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.
My PCP also does my Dot physical. So he is aware of my medications because he prescribed them. My question is as long as he is on the national registry am I good or should I see a separate Dr for my dot physical.
@ Christopher
You’re as good as gold. Best possible combination.
Thank you very much.
I am looking to obtain my first CDL. I had a heart attack 4 years ago and had a stent put in. My cardiologist since has given me a clean bill of health every time I see him him and has discontinued medications originally prescribed at the time of getting the stent. He has never ordered a stress test. I’m seeing I need one every 2 years. Do I need to have him order the test or can my PCP do that? This is all new to me and want to be prepared before scheduling the exam. I also had my appendix removed 5 years ago with zero complications. Do I need to report that? Thank you!
@ Rick S
For a class A cdl you will need a stress test every two years, according to DOT/FMCSA. A lesser class cdl will be under your states guidelines and regulations. Your PCP may be able to order it. Let them know it is part of the cdl process, if going for a class A cdl.
I recently had a dot physical and examiner wants a clearance letter on a one off seizure I had eleven years ago. I’ve never been prescribed medication or had an epilepsy diagnosis. I also had TIA’s and a carotid endarterectomy nine years ago. What testing does a neurologist use to determine my fitness? Will I need a clearance letter from a neurologist every year I renew?
@ Ray M
For class A cdl, interstate, DOT/FMCSA requires a medical release form from your physicians for any major condition that you are being treated or have been treated for in the past.
My Dad had stints and a pacemaker put in back in 2017 and has been in good health since. He went to renew his CDL last year and did a chemically induced stress test because he has one leg shorter by about 1 inch due to an accident many years ago, so running on a treadmill is difficult. The test came back inconclusive. His cardiologist signed off last year because he has not had any issues in the past seven years. This year he went to get a letter from the cardiologist to bring to his DOT physician and she said she needs him to do a nuclear stress test. I called and spoke to them saying that is over the top and an undue exposure to radiation. I told them he only needs a stress test every other year. Then they told me they no longer provide cardiac clearance letters per their management. If his own cardiologist will not provide a clearance letter because I am sure it is a cya thing, what is my Dad supposed to do? He does his annual visits with them and always has his pacemaker checked. He just wants to drive in his little town hauling water for cattle and some gravel and soil for farm jobs. He is very frustrated with all the red tape. Any guidance would be appreciated. Thank you
@ Brenda
What class cdl? Lots depends on class and distance. He could look into intra-state only. That way he falls under the states regulations and not federal DOT/FMCSA.
I had a heart attack in 2014. I held a CDL in my previous state. After my heart attack, I had a yearly physical. I was also told that I needed a stress test every two years.I had a couple of stress tests in the beginning, but my doctor said that was archaic thinking and I didn’t need a test that often. I moved to a new state in 2021 and gave up my CDL. I am thinking of getting it again. How long does the stress test requirement last? I don’t want to get into insurance issues for a test my doctor says I don’t need that often. I am an ideal paitient, have cholesteral of 127 and my blood pressure was 120/70 at my last visit this summer.
@ David
For a class A interstate driver, DOT/FMCSA requires a stress test be done every two years. Lesser class cdl or intra-state only will fall under the states requirements and regulations.
I had heart surgery 23 years ago and a mastectomy 13 years ago. Will I be required to have a medical release?
@ Rosemary O
Most likely not, but the CME may request one if he feels the need to support any additional findings.
I was in a rollover accident and had a Traumatic Brain Injury I was given nuedexta and a neurologists Dr’s. note saying it was safe for me to drive while on the medication. My employer disregarded the note and said I have to take a DOT recertification physical. I disagree. Who is right in this case?
@ Douglas B
DOT/FMCSA for a class A driver. Any illness or injury which takes the driver from behind the wheel requires a new medical certification examination before returning to driving.
Getting DOT medical card soon and I am on Suboxone. How can I confirm this is NOT a medication disqualifier? From what I have learned so far, it is not mentioned. I’m asking my prescriber/provider tomorrow if she will sign a medical release opinion for me. If the medication doesn’t disqualify me, and she signs the release, what are the odds the the CME will still not approve me?
@ Les
Hard to say. If they only go with the old guidelines and regs, then it will not fly. If they take it on a case by case, then the letter will be a help.
my husband had a heart attack and did his stress test after the 3 months and was given a 2 yr physical card that was in 2020 he hasnt had a stress test since and keeps getting renewed he has been having what he states to feel the way he did when the first heart attack happened .my question is ,,isnt he out of compliance and now that he is aware who is responsible for the oversight and can his current employer fire him ?based on the fact that he doesnt want to drive until he is cleared.
@ Jay
He has been out of compliance since the first heart attack.
DOT/FMCSA regulations for a class A driver, stress test every two years, medical card is good for one year at a time. Has he been re-evaluated by his cardiologist within the past year? He should be providing medical release forms from his physicians since the original incidence. Lots about this does not make sense. The medical examiner is not following regs, the safety director is not doing proper follow-up for the company and if he is feeling the same symptoms as before, he needs to be followed up with his cardiologist.
I was diagnosed with a small blood clot on my right lower lung. My doctor prescribed a blood thinner and said that it would stop the clot from growing and will start to dissolve it. She said I was good to return to work and it posed no immediate danger or health risk. However my company safety department wants to put me out of service for three months per DOT rules. Is there anything I can do? Or an exemption?
@ Dan F
For a class A interstate OTR driver, by DOT/FMCSA regulations, you have a short waiting period before returning to driving. Your safety department is following the regulations. And you will need a new medical examination and medical card before returning to work. We know of no exemption to this issue.
I I’m going for my DOT physical examination and I take Klonopins. The examiner wrote a note to my position letting her know what I needed in order to come back and get my certificate. They needed documentation that the dosage had been lowered, I went through necessary substance abuse treatment and that I am safe to drive. Also that I’ve had no depression in the past 6 months to one year. My position provided all of that and I went in to receive my certificate however the doctor came in and stated he needed one more thing from my position. That was she did not write the exact wording of I feel safe for him to drive a commercial DOT vehicle. I then called my position and had her provide that and she did. The examiner called me back about 2 hours later stating that he now needed something from the PDMP database stating that she lowered the medication which she just did yesterday, that there are no side effects from the medication, I take the medication 8 hours before I drive and again that she feels safe for me to operate the vehicle. Is that okay for him to ask for. I understand what the PDMP database is but if I am providing all this information that he is requesting how much more does he need
@ Adrian
Unfortunately the CME must abide by DOT/FMCSA guidelines and regulations, which your physicians do not have to do. Before the CME can make a final decision on this he needs as much information as he can acquire to determine all of the potential risk factors. Be patient, he seems to be working with you, he just needs to cover all his bases too.