Guide for Aviation Medical Examiners

Special Issuances
AME Assisted - All Classes - Mitral and Aortic Insufficiency

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 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 summary of the applicant's medical condition since the last FAA medical examination, including a statement regarding any further episodes of atrial fibrillation; and
• A current 2-D echocardiogram with Doppler performed within last 90 days.

The Examiner must defer to the AMCD or Region if:

• The mean gradient across the valve reaches 40 mm Hg;
• New symptoms occur;
• An arrhythmia develops; or
• The treating physician or Examiner reports the murmur is now moderate to severe (Grade III or IV).