DRIVER HEALTH & MEDICAL CONDITIONS
1. Cardiovascular: Angina (chest pain), Myocardial Infarction (MI or heart attack), Percutaneous Coronary Intervention (PCI) or angioplasty with or without stents, Coronary Artery Bypass Graft ( CABG), valvular heart disease, Permanent Pacemaker Placement (PPP).
2. Endocrine: Diabetes mellitus.
3. Pulmonary: Sleep Apnea, Chronic obstructive pulmonary disease (COPD)
4. Neurological: Transient ischemic attack (TIA or "mini-strokes), Cerebro-vascular accidents (stroke), Traumatic brain injury (TBI).
5. Psychiatric: Depression, Anxiety disorder, Bipolar disease, Attention Deficit Hyperactive Disease
6. Certain medications that you are taking: prescribed opiods, muscle relaxants, anti-depressants, migraine and ADHD medications etc.
Stop here if you have any of the medical conditions listed above, or diagnosed with other conditions, or currently taking prescribed or over the counter medications. Please get a letter from your treating physician now before coming in for your DOT physical in order to save yourself time.
Have your doctor review the requirements and guidelines for your particular medical condition and Include any supporting diagnostic tests or lab work that may be required in their response letter to us.
Your treating doctor may also wish to consult the FMCSA Medical Examiner's Handbook for elaboration, or for further information regarding any other medical conditions not covered here. Have your doctor contact us with any questions.
Federal Diabetes Exemption Program
FMCSA Guidelines/Diabetes Exemption Program Requirements
Federal Motor Carrier Safety Regulation (FMCSR) 49 CFR 391.41(b)(3): "A person is physically qualified to drive a commercial motor vehicle if that person — Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control."
The FMCSA guidelines further state: "As a medical examiner, your fundamental obligation during the assessment of a driver with diabetes mellitus is to establish whether the driver is at an unacceptable risk for sudden death or incapacitation, thus endangering public safety. The risk may be associated with the disease process and/or the treatment for the disease."
Although the risks with hyperglycemia can impair a driver's ability to operate a commercial vehicle safely, the prevention of hypoglycemia is the most critical factor in ensuring safety in driving because of its ability to cause sudden incapacitation. Furthermore, long term complications from diabetes such as retinopathy, neuropathy, nephropathy if severe or uncontrolled can disqualify a driver. Please note that although we are addressing ITDM here, the medical complications of diabetes mentioned here can occur in all diabetics, whether or not they use insulin.
Therefore, it is most important as usual to carefully assess each driver on an individual basis as you would with any other medical condition or drug use to assess their risk for sudden incapacitation by using the medical guidelines provided. ITDM being one of four non-discretionary standard (others include epilepsy, vision, and hearing), requires that the medical examiner evaluate the driver and perform a physical examination to see if he would meet the standards otherwise, if not for the condition (i.e. ITDM , epilepsy etc). If the driver is qualified otherwise, then he can seek relief from the standard through an exemption process or variance by applying to the Federal Diabetes Exemption Program. Only by going through the Federal Diabetes Exemption Program can it be determined that the driver meets the program requirements and be granted an exemption.
Please consult the FMCSA Medical Examiner's Handbook for more information regarding the risks of diabetes with respect to the operation of a commercial motor vehicle, as well as the evaluation and guidelines for certification of diabetics in general (whether using insulin or other medications).
Steps to Follow:
1. Obtain a Diabetes Exemption Package. Complete the Applicant Information Checklist.
2. Medical Examiner. Bring Certifying Medical Examiner Evaluation Letter from Diabetes Exemption package to the appointment with the medical examiner. The medical examiner must determine that you meet all other FMCSA physical qualification guidelines except for the fact that you use insulin. If the driver has any other medical problems or conditions (besides the use insulin to treat their diabetes), they must be corrected before applying to the Federal Diabetes Exemption Program. The applicant driver must provide the medical examiner with a 5 year medical history for review. Applicant is to submit completed Medical Examination Report Form and Medical Examiner's Certificate with his application to the Diabetes Exemption Program. The form and certificate is available from the medical examiner. The medical examiner's certificate should indicate that the driver is certified ONLY if he has a diabetes exemption and expires 1 year from the date of examination. The medical examiner's certificate is NOT valid unless the insulin exemption is granted by the FMCSA.
3. Endocrinologist Evaluation (Board Certified or Eligible). After the medical examiner certifies the driver, the applicant must bring the Endocrinologist Evaluation Checklist from the Diabetes Exemption Package and glucose logs to the appointment with the endocrinologist. Endocrinologist will complete all parts of the 4 page checklist. Applicant is to submit the checklist, signed endocrinologist letter head and any additional report outlined in the check list. The endocrinologist evaluation is good for 6 months and must be renewed if it expires during the application process
4. Ophthalmologist or Optometrist. Vision Evaluation Checklist is also to be performed after the medical examiner certifies applicant. An ophthalmologist evaluation is required if applicant has retinopathy. The optometrist or ophthalmologist will complete all parts of the 2 page checklist. Again, this checklist is also valid for 6 months and must be renewed during the application process if it expires. A signed letterhead from the ophthalmologist or optometrist is also required.
5. Mail completed Applicant Information Checklist, Both sides of driver's license and current commercial motor vehicle record along with items 2, 3 and 4 above to the address listed on the Diabetes Exemption Package.
Cardiovascular Medical Guidelines
Instructions to treating physician:
Please review the FMCSA medical guidelines below for the medical condition(s) that apply to the driver. If the driver meets these criteria and it is your opinion that he or she can operate a commercial vehicle safely, please respond accordingly on your letter head stating that all criteria for the particular diagnosis have been met. Also, include with your letter any supporting documents such as diagnostic tests performed ( ETT, echocardiogram etc). If more than one condition affects a driver and there is a waiting period for both conditions, the longer of the two waiting periods will apply (i.e. driver with both PCI and MI, the 2 month waiting period for MI would apply instead of 1 week PCI).
*Please note that the Medical Examiner is responsible for making the final determination of driver status for the purpose of certification for commercial driving after considering the opinion of treating physician. If the driver does not meet the guidelines and it is still your opinion that the driver is safe to operate a commercial vehicle, please identify the particular guidelines not met and state the reason why you feel the driver should continue to operate a commercial vehicle. We will use our best discretion, keeping in mind public safety being paramount. Feel free to contact us with any questions.
Angina "Chest Pain"
- Minimum waiting period of 3 months post CABG
- Healed sternum.
- LVEF greater than or equal to 40%.
- Asymptomatic status with no angina
- Tolerance to medications, no orthostatic symptoms.
- Yearly exam and clearance by cardiologist.
- Has no current diagnosis of CHD or CVD that exhibits syncope, dyspnea, collapse, or congestive heart disease that interferes with the safe operation of a commercial motor Vehicle (CMV).
- The following is required yearly beginning 5 years post CABG:
- Still with no current diagnosis of CHD or CVD that exhibits syncope, dyspnea, collapse, or congestive heart disease that interferes with the safe operation of a CMV.
- Is responding to medication and has been advised regarding use and side effects that may interfere with operation of a CMV
- Beginning 5 years post-surgery, he must have an satisfactory ETT yearly.**
- Imaging stress test if indicated. Has an LVEF equal to or greater than 40%
- Your recommendation is that he can safely operate a CMV.
MI "HEART ATTACK"
- Minimum 2 month waiting period post MI
- Is asymptomatic
- Tolerates medications/cardiovascular therapy
- Has a satisfactory ETT (post MI aprox.4-6 wks).**
- LVEF greater than or equal to 40%
- No resting ECG ischemic changes
- No Angina at rest, or change in angina pattern within 3 months of examination
- Satisfactory ETT every 2 years.**
Clearance by cardiovascular specialist who understands the functions and demands of commercial driving such as load/unloading cargo, tarping trailers, inspecting brake lines and putting on tire chains.
- Mandatory 1 week waiting period
- Is asymptomatic at examination.
- Tolerates medications.
- Has no injury to the vascular access site.
- No incomplete healing or complication at vascular access site.
- No Resting angina.
- No Ischemic electrocardiogram (ECG) changes.
- Following initial certification to drive, the driver should have a satisfactory ETT 3 to 6 months post-percutaneous coronary intervention and bring results to a 6-month follow-up examination.
- Satisfactory ETT**
Clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.
Satisfactory ETT every two years**
If an ETT is inconclusive, an imaging stress test may be indicated.
Angina "Chest Pain"
- Minimum of 3 months with no resting angina or change in angina pattern or decreased response to medication.
- Has stable angina
- Is asymptomatic.
- Tolerates medications.
- Has a satisfactory ETT**
Evaluation and clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.
Satisfactory ETT every two years.**
NOTE: If an ETT is inconclusive, an imaging stress test may be indicated.
- Minimum 1 month post-pacemaker implantation if underlying disease is sinus node dysfunction or AV block
- Minimum 3 month post-pacemaker implantation if underlying disease is Neurocardiogenic syncope or Hypersensitive carotid sinus with syncope.
- Driver has a functioning pacemaker.
- Driver has completed routine pacemaker checks.
- No other underlying disease that could interfere with safe driving of a commercial motor vehicle.
Valvular heart Disease
- Has no current diagnosis of CHD or CVD that exhibits syncope, dyspnea, collapse, or congestive heart disease that interferes with the safe operation of a CMV.
- Is responding to medication and has been advised regarding safe use and side effects that may interfere with operation of a CMV.
- Normal ETT.**
- Has an LVEF equal to or greater than 40%
- Generally, drivers classified as II, III, IV Class of New York Heart Association do not qualify for driving.
- Pulmonary hypertension less than 50% of systemic systolic.
- It is your recommendation is that he can safely operate a CMV.