Many Airman are confused about the regulations and process of medical certification. This is certainly understandable because it is governed by Federal Laws and Policy statments and Orders. Plus, it is a moving target with changes (usually for the benefit of pilots, but not always) coming every few weeks at this point.
The FAA knows that that there are very, very few pilots in absolutely perfect physical and mental condition. The laws allow for quite a bit of imperfection as long as diseases and conditions do not reduce the safety of people using (or underneath) the National Airspace. As is the case with most of the FARs, the medical regulations are written in the blood of previous accidents. Part 67 explicitly declares in the law that there are 15 Specifically Disqualifying Medical conditions. Presence of any of these conditions in an Airman mandates that the AME not issue a Medical Certificate. However, the Federal Air Surgeon, may, in his or her judgement (14CFR67.401), grant a waiver to specific airmen, under specific conditions to fly. These waivers, known as Special Issuances, are allowed because under the specified conditions, because experience has shown that flight operations can be done safely. Special Issuances are usually time-limited to a year and require medical followup. Recently, it was decided it was safe, after an initial Special Issuance by the FAA Medical Staff, that local AMEs could re-issue a special issuance, provided that the airman provide proof that their condition is stable. This process is called AASI, or AME Assisted Special Issuance and allows the airman to avoid the delay of processing through Oaklahoma CIty. An AASI comes with a Letter of Authorization that lists some specific requirements (for example a letter from your doctor, lab tests, etc.) that must be brought to the AME to check out. The Authorization for the AME to act is usually good for six years.
Beyond the 15 Specifically Disqualifying conditions written into the law, there are also other conditions, not explicitly mentioned in the regs, but still Generally Disqualifying. Some will still require an FAA review, but many have recently become CACI (Conditions AMEs can Issue) when the airman meets the requirements of a worksheet that the FAA provides.
Another pathway for pilots with disqualifying conditions is the SODA or Statement of Demonstrated Ability. A SODA is issued to airmen with a permanent, unchanging condition like amputation, or blindness in one eye. SODAs do not expire, but are only applicable to specific medical class (I, II, or III) for which they are issued.
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