We informed everyone in the past about the federal air surgeon “downgrading,” so to speak, several medical conditions that at prior times required pilots to go through the special issuance medical process. In the past several months, the FAA has added one condition to the list and changed some recommendations on another.
For those of you who don’t recall what a “CACI” is or are new to this acronym, a CACI is a condition an AME can issue. This means that an airman who has one of these conditions must bring to their AME at the time of the FAA examination what the FAA calls a “current status report.” To locate the FAA worksheets for each of the CACIs, go to the FAA's website, click on the medical certification link under Licenses & Certificates, click the link to the “Guide for Aviation Medical Examiners,” and finally click on the link to the “CACI Certification Worksheets.” You could print the worksheet and bring it to your treating physician, who can write a report answering the questions on the sheet; some AMEs will accept the physician just filling in the worksheet by providing some details. Your AME does not have to send these into the FAA medical certification office; instead, he or she maintains them in your records and annotates in the examination section (Block 60) of the online form that you meet the criteria as listed on the worksheet. If you meet all the criteria, the certificate can be issued to with no restrictions. If you don’t meet the criteria, he or she will have to defer issuance and send the information to the FAA, whereupon you will eventually receive a special issuance authorization letter.
The latest condition added to the CACI program is for kidney stones, specifically “retained kidney stones.” A retained stone is one that has not passed and is still residing somewhere in the kidney.
A single episode of “renal colic,” doctor-speak for symptoms of a kidney stone, including pain and blood in the urine, with successful passage of the stone, and without evidence of retained stones, simply requires that the AME annotate the history and resolution of the event on the online application form. You will, however, need to bring in documentation about the stone passage event and some X-ray proof (generally a CT scan) that the stone has passed and there aren’t any retained stones.
If there are retained stones you must fulfill several conditions:
For the hypertension (high blood pressure) on medications CACI, you will need—you guessed it—the CACI hypertension worksheet. Don’t forget to complete this worksheet. For pilots applying for a third class medical certificate, this worksheet must be completed with every FAA examination.
The main change for the high blood pressure CACI is the recommendation that pilots self-ground for seven days after starting a new medication to ensure they do not experience any adverse side effects. Previously, the FAA recommended that pilots be grounded for 14 days. The revised policy allows pilots to take up to three blood-pressure-lowering medications at one time. If you take more than three medications, you can still obtain certification but under a special issuance.
Lastly, the FAA added a worksheet for prostate cancer. Previously, the protocol was included in a table on the “Guide for Aviation Medical Examiners” entitled “Decision Protocols.” Prostate cancer treated with surgery in which the pathology report demonstrates that the tumor was confined completely within the removed gland no longer requires a special issuance. You must bring a letter from the treating urologist that states what kind of procedure you had, when you had it, if there were any complications, and a copy of the pathology report. Cancer treated with radioactive seeds (called brachytherapy) or active surveillance is also included. Your PSA level must be 0.2 or less if you had a prostatectomy. The PSA can be as high as 20 if the cancer was treated “conservatively” and the prostate gland was not removed.