Guide for Aviation Medical Examiners

Special Issuances
AME Assisted - All Classes - Venous Thromboembolism (VTE) - Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE), and/or Hypercoagulopathies

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.

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 application for an AASI for the above disease/condition and the applicant has all the required 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.

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

• A valid Authorization for Special Issuance granted by the FAA;
• A summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of VTE (DVT, PE) or other complication of hypercoagulopathy (see below*), future treatment plan, and prognosis;
• The name and dosage of all medication(s) used for treatment and/or prevention with comment regarding side effects, if any; and
• If using Coumadin (Warfarin), obtain a minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months (see below*); and
• If using other types of anticoagulants such as NOAC/DOAC (i.e. Xarelto, Eliquis, Pradaxa, Savaysa, etc.), the airman should obtain a statement from their treating/prescribing physician with details of the underlying condition, tolerance of the medication to include the presence or absence of side effects, any bleeding episodes requiring medical attention, and any occurrence/recurrence of deep vein thrombosis or pulmonary embolism.

* The Examiner must defer to the AMCD or Region if:

• If using Coumadin (Warfarin) and more than 20% of INR values are <2.0 or >3.0; or
• If applicant experienced any side effects or bleeding episodes requiring medical attention; or
• The applicant develops emboli, thrombosis, bleeding, or any other cardiac or neurologic condition previously not diagnosed or reported.