- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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.
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?