Guide for Aviation Medical Examiners

Special Issuances - AME Assisted - All Classes Coronary Heart Disease (CHD)

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to reissue an airman medical certificate 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 for an applicant with a history of Angina Pectoris; Atherectomy; Brachytherapy; Coronary Bypass Grafting; Myocardial Infarction; Percutaneous Transluminal Angioplasty (PTCA); Rotoblation; or Stent Insertion for any class.

The FAA physicians provide the initial certification decision and grant the Authorization for Special Issuance of a Medical Certificate (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 issuance determination. If this is first-time application for an AASI for the above disease/condition, and the airman has all the requisite medical information necessary for a determination, you must defer and submit all of the documentation to the AMCD or your RFS for the initial determination.

Examiners may re-issue an airman medical certificate if the applicant provides the following:

  • Authorization granted by the FAA;
  • Status report - Performed within the past 90 days in accordance with the CHD Protocol; and
  • Current maximal stress test GXT - See GXT Protocol.

The AME must defer medical certification if the applicant has:

  • Any other disqualifying medical conditions or therapy not previously reported;
  • Any other reason for not renewing an AASI;
  • Bleeding that required medical intervention or other;
  • Chest pain - Complains of chest pain at any time (exclude chest pain with a firm diagnosis of non-cardiac causes of chest pain);
  • New Event - Has another event, develops a new condition or identification of an additional cardiac condition not previously reported (such as myocardial infarction, or restenosis requiring CABG, atherectomy, brachytherapy, PTCA, stent or other procedure);
  • Nitrate - Is placed on a long acting nitrate for any reason;
  • Risk factors - Inadequately controlled; or
  • Unacceptable exercise stress test (GXT) results include:
All classes Exercise stress test (EST) PMHR (predicted maximal heart rate) less than 85%;

Time less than 9 minutes--under age 70;
Time less than 6 minutes --age 70 or greater

1 mm ST depression or greater at any time during stress testing - UNLESS the applicant has additional medical evidence such as a nuclear imaging study or a stress echocardiogram showing the absence of reversible ischemia or wall motion abnormalities reviewed and reported by a qualified cardiologist.

NOTE: If ANY of the items from the regular Bruce EST are not acceptable, the AME MUST DEFER. An AME is NOT authorized to recertify a CHD AASI for any class if a nuclear stress test or stress echo is required.

Last updated: Wednesday, March 17, 2021