Chronic lymphocytic leukemia (CLL/SLL)
What the FAA's documents say about chronic lymphocytic leukemia (CLL/SLL), in plain words, with the FAA's own words one press away.
FAA term: Chronic Lymphocytic Leukemia (CLL)/ Small Lymphocytic Lymphoma (SLL)
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ARai stage 0 – 1 and/or Binet stage A, followed by oncology for 5 or more years, and asymptomatic with no evidence of active disease, treated with observation only, and age 40 or older at the time of diagnosis. | Worksheet | CACI |
| Row BRai stage 0 – 2 and/or Binet stage A or B, and followed by oncology for less than 5 years, and asymptomatic with no evidence of active disease and treated with observation only. | Defers to the FAA | Special Issuance |
| Row CAll others. The row lists Rai stage 3 or 4 and/or Binet stage C, or followed by oncology for less than 5 years, or active disease or symptomatic, relapsed disease, or treated with targeted therapy and/or chemotherapy. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Chronic lymphocytic leukemia (CLL/SLL)
- Row A · CACI
Rai stage 0 – 1 and/or Binet stage A, followed by oncology for 5 or more years, and asymptomatic with no evidence of active disease, treated with observation only, and age 40 or older at the time of diagnosis. The table sends the examiner to the CACI worksheet for CLL/SLL, and says this requires a current, detailed clinical progress note from the treating oncologist and lab. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE, and has the examiner annotate the elements or findings in Item 60, annotate the correct CACI statement in Block 60, and keep the required supporting information on file.
Rai stage 0 – 1 AND/OR Binet stage A Followed by oncology for 5 or more years AND … Asymptomatic with no evidence of active disease; … Treated with observation only … Age 40 or older at time of diagnosis … See the CACI - Chronic Lymphocytic Leukemia (CLL)/ Small Lymphocytic Lymphoma (SLL) Worksheet. … This requires a current, detailed Clinical Progress Note from the treating oncologist and lab. … If the pilot meets all CACI worksheet criteria and is otherwise qualified ISSUE Annotate (elements or findings) in Item 60. Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row B · Special Issuance
Rai stage 0 – 2 and/or Binet stage A or B, and followed by oncology for less than 5 years, and asymptomatic with no evidence of active disease and treated with observation only. The examiner defers, submits the listed information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
Rai stage 0 – 2 AND/OR Binet stage A or B AND Followed by oncology for less than 5 years AND … Asymptomatic with no evidence of active disease; and … Treated with observation only … Submit the following: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- Row C · Special Issuance
All others. The row lists Rai stage 3 or 4 and/or Binet stage C, or followed by oncology for less than 5 years, or active disease or symptomatic, relapsed disease, or treated with targeted therapy and/or chemotherapy. The examiner defers, submits all the information in row B to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
All others Rai stage 3 or 4 AND/OR Binet stage C OR Followed by oncology for less than 5 years OR … Active disease or symptomatic; … Relapsed disease; or … Treated with targeted therapy and/or chemotherapy … Submit the following: 1. ALL information in Row B DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- A note on the table, 1
The table's note says rows B and C require the same initial evaluation data, and that row B may qualify for AASI consideration after follow-up.
Note: Rows B and C require the same initial evaluation data. Row B may qualify for AASI consideration after follow-up.
The FAA pathways for chronic lymphocytic leukemia (CLL/SLL)
Which exam
Your step-by-step plan
Step 1: The progress note from the treating oncologist
The note the examiner reviews, and what the oncologist finds.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
The treating oncologist finds
- The condition stable, and without symptoms
- Observation only recommended
- Monitored for 5 or more years
Show the FAA's words: The progress note from the treating oncologist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – CLL/SLL Worksheet. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
This requires a current, detailed Clinical Progress Note from the treating oncologist and lab.
FAA source: CLL/SLL Disposition Table. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
Treating Oncologist finds the condition stable and
Asymptomatic
Recommends observation only
Monitored for 5 or more years
[ ] Yes
FAA source: CACI – CLL/SLL Worksheet. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
Step 2: Labs
Lab results from the past 90 days, and what they show.Within 90 days before the examLabs within the past 90 days.
They show
- Hemoglobin > = 11 mg/dL
- Platelets > = 100,000/microL
- A total or absolute lymphocyte count doubling time greater than 6 months
Show the FAA's words: Labs
Lab(s) within the past 90 days show:
Hemoglobin > = 11 mg/dL
Platelets > = 100,000/microL
Total or absolute lymphocyte count doubling time is greater than 6 months
[ ] Yes
FAA source: CACI – CLL/SLL Worksheet. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
Step 3: The worksheet's other criteria
Age at diagnosis, stage, and no evidence of active disease.The worksheet's other criteria.
The criteria
- Age at diagnosis 40 or older
- Rai stage 0 - 1 and/or Binet stage A
- No evidence of active disease (the worksheet says to consider iwCLL criteria)
Examples of active disease
- Not: Unintentional weight loss greater than 10 pounds
- Not: New palpable lymph nodes
Show the FAA's words: The worksheet's other criteria
Age at diagnosis [ ] 40 or older
FAA source: CACI – CLL/SLL Worksheet. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
Rai stage 0 - 1 and/or Binet stage A [ ] Yes
FAA source: CACI – CLL/SLL Worksheet. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
Applicant has NO evidence of active disease.* (Consider iwCLL criteria.)
*Examples of active disease include weight loss (unintentional) greater than 10 pounds; new palpable lymph nodes
[ ] Yes
FAA source: CACI – CLL/SLL Worksheet. FAA date 31 May 2023; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AWorksheetCACI
The table sends the examiner to the CACI worksheet for CLL/SLL, and says this requires a current, detailed clinical progress note from the treating oncologist and lab. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE, and has the examiner annotate the elements or findings in Item 60, annotate the correct CACI statement in Block 60, and keep the required supporting information on file.
Row BDefers to the FAASpecial Issuance
The examiner defers, submits the listed information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
If the examiner defersRow CDefers to the FAASpecial Issuance
The examiner defers, submits all the information in row B to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · CACI
Rai stage 0 – 1 and/or Binet stage A, followed by oncology for 5 or more years, and asymptomatic with no evidence of active disease, treated with observation only, and age 40 or older at the time of diagnosis. The table sends the examiner to the CACI worksheet for CLL/SLL, and says this requires a current, detailed clinical progress note from the treating oncologist and lab. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE, and has the examiner annotate the elements or findings in Item 60, annotate the correct CACI statement in Block 60, and keep the required supporting information on file.
Rai stage 0 – 1 AND/OR Binet stage A Followed by oncology for 5 or more years AND … Asymptomatic with no evidence of active disease; … Treated with observation only … Age 40 or older at time of diagnosis … See the CACI - Chronic Lymphocytic Leukemia (CLL)/ Small Lymphocytic Lymphoma (SLL) Worksheet. … This requires a current, detailed Clinical Progress Note from the treating oncologist and lab. … If the pilot meets all CACI worksheet criteria and is otherwise qualified ISSUE Annotate (elements or findings) in Item 60. Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row B · Special Issuance
Rai stage 0 – 2 and/or Binet stage A or B, and followed by oncology for less than 5 years, and asymptomatic with no evidence of active disease and treated with observation only. The examiner defers, submits the listed information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
Rai stage 0 – 2 AND/OR Binet stage A or B AND Followed by oncology for less than 5 years AND … Asymptomatic with no evidence of active disease; and … Treated with observation only … Submit the following: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- Row C · Special Issuance
All others. The row lists Rai stage 3 or 4 and/or Binet stage C, or followed by oncology for less than 5 years, or active disease or symptomatic, relapsed disease, or treated with targeted therapy and/or chemotherapy. The examiner defers, submits all the information in row B to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
All others Rai stage 3 or 4 AND/OR Binet stage C OR Followed by oncology for less than 5 years OR … Active disease or symptomatic; … Relapsed disease; or … Treated with targeted therapy and/or chemotherapy … Submit the following: 1. ALL information in Row B DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
The CACI worksheet's criteria
Progress note
- The condition stable, and without symptoms
- Observation only recommended
- Monitored for 5 or more years
Lab results
- Hemoglobin > = 11 mg/dL
- Platelets > = 100,000/microL
- A total or absolute lymphocyte count doubling time greater than 6 months
The worksheet's other criteria
The criteria
- Age at diagnosis 40 or older
- Rai stage 0 - 1 and/or Binet stage A
- No evidence of active disease (the worksheet says to consider iwCLL criteria)
Examples of active disease
- Not: Unintentional weight loss greater than 10 pounds
- Not: New palpable lymph nodes
Show the FAA's words: the CACI worksheet's criteria for Chronic lymphocytic leukemia (CLL/SLL)
- Stable, with no symptoms, observation only, and monitored for 5 or more years
FAA criterion: the treating oncologist finds the condition stable, and asymptomatic, recommends observation only, and the condition has been monitored for 5 or more years.
Treating Oncologist finds the condition stable and … Asymptomatic … Recommends observation only … Monitored for 5 or more years … [ ] Yes
- Age at diagnosis 40 or older
FAA criterion: age at diagnosis 40 or older.
Age at diagnosis [ ] 40 or older
- Rai stage 0 - 1 and/or Binet stage A
FAA criterion: Rai stage 0 - 1 and/or Binet stage A.
Rai stage 0 - 1 and/or Binet stage A [ ] Yes
- No evidence of active disease
FAA criterion: the pilot has no evidence of active disease, and the worksheet says to consider iwCLL criteria. Its examples of active disease include unintentional weight loss greater than 10 pounds, and new palpable lymph nodes.
Applicant has NO evidence of active disease.* (Consider iwCLL criteria.) … *Examples of active disease include weight loss (unintentional) greater than 10 pounds; new palpable lymph nodes … [ ] Yes
- Labs within the past 90 days
FAA criterion: labs within the past 90 days show hemoglobin > = 11 mg/dL, platelets > = 100,000/microL, and a total or absolute lymphocyte count doubling time greater than 6 months.
Lab(s) within the past 90 days show: … Hemoglobin > = 11 mg/dL … Platelets > = 100,000/microL … Total or absolute lymphocyte count doubling time is greater than 6 months … [ ] Yes
If the examiner defersSpecial Issuance
The table's row B is Rai stage 0 – 2 and/or Binet stage A or B, and followed by oncology for less than 5 years, and asymptomatic with no evidence of active disease and treated with observation only. The table marks it DEFER.
The table's row C is All others. It lists Rai stage 3 or 4 and/or Binet stage C, or followed by oncology for less than 5 years, or active disease or symptomatic, relapsed disease, or treated with targeted therapy and/or chemotherapy, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A CLL/SLL Status Summary, which the table says is to expedite case processing.
- Item 2. A current, detailed clinical progress note generated from a clinic visit with a board-certified oncologist no more than 90 days before the exam. The table says it must include a detailed summary of the history of the condition; current medications, dosage and side effects (if any); physical exam findings; results of any testing performed; the diagnosis; the assessment and plan; the prognosis based on Rai/Binet stage and other clinically indicated markers; and follow-up.
- Item 3. The table says the note must specifically include performance status, disease staging, and the treatment plan (including observation).
- Item 4. Lab performed no more than 90 days before the exam, to include a CBC and beta-2 microglobulin.
- Item 5. Flow cytometry.
- Item 6. Any other testing already performed or deemed clinically necessary by the treating physician.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's row B is Rai stage 0 – 2 and/or Binet stage A or B, and followed by oncology for less than 5 years, and asymptomatic with no evidence of active disease and treated with observation only. The table marks it DEFER.
Rai stage 0 – 2 AND/OR Binet stage A or B AND Followed by oncology for less than 5 years AND … Asymptomatic with no evidence of active disease; and … Treated with observation only … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 2
The table's row C is All others. It lists Rai stage 3 or 4 and/or Binet stage C, or followed by oncology for less than 5 years, or active disease or symptomatic, relapsed disease, or treated with targeted therapy and/or chemotherapy, and the table marks it DEFER.
All others Rai stage 3 or 4 AND/OR Binet stage C OR Followed by oncology for less than 5 years OR … Active disease or symptomatic; … Relapsed disease; or … Treated with targeted therapy and/or chemotherapy … DEFER Submit the information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
A CLL/SLL Status Summary, which the table says is to expedite case processing.
A CLL/SLL Status Summary (to expedite case processing);
- Item 2
A current, detailed clinical progress note generated from a clinic visit with a board-certified oncologist no more than 90 days before the exam. The table says it must include a detailed summary of the history of the condition; current medications, dosage and side effects (if any); physical exam findings; results of any testing performed; the diagnosis; the assessment and plan; the prognosis based on Rai/Binet stage and other clinically indicated markers; and follow-up.
A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified ONCOLOGIST no more than 90 days before the AME exam. It must include: … A detailed summary of the history of the condition; … Current medications, dosage, and side effects (if any); … Physical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and plan; … Prognosis based on Rai/Binet stage and other clinically indicated markers; and … Follow-up;
- Item 3
The table says the note must specifically include performance status, disease staging, and the treatment plan (including observation).
It must specifically include performance status, disease staging, and treatment plan (including observation);
- Item 4
Lab performed no more than 90 days before the exam, to include a CBC and beta-2 microglobulin.
Lab performed no more than 90 days before the AME exam to include: … CBC … Beta-2 microglobulin;
- Item 5
Flow cytometry.
Flow cytometry; and
- Item 6
Any other testing already performed or deemed clinically necessary by the treating physician.
Any other testing already performed or deemed clinically necessary by the treating physician.
After the FAA decides
AASIThe AASI sheet for CLL/SLL says an FAA physician makes the first decision and grants the Authorization. After that, the sheet says the examiner may reissue under the Authorization when the pilot provides what it lists.
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 . … AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
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
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the AASI sheet lists what the pilot provides for the examiner to reissue. That is the Authorization itself; a CLL/SLL Status Summary and a current, detailed clinical progress note from the treating physician that includes all of the required information; and the results of a complete blood count (CBC) performed no more than 90 days before the exam.
Show the FAA's words: at later exams
AMEs 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 CLL/SLL Status Summary and a current, detailed Clinical Progress Note from the treating physician that includes all of the required information; and … The results of a complete blood count (CBC) performed no more than 90 days before the AME exam.
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 sheet's list for a reissue begins with the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
AMEs 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 CLL/SLL Status Summary and a current, detailed progress note
The AASI sheet asks for a CLL/SLL Status Summary and a current, detailed clinical progress note from the treating physician that includes all of the required information.
Show the FAA's words: A CLL/SLL Status Summary and a current, detailed progress note
A CLL/SLL Status Summary and a current, detailed Clinical Progress Note from the treating physician that includes all of the required information; and
A complete blood count (CBC) from no more than 90 days before the exam
The AASI sheet asks for the results of a complete blood count (CBC) performed no more than 90 days before the exam.
Show the FAA's words: A complete blood count (CBC) from no more than 90 days before the exam
The results of a complete blood count (CBC) performed no more than 90 days before the AME exam.
What the Authorization letter comes with
The AASI sheet 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 sheet says the examiner must defer to the AMCD or Region if the condition worsens, the pilot becomes symptomatic, or new treatment is initiated; the condition currently requires treatment with a chemotherapeutic agent; the Rai stage is 3 or higher or the Binet stage is C; there is evidence of active disease; or the hemoglobin is less than 10, the platelet count is less than 100,000/microL, or the total or absolute lymphocytic count doubling time is less than 6 months.
Show the FAA's words: When the examiner defers a reissue
The AME must defer to the AMCD or Region if: … The condition worsens, individual becomes symptomatic, or new treatment is initiated; … The condition currently requires treatment with a chemotherapeutic agent; … Rai stage is 3 or higher or Binet stage is C; … Evidence of active disease; … The hemoglobin is less than 10, the platelet count is less than 100,000/microL, or the total or absolute lymphocytic count doubling time is less than 6 months.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Rows B and C need a board-certified oncologist
On rows B and C the table asks for the progress note to come from a clinic visit with a board-certified oncologist, no more than 90 days before the exam.
Show the FAA's words: good to know, 2
A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified ONCOLOGIST no more than 90 days before the AME exam.
Row C repeats everything in row B
Row C asks for all the information in row B. The table's note says rows B and C require the same initial evaluation data.
Show the FAA's words: good to know, 3
Submit the following: 1. ALL information in Row B … Note: Rows B and C require the same initial evaluation data.
Age 40 or older at diagnosis
Age 40 or older at the time of diagnosis is in the table's row A and on the worksheet.
Show the FAA's words: good to know, 4
Age 40 or older at time of diagnosis
Age at diagnosis [ ] 40 or older
The first AASI is deferred to the FAA
For a first-time AASI application for this condition, with all the medical information needed for a determination, the AASI sheet says the examiner must defer and submit all of it 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 AME 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.
- Open to print: CACI – CLL/SLL Worksheet, a PDF at the FAA, in a new tab
- CLL/SLL Disposition TableOpen to print: CLL/SLL Disposition Table, a PDF at the FAA, in a new tab
Special Issuance
- Open to print: AASI – CLL and SLL, a page 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
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.