Section 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:(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(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 82 FR 3165 , 5/1/2017; 87 FR 71238 , 12/22/2022