Aortic insufficiency
What the FAA's documents say about aortic insufficiency, in plain words, with the FAA's own words one press away.
Short version
The FAA's table sorts it into two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| InitialAn initial Special Issuance | Defers to the FAA | Special Issuance |
| Follow-upA follow-up Special Issuance | Examiner issues | AASI |
Show the FAA's words: the FAA's table for Aortic insufficiency
- Initial · Special Issuance
An initial Special Issuance for aortic insufficiency. The Valvular Disease page lists the CVE Protocol with ECHO and says an initial Special Issuance requires an FAA decision. The AASI says that for a first-time application the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Aortic Insufficiency * … CVE Protocol ( PDF ) with ECHO … Initial Special Issuance – Requires FAA Decision
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
- Follow-up · AASI
A follow-up Special Issuance, where the pilot holds an Authorization. The Valvular Disease page says to see the AASI Protocol. The AASI says examiners may reissue under an Authorization if the pilot provides what it lists.
Aortic Insufficiency * … Followup Special Issuance's – See AASI Protocol
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
- A note on the table, 1
A footnote under the Valvular Disease page's table says that for mitral valve disease (mitral regurgitation, mitral insufficiency, mitral valve prolapse (MVP)), see the disposition table.
* For Mitral Valve Disease [Mitral Regurgitation, Mitral Insufficiency, Mitral Valve Prolapse (MVP)] see disposition table .
The FAA pathways for aortic insufficiency
Which exam
Your plan
Step 1: An initial Special Issuance
The evaluation the Valvular Disease page lists, for the FAA's decision.Cardiology evaluation
The CVE's cardiology evaluation: a current, detailed progress note.
It includes
- History of any cardiac or co-morbid conditions
- Personal and family history, including premature heart disease
- Current medications, dosage and any side effects
- Cardiac and general physical exam findings
- Results of any testing
- Diagnosis
- Assessment and plan (prognosis)
- Follow-up
And specifically
- If there was a hospital stay or procedure, the events that led to the cardiac intervention or treatment
- Your functional capacity, and whether you have been cleared to return to regular activity
- Attempts to meet the guidelines for modifiable risk factors, such as lipid levels, aspirin, beta-blockers and stopping smoking
- The prognosis for incapacitation
CVE labs
Within 90 days before the examLabs performed no more than 90 days before the exam.
The labs
- Hemoglobin A1c
- Blood lipid profile: total cholesterol, HDL, LDL and triglycerides
- Monthly INR readings, if you are on warfarin (Jantoven)
Echocardiogram (ECHO)
An ECHO, which the Valvular Disease page lists with the CVE Protocol for aortic insufficiency.
Your medical information on this condition
All the medical information needed for a determination. Your AME defers and submits all of it to the AMCD or RFS.
Show the FAA's words: An initial Special Issuance
An FAA CVE is comprised of Cardiology Evaluation + Lab Testing
Cardiology Evaluation should be submitted in the form of a current, detailed Clinical Progress Note and include: • A detailed summary of the history of any cardiac or co-morbid condition(s); • Personal and family medical history including premature heart disease; • Current medications, dosage, and side effects (if any); • Clinical cardiac and general physical exam findings; • Results of any testing performed; • Diagnosis; • Assessment and plan (prognosis); and • Follow-up. It must specifically include: • If hospitalization or procedure, include a summary of events that led to the cardiac intervention(s) or treatment; • A statement regarding the individual’s functional capacity and if they have been cleared to return to regular activity; • Attempts to meet the guidelines for modifiable risk factors (such as lipid levels, aspirin use, beta-blocker use, and smoking cessation per the American College of Cardiology and American Heart Association); and • Prognosis for incapacitation.
FAA source: Cardiovascular Evaluation (CVE) Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Labs must be current (performed no more than 90 days before the AME exam) and include: • Hemoglobin A1c; • Blood lipid profile with total cholesterol, HDL, LDL, and triglycerides; and • INR monthly readings if on warfarin (Jantoven)
FAA source: Cardiovascular Evaluation (CVE) Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Aortic Insufficiency *
CVE Protocol ( PDF ) with ECHO
FAA source: Item 36 – Valvular Disease. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
FAA source: AASI – Aortic Insufficiency. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Note: CVE does not include stress testing. See the corresponding disposition table or FAA letter to identity which type of stress test (if any) is required.
FAA source: Cardiovascular Evaluation (CVE) Protocol. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
InitialDefers to the FAASpecial Issuance
The Valvular Disease page lists the CVE Protocol with ECHO and says an initial Special Issuance requires an FAA decision. The AASI says that for a first-time application the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
If the examiner defersFollow-upExaminer issuesAASI
The Valvular Disease page says to see the AASI Protocol. The AASI says examiners may reissue under an Authorization if the pilot provides what it lists.
Show the FAA's words: what the examiner does on each row
- Initial · Special Issuance
An initial Special Issuance for aortic insufficiency. The Valvular Disease page lists the CVE Protocol with ECHO and says an initial Special Issuance requires an FAA decision. The AASI says that for a first-time application the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Aortic Insufficiency * … CVE Protocol ( PDF ) with ECHO … Initial Special Issuance – Requires FAA Decision
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
- Follow-up · AASI
A follow-up Special Issuance, where the pilot holds an Authorization. The Valvular Disease page says to see the AASI Protocol. The AASI says examiners may reissue under an Authorization if the pilot provides what it lists.
Aortic Insufficiency * … Followup Special Issuance's – See AASI Protocol
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
If the examiner defersSpecial Issuance
An initial Special Issuance requires an FAA decision, and the AASI says that for a first-time application the examiner must defer.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
An initial Special Issuance requires an FAA decision, and the AASI says that for a first-time application the examiner must defer.
Aortic Insufficiency * … Initial Special Issuance – Requires FAA Decision
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
After the FAA decides
AASIThe AASI says an FAA physician provides the initial certification decision and grants the Authorization, and that examiners may then reissue under the Authorization if the pilot provides what it lists. The Valvular Disease page says to see the AASI Protocol for follow-up Special Issuances.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401 . … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
Followup Special Issuance's – See AASI Protocol
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
The Valvular Disease page's row for aortic insufficiency gives the class as All.
Show the FAA's words: how often the FAA asks again
Aortic Insufficiency * … All … CVE Protocol ( PDF ) with ECHO
Under an Authorization, the AASI lists what the pilot provides for the examiner to reissue -- the Authorization granted by the FAA; a summary of the pilot's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation; and a current 2-D echocardiogram with Doppler performed within the last 90 days.
Show the FAA's words: at later exams
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … A summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation; and … A current 2-D echocardiogram with Doppler performed within last 90 days.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI's list for a reissue begins with the Authorization granted by the FAA.
Show the FAA's words: The Authorization granted by the FAA
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
A summary of the condition since the last FAA exam
The AASI asks for a summary of the pilot's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation.
Show the FAA's words: A summary of the condition since the last FAA exam
A summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation; and
A current 2-D echocardiogram with Doppler
The AASI asks for a current 2-D echocardiogram with Doppler performed within the last 90 days.
Show the FAA's words: A current 2-D echocardiogram with Doppler
A current 2-D echocardiogram with Doppler performed within last 90 days.
What the Authorization letter comes with
The AASI says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI says the examiner must defer to the AMCD or Region if the mean gradient across the valve reaches 40 mm Hg, new symptoms occur, an arrhythmia develops, or the treating physician or examiner reports the murmur is now moderate to severe (Grade III or IV).
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … The mean gradient across the valve reaches 40 mm Hg; … New symptoms occur; … An arrhythmia develops; or … The treating physician or Examiner reports the murmur is now moderate to severe (Grade III or IV).
Good to know
Points from the FAA's own documents that are easy to miss.
A mean gradient of 40 mm Hg is deferred
The AASI says the examiner must defer to the AMCD or Region if the mean gradient across the valve reaches 40 mm Hg.
Show the FAA's words: good to know, 1
The Examiner must defer to the AMCD or Region if: … The mean gradient across the valve reaches 40 mm Hg;
A murmur now moderate to severe is deferred
The AASI says the examiner must defer to the AMCD or Region if the treating physician or examiner reports the murmur is now moderate to severe (Grade III or IV).
Show the FAA's words: good to know, 2
The Examiner must defer to the AMCD or Region if: … The treating physician or Examiner reports the murmur is now moderate to severe (Grade III or IV).
The reissue summary asks about atrial fibrillation
The AASI's summary of the condition since the last FAA exam includes a statement regarding any further episodes of atrial fibrillation, in those words. It also has the examiner defer if an arrhythmia develops.
Show the FAA's words: good to know, 3
A summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation; and … The Examiner must defer to the AMCD or Region if: … An arrhythmia develops; or
The reissue echo is from the last 90 days
The AASI asks for a current 2-D echocardiogram with Doppler performed within the last 90 days.
Show the FAA's words: good to know, 4
A current 2-D echocardiogram with Doppler performed within last 90 days.
The first AASI is deferred to the FAA
When this is a first-time application for this AASI and the pilot has all the requisite medical information necessary for a determination, the AASI says the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 5
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Item 36 – Valvular DiseaseOpen to print: Item 36 – Valvular Disease, a page at the FAA, in a new tab
Special Issuance
- AASI – Aortic InsufficiencyOpen to print: AASI – Aortic Insufficiency, a page at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Open at the FAA: Cardiovascular Evaluation (CVE) Protocol, a PDF at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.