Prior to 2013, an Aviation Medical Examiner was limited to one of two options when they completed a flight physical:
-
The airman met all qualifications with no discrepancies and could be issued their certificate
-
The airman did not meet the above criteria and would have to be deferred to the FAA[1]
Given that the average age of pilots in America has been in the mid-40s for the last couple of decades[2] you can imagine that not everyone was leaving their exam with their medical certificate. By 2010 it was estimated that 34-37% of Americans in their mid-40s had high blood pressure[3], which would have been disqualifying. The average American is not necessarily the average pilot, but still, you can see how there were a lot of pilots that were getting stuck with their medical being deferred to the FAA. As we previously discussed, that process can really eat away at some time.
Not only was this a problem for pilots, but it was also a problem for the FAA Aeromedical Certification Division. They had mountains of cases to review and very many were quite stable and presented no danger to flying.
One way to help alleviate the delay for pilots and the burden on the FAA was to figure out what were some of the most common medical conditions that were being deferred, yet were very stable and represented virtually no risk to flight. To meet the criteria, each condition had to be common, low risk, have easy lines of demarcation before changing risk level, and not be considered responsible for accidents or mishaps.[1]
This developed into what is now known as Conditions AMEs Can Issue, or CACI, and was active by the start of 2014. Released under Dr. James R Frasier, the Federal Air Surgeon at the time, the initial list of conditions that qualified for CACI numbered 12 and included:[4]
- Arthritis
- Asthma
- Colitis
- Glaucoma
- Hepatitis C – Chronic
- Hypertension
- Hypothyroidism
- Migraine and Chronic Headache
- Pre-Diabetes
- Prostate Cancer
- Renal Cancer
- Testicular Cancer
Under specific guidelines, assuming the pilot met all the criteria, an Aviation Medical Examiner could issue a medical certificate to a pilot for one of the above conditions. Previously the pilot would have been deferred and have had to receive a Special Issuance from the FAA.
The list of CACI conditions has since expanded. All of the original conditions are still available via CACI, but more continue to be added and include:[5]
- Bladder Cancer
- Breast Cancer
- Chronic Immune Thrombocytopenia
- Chronic Kidney Disease
- Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)
- Colon Cancer
- Essential Tremor
- Mitral Valve Repair
- Polycystic Ovarian Syndrome
- Primary Hemochromatosis
- Retained Kidney Stone(s)
- Weight Loss Management
The Aviation Medical Examiner’s ability to issue a certificate based on a CACI is predicated on that physician having all the required information. Each condition has a set of guidelines and criteria for issuance. In keeping with Dr. Monlux’s article on the Top 10 Ways to Fail Your Next FAA Flight Medical Exam and Dr. McKinley’s article on How to prepare for your next flight physical, it is incumbent on you as the pilot to be proactive in working with your examiner to ensure they have all the information they will need at the time of your exam.
Over time we will take a look at each of these CACI conditions in detail to help you understand how best to engage with your examiner if you should have, or develop, one of these medical conditions.
[4] “Federal Air Surgeon’s Medical Bulletin, vol. 52, no.3,” p. 2.
