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 was just told by a doctor at the clinic where I went to get a DOT physical, that, because I take Vyvanse, she can’t issue me a DOT card (in Tennessee) even if I have my doctor fax a medical release form, because it has some ingredients in it that are stimulants. I’ve had a DOT card for 17 years, and the last three times I had a physical, I was taking Vyvanse and listed it. Why now? Why this doctor? It’s going to cost me a great job!
@Scoot
We recommend that you go get a second opinion and make sure you start with the medical release form in hand. If you have been on these medications for some time, then you need to explain and have your doctor explain why and how often and for what condition you are taking these meds.
FMCSA seems to be on a witch hunt at the moment and a lot of the CME’s are simply not willing to take any possible risk that would be questioned.
Have a second opinion I am currently on same medication just ‘re certified my DOT card no problem. Good luck
Ive had a 3month medical card due to blood pressure,the physician im seeing has me on medication,they say 140/90,is the desired target,im hovering around 150,s/100,s,can I get another 3month while under Dr,s care,or can I go somewhere else,I need to get back to work.
@Russell
You get a one time three month card. If you cannot get your blood pressure under the 140/90, then you are disqualified until you do get it below the FMCSA requirement. If you go somewhere else, be aware that the one time card is in the FMCSA data base and you would flag yourself as doctor shopping. Work with your doctor to get it under control.
We live in Florida my husband went for his DOT exam today, he is diabetic and provided all labs to DOT examiner, as well as a letter from the eye doctor indicating no vision issues as a result of being diabetic. The DOT examiner measured my husband neck and said that his BMI was 32, at which time told him he has to go for a sleep study. This seems to be some type of ongoing tactic for a lot of the DOT examiners. I reviewed my personal medical insurance and he does not meet the medical necessity qualifications for the sleep study. What are his options? The DOT examiner gave him a 3 month clearance. Does he have to return to that DOT examiner or can he go somewhere else? This just does not seem fair to have to pay out of pocket for this very expensive test.
@Danielle
Some time before your last medical card expires, go somewhere else for a second opinion. No new rules regarding sleep study testing, bmi and neck measurements. Once diagnosed with so, then there are regs, but not in the FMCSA prior to that diagnosis. Second opinions are worth the time.
It has gotten to the point where many of these “medical examiners” are making choices they normally would not have in the past. I do not know what is driving these decisions but it is getting extremely tiresome to deal with some of these examiners.
As a CME I can tell you at least 70% of the drivers I have required to get tested for OSA do have the condition. To help with costs I require a screening overnight SaO2 which is offered free of charge in our community. If that comes back positive an apnea link is only $190. Medicare takes that as definitive enough to qualify for treatment. With a positive screening , insurance companies then cover costs also.
3 years ago, I caught an infection (sepsis) that destroyed my mitral valve. I had the valve replaced with a tissue valve. The cause of the valve replacement was purely due to the infection, there is no other vascular or heart disease. They gave me a pacemaker right afterwards, to coordinate my intake and output heartbeats. 5 weeks later, my heart healed electrically, and the pacemaker was turned down to the point that it no longer paces. My heart has been doing all the work on its own for nearly 3 years since, and they expect that to continue to be the case. I am on no medications at all except 25mg of Losartin per day for high blood pressure. My cardiologist says I’m not pacemaker dependent (I get it checked every 6 months, and it always shows that it hasn’t been used), and that I am good to go to drive or to do whatever line of work I want with no restrictions. I’m about to have a DOT physical for a CDL. I have no other medical issues, but I’m nervous! Should the release form you provide be good enough? I’ve downloaded it and am planning on taking it to my cardiologist to fill out.
@Jer
Just make sure you have a medical release from from your doctor explaining your particular situation.
If there are no other issues, then you should get a one year medical card. The CME may request a stress test result from within the past two years, so if you have one, take it with you to the examination. Good Luck
I work for an ambulance service. I had a black out spell in September of this year. I went to see a neurologist and he stated that all of my tests come back completely normal. He told me that I’m not allowed to drive for 6 months though because of the one time episode. I am just wanting to know if this is true or not? My job does not require me to have a CDL, my regular drivers license is all that is required for my job. So, am I allowed to drive the ambulance or not?
@Trisha
It’s not the cdl that is in question with you, it’s the medical certificate.
As a class A driver running interstate you would be disqualified to drive.
As a class D/standard drivers license, you fall under the states rules and regulations. Check with your local drivers license department to make the final decision.
1)I was advised earlier this year I have an A1C of 6.1. I was given metformin as preventative measures and to help lose weight. I stopped them about 1 1/2 months later. Will I need a dr release form?
2)I have a thumb (right hand and I’m right handed) that cannot bend all the way, only slightly. It has been this way from birth.I have never had any problems performing any tasks. Will this disqualify me? Do I need a release letter?
3)I had asthma since age 4/5, and used to have many issues as a child. I had a nebulizer machine and inhalers. I have not had any issues with it in the last few years, nor do I have any current meds. Will I need a release form?
4)I have only been seeing my current dr since February this year. Last dr was about 2 years or so prior. Will the release form (if needed) be creditable/valuable from the current dr?
5)Does the examiner need to be advised if you have HSV1 or 2 and take med’s (rarely) for it? Do I need a release form?
Thanks in advance!
@ very concerned
1. Yes.
2. No, as long as you have a good grip and grasp you should be fine.
3. Medical release form would put the CME’s mind at rest and have an emergency inhaler as a backup, just in case.
4. Should be OK if the new doctor is functioning off of your older doctors records. If not working off old records, make sure he has a working knowledge of your physical condition and get him a job description for a driver. (check FMCSA for that)
5. Should not be an issue, but a medical release would not hurt.
I have recently went and passed my DOT physical examination and obtained my 1 year card for a pr employment opportunity. On my paper work I put that I take Tyenol 3 and Lysinpril. They sent out my drug test and it came back positive for codeine. The medical Examiner called me up and asked if I had a prescription for this drug and I told him that I did. He asked for me to have my DR fax over a paper for the prescription on what it is etc. I usually only take this is in the evening and doesn’t require e me to take it all the time. I have already started my training with the company prior to this drug test other than the actual driving part. Will this now stop me from getting this job or should the documentation from my Dr be enough? Im worried that Examiner is going to hold me back from driving for this company.
@Cory
Should not be a problem as long as you can support the medication use with a properly prescribed RX. You could also have your doctor complete a medical release form for you explaining the medications usage and dosage.
Question.
I had a brain surgury 10 months ago i have not gotten any seizures i have no issues what so ever. My dot was denied right after surgery when my dot expired. Would i be able to get a dot after almost a year?
@ Oliver J
Make sure you bring supporting medical documentation, along with a medical release form from your doctors, before going for the DOT medical examination.
Iw as just diagnosed with hemiplegic migraines which have caused some sensory deficits on the right side of my body. I have loss of strength and cant tell hot/ cold or sharp/ dull and other issues. Nuero doesnt see anything at this time that will prevent me from hopefully making a full recovery but if I dont I am worried I wont be able to work for my company anymore becasue we are regulated by the DOT but we dont use CDL unless we are over the road drivers. Any help would be greatly appreciated. Also i had tremors during this episode that would last 30 minutes and leave me stroke like. When the migraine is beginning I have been losing strength on the right side.
@Christopher
You will need to be examined by an examiner that understands your states variances. You could be OK, but it falls under the states regulations, not FMCSA.
Hi my name is Jimmie,
I moved from Colorado to Kansas a little over 1 year ago and had a doctor that I saw for everything I needed her for. I find myself here in Wichita Kansas and had to have a referral to a pain clinic concerning my ongoing pain I have in my back and shoulders. I recently got a job driving a bus on a contingency basis providing I can pass all the CDL training they are offering. I explain to them the only problem I will have here that I did not have in Colorado is the little PA from the pain clinic will probably not fill the form out for me.
I have taken Percocet 10/325 and a muscle relaxer for years. Of course I would not take the short acting meds at all except for after my day ends and only 6 hours before. I can certainly see the risk in taking these kinds of medicines but I am tolerant to them and they do not impair my judgment as they do some people.
This is going to be my livelihood as I have a hard time with other kinds of work. I am disabled and on Social security disability income but recently gat a letter from them stating I can test my ability to work. Driving does not bother me like other kinds of work. Any suggestions would be appreciated.
Thanks
@Jimmie
Get a medical release from your original doctor explaining your medications and their needs. That should help the CME make an informed decision. Also check and see if your driving is going to be over the road or intra-state only. Intra-state only falls under state variances and not FMCSA/OTR driving.
Hi, I’m only intra-state in Washington. What are the prescription meds restrictions for a school bus driver. I’m having trouble securing my medical card do to meds I’ve been on for years. I’ve also been driving for 31 years for the same company.
Thank you
@Judith
If you have always cleared in the past, then you need to explain to the examiner that you drive intra-state only and that you fall under the states variances and not FMCSA interstate rules.
I’ve had controlled lupus for 14 years and I take medication everyday I’m on hydroxycloroquine twice a day that doesn’t cause drowsiness and I’m on 10-325 hydrocodon as needed for lupus pain I don’t have to take it every day and it doesn’t cause drowsiness or blurred vision or anything like that with the stop me from getting my CDL?
@Estrella
The medications are going to cause questions.
The CME doing the medical examination is going to need supporting documentation from your prescribing doctor. Have the prescribing doctor explain the length of time that you’ve been on this medication, and what if any side effects you’ve experienced.
It’s still up to the CME to make the final determination.
My husband had 3 strokes on 09/06/2016, has fully recovered but we are both worried about his CDL. He’s been cleared from his PCP, NEURO, and CARDIO to return to work full duty.
With their clearances is there still a possibility he wouldn’t be cleared with a DOT physical?
Thanks,
Julie
@Julie
Minimum of a one year wait to be cleared for an interstate medical card.
Check with your local drivers license department about their requirements for intrastate.
I have Trigeminal nerve damage since 1980. The pain never ends… I take four Norco and two oxycontin daily to control the pain so I can have a life and work. I’ve been own these meds for about ten years now. I have never mentioned it on my DOT forms, I’m afraid to open up a major can of worms now and lose my job.
Has anyone out there been approved for a DOT cert on these meds? I have a non CDL driving job but I do need a DOT physical each year. (i’m on blood pressure meds) I’m thinking just keep my mouth shut and keep going as is and hope I never get asked for a drug test urine.
Does anyone know a DOT Doctor on Long Island, NY that would give me a DOT cert with these meds if I get the proper forms from my neurologist?
Fast acting narcotics are OK Aa long as you take it after work or 6 hours before your shift . time release is not allowed at all. It’s better to be honest then get caught for falsifying. Good luck wish there were more research done on how safe these are with people who are tolerant
Thanks for your reply Bella. I’m really getting conflicting answers for this question. I read a lot that if I just get a letter from my Dr stating that I am under his care and that I have no serious side effects from the meds that I will be ok.
Now you say that the time released meds (oxycontin) is no good. This is the first I’m hearing of this. I wish the Dr would give his opinion. I get 5 norco a day, most days I only need 4. If I say I only take it after work that may be a red flag. I seriously don’t know what to do.
If I had a very mild stroke rececently,but have made a full recovery(no neurological or physical deficits) from the stroke am i still disqualified for 1 year from being allowed to drive? Is it possible to receive a variance if a board certified neuroligist gives me a clean return to work statement?
@Joe
That’s only a possibility.
Are the guidelines different for intrastate and interstate driving
@Joe
Each state has their own, different, intrastate variances.
I have been diagnosed with heart failure and HB. i had a heart procedures on right and left heart catheterization. I am currently on carvedilol and lisinopril. My cardiologist says I will not pass the DOT physical. I need to recertification for my job. My cardiologist is giving me 4 weeks to see if the medicine is working. With a medical release form from him will I get cleared? I only have 5 months until retirement. Thanks
@Maureen
You may clear at an intrastate only level – maybe.
You will not clear at a federal level.
I am recently a dialysis patient. My kidney doc says my kidneys work, just not enough on their own. Is dialysis alone,enough to disqualify me. I passed every test but when I mentioned dialysis to the examiner, he immediately failed me.
@Chris
You will be limited to driving intra-state only, but can have a cdl and work within the state. You want to confirm with your local drivers license department as to what the policy of the state is for you to continue to drive within the state only.
I’m a struggling diabetic with out of control diabetes. I take insulin. If my A1C’s have been over 10 for over a year would this disqualify me for a DOT
You would be automatically DQ’d for taking insulin. You must also have an A1c under 10.
I have some medical issues issues that I am concerned might throw up some red flags for the CME:
1. I have had a history of major depression for the last 15 years, but it has been well controlled by taking an SSRI (was fluoxetine, now is sertraline and bupropion).
2. I had surgery for diverticulitis a few years ago, which was completely resolved. Since then, I have had a couple of recurrent ventral hernias. They have been repaired, and I had mesh installed to help prevent future ones. I have some weakness in the abdomen as a result (I cant really do sit-ups) but can function OK in everyday situations.
3. I was diagnosed with psoriasis and psoriatic arthritis a couple of years ago, but it has been well controlled by taking bi-weekly shots of Humira.
I am at the point now where I am only exploring the possibility of becoming an OTR / long haul driver, and would love to know if this might disqualify me before I spend thousands on driver training.
Thank you for being so generous with your time on this forum. I have learned a lot by scrolling through and reading the questions and your responses.
@Brett
Long before you need to spend any serious money the trucking school should ask for a valid medical card.
To get started on that you want to have medical releases from your prescribing doctors explaining your situation and need for the medications that you are taking. The meds for your depression and the condition are going to raise questions. So when you get your medical release from your doctor make sure he explains that you have been on these meds for a while and that you have no residual side effects from their usage. All conditions are stable and your medication usage is also stable.
With these supporting information in hand you will have done all you can to be pro-active.
I got a defibrillator and if it don’t go off with in 6 mo.can I go back driving a cmv again on interstate
@Terry
Defibrillator is a disqualifier for class A interstate drivers, even with the doctors note.
But you may be able to driver cdl intra-state only and be just fine. Check with your local drivers license department and ask them for full verification.
I am going through a school for cdl. I went in for a d.o.t test i let them know i used to take ambian but i have stopped all my meds. She disqualified me. My dr said he would fax them a letter, i didn’t realize i was going to need one. They wont take it and they say its gonna be 6 months before i can take another physical. I didn’t test positive or anything. What do i do now?
@Chrystal
Get a medical release from your doctor and then go somewhere else for a second opinion. If you have been cleared from this medication usage, then you should not have any issues with proper documentation in hand with a new CME.
Who does the skill performance evaluation the CME? I was born with a hand missing there are NE restrictions on my class d licence I can drive a manual transmission car and want to get my class a will that be difficult or do I just pass a test? And I have worked my entire life no liability I can do pretty much anything anyone else can do.
@James
You want to check with your local drivers license department to see who they recognize as a SPE doctor. That way you get it right the first time. The CME does not do this test.
Hello and thank you so much for any help you can give me. My name is Brandon and i have mild ADHD. I am prescribed 20mg of Adderall twice daily. I am about to go to a company sponsored CDL training and i am very concerned on whether i will be cleared by the medical examiner. I am planning on taking a letter from my family doctor who has been my doctor for the last 6 years. He says it will in no way impair my driving. My concern is if i am not cleared by the companies medical examiner i will have to pay back 7000 dollars that i do not have. The information online is very vague and unhelpful. I leave in a week and any information would be a great help at this point. If necessary i am willing to discontinue the medicine. What is the best way to move forward? I want to drive over the road more than anything!
@Brandon
A medical release form and a brief explanation by your primary doctor should be all that is needed at this point. Have all of this in hand before you show up for the examination.
Get medical release form from DOT website. Currently taking same medication no problem. Good Luke