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 put on a low dosage prescription for high blood pressure . Will getting a one year card jeopardize getting the new job I’m taking the physical for ?
As long as your treated it with a physician you have no problem getting a new job and or physical
I am 73 and diabetic but not taking insulin. I had my physical exam done at Concentra on Nov. 15th and the Medical examiner gave me this letter (clearance form) to be signed by my doctors at the VA, particularly for my heart and knees. I just did my stress test at the VA and I was given a go signal to go back to work and even provided me with her notes and reports that I could show to DOT medical examiner. I showed the note/report but it was insufficient and told me to have the letter signed by my cardiologist. I have yet to hear from her on the letter.
Re my knees, the medical examiner saw me limping and asked me to bend, squat and touch my toes and passed the test, too. I have bilateral osteoarthritis of knees. I could walk without difficulty and pain. I don’t have a VA specialist for my knee since there was no work to be done). My PCP found no problem that will hinder me from driving a truck.
I have been going to VA for my check-ups and has all my medical records and test results. My problem is my Primary Care Physician is at the VA and wouldn’t sign the DOT letter for my knee because it’s functional work and I should go see another doctor.
Your advice will be greatly appreciated.
If I were to become a living liver donor, would that effect my ability to certify for my CDL and medical card after recovery. I HAVE NO CURRENT MEDICAL CONDITIONS.
I broke my leg and noticed my dot medical card is going to expire before the my leg gets better and reahabilitation of my leg? What can i do i dont want to loose my license or anything. Thank you
I had a very small heart attack in 2000 with minimal damage that does show up on ECG…that resulted in a CABG of the LAD using the Mammary artery to bypass…I am completely symptom free and have been since then…and am on no meds…So, my question is…Can I still qualify for a 2 year DOT medial card?
Hi my name is Bill I’m trying to obtain a physical for commercial driver’s license I take no medications have only one medical condition I am on dialysis I have no restrictions other than going to dialysis 3 days a week is there a way around getting a physical card for somebody on dialysis
@William
You will be restricted to “intrastate only” and with proper documentation from your primary physician you shouldn’t have any problems. You fall under state variances, not FMCSA.
Motor Carrier does not recognize any form of dialysis you are deemed disabled your only option is probably a kidney transplant
No form of dialysis it’s acceptable I’m going through dialysis myself if you get lucky enough to get a physical card you’ll be slipping through the cracks if you’re able to get a kidney transplant that’s probably your best option then he’ll be able to return to work
Hello all,
I slipped on ice in the parking lot 5 and a half years ago. The doctor talked me into removing a minor amount of blood off of the back of my brain. Since that surgery, I have taken no meds, had no issues, and passed fed med card stuff every year(due to my original Dr. Examiners request).
I stopped in last summer, my Dr was busy, so some crazy pants lady examined me, I passed everything as usual, then she read through med history, and went berzerk, shutting down my cert, demanding I get cleared by a neurologist, then telling me I would only be cleared for 3 months at a time!!
Is this true? Also, since it has been over 5 years now(almost 6), and I have had zero issues, do I still need some silly neurological clearance?(when I passed the first four years after the surgery no problem)…
@Uncleared
You may want to go elsewhere, for a second opinion, or go back to your original doctor.
two years a go i went to company paid doctor who looked at my neck and said i need to take apnea test. so i did, as I believe everyone has it to a degree as mine is very slight. now with all the uproar and confusion I have my DOT physical coming up and wondering if I went to another doctor with a good bill of health would I need to still produce proof of cpap usage
@Dennis
If you’re not using a CPAP machine now then you should not have a problem as long as you do not present with any health conditions that may indicate you have sleep apnea. BMI and neck measurements are not to be use as sole indicators for sleep apnea testing.
I take a low dose 1/2 pill of 0.5 Zanex daily for last 20 years. Since I started driving a truck 6 years ago and am on the road for long periods of time my doctor writes my prescription for 2 pills daily so don’t have to come in every month. On my recent med card exam I was told this is inexcusable. What are my options.
We live in Oklahoma, my husband has held a CDL for 20+ years he recently applied for another driving position and naturally they sent him for a drug test and although he still has a current DOT card not due to expire til October they want this particular facility to issue a DOT card…. He had a reverse shoulder replacement back in 2015 but has since returned to work and also had his orthopedic surgeon send his release to the medical examiner and the Nurse Practioner told him he needed to go to the FMCSA SPE website and print off an application and get a list of doctors to do a skilled performance evaluation… In the meantime she sent a fail to the prospective employer. What is he to do… He has gone and renewed his DOT card with absolutely no problem since.
@Carol
Unless there are restrictions in operating the shoulder, an SPE evaluation is unnecessary.
Go and get a second opinion from another medical examiner.
class A: II had under gone a couple of surgeries within a 4 mo span. It took the doctors almost a year to find out why I was in so much pain. I was given a rx of the lowest dose of a pain medicine. I NEVER took my medicine when I had to work. A dot pysical dr looked at my record and freaked out because of the length of had been prescribed medication and how many times I COULD take. He disqualified me. He had requested a letter from my primary and that she was in compliant. That would not satisfy him. He never even drug tested me. What do I do now? Can I go to another dot and provide this information and get certified?
@Susan
Yes, try a second opinion from another medical examiner. Take as much documentation with you to help the examiner make an informed decision.
I’m in the same boat I’m prescribed pain medicine for many years and the doctor told me that I have to have a primary doctor write a note for the prescription he gives me and he took my CDL license and that I can’t have this medication without a doctor stating that I’m not risk behind the wheel and my doctor won’t do that so the federal government took my CDLs even though I passed ma DOT physical he said He could not sign my DOT card cuz my doctor would not right a letter Stayton I wasn’t at risk
I have a ky medical waiver. Can I get my full dot medical card back to drive out of state if my heart attack was over 5 years ago and not having any problems. No longer taking any meds.
@Adam
More than likely, yes, if all else is normal. Your medical card will be limited to a one-year card.
I take subsolv (suboxone) and have for some time now. I do not have a cdl and only drive a small box truck. I went to get my med card and the dr gave it to me but i have to get a waiver. Do i need this waiver since I only drive small vehicles and don’t need a cdl? Thanks for your input and I live in KY and only drive in state.
@Tharog
You fall under state variances so check with your local drivers license department. You should not need a waiver but a medical release form from your primary physician would be helpful for the medical examiner.
July 2016 i collapsed at an outside event on a 100 degree day, My heart stopped. After a week in the hospital i was not diagnosed with any condition or illness and while not required an ICD was heavily suggested to prevent it again. Keep in mind the temperature and i didnt eat or drink anything since 6 the night before. On top of that no blood work or temperature was recorded before getting hooked up at the hospital. (after being on an IV in the ambulence) Everyone ive spoken to thinks it was heat stroke. Ive since gotten the doctor to turn the implant off completely and its only monitoring my heart now. I should be able to pass a medical exam now right?
Pennsylvania Class A License
@David
It will be very questionable. FMCSA regulations state that any class A driver with an ICD is disqualified as an OTR driver. With proper documentation from your cardiologist you should be able to do intra-state driving. We suspect that most CME’s are going to hold you back until the unit is removed completely, but it is worth a try with a medical release form and proper documentation.
I am uunder pain management and im interviewing for a management position but have to get a DOT card because about 25% Of my job will be driving. I am prescribed percocet, i only take them when i know i won’t have to drive for any reason. Am I disqualified from getting DOT card???
@Chad
Based on your class drivers license and your need for a medical card, you may fall under your state’s variances and not Federal DOT regulations. Check with your state’s DLD.
I have a client that had passed his DOT with another provider. Now his new employer wants him to be examined by our Co. This client has cerebral palsy with mild residual in his right arm movement
What is the federal guideline for evaluating a client with cerebral palsy. I would appreciate any direction with this question.
@Pam
We would have to start with, what class drivers license does this driver have?
Some medical exams vary from state to state. This driver may fall under state variance that allow him to pass within the state’s regulation and not FMCSA.
I had a motorcycle accident back in September and lost use of my right arm. I drove interstate commerce. I was denied disability and need to get back to trucking (which I have done for 20 years). I was told by my driver’s license center here in PA that a FMCSA doctor can sign off on me. I was also told by a representative at a congressmans office which talked to the federal boy’s. Is this correct? Can I drive and not have to do a SPE?
@Nathan
Class A, interstate driver, no, you will need the SPE before you would be re-qualifed to drive.
It is not up to the CME to make that decision, he needs documentation from the other examiners before he can make his final decision.
Where can I get a SPE packet and in what order do I apply?
I am a CME and recently examined someone who has been on Suboxone as well as Xanax. The combination is not recommended in the first place. Suboxone is used in place of Methadone which is an absolutely excluded drug but I can not find reference Suboxone in official site. Lastly the pt told me he only takes Xanax three time weekly, but, I checked on State online Narcotic Site and found that he fills Rx for 60 every month. So, he is either taking it twice daily or it is being diverted some how.
Thoughts would be appreciated, especially if you can reference official recomendations
Thanks
@ Dr S
Pointing you in the direction of a reference will be difficult since FMCSA removed their guideline some 27 months ago for site updates.
So it really becomes your call based on any and all available documentation from the driver’s primary doctor.
Even though suboxone is used for a methadone replacement, it is also used as a pain reliever. So you want to contact the primary doctor, or have a medical release form from the doctor explaining the drivers need, usage and length of time using this medication. Do the same thing for the Xanax.
In the end it will be your call on whether the driver should or should not be driving based on all of the available documentation presented to you via the driver. Is he safe to drive and is he fit for duty? – That is the final decision you have to make. And it is the driver’s responsibility to provide the information to your office.
I would like to solely comment in the driver’s defense solely on the suboxone. Not the xanax! I will say I was on pain killers for around 2 years. I will say the only thing that has saved my life and has given me a second chance is suboxone. Their is research to show long use to opiates can damage the brain and for the rest of our life we will always crave opiates every few months. I can say I came off pk’s for over 3 months and I still felt withdrawal symptoms everyday. I found suboxone through an illegal source. However later as I found a doctor who has prescribed me for about 2 years. I do not feel like I am on pk’s and have’t for a very long time. I forget to take it actually. Suboxone also blocks the receptors.So let’s say I found pk’s and took the entire bottle. I wouldn’t feel any high. Suboxone has never made me feel like I am drugged or that high I have completely forgotten. I am normal and forget about it. Unlike methadone that has made me sleepy. Suboxone has never and I mean never made me feel tired or drugged after the first few days you are a normal guy.
Bernie , Indianapolis .
I have a difribulator for almost a year now . Have made full recovery , doc will release me to go back to work when I’m ready . With the difribulator and a good ejection fraction is there any possible waiver to obtain to renew med. card ?
@Bernie
Once fully released, make sure you have a medical release form from your doctor, and your ejection factor report.
A lot will depend on the type of driver you are. FMCSA has a set of very strict rules regarding class A Interstate driver and defib units.
So a lot will depend on the type of driver class that you are. We are not aware of a waiver that is available for a class A Interstate driver. If you are class A, then you will want to contact the FMCSA directly for final verification. Good luck.
I’m will soon be getting a pacemaker and they told me I will be pacemaker dependent will I still be able to get my medical cert so I can keep driving commercially ?
@Bob
Yes, as long as there is not a defib. unit attached you can continue to drive, once fully healed, medical release in hand and ready to return to work.
The CME may want to see further testing results so be prepared to answer any questions and be able to get any additional information that he may request.
Can a doctor be sued for signing a medical waiver? My husband’s doctor seems to think so.
We live in WA state. Please answer as soon as possible. His career is on the line. Thanks.
@Cindy
We are doctors, not legal advisors. Can’t give legal advice, especially on little to no information.