What Are DOT Disqualifying Medical Conditions
Commercial trucking is essential for a healthy national economy. To get certified under Department of Transportation (DOT) regulations, commercial truck drivers are required to have a physical examination by a health care professional listed on the National Registry of Certified Medical Examiners (NRCME). In the interest of safety, DOT disqualifying medical conditions may take truckers off the road near-term, but these conditions may not be a permanent roadblock for the driver or the employer. Understanding the guidelines, the medical examiner’s role, and when there is room for discretion in deciding whether to grant certification can help keep your trucking business running at full throttle.
Snapshot: Commercial Truck Drivers
The trucking industry enjoyed a banner year in 2018 – hauling 6.6 percent more freight tonnage, a 70 percent increase over the prior year. Three-and-a-half million commercial drivers move about 70 percent of the nation’s freight, and demand is growing. The industry has forecast a shortage of 175,000 truck drivers by 2026. It is seeking to augment an aging workforce (primarily men over age 45) by attracting younger drivers.1
1 American Trucking Association
A Compelling Business Need
Employers with truck fleets and the truck drivers themselves have a compelling business need to stay on the road by complying with Federal Motor Carrier Safety Administration (FMCSA) regulations. This includes having drivers pass DOT physical exams to receive certification, usually for up to two years.
A small percentage of drivers each year do not pass the physical due to DOT disqualifying medical conditions. What are DOT disqualifying medical conditions? And what happens next if one of your drivers (or you) are disqualified from certification for medical reasons?
An Expert View on DOT Disqualifying Medical Conditions
Concentra® has a clinical staff that includes more than 1,200 certified medical examiners listed on the NRCME – at least one at each of our more than 520 community-based medical centers nationwide, so there is always one near you. As America’s leading provider of DOT exams, we are able to answer all your questions and provide the forms you need.
Regarding DOT disqualifying medical conditions, in this article, we’ll discuss:
- Medical conditions that disqualify drivers outright;
- Instances when certification may be granted for a shorter duration, based on the medical examiner’s discretion, such as the need to monitor a medical condition; and
- FMCSA waivers/exemptions from hearing, vision, or seizure standards.
Before turning to those topics, a quick word about the importance of the DOT physical examination illustrates the value of full disclosure of health history, even when a DOT disqualifying medical condition is involved.
Why Do Drivers Need A DOT Physical Exam?
In most states, drivers spend hours each day for up to seven weeks or more to gain the knowledge they need to pass a series of written exams for a commercial driver’s license (CDL). That’s a lot of preparation to get behind the wheel. So, why is a DOT physical exam necessary? Is it just one more hoop to jump through or is there a reason it is required?
A big reason for the DOT physical examination is that commercial driving is a physically and mentally demanding job, one that requires a certain level of fitness.
Protecting the well-being of commercial drivers helps ensure safety on the roads. The medical professionals listed on the NRCME are all trained to equivalent standards, so you can be sure your driver’s physical exam is in accordance with requirements.
At a DOT exam, the driver is required to complete a personal health history and acknowledge that the information is accurate and true. It is in the driver’s and the employer’s best interest to provide a complete and accurate medical history. Providing inaccurate or misleading information, or withholding information, may invalidate certification or lead to civil or criminal penalties.
DOT Disqualifying Medical Conditions
Under FMCSA regulations (49 CFR 391.41), a medical examiner may not certify a driver who has a DOT disqualifying medical condition or uses a medication/substance that compromises the ability to drive safely. DOT disqualifying medical conditions include those that may lead to loss of consciousness or involve inadequate hearing or vision, a compromised nervous system, or physical limitations that interfere with driving ability. Drivers who are able to resolve a DOT disqualifying medical condition are allowed to seek re-certification, and frequently do.
While a complete list of DOT disqualifying medical conditions is not possible here, the primary ones you may encounter are below:
- Certain heart conditions. Examples of heart conditions that are disqualifying until they are resolved and/or clearance is given by a cardiologist include current clinical diagnoses of heart attack, chest pain or discomfort due to heart disease (angina pectoris), reduced blood flow through one or more coronary arteries (coronary insufficiency), or risk of forming a blood clot (thrombosis). Taking nitroglycerine for angina is not necessarily medically disqualifying, provided the angina is stable.
- Epilepsy or other conditions that can result in loss of consciousness. FMCSA regulations prohibit a person with epilepsy or other seizure disorder from operating a commercial vehicle across state boundaries. Drivers who can show that their seizures are under control may be eligible to submit an application to the FMCSA for a seizure exemption. (See “Seizure Package” at the end of this article.)
- Inner ear diseases or disorders that cause vertigo (spinning/dizziness) or other balance issues. Meniere’s disease is an example. It affects the inner ear. Many lifestyle aspects of trucking might trigger vertigo for a driver with Meniere’s disease, which is why it is classified as a DOT disqualifying medical condition. Meniere’s disease is unpredictable and its triggers include overwork, fatigue, smoking, and too much salt in the diet.
Certain medications for the treatment of vertigo also may be disqualifying if the medical examiner concludes there are potential sedative effects that may compromise safety. On occasion, drivers with certain balance disorders are able to seek re-certification after being symptom-free for a period of time.
- Diabetes, high blood pressure, and respiratory conditions are discussed in the next section on DOT disqualifying medical conditions where the medical examiner has discretion in deciding whether or not to grant DOT certification.
- Vision and/or hearing loss. Drivers unable to demonstrate at least 20/40 vision in each eye and both eyes together, with or without corrective lenses, are medically disqualified. However, there is a vision exemption available. A driver must be able to meet peripheral vision requirements and also able to recognize the colors of traffic signals and devices showing the standard red, green, and amber colors.
For hearing, two tests may be performed. If the driver passes the first test (forced whisper), then the second test (an audiometry test) is not needed. In the forced whisper test, the driver must be able to hear a forced whisper in one ear (the better ear) at five feet, with or without a hearing aid. If the driver cannot pass the forced whisper test, passing an audiometry test still may allow certification. Failing both tests makes hearing loss a DOT disqualifying medical condition.
As with vision and seizure, the driver may apply for an exemption.
- Use of marijuana. Even if a licensed medical practitioner has prescribed or recommended it, marijuana use is a DOT disqualifying medical condition. This is true whether it is used alone, as CBD oil, or in any product or preparation derived from hemp or cannabis. The federal Drug Enforcement Agency (DEA) prohibits use of Schedule I substances, which include marijuana, heroin, LSD, mescaline, MDMA (“ecstasy”), psilocybin mushroom, methaqualone (Quaalude), cathinone/khat, and 3,4-methylenedioxypyrovalerone (MDPV).
Medical Conditions Addressed Using Medical Examiner Discretion
- Diabetes. Commercial drivers who have insulin-treated diabetes no longer need to apply for an exemption to obtain DOT certification. A new process was finalized in 2018. Now, drivers who have a stable insulin regimen and properly controlled diabetes only need to visit their treating clinician within 45 days prior to seeing the medical examiner. The treating clinician will complete an Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870 if requirements are met. The driver brings this form, along with three months of electronic glucose records, when visiting the medical examiner. If three months of electronic glucose logs are not available, the medical examiner may certify the driver for up to three months so the records can be collected. The medical examiner reviews all of this information and, if everything is in order, is able to certify the driver for up to one year (rather than the standard two years).
- High blood pressure. Medical examiners are provided guidelines, but also may use discretion in deciding whether to grant certification.
Normal blood pressure is less than 120/80. Up to 121-129/<80, blood pressure is considered elevated, but not classified as high blood pressure or hypertension. When blood pressure exceeds this level, it moves into progressively worse high blood pressure stages:
- Stage 1 130 to 139 systolic (above line) or 80 to 89 diastolic pressure (under line)
- Stage 2 140 or higher systolic or 90 or higher diastolic pressure
- Stage 3 Higher than 180 systolic and/or higher than 120 diastolic pressure.
- Stage 3 is a hypertensive crisis that requires immediate medical attention. Elevation to Stage 3 is a DOT disqualifying medical condition. When the condition resolves and blood pressure goes down to 140/90, the driver may be certified at six-month intervals. If a driver is able to lower blood pressure, has lost weight, and is off all blood pressure medications, the medical examiner has discretion to grant certification for up to two years.
For the other two high blood pressure stages, these recommendations apply:
- Elevation to Stage 1 may limit certification to one year.
- Elevation to Stage 2 may result in a three-month certification and, if blood pressure goes below 140/90 within that time, a driver may receive certification for one year.
- Respiratory conditions. Certain respiratory diseases may be DOT disqualifying medical conditions. The medical examiner can seek further tests and/or send a driver to a pulmonary specialist to gain additional insight into whether a respiratory condition should be disqualifying. If the driver is receiving oxygen therapy, this is disqualifying because of the risk of oxygen equipment malfunction or explosion.
- Proteinuria. Potentially a DOT disqualifying medical condition, proteinuria or excessive protein in the urine may indicate kidney disease. The medical examiner has the discretion to certify outright, certify with a time limit, or disqualify a driver with proteinuria.
Waivers/Exemptions for DOT Disqualifying Medical Conditions
Only a medical examiner in the National Registry can grant DOT certification, but a medical examiner cannot approve a waiver or exemption (which provides a driver relief from a regulation for a period of time). Only the FMCSA can grant a waiver or exemption for certain medical conditions.
Drivers must meet exemption criteria to submit an application and then submit the required information to the FMCSA for consideration. Here are the primary exemption packages, as shown on the FMCSA’s website:
Where to Go for a DOT Physical Exam
Because there are so many regulations for commercial drivers, the FMCSA only allows medical examiners listed on the NRCME to perform DOT exams. As noted earlier, Concentra has more than 1,200 certified medical examiners on the NRCME – at least one in each of more than 520 community-based medical centers nationwide.