Regulatory medical certification policy is an evolutionary process, sometimes slow moving, sometimes not so much. Medicine is a conservative discipline, and regulatory civil aviation medicine is, too. So, when positive things happen within the regulatory halls at FAA, that’s a good thing. The FAA’s medical certification policy goal is to allow medical certification for as many pilots as possible, as long as it can be done safely. For that to happen often takes time, and in some cases, a lot of time.
Special issuances for many of the complex and complicated medical cases seen by the FAA can take many months because of the amount of data required to assess the potential risk for incapacitation. That review process often involves a specialty consultant or one of the Federal Air Surgeon’s consultant panels of physicians. The pathway to medical certification, then, is often long and costly, but the result is frequently a special issuance authorization for the happy pilot.
However, over the last several years an off ramp to the special issuance medical certificate has evolved. The FAA currently employs a CACI (pronounced just like the fabric, khaki), the acronym for Conditions AMEs Can Issue. These medical conditions, in a previous life in the regulatory world, required FAA-approval as special issuance conditions. Previous Federal Air Surgeons, dating back ten or more years, were (and still are) hounded by pilot advocates who complain about those long delays in making certification decisions and getting deferred medical applications and subsequent medical certificates into pilots’ hands. That probably won’t change in the foreseeable future because of federal regulatory process requirements, federal manpower in the FAA, and the complexity of those medical cases mentioned above.
Fortunately, the FAA regulators are reasonably open-minded and always looking to make processes and policies easier for pilots and the government to implement without compromising safety. The CACI program is the most recent iteration of relaxation of bureaucracy born from another special issuance abbreviation called the AME Assisted Special Issuance (AASI) that has been around for many years. The AASI allows an aviation medical examiner to reissue a previously granted special issuance authorization to pilots for several “lower risk” medical conditions. The CACI now takes that one step further, and reduces some medical conditions from the special issuance category completely and renders them to an office issuance by the AME. The FAA is employing a common pilot tool, a checklist (or worksheet) with a list of requirements that the pilot obtains from the treating physician for these CACI conditions. If the worksheet has all the boxes checked in the right way, the AME can issue a normal duration medical certificate to the pilot at the time of the examination.
Currently, there are eighteen medical conditions included as CACIs. It’s a diverse group of conditions, too, from arthritis to breast cancer to migraine headaches to testicular cancer. Although the number of CACIs isn’t increasing quickly, it is increasing, and under the new FAR Part 68 medical regulations from which BasicMed was born, the FAA is charged with increasing the number of CACI conditions, so we can expect to see more of them coming, sometime in the future!