Updated: May 2020
One of the complications of getting your medical certificate is if you have a medical condition that may pose a risk to safety while operating a commercial motor vehicle.
How does this play into the FMCSA DOT physical exam?
Here’s what the DOT doctor is checking for:
- Have you had a medical condition which poses a risk to safety?
- Do you have symptoms that may indicate an undiagnosed condition?
- Do you currently have a diagnosed condition?
- Is the condition being treated?
- Is the treatment effective, and safe, for you to drive a CMV?
- Is the medical condition stable, and safe, for you to drive a CMV?
If a medical condition is a concern, the medical examiner must evaluate whether the condition is a risk for incapacitation:
- Is the onset of incapacitation symptoms so rapid as to interfere with safe driving?
- Is the onset so gradual that you may be unaware of diminished capabilities?
Medical Release Opinion
To ensure that the medical examiner can complete the DOT physical exam at your appointment you should bring a Medical Release Opinion letter from your treating physician. You can download instructions and a letter template here, or refer your treating physician to this page for the necessary information.
If you do not have the necessary documentation with you, for the DOT physical exam, the medical examiner may have to temporarily disqualify your medical certificate. You will need this documentation before you can be reconsidered for qualification for a medical certificate.
Medical Conditions
These are the medical conditions listed on the FMCSA long form for which you should have supporting documentation for the medical examiner:
Illness or injury within the last 5 years • Head/Brain injuries, disorders or illnesses • Seizures, epilepsy • Eye disorders or impaired vision (except corrective lenses) • Ear disorders, loss of hearing or balance • Heart disease or heart attack; other cardiovascular condition • Heart surgery (valve replacement/bypass, angioplasty, pacemaker • High blood pressure • Muscular disease • Shortness of breath • Lung disease, emphysema, asthma, chronic bronchitis • Kidney disease, dialysis • Liver disease • Digestive problems • Diabetes or elevated blood sugar controlled by diet or pills or insulin • Nervous or psychiatric disorders e.g. severe depression • Loss of, or altered consciousness • Fainting, dizziness • Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring • Stroke or paralysis • Missing or impaired hand, arm, foot, leg, finger, toe • Spinal injury or disease • Chronic low back pain • Regular, frequent alcohol use • Narcotic or habit forming drug use
Role Of A Commercial Driver
It’s important that your primary care physician, who is treating you for the medical condition, also understands the physical, mental, and emotional demands of your job, as well as the responsibilities, work schedule and job stresses you have to deal with.
These are extraordinary factors that a family practice physician or specialist does not encounter when dealing with their general patients. These factors must be considered in the doctor’s Medical Opinion Release letter. See Driver’s Role – FMCSA 49 CFR 391.41 (responsibilities, work schedules, physical and emotional demands, and lifestyles, etc).
Qualification For Your Medical Certificate
The DOT doctor, aka certified medical examiner, has been certified for evaluating the special circumstances of a commercial driver.
The Medical Opinion Release letter from your primary care physician helps the DOT doctor to evaluate your medical condition in view of the safety risk in driving a commercial vehicle. However, the decision to qualify or disqualify you for a medical certificate rests with the DOT doctor, not your primary care physician.
Additional Resources:
Guidebook: How To Take The Stress out of Getting Your DOT Medical Card
Comments Please! (not Questions)
Your comments are welcome in the Comments section below.
Please do not post questions about medical conditions below. If you have questions about specific medical conditions related to the DOT physical, please go to the Frequently Asked Questions section, and post your question in the appropriate category. Trucker Docs™ will answer your question as soon as possible.
I am a doctor, but not a CME (I have no desire to be a CME).
I treat a lot of patients with acoustic neuromas and dizziness.
Can you help point me to some resources that provide some guidance regarding how to counsel these drivers?
My understanding was that an acoustic neuroma meant that a driver could no longer drive– should be removed from duty at the time of diagnosis and not allowed to be reinstated unless the tumor has been removed and the individual symptom free for a few years. Is this wrong?
Just looking for help here. As you know, they don’t teach DOT/CDL stuff in medical school.
@Ear Guy
You are correct in your evaluation to remove the driver from operating a commercial motor vehicle.
The FMCSA has a guideline manual that would support the direction that you are headed.
Until the tumor has been removed and all symptoms have dissipated, the driver is disqualified from operating a CMV. Time frames can vary to some degree, but the driver must be free from all signs and symptoms, also a medical release form from his surgeon and PCP are going to be needed for the driver to have his medical examination done.
The best reference is the FMCSA guidelines. That document was available online from the FMCSA.dot.gov website, if they have it up. It has not been available for months as FMCSA was/is in the process of making changes.
Can I get my medical card and CDL back? I recently rolled my car and was ejected from the vehicle. I suffered from a severe brain injury, but have never had seizures. Can I get my CDL back?
@Mae
FMCSA is going to put you on a waiting period for the severe head injury. You are looking at a possible one year waiting period before qualifying to do the DOT examination. Since there is the possibility of an unprovoked seizure and those possibilities are high and they do not reduce much with time. The FMCSA makes a very strong recommendation not to certify for at least one year post accident. Even then you will need a medical release form from your neurologist before any CME is going to do a DOT medical certification examination.
A year from my accident or my hospital release?
My husband took his DOT physical, but failed it because of his blood pressure. He told the doc he has white coat syndrome and they wouldn’t listen…he needed to get relaxed, but they took it three times and failed him. Then the doctor told him he needed a sleep apnea test and he told them that it isn’t required. Can he go to another doctor, or is it reported that he already failed his test?
@Jill
So yes it was reported to the FMCSA as a failed test.
And that being said, you can go anywhere you like and have the test done again. If you pass this time, it overrides the failed test report and starts a new medical certificate. Just make sure the blood pressure is under control and if you are taking medications for the HBP make sure you take a medical release form from your doctor with you.
The medical card system has now turned into a political game where you are limited and forced to work at McDonald’s for diseases of-age that may eventually lead to a disability. How about convicting someone for a future crime before they commit it. A 4-wheeler is more likely to run into a ditch after 400 miles of night driving than a 60yo driving a Rig for 1500 miles. But what .. a driver from Mexico is exempt from carrying a Medical Card on his person but enter the USA? Oh wait .. I forgot, there are no diseases in Mexico or Canada. My bad .. forget what I said. I’ll go work at McDonald’s.
Well said, they wont listen even though you made a very good point… Congressman maybe ?? lol
I agree
I’m thinking of starting a career in transportation. I’ve passed out 3 times in my life (I’m 33 years old), the most recent time was about 3 and half years ago. I’ve went to the ER when it happens and they just say that I was too tired, dehydrated, and once said that my potassium levels were a little low. They have given me MRIs, X-rays, and echocardiogram (sp?), but ultimately they never did anything else beyond let me rest drink water and gave me potassium pills once. Would this be an issue that I would need to have extensive testing on before trying to obtain a medical card? Thanks.
@Paul
You will need to have your primary doctor fill out a medical release form stating your situation and any issues that he has dealt with regarding you passing out. As you can imagine, this is a problem when 80,000 pounds is moving without a driver. If you have the medical release form in hand at the time of the examination, then the CME can make a more informed decision regarding your DOT physical.
Here in Canada I’m on a 10 year waiting list for a primary care doctor. ER doctors (whose names I’m sure I could never recall) have been the only ones to have seen me about this. Should I try to seek out a private doctor for this? If so would he even be able to give any type of medical release? Thanks.
@Paul
I’m sure there is a question here, but I can’t find it.
Recently diagnosed with aortic anyurism not big enough for surgery yet any advice about dot or physical
@Tom
Just be aware that aneurysms are normally progressive and can increase in size as life goes on. You want to have radiographs or CAT scans for base line size and then monitor routinely. This may cause your medical card to be limited to one year at the time and you will need a medical release form from your doctor explaining your situation and prognosis.
What are an employers responsibilities if an employee with a CDL loses consciousness?
@Susan
A driver who loses consciousness is now a disqualified driver and his medical card is invalid.
The driver needs to get with his primary care physician and find out what happened and why. From there the issue needs to be corrected, if possible, and then the driver can apply for a new medical card. He will need to have a medical release form completed by his doctor and take the form with him at the time of the new examination.
My best friend is looking to get her cdl license soon but she’s HIV positive, but is doing great and hasn’t had any issues since diagnosed as a kid. Will she be able to pass a physical or will she be wasting her time. She has been on the same medicine for years and hasn’t had any problems with it. It says it may cause drowsiness so she only takes it at bedtime.
@Jane
She should have her medical doctor fill out a medical release form for her. It should explain that her condition has been in play since childhood and that she is on medications that are not a safety issue. Otherwise she should not have any problems.