Cirrhosis
What the FAA's documents say about cirrhosis, in plain words, with the FAA's own words one press away.
FAA term: Cirrhosis (alcoholic and non-alcoholic)Covers: All classes
Show the FAA's words: which classes the FAA's table covers
CIRRHOSIS All Classes
- Row A's note says that if diagnosed with MASLD, NAFLD, or MASH/NASH, see that page. MASH/NASH has its own page.
Short version
The disposition table has three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AIdentified on imaging only (for example, ultrasound or MRI) | Examiner issues | Examiner can issue |
| Row BNon-alcoholic cirrhosis | Defers to the FAA | Special Issuance |
| Row CAlcoholic cirrhosis | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Cirrhosis
- Row A · Examiner can issue
Cirrhosis identified on imaging only (for example, ultrasound or MRI). The row's note says that if a diagnosis of cirrhosis is confirmed, go to row B or C, and that if diagnosed with MASLD, NAFLD, or MASH/NASH, see that page. The examiner should review the most recent detailed clinical progress note from the treating physician. If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease, the table says ISSUE. The examiner annotates this information in Block 60 and submits the evaluation to the FAA for retention in the file.
A. Cirrhosis identified on imaging only (e.g. ultrasound/ MRI) The AME should review the following: • Most recent detailed clinical progress note from the treating physician If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease: NOTE: If diagnosis of cirrhosis is confirmed, go to row B or C. If diagnosed with metabolic dysfunction associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), or non-alcoholic/metabolic associated steatohepatitis (MASH/NASH), see that page. ISSUE Annotate this information in Block 60 and submit the evaluation to the FAA for retention in the file.
- Row B · Special Issuance
Non-alcoholic cirrhosis. The table lists eight items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
B. Non-alcoholic cirrhosis Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- Row C · Special Issuance
Alcoholic cirrhosis. The table asks for all items in Row B and, once stable, all items for Substance Abuse/Dependence. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
C. Alcoholic Cirrhosis Submit the following for FAA review: 1. All items in Row B 2. Once stable, all items for Substance Abuse/Dependence DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
The FAA pathways for cirrhosis
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: Row A: identified on imaging only
The note the examiner reviews, and what it verifies.The most recent detailed clinical progress note from your treating physician. Your AME should review it.
The table's note
- If a diagnosis of cirrhosis is confirmed, go to row B or C
- If diagnosed with MASLD, NAFLD, or MASH/NASH, see that page
Show the FAA's words: Row A: identified on imaging only
A. Cirrhosis identified on imaging only (e.g. ultrasound/ MRI) The AME should review the following: • Most recent detailed clinical progress note from the treating physician
FAA source: Cirrhosis(alcoholic and non-alcoholic). FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease:
ISSUE
FAA source: Cirrhosis(alcoholic and non-alcoholic). FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
ISSUE Annotate this information in Block 60 and submit the evaluation to the FAA for retention in the file.
FAA source: Cirrhosis(alcoholic and non-alcoholic). FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
NOTE: If diagnosis of cirrhosis is confirmed, go to row B or C.
FAA source: Cirrhosis(alcoholic and non-alcoholic). FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
If diagnosed with metabolic dysfunction associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), or non-alcoholic/metabolic associated steatohepatitis (MASH/NASH), see that page.
FAA source: Cirrhosis(alcoholic and non-alcoholic). FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
Step 2: See your AME
The examiner should review the most recent detailed clinical progress note from the treating physician. If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease, the table says ISSUE. The examiner annotates this information in Block 60 and submits the evaluation to the FAA for retention in the file.Exam day- The examiner should review the most recent detailed clinical progress note from the treating physician. If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease, the table says ISSUE. The examiner annotates this information in Block 60 and submits the evaluation to the FAA for retention in the file.
Show the FAA's words: See your AME
A. Cirrhosis identified on imaging only (e.g. ultrasound/ MRI) The AME should review the following: • Most recent detailed clinical progress note from the treating physician If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease: NOTE: If diagnosis of cirrhosis is confirmed, go to row B or C. If diagnosed with metabolic dysfunction associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), or non-alcoholic/metabolic associated steatohepatitis (MASH/NASH), see that page. ISSUE Annotate this information in Block 60 and submit the evaluation to the FAA for retention in the file.
FAA source: Cirrhosis(alcoholic and non-alcoholic). FAA date 25 February 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The examiner should review the most recent detailed clinical progress note from the treating physician. If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease, the table says ISSUE. The examiner annotates this information in Block 60 and submits the evaluation to the FAA for retention in the file.
Row BDefers to the FAASpecial Issuance
The table lists eight items to submit for FAA review. The examiner defers, submits the 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 table asks for all items in Row B and, once stable, all items for Substance Abuse/Dependence. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Cirrhosis identified on imaging only (for example, ultrasound or MRI). The row's note says that if a diagnosis of cirrhosis is confirmed, go to row B or C, and that if diagnosed with MASLD, NAFLD, or MASH/NASH, see that page. The examiner should review the most recent detailed clinical progress note from the treating physician. If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease, the table says ISSUE. The examiner annotates this information in Block 60 and submits the evaluation to the FAA for retention in the file.
A. Cirrhosis identified on imaging only (e.g. ultrasound/ MRI) The AME should review the following: • Most recent detailed clinical progress note from the treating physician If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease: NOTE: If diagnosis of cirrhosis is confirmed, go to row B or C. If diagnosed with metabolic dysfunction associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), or non-alcoholic/metabolic associated steatohepatitis (MASH/NASH), see that page. ISSUE Annotate this information in Block 60 and submit the evaluation to the FAA for retention in the file.
- Row B · Special Issuance
Non-alcoholic cirrhosis. The table lists eight items to submit for FAA review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Item 60.
B. Non-alcoholic cirrhosis Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Item 60.
- Row C · Special Issuance
Alcoholic cirrhosis. The table asks for all items in Row B and, once stable, all items for Substance Abuse/Dependence. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
C. Alcoholic Cirrhosis Submit the following for FAA review: 1. All items in Row B 2. Once stable, all items for Substance Abuse/Dependence DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
If the examiner defersSpecial Issuance
The table marks Row B, non-alcoholic cirrhosis, DEFER.
The table marks Row C, alcoholic cirrhosis, DEFER.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row B, non-alcoholic cirrhosis, DEFER.
B. Non-alcoholic cirrhosis … DEFER Submit the information to the FAA for a possible Special Issuance
- Reason 2
The table marks Row C, alcoholic cirrhosis, DEFER.
C. Alcoholic Cirrhosis … DEFER Submit the information to the FAA for a possible Special Issuance
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 workGood 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.
Imaging only, and a confirmed diagnosis
Row A is cirrhosis identified on imaging only. Its ISSUE rests on the most recent detailed progress note verifying no history of or concern of a diagnosis of cirrhosis or liver disease, and its note says that if a diagnosis of cirrhosis is confirmed, go to row B or C.
Show the FAA's words: good to know, 2
A. Cirrhosis identified on imaging only (e.g. ultrasound/ MRI) … If this documentation verifies no history of or concern of a diagnosis of cirrhosis or liver disease: NOTE: If diagnosis of cirrhosis is confirmed, go to row B or C.
MASLD, NAFLD and MASH/NASH have their own page
Row A's note says that if diagnosed with MASLD, NAFLD, or MASH/NASH, see that page.
Show the FAA's words: good to know, 3
If diagnosed with metabolic dysfunction associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), or non-alcoholic/metabolic associated steatohepatitis (MASH/NASH), see that page.
Row A's evaluation also goes to the FAA
Under Row A, which says ISSUE, the examiner both annotates this information in Block 60 and submits the evaluation to the FAA for retention in the file.
Show the FAA's words: good to know, 4
ISSUE Annotate this information in Block 60 and submit the evaluation to the FAA for retention in the file.
An abnormal CogScreen-AE
Row B asks for a neuropsychological evaluation with interpretation of CogScreen-Aeromedical Edition, and its note says that if CogScreen-AE is interpreted as abnormal, completion of neurocognitive testing per specs for Potential Neurocognitive Impairment is indicated.
Show the FAA's words: good to know, 5
7. Neuropsychological Evaluation with interpretation of CogScreen-Aeromedical Edition.* … *Note: If CogScreen-AE is interpreted as abnormal, completion of neurocognitive testing per specs for Potential Neurocognitive Impairment is indicated.
Alcoholic cirrhosis adds the substance items, once stable
Row C asks for all items in Row B and, once stable, all items for Substance Abuse/Dependence. The table does not list those items here or say what stable means.
Show the FAA's words: good to know, 6
C. Alcoholic Cirrhosis Submit the following for FAA review: 1. All items in Row B 2. Once stable, all items for Substance Abuse/Dependence
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.
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.