Multiple sclerosis
What the FAA's documents say about multiple sclerosis, in plain words, with the FAA's own words one press away.
FAA term: Multiple Sclerosis (MS)Covers: All classes
Show the FAA's words: which classes the FAA's table covers
MULTIPLE SCLEROSIS (MS) All Classes
- Row C says if optic neuritis, see that page. Crosscheck has a page on optic neuritis, written from the FAA's Optic Neuritis disposition table.
Short version
The disposition table has three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AMultiple sclerosis | Defers to the FAA | Special Issuance |
| Row BNMOSD or MOGAD | Defers to the FAA | Special Issuance |
| Row CClinically isolated syndrome (CIS), no matter how long ago | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Multiple sclerosis
- Row A · Special Issuance
Multiple sclerosis. After a minimum of 6 (six) months of clinical and radiological stability, the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
A. Multiple Sclerosis After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row B · Special Issuance
Neuromyelitis optica spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein antibody disorder (MOGAD). After a minimum of 6 (six) months of clinical and radiological stability, the table asks for all information listed above for MS Row A, and says that on
B. Neuromyelitis Optica Spectrum Disorder (NMOSD) OR Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD) After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review: • All information listed above for MS Row A • On #6 Lab. NMO and anti-MOG antibody panel are required. (submit most recent test result). DEFER Submit the information to the FAA for a possible Special Issuance.
- Row C · Special Issuance
Clinically isolated syndrome (CIS) -- any history of, no matter how long ago, and including transverse myelitis. The row says if optic neuritis, see that page. After a minimum of 6 (six) months of clinical and radiological stability, the table asks for all information listed above for MS Row A, and says that on
C. Clinically Isolated Syndrome (CIS) • any history of • no matter how long ago • include Transverse Myelitis If optic neuritis, see that page After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review: • All information listed above for MS Row A • On #3 MRI cervical and thoracic spine-submit only if clinically indicated or already performed. DEFER Submit the information to the FAA for a possible Special Issuance.
The FAA pathways for multiple sclerosis
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: Six months of stability
The wait before anything is submitted, for every row.For every row, what the table lists is submitted for FAA review after a minimum of 6 (six) months of clinical and radiological stability.
Show the FAA's words: Six months of stability
After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review:
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
Step 2: Neurological and neuropsychological evaluations
The neurological evaluation from your treating neurologist; both to the FAA's specifications.Neurological evaluation
Within 90 days before the examA current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, from a clinic visit with your treating neurologist no more than 90 days before the exam.
Neuropsychological (NP) evaluation
A neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
Show the FAA's words: Neurological and neuropsychological evaluations
1. 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.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
5. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
Step 3: MRI of the brain and spine
With and without gadolinium, sent as a report and on CD.MRI brain
Within 90 days before the examAn MRI brain with and without gadolinium, performed no more than 90 days before the exam.
How it is sent
- The interpretive report on paper
- Imaging on CD in DICOM readable format, with a file named 'DICOMDIR' in the root directory of the CD-ROM
- The CD verified to display the images before sending, and a copy of all films kept
MRI cervical and thoracic spine
Most recent, if already performed; for Row C, only if clinically indicated or already performed.
Most recent, if already performed; for Row C, only if clinically indicated or already performed.
An MRI cervical and thoracic spine with and without gadolinium, the most recent, if already performed.
How it is sent
- The interpretive report on paper
- Imaging on CD in DICOM readable format, with a file named 'DICOMDIR' in the root directory of the CD-ROM
- The CD verified to display the images before sending, and a copy of all films kept
Show the FAA's words: MRI of the brain and spine
2. MRI brain with and without gadolinium performed no more than 90 days before the AME exam.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
3. MRI cervical and thoracic spine with and without gadolinium (most recent, if already performed).
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
• All information listed above for MS Row A • On #3 MRI cervical and thoracic spine-submit only if clinically indicated or already performed.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
• For each MRI 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. Retain a copy of all films as a safeguard if lost in the mail.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
Step 4: Eye evaluation
From your treating ophthalmologist, with visual field testing.Eye evaluation
Within 90 days before the examAn eye evaluation: a current, detailed progress note from a clinic visit with your treating ophthalmologist, no more than 90 days before the exam.
It must include
- A detailed summary of the history of any eye condition(s)
- Current medications, dosage, and side effects, if any
- Physical exam findings
- Results of any testing performed
- Diagnosis
- Assessment and plan (prognosis)
- Follow-up
- Specifically, an interpretation of the visual field testing
Visual field testing
Visual field testing (24-2 SITA standard), performed within the previous 90 days.
Optical coherence tomography (OCT)
If performed.
If performed.
Optical coherence tomography (OCT), if performed.
Show the FAA's words: Eye evaluation
4. Eye evaluation. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ophthalmologist no more than 90 days before the AME exam. It must include a detailed summary of the history of any eye condition(s); current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up. • It must specifically include an interpretation of the visual field testing;
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
• Visual field testing (24-2 SITA standard) performed within the previous 90 days; and
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
• Optical Coherence Tomography (OCT), if performed. Supply the color draft and printouts.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
Step 5: Labs and other testing
What is already done, or clinically indicated.Lab testing
If already performed or clinically indicated.
If already performed or clinically indicated.
The lab testing the table lists, if already performed or clinically indicated.
The table lists
- Rheumatological antibody screening (ANA, RF, Lyme titer)
- Cerebrospinal fluid (CSF) testing
- All evoked potential testing
- An NMO antibody panel (such as anti AQP4, anti MOG) in cases with spinal involvement, optic neuritis, or concerns for NMO-SD, with the most recent test result
Other testing
If already performed or deemed clinically necessary.
If already performed or deemed clinically necessary.
Any other testing already performed or deemed clinically necessary by your treating physician.
Show the FAA's words: Labs and other testing
6. Lab. The following testing, if already performed or clinically indicated: • Rheumatological antibody screening (ANA, RF, Lyme titer); • Cerebrospinal Fluid (CSF) testing; • All evoked potential testing; and
• NMO antibody panel (such as anti AQP4, anti MOG) in cases with spinal involvement, optic neuritis, or concerns for NMO-SD. (Submit most recent test result.)
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
• All information listed above for MS Row A • On #6 Lab. NMO and anti-MOG antibody panel are required. (submit most recent test result).
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
7. Any other testing already performed or deemed clinically necessary by the treating physician.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
Step 6: See your AME
After a minimum of 6 (six) months of clinical and radiological stability, the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.Exam day- After a minimum of 6 (six) months of clinical and radiological stability, the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
Show the FAA's words: See your AME
A. Multiple Sclerosis After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review:
DEFER Submit the information to the FAA for a possible Special Issuance.
FAA source: Multiple Sclerosis. FAA date 27 August 2025; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row ADefers to the FAASpecial Issuance
After a minimum of 6 (six) months of clinical and radiological stability, the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defersRow BDefers to the FAASpecial Issuance
After a minimum of 6 (six) months of clinical and radiological stability, the table asks for all information listed above for MS Row A, and says that on
If the examiner defersRow CDefers to the FAASpecial Issuance
After a minimum of 6 (six) months of clinical and radiological stability, the table asks for all information listed above for MS Row A, and says that on
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Special Issuance
Multiple sclerosis. After a minimum of 6 (six) months of clinical and radiological stability, the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
A. Multiple Sclerosis After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row B · Special Issuance
Neuromyelitis optica spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein antibody disorder (MOGAD). After a minimum of 6 (six) months of clinical and radiological stability, the table asks for all information listed above for MS Row A, and says that on
B. Neuromyelitis Optica Spectrum Disorder (NMOSD) OR Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD) After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review: • All information listed above for MS Row A • On #6 Lab. NMO and anti-MOG antibody panel are required. (submit most recent test result). DEFER Submit the information to the FAA for a possible Special Issuance.
- Row C · Special Issuance
Clinically isolated syndrome (CIS) -- any history of, no matter how long ago, and including transverse myelitis. The row says if optic neuritis, see that page. After a minimum of 6 (six) months of clinical and radiological stability, the table asks for all information listed above for MS Row A, and says that on
C. Clinically Isolated Syndrome (CIS) • any history of • no matter how long ago • include Transverse Myelitis If optic neuritis, see that page After a minimum of 6 (six) months of clinical and radiological stability, submit the following for FAA review: • All information listed above for MS Row A • On #3 MRI cervical and thoracic spine-submit only if clinically indicated or already performed. DEFER Submit the information to the FAA for a possible Special Issuance.
If the examiner defersSpecial Issuance
The table marks Row A, multiple sclerosis, DEFER.
The table marks Row B, NMOSD or MOGAD, DEFER.
The table marks Row C, clinically isolated syndrome (CIS), DEFER.
What the FAA lists to send
- Item 1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, from a clinic visit with the treating neurologist no more than 90 days before the exam.
- Item 2. An MRI brain with and without gadolinium performed no more than 90 days before the exam.
- Item 3. An MRI cervical and thoracic spine with and without gadolinium, the most recent, if already performed.
- Item 4. An eye evaluation, a current, detailed clinical progress note from a clinic visit with the treating ophthalmologist no more than 90 days before the exam, with visual field testing (24-2 SITA standard) performed within the previous 90 days and, if performed, optical coherence tomography (OCT).
- Item 5. A neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
- Item 6. Lab testing the table lists, if already performed or clinically indicated.
- Item 7. Any other testing already performed or deemed clinically necessary by the treating physician.
- Item 8. For Row B, the NMO and anti-MOG antibody panel, which the table says are required, with the most recent test result.
- Item 9. For Row C, the MRI cervical and thoracic spine only if clinically indicated or already performed.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row A, multiple sclerosis, DEFER.
A. Multiple Sclerosis … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 2
The table marks Row B, NMOSD or MOGAD, DEFER.
B. Neuromyelitis Optica Spectrum Disorder (NMOSD) OR Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD) … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 3
The table marks Row C, clinically isolated syndrome (CIS), DEFER.
C. Clinically Isolated Syndrome (CIS) … 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 FAA Specifications for Neurologic Evaluation, from a clinic visit with the treating neurologist no more than 90 days before the exam.
1. 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
An MRI brain with and without gadolinium performed no more than 90 days before the exam.
2. MRI brain with and without gadolinium performed no more than 90 days before the AME exam.
- Item 3
An MRI cervical and thoracic spine with and without gadolinium, the most recent, if already performed.
3. MRI cervical and thoracic spine with and without gadolinium (most recent, if already performed).
- Item 4
An eye evaluation, a current, detailed clinical progress note from a clinic visit with the treating ophthalmologist no more than 90 days before the exam, with visual field testing (24-2 SITA standard) performed within the previous 90 days and, if performed, optical coherence tomography (OCT).
4. Eye evaluation. A current, detailed Clinical Progress Note generated from a clinic visit with the treating ophthalmologist no more than 90 days before the AME exam. … • Visual field testing (24-2 SITA standard) performed within the previous 90 days; and • Optical Coherence Tomography (OCT), if performed.
- Item 5
A neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
5. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
- Item 6
Lab testing the table lists, if already performed or clinically indicated.
6. Lab. The following testing, if already performed or clinically indicated:
- Item 7
Any other testing already performed or deemed clinically necessary by the treating physician.
7. Any other testing already performed or deemed clinically necessary by the treating physician.
- Item 8
For Row B, the NMO and anti-MOG antibody panel, which the table says are required, with the most recent test result.
• On #6 Lab. NMO and anti-MOG antibody panel are required. (submit most recent test result).
- Item 9
For Row C, the MRI cervical and thoracic spine only if clinically indicated or already performed.
• On #3 MRI cervical and thoracic spine-submit only if clinically indicated or already performed.
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.
CIS is Row C, no matter how long ago
Row C is any history of clinically isolated syndrome (CIS), no matter how long ago, and it includes transverse myelitis. The table marks it DEFER.
Show the FAA's words: good to know, 2
C. Clinically Isolated Syndrome (CIS) • any history of • no matter how long ago • include Transverse Myelitis … DEFER Submit the information to the FAA for a possible Special Issuance.
The NMO antibody panel
Row A's lab item lists an NMO antibody panel (such as anti AQP4, anti MOG) in cases with spinal involvement, optic neuritis, or concerns for NMO-SD. For Row B the table says the NMO and anti-MOG antibody panel are required.
Show the FAA's words: good to know, 3
• NMO antibody panel (such as anti AQP4, anti MOG) in cases with spinal involvement, optic neuritis, or concerns for NMO-SD. … • On #6 Lab. NMO and anti-MOG antibody panel are required. (submit most recent test result).
A neuropsychological evaluation is on the list
Row A's list, which Rows B and C also ask for, includes a neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment.
Show the FAA's words: good to know, 4
5. A Neuropsychological (NP) evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment. … • All information listed above for MS Row A
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.