- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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 a good, still valid medical card, but I started working for a new company that required me to get a new one from Concentra. Of course they ordered a sleep study that evolved into my getting a CPAP. That machine was recalled because of a design flaw and I was diagnosed with esophageal cancer last year. Chemo, radiation and surgury along with the developing shortness of breath and the Gerd that was a contributing factor to my cancer.
Can I sue Concentra, the D.O.T, or my employer for requiring me to have the sleep study done? I know now that there was a lawsuit against the manufacturer, but it seems that the lawyers will not take new cases as of June, 2024. That’s how my luck goes… smh.
@ James
That question is for legal counsel only.
If a DOT examiner recommends a sleep test for sleep apnea while getting a exam , am i required to complete one ?
@ william B
If he only recommended it and does not provide any additional information regarding the suggestion, then is it not a mandatory suggestion. If you are having difficulty with daytime sleepiness then you should look into having the test. If you have no daytime sleepiness issues, then don’t.
I was given a 30 day card to do a study couldn’t get in anywhere now disqualified can anyone help
@ Patrick
Go some where else and get a second opinion.
My company said I cannot seek another opinion from a cdl medical examiner and that I must follow through with the recommendation of the original examiner for sleep studies etc. A sleep study test ruled mild osa with recommendations of cpap. Ruling out moderate to severe . I don’t feel that I need any equipment. What are my options?
@ Bob
Sounds like the company has an agenda, ask to see the written company policy in the HR department. You have the right to a second opinion, if you disagree with one CME’s opinion.
Did the ME give you the 2 year card after it came back Mild?
Hello, I just now found this page. I have a question. The CME just gave me a 90 day card stating I needed a sleep study, I’m 55, weigh 243 6′ tall neck 18″. He said I have sleep apnea based on my neck size. I have had no symptoms, my wife has observed no symptoms. I drive an armored truck, non-CDL with a chauffeur license. I have no medical insurance. Am I still required to be tested? Can my doctor override his opinion?
@ Bob J
You do not fall under the Federal DOT guidelines. Go get a second opinion from a CME who knows the difference between federal DOT and your states variances.
Bob I’m curious to know what your outcome was. Today I got flagged by concentra for 17″neck weight 276 age 46 90day only card and told to complete sleep test.
Does the fed dot require a certain usage percentage of a cpap machine? Wisconsin requires 80 percent usage to comply. They require a 90 day download at the time of your physical. Does the fed dot require a percentage of use and do they require a certain amount of days for downloads off the CPAP machine?
@ Brian B
70% compliance and if possible a 90 day readout showing your compliance.
Never been diagnosed with sleep apnea. How and where can I renew my DOT medical card in Charlotte, NC without being sent for a sleep apnea test?
@ Daryl W
Try to stay away from the ‘Doc in a box’ facilities. Look for a private examiner that understands the FMCSA guidelines and is not tied to a sleep study facility.
I have used a C pap machine since 2003, This machine has NO chip. In the passed I would take it in to get read, with no problem. . Can I still use this machine or do I have to purchase an updated machine
@ Gary R
Just make sure you have a recent reading off your old machine and you’ll be fine.
Why is the most replied response from the trucker docs “get a second opinion” and why don’t they answer when someone says they sleep better without the machine? I’ve been driving for 35 yrs, never fallen asleep at the wheel, been diagnosed with sleep apnea because I said I snored, I sleep horribly with the machine but as long as I use it I’m legal to drive but way more tired during the day, if I use the machine and am more tired and fall asleep and kill someone it’s just an accident because I use the machine… if I don’t use the machine I am way better rested and do not ever get tired during the day… it is a racket designed to do nothing but make money, machines are a thousand dollars or more plus all the tests… answer that trucker docs, hopefully it’s not your family I kill because I use the machine and am way way more tired…
@ John p
The FMCSA guidelines are spot-on at times and vague at others. There were no new rulings regarding neck size and BMI as a proper diagnosis of sleep apnea. There are facilities that take advantage of the vagueness. Get a second opinion, because in most cases, just like your, the facility may have taking advantage of the guidelines. Find a driver friendly CME that actually understands your type of work.
I feel the same way Trucker. The funny thing is …Everytime i see any conversation about Cpap…I see Concentras name…They sent me to get a sleep test and told me i have sleep apnea….Like you ..I’ve been driving for over 35 years…and never have an issue with falling alseep behind the wheel or any accident related to falling asleep behind the wheel. I started using the phillips cpap for 2 years now…and it doesn’t do me any good .Can’t sleep’ ,it is also under recall. i started breaking out in hives and face swelling. So i stopped using it. Now my med card renewal coming up I don’t know whats going to happen. I think concentra is working with someone to help selll these cpap machines.
@ Henry W
Go somewhere else beside that particular ‘Doc in a Box’.
CME’s should take all available information into consideration, without any sort of conflict of interest. DOT/FMCSA has NEVER mandated a sleep study be done unless there are a multitude of signs and symptoms that would put you at risk.
MY NAME IS TERRANCE D K (edited by admin for privacy)! I WAS DIAGNOSED WITH SLEEP APNEA IN FEB. 2018! I TRIED TO DO THE TREATMENT! BUT I COULD NOT GET ANY REST WITH THE MACHINE! THEN ALL KINDS OF THINGS STARTED HAPPENING, TICKETS, BAD DECISION MAKING, EVEN HAD TO STOP ON OCCASION JUST TO TAKE A NAP! SO I COULD FINISH DELIVERING MY LOAD! I DROVE OTR FOR THE LAST 3 YEARS AND I HAVEN’T HAD TICKETS OR MINOR OR MAJOR ACCIDENTS ON MY PART UNTIL I STARTED USING THE CPAP MACHINE! I COMPLAINED AND HAD NO LUCK, SO I LEFT THE JOB BECAUSE I WAS TEARING UP MY DRIVING RECORD, THAT I TRIED VERY HARD TO KEEP UP! I AM TRYING TO FIND WORK ELSEWHERE, BUT THERE IS NOTHING I CAN DO BUT GO BACK TO TRUCK DRIVING! AND I DON’T HAVE THE MACHINE ANYMORE AND THEY HAVE DROPPED MY CLASS A CDL W/TANKER TO A CLASS C! AND I CAN’T FIND A JOB ANYWHERE! I AM HOMELESS AND I AM ABLE TO WORK IF NOT FOR THE SLEEP APNEA STUDY AND CPAP MACHINE I PROBABLY WOULD HAVE HAD NO PROBLEMS BESIDES MAKING SURE I GET THE MILES I NEED TO MAKE A DECENT LIVING! IT SEEMS LIKE THIS SLEEP APNEA STUDY AND CPAP ARE TARGETING THE MEN IN THE TRUCK DRIVING INDUSTRY AND IS VERY UNFAIR, ESPECIALLY IF I PAY $1000.00 BACK CHILD SUPPORT A MONTH! I AM GLAD I AM NOT MARRIED BECAUSE MY WIFE WOULD HAVE LEFT ME ON THE ACCOUNT OF THIS! STILL! MY DRIVING CAREER IS ENDED! AND NO OTHER JOB I CAN GET WILL COME CLOSE TO THE PAY I WOULD HAVE MADE AS A TRUCK DRIVER! I AM THINKING OF FILING A LAWSUIT! BECUASE THIS MAKES NO SENSE! I NEED HELP!?
@ Terrance D K
The FMCSA, once upon a time, issued guidelines for neck and BMI for drivers. Those guidelines were up on the FMCSA website for a very short time frame, like two days. If those guidelines were to be followed it would have taken 60+% of the drivers off the road. So at this time there are no neck and BMI regulations. But some opportunist have used the initial FMCSA information to grease their pockets. If you have a true OSA situation then the cpap would have been a life saver, but there are many other test and questions to be answered before requesting a sleep study. But if the test is being requested based on neck size and BMI, we would recommend seeking a second opinion elsewhere.
Can you go to another medical examiner to get your dot card? Don’t they call that shopping?
@ Derek
If you disagree with a medical examiner’s opinion, you have the right to seek a second opinion.
Thats sucks man….