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’m a driver of more than 20 years. Last September I had a stroke (CVC). I have made, what I feel, is a remarkable recovery over the past year. No risk of seizure. Is it possible for me to regain my Med Cert?
@ Stephen
It requires a one year waiting period and then medical release forms from your doctors, but it is ppossible
My husband was just diagnosed with cirrhosis of the liver. Will this affect him getting his CDL renewed.
@ Kathy S
It will require a medical release form from your doctor and the examiner may ask for more supporting documentation before making his final decision.
From Idaho – Last year I only got recertified for 1 year as my blood pressure was 137/89. – (White coat syndrome & waited 2 hours to see the dr.. I was ticked)
Just went to get recertified and again blood pressure was 140/82. I see my Dr. regularly and we’ve discussed this issue as I DO NOT have high blood pressure ever at her office. I usually run 117/82-84. Dr. told me I have to come back 3 months and if its not lower at his office, I will not be certified any longer. No options.. Is this correct??
We do tend to get a bit excited when going to drs office, since about 1995ish every dot doc is an ALARMIST to the extreme, see, I know and trust what you’re saying. Really do.
I was on a hiatus in 2012 and 13, I had my 30 yrs and millions logged, I wasn’t thinking and hadn’t kept up with all the SISSY ARSE RULE CHANGES in ref to physicals and CDL in my pocket. In 2014 I strolled into a license agency to renew my classA CDL and this examiner, we’ve ( my family) seen for years, asked for my medical card, I told her it lapsed and unless a good local job opens, I’m partially retired. She didn’t say hey, go get your medical, no, she kept and downgraded me to operator. Strange stuff,
Good luck driver
@ busdriver 50
No. But he may be looking for an improvement placing you below 140/90, which is a FMCSA reg.
My husband is starting radiation and chemotherapy for his cancer diagnosis. He’ll be undergoing this treatment for 6 weeks. His dot med. certificate expires end of August. He doesn’t want to lose his class A license because of a delay in getting his certificate renewed. If he gets his med. certificate renewed at a later date, how will that affect his license?
@ Aubrey B
You will want to talk with your states drivers license department for your best answer.
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.
so i had an unprovoked siezure 1 year ago today i stepped away from my garbage man job due to it because i didnt know what the future would bring now ive had clean eegs and no siezures prior or since should i be worried about failing my DoT physical now that im trying to go back to my job since i have my PCP clearing me and backing me? i live in illinois and i know some rules vary state to state i just know it is what im good at im 26 and without the job ill lose everything i have
@ Richard G
Just make sure you have a medical release form from your doctor and have him explain that your seizure was unprovoked and any supporting information that the CME may request.
Thank you for all the information. It’s great to find a resource such as this. One question I have which I haven’t found an answer to is: If a CMV driver who holds a current Medical Certificate is prescribed a Schedule IV drug (Phentermine to be specific) are there any steps that must be taken to insure continued compliance?
@ Chris M
The medication will pose questions, so make sure you have a medical release form from your prescribing doctor when you go for your next DOT physical.
I have a question regarding my husband. He had a mild heart attack in 2012, there was zero damage and a stent was placed. He was under a cardiologist’s care for 2 years and released to go be monitored by our GP. 2 years ago when he went in to renew his card, he was surprised with a requirement to take a stress test, which he did and passed. He’s coming up on needing to take one again this year, and we’re wondering if there is any way that we can get a waiver to not to have to go through the expense of this ever again. Who would we contact? He tried calling NDOT who told him to call the Dr who does his exams who told him to call NDOT.
@ Ann W
FMCSA has set the guidelines for this at a new stress test every two years for class A, OTR drivers. You may find out about a waiver by contacting the FMCSA.
If I have a regular prescription from my doctor for oxycodone which is part of my treatment regimen and does not impair me at all does that automatically disqualify me for getting my cdl?
@ Mitch
CDL and medical certificates are two different things. You need a valid medical certificate to maintain a valid class A drivers license. Oxycodone disqualifies you according to the FMCSA.
You can have your doctor sign a release that it does not affect you’re being able to drive. I have been on Oxycodone for 7 years and hold my Class A and FedMed. I have to do a physical every year though.
Had a recent physical to get medical card renewed unfortunately gotnit denied due to a recent questionable TIA in November. 2weeks after this incident went to neurologists as instructed by Dr. she gave me the all clear to return to work as well as Drive with no neurological deficit.
I had taken release form to physical and unfortunately the PA-C would not release me due to diagnosis of TIA on assessment from neurologist. Pa-C advises me that neurologist needed to change diagnosis on assessment to clear me for my renewal which has now expired on 1/15. Mind you I had also gone back to neurologist within the past week to do another assessment on me with no sign of any sort of TIA symptoms. And again wrote a formal letter to the PA-C stating that she has released and cleared me of working and driving without limitations. Unfortunately yet again PA-C would not renew cause of this whole TIA diagnosis previous. I had also gone to see a chiropractor who had diagnosed me with a pinched nerve in my neck/shoulder which would have given me the symptoms of an apparent TIA. I had also given that to the PA-c with no avail as well. Of course this non renewal of my dot medical card has cost me my job because of this. And I don’t feel that waiting a year to be able to try to renew is ludicrous. Any other options? Please help
@ Jas
Get full clarification from the neurologist, did you or did you not have a TIA? If you did then you are held back by the FMCSA guidelines, and the PA-c is correct, and they make the final judgment. The wording of the FMCSA guidelines can be gray in some areas, have them re-read the FMCSA guidelines and see if there is any areas of question.
If you have a pain pump inplanted in your back for pain from a pain dr.does that disqualify you from driving semi.I have my cdl class a already.
@ Rick W
Your situation is going to raise lots of questions. So make sure you bring as much documentation and a medical release form from your doctors to the examining CME. He is going to need as much information as possible to make his final decision.
My husband is trying to obtain a CDL in Ohio he is a veteran with a disability rating for PTSD. He has a letter from his physician that says “no tx needed and “not engaged in an ongoing medications tx.” regarding the PTSD dx. The DOT said that this was not good enough and he would not approve him. What do you recommend
@Nichole
If your husband has any supporting information from his treating physician, then we don’t see a problem. Ask the CME what further information would be required. In some cases the examiner is looking for a release form from the treating psychologist.
My primary care provider is a nurse practitioner. Can he sign a medial release?
I had my left knee replaced 11/01/2017 in Arkansas.
I last saw my doctor on 12/06/2017, he was pleased with my progress.
When I next see him on 01/03/2018, I’m going to try to go back to work.
I’ll have had 30 days of physical therapy, my last day is 12/29/2017.
What form(s) do I need to satisfy my employer in AR., and the state of AR?
My license and medical card are current.