Guide for Aviation Medical Examiners
Special Issuances

Third-Class AME Assisted
Coronary Heart Disease

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.

This AASI is presently restricted to the issue of a third-class airman medical certificate for an applicant with a history of Angina Pectoris; Atherectomy; Brachytherapy; Coronary Bypass Grafting; Myocardial Infarction; Percutaneous Transluminal Angioplasty (PTCA); Rotoblation; or Stent Insertion. First- and second-class applicants must be deferred to the FAA.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of 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.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• A current status report performed within the past 90 days in accordance with the CHD Protocol; and
• A current maximal GXT – See GXT Protocol.

The Examiner must defer to the AMCD or Region if:

• The applicant complains of chest pain at any time (exclude chest pain with a firm diagnosis of non-cardiac causes of chest pain);
• The applicant has another event (myocardial infarction, or restenosis requiring CABG, atherectomy, brachytherapy, PTCA, or stent);
• The applicant for whatever reason is placed on a long acting nitrate;
• The applicant’s risk factors are inadequately controlled; or
• Has any reason for not renewing an AASI – See GXT Protocol.