- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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 had my dot physical done today for my job passed everything blood pressure perfect not overweight etc well during the questionnaire it asked if I snore and only if I’m exhausted I do and recalled talking yrs ago to my family dr about it but never had a sleep study done or any tests and I informed my examiner of this they contacted my old dr and they said that I was diagnosed w sleep apnea so bc of that they refused to sign off on my papers until I get this resolved idk what to do bc I may lose my job bc of it
Basically question I’m asking is 1.how can I be diagnosed w something that I’ve never been tested for
2. What do I need to do to get around this and if they make me take a sleep test what do they look for I’m not tired all the time I’m go go go I snore on occasion and don’t stop breathing
3 if they diagnose me for some reason can I still get certified if so how long does it usually take b4 they can do that
@aj
Who diagnosed you with sleep apnea? Since there were no new rules regarding sleep apnea and no neck measurements or BMI charts, who made this diagnosis and how. Try going to the original doctor from your past and have him give you a medical release form stating what his findings were. That should help the most.
Just got my cpap today and my dot medical card expires today. How long do I have to be on cpap before going back on the road? Thx
@Hefty
The CME will want to see a 70% compliance record for at least thirty (30) day before issuing a new medical card.
Hi, on 09/14/15 I renew my DOT card everything when well but towards the end the examiner said I was over weight n that my neck size was 14 n that he was giving me the card for 3 months n that I needed to have a sleep apnea done. I don’t feel sleepy during the day nor am I tired. I made the mistake of sharing this with my supervisor because I thought it was odd n now he said I can’t return to work until I get this test done. Can my supervisor do this to me? Thanks
@Adrianna
Only if it is a company policy.
The neck size is way under the mark, so I don’t understand why you would have been told such a thing. Why not go get another physical somewhere else and have it supersede the last one.
Hi, i’m 45 years old, I got sleep apnea and I can’t get use to a cpap machine, I wear it for about 5 to 8 mins and then I need to take it off, can’t breath. got a cdl been driving truck for over 22 years. I am worried about failing my med card now. what are my options? can I collect disability? Can I get help to get retrained in another field? help please very worried
thank you
@LeoBear
You should still be working with your doctor regarding your machine and its settings. Explain to him your situation. It may be as simple as getting a low profile mask and changing the setting on the unit. You should be breathing easier, not harder. You are going to have to demonstrate proper usage and compliance with your CPAP before you will clear with the DOT examiner. So talk with your doctor beforehand and get things under control.
Ok, it took me about 3 months to totally get used to my machine. Its the best thing I`ve ever done in my life. I feel better and I don’t fall asleep during the day.
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.