What a Special Issuance actually is
Most medical certificates are issued because you meet the standards in Part 67. A Special Issuance is the other route. It exists for pilots who do not meet those standards but who can still show the FAA they can do the job safely.
The regulation is 14 CFR 67.401, and it is worth reading in the FAA's own words rather than mine:
"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 provisions of subparts B, C, or D of this part 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."
14 CFR 67.401(a). Read the section on eCFR.
Three things in that sentence do most of the work.
- Discretion. An Authorization is granted at the discretion of the Federal Air Surgeon. It is not something you qualify for by hitting a number.
- A specified period. It is time-limited by design. That period is often shorter than the standard duration for your class.
- You carry the burden. The applicant shows the FAA the duties can be performed safely, not the other way around.
The same paragraph sets out what happens to the certificate itself:
"An airman medical certificate issued in accordance with this section shall expire no later than the end of the validity period or upon the withdrawal of the Authorization upon which it is based."
14 CFR 67.401(a).
So the certificate is tied to the Authorization underneath it. Two clocks, and the earlier one wins.
Quoted from 14 CFR 67.401, current text as amended by Amdt. 67-23 (90 FR 42525, Sept. 3, 2025). Verified 2026-08-29.
The distinction that trips people upSpecial Issuance is not the same as CACI
I see these used interchangeably all the time and they are genuinely different. If you have a condition on the CACI list and you meet the criteria, you may never need a Special Issuance at all.
| Pathway | Who issues the certificate | What you owe afterwards |
|---|---|---|
| CACIConditions an AME can issue | Your AME, in the office, if you meet the criteria on the FAA's worksheet for that condition. | No FAA Authorization letter. The FAA's own worksheet says documents do not need to be submitted to the FAA. You bring current information to each exam. |
| AASIAME Assisted Special Issuance | The FAA grants the Authorization first. After that, your AME may reissue in the office once the AASI criteria are met. | An Authorization with its own clock, plus the documentation its attachments call for. |
| Special Issuance14 CFR 67.401 | The FAA. Your AME defers, and the Aeromedical Certification Division or a Regional Flight Surgeon makes the determination. | A time-limited Authorization and recurring documentation on the schedule the FAA sets. |
The clearest statement of the CACI difference is on the FAA's own worksheet. It tells the AME to note one of these in Block 60:
"[ ] CACI qualified hypertension. (Documents do not need to be submitted to the FAA.)"
"[ ] Has current OR previous SI/AASI but now CACI qualified hypertension."
"[ ] NOT CACI qualified hypertension. I have deferred. (Submit supporting documents.)"
FAA CACI - Hypertension Worksheet (Updated 04/13/2022). Read the worksheet (PDF).
Notice the middle line. A pilot can move between lanes. Someone who held a Special Issuance for hypertension can end up CACI qualified later, and someone who is CACI qualified today can be deferred at the next exam if things change.
Hypertension is the example the FAA makes easiest to follow. Its disposition table splits three ways: no medication and meeting standards is a straight issue, treatment with three or fewer acceptable medications routes to the CACI worksheet, and four or more medications, uncontrolled pressure, unacceptable medications, or side effects go the other way. Same condition, three outcomes, decided by the detail.
From the FAA's Hypertension Disposition Table and Item 55 guidance. Verified 2026-08-29.
What AASI meansThe middle path: AME Assisted Special Issuance
AASI is the reason a lot of pilots with a Special Issuance never have to wait on Oklahoma City again after the first time. The FAA describes the sequence like this:
"If this is a first-time application for an AASI for the applicable disease/condition, and the airman has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination."
"Following the granting of an Authorization for Special Issuance of a Medical Certificate (Authorization) by the AMCD or RFS, an Examiner may reissue a medical certificate to an applicant with a medical history of an initially disqualifying condition once the AASI's specialized criteria is met and the applicant is otherwise qualified. An Examiner's decision or determination is subject to review by the FAA."
FAA Guide for Aviation Medical Examiners, Special Issuances (last updated August 28, 2024). Read the FAA's page.
So the first one goes to the FAA. After that, if your condition has an AASI and you keep meeting its criteria, your AME can handle the reissue in the office. That last sentence still matters though. The Examiner's decision is subject to review by the FAA.
How you would knowDo I have one?
If you have a Special Issuance, the FAA mailed you a letter. It is called an Authorization for Special Issuance of a Medical Certificate, and pilots usually shorten it to an SI letter or an AASI letter.
The other tell is on the certificate itself. If your expiration date is earlier than the standard duration for your class under 14 CFR 61.23(d), that is usually the Authorization's clock showing through. My duration guide has the standard periods if you want to compare.
What the FAA asks for at renewal, and what governs
This is the part I would most like to give you a clean checklist for, and it is the part where a clean checklist would be a lie. What you owe depends on your condition, your class, and on your own Authorization.
The AME Guide is direct about where the authority sits:
"The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination."
FAA Guide for Aviation Medical Examiners, Special Issuances. Read the FAA's page.
Which means the AME Guide page for your condition tells you what is typical. Your letter tells you what is required. When they differ, the letter wins.
In practice most Authorizations ask for some combination of the Authorization itself, a current status report from your treating physician, and whatever testing your condition calls for, on a stated cadence. The FAA's hypertension guidance, for one, asks the treating physician's report to address whether the condition is stable and for how long, any secondary cause, any co-morbid condition, any history of end organ damage, and your medications with the presence or absence of side effects. Note the FAA's phrasing there. Presence or absence. Side effects get addressed either way rather than left unmentioned.
From the FAA AME Guide's AASI hypertension page. Your own Authorization's attachments govern.
The part nobody mentionsAn Authorization can be withdrawn
Worth knowing before you need to know it. An Authorization is not a permanent grant, and the regulation spells out both when it can be pulled and what happens next.
14 CFR 67.401(f) allows withdrawal "at the discretion of the Federal Air Surgeon, at any time" on five grounds:
- There is adverse change in the holder's medical condition.
- The holder fails to comply with a statement of functional limitations or operational limitations issued as a condition of certification.
- Public safety would be endangered by the holder's exercise of airman privileges.
- The holder fails to provide medical information reasonably needed by the Federal Air Surgeon for certification.
- The holder makes or causes to be made a statement that is the basis for withdrawal under subpart D of part 3.
Read the fourth one twice. Not sending in what the FAA asked for is itself a ground for withdrawal. That is the whole reason the paperwork side of a Special Issuance is worth taking seriously.
If it does happen, 67.401(i) sets out the process: a letter of withdrawal stating the reason, then no later than 60 days after that letter is served you may request in writing that the Federal Air Surgeon review the decision, and that request may be accompanied by supporting medical evidence. A written final decision affirming or reversing the withdrawal is issued within 60 days of receiving the request. A certificate rendered invalid by a withdrawal "shall be surrendered to the Administrator upon request."
Conditions the FAA commonly handles this way
These are 25 of the conditions pilots ask about most, with the pathway the FAA generally uses and a link to the FAA's own page for each. The pathway column is the usual route, not a promise about your case: as the hypertension example above shows, the same condition can land in a different lane depending on how it is treated and controlled.
| Condition | Usual pathway | FAA source |
|---|---|---|
| Hypertension on medication | CACI | AME Guide · worksheet (PDF) |
| Obstructive sleep apnea (OSA) | SI / AASI | AME Guide |
| Type 2 diabetes on oral or non-insulin medication | SI / AASI | AME Guide |
| Insulin-treated diabetes (ITDM) | SI / AASI | AME Guide |
| Depression or anxiety on an FAA-approved SSRI | SI / AASI | AME Guide |
| Coronary artery disease, post heart attack | SI / AASI | AME Guide |
| Coronary stent (PCI) | SI / AASI | AME Guide |
| Coronary artery bypass graft (CABG) | SI / AASI | AME Guide |
| Atrial fibrillation | SI / AASI | AME Guide |
| Cardiac pacemaker | SI / AASI | AME Guide |
| Heart valve replacement or repair | CACI | AME Guide · worksheet (PDF) |
| Stroke or transient ischemic attack (TIA) | SI / AASI | AME Guide (PDF) |
| Migraine or chronic headache | CACI | AME Guide · worksheet (PDF) |
| Substance use or dependence (HIMS) | SI / AASI | AME Guide |
| Attention deficit / ADHD | SI / AASI | AME Guide |
| Asthma | CACI | AME Guide · worksheet (PDF) |
| Chronic obstructive pulmonary disease (COPD) | SI / AASI | AME Guide |
| Pulmonary embolism or DVT on anticoagulation | SI / AASI | AME Guide |
| Kidney stones (renal or ureteral calculi) | CACI | AME Guide · worksheet (PDF) |
| Melanoma | SI / AASI | AME Guide |
| Prostate cancer | CACI | AME Guide · worksheet (PDF) |
| Hypothyroidism | CACI | AME Guide (PDF) · worksheet (PDF) |
| Seizure disorder or epilepsy | SI / AASI | AME Guide (PDF) |
| Traumatic brain injury (TBI) | SI / AASI | AME Guide (PDF) |
| Bariatric surgery | SI / AASI | AME Guide |
Every link above was checked against the FAA's live page on 2026-08-29. The FAA revises this material, sometimes without notice, so treat the FAA's page as current and this table as a directory.
Keeping the cycle straightHow Pilot Medical Guardian helps
A Special Issuance turns a medical into a recurring paperwork obligation, usually on a longer cycle than anyone can hold in their head. The lab you need 90 days before the exam. The status report your doctor has to write. The Authorization's own expiration, which may land before your certificate's.
Pilot Medical Guardian keeps that cycle in one place. You record your Authorization and its dates, and the app builds a requirements checklist for your condition drawn from the FAA's own AME Guide, with the source cited on every line and a link to the FAA's page. Each item carries its cadence, takes the document you scan for it, and can hold a reminder you set. It is a privacy-first app for iPhone, iPad, and Mac: your records stay on your own device and iCloud, and I can never see them.
What it does not do is tell you what your own Authorization requires. Notice the line under each item in that screenshot: typical, confirm against your authorization letter. That is deliberate, and it is the same thing the FAA says. The AME Guide describes what is generally expected for a condition. Your letter's attachments are what govern for you, and no app can read your letter for you.
It is an information and record-keeping tool. It shows you the FAA's material and tracks your dates and documents. It does not make any determination about your certification, and it never advises you on what to disclose. You stay in control.
Free to download. Your medical data stays on your device and your own iCloud, and this website never sees it. Here's exactly how that works.
FAA Special Issuance FAQ
What is an FAA Special Issuance?
Under 14 CFR 67.401, at the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a Medical Certificate, valid for a specified period, may be granted to a person who does not meet the medical standards in subparts B, C, or D of Part 67, if that person shows the duties of the class applied for can be performed without endangering public safety. A medical certificate issued under that section expires no later than the end of the validity period, or upon withdrawal of the Authorization it is based on.
Is CACI the same thing as a Special Issuance?
No. CACI is a pathway where your AME can issue the certificate in the office if you meet the criteria on the FAA's worksheet for that condition. The FAA's CACI Hypertension Worksheet has the AME note in Block 60 that the applicant is CACI qualified, and states in parentheses that documents do not need to be submitted to the FAA. A Special Issuance is different: the FAA grants a time-limited Authorization, and you owe documentation on a recurring schedule.
What is an AASI?
AASI stands for AME Assisted Special Issuance. The FAA AME Guide describes it this way: a first-time application for an AASI condition must be deferred by the Examiner to the Aeromedical Certification Division or Regional Flight Surgeon for the initial determination. After the FAA grants the Authorization, an Examiner may reissue the certificate once the AASI's specialized criteria are met and the applicant is otherwise qualified. The Guide adds that an Examiner's decision or determination is subject to review by the FAA.
How would I know if I have a Special Issuance?
If you have one, the FAA mailed you an Authorization for Special Issuance of a Medical Certificate. Another common sign is that your certificate's expiration date is earlier than the standard duration for your class under 14 CFR 61.23(d), because the Authorization is running its own clock. Only your AME and the FAA can tell you what applies to your situation.
What documents does the FAA want at each renewal?
It depends on your condition and on your own Authorization. The FAA AME Guide states that the Authorization letter is accompanied by attachments that specify the information that treating physicians must provide for the reissuance determination. The AME Guide's page for a condition describes what is typically expected, but your Authorization letter and its attachments are what govern for you.
Can an FAA Authorization be withdrawn?
Yes. 14 CFR 67.401(f) allows an Authorization or SODA to be withdrawn at the discretion of the Federal Air Surgeon at any time on five listed grounds, including an adverse change in the holder's medical condition and failure to provide medical information reasonably needed for certification. 67.401(i) sets the procedure: a letter of withdrawal stating the reason, 60 days for the holder to request review in writing with supporting medical evidence, and a written final decision within 60 days of receiving that request.
What is a SODA, and how is it different from an Authorization?
Under 14 CFR 67.401(b), a Statement of Demonstrated Ability may be granted instead of an Authorization to a person whose disqualifying condition is static or nonprogressive. The regulation says a SODA does not expire and authorizes a designated AME to issue a certificate of a specified class if the examiner finds the condition described on its face has not adversely changed. Not expiring is not the same as permanent: a SODA can still be withdrawn under 67.401(f).
This guide describes the FAA's own rule (14 CFR 67.401) and the FAA's Guide for Aviation Medical Examiners in plain language. It is an information resource. It is not medical, legal, or FAA compliance advice, and it is not affiliated with or endorsed by the FAA. Whether you require a Special Issuance, what your Authorization obligates you to provide, and whether any certificate covers a given operation are determined by the FAA and its regulations. Always rely on the official FAA sources linked above and on your own Authorization letter.