- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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.
Went for my DOT. I am 6’5” and around #340. Moderate hypertension under control with med for years. They gave me 30 days and said report to pulmonary Dr. for sleep apnea evaluation. BMI over DOT limit, and neck size 19″. The last time my neck was less than 17″ was in the 10th grade. I do not have any symptoms of sleep apnea. Do I have to have a sleep study to get DOT cleared, or just self certify and ignore the visit to the sleep Dr.
Can’t lose my CDL, but the 30 day extension does not give me much time. What is the best direction to take? BTW, it was a PA and they used three different machines for my blood pressure and got three different readings in less than 15 minutes. Went to my regular physician last month and he said my BP was good/normal.
@Bigiron
You need to have a valid medical card before you will be able to maintain your drivers license.
Your best best is to go somewhere else to get your DOT medical certificate.
There were no new rules and there is no such thing as a BMI limit for the FMCSA. So someone is over-reading their study materials and trying to take advantage of a situation. Now if you do experience excessive daytime sleepiness then you do want to take the sleep test, but if you function fine all day long, then you probably don’t need to take an expensive test.
AHI is a 6 is that normal and will still be able to pass my physical to drive
@Marie
You’ll need a medical release form from your sleep doctor and a printed copy of your last report from your unit before a CME is going to do an examination. Based on all of his findings will determine whether you’ll pass or not. It’s never just one thing, but a picture of the whole person that the CME must address.
I am trying to figure out if a trucking company can force you to use a company 850 miles away instead of your PCP. because of that I couldn’t get a mask that fit properly and lost my job. I know of several drivers who have been suspended for mask not fitting properly. One driver had been tested 4 years ago and was under care of his PCP and was told he couldn’t do that anymore and had to use this other company. Can a company force you to do that?
@Paul
Not sure if any company has a policy that would force you to do such a thing. And if the policy of the company is such, do you really want to work for them? You could ask for a copy of the policy from the HR department so that you could see it writing, and then make your final decision.
Question: I was required to do a sleep study. Among the paperwork they require you to sign before they even talk to you states ” I agree that I have been tested for and have been found to have OSA obstructive sleep apnea.” Of course I refused to sign it and they told me they are not supposed to give me the test if don’t sign it. Is that even legal? In short they gave me the test, I wore it for 6hr 4min, it evaluated from 1:45am to 5:12am. They are trying to get me to take an in-house test stating that the flow evaluation on registered 29 minutes and they need 2 hrs. I have the papers, can my employer make me take another one because they request it?
@Karl
Question #1: It may be their policy and you were right to refuse. No law has ever stated this as mandatory.
Question #2: I guess if the employer is going to pay for it, they could ask you to take the test, but otherwise I don’t think so, unless the company has some policy that is already in place.
Hello,I recently went for my DOT physical and everything was fine however the Examiner said that because of my BMI and neck size, that I would have to go for a sleep study. CRAZY!!!! Because I’ve never been diagnosed with any type of sleep disorders so with that being said what can I do?
@Freeman
No new rules or regulations regarding sleep apnea. Take your business elsewhere. If they based their entire decision on bmi and neck measurements, then they don’t understand the FMCSA guidelines very well, so go elsewhere for a DOT physical.
Hello, My husband has a CDL and went to Concentra for a DOT phyical had see heart Dr before going to Concentra. Heart DR did the EKG and blood work all was good.
Now Concentra states that he will need to have a sleep study be cause of High BMI Neck Size and BP.
Is this Something that HE has to have for the CDL? We do have an appointment with our PCP however with appointment after appointment it could be 6 months until all are done.
Thank you for your time
@Dawn
There were no new rulings on sleep apnea and bmi or neck measurements, (according to FMCSA), so unless there is excessive daytime sleepiness signs and symptoms I would get a note from your primary doctor stating that your hubby does not have sleep apnea. Then I would take my business elsewhere.
Last year my physical was up right after we got off contract I am gone for 5 to 6 month during the summer so I had a week to get my physical so I went to the local urgent care to a doc that knew nothing about me. I had a hart issue 4 years ago i am on meds visit my doc on a regular schedule the doc that did my physical told me that since I had this in my history I had to do a stress test and a hart ultrasound it cost me over 3000.00 that’s almost 10% of what I make a year do I have to repeat this very year the hart doc cost almost 700.00 for about 15 min visit on my old physical slip it said no restrictions
@Max
Certain heart conditions require a stress test every two years. So, not knowing what your specific conditions is, I will assume that one stress test every two years and a medical release form completed by your cardiologist each year should do for you.
My husband was tricked into getting a sleep study done the Dr told him it was regulation that he had to take to it but he heard from his safety man they was no regulations for him to take it. Is there anything he can do to fight it? Thank you
@Dianna
File a complaint with the FMCSA and talk with a good attorney.
I’m having this same issue. I went and had my DOT physical done June 26. The nurse practitioner walked in the room and without saying anything else looked me straight in the face and said “You’re not going to like what I have to say. You’re fat and you need a sleep apnea test done.” I inquired whether or not this is mandatory and she informed me that its a law. My employer does not mandate it, I have found no information regarding any laws in Indiana with the DOT or FMCSA. I contacted a lawyer and they said there was nothing they could do since it is an adopted guideline, its not considered malpractice. I can’t afford to pay out of pocket for this unnecessary procedure when they’re only motivation is telling me I’m fat…therefore…..
HELP!
@Heather
We’ll start with the fact that the nurse practitioner is WRONG, it is not law.
If your company does not have an issue with going somewhere else, then that’s what you should do.
If you need, bring a medical release form from your doctor with you explaining your situation. That will answer most of the questions that a CME will have.
I have been driving trucks for 30 years since 1984 and the Dr did some of the same things that I read in some of your story walk in after going through all the eye test and blood pressure test Doc ask if I snore i told her I don’t know I am sleep she told me my height to body weight I have to take a sleep app test by time i got a test schedule my 3 month card expired now that I had the test done they tell me I need to be on the machine for 90 days before I can come back for my card I am only a local driver and I don’t have problem sleep but you want me to pay a 164.00 deductible for it and I am not working really this is crazy anybody know how long you have to be on it before you can return to work woe
@Anthony
It sounds crazy.
Why not go somewhere else, get a second opinion from someone who understands the difference between a local vs an OTR driver and get a new medical card so you can get back to work. 90 days on the CPAP with a 70% compliance for an interstate OTR driver is what FMCSA wants, but that isn’t you.
are thee any new guidelines or regulations regarding the print out from a CPAP?
In that my question is overall, on a 90 day period it showed my usage at 70%. The >4 hour usage was at 63%.
When I went into Concentra for current physical the PA who performed my physical was not going to give me a medical card. She stated that guidelines state that the >4 hours had to be at 70%.
Is a PA certified to do DOT Physicals and or issue medical cards?
@ Robert
If the PA is on the NRCME registry, then yes they can do DOT examination and can give out medical cards. The CME is correct, but could, if they choose to, give you a 90 day for you to show full compliance with your unit. Some CMEs will work with you and others won’t. It’s about safety and CYA.
Hi,
My husband applied for a driving position recently (In Michigan). He once had sleep apnea but that was 8 years ago (when he was a child, and overweight). Because of this he took a sleep test so he could be MDOT certified. His doctors office got the reports back from the study saying he does not have sleep apnea, but the original place he took the drug test at, concentra, is saying he did not fulfill enough hours with the sleep test on. He does not fit any of the criteria of a person at risk for sleep apnea now. His BMI is normal and so is his neck size. His doctor wants to refer him to a sleep specialist to prove he does not have it. This is going to cost a lot of money. What I’m wondering is 1, will the sleep expert doctor saying he doesn’t have it solve the problem? and 2, since he has moved on from the original position he applied to does resolving this now aid us if he will be applying to driving positions later on? Are you flagged somehow when applying to driving positions if this isn’t resolved? Or is it more of a situation where if 90 days pass you’ll have to take the sleep study thing all over again regardless of past results?
Thanks for the help!
@Amber
You are not flagged, and yes it would be a big help for the CME to have a medical release form from the primary sleep doctor. That release can then bypass the CME who is over-reading his job description and releases him from some level of perceived risk factor.
Hi doc, I know you’ve answered this question before, but if the cme tells me I need a sleep apnea screening purely and solely based on a high bmi and then writes it on a piece of paper and only gives me a 2 month card, am I required to give that information to my new doctor For my next card? Thank You..
@Henry
No new rules or regulations regarding sleep apnea. So no you don’t have to give anybody anything. Just answer the questions on the intake form truthfully and you should not have any issues.
Hi,
I’m in a rock and a hard place… I was diagnosed with Sleep apnea back in 2013, and I missed my annual check up with my Sleep Doctor back in Nov of 2014. I no longer have any insurance due to the fact that I only work part time. I went to get my physical done which is good for 3mos because my blood pressure was high and the company paid for it. Now, I’m trying to go full time with a different beverage company that required me to get a new physical. I was able to pass my physical, but I’m have a temporary disqualification due to my sleep study paperwork is out of date.
My sleep Doctor won’t see me because I have no insurance and I have not been in his office in over a year.
The beverage company won’t hire me unless I can get the “a okay” from my Sleep Doctor.
So, I have no insurance and I don’t have the money to get it and then, a new sleep study if needed.
Is there anything that can be done?
Thank you.
@Alex
Not much you will able to do until you can get the sleep doctor to see you and sign off on the whole issue. The regs are pretty strict on this one. Could you borrow the money to get in and get it done?
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.