- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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.
Dear Doctors,
I’m a Teamster CDL B driver. My Medical Card expired This month was told to get a new one before April 24 here in the state of Michigan or lose my CDL license . I went to Concentra Medical for my test last week I passed except my Sleep Apnea which I have been using CPAP for 16 years and never missed a night using it then I was told Doc will not issue me a Certificate from my not having a CPAP card year of use. I never needed a card for machine in my 25 years as a truck driver and always told the Dr in past about my SA I never lied. I have been offered a job this week but cant take it I have been out of work for 11/2 years. my present machine is new and I was able to get 1 week of use to Dr but he wants a full year. I never knew about this new law. HELP!!!!
@LeRoy
First you are a class B driver and someone is trying to hold you to a class A, interstate standard, wrong.
Second, all you need by law would be a thirty day readout from your machine.
Get a medical release form from your doctor with an explanation of your situation and then go somewhere else for a second opinion. The doc-in-a-box facilities are looking to make money, not work with the drivers. Good luck with the new job.
Ok. Reading through, I’m actually curious as you’re stating decisions after specifically expressing that you are an authority without providing your documentation. By what grounds did you come to your conclusion. You may have much more data or read a recent article (or there may be a new one that trumps yours now and we wont know given you gave no supporting documentation). So.. we should begin discussion as your position stated above is black and white about what they would need. So…
“At one year, future recertification should be dependent upon proof of continued compliance with treatment. At the end of one year the certifying physician should review all compliance data for that year.” https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/Sleep-MEP-Panel-Recommendations-508.pdf
Why are you saying that the doc just needs 30 days (separate discussion from the class A/B issue)? And when you say “by law” what are you quoting? What has become law? Is there actual law or are we going back to recommendations listed above again.. and if that’s so then why isn’t it on the following standard:
Individuals recently diagnosed with OSA may be conditionally certified for one month during which time they will be started on CPAP therapy. At the end of this month, they can be conditionally certified for 3 months if compliance to CPAP is documented in the two previous weeks. Compliance should be reassessed at 3 months. If at the three month assessment such an individual demonstrates treatment compliance, that individual may be certified for a period of one year. The commercial driver needs to receive information that if they stop using their CPAP during this one year period, they should stop driving a commercial vehicle. They should be warned that if they stop using their CPAP and are involved in a crash, then it is likely that they will be considered liable by the legal community. At one year, future recertification should be dependent upon proof of continued compliance with treatment. At the end of one year the certifying physician should review all compliance data for that year.
Second issue. Sleep apnea doesn’t only lead to sleepiness overnight, but daytime sleepiness as well. So daytime vrs night time driving isn’t a reason to change your certification standards. Either B or A certification is that the provider decide that there is not a medical reason for someone to be unfit to certify. Daytime sleepiness included. This driver has the diagnosis of OSA (not being screened, but already dx.. that is another issue entirely). If the FMCSA has come up with considerations on their expert panel to screen and help reduce the risk that some drivers present and that provider is convinced after reading the literature that that would pose a risk if untreated, then it is their responsibility to assess compliance. Correct?
If the driver has gaps in coverage because of intermittent noncompliance (I can’t tell you how often I hear folks saying they only treat before an exam.. high blood pressure and osa included in that mania) and the examiner didn’t require the recommended ENTIRE year of paperwork.. then… he didn’t actually follow the recommendations. But again.. that’s for class A.
I live in PA and have a class A licence but my job only requires a class B.
I recently went for my physical and was ordered to take a OSA test and issued a 90 day card however I can not get an appointment before the card expire
Can I go to another DR and get a new physical?
I’m being told that with the new laws for 2017 that isn’t allowed and that my CDL will be red flagged and I will lose it. Is this true.
Someone please help
@Addam
You are welcome to go and get a second opinion with any NRCME registered doctor.
Hi, My Medical card was expired for almost a year. I went to renew it, and was told I will only get a 60 day renewal and that I need a Sleep abnea test. I think this is bs, I have been driving for 20 yrs with no problems. I didn’t turn any form into the CA Dmw. My question is, can I wait for the 60 day to expire and than get another physical from a different doctor without the sleep test? I had type1 hypertension, and was told I’m obesit, I’m 6’1 and 228, lol. I exercise daily and have been eating healthy. My blood pressure is now normal. Thanks.
Hello I would love to help you. The whole Sleep apnea testing will soon be mandatory.The reason this is so important is because sleep apnea is very dangerous and increases your risk 5 times higher to be involved in an accident and increases risks for heart attack and other health issues related to hypertension and obesity. I work for a home sleep testing facility that can ship a sleep testing device to you it has three attachments you sleep on it wherever you are and send it back via mail or one of our locations.
@Richard
A history of high blood pressure and on medications will cause a limited DOT physical to one year at the time.
If you are no longer taking medications, make sure you have a note from your primary doctor indicating that you no longer need meds to maintain your BP. As far as the sleep study, you can wait out the 60 days and go somewhere else for a second opinion. Since there were no new rules regarding sleep studies, you can get a second opinion any time you like.
i changed my sleep habits to sleeping with my upper body elevated it cured my apnea i told the cpap supplier
this and they keep me on the mechine can i stop using the cpap machine and not lose my cdl class b license
i live in Indiana
@Dale
Most professions, once they have you on something, are highly motivated to keep you on it. You are a class B driver and don’t drive OTR for extended periods of time. Not sure about your state requirements, so check with your local drivers license department and see what they have to say. We suspect that you will not lose your CDL, but may have some serious questions when it comes to getting your medical certificate. Most of those issues should be resolved with an explanation about the changes you made and the type of driver you are. It would be great if your sleep doctor would write a release note indicating that he agrees that you do not need the CPAP.
I don’t think the FMCSA provider actually personally cares if you have apea or not. They normally just want to fill out their paperwork and be done. They aren’t the docs who are to make any diagnosis (they have to ask other docs to do that). The FMCSA doc who does your exam doesn’t have any stake in you doing your CPAP. So would be super happy that you’re happy, but would require a release note from a treating Sleep doctor that states you don’t have expressed medical condition so they don’t have to go by those standards with you anymore. That being said, there are only a few methods listed to actually accomplish this that are considered acceptable. This is do to measuring the compliance of therapy. While there were no specific recommendations on pillows one can extrapolate how they would handle this as is similar to dental appliances given the recommendations are based on if t’s permanent and can be proven. However, again, no specific statement. As with many medical conditions folks are always coming out with different ways to treat them, which may be fantastic, however it often takes data to prove to folks that they are indeed, wonderful. The (semi)permanent fixes for apnea (weight loss surgery) do have guidelines for docs on how to prove that the drivers no longer have apnea and to get those folks to remove the sleep anea treatment needs from their medical history (not that they had it before, but now include that they had it, lost it, and no longer need treatment for it). The temporary solutions (dental appliances and likely pillows) can be removed, replaced, unused etc. “Currently there is no method of measuring compliance among individuals treated with dental appliances. Consequently, use of dental appliances cannot be considered an acceptable alternative to PAP in individuals who require certification to drive a commercial motor vehicle for the purposes of interstate commerce.” I assume pillows may go the same way. Again.. new things have not been studied, always possible that it will swing in your favor. Even then, you kinda’ have to prove it’s working by using the pillow showing on a study that it did actually remove your apnea and get a sleep doctor to agree and write you a letter proving it (even weight loss surgery doesn’t always work… so they have to take a study after doing it to see if it’s actually gone). However again.. just like with dental appliances… it’s still not likely to be accepted.
https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/Sleep-MEP-Panel-Recommendations-508.pdf
I am not a truck driver, but a school bus driver. We have to do the same DOT Medical tests that truckers have to do even though I am very local which I feel is wrong.
Last year I went for my exam and because I was in the process of not only driving early mornings, had several sick family members at home, and was packing to move to a new home I yawned in front of the doctor (I did explain all this to her after she asked if I was tired). She immediately said I had to go get tested cause I was sleepy in the middle of the day and I was overweight (mind you I had lost 25 lbs. from the prior year). She gave me a 3 month card till I had the test and it took 2 months to get into an ENT to order the test. The test showed I have a very mild case of sleep apnea (under 5 episodes in that session). Even though I have such I mild case I am being told I have to wear a CPAP in order to be incompliance with DOT medical regulations. I have done so even though I feel it is stupid for something that a mouth guard would cure. I feel though that I get less sleep with this machine on cause if the nose thing slips I instantly wake up and readjust it which means I am losing sleep fussing with this device 2-3 times a night. Recently though I have been having problems with the device causing excess air to build up in my stomach to the point that it actually has made me sick. I stopped wearing it and have slept actually through the night for the past month (except now I have a cold). I did finally get ahold of the supervising company and my ENT doctor agreed to lower the pressure, but it wasn’t done, so I still won’t wear the CPAP until I feel like I won’t blow up like a balloon.
What I want to know is there anything about mild sleep apnea having to HAVE TO wear this device? If so/not where? I want to be able to go into my ENT and the DOT doctors with informed information so that I hopefully can get off this device for good.
@Laura
We have no idea why a school bus driver who is not a class A over the road driver is being held to a class A standard.
The CME that is doing this to you simply does not understand what they need to be evaluating. We suggest that you go get a second opinion from another examiner that understands that you are a school bus driver and see what they have to say. Since there where no new rules regarding sleep apnea, even for the class A OTR drivers, you are being taken for a ride. Time to get off this train and change examiners.
OK I am a mechanic I don’t drive. Unless it’s to take a broken down bus or tractor out to a driver and I have to do the ODT physical.
17.5″ neck, bmi >35, man, >50 y.o. These are the guidelines they say require a sleep test for me. Insurance company denied 2 referrals from pc physician. DOT medical examiner would not issue card without it. I am in the Utility industry, we drive maybe 1-1 1\2 hrs in an 8 hr day. Head of safety says there is no law for this, insurance says no medical necessity, no other symptoms, had spell of being tired 12 years ago, in hospital test was negative.
What do we do? It has been 45 days since my appointment, because of the back and forth with the insurance I’m now going to have to take another physical even after I finally get a sleep apnea test appointment. Why isn’t Congress going back to the FMCSA and telling them to drop their guidelines until the regulation takes effect on 6/22/2018 which allows the medical examiner to require testing under the guideline criteria? That is exactly what the law Congress past, told them to do.
@Charles
There are no rules or regulations in the FMCSA guidelines requiring a sleep study based ONLY on neck measurements and BMI. Go get a second opinion from someone else.
I operate a wrecker locally never over 100 miles a day. Never 10 consecutive hours. Job pays 350 a week can’t afford no health insurance this will not accomplish anything trucker’s should surround these hospitals and refuse to move .We leave our families eat bad food and keep American moving we stop this will to they can’t tow us all band together we are all professional protesters
Because of my neck size….yes, I have to have a sleep study. Have class A and have been driving 25 years. Tried study at home, didn’t work so well. Had study done at sleep center in VA. where I live. Very difficult to try and sleep with wires in all directions coming off of you. That being said, they determined I have “sleep apnea”. Now they want to do another test using a cpap machine. Hmmmm. Think I’ll sleep better without all the wires? I expect so! But that doesn’t seem fair! Why not test me with nothing attached to get a true reading, because I have no problem sleeping at home as it is. Seems like a scam to me. Can you help?
Hey post – I learned a lot from the info ! Does anyone know where my assistant might be able to acquire a sample NJ UST-021 copy to edit ?