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 have had a cdl license for 30 years but let it lapse. I now have three artificual joints, both knees and left shoulder. can l reapply for a cdl?
@Kasey
Sure, you just need to make sure you will be able to fulfill the duties of a commercial motor vehicle operator.
IN OCT 2013 I FELL OFF A TRAILER AND HIT MY HEAD AND BACK ON THE GROUND. MY QUESTION IS CAN I BE CERTIFICATED TO DRIVE AFTER HAVING A SEVERE TBI? I STILL FEEL THE AFFECTS AND THE DR I SEE IS A SPORTS MEDICINE DOC, AND I HAVE NEVER HAD ANY NEUROLOGICAL EXAMS OR HAVE I EVER SEEN A NEUROLOGISTS. BUT I AM AT MMI ACCORDING TO THE CONCUSSION DR.
@Tim
You will need a medical release form completed by your primary doctor.
You may also need to have a neurological evaluation to determine the extent of the TBI residuals.
Medical release first and then try the DOT examiner. He may request the neuro evaluation.
Is it possible to have your class A and be on dialysis?
@Elvira
Maybe as an intra-state only driver, but not as an interstate driver.
So check with your state Drivers License Department to make that final determination.
what is the ejection fraction number required by DOT to obtain a CDL license in NC after bypass surgery?
@Banditt
Greater than 40 % LVEF.
Is there a liaison that helps with concerns about DOT certification? My husband was offered a job pending his physical and passed the physical with flying colors. However, the CME has temporarily disqualified him based on pain medications. He is legally prescribed these opioid medications by a reputable doctor specializing in pain management who also treats spinal injuries (reason for my husband’s treatment).
The CME refuses to grant the certification unless my husband stops taking his meds but the process for coming off of six years of pain management is longer than one weekend and my husband needs to start work on Monday. We attempted to explain this and asked if we could provide documentation from his prescribing doctor but the CME wouldn’t entertain the idea. He’s made a broad-based decision with no merit and no evaluation of medical history. This seems unfair at minimum and borderline discriminatory in reality. Do we have any recourse? I’ve been scouring the internet for information and advice.
Right now our outlook is bleak. It seems the only option my husband has is to stop his medication immediately in order to get his certification from this guy. Doing so is extremely risky and can result in life-threatening detox. The company is only having my husband drive a pickup truck for them but they are insistent on DOT certification. The CME also completely disregardedrour request for temporary certification (90 days) to allow my husband to come off his medication safely.
@Confused
The primary question: Did your husband take a medical release form, completed by the prescribing doctor, with him to the DOT examination? That, in and of itself, may help you out immensely. The CME has to have supporting information from the primary prescribing doctor, so see if that will answer the main CME’s questions.
No, because we didn’t know anything about any of this. When the original CME temporarily disqualified him, we asked about a medical release because we immediately started looking up information and discovered that he could rule in my husband’s favor with a release.
The CME refused to accept any communication from the prescribing doctor and said that the only way he would qualify my husband was if he immediately stopped taking his medication (which would be very dangerous). Another CME happily certified my husband without even batting an eye at his medications. Will this certification stand if the first CME temporarily DQ’d him?
@Confused
This is not the CME position to do such a thing.
So if you went to another medical examiner, one that understands his position, and he clears your hubby, then you should be good to go.
If your hubby has a CDL, then this is the medical certificate your hubby submits to your state DMV for self-certification record with his CDL.
Don’t be so manipulated good grief. You always have a choice. Stay on the pills. Drop their offer go somewhere else.it ain’t legit.
Hi Just had an angioplasty and a stent. Cardiologist sent cardiac clearance to dot dr. Already have a class A cdl. We’ll be getting a Passenger and School bus endorsement.
How long will my medical card be good for 6 months or 1 yr in state of florida.
Thanks for the help
@Stephen
Once you are fully healed you will receive a one year card from this point on.
You will also need supporting testing regarding your heart each time you go for your re-examination with the DOT examiner. Some of the testing need only be done every two years, so check with your examiner to see what all you will need starting now. Good Luck.
I am currently a driving instructor, and I have a student who knows he is suffering from kidney failure, it is to the point of causing him tears.
He wants to complete the instruction and obtain his CDL for local work at home. I know it is a risk, but he is a good driver. I have researched FMCSR for this and it is rather vague. . .
My question is; “If he regulated his treatments, once it comes to that, can he still hold a valid CDL and work?”
Thank you for your time!
Zac
@Dude
Tough one. He may be able to get an intra-state only CDL.
He would not pass the DOT federal examination.
So check with your state Drivers License Department and go from there. Good Luck.
I have been licensed as a Commercial Driver for numerous years, I have Type 2 Diabetes and have controlled in the past with diet and oral medications. About 1 1/2 years ago I started on Insulin injections. I work and reside in Georgia now and only drive in the state. I took a new Medical Exam in July of this year and passed all ok and was issued a certificate good for 1 year. I got a job operating a Yard Dog truck here locally in August, they called me in yesterday and told me that to their understanding I am not qualified to operate a Commercial vehicle if I am taking Insulin and are going to lay me off……….Help I need some good answers
@Tim
Check your present medical card and determine if the examiner has you as an intra-state only driver.
Most of the state DMV’s will let you drive intra-state with a state diabetes waiver.
Check with your state DMV and determine if you can drive intra-state as an insulin dependent driver and what the process is to acquire the state waiver. Good Luck!
I am hard of hearing and fail my dot physical exam. Can I retake my hearing test with temporary hearing aids?
@Jaliyl
To pass the DOT examination you will probably need to get a permanent pair of hearing aids.
Once you pass the test using a hearing aid it will be marked on your medical certificate that the driver must wear hearing aids at all times to operate a commercial motor vehicle.
I was diagnosed with minor sleep apnea while in the military. I’ve been using the CPAP for almost three years now prescribed by my military physician. Next month I retire from the service and I’ll be attending truck driving school to obtain my CDL class A. I was told a medical exam was a part of the class and I’d have to disclose medical information on some form. If I disclose my sleep apnea will I have to participate in another sleep study even though I’ve been compliant and still receiving treatment? I already have a machine. I’m already using it on a constant basis. Are they going to make me do another sleep study? It was a long process to get my sleep study done while in the military and I’d hate to go through it again. This is stressing me out. Is there an investigation done to see if everything on the medical form is truthful? Are they going to dig into my VA/military medical records.
@Scotty
Just have your primary doctor fill out your medical release form and have a recent readout from your cpap unit, showing full compliance and you should be good to go. Good Luck
More info:
See articles on Sleep Apnea
You must be truthful on the medical form.
I have been diagnosed with urgency incontinence and I will be taking Oxybutynin. One side effect of this drug, and an alternative (tolterodine), is “sleepiness.” Does taking either one of those drugs *automatically* disqualify, my CDL-A? And would this be a questionable drug requiring physician intervention/explanation? Thank you.
@Lawrence
Once you have been on these medications for a while and you see how you react to them, then you will know which way to go.
You will need a medical release form completed by your primary doctor so you can take it with you to do your next DOT physical. But the medical release form should answer the CME’s primary questions. Good Luck
I was diagnosed with a stroke last year which medically disqualified me for a year. That year has passed. What do I need to do to be qualified to pass my DOT physical.
@Brian
The wait is over, just have your primary doctor complete a medical release form for you and take it with you to your DOT medical examination. That release form should answer any of the questions that the CME may have. Good Luck.
Last November I had a sleep study done and I was put on a c-pap with oxygen only used at night. I went for my physical today and the PA-C told me that I had to 70% complaints but my doctor says I need 90% to drive a school bus. Is this something the DOT set or the doctor? I know to go back to driving I need a releases form made out but……who is right?
@Tracy
The DOT medical examiner is following the FMCSA guides, not sure what your doctor is following.
The main thing is use of the unit should reduce excessive daytime sleepiness and make the driver more alert.
Another thing to take into consideration is you are a school bus driver and not a full-time over-the-road driver. So check with your state DLD and see what standards they are operating with.
I am prescribed oxycodone 15 mg 3x day and 1 mg zanex at bedtime if my dr gives me clearance and a letter will I be able to get a CDL class b license?
I have a few herniated discs in lower back I’ve been on the meds for years how do I get my CDL class B?
@boo boo
Complete medical release form from your doctor, take that with you when you go for your medical certificate. You will be good to go.
@boo boo
Get your doctor to fill out your medical releasee form and take it with you to the medical certificate examination.
The release answers most of the questions the CME will have.
Please help,
I am attempting to get my CDL and I have sleep apnea. The DOT Examiner says I need a 30 day compliance report from my CPAP machine, however I just got my CPAP machine last week. Can I get a 30 day card until my compliance report is ready? I really need the job and I am afraid they are going to give it to someone else before my 30 day compliance report is ready. I have passed every hoop but this one and my family desperately needs me to land this job. My Primary Doctor says she is willing to write me a letter saying I have been on it for a week as long as I bring her the card out of my machine supporting the action.
@LB
FMCSA regulation states that you must be on the unit for at least 30 days before a medical card can be written. As a regulation, there is no getting around this for the moment. It’s a safety issue and I don’t think anyone will sign off until the 30 days are met. Good Luck
Hi! My husband was just presented with a job opportunity that is a blessing to our family. He would need to get his CDL and the only issue at hand is that he’s a diabetic. He takes Metformin and Glimperide currently. He’s taken insulin years ago, but not now–he’s managing with the medication and diet. We didn’t foresee this coming, and he hasn’t been great about checking his levels, but they’ve been stable. I know his doctor will fill out the form for him, but I was curious as to how they check these sugar levels. I know he could be under 200, but I’m not sure if he’s gotten up over that in the last few months-so I don’t know if that shows up as an average in your system–or if they check right there by a finger prick? Thanks in advance for your help–this is all so confusing to me and he Really needs this job!
@Heather
As a diabetic, you want your primary doctor to complete a medical release form before he goes for his DOT medical examination. If his condition is stable, according to his primary, then he will be restricted to a one year card, but should be ready to go. Good Luck
I had a dot about 14 months ago. They put me on warfarin and installed a small filter to “catch” any clots that might go to my heart or lungs. I have had zero issues since. Would any of the above disqualify me from a Class A CDL?
Thanks.
@Todd
More questions than answers. Why are you on warfarin? Why did they install a clot catch?
Without these questions answered, it would become a guessing game to figure out the answer to your question.
Both of these situations will require a medical release form completed by your primary doctor. That will help the CME make his final decision.
Hip surgery on May 9 2014. And I’ve been on lithium and 100 milligrams of seroquel for 7 years..With no problems. .will this affect me getting DOT card ?
@Kathy
Have a medical release form completed by your prescribing doctor explaining your meds usage.
Do that before you go for your examination and it will explain any questions the CME should have. Good Luck.
I went to get my physical renew. for my C D L When the doctor ask what medicine I was taking I told him I was taking Chantix to quite smoking, I was told I couldn’t get my CDL because this is a drug that I can’t take while I am driving a school bus.
I have a pacemaker in upper left chest area, does that make me medically disqualified to drive under dot regulations. I have c d l class b license. I drive school bus only.
@Luster
This is a state-related question. You’ll need to contact your state licensing department to clarify this answer.
I do not believe you will have any problems.
@Betty
For class A drivers traveling interstate, this may be true. If you are less than a class A driver and driving a school bus, then check with your DMV. I do not believe that this medication is on their “no drive” list.
my co-worker had an accident resulting in brain trama he wants his c.d.l back so he can return to work(class a) what tests will he need to pass so he can be reinstated.his problem is his short term memory,he’s getting better every day with his memory
@Steven
This will be tough for a while. He will need to have his neurologist complete a medical release form stating that the driver is physically, mentally and emotionally stable and can be safe behind the wheel of a class A vehicle.
Brain injuries are required to have a stabilizing wait period before returning to operating a commercial motor vehicle. It is do-able, but may require a little more patience to get it done. Good Luck.