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 a nerve and spine issue caused by cancer a few years ago that now keeps causing my legs to go numb all the time, does this disqualify me from a medical certificate?
@ Mike T
For a class A, over the road, interstate driver, yes. Intra-state only falls under the states guidelines and variances.
I have a bad nerve and spine issue that is causing permanant weakness in my legs. Is this a disqualifying matter?
@ Mike
If it limits your abilities to perform the duties of a class A driver, then yes it is a disqualifying matter.
I’ve had a complete reverse shoulder replacement due I tore all rotator cuff muscles. The range will never be 100 percent and will have weight restrictions so I’ll be released with some form of restrictions does this disqualify me??
@ Paul H
Class A driver, DOT/FMCSA guidelines are going to be strict and will need medical documentation and release forms from your doctors. Lesser class license fall under your states guidelines and variances and will be different than the federal DOT/FMCSA guidelines. Check with your local DLD for guidance.
I had a brain injury back in 2018 and was given a medical card at the end of that year. I went to renew my card and was told that I failed. Can I get one from the same place that gave it to me.
@ Phillip
Yes, you can always request a second opinion. The injury will need supporting documentation and a medical release from your doctors, but you should be OK. The CME needs the medical documentation and releases for risk factors and decision making process’s.
I have diabetic retinopathy. I have filled out all necessary forms for insulin dependent diabetic and supplied other forms required from my retina specialist. The examiner informed now that due to the retinopathy I can’t get a medical card. That the condition disqualifies me. I tried looking for it on the internet like she told me but can’t find it. Can you tell me if this is true or where I can find this information? Plus is there anything I can do to get an exemption. I’ve been driving at my present job now for 6 months but in jeopardy of losing my job. Thanks for your help.
@ Joe
Of course your condition is raising questions. According to the DOT/FMCSA guidelines:
• Vision Annual Evaluation Checklist.
o Exemption requires evaluation by an ophthalmologist or optometrist.
o The driver diagnosed with diabetic retinopathy is required to have an eye examination by
an ophthalmologist.
It requires the CME to read and understand the guidelines and do further evaluation and request additional information from your physicians, if needed.
Can be re-certified once a year, if all other areas are within normal limits.
You, DOT Physical Doctors all assume that all CDL drivers drive Class A Tractor trailers and that we all drive 12 to 14 hour days. Well That’s not true and I feel that I’m being scrutinized and discriminated against for Holding a Class B and only driving sometimes 4 to 6 hours a day. I ‘am a CPAP user and have used one for over 10 years now and it has done wonders for me But, every year and not every 2 years because of WI. Law, I have to take a DOT Physical because you think that I’ll be falling a sleep behind the wheel. You assume, you have no proof of this and yet I’m still being scrutinized. If all you DOT Doctors feel this way then Why not test all drivers for sleep APENA. People that drive Cars, Trucks, Motorcycles, etc.. God knows that I have seen people on the roads that could probably use it the way they drive. Maybe yourself. I agree, we all want safer roads. But why just punish just the few that don’t drive Class A’s. I’m tired of this political B.S.
Well Mike we will say that there are those of us who understand the differences between DOT/FMCSA class A guidelines and state regulations and variances. Unfortunately too many individuals saw an opportunity to become CME’s and still don’t understand the differences. Best bet when you go in for your next medical card examination, explain to the examiner that you are a class B driver and that you fall under the states variances, not FMCSA. If the examiner does not understand the difference, get up and leave.
Thank You for your output on my concern regarding this situation. Wouldn’t it be nice if they had a form asking you on what kind of class that your applying for to avoid this. Also the clinic that I go to requires payment upfront before any testing is preformed, thus just getting up to leave because he doesn’t recognize the differences between state and federal guidelines would be costly of over $100.00. Suppose I could ask if the examiner understands the difference between the two before the exam. Thanks for your output.
@ Michael
Best bet is to get your answers first, before you pay anybody anything. Or go else where for your examination, these guys can’t be the only game in town.
My husband had a stroke in 2018. We live in Ohio. He needs a dot physical to drive for a company he is to start with in April. He went to get a dot physical a few days ago and they told him that he needs to take the call test both written and driving over again since his stroke. He has waited the one year and he has all the letters from neuro and cardiology and even pulmonologist and pcp saying he is good to drive, etc. he keeps getting the run around and they have told him twice when they slap this big boom in front of him that he is not meeting the guidelines to get his dot physical done..??? But yet when we ask for specific and where and who to talk to no one can seem to help ?!
@ Tisha B
If the state is saying he needs to redo the cdl testing, written and driving, then his issue is with the state. Go up the supervisors chain within the state drivers license department for further assistance. It sound like he can provided the medical review officer with the proper documentation, so do not see where the holdup would be. A CME can perform the DOT/FMCSA medical certification examination without a cdl license.
All this BS to keep a CDL I been out of work for over year because my heart doctor will not sign one paper till I pay Thousands of dollars for test been a driver for 43 years Bo not no what to do
My husband’s cardiologist signed a cardiac release exemption and concentra is rejecting it and disqualifying him regardless. Am I correct that he is entitled to an exemption due to cardiologist making the exemption?
@ Amanda
Get a second opinion from another CME. Not sure what class drivers license or exemption you may be dealing with. Unless your cardiologist is FMCSA certified, then his exemption must be cleared by another DOT/FMCSA certified medical examiner.
Had a mini stroke in aug of 2019 then again oct 14 2019 i was cleared by my doctor to return back to work my job wants me to renew my dot physical the mro says i have wait a year ive read up on it says recommend but not required what can i do to really find out
@ Jeff
Two strokes in 2 months, not good. Nearly all CME’s are going to hold to the one year wait following the last stroke. The risk is far too high for the examiners to try to justify a new medical card. If you drive intra-state only, you may fall under the states variances, check with your state drivers license department for their guidelines and regulations on this issue.