from the FAA, that I can go jump in my plane and go fly? (if everything is legal, of course) Or does this grant me the 6 months to get with an FAA examiner, do the SODA, he signs off, sends paperwork to the FAA, and then send in any other paperwork requested during that time? I am very skeptical at this time as I have been on hold for two years on getting my renewal from the FAA. I am thinking I still have to get with an FAA examiner and submit more paperwork. I have ocular hypertension that is control with eye drops. Thanks for the input. Just discouraged.

  21. FannieK
    FannieK says:

    Pilot Medical,

    Fantastic website love being part of community where I can get feedback from experienced experts. Do you have any recommendations on how to avoid being denied for my next FAA medical exam?
    I have CAD and don’t want to risk losing the Sport Pilot or Basic Med option. Many thanks!

  22. Jim Hersh
    Jim Hersh says:

    I am pleased to read this page which indicates I am fit to fly under Basic Medical rules or FAA medical certification…tons of useful information, thanks!


  23. Zach D
    Zach D says:

    looking for help, in Oct 2015 I had a mild concussion or TBI due to a head injury. 2 months after the injury I completed a neuro-pysch eval/consultation negative findings and recommended flight status. A year later I completed another neuro/psych eval/consultation negative findings no symptoms, recommendation. With this information and knowledge would an AME be able to clear me without a special issuance for a Class 2 physical?

  24. Zach D
    Zach D says:

    Is a special issuance needed for a mild tbi because of a head injury with neuro/psych evals/consultations with negative findings recommending flight status? I see it says without a medical explanation of cause but I do have one.

  25. Evan
    Evan says:

    I was diagnosed with Bipolar Disorder at the age of 11 after being placed in a behavioral facility. I am now 30 and have not been on any medication for it since 2009. Interestingly enough I saw one psychiatrist after the diagnosis who did not agree with it, but my Mother called him a “quack” and we never saw him again. I am in therapy because I was in a fatal plane accident in 2012 and she disagrees with the diagnosis. I see a psychiatrist for OCD (I am not on medication for it) and he also does not see a reason to treat me for Bipolar Disorder. Any shot of a special issuance or a SODA? I don’t even think I really have it to begin with and I don’t know how to reverse the diagnosis. I’m not even sure anything was done based on what I would say to the doctor but more what my mother told them.

  26. Mike
    Mike says:

    10 years ago when i was 18 a messed up incident occurred. A family member got drunk violently assaulted me and i called the police. Instead of pressing charges against who assaulted me, police involuntarily took me to a psychiatric hospital (5150) to be evaluated on the basis of a sarcastic comment i said “you make me want to kill myself”. I was not hospitalized or diagnosed with any condition. I was promptly released. The military rejected me because of this incident. Is unrestricted certification possible if I didn’t attempt suicide and only said something stupid 10 years ago?

  27. Jack R
    Jack R says:

    HI – I had a denied medial in 2016 for being on adderal. I went off the drug and then went through years of fighting the FAA for a special issuance. Finally did all the required cog tests and was issued a 3rd class medial special issuance. According to the letter, I need to resubmit annually. Do these tests again, etc. I am getting mixed answers on whether or not I can go on basic med now that I have the 3rd class SI. The letter from the FAA says nothing about me being allowed to go on basic med, but my HIMS and the neuro doc that gave me the tests, said that I need to do the SI again. AOPA says I do NOT and I can go on basic med and never deal with the FAA again. I am confused. Any info greatly appreciated.

  28. Joe Pilot
    Joe Pilot says:

    4 years ago I experienced DVT in the leg. My FAA Medical since then has been issued under a Special Issuance due to the fact that I have Factor 5 Leiden. I just experienced another episode of DVT. Since I have experienced a recurrence I am required to notify the FAA and cannot operate an aircraft under the terms of the Special Issuance. After I notify the FAA will I lose my Special Issuance and have to apply for another one? Does the FAA look unkindly on repeat episodes of DVT?

    • admin
      admin says:

      The FAA is interested in any DVT episode and especially when one has had a change in their condition under the terms of their Special Issuance. That said, it is possible that FAA medical approval can be obtained provided there is correction of the offending cause. Contact leftseat to discuss the case in detail.


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