Special Issuance
Your Roadmap Back to the Cockpit
A cardiac event doesn't have to end your flying career. Dr. Davenport has guided thousands of pilots through the FAA Special Issuance process — he wrote the book on it.
Your Cardiologist Treats Your Heart.
We Get You Back in the Air.
FAA Special Issuance lets pilots fly again after a disqualifying cardiac event. It requires specific tests, precise timing, and documentation that speaks the FAA's language — not just a standard cardiology workup.
Dr. Davenport is the FAA's Cardiovascular Specialty Consultant and author of every USAF cardiac waiver guide since 2009. He doesn't just understand the process — he helped design it.
We've Seen Your Diagnosis Before
Click any condition below to see your path back to the cockpit. Every cardiac condition has a different route through Special Issuance — Dr. Davenport knows each one.
Waiting Period
1st and 2nd Class (airline and commercial pilots): 6 months after your heart attack before testing can begin.
3rd Class (private pilots): No mandatory FAA waiting period, though your treating doctor should clear you first. Testing can begin once you're medically stable.
Required Testing
- Hospital records — Your admission paperwork, any procedure reports, discharge summary, and all test results from your cardiac event.
- Nuclear stress test (1st/2nd Class) — A treadmill test where a small amount of radioactive tracer is injected to photograph blood flow through your heart muscle. This shows whether any areas of your heart aren't getting enough blood. Must be done at least 6 months after your event.
- Exercise stress test (3rd Class) — A treadmill test called a "Bruce protocol" where you walk at increasing speed and incline for at least 9 minutes (6 minutes if you're 70 or older) while hooked up to an ECG. The goal: demonstrate your heart can handle real-world physical stress.
- Coronary angiogram (1st/2nd Class) — An imaging procedure where dye is injected through a catheter so doctors can see your coronary arteries in detail. Includes films and drawings of your artery anatomy.
- Blood work — Fasting cholesterol panel, blood sugar, and hemoglobin A1C (a measure of your average blood sugar over 3 months).
- Cardiologist status report — A letter from your heart doctor covering your current condition, medications, how well you're functioning, and prognosis.
Your Roadmap
Typical Timeline
1st/2nd Class: 8–12 months from event to authorization (6-month wait + testing + 2–3 months FAA review).
3rd Class: 4–8 months, depending on recovery speed and how complete your initial submission is.
What Makes a Strong Case
- Good heart function after the event — the FAA wants to see an ejection fraction (how well your heart pumps) above 40%
- Clean stress test with no signs of ongoing blood flow problems
- Risk factors under control: blood pressure, cholesterol, blood sugar, no smoking
Class Differences
1st and 2nd Class require nuclear stress testing and a coronary angiogram — more extensive imaging than 3rd Class. Third Class applicants need only the treadmill stress test, not nuclear imaging or catheterization. However, if your treadmill test shows any abnormalities, additional imaging may be required.
Good news about renewals: After your first approval, annual renewals are much simpler. As of 2024, you no longer need a follow-up stress test every year as long as your cardiologist confirms everything is stable. Your AME can renew your certificate same-day through the AASI program.
Waiting Period
Standard stent (1st/2nd Class): 3 months after the procedure.
Left main coronary artery stent (1st/2nd Class): 6 months — this artery supplies most of the heart, so the FAA requires a longer observation period.
3rd Class: No mandatory FAA waiting period for any stent type, though your cardiologist should clear you first.
Required Testing
- Hospital records — All records from the stent procedure, including the make, model, and serial number of your stent, where it was placed, and its dimensions.
- Nuclear stress test (1st/2nd Class) — A treadmill test combined with radioactive imaging to show blood flow through your heart. Must be done after the waiting period.
- Exercise stress test (3rd Class) — A treadmill test (Bruce protocol) for at least 9 minutes with continuous ECG monitoring.
- Coronary angiogram (1st/2nd Class) — Detailed imaging of your coronary arteries to confirm the stent is working and blood flow is good.
- Blood work — Fasting cholesterol panel, blood sugar, and hemoglobin A1C.
- Cardiologist status report — Current condition, medications, functional ability, and prognosis.
Your Roadmap
Typical Timeline
Standard stent, 1st/2nd Class: 5–9 months (3-month wait + testing + FAA review).
LMCA stent, 1st/2nd Class: 8–12 months (6-month wait + testing + FAA review).
3rd Class: 3–6 months total, assuming clean recovery.
What Makes a Strong Case
- Clean stress test with no evidence of reduced blood flow (no "reversible ischemia")
- Good heart pump function (ejection fraction above 40%)
- Stable on medications with risk factors well controlled
Class Differences
The biggest difference is in testing: 1st/2nd Class requires both nuclear stress testing and a coronary angiogram. 3rd Class needs only a standard exercise treadmill test. Also, 1st/2nd Class has mandatory waiting periods (3 or 6 months), while 3rd Class has none.
Waiting Period
1st and 2nd Class: 6 months after surgery before testing can begin.
3rd Class: No mandatory FAA waiting period, but you need to be released by your surgeon and cardiologist.
Required Testing
- Hospital records — Complete surgical records including operative report, admission paperwork, and discharge summary.
- Nuclear stress test (1st/2nd Class) — Treadmill stress test with radioactive imaging to evaluate blood flow through your heart and bypass grafts. Done no sooner than 6 months after surgery.
- Exercise stress test (3rd Class) — Treadmill stress test (Bruce protocol), at least 9 minutes, with continuous ECG monitoring.
- Coronary angiogram (1st/2nd Class) — Detailed imaging showing your bypass grafts and native arteries.
- Blood work — Fasting cholesterol panel, blood sugar, and hemoglobin A1C.
- Cardiologist status report — Assessment of your current cardiac status, medications, functional ability, and long-term outlook.
Your Roadmap
Typical Timeline
1st/2nd Class: 9–14 months from surgery to authorization. Bypass surgery is major; recovery takes longer, and the FAA wants to see stable results.
3rd Class: 5–9 months, depending on recovery and submission completeness.
What Makes a Strong Case
- All bypass grafts functioning well with no signs of blockage or reduced blood flow
- Good heart pump function (ejection fraction above 40%)
- Clean stress test and well-controlled risk factors (blood pressure, cholesterol, diabetes)
Class Differences
Same structure as other coronary heart disease: 1st/2nd Class requires nuclear imaging and angiography, while 3rd Class needs only an exercise treadmill test. The waiting period is 6 months for 1st/2nd Class and no mandatory wait for 3rd Class.
Waiting Period
Valve replacement (all types): 6 months for 1st/2nd Class. No mandatory wait for 3rd Class.
Valve repair: 3 months (90 days) for all classes.
Mitral valve repair (5+ years post-op, stable): May qualify for a simpler pathway where your AME can issue your certificate directly without FAA review.
Required Testing
- Hospital records — Surgical report, discharge summary, and pathology report if the old valve was removed. For replacement valves: the device make, model, serial number, and size.
- Echocardiogram — An ultrasound of your heart that shows how well your new or repaired valve is working. Must be done within 90 days of your FAA exam.
- Exercise stress test — Treadmill test (Bruce protocol) with 12-lead ECG to demonstrate your heart handles exertion well.
- 24-hour Holter monitor — A portable ECG device you wear for a full day. Records every heartbeat to detect rhythm problems that might not show up in a short office visit.
- Blood work — Fasting cholesterol, blood sugar, hemoglobin A1C.
- INR monitoring (mechanical valves only) — If you have a mechanical valve and take a blood thinner (warfarin), the FAA needs 6 months of monthly blood-clotting results showing your levels are in the safe range.
- Cardiologist report — Type of valve/repair, any complications, medications, and how well you're doing.
Your Roadmap
Typical Timeline
Valve replacement: 9–14 months from surgery to authorization for 1st/2nd Class. 5–9 months for 3rd Class.
Valve repair: 5–9 months for 1st/2nd Class. 3–6 months for 3rd Class.
What Makes a Strong Case
- Echo shows the valve is working well — no significant leaking, no narrowing, good blood flow
- Stable heart rhythm — no new arrhythmias (irregular heartbeats) after surgery
- For mechanical valves: blood thinner levels consistently in the therapeutic range (at least 80% of readings)
Class Differences
The basic testing requirements are similar across all classes for valve conditions. The main difference is that 3rd Class has no mandatory waiting period for replacement. Also, mitral valve repair patients who are 5+ years out with no complications may qualify for an expedited pathway where the AME can issue directly.
Waiting Period
After ablation (a procedure to fix the electrical signals causing the irregular rhythm): 3 months.
After cardioversion (a procedure to shock the heart back to normal rhythm): 1 month.
If managed with medication only (rate or rhythm control): No specific waiting period — you can apply once your condition is stable and controlled.
Required Testing
- 24-hour cardiac monitor (Holter) — Worn for a full day to record every heartbeat. The FAA looks at your average heart rate, maximum heart rate, and whether you have any long pauses. Your average must be under 100 and max non-exercise rate under 120.
- Exercise stress test — Treadmill test (Bruce protocol) with ECG monitoring.
- Echocardiogram — Heart ultrasound to check chamber sizes and pump function.
- Thyroid function tests — Blood tests to rule out thyroid problems, which can cause or worsen irregular heartbeats.
- Sleep study — To rule out sleep apnea, which is a common trigger for AFib.
- Cardiologist status report — Must address your management approach, symptom control, medication plan, and a "CHA2DS2-VASc" score (a standard tool doctors use to assess stroke risk in AFib patients).
Your Roadmap
Typical Timeline
After ablation: 5–8 months (3-month wait + testing + FAA review).
Medication-managed: 3–6 months once stable and controlled.
What Makes a Strong Case
- Heart rate well controlled on monitoring — average under 100, max under 120, no long pauses
- If your stroke risk score is 2 or higher, you must be on a blood thinner and tolerating it well
- No stroke, mini-stroke (TIA), or blood clot events since diagnosis
Class Differences
The requirements for AFib and flutter are the same across all pilot certificate classes — 1st, 2nd, and 3rd Class all follow the same protocol.
Waiting Period
After ablation (a catheter procedure that fixes the abnormal electrical pathway): 3 months.
After cardioversion: 1 month.
For PVCs, heart block, and other rhythm issues: No mandatory waiting period — depends on the specific condition and evaluation results.
Required Testing
- 24-hour Holter monitor — A portable ECG recorder you wear for a full day to capture your heart rhythm continuously.
- Echocardiogram — Ultrasound to check heart structure and function.
- Exercise stress test — Treadmill test to see how your rhythm behaves during exertion. For PVCs, the FAA wants to see them disappear with exercise.
- Resting ECG — Standard heart tracing.
- Cardiologist report — Detailed assessment of the arrhythmia type, treatment, and prognosis.
Your Roadmap
Typical Timeline
Post-ablation: 5–8 months (3-month wait + testing + FAA review).
Simpler arrhythmias (isolated PVCs, mild heart block): Some of these can be resolved at your AME visit if the workup is clean — your AME may be able to issue your certificate without sending it to the FAA.
What Makes a Strong Case
- No underlying structural heart disease — the arrhythmia is an electrical issue, not a muscle or valve problem
- Post-ablation: clean Holter monitor with no recurrence of the arrhythmia
- For PVCs: they go away during exercise (a sign they're benign)
Class Differences
Arrhythmia requirements are the same across all pilot certificate classes. The FAA evaluates arrhythmias based on the specific type and severity, not the class of medical you're seeking.
What You Need to Know
The FAA evaluates cardiomyopathy on a case-by-case basis. The key factor is how well your heart pumps, measured as your "ejection fraction" (EF) — the percentage of blood your heart pushes out with each beat. A normal EF is 55–70%. The FAA generally requires at least 40% for certification.
Dilated Cardiomyopathy
May be considered for all classes (1st, 2nd, and 3rd) if your ejection fraction is at least 40%, you have no defibrillator (ICD), and your condition is stable on medication.
Hypertrophic Cardiomyopathy (HCM)
Currently limited to 3rd Class only — the FAA does not certify HCM pilots for 1st or 2nd Class. To qualify for 3rd Class, you must be over 40, have no history of fainting, no dangerous heart rhythm problems, and no immediate family members who died of sudden cardiac arrest. We'll review your specific situation and give you an honest assessment.
Required Testing
- Echocardiogram — Heart ultrasound showing chamber sizes, wall thickness, and pump function. Required annually for recertification.
- 24-hour Holter monitor — Continuous heart rhythm recording to detect dangerous rhythms.
- Nuclear stress test — Treadmill test with imaging to evaluate blood flow.
- Cardiac catheterization — May be required depending on the specific type and severity.
- Cardiologist report — Detailed assessment including medications and prognosis.
Your Roadmap
Typical Timeline
Varies significantly by condition type — generally 6–12+ months. Cardiomyopathy cases often require the FAA's Cardiology Panel to review, which can add time. We'll give you a realistic estimate based on your specific situation.
What Makes a Strong Case
- Ejection fraction at or above 40% — this is the FAA's threshold
- Stable condition on current medications with no recent decline
- No defibrillator (ICD) implanted, no dangerous rhythm disturbances
Waiting Period
All classes: 2 months (60 days) after pacemaker implantation. This allows the device and leads to stabilize in your heart.
Required Testing
- Hospital records — All records from the implant procedure, including the generator and lead specifications (make, model, serial numbers).
- Cardiologist narrative — A detailed report covering your current cardiac condition, why the pacemaker was needed, how it's programmed, your functional capacity, and all medications.
- 24-hour Holter monitor — Continuous heart rhythm recording showing how the pacemaker is performing, including any pauses, extra beats, or rhythm issues.
- Echocardiogram — Heart ultrasound to evaluate overall heart structure and function.
- Exercise stress test — Treadmill test to demonstrate you can handle physical exertion.
- Blood work — Hemoglobin A1C and cholesterol panel.
Your Roadmap
Typical Timeline
4–8 months from implant to authorization (2-month wait + testing + FAA review). The FAA has a dedicated Pacemaker Status Summary form that streamlines review and can significantly speed up the process.
What Makes a Strong Case
- Pacemaker functioning normally with no complications
- Good heart function overall, no dangerous rhythm problems on monitoring
- Stable condition with a clear reason for the pacemaker (e.g., slow heart rate rather than a more serious underlying disease)
Important update: As of August 2021, the FAA no longer requires an evaluation of whether you are "pacemaker dependent" — this was a significant simplification of the process.
About ICDs (implantable defibrillators): Historically, having an ICD has been disqualifying for all classes. However, in April 2025, the FAA granted its first-ever medical certificate to a pilot with an active ICD — a breakthrough case Dr. Davenport is familiar with. While this is not yet standard policy, if you have an ICD, contact us to discuss your options. We stay at the leading edge of what's possible.
Waiting Period
After surgical repair: 6 months for all classes.
Small, untreated aneurysms under monitoring: No waiting period, but the FAA generally will not certify if the aneurysm exceeds 4.5 cm in diameter.
Required Testing
- Hospital records (if surgical repair) — Operative report, admission and discharge summaries, all diagnostic imaging.
- Exercise stress test — Treadmill test with complete ECG tracings to assess cardiovascular function.
- Cardiovascular evaluation — Comprehensive cardiac exam from a cardiologist or vascular specialist.
- Status report from treating physician — Current condition, treatment plan, and prognosis with detailed narrative.
- Monitoring imaging (untreated/conservatively managed) — Ultrasound or CT scans every 6–12 months showing the aneurysm is stable.
Your Roadmap
Typical Timeline
Post-repair: 8–12 months (6-month wait + testing + FAA review).
Small aneurysm under monitoring: Varies by case — we'll review your imaging and give you a realistic estimate.
What Makes a Strong Case
- Successful repair with no complications and stable follow-up imaging
- For monitored aneurysms: size under 4.5 cm and not growing
- Risk factors under control: blood pressure managed, no smoking, cholesterol treated
Class Differences
The basic requirements are the same across classes. Aortic conditions are evaluated on a case-by-case basis regardless of the class of medical you're seeking.
Not Sure Where Your Condition Fits?
Every case is different. Tell us about your situation — we'll give you an honest answer about your options.
Start Your CaseHow Special Issuance Works
Consultation
Submit our intake form or contact us. We review your situation and tell you honestly whether Special Issuance is viable.
Records & Intake
We send a condition-specific checklist. You gather records; we handle the rest.
Evaluation
Comprehensive assessment — candidacy determination, testing protocol, documentation strategy.
FAA Submission
We prepare and submit your complete package — formatted exactly as the FAA expects.
Authorization
FAA reviews your case. We communicate directly with them as needed. You get cleared to fly.
After Your First Approval?
Renewals are dramatically simpler. Through the AME Assisted Special Issuance (AASI) program, your AME can issue your certificate same-day — no FAA wait. Authorization lasts 5 years with annual follow-up testing.
Special Issuance FAQ
Straight answers to the questions pilots ask most.
It depends on your condition, but here are realistic ranges. A straightforward case with a complete initial submission typically takes 2–3 months for FAA review after you've completed your waiting period and testing. If the FAA requests additional information (common for first-time applications), each request-response cycle adds 2–4 weeks. Complex or unusual cases can take 6–12 months for FAA review alone.
The biggest factor in timeline is completeness of your initial submission. Incomplete packages trigger information requests that add months. That's exactly why working with someone who knows what the FAA expects — before you submit — makes such a difference.
Renewal is a different story. After your first approval, your AME can renew your certificate the same day you walk into their office, through a program called AASI (AME Assisted Special Issuance).
For most cardiac conditions we handle — heart attacks, stents, bypass surgery, valve replacements, AFib — the approval rate is high when the application is done right. The FAA wants to return pilots to flying when it's safe to do so. These aren't automatic denials — they're pathways with clear requirements.
That said, we're honest about every case. Some conditions are more challenging than others. During your initial consultation, we'll review your specific situation and give you a straightforward assessment of your chances — not a sales pitch.
Generally no — not while an initial Special Issuance application is under review. You need the authorization before you can fly. That's why minimizing the processing time matters so much.
There are some limited exceptions. If you hold an existing Special Issuance and you're renewing it, you may be able to continue flying under your current certificate until it expires. We'll clarify your specific situation during consultation.
There are two types of costs: our professional fees for evaluation and case management, and the medical testing costs required by the FAA (stress tests, echocardiograms, blood work, etc.).
Our fees are outlined on our Services page. The medical testing costs depend on your insurance and the specific tests your condition requires. We'll give you a clear picture of what to expect during your initial consultation.
An initial phone or email consultation to discuss your situation is complimentary. We won't ask for a commitment until you understand your path and costs.
Not necessarily. Much of the Special Issuance process — records review, testing coordination, documentation preparation — can be handled remotely. Many of our clients are from across the country and even internationally.
If an in-person evaluation is needed, we're conveniently located near the Dayton, Ohio airport (DAY). But we work with pilots' local cardiologists regularly, coordinating testing to FAA specifications so you don't have to travel unless it's truly necessary.
Cincinnati/Northern Kentucky International Airport (CVG) is less than 50 miles away — featuring advanced security scanners, average TSA wait times under 5 minutes, excellent airline lounges, and rapidly expanding direct flight options across the U.S. and abroad. The Cincinnati area is also home to the Reds and Bengals, and the nearby Kentucky Bourbon Trail makes for a worthwhile side trip.
An FAA denial is not always the final word. You have the right to appeal, and the appeal process can include submitting additional evidence or requesting reconsideration. In some cases, conditions that initially resulted in denial can be re-evaluated as your health improves or as FAA policy evolves.
Our goal is to avoid denial in the first place by submitting a complete, well-documented case. But if a denial does happen, we'll help you understand why and what your options are.
BasicMed is an alternative to the standard FAA medical certificate for private flying (operations that would only need a 3rd Class medical). It uses a regular doctor's exam instead of an AME exam, with fewer testing requirements.
However, there's a catch for cardiac conditions. If you've had a heart attack, coronary disease requiring treatment, valve replacement, or heart transplant, you must first obtain at least one FAA Special Issuance before you can use BasicMed. You can't skip straight to BasicMed with these conditions.
For some pilots, the strategy is: get your first Special Issuance, then transition to BasicMed for subsequent renewals to avoid the ongoing FAA paperwork. Whether this makes sense depends on what class of medical you need (BasicMed only covers 3rd Class operations) and your specific condition. We can help you think through the best long-term approach.
AASI stands for AME Assisted Special Issuance. It's a program that lets your Aviation Medical Examiner (AME) renew your Special Issuance medical certificate right in their office, same day — without sending your paperwork to the FAA in Oklahoma City for review.
Here's how it works: After the FAA approves your first Special Issuance, they give you an authorization letter that's good for up to 5 years. At each annual renewal, you bring your required follow-up testing and a status summary form to your AME. If everything looks good — all the checkboxes on the status summary are in the "yes" column — your AME issues your certificate on the spot.
This is a huge improvement over the old system, where every renewal had to go through FAA review in Oklahoma City, taking weeks or months. AASI makes the annual renewal nearly as fast as a regular medical exam.
Yes. Thousands of pilots have returned to flying after a heart attack through the FAA Special Issuance process. The key requirements are a 6-month waiting period (for 1st/2nd class), passing a nuclear stress test and coronary angiogram, and demonstrating that your heart function and risk factors are well-controlled.
Dr. Davenport has guided hundreds of pilots through this exact process. He wrote the USAF cardiac waiver guides that form the foundation of military and civilian aviation cardiology standards. See the full heart attack roadmap above, or contact us for a free consultation to discuss your specific situation.
True aviation cardiologists — cardiologists who are also FAA Aviation Medical Examiners and understand FAA Special Issuance requirements — are extremely rare. There are only about ten FAA cardiovascular specialty consultants in the entire country.
The good news is that you don't necessarily need a local aviation cardiologist. Much of the Special Issuance process can be handled remotely, including records review, candidacy assessment, and documentation preparation. MACH I works with pilots from every state, coordinating with your local cardiologist when in-person testing is needed.
Contact MACH I for a free initial consultation — phone or in-person — to discuss your case regardless of where you're located.
If your FAA medical certificate has been denied due to a cardiac condition, you have several options. You can submit additional medical documentation for reconsideration, apply for a Special Issuance authorization under 14 CFR section 67.401, or in some cases pursue a formal appeal.
The most common and effective path is the Special Issuance process. An FAA denial for a cardiac condition doesn't mean you can never fly again — it means you need the right medical documentation, formatted the way the FAA expects it, reviewed by a cardiologist who understands aviation medicine standards.
Dr. Davenport regularly helps pilots who have been denied or deferred. As an FAA Cardiovascular Specialty Consultant, he knows exactly what the FAA is looking for and can often identify why a previous application was unsuccessful. Start your case or ask a question.
BasicMed vs. Special Issuance for Cardiac Conditions
Many pilots wonder whether BasicMed can replace the Special Issuance process after a cardiac event. The answer depends on your condition and your goals.
BasicMed requires a one-time Special Issuance first if you've had a heart attack, coronary heart disease requiring treatment, heart valve replacement, or heart transplant. You cannot skip directly to BasicMed with these conditions — the FAA requires at least one successful Special Issuance authorization before you're eligible.
Once you have that initial Special Issuance, BasicMed becomes an option for 3rd class medical operations only — private flying with the aircraft and altitude limitations BasicMed imposes. If you need a 1st or 2nd class medical for commercial or airline operations, Special Issuance remains your only pathway.
Some pilots use a strategic approach: obtain the initial Special Issuance through our practice, then transition to BasicMed for ongoing renewals to avoid the annual FAA paperwork. Dr. Davenport can help you evaluate whether this approach makes sense for your specific situation and flying goals.