- 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Previous FMCSA Proposed Recommendations on Obstructive Sleep Apnea were withdrawn by FMCSA in April 2012, and on October 15, 2013 the “sleep apnea bill” was signed into law by the President.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.
Will you still be able to get a 3 month, 6 month DOT card in 2018? I’m a diabetic and on one of the new drugs that dumps sugar into your urine. Even though the finger stick shows a very good reading (98) and my A1C is below disqualifying I still have to have my doctor fill out paperwork saying I’m not on insulin and it’s controlled with the meds. I got all the info within 3 days, returned it and for the 1st time ever got issued a 3 month card. I keep telling the Dr. you have to educate yourself on these new drugs and how they work. It seems like where I go for the physical no one there is comfortable qualifying me. Next time I’m bringing everything from my regular Dr. with me.
@Kathy
You always want to take you latest A1C and the name of the medication so the CME understands why there is a sugar spillover in your urine. And you may be cleared for one year.
That’s my plan moving forward. However, we were told that in 2018 you would not be issued a 3, 6 month card. I don’t believe that part of the law has changed. I fully understand the new 45 days rule. So, my question is will or could you still be issued a 3 or 6 month card if the Doctor wants to closely watch your medical issue.
@Kathy
Of course. The medical examiner may issue a short card any time a medical condition needs to be monitored closely.
My situation has been a complete nightmare. So much that I stopped driving because of it. I went 8 months without pay while they preformed their witch hunt. But I have a great opportunity now and would like to start driving again. The dot doctor, seen in the system, that a neurologist ordered a sleep study because I was having headaches. The first one showed no sleep apnea so they scheduled a 2nd one. The second gave them just enough to claim I have sleep apnea. Now, I don’t have trouble sleeping nor am I tired during the day. They gave me a cpap machine but I was fired before I could complete the first 30 days of using it. And to be honest, i feel absolutely horrible when I use it. I’ve since then…lost about 30lbs.
My questions are
Can I just go to another dot doctor and get a physical and med card. The only reason this came up to begin with was the dot doctor was at the same hospital as my doctor and the neurologist.
If not, can I get a “second opinion” sleep study done? It’s been 8 months since I had the last one. What’s even worse was at the time I had this done, I still had a valid med for that was good for a year and half. Please help. Thank you.
@Jamie
Go to a different certified medical examiner for your DOT medical and get a second opinion.
Is it legal for me to do so after the 2nd sleep study showed mild sleep apnea? I know if I just go to a different dot doctor I’ll pass with flying colors.
@Jamie
Yes, you are entitled to go and get a second opinion.
Does this apply in every state? I’m in Texas and this sounds like my husband’s story minus the headaches. He d.c. doesn’t get sleepy during the day and sleeps all night besides the occasional wake interruption from our toddlers.
The regulations that were implemented only benefited the sleep apenea Doctors and the CPAP machine!
My horror story: I am a day driver, class B with air brakes, M-F 7am to 3:30.
I have to have a DOT medical card. One day a few years back, it was time for the physical. At the clinic, a girl comes in, puts a tape measure around my neck, on the outside of my shirt collar. I had no idea what this new thing is for, obviously she didn’t know how to measure inside a shirt. The Dr comes in, says won’t give me a med card until I go get tested for sleep apnea, shock to me, I have always slept great, never nap during the day. But ok, a test will show I don’t have sleep apnea. But NO, apparently many “Sleep Doctors” are aware of the new regulations! Guess what, not covered by insurance, because my personal Dr did not request it, a person at a walk in clinic did. So I have to pay $1500 to get the test, The sleep Dr says I do have it! I could not believe it. So more money for the machine. I have not had a good nights sleep since. I was in the SYSTEM. I still did not think I had a sleeping problem, so I paid for a second test, different Dr, guess what, he says I do not have sleep apnea, I go to the DOT clinic with my new test results, sorry mam, once your in the system, we can’t take you out of it. I go back to the first sleep Dr, of course angry, his exact reply to me, “SLEEP APNEA HAS BECOME A VERY LUCRATIVE BUSSINESS SINCE THE NEW REGULATIONS, MANY OF MY FRIENDS HAVE CHANGED TO SLEEP STUDY MEDICINE, I HAVE NOT HAD ONE SINGLE PATIENT WHO HAS NOT HAD SLEEP APNEA.!
No matter what I have tried or done, I can not get out of THE SYSTEM!
It was always about money, I pray my company will drop this stupidity! I want to sleep at night again!
I am applying for a new job with a company that sent me to the local DOT medical
outpatient shop. I have a hearing problem. For which I didn’t wear my hearing aides
to the office. The doctor threatened me with writing a report that would finish me
medically from driving a truck again. Because I meet the guidelines of the
recommended sleep apnea testing, which I questioned him and said it is
a recommendation not a requirement. He then got upset and threatened the
above. Saying his report would finish me from driving. Can he get away with
this. How do I counter this if necessary.
@Stephen
No, the CME cannot write a report that will finish you as a driver.
Secondly, wearing your hearing aids, go and get a second opinion somewhere else.
I do not have a CDL.I drive a 26ft straight truck that is under the weight. I took a DOT Physical last month and everything went well until they did the neck measuring. The Doctors says I need a sleep apnea test. I have no Medical because I just started this job.
(1) Does anyone know how much a sleep apnea test cost?
(2) I DO NOT have a CDL, just the basic class C, Am I still under these same guidelines?
(3) I know I can go for another DOT Physical when this 3 month DOT Card expires but do I have to tell this new Doctor that I recently had a 3 month card????? If I dont tell him I already “failed” can anyone fine out?? Thanks
@Jski
You fall under state variances, not FMCSA. Go for a second opinion and explain that you’re a class C driver, not a class A driver.
Thanks for replying back, I will do that!
Hello
You can go to the hospital they do sleep tests and ask to do this test at home. At the hospital it cost 1,500 if you do it at home it’s 500. And then you can make payments that way.
Best of luck to you
The FMCSA medical has provided very clear guidance to the CME 11/2016
Abmi 40 and great should be tested gor sleep disturbances or a i 33-39 and the driver has 3- or more other risk factors/ symptons should be tested .
S
Testing standards in lab is always best
Or a home sleep test (if a board certified clinician in sleep medicine approves) .the home sleep test should be for at least two nights and accompanied by a chain of custody ( so tge driver may demonstrate to the CME he/sge is the one testing at home.
If no chain of custody and the driver shows a Normal result the CME may not except the result.
There is a full guidance report on the Gederal regulation website
Hello, Im a Class B CDL holder in Indiana. I am a supply manager for the local power company and am required to hold a CDL if the need to drive a truck arises. I went to a doc in a box to get my re cert. She hit me with a 90 day cert for a blood pressure of 144/92 from what your site says that should be Stage 1 and should be a 1 year cert. On top of that recommends a sleep study solely on BMI per the notes. I have never had any issues before getting a two year cert before. I feel she did not understand what the guide lines are for a DOT physical. Now my job is a jeopardy if I don’t comply with her findings. Which I believe are incorrect. I have changed my diet, I hope to have this blood pressure under control when I see my doctor to clear up this 90 day cert. Can she write up what ever she thinks and I am forced to comply even if it’s against guidelines?
@Jason
You can always go somewhere else for a second opinion. The CME is always looking for possible risk factors, but you hold a class b cdl and should fall under the states variances. As far as the blood pressure, if you do not take blood pressure medication and this is the first time with stage one hypertension, then the CME has the privilege of limiting the length of the certificate to a shorter time frame, so that you will get your blood pressure under control, one way or another.
What about the new blood pressure categories? As of 11/2017
take a blood pressure pill an hour or two before you go in…borrow one if u have to and no coffee or smoking for that day…
I drive a box truck under 26000 lbs and pull a concession trailer with a ford heavy duty van (under 15000 lbs) intrastate only in indiana,both non CDL but we have now been told we will need DOT physicals and sleep test indiana BMV said we do not need but the company said they like the federal guild line better than the states guild line that’s why we would need the physicals and didn’t want to list as intrastate since they already have Federal DOT numbers (their words). anyway can they make use have things we don’t need even
@Mark
You do not need a class A longhaul interstate DOT medical certificate.
What you do need is a valid medical certificate to drive your box truck. You fall under the states variances. Think of it like apples and oranges. You can’t grade an apple by an oranges standards and vice versa. So explain to the medical examiner what your job entails and make sure he/she is going by the state’s standards. That should get you a valid medical certificate, no need for the sleep study unless there are other signs or symptoms, and allows you to drive interstate if needed. Thus satisfying the company’s request.
I have over a year left on my Med Card yet a prospecie employer is requiring a “physical test” by a third party DR. Insight at orientation at which time a new DOT medical exam card “may” be issued.
This third party pushes cpap machines and so if they give a 90 day card to do apnea testing can I just go get my doctor to do a new exam immediately? Or do I have to wait for the 90 days to run out?
I’m thinking of just not going risking it and just finding a different job.
Thank you
Am I
@Brian
If you go for the job, then you would want wait for a reasonable amount of time, before requesting a second opinion. FMCSA would see it as doctor shopping, if done one right on top of the other. If you know that you do not have OSA, then you could get your doctor to write a note stating so.
I have found if you work for a small trucking company they don’t care where you get your medical card as long as it’s valid.
You may not make as much money working for a small company but there is less bs.