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Guide for Aviation Medical Examiners

Special Issuances - Third-Class AME Assisted - Coronary Heart Disease (CHD)

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;
  • Has any reason for not renewing an AASI - See GXT Protocol; or
  • The applicant develops bleeding that required medical intervention or other cardiac condition not previously diagnosed or reported.

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