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 recently had to undergo a sleep study to determine if I had sleep apnea. it turns out I do and I’m now under treatment of a cpap machine. I recently got a citation for speeding so I decided to check my mvr. here’s where I find out my cdl is canceled supposedly indefinitely because I failed to report medical/disability but I’ve had follow ups with my dot doc and everything else is going well. so I’m confused as to what this could mean
@Antonio
This has to do with your state drivers license department, so check with them. They should be able to answer your questions.
My boyfriend twisted his ankle and the doctor put him in a cast for a few weeks. No breaks, just tendon damage. He has a year before his next dot physical is due, but his company is saying that when he’s released to go back to work, dot regulations state he has to get a new dot physical. He’s upset because they cost $ and he still has a year. I just want to verify this. Can you point me in the right direction for answer or help verify. Thank you.
@Sarah
FMCSA states that any injury that takes a driver from behind the wheel, for any reason, must have a new DOT physical before returning to driving. Check FMCSA website. It’s not about the time left on the medical card, it’s about the ability to perform the duties of a CMV operator.
I had one of my disks in my back herniate a few years ago. When I got it checked out they told me 2 of my disks were messed up. one had herniated awhile before which cause the other one too. I never received any surgery. I got the steroid shots done in it. I usually only take motrin for the pain if it causes me problems. In the military it has caused problems because of wha I do. I do not feel it would effect anything as a driver. Would this cause me to fail MY CDL medical exam?
@Douglas
No, as long as you can perform the duties of a commercial driver then you will be just fine.
I’m taking ambien for sleeping at night when on break. Dr knows I’m a driver. Is this ok to have in truck ?
@Walter
FMCSA will have a ton of questions and so will the DOT. Too many of the wrong type of side effects with this medication. DOT will, most likely, have a very negative outlook on the medication in the possession of an OTR driver on the road.
Hello,
I am 22, about to be 23. When I was a year old I had heart surgery to sew up a hole, and had a stroke during the surgery, but it hasn’t put any affect on my daily life. When I was about 9 or 10 I had a nocturnal seizure and was put on medication for a few years and stopped before i got my licences and haven’t had any recorded since then. (added) Scratch that, I have had 1 recorded since then, meaning I went to a hospital, and one where I could have had one but didn’t go to the hospital for it. And they all happened within a five year span.
I don’t believe my sleeping patterns have changed any and don’t believe I’ve had any since then, and the ones I have had have been strictly while sleeping. Is this gonna affect me passing my dot physical. I also haven’t had a PCP for a few years now. Will I have to give my full medical history while I’m there? Thank you and have a good day.
@Melenda
You are going to need a medical release form from a neurologist before any CME is going to do any DOT examinations. Because the first question is “are you now or have you ever had a stroke or seizure?”
I had a triple bypass done 2 months ago. I am trying to get everything together to take to my medical examiner to get it all done. I had a Q stress test before I started cardiac rehab. Is that the type stress test that is acceptable to allow me to receive my medical exam card back?
@Norman
Make sure you have a medical release form from your cardiologist along with the test results before you go for your next DOT medical examination. You should be fine if you are ready to return to work, once the cardiologist releases you.
My wife had a triple bypass done in 2016 now there is a leaky heart valve that is not allowing full blood flow to one chamber of the heart her doctor it treating it with meds but took her CDL which she has had for over 30 years. The job she has now for the last 5 years is truck mechanic and a CDL is required so now with out a CDL she is endanger of loosing her job . The CDL is so she can road test and move trucks she works on! What options does she have?
@David
Check into intra-state only with your local drivers license department to verify, but we believe that would allow her to maintain a valid medical card and her only restriction would be that she could not drive a class A vehicle outside of your states borders.
I had PCI 15 years ago, all went well and have been stable ever since. I have elevated blood pressure, but it is stabilized with medication. I do the Nuclear Stress Test every 2 years and achieve good results. Did the nuclear stress test last year and took the results along with a clearance letter from my cardiologist. I completed the exam this year with satisfactory results, but the medical examiner temporarily disqualified me until I provided them with:
All medical records and results
Current echocardiogram results within the last 1 year
Current exercise or nuclear stress test within the last 2 years
Current medications and treatments
Clearance letter from cardiologist
When I read the FMCSA web site I see I need the stress test, I have that.
Annual Medical Examination, I’m there for that.
Current medications, listed on Medical Exam form.
Letter from cardiologist, I have that
It took will be 10 days before my appointment to get a Echocardiogram!
Why the echocardiogram all of a sudden and all medical records when I am asymptomatic for 15 years and have what FMCSA lists that I need after a PCI?
@Kinney
Your CME is trying to work with the FMCSA and is requesting everything that the FMCSA guidelines recommend. You have everything that is required for the DOT examination, but your CME is looking to cover their a** for any possible safety risk factors.
Thanks Guys, Keep up the good work.
We Appreciate it.
The FMCSA is some what over doing these medical conditions. I feel that a medical card is not necassary in order to drive.
It’s like a second license to drive, and the cdl is worthless to obtain.
It’s just my opinion, don’t get me wrong safety is a concern. Leave that up to the cdl holder who knows there health better than the CME Does.
I applied for a job and they did a background check and then called me to go do a drug test so I did. I told the office doing the drug test that I was on Narco from my doctor and had the hard copy from pharmacy. The office doing the drug test told me to show it to my employer so I did and they made copies and said their shouldn’t be a problem. It has been three days and haven’t heard nothing from employer or the doctor. And now it’s the weekend. I was wondering how long it takes for them to get back with me and will I be able to get the job or can they deny me a job because of the medication.
@Dean
With the medications that you are taking, there will be issues.
The job drug test will go to the medical review officer for further evaluation. This can take a few days to a week before you get results. The MRO should be trying to get a hold of you for a copy of the prescription. One way or the other someone is going to get in touch with you.
I have type two diabetes and I am currently on insulin to help control it. I have never had any accidents or injuries that have resulted from my diabetes. However I will be taking my first DOT physical next month and I was told that diabetics usually don’t pass. My diabetes has been heavily monitored by an endocrinologist for well over a year now. What can I do to prepare for my physical? Is there any specific paper work that I need?
@Oceana
As an insulin dependent diabetic, you are going to need a medical release form from your doctor.
And even with that, you may pass the examination, but will have to go through the FMCSA waiver process to drive as a diabetic on insulin. This process may take a few months to get through. It will also depend on what type of driver and what class license you are going for. But as an over-the-road driver, you will need a diabetes waiver before you can drive OTR.
I have a medical waiver signed by my Dr. For 2yrs. But the medical center said they could only sign my medical card for 1 yr be cause I have a medical waiver. What reason do they have for saying that?
@David
If your doctor is on the NRCME, then his will hold up, but if he is not a CME on the National Registry, then the CME’s card is the only valid medical certificate. Check with the FMCSA regarding the reasoning.
I had a frontal lobe brain tumor removed a year ago in sept of 2014. I was off work for 2 1/2 months recovering. I was cleared to go back to work with no restrictions by the nuero surgeon, the nuerologist and my companies safety director. I was 1 year into a 2 year physical at the time of the procedure. I have been working since released to go back to work. my current 2 year physical expires august 31 of 2015. the CME told me, after I passed the physical, that she could not certify me because I wasn’t to be driving for 2 years post op. the nuero surgeon is livid regarding this as I have had no seizures and follow up mri showed no tumor. I read above that you had stated that a later date passed physical would supercede a failed physical. so I can go to another doctor and get a passing physical to send in? please advise. thank you
@Patrick
If you have been completely released from the neurologist and neurosurgeon and have had no physical, mental, emotional symptoms and there is no seizures to report and you are not on any seizure medications — Then with proper documentation you should be able to pass the DOT certification.
The CME may hold you to a one year card to continue to monitor your situation, but you would be able to continue driving. You should take all of the available information and the medical release from your doctors with you to the next examination.
If you pass the examination, then yes it will supersede the non-qualified exam report.
My husband has aortic aneurysm and he has been treated/seen by a doctor for the last 3 years. It is checked every year to see if it has grown. Per his doctor, they may never operate, it all depends on if the aneurysm grows or not. Will this diqualify him from driving in NYS? They will not operate based on its current size so can the doctor complete the “Medical Release Opinion” and will the DOT Doctor accept this?
@Chris
The CME will need a medical release from your cardiologist and a given size of the aneurysm.
The FMCSA has a guideline that will be followed, so depending on the size of the aneurysm and the doctors release, you should be OK.
Thank you for your reply. What is the FMCSA guideline size?
@Chris
FMCSA uses a series based on likelihood of additional problems. Starting in the range of 4 mm in size. That’s why you want to have your doctor confirm on his medical release information the size and likelihood of any possible changes within a given time frame. The CME may choose to limit the length of your medical certificate so that he is kept abrest of any changes in your situation or condition. The guidelines are just that, guidelines and the ultimate bottom line is safety to both the drivers and the public at large.
I got my ICD implanted almost a year ago because of SCA. It have never fired, and haven’t heard a peep from it. I do not have a heart problem. I had SCA only because of low potassium. Right now I am not taking any meds. If I get the ICD deactivated or removed, will I be qualified to drive commercial again?
@David
If you get the unit removed, then there should not be much in the way of questions, just a medical release from your cardiologist. Not sure about just having it de-activated. Again a medical release form would need to explain your condition and situation. With the unit removed, you should be able to return to driving.
I am a doctor, but not a CME (I have no desire to be a CME).
I treat a lot of patients with acoustic neuromas and dizziness.
Can you help point me to some resources that provide some guidance regarding how to counsel these drivers?
My understanding was that an acoustic neuroma meant that a driver could no longer drive– should be removed from duty at the time of diagnosis and not allowed to be reinstated unless the tumor has been removed and the individual symptom free for a few years. Is this wrong?
Just looking for help here. As you know, they don’t teach DOT/CDL stuff in medical school.
@Ear Guy
You are correct in your evaluation to remove the driver from operating a commercial motor vehicle.
The FMCSA has a guideline manual that would support the direction that you are headed.
Until the tumor has been removed and all symptoms have dissipated, the driver is disqualified from operating a CMV. Time frames can vary to some degree, but the driver must be free from all signs and symptoms, also a medical release form from his surgeon and PCP are going to be needed for the driver to have his medical examination done.
The best reference is the FMCSA guidelines. That document was available online from the FMCSA.dot.gov website, if they have it up. It has not been available for months as FMCSA was/is in the process of making changes.
Can I get my medical card and CDL back? I recently rolled my car and was ejected from the vehicle. I suffered from a severe brain injury, but have never had seizures. Can I get my CDL back?
@Mae
FMCSA is going to put you on a waiting period for the severe head injury. You are looking at a possible one year waiting period before qualifying to do the DOT examination. Since there is the possibility of an unprovoked seizure and those possibilities are high and they do not reduce much with time. The FMCSA makes a very strong recommendation not to certify for at least one year post accident. Even then you will need a medical release form from your neurologist before any CME is going to do a DOT medical certification examination.
A year from my accident or my hospital release?
My husband took his DOT physical, but failed it because of his blood pressure. He told the doc he has white coat syndrome and they wouldn’t listen…he needed to get relaxed, but they took it three times and failed him. Then the doctor told him he needed a sleep apnea test and he told them that it isn’t required. Can he go to another doctor, or is it reported that he already failed his test?
@Jill
So yes it was reported to the FMCSA as a failed test.
And that being said, you can go anywhere you like and have the test done again. If you pass this time, it overrides the failed test report and starts a new medical certificate. Just make sure the blood pressure is under control and if you are taking medications for the HBP make sure you take a medical release form from your doctor with you.
The medical card system has now turned into a political game where you are limited and forced to work at McDonald’s for diseases of-age that may eventually lead to a disability. How about convicting someone for a future crime before they commit it. A 4-wheeler is more likely to run into a ditch after 400 miles of night driving than a 60yo driving a Rig for 1500 miles. But what .. a driver from Mexico is exempt from carrying a Medical Card on his person but enter the USA? Oh wait .. I forgot, there are no diseases in Mexico or Canada. My bad .. forget what I said. I’ll go work at McDonald’s.
Well said, they wont listen even though you made a very good point… Congressman maybe ?? lol
I agree
I’m thinking of starting a career in transportation. I’ve passed out 3 times in my life (I’m 33 years old), the most recent time was about 3 and half years ago. I’ve went to the ER when it happens and they just say that I was too tired, dehydrated, and once said that my potassium levels were a little low. They have given me MRIs, X-rays, and echocardiogram (sp?), but ultimately they never did anything else beyond let me rest drink water and gave me potassium pills once. Would this be an issue that I would need to have extensive testing on before trying to obtain a medical card? Thanks.
@Paul
You will need to have your primary doctor fill out a medical release form stating your situation and any issues that he has dealt with regarding you passing out. As you can imagine, this is a problem when 80,000 pounds is moving without a driver. If you have the medical release form in hand at the time of the examination, then the CME can make a more informed decision regarding your DOT physical.
Here in Canada I’m on a 10 year waiting list for a primary care doctor. ER doctors (whose names I’m sure I could never recall) have been the only ones to have seen me about this. Should I try to seek out a private doctor for this? If so would he even be able to give any type of medical release? Thanks.
@Paul
I’m sure there is a question here, but I can’t find it.
Recently diagnosed with aortic anyurism not big enough for surgery yet any advice about dot or physical
@Tom
Just be aware that aneurysms are normally progressive and can increase in size as life goes on. You want to have radiographs or CAT scans for base line size and then monitor routinely. This may cause your medical card to be limited to one year at the time and you will need a medical release form from your doctor explaining your situation and prognosis.
What are an employers responsibilities if an employee with a CDL loses consciousness?
@Susan
A driver who loses consciousness is now a disqualified driver and his medical card is invalid.
The driver needs to get with his primary care physician and find out what happened and why. From there the issue needs to be corrected, if possible, and then the driver can apply for a new medical card. He will need to have a medical release form completed by his doctor and take the form with him at the time of the new examination.
My best friend is looking to get her cdl license soon but she’s HIV positive, but is doing great and hasn’t had any issues since diagnosed as a kid. Will she be able to pass a physical or will she be wasting her time. She has been on the same medicine for years and hasn’t had any problems with it. It says it may cause drowsiness so she only takes it at bedtime.
@Jane
She should have her medical doctor fill out a medical release form for her. It should explain that her condition has been in play since childhood and that she is on medications that are not a safety issue. Otherwise she should not have any problems.