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More conditions AMEs can issueMore conditions AMEs can issue

Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986
  • Migraine and chronic headaches: The condition must be stable. The diagnosis must be classical or common migraine, chronic tension (or muscle contracture headaches), or cluster headaches. There can be no more than one headache episode per month. In the year just prior to the certification there cannot have been any in-patient hospital admissions and no greater than two outpatient or urgent care visits for any exacerbations. The only daily prophylactic medications are calcium channel agents or beta-blockers. If the headaches are relieved by daily doses of nonsteroidal anti-inflammatory drugs (NSAIDS), that would not be a problem either.
  • Pre-diabetes: This includes several conditions: metabolic syndrome, impaired fasting glucose, insulin resistance, and glucose intolerance. The conditions must be stable. The airman does not have any symptoms of diabetes. The airman may not have had any hypoglycemic events. Fasting sugar must be no less than 70. Current hemoglobin A1C level should be less than 6.5. Should an oral glucose tolerance test have been performed, the sugar at one hour cannot be greater than 1. Metformin is the only oral agent permitted.
  • Renal cancer: Lastly is kidney cancer. The condition must be stable as in all the others. The tumor cannot have extended beyond the capsule, no evidence of metastatic disease can be present, and no paraneoplastic syndromes evident. Any treatments must be completed and the airman back to full activities.

For more information on the AOPA Pilot Protection Services program, visit

Dr. Warren Silberman is the former manager of FAA Aerospace Medical Certification and a doctor of osteopathic medicine. A pilot since 1986, he is recognized nationally as an expert in aerospace/preventative medicine, and is a regular writer forAOPA’s Pilot Protection Services.

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Conditions AMEs can issue (CACIs) allow your aviation medical examiner (AME) to issue your medical certificate in the office for some medical conditions that previously required a special issuance authorization. I am going to go over the final three medical conditions included in the CACI group.

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