FMCSA Rules for DOT Physical Examinations
Things to know about requirements regarding medical history.
Head/Brain injuries, disorders or illnesses
- Mild injury without early seizure or stroke without risk for seizure.
- Intra-cerebral or subarachnoid brain bleed without risk for seizure.
- Moderate injury without early seizure
- Mild insult with early seizure
- Moderate injury with early seizure
- Stroke with risk for seizure
- Intra-cerebral or subarachnoid brain bleed with risk for seizure
Eye disorders or impaired vision (except corrective lenses)
If a driver has any of the following conditions, the driver will need documentation or letter from the treating physician stating that treatment has been shown to be adequate/effective, safe, and stable:
- Macular Degeneration
Ear disorders, loss of hearing or balance
Heart disease or heart attack; other cardiovascular condition
- Ejection Fraction of at least 40%.
- Exercise Tolerance Test with acceptable results. Guidelines for the exercise tolerance test are found here: http://nrcme.fmcsa.dot.gov/mehandbook/cardio_tests_ETT_ep.aspx.
- Clearance by the cardiologist to return to work. Angina is not an automatic disqualifier but there are strict criteria. The angina has to be stable for at least 3 months, this means no pain at rest and no change in pattern of angina. The driver will also have to provide a note from the cardiologist stating the angina is stable, that medicine is well tolerated and the driver is cleared for driving. The driver must also provide documentation of a satisfactory exercise tolerance test. Guidelines for the exercise tolerance test are found here: http://nrcme.fmcsa.dot.gov/mehandbook/cardio_tests_ETT_ep.aspx.
Heart surgery (valve replacement/bypass, angioplasty, pacemaker)Coronary artery bypass surgery
The driver will need to be off work for at least three months and will need to provide the following:
- Ejection Fraction of at least 40%
- Exercise Tolerance Test with acceptable results:
- Clearance by cardiology
Angioplasty surgery or stents;
- Clearance from the cardiologist
- Documentation indicating the presence of a functioning pacemaker (not a defibrillator)
- Documentation indicating completion of routine pacemaker checks.
High blood pressure;
- Stage 1 hypertension: Systolic (top number) of 140-159 and/or a diastolic (bottom number) of 90-99. If there is no prior diagnosis of hypertension and the driver is not on any blood pressure medicines, the driver will get a one-time 1 year certificate and have to get the blood pressure down to less than 140/90 before the next renewal. If the driver has a diagnosis of hypertension or have already gotten the one time, 1-year certificate due to hypertension then certification is limited to a 1 time 3 month certification to allow time to get the blood pressure under 140/90. After that, the driver is disqualified until the pressure is below 140/90.
- Stage 2 hypertension: Systolic (top number) of 160-179 and/or a diastolic (bottom number) of 100-109 diastolic. Certification is limited to a one-time certification of three months. Once the blood pressure is less than 140/90 a 1-year certificate will be issued from the date of the initial examination, not the expiration date of the one-time, 3-month certificate. If the driver fails to lower blood pressure by the expiration date of the one-time, 3-month certificate, the driver will be disqualified until blood pressure is at or less than 140/90.
- Stage 3 hypertension: Blood pressure is higher than 180 systolic and / or 110 diastolic The driver is disqualified until the blood pressure is reduced to less than 140/90 and treatment is well tolerated. After a diagnosis of stage 3 hypertension, the driver may only be certified for 6 months and biannually (every 6 months) thereafter (the blood pressure must stay under 140/90).
Drivers with Diabetes or Kidney Disease;
IF YOU ARE A SMOKER;
- Isaac’s syndrome
- Stiff-man syndrome
- Neuromuscular junction disorders
Shortness of breath;
Lung disease, emphysema, asthma, chronic bronchitis;
Kidney disease, dialysis;
Diabetes or elevated blood sugar;
- Loss of consciousness
- Need of assistance from another person
- Period of impaired cognitive function
Nervous or psychiatric disorders, e.g. severe depression;
Anxiolytic (anti-panic or anti-anxiety agent) and sedative hypnotic (sleeping pills) therapies:
May certify for 2 years only if half-life is < 5 hrs and the medication is used for no longer than 2 weeks.
ADHD meds or CNS stimulators:
Bipolar and major depression:
- Waiting period minimum of 6 months symptom free if brief reactive psychosis or schizophreniform disorder.
- Waiting period minimum of 1 year if any other psychotic disorder.
- Meniere’s disease
- Labyrinthine fistula
- Nonfunctioning labyrinths
Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring:
Stroke or paralysis;
- Cognitive abilities
- Physical strength
- Reaction time