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.
2014 Diagnosed with colon Cancer, 2017 prostrate Cancer I am clear of both now, however I did Develop IBS-D and the Doctor just recently put me on Viberzi as no other OTC Like Imodium worked. Will Viberzi restrict me.
@ Brandon
It shouldn’t, as long as it helps control the IBS-D. FMCSA is thinking safety first and foremost.
I had a brain aneurysm in early December and was fully released by my neurologist and the dot medical examiner denied my recertification without even looking at any of my releases or paperwork from my neurologist, what can I do to rectify this?
@ Robert H
Take your paper work and your releases to another DOT examiner. If there are questions, and there will be, then the examiner should tell you what is needed.
How do I get some one to sign the limb waiver or do you know any doctor that can. I had my right leg imputated from my knee down about a year and half ago and I haven’t work since and I need to work. I’m getting behind on my bills I need some help please. I leave in New Braunfels Texas
@ Jose
Check with your local drivers license department. They should have a list of doctors that can perform the driving test and can sigh off on the waiver.
My husband was sent to tucson az for his physical, worked out of Illinois,but for a couple of moths he was having feet swelling problems, migraine headaches,fatigue,had reported to dispatch,the company kept pushing him into force loads even though he needed to see a Dr and was intentionally dispatched to late to get home for them,and was a lease operator,well 1 day after his dot physical he was found deceased it was a brain. Aneurysm,the company has told only one thing he’s not covered,he was 60 yrs old,I know he was constantly put off for appointments, is there anything I can do regarding this,I not educated and my husband was my sole support, it had left me homeless
@ Joyce McG
We are sorry for your loss, Best to talk with a good lawyer in this case.
My husband had an ICD placed on 06-08 2017 and went for a DOt physical and was denied. Can his cardiologist write a letter and stae he has had no episodes, or shocks since he received it. I thought I read they can and he would need his last stress test and ekg .Pleas help .
@ Erin
If he wants to drive class A interstate, FMCSA says no ICD’s. Intra-state or a lesser drivers license class, then he falls under the states variances and may be able to drive. Check with the local drivers license department for an answer.
I know someone that has a sleep disorder meaning they fall asleep out of nowhere and it has caused him accidents in the pass and has a horrible hernia in belly and has his hazmat can that have him denied on CDL
@ Toby
Yes. This person is a safety issue and should not be driving without some level of intervention.
A friend of mine recently had a major depressive episode while on the job. How does this affect his CDL license? After proper treatment when can he be reinstated to work and how does he go about doing so? Is the waiting period mandatory or is it the discretion of the medical examiner?
Class A CDL FYI regarding the above question
@ Evan
He will need medical release forms from his treating physician and his prescribing physician. With supporting documentation in hand he may be able to return to driving, once the CME is satisfied that he will continue to be a safe driver.
I had a presumptive TIA (Mini-stroke) 25 years ago and a CME has denied my physical until I get a release form from a neurologist. I haven’t had any in 25 years and even got through the Marine Corps and other DOT physicals with it being known without any release form. Is there a statute of limitations for requiring a release from a neurologist?
@ Lee
Suggest that you go get a second opinion from another CME.
I am a combat veteran with 70% disability for ptsd and 10% for hypertension. I am being asked by dr all kinds of questions about p tsd, depression, etc. If I am honest I will loose my class a. I need to work to support my family. Please help
@ Stan
The CME should only request information to support his final decision to either pass or fail you on the DOT medical examination. You should be able to have a medical release form completed by your doctors, stating that they feel it would be OK for you to drive on a full time basis without any restrictions. Once you have the medical release forms completed, make sure you take a copy with you for the DOT examination.
I am a Certified Diabetes Educator; have recently helped a pt bring his A1c down from >10% to well controlled and stable per home BG testing (not long enough yet to repeat A1c). He was started on basal insulin and tapering down with add-on SGLT-2i pills; will likely get off the Lantus insulin, so I don’t think my pt has to worry about his desired INTRAstate CDL in Oregon.
However, the DOT certified medical examiner (not realizing the patients DM care plan since his initial exam) has totally dumped this on the PCP that he is to provide an insulin waiver as one of the various things on the pts “to-do list” for various health issues; letters from specialists etc.
My question– saying the pt actually DID need to stay on low dose basal insulin– WHICH DOCTOR IS RESPONSIBLE FOR ACTUALLY SIGNING THE “INSULIN WAIVER” (quoting the ODOT med examiner’s words in his summary letter to the pt’s to-do’s)? Is it the primary care provider (or endocrinologist if one were part of the care team) or the ODOT physician? We can’t seem to get the answer from anyone.
We (myself and PCP who work in the same clinic) can’t locate any “insulin waiver” form anywhere, and it seems that the DOT physician should be supportive in making what is needed clear. Is it just a letter from the PCP indicating the pt has stable DM and low risk of hypoglycemia on his current regimen which includesl insulin, or does the PCP have to sign some ODOT/DOT official form? Does this signing put the signer at risk of their medical license should an adverse event occur?
Seems to me the DOT provider should be the one that signs any waiver, as they are the one certifying after they obtain info from providers who know, evaluate and treat the pt.
I appreciate your help.
@ Julie S
The waiver would come from the FMCSA/DOT and is signed by the medical examiner that is in charge of the patient. The CME simply needs to see the waiver, which has to be presented at the time of the DOT examination. FMCSA has made it sound like the medical community is at risk by signing a patient off. This is due to wording, but is not reasonable by any standard. The PCP has the best information since they have the longest relationship with the driver and the CME should only request additional information to support his final decision making process based on FMCSA guidelines and regulations.