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Aeromedical Forum

Conditions an AME Can Issue (CACI): Your Fast Lane to Certification

Last month we talked about Special Issuances, the route to medical certification when you have a significant medical condition that might affect your flying. This involves getting reports from your treating physician along with tests, sending them to the FAA, getting a flight physical from your AME, waiting four to six weeks and, if all is well, getting your medical.

A few years back the FAA took a look at sorting out those airmen that had a medical condition that might be an issue but were doing well. As such, they were pretty clearly fit to fly. For example, high blood pressure. Hypertension is common. These days most airmen find out that their pressure is up when going to their doctor or AME. They are prescribed a pill that usually does not have side effects. Their blood pressure drops back down to normal and they are fine. Because it was treated early and well, they have no complications such as an enlarged heart, kidney disease or vision impairment. If all of this is true, these guys clearly don’t need the microscopic examination the FAA does so well. For them the CACI was created. Each CACI has a work sheet for your AME to check off.

For hypertension the AME determines that your condition is stable. You have no symptoms due to high blood pressure. Your pressure in the office is at or below 155/95. You are on acceptable medications that don’t usually make you goofy and indeed you are not goofy—at least due to the meds. If all of this is true, voila! He can issue you a medical certificate on the spot without propitiating the FAA. He will indicate that he issued a CACI in his report to the FAA and they may review it. If they agree you’ll get a nice letter from then saying so. It’s pretty unusual for the FAA to reverse an AME on his decision to issue assuming you give him all the facts.

Currently there are eighteen medical conditions with which a medical certificate can potentially be issued under the CACI program. They are arthritis, asthma, bladder cancer, breast cancer, chronic kidney disease, colitis, colon cancer, glaucoma, chronic hepatitis C, hypertension, hypothyroidism, migraine and chronic headache, mitral valve repair, pre-diabetes, prostate cancer, renal cancer, retained kidney stone, testicular cancer. The FAA plans to add additional conditions as time goes by. There are, of course, a few caveats.

There are currently six cancers that could fall under CACI qualification. With each of these, however it is assumed that you are off of chemotherapy, the cancer is currently under control or has been eliminated with no indication of recurrence and that you are having no side-effects from either the cancer or the completed treatment. If that is not the case then it’s off to the Special Issuance path we talked about last month.

What’s an airman with one of these problems to do? First of all ask yourself, “Do I feel fit to fly?” If the answer is a true and honest yes then look up the CACI Worksheet for your condition. Here’s a handy link: Alternately, Google the CACI for your condition. It’s important to get the worksheet fresh from the FAA as some of the qualifications do change from time to time.

Once you have your CACI Worksheet carefully review each of the boxes to be checked off by your AME. Do you fulfill all of the criteria? Does the worksheet call for a statement from your treating physician? For most CACI conditions, the answer to that question is yes. Make a follow-up appointment with your doc and for heaven’s sake bring along a copy of the CACI Worksheet with you! Put it under his nose so he can determine exactly what the FAA is asking of him. Also check beforehand and if there are any lab tests that need to be done make sure that they are ordered. Even if your doc does not think they are necessary the FAA does!

Now you’ve got the statement from your doc. It says what the FAA wants it to say. You’ve got all the required lab tests and they are all within the FAA’s acceptable limits. Sit down and do a recheck of the CACI Worksheet. Is everything A-OK? Great! Make an appointment with your AME and bring all that stuff along. Since you have done your homework you should be able to walk out with a shiny new medical certificate. Good job!

Fly wisely. See you next month.


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