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.
We live in Oklahoma, my husband has held a CDL for 20+ years he recently applied for another driving position and naturally they sent him for a drug test and although he still has a current DOT card not due to expire til October they want this particular facility to issue a DOT card…. He had a reverse shoulder replacement back in 2015 but has since returned to work and also had his orthopedic surgeon send his release to the medical examiner and the Nurse Practioner told him he needed to go to the FMCSA SPE website and print off an application and get a list of doctors to do a skilled performance evaluation… In the meantime she sent a fail to the prospective employer. What is he to do… He has gone and renewed his DOT card with absolutely no problem since.
@Carol
Unless there are restrictions in operating the shoulder, an SPE evaluation is unnecessary.
Go and get a second opinion from another medical examiner.
class A: II had under gone a couple of surgeries within a 4 mo span. It took the doctors almost a year to find out why I was in so much pain. I was given a rx of the lowest dose of a pain medicine. I NEVER took my medicine when I had to work. A dot pysical dr looked at my record and freaked out because of the length of had been prescribed medication and how many times I COULD take. He disqualified me. He had requested a letter from my primary and that she was in compliant. That would not satisfy him. He never even drug tested me. What do I do now? Can I go to another dot and provide this information and get certified?
@Susan
Yes, try a second opinion from another medical examiner. Take as much documentation with you to help the examiner make an informed decision.
I’m in the same boat I’m prescribed pain medicine for many years and the doctor told me that I have to have a primary doctor write a note for the prescription he gives me and he took my CDL license and that I can’t have this medication without a doctor stating that I’m not risk behind the wheel and my doctor won’t do that so the federal government took my CDLs even though I passed ma DOT physical he said He could not sign my DOT card cuz my doctor would not right a letter Stayton I wasn’t at risk
I have a ky medical waiver. Can I get my full dot medical card back to drive out of state if my heart attack was over 5 years ago and not having any problems. No longer taking any meds.
@Adam
More than likely, yes, if all else is normal. Your medical card will be limited to a one-year card.
I take subsolv (suboxone) and have for some time now. I do not have a cdl and only drive a small box truck. I went to get my med card and the dr gave it to me but i have to get a waiver. Do i need this waiver since I only drive small vehicles and don’t need a cdl? Thanks for your input and I live in KY and only drive in state.
@Tharog
You fall under state variances so check with your local drivers license department. You should not need a waiver but a medical release form from your primary physician would be helpful for the medical examiner.
July 2016 i collapsed at an outside event on a 100 degree day, My heart stopped. After a week in the hospital i was not diagnosed with any condition or illness and while not required an ICD was heavily suggested to prevent it again. Keep in mind the temperature and i didnt eat or drink anything since 6 the night before. On top of that no blood work or temperature was recorded before getting hooked up at the hospital. (after being on an IV in the ambulence) Everyone ive spoken to thinks it was heat stroke. Ive since gotten the doctor to turn the implant off completely and its only monitoring my heart now. I should be able to pass a medical exam now right?
Pennsylvania Class A License
@David
It will be very questionable. FMCSA regulations state that any class A driver with an ICD is disqualified as an OTR driver. With proper documentation from your cardiologist you should be able to do intra-state driving. We suspect that most CME’s are going to hold you back until the unit is removed completely, but it is worth a try with a medical release form and proper documentation.
I am uunder pain management and im interviewing for a management position but have to get a DOT card because about 25% Of my job will be driving. I am prescribed percocet, i only take them when i know i won’t have to drive for any reason. Am I disqualified from getting DOT card???
@Chad
Based on your class drivers license and your need for a medical card, you may fall under your state’s variances and not Federal DOT regulations. Check with your state’s DLD.
I have a client that had passed his DOT with another provider. Now his new employer wants him to be examined by our Co. This client has cerebral palsy with mild residual in his right arm movement
What is the federal guideline for evaluating a client with cerebral palsy. I would appreciate any direction with this question.
@Pam
We would have to start with, what class drivers license does this driver have?
Some medical exams vary from state to state. This driver may fall under state variance that allow him to pass within the state’s regulation and not FMCSA.
I had a motorcycle accident back in September and lost use of my right arm. I drove interstate commerce. I was denied disability and need to get back to trucking (which I have done for 20 years). I was told by my driver’s license center here in PA that a FMCSA doctor can sign off on me. I was also told by a representative at a congressmans office which talked to the federal boy’s. Is this correct? Can I drive and not have to do a SPE?
@Nathan
Class A, interstate driver, no, you will need the SPE before you would be re-qualifed to drive.
It is not up to the CME to make that decision, he needs documentation from the other examiners before he can make his final decision.
Where can I get a SPE packet and in what order do I apply?