Answered By AOPA
I have been flying with a mild case of asthma for 50 years. I started taking Montelukast four years ago for allergies and asthma. I use a Ventolin inhaler as needed (about 5 times a year). I was issued a Third Class Medical (Special Issuance) in Jan 2020. How do I obtain a Third Class Medical without the Special Issuance?
5 Replies
AOPA Staff Answer
The FAA has created what is termed a CACI (Condition the AME Can Issue) worksheet. If an airmen meets the criteria in this worksheet then the AME has the ability to issue a medical certificate in the office. In some cases, the FAA may instead grant the airman a Special Issuance. A pilot does reserve the right to write a letter to the FAA asking that the Special Issuance be removed. The FAA will require documentation showing that the condition is stable from a treating physician before they will reconsider their decision.
I don't know about my peers, but if this comes back with the appropriate boxes signed and dated by the doc, I cancel the SI and we're on CACI.
But we need also the report of the pulmonary functions to do this....(!)CACI(Asthma4Signature)09.26.19.pdf
Thanks to everyone that responded to my medical question.
In 2018 I received a Third Class Medical and no problems concerning my asthma. In 2020 there was no change in my asthma but they decided to give me a Special Issuance. I am still trying to understand why no change would warrant a Special Issuance. Basic Med may be the way to go.
Thanks again for the comments
Key words here are "know before you go."  Review that worksheet with your personal physician and then your AME before you do the MedXpress paperwork so you know you qualify before you sign and submit the medical.  If you don't meet the CACI criteria, you have to decide whether you want to go through the SI process (with which I gather you are familiar) or drop the medical certificate and to Basic Med instead.  But once you start the SI process, you can't stop -- you either get the SI renewed or you lose the Basic Med option.
Per the FAA AME guide:
If the applicant has mild symptoms that are infrequent, have not required hospitalization, or use of steroid medication, and no symptoms in flight, the Examiner may issue an airman medical certificate. 

Bruce can confirm this, but since neither of the two meds you said you're using are steroidal, you may be able to do that.  Bruce can give you the details.  If he doesn't show up here, contact him via