- Part 1 – Can A DOT Medical Examiner Refuse You A Medical Card Unless You Have A Sleep Study Done?
- Part 2 [You Are HERE] – DOT Physical And Sleep Apnea Testing: Are Medical Examiners Caught Between A Rock And A Hard Place?
- Part 3 – Commercial Driver Awareness About The Sleep Apnea Issue
- Part 4 – OSA: How To Know If You Have It
- Part 5 – Commercial Drivers Can Manage Sleep Apnea And Maintain Their CDL
More and more drivers are being held-up (not able to renew), or held on a very short leash (30-60 day medical card) by the sleep apnea testing issue.
Some DOT Certified Doctors, aka Certified Medical Examiners, are stating so-called FMCSA sleep apnea guidance or rules that the driver “has to have a sleep study test done” before getting a new medical card. Drivers who have never been diagnosed with any type of pulmonary or sleep related conditions are being targeted because their BMI or their neck size is “too big”.
As the situation currently stands…
There are NO FMCSA guidelines or rules on sleep apnea.
Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President. The law forbids the FMCSA from using guidance alone to address sleep apnea screening for drivers. It requires that if the agency take action regarding sleep apnea screening, that it do so via the formal rule-making process, and not guidance.
The sponsors of the sleep apnea bill inferred that guidance alone would make the transportation industry extremely vulnerable to litigation.
In short…
– THE ROCK –
There is no FMCSA sleep apnea guidance or rule.
So let’s explore the doctor’s perspective.
– THE HARD PLACE –
The Medical Examiner is held responsible for ensuring that a driver is medically fit to drive a commercial motor vehicle.
Medical Examiner’s Certificate
The primary responsibility of the Medical Examiner is to determine the driver’s medical fitness for duty to safely operate a commercial motor vehicle.
- FMCSA Regulations: The examiner must comply withFMCSA regulations.
- FMCSA Guidance: FMCSA provides medical guidance or advisory criteria to assist in the evaluation of medical fitness to operate a commercial motor vehicle. These guidelines are based on expert review and considered best practice.
The examiner may or may not choose to use these recommended guidelines. When the certification decision does not conform to the recommendations, the reason(s) for not following the medical guidelines should be included in the documentation / long form.
- Refer for further Testing / Evaluation: The examiner does not have the job of diagnosing or treating any condition that a driver may present with. The examiner is responsible to refer the driver for further testing / evaluation if the examiner suspects an undiagnosed or worsening medical problem.
This puts the Medical Examiner between a rock and a hard place and there is lots of room for interpretation here.
And where there’s interpretation, there’s opportunity for litigation.
The last thing a doctor needs is litigation – for the price of a DOT physical exam!
So…
Some doctors are being extra cautious, and…
The “you-know-what” continues to roll downhill, and…
Commercial drivers are at the bottom of the hill!
What can commercial drivers do to avert this situation?
Be aware of the difference circumstances and perspectives around the sleep apnea issue that could affect both your livelihood and your life.
Put In A Nutshell
Since there is no FMCSA regulation regarding sleep apnea evaluation and the basic parameters are subject to interpretation, then be aware of the Medical Examiner’s position.
- The medical examiner’s job is not to diagnose. It is to assess the driver’s medical fitness to determine if any safety risk issues exist.
- If there is a reasonable chance of risk then the examiner will request that a specialist in that field provide a proper diagnosis and treatment if necessary.
- If you’ve been diagnosed with sleep apnea, then another set of regulations apply.
By being proactive, you get to manage this before it becomes an issue.
Thanks to Trucker Docs expert panel doctor, Dr. Kenn Seals, for contributing to this article.You can find Dr. Seals at Chiro Stop in Salt Lake City, UT.
I wanted to renew my physical card but my company told me that they preferred. Me to take my d.o.t physical up there in south Dakota i was tricked in to it i had no ideal what i was in store for.my blood pressure. Was almost perfect but they wrote me fir only 3months and now im running around like a headless chicken trying my hardest to get all if this done by the dead line f ok r my medical card wich will be up on the 16th of this month.so my question is if i cant make my deadline and my license are pulled dies that mean that im done for ever or if i get the proper treatment can i get my class A and my dot medical card renewed?
@Levertis
So what is almost perfect blood pressure? DOT requires a BP of 140 / 90 or less. No one is going to pull your driver’s license, but you will need to get your blood pressure inside a window for the examiner to extend your medical card out to a year.
If you have never had an issue with your BP, then you should be able to get it into the 140/90 range and get a one year card to give you time to get it down even further.
I have to get a new DOT MED CARD but the Dr I went to says I have to get a sleep study test done . Is this a new law now that I have to get this done before my MED CARD is renewed ? in California ?
@Glenn
Read the Sleep Apnea articles listed above. It’s not a new law, it’s not a law, and nothing different in California than the Federal requirements.
If your overall health condition presents a risk for OSA then the medical examiner will require you to have a sleep study test done.
Same thing happened to me today, and It cost $250 to have a sleep study done, plus $50 Co pay from a dr that I have to be referred by, all because my neck measured 18″ can I go to ANOTHER DOT PHYSICAL PLACE for another review? ?
@Terry
If you have a difference of opinion and want a second opinion, then you can go to another CME. There were no new rules regarding sleep apnea and BMI or neck measurements, but the CME’s should be looking at 6-8 different things that may be indicators.
Wait for a month before you retake the examination, otherwise FMCSA looks at this as ‘doc shopping.’ If there are other indicators point at the probability of EDS, then you may be sent for a sleep study.
Went for MI DOT in Nov. 2014 was seen by a PAC, blood pressure was high, and needed evaluated and cleared by a certified sleep specialist with evaluation, recommended treatment, follow up and sleep study results, because I answered yes to snoring. Went to my regular Dr. put me on meds for blood pressure, now I went and got a at home sleep apnea test done, went for consultation with specialist who hadn’t even seen my results until sitting there with me in front of her, says I have apnea and need a sleep study. How accurate are at home test? To even base any of this on? Now I find out my Dr. is certified for DOT can I just by pass the original exam by the PAC and go to my Dr. that I know and trust and do a new physical with him without reprocussions from original exam.
@Mary Ann
YES.
I am a route driver with Class D license in New Jersey. I have in the past gotten 2 year dot cards with no problems from medical examiners paid for by employers. One in April of 2012. Then another in October of 2012 is now expired. I got hired by a company to drive a 16′ box truck with dot physical agaon paid for by employer. I went on 11/28/2014 and was told by medical professionals examiner my eyesight was 20/50 and needed eye exam. I was then told with size 19″ neck height 5’8″ and 280 lbs my bmi was 46 and I need a sleep study. I sleep fine and have not been in an accident in 30 years. I found a sleep center which is jerking me around with 2nd sleep study needed now because Dr says I have sleep apnea and need cpap machine. CME will not even give me 30 day card now with eyes good now until my cpap machine shows at least one week of me using it. He originally said he would give me 30 day card with eye exam so I could start work while resolving supposed sleep disorder. This sounds to me like it is all about milking my insurance and not my well being for providing for my family. Concentra is the dot examiner.
@Mark
If your vision is now corrected you should be fine.
There are no new rules regarding sleep apnea. Ask to see the law, they can’t show it to you.
Go somewhere else for your DOT physical.
Is their a number that the doctor go bye for example my cpap card reads 73.3% is that good .or should it be lower or higher.For iam under doctor care can a DOT physical exam stop me from working/driving
had a cdl phyiscal in june was told by doctor that before my next phyiscal this coming june i have to have a sleep study done again. i have had sleep apnea for the last 8 yrs under doctor care and use machine every nite to sleep. was wondering if i do need another sleep study before this or can i get a letter from my sleep doctor
@Dan
Just have your sleep doctor complete your medical release form and have your compliance stats with you and you’ve just answered most of the questions that a CME will have.
My current c pap machine is outdated . need one with chip to show usage. Question- Can medical examiner help me with a prescription to get my setting changed on a machine I am going to buy? my deductible is to high to buy a new one . plus my primary Dr is trying to send me through sleep study and buy a new machine. can’t afford any ideas around this?
@Mark
It is not the CME’s position to prescribe or diagnosis or treat any condition.
Your primary already knows that you need the unit, then why would he want another sleep study? Just ask to be upgraded.
so is it the law now that we have to have a sleep study for dot.or is the company pushing it.
just wounding thanks.and if the company is pushing it should they have to pay for it. thanks
@Weasel
No laws. And if the company is pushing it, for some reason, then they should pay for it.