Special Issuance
How an FAA Authorization for Special Issuance comes about, in stages, and what it means at later exams.
- From 12 FAA documents
- Checked by Crosscheck 14 October 2026
- Not affiliated with the FAA
What Special Issuance is
An FAA Authorization, for a specified period, for a pilot who does not meet a medical standard.
The FAA grants it. Examiners may not issue an initial Authorization.
The FAA's definition in full
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.
FAA source: what Special Issuance means
At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a Medical Certificate (Authorization), valid for a specified period, may be granted 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 medical certificate applied for can be performed without endangering public safety during the period in which the Authorization would be in force.
The stages of a Special Issuance
Stages, not a fixed sequence. They can overlap, and the FAA's instructions for a condition can set their own order.
Prepare medical documentation
The FAA recommends researching the Guide's requirements for a condition or medication, and gathering the documents, before the exam appointment.
AME examination and FAA coordination
The FAA recommends gathering documents before the exam. Examiners may not issue an initial Authorization. For some conditions, or when required documentation is missing, the examiner must defer the exam to the FAA.
The FAA's evaluation
After a deferral the FAA writes, and most letters list items to provide, mostly medical records. An FAA physician may review the documents.
The FAA's determination
The Federal Air Surgeon, the Manager of the AMCD, or an RFS decides whether to grant an Authorization.
The Authorization's requirements
It names the class of certificate, and may set how long it lasts, the tests, examinations or evaluations needed for a new one, and operational or functional limitations.
With a valid Authorization, a certificate of the appropriate class may be issued if the pilot is otherwise eligible. It expires no later than the end of the validity period, or when the Authorization is withdrawn.
View FAA sources for these stages: The stages of a Special Issuance
- Stage 1. Prepare medical documentation
The FAA recommends researching the Guide's requirements for a condition or medication, and gathering the documents, before the exam appointment.
Before your AME exam appointment gather necessary documents! It is highly recommended that if you have any current or past medical condition(s) or take medication(s), you research the requirements for medical certification in the Guide for Aviation Medical Examiners .
- Stage 2. AME examination and FAA coordination
The FAA recommends gathering documents before the exam. Examiners may not issue an initial Authorization. For some conditions, or when required documentation is missing, the examiner must defer the exam to the FAA.
Before your AME exam appointment gather necessary documents! It is highly recommended that if you have any current or past medical condition(s) or take medication(s), you research the requirements for medical certification in the Guide for Aviation Medical Examiners .
- Stage 2. AME examination and FAA coordination
The FAA recommends gathering documents before the exam. Examiners may not issue an initial Authorization. For some conditions, or when required documentation is missing, the examiner must defer the exam to the FAA.
Examiners may not issue initial Authorizations.
- Stage 2. AME examination and FAA coordination
The FAA recommends gathering documents before the exam. Examiners may not issue an initial Authorization. For some conditions, or when required documentation is missing, the examiner must defer the exam to the FAA.
For some conditions, or if missing required documentation, the AME must defer the examination to the FAA for review and/or further investigation.
- Stage 3. The FAA's evaluation
After a deferral the FAA writes, and most letters list items to provide, mostly medical records. An FAA physician may review the documents.
Documents received may be reviewed by an FAA physician with expertise in aerospace medicine, occupational medicine, family medicine, internal medicine, or a variety of specialties
- Stage 3. The FAA's evaluation
After a deferral the FAA writes, and most letters list items to provide, mostly medical records. An FAA physician may review the documents.
If the AME defers your examination, you will receive a letter from the FAA. Most letters will list items you need to provide to the FAA (most will be medical records) regarding your condition(s) or medication(s).
- Stage 4. The FAA's determination
The Federal Air Surgeon, the Manager of the AMCD, or an RFS decides whether to grant an Authorization.
At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a Medical Certificate (Authorization), valid for a specified period, may be granted 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 medical certificate applied for can be performed without endangering public safety during the period in which the Authorization would be in force.
- Stage 4. The FAA's determination
The Federal Air Surgeon, the Manager of the AMCD, or an RFS decides whether to grant an Authorization.
The authority of the Federal Air Surgeon under the special issuance section of part 67 (14 CFR 67.401) is also exercised by the Manager, AMCD, and each RFS.
- Stage 5. The Authorization's requirements
It names the class of certificate, and may set how long it lasts, the tests, examinations or evaluations needed for a new one, and operational or functional limitations.
In granting an Authorization, the Federal Air Surgeon specifies the class of medical certificate authorized to be issued and may do any or all of the following: Limit the duration of an Authorization; Condition the granting of a new Authorization on the results of subsequent medical tests, examinations, or evaluations; State on the Authorization, and any medical certificate based upon it, any operational limitation needed for safety; or Condition the continued effect of an Authorization, and any second- or third-class medical certificate based upon it, on compliance with a statement of functional limitations issued to the person in coordination with the Director of Flight Standards or the Director's designee
- How it ends
With a valid Authorization, a certificate of the appropriate class may be issued if the pilot is otherwise eligible. It expires no later than the end of the validity period, or when the Authorization is withdrawn.
A medical certificate of the appropriate class may be issued to a person who fails to meet one or more of the established medical standards if that person possesses a valid agency issued Authorization and is otherwise eligible.
- How it ends
With a valid Authorization, a certificate of the appropriate class may be issued if the pilot is otherwise eligible. It expires no later than the end of the validity period, or when the Authorization is withdrawn.
An airman medical certificate issued in accordance with the special issuance section of part 67 (14 CFR 67.401), shall expire no later than the end of the validity period or upon the withdrawal of the Authorization upon which it is based.
Good to know
Each AASI has its own criteria
DetailsEach AASI has its own specialized clinical criteria, by which an examiner may reissue a certificate to an applicant with a history of an initially disqualifying condition, if otherwise qualified.
FAA source: Special Issuance, Each AASI has its own criteria
Each AASI has their own specialized clinical criteria, by which an Examiner may reissue a medical certificate to an applicant with a medical history of an initially disqualifying condition, if otherwise qualified.
Does everyone follow the same process?
DetailsThe FAA's sheets for some conditions set their own order. The ADHD fast-track sheet, for one, has the pilot make an appointment with a licensed psychologist or neuropsychologist first; once its steps are done, the pilot sees the examiner and brings the completed FAA ADHD Summary, the evaluator's report and the records reviewed. That track is not a Special Issuance as such. The ADHD Summary may allow the examiner to issue; if not, the exam must be submitted as deferred.
FAA source: Special Issuance, Does everyone follow the same process?
Find and make an appointment with a doctoral level ( PhD or PsyD ) licensed psychologist or neuropsychologist … When you have accomplished all of the above: … See your AME for the exam portion; … Bring all the following to your AME visit: … Completed FAA ADHD Summary; … Actual clinical summary report from the psychologist or neuropsychologist; … Any records reviewed by the psychologist or neuropsychologist. … The FAA ADHD Summary may allow the AME to issue a medical certificate for pilots, … If the AME is not able to issue, they must submit your exam as DEFERRED.
How documents reach the FAA
DetailsThe FAA's sheet on submitting documents for insulin-treated diabetes (the CGM option), for one, calls an upload by the examiner the fastest and most efficient way to submit reports, and allows the pilot to mail paper copies instead, but not both.
FAA source: Special Issuance, How documents reach the FAA
The fastest and most efficient way to submit reports to the FAA is through your AME as a direct upload. … As an alternative to your AME uploading digital reports, you may mail the diabetes information in paper format … If your documents have been uploaded by your AME using the AMCS document upload feature, DO NOT also mail the documents.
What the FAA tells pilots
DetailsThe FAA's pilot page says a certificate under a Special Issuance authorization requires more rigorous medical information or testing, and that its duration is usually more restrictive. It adds that a pilot with one may usually operate an aircraft in the same manner as a pilot with an unrestricted certificate.
FAA source: Special Issuance, What the FAA tells pilots
A medical certificate issues under a Special Issuance authorization requires more rigorous medical information and/or testing documentation to ensure aviation safety. Additionally, its duration is usually more restrictive. However, an airman with a Special Issuance medical certificate may usually operate an aircraft in the same manner as an airman with an unrestricted medical certificate.
At later exams
At later exams
DetailsTo obtain a new certificate or a Re-Authorization, the Guide says the pilot must show the Federal Air Surgeon again that the duties can be performed without endangering public safety.
FAA source: Special Issuance, At later exams
An airman must again show to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical certificate applied for can be performed without endangering public safety in order to obtain a new medical certificate and/or a Re-Authorization.
It can be withdrawn
DetailsThe Guide lists when an Authorization may be withdrawn. The list begins with an adverse change in the holder's medical condition, and includes not providing medical information the Federal Air Surgeon reasonably needs.
FAA source: Special Issuance, It can be withdrawn
An Authorization granted to a person who does not meet the applicable medical standards of part 67 may be withdrawn, at the discretion of the Federal Air Surgeon, at any time if: There is adverse change in the holder's medical condition; … The holder fails to provide medical information reasonably needed by the Federal Air Surgeon for certification under the special issuance section of part 67
Requirements for your condition
Look up a condition to see which pathways the FAA's documents put it on, with the FAA's own documents.
Conditions whose FAA guidance includes Special Issuance: conditions whose FAA guidance includes Special Issuance
Many conditions have more than one pathway. Open a condition to see when its FAA guidance uses this one.
- Acoustic neuroma
- Acute lymphocytic leukemia (ALL)
- ADHD
- Alzheimer's disease or dementia
- Aortic insufficiency
- Arthritis
- Asthma
- Atrial fibrillation
- AVM of the brain or spinal cord
- Barrett's esophagus
- Bell's palsy
- Blood clots (DVT and PE)
- Blood disorders
- Bone infection (osteomyelitis)
- BPPV (positional vertigo)
- Brain abscess, encephalitis or meningitis
- Brain aneurysm (not ruptured)
- Brain bleed
- Brain tumor
- Breast cancer
- Bronchiectasis
- Cerebral palsy
- Chiari malformation
- Chronic kidney disease
- Chronic lymphocytic leukemia (CLL/SLL)
- Cirrhosis
- Cochlear implant
- Cognitive or mental impairment
- Colitis, Crohn's disease or IBS
- Colon cancer
- Concussion and head injury
- Conductive keratoplasty (CK)
- Congenital heart conditions
- Congenital sucrase-isomaltase deficiency (CSID)
- COPD
- Coronary heart disease
- Cystic fibrosis
- Depression or anxiety treated with an antidepressant
- Diabetes controlled by diet
- Diabetes treated with medication
- Dystonia
- Endocarditis
- Enlarged spleen (splenomegaly)
- Esophageal varices
- Essential tremor
- Fibromuscular dysplasia
- Gallstones
- GERD (acid reflux)
- GI procedures (EGD, colonoscopy)
- Glaucoma
- Guillain-Barre syndrome
- Heart murmur
- Heart transplant
- Heart valve replacement
- Hepatitis C
- Hernia
- Hiatal hernia
- High blood pressure
- HIV
- Hormone replacement therapy (female)
- Huntington's disease
- Hydrocephalus
- Hyperthyroidism
- Hypertrophic cardiomyopathy (HCM)
- Hypothyroidism
- Immune thrombocytopenia (ITP)
- Insulin-treated diabetes (first and second class)
- Insulin-treated diabetes (third class)
- Kidney cancer
- Kidney stones
- Labyrinthitis and vestibular neuritis
- Liver transplant
- Low testosterone (hypogonadism)
- Lymphoma and Hodgkin's disease
- Melanoma
- Meniere's disease
- Middle ear problems
- Migraine and chronic headache
- Mitral valve disease
- Multiple sclerosis
- Myasthenia gravis
- Narcolepsy and idiopathic hypersomnia
- Neuralgia
- Neurofibromatosis
- Neuropathy
- Optic neuritis
- Outer ear problems
- Pacemaker
- Paraplegia
- Parkinson's disease
- Paroxysmal atrial tachycardia
- Pectus excavatum
- Perilymph fistula
- Polio
- Polycystic kidney disease
- Polycystic ovarian syndrome (PCOS)
- PPPD (persistent postural perceptual dizziness)
- Prediabetes
- Premature atrial contractions (PACs)
- Primary hemochromatosis
- Prostate cancer
- Pseudotumor cerebri
- Psoriasis
- Seizures and epilepsy
- Sleep apnea
- Stroke or TIA
- Superior canal dehiscence (SSCDS)
- Syncope (fainting)
- Testicular cancer
- Tourette syndrome or tic disorder
- Transient global amnesia (TGA)
- Unexplained loss of consciousness (ULOC)
- Weight loss management
- Wolff-Parkinson-White (WPW)
FAA sources for this page
If Crosscheck's wording and the FAA's differ, the FAA's document is the one that counts.
- Authorization for Special Issuance and AASIFAA date 10 March 2023
- How do I get a Medical Certificate and what to expect during the AME examinationFAA date 14 May 2026
- ADHD Fast Track Evaluation – General InformationFAA date 30 October 2024
- ITDM (CGM) – Submitting Documents for Initial and RenewalFAA date 30 August 2023
- Authorization for Special Issuance and AME Assisted Special Issuance (AASI)FAA date 28 August 2024
- Special IssuancesFAA date 28 August 2024
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.
Where Crosscheck's FAA information comes fromOfficial FAA references