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 CME and recently examined someone who has been on Suboxone as well as Xanax. The combination is not recommended in the first place. Suboxone is used in place of Methadone which is an absolutely excluded drug but I can not find reference Suboxone in official site. Lastly the pt told me he only takes Xanax three time weekly, but, I checked on State online Narcotic Site and found that he fills Rx for 60 every month. So, he is either taking it twice daily or it is being diverted some how.
Thoughts would be appreciated, especially if you can reference official recomendations
Thanks
@ Dr S
Pointing you in the direction of a reference will be difficult since FMCSA removed their guideline some 27 months ago for site updates.
So it really becomes your call based on any and all available documentation from the driver’s primary doctor.
Even though suboxone is used for a methadone replacement, it is also used as a pain reliever. So you want to contact the primary doctor, or have a medical release form from the doctor explaining the drivers need, usage and length of time using this medication. Do the same thing for the Xanax.
In the end it will be your call on whether the driver should or should not be driving based on all of the available documentation presented to you via the driver. Is he safe to drive and is he fit for duty? – That is the final decision you have to make. And it is the driver’s responsibility to provide the information to your office.
I would like to solely comment in the driver’s defense solely on the suboxone. Not the xanax! I will say I was on pain killers for around 2 years. I will say the only thing that has saved my life and has given me a second chance is suboxone. Their is research to show long use to opiates can damage the brain and for the rest of our life we will always crave opiates every few months. I can say I came off pk’s for over 3 months and I still felt withdrawal symptoms everyday. I found suboxone through an illegal source. However later as I found a doctor who has prescribed me for about 2 years. I do not feel like I am on pk’s and have’t for a very long time. I forget to take it actually. Suboxone also blocks the receptors.So let’s say I found pk’s and took the entire bottle. I wouldn’t feel any high. Suboxone has never made me feel like I am drugged or that high I have completely forgotten. I am normal and forget about it. Unlike methadone that has made me sleepy. Suboxone has never and I mean never made me feel tired or drugged after the first few days you are a normal guy.
Bernie , Indianapolis .
I have a difribulator for almost a year now . Have made full recovery , doc will release me to go back to work when I’m ready . With the difribulator and a good ejection fraction is there any possible waiver to obtain to renew med. card ?
@Bernie
Once fully released, make sure you have a medical release form from your doctor, and your ejection factor report.
A lot will depend on the type of driver you are. FMCSA has a set of very strict rules regarding class A Interstate driver and defib units.
So a lot will depend on the type of driver class that you are. We are not aware of a waiver that is available for a class A Interstate driver. If you are class A, then you will want to contact the FMCSA directly for final verification. Good luck.
I’m will soon be getting a pacemaker and they told me I will be pacemaker dependent will I still be able to get my medical cert so I can keep driving commercially ?
@Bob
Yes, as long as there is not a defib. unit attached you can continue to drive, once fully healed, medical release in hand and ready to return to work.
The CME may want to see further testing results so be prepared to answer any questions and be able to get any additional information that he may request.
Can a doctor be sued for signing a medical waiver? My husband’s doctor seems to think so.
We live in WA state. Please answer as soon as possible. His career is on the line. Thanks.
@Cindy
We are doctors, not legal advisors. Can’t give legal advice, especially on little to no information.
I was just told by a doctor at the clinic where I went to get a DOT physical, that, because I take Vyvanse, she can’t issue me a DOT card (in Tennessee) even if I have my doctor fax a medical release form, because it has some ingredients in it that are stimulants. I’ve had a DOT card for 17 years, and the last three times I had a physical, I was taking Vyvanse and listed it. Why now? Why this doctor? It’s going to cost me a great job!
@Scoot
We recommend that you go get a second opinion and make sure you start with the medical release form in hand. If you have been on these medications for some time, then you need to explain and have your doctor explain why and how often and for what condition you are taking these meds.
FMCSA seems to be on a witch hunt at the moment and a lot of the CME’s are simply not willing to take any possible risk that would be questioned.
Have a second opinion I am currently on same medication just ‘re certified my DOT card no problem. Good luck
Ive had a 3month medical card due to blood pressure,the physician im seeing has me on medication,they say 140/90,is the desired target,im hovering around 150,s/100,s,can I get another 3month while under Dr,s care,or can I go somewhere else,I need to get back to work.
@Russell
You get a one time three month card. If you cannot get your blood pressure under the 140/90, then you are disqualified until you do get it below the FMCSA requirement. If you go somewhere else, be aware that the one time card is in the FMCSA data base and you would flag yourself as doctor shopping. Work with your doctor to get it under control.
We live in Florida my husband went for his DOT exam today, he is diabetic and provided all labs to DOT examiner, as well as a letter from the eye doctor indicating no vision issues as a result of being diabetic. The DOT examiner measured my husband neck and said that his BMI was 32, at which time told him he has to go for a sleep study. This seems to be some type of ongoing tactic for a lot of the DOT examiners. I reviewed my personal medical insurance and he does not meet the medical necessity qualifications for the sleep study. What are his options? The DOT examiner gave him a 3 month clearance. Does he have to return to that DOT examiner or can he go somewhere else? This just does not seem fair to have to pay out of pocket for this very expensive test.
@Danielle
Some time before your last medical card expires, go somewhere else for a second opinion. No new rules regarding sleep study testing, bmi and neck measurements. Once diagnosed with so, then there are regs, but not in the FMCSA prior to that diagnosis. Second opinions are worth the time.
It has gotten to the point where many of these “medical examiners” are making choices they normally would not have in the past. I do not know what is driving these decisions but it is getting extremely tiresome to deal with some of these examiners.
As a CME I can tell you at least 70% of the drivers I have required to get tested for OSA do have the condition. To help with costs I require a screening overnight SaO2 which is offered free of charge in our community. If that comes back positive an apnea link is only $190. Medicare takes that as definitive enough to qualify for treatment. With a positive screening , insurance companies then cover costs also.
3 years ago, I caught an infection (sepsis) that destroyed my mitral valve. I had the valve replaced with a tissue valve. The cause of the valve replacement was purely due to the infection, there is no other vascular or heart disease. They gave me a pacemaker right afterwards, to coordinate my intake and output heartbeats. 5 weeks later, my heart healed electrically, and the pacemaker was turned down to the point that it no longer paces. My heart has been doing all the work on its own for nearly 3 years since, and they expect that to continue to be the case. I am on no medications at all except 25mg of Losartin per day for high blood pressure. My cardiologist says I’m not pacemaker dependent (I get it checked every 6 months, and it always shows that it hasn’t been used), and that I am good to go to drive or to do whatever line of work I want with no restrictions. I’m about to have a DOT physical for a CDL. I have no other medical issues, but I’m nervous! Should the release form you provide be good enough? I’ve downloaded it and am planning on taking it to my cardiologist to fill out.
@Jer
Just make sure you have a medical release from from your doctor explaining your particular situation.
If there are no other issues, then you should get a one year medical card. The CME may request a stress test result from within the past two years, so if you have one, take it with you to the examination. Good Luck