§ 68.9 Special Issuance process. ( a ) *General.* An individual who has met the qualifications to operate an aircraft under § 61.113(i) of this chapter and is seeking to act as a pilot in command or serve as a required flightcrew member under that section must have completed the process for obtaining an Authorization for Special Issuance of a Medical Certificate for each of the following: ( 1 ) A mental health disorder, limited to an established medical history or clinical diagnosis of— ( i ) A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
( ii ) A psychosis, defined as a case in which an individual— ( A ) Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
( B ) May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
( iii ) A bipolar disorder; or
( iv ) A substance dependence within the previous 2 years, as defined in § 67.307(a)(4) of this chapter.
( 2 ) A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following: ( i ) Epilepsy;
( ii ) Disturbance of consciousness without satisfactory medical explanation of the cause; or
( iii ) A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
( 3 ) A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following: ( i ) Myocardial infarction;
( ii ) Coronary heart disease that has required treatment;
( iii ) Cardiac valve replacement; or
( iv ) Heart replacement.
( b ) *Special rule for cardiovascular conditions.* In the case of an individual with a cardiovascular condition, the process for obtaining an Authorization for Special Issuance of a Medical Certificate shall be satisfied with the successful completion of an appropriate clinical evaluation without a mandatory wait period.
( c ) *Special rule for mental health conditions.* ( 1 ) In the case of an individual with a clinically diagnosed mental health condition, the ability to operate an aircraft under § 61.113(i) of this chapter shall not apply if— ( i ) In the judgment of the individual's State-licensed medical specialist, the condition— ( A ) Renders the individual unable to safely perform the duties or exercise the airman privileges required to operate an aircraft under § 61.113(i) of this chapter; or
( B ) May reasonably be expected to make the individual unable to perform the duties or exercise the privileges required to operate an aircraft under § 61.113(i) of this chapter; or
( ii ) The individual's driver's license is revoked by the issuing agency as a result of a clinically diagnosed mental health condition.
( 2 ) Subject to paragraph (c)(1) of this section, an individual clinically diagnosed with a mental health condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that mental health condition.
( d ) *Special rule for neurological conditions.* ( 1 ) In the case of an individual with a clinically diagnosed neurological condition, the ability to operate an aircraft under § 61.113(i) of this chapter shall not apply if— ( i ) In the judgment of the individual's State-licensed medical specialist, the condition— ( A ) Renders the individual unable to safely perform the duties or exercise the airman privileges required to operate an aircraft under § 61.113(i) of this chapter; or
( B ) May reasonably be expected to make the individual unable to perform the duties or exercise the privileges required to operate an aircraft under § 61.113(i) of this chapter; or
( ii ) The individual's driver's license is revoked by the issuing agency as a result of a clinically diagnosed neurological condition.
( 2 ) Subject to paragraph (d)(1) of this section, an individual clinically diagnosed with a neurological condition shall certify every 2 years, in conjunction with the certification under § 68.3(b)(3), that the individual is under the care of a State-licensed medical specialist for that neurological condition.
[Docket FAA-2016-9157, Amdt. 68-1, 82 FR 3165, Jan. 11, 2017, as amended by Docket No. FAA-2021-1040, Amdt. Nos. 61-152, 87 FR 71238, Nov. 22, 2022]