Essential tremor
What the FAA's documents say about essential tremor, in plain words, with the FAA's own words one press away.
FAA term: Tremor (Essential Tremor)
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row APhysiologic tremor that does not require medication, is not progressing, and has no functional limitations. The table's note says this is not a disease, and can be a normal physiological finding for the situation. | Examiner issues | Examiner can issue |
| Row BEssential tremor treated with an acceptable medication. The table notes that the previous term was benign essential tremor. | Worksheet | CACI |
| Row CAll others. The row names a diagnosis that is suspect or uncertain; an individual who is dependent on medication to be functional or requires a medication change; assistive devices (such as weighted gloves, utensils) in use; a condition that is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/or, where the row continues on the table's second page, dependent on medication. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Essential tremor
- Row A · Examiner can issue
Physiologic tremor that does not require medication, is not progressing, and has no functional limitations. The table's note says this is not a disease, and can be a normal physiological finding for the situation. If the examiner can determine the pilot has no symptoms that would interfere with flight duties, the table says ISSUE, and has the examiner annotate this information in Block 60.
A. Physiologic tremor • Not requiring medication • Not progressing • No functional limitations Note: This is not a disease. It can be a normal physiological finding for the situation. … If the AME can determine the pilot has no symptoms that would interfere with flight duties: ISSUE Annotate this information in Block 60
- Row B · CACI
Essential tremor treated with an acceptable medication. The table notes that the previous term was benign essential tremor. The table has the examiner follow the CACI worksheet for essential tremor, and says this requires a current, detailed clinical progress note from the treating physician, and that the acceptable medication for CACI is none or a beta-blocker, with all others going to row C. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE with no time limitation; the examiner annotates the correct CACI statement in Block 60 and keeps the required supporting information on file.
B. Essential Tremor Treated with an acceptable medication. Note: Previous term was “Benign Essential Tremor” … Follow the CACI – Essential Tremor Worksheet. This requires a current, detailed Clinical Progress Note from the treating physician. Acceptable medication for CACI is NONE or a beta-blocker. (All others go to Row C). If the pilot meets all CACI worksheet criteria and is otherwise qualified: ISSUE with no time limitation Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
All others. The row names a diagnosis that is suspect or uncertain; an individual who is dependent on medication to be functional or requires a medication change; assistive devices (such as weighted gloves, utensils) in use; a condition that is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/or, where the row continues on the table's second page, dependent on medication. The table lists what to submit to the FAA for review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates elements or findings in Block 60.
C. All others The diagnosis is suspect or uncertain; The individual is dependent on medication to be functional or requires a medication change; Assistive devices (such as weighted gloves, utensils) are used; Condition is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/or … dependent on medication; … Submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate elements or findings in Block 60.
- A note on the table, 1
The table's note in its last row says most medication to treat tremor is not acceptable (e.g., gabapentin, mysoline [primadone]).
Note: Most medication to treat tremor is not acceptable (e.g., gabapentin, mysoline [primadone]).
- A note on the table, 2
The table's note says that if the tremor is due to a specific condition (e.g., Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury, etc.), see that section, and if a deep brain stimulator (DBS) is in place, see that section.
Note: If the tremor is due to a specific condition (e.g., Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury, etc.) - see that section. If a deep brain stimulator (DBS) is in place - see that section.
The FAA pathways for essential tremor
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: The progress note from the treating doctor
The note the examiner reviews, and what the worksheet asks of it.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician, no more than 90 days before the exam, with any supporting documents. Your AME reviews them.
It verifies
- The diagnosis is essential tremor
- Stable: no disease progression and no treatment changes recommended
The worksheet's questions
- Not: Any evidence of a disabling tremor that limits day-to-day functioning, such as holding a cup, handwriting or flipping switches on aircraft
- Not: Relying on the medication to be functional
Show the FAA's words: The progress note from the treating doctor
The AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND any supporting documents to determine the applicant's eligibility for certification.
FAA source: CACI – Essential Tremor Worksheet. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.
A current, detailed Clinical Progress Note from the treating physician or neurologist verifies the diagnosis is essential tremor and the condition is stable (no disease progression and no treatment changes recommended). [ ] Yes
FAA source: CACI – Essential Tremor Worksheet. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.
Any evidence of a disabling tremor that limits day-to-day functioning? (E.g., holding a cup, handwriting, flipping switches on aircraft, or other). [ ] No
FAA source: CACI – Essential Tremor Worksheet. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.
Does the applicant rely on the medication to be functional? (Does the applicant have a disabling tremor when they do not take the medication or if the medication wears off?) Note: Beta blocker is the ONLY CACI-eligible medication for this condition. [ ] No
FAA source: CACI – Essential Tremor Worksheet. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.
Step 2: Treatment
The treatment the worksheet accepts, and what it does not.No treatment, or a beta blocker.
Acceptable
- None
- A beta blocker, such as propanolol, metoprolol or Lopressor (the worksheet's spelling)
Not acceptable for CACI
- Not: Other medication or treatments: weighted gloves, specialized utensils, a deep brain stimulator
- Not: Gabapentin, primidone (Mysoline), and other potentially sedating medications
Show the FAA's words: Treatment
Treatment for condition Note: Other medication or treatments (weighted gloves, specialized utensils, and deep brain stimulator) do NOT CACI qualify. See Tremor Disposition Table for possible Special Issuance information. Gabapentin, primidone (Mysoline), and other potentially sedating medications are not acceptable for aeromedical purposes. Do NOT CACI. [ ] None Or [ ] Beta blocker (e.g., propanolol, metoprolol, Lopressor)
FAA source: CACI – Essential Tremor Worksheet. FAA date 26 July 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 AExaminer issuesExaminer can issue
If the examiner can determine the pilot has no symptoms that would interfere with flight duties, the table says ISSUE, and has the examiner annotate this information in Block 60.
Row BWorksheetCACI
The table has the examiner follow the CACI worksheet for essential tremor, and says this requires a current, detailed clinical progress note from the treating physician, and that the acceptable medication for CACI is none or a beta-blocker, with all others going to row C. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE with no time limitation; the examiner annotates the correct CACI statement in Block 60 and keeps the required supporting information on file.
Row CDefers to the FAASpecial Issuance
The table lists what to submit to the FAA for review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates 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
Physiologic tremor that does not require medication, is not progressing, and has no functional limitations. The table's note says this is not a disease, and can be a normal physiological finding for the situation. If the examiner can determine the pilot has no symptoms that would interfere with flight duties, the table says ISSUE, and has the examiner annotate this information in Block 60.
A. Physiologic tremor • Not requiring medication • Not progressing • No functional limitations Note: This is not a disease. It can be a normal physiological finding for the situation. … If the AME can determine the pilot has no symptoms that would interfere with flight duties: ISSUE Annotate this information in Block 60
- Row B · CACI
Essential tremor treated with an acceptable medication. The table notes that the previous term was benign essential tremor. The table has the examiner follow the CACI worksheet for essential tremor, and says this requires a current, detailed clinical progress note from the treating physician, and that the acceptable medication for CACI is none or a beta-blocker, with all others going to row C. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE with no time limitation; the examiner annotates the correct CACI statement in Block 60 and keeps the required supporting information on file.
B. Essential Tremor Treated with an acceptable medication. Note: Previous term was “Benign Essential Tremor” … Follow the CACI – Essential Tremor Worksheet. This requires a current, detailed Clinical Progress Note from the treating physician. Acceptable medication for CACI is NONE or a beta-blocker. (All others go to Row C). If the pilot meets all CACI worksheet criteria and is otherwise qualified: ISSUE with no time limitation Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
All others. The row names a diagnosis that is suspect or uncertain; an individual who is dependent on medication to be functional or requires a medication change; assistive devices (such as weighted gloves, utensils) in use; a condition that is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/or, where the row continues on the table's second page, dependent on medication. The table lists what to submit to the FAA for review. The examiner defers, submits the information to the FAA for a possible Special Issuance, and annotates elements or findings in Block 60.
C. All others The diagnosis is suspect or uncertain; The individual is dependent on medication to be functional or requires a medication change; Assistive devices (such as weighted gloves, utensils) are used; Condition is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/or … dependent on medication; … Submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate elements or findings in Block 60.
The CACI worksheet's criteria
Progress note
It verifies
- The diagnosis is essential tremor
- Stable: no disease progression and no treatment changes recommended
The worksheet's questions
- Not: Any evidence of a disabling tremor that limits day-to-day functioning, such as holding a cup, handwriting or flipping switches on aircraft
- Not: Relying on the medication to be functional
Your treatment for tremor
Acceptable
- None
- A beta blocker, such as propanolol, metoprolol or Lopressor (the worksheet's spelling)
Not acceptable for CACI
- Not: Other medication or treatments: weighted gloves, specialized utensils, a deep brain stimulator
- Not: Gabapentin, primidone (Mysoline), and other potentially sedating medications
Show the FAA's words: the CACI worksheet's criteria for Essential tremor
- The diagnosis is essential tremor, and the condition is stable
FAA criterion: a current, detailed progress note from the treating physician or neurologist verifies the diagnosis is essential tremor and the condition is stable (no disease progression and no treatment changes recommended).
A current, detailed Clinical Progress Note from the treating physician or neurologist verifies the diagnosis is essential tremor and the condition is stable (no disease progression and no treatment changes recommended). [ ] Yes
- No evidence of a disabling tremor that limits day-to-day functioning
FAA criterion: the worksheet asks whether there is any evidence of a disabling tremor that limits day-to-day functioning (e.g., holding a cup, handwriting, flipping switches on aircraft, or other), and the acceptable answer on it is no.
Any evidence of a disabling tremor that limits day-to-day functioning? (E.g., holding a cup, handwriting, flipping switches on aircraft, or other). [ ] No
- Not relying on the medication to be functional
FAA criterion: the worksheet asks whether the applicant relies on the medication to be functional (whether the applicant has a disabling tremor when they do not take the medication or if the medication wears off), and the acceptable answer on it is no. Its note says a beta blocker is the only CACI-eligible medication for this condition.
Does the applicant rely on the medication to be functional? (Does the applicant have a disabling tremor when they do not take the medication or if the medication wears off?) Note: Beta blocker is the ONLY CACI-eligible medication for this condition. [ ] No
- Treatment for the condition
FAA criterion: under treatment for the condition the worksheet's boxes are None, or Beta blocker (e.g., propanolol, metoprolol, Lopressor). Its note says other medication or treatments (weighted gloves, specialized utensils, and deep brain stimulator) do not CACI qualify, and points to the Tremor Disposition Table for possible Special Issuance information. It says gabapentin, primidone (Mysoline), and other potentially sedating medications are not acceptable for aeromedical purposes, and not to CACI.
Treatment for condition Note: Other medication or treatments (weighted gloves, specialized utensils, and deep brain stimulator) do NOT CACI qualify. See Tremor Disposition Table for possible Special Issuance information. Gabapentin, primidone (Mysoline), and other potentially sedating medications are not acceptable for aeromedical purposes. Do NOT CACI. [ ] None Or [ ] Beta blocker (e.g., propanolol, metoprolol, Lopressor)
If the examiner defersSpecial Issuance
The table's last row is All others. It names a diagnosis that is suspect or uncertain, dependence on medication to be functional or a medication change, assistive devices, and a condition that is clinically uncontrolled or disabling, and/or dependent on medication, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A current, detailed neurological evaluation that meets the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the exam.
- Item 2. MRI and/or CT of the brain (the most recent test). The table says to submit the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named DICOMDIR in the root directory of the CD-ROM; to verify the CD will display the images before sending; and that a copy of all films may be retained as a safeguard if lost in the mail.
- Item 3. An electroencephalogram (EEG) performed no more than 12 months before the exam. The table says it must be a sleep-deprived EEG -- awake, asleep, and with provocation (hyperventilation, photic/strobe light) -- to include any previous EEG(s) available for comparison, to submit both the final interpretive report(s) and the actual tracings (all pages) for any EEGs on CD, and that the CDs of EEG recordings must have proprietary opening software that is compatible with Windows 10.
- Item 4. Other testing already performed by the treating physician for this condition (the table's words are "Other testing already performed the treating physician").
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is All others. It names a diagnosis that is suspect or uncertain, dependence on medication to be functional or a medication change, assistive devices, and a condition that is clinically uncontrolled or disabling, and/or dependent on medication, and the table marks it DEFER.
C. All others The diagnosis is suspect or uncertain; The individual is dependent on medication to be functional or requires a medication change; Assistive devices (such as weighted gloves, utensils) are used; Condition is clinically uncontrolled or disabling (limits any day-to-day function such as holding cup, handwriting, flipping switches, etc.); and/or … dependent on medication; … DEFER Submit the information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
A current, detailed neurological evaluation that meets the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the exam.
A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.
- Item 2
MRI and/or CT of the brain (the most recent test). The table says to submit the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named DICOMDIR in the root directory of the CD-ROM; to verify the CD will display the images before sending; and that a copy of all films may be retained as a safeguard if lost in the mail.
MRI and/or CT of the brain (the most recent test). Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root … directory of the CD-ROM). Please verify the CD will display the images before sending. You may wish to retain a copy of all films as a safeguard if lost in the mail.
- Item 3
An electroencephalogram (EEG) performed no more than 12 months before the exam. The table says it must be a sleep-deprived EEG -- awake, asleep, and with provocation (hyperventilation, photic/strobe light) -- to include any previous EEG(s) available for comparison, to submit both the final interpretive report(s) and the actual tracings (all pages) for any EEGs on CD, and that the CDs of EEG recordings must have proprietary opening software that is compatible with Windows 10.
Electroencephalogram (EEG) performed no more than 12 months before the AME exam. It must be sleep-deprived EEG: awake, asleep, and with provocation (hyperventilation, photic/strobe light). Include any previous EEG(s) available for comparison. Submit BOTH the final interpretive report(s) and the actual tracings (ALL pages) for any EEGs on CD. The CDs of EEG recordings must have proprietary opening software that is compatible with Windows 10.
- Item 4
Other testing already performed by the treating physician for this condition (the table's words are "Other testing already performed the treating physician").
Other testing already performed the treating physician for this condition
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 exams
- 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.
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.
Physiologic tremor has its own row
Physiologic tremor that needs no medication, is not progressing and has no functional limitations is ISSUE on the table if the examiner can determine the pilot has no symptoms that would interfere with flight duties. The table notes it is not a disease.
Show the FAA's words: good to know, 2
A. Physiologic tremor • Not requiring medication • Not progressing • No functional limitations Note: This is not a disease. … If the AME can determine the pilot has no symptoms that would interfere with flight duties: ISSUE
A beta blocker is the only CACI medication
The worksheet says a beta blocker is the only CACI-eligible medication for this condition. The table says the acceptable medication for CACI is none or a beta-blocker, with all others going to row C.
Show the FAA's words: good to know, 3
Note: Beta blocker is the ONLY CACI-eligible medication for this condition.
Acceptable medication for CACI is NONE or a beta-blocker. (All others go to Row C).
Block 60 carries one of three statements
The worksheet says the examiner must note one of three in Block 60: CACI qualified (documents do not need to be submitted to the FAA); has current or previous SI/AASI but now CACI qualified; or NOT CACI qualified, which says the examiner has deferred and to submit supporting documents.
Show the FAA's words: good to know, 4
AME MUST NOTE in Block 60 one of the following: … CACI qualified Essential Tremor. (Documents do not need to be submitted to the FAA.) … Has current OR previous SI/AASI but now CACI qualified Essential Tremor. … NOT CACI qualified Essential Tremor. I have deferred. (Submit supporting documents.)
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 – Essential Tremor Worksheet, a PDF at the FAA, in a new tab
- Essential TremorOpen to print: Essential Tremor, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- 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.
Medication guidance
Medications Crosscheck lists as taken for essential tremor, each with its own page on what published FAA guidance says about it.
- Beta blocker, essential tremor
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.