DOT Disqualifying Medical Conditions
If you are planning to apply for your CDL, you’re probably wondering what can disqualify you from a DOT physical. In this article, you will learn why the DOT physical is important, what DOT disqualifying medical conditions could result in you failing the exam, and what you should do if you fail.
If you are a medical professional interested in obtaining a DOT medical examiner certification, here is an overview of the process and what it entails.
The DOT physical exam is important in ensuring the safety of both CMV drivers and the general public. As a commercial driver, you are required to work long hours in a sitting position while maintaining concentration. Your job may also require a certain level of physical exertion. The DOT exam assesses whether you are able to safely tolerate the health risks posed by this—physically, mentally and emotionally. Therefore, medical disqualifications for CDL drivers must be taken very seriously.
The DOT physical exam begins with completing forms about your medical history, existing medical conditions and any medication you are taking. Note that withholding information, or providing inaccurate or misleading information, could invalidate your certification or even lead to criminal charges, so it is important to be honest in your answers.
Once you have detailed your medical history, you will undergo a physical examination and consultation carried out by a certified medical examiner. Factors that will be assessed include your vision; hearing; vitals, including blood pressure; urine; and mental health.
If you do not have any DOT disqualifying medical conditions, you will then be issued with a certificate, which you should keep in your driver qualification file. In total, the process usually takes around 45 minutes.
It is possible to fail the DOT physical exam if you have any DOT disqualifying medical conditions. Thirteen standards are used to determine your medical fitness for duty. Three of these—vision, hearing, and epilepsy or seizure disorders—are objective or “non-discretionary”. If you do not meet the specified standards for these, you will fail the physical.
For the other 10 “discretionary” standards, the medical examiner makes a clinical judgment in line with the certification requirements. Alcoholism and abuse of drugs such as cocaine, opiates, marjuana and PCP are considered DOT disqualifying medical conditions. Other potential disqualifying medical conditions for CDL include:
These conditions are assessed according to the medical examiner’s discretion. Based on your current state and the examiner’s understanding of the scenario, they may be able to grant a temporary certification, even if you have a DOT disqualifying medical condition. This allows them to monitor the condition, and necessitates reassessment and recertification within a shorter timeframe than usual, typically 12 months.
So long as you are forthcoming about your medical history and conditions, you will likely be allowed to get a second opinion. Sometimes, experts are called on to provide additional reports on certain conditions, such as diabetes and vision issues.
If you have a history of epilepsy or seizure disorder, or have hearing issues that are typically considered a DOT disqualifying medical condition, you may be able to apply to FMCSA for an exemption. This is covered in more detail below.
If you fail your DOT physical due to DOT disqualifying medical conditions, you can try applying for FMCSA’s driver exemption programs. These exemptions only grant regulatory relief to drivers who intend to operate CMVs in interstate commerce, i.e. for trade, traffic or transportation that involves the crossing of a state boundary; they cannot exempt you from intrastate requirements (within a single state).
You may apply for an exemption if you do not currently meet the seizure or hearing standards and are unable to obtain a non-restricted medical card. To apply for an exemption, you must submit an application containing information such as medical exams, expert opinions, employment history, driving experience and motor vehicle records. After receiving your application, FMCSA will make a final decision within 180 days.
Read on for a detailed description of what is needed to apply for an exemption for seizure and hearing conditions, as well as insights into the new rules for DOT disqualifying medical conditions relating to vision and diabetes.
Interstate commercial vehicle drivers with a history of epilepsy, or other conditions that can cause loss of consciousness or ability to control a vehicle, can apply for an exemption from the FMCSA. To grant a Federal medical exemption, FMCSA must ensure a level of safety equivalent to, or greater than, the level achieved without the exemption will be maintained.
To determine if an exemption for this DOT disqualifying medical condition should be granted, those who have experienced seizures must supply various information and documentation. This includes details of your most recent medical examination, and a physician statement that includes your diagnosis, the date of your last seizure, medication information and a statement of support for you to drive a CMV.
Those who have experienced a single provoked seizure will be assessed based on the risk of recurrence. “Low risk” scenarios include seizures brought on by medication or substances; head injuries with loss of consciousness less than 30 minutes; and more. Those who have experienced a single unprovoked seizure must be seizure-free for four years to gain an exemption, and must gain recertification every two years.
High-risk scenarios include head injuries resulting in loss of consciousness greater than 30 minutes; penetrating head injuries; intracerebral hemorrhage associated with a stroke or trauma; infections; intracranial hemorrhage; postoperative complications from brain surgery with significant brain hemorrhage; brain tumor; or stroke. To obtain an exemption, applicants with moderate-to-high-risk epilepsy or seizure disorder must have been seizure-free for eight years, on or off medication (with caveats). Drivers with epilepsy must gain recertification every 12 months.
Previously, insulin-treated diabetes was a blanket DOT disqualifying medical condition. In November 2018, standards were revised to permit insulin use in CMV drivers with insulin-treated diabetes mellitus, providing a medical certification is acquired every 12 months and certain physical requirements are met. FMCSA exemptions are therefore no longer required for insulin users.
If you have insulin-treated diabetes, you must now get an evaluation from your treating clinician ahead of your DOT physical. They must complete an ITDM Assessment Form, MCSA-5870, which evaluates whether you have a stable insulin regimen and properly controlled diabetes mellitus. Once completed, this form is valid for 45 days and will be evaluated by the medical examiner during your DOT physical. Applicants with severe nonproliferative or proliferative diabetic retinopathy, however, will face permanent disqualification, as this is considered a DOT disqualifying medical condition without exemption.
In March 2022, the vision standard for the DOT physical was amended. Drivers with monocular vision—i.e. those those who do not satisfy, with the worse eye, either the previous distant visual acuity standard with corrective lenses or the field of vision standard, or both—now have to follow the provisions adopted in the new alternative vision standard rather than seeking a Federal vision exemption.
Drivers with monocular vision are now subjected to a road test under certain circumstances and must obtain a Vision Evaluation Report, Form MCSA-5871, from a licensed ophthalmologist or optometrist covering visual acuity, field of vision and recognition of colors. This report is valid for 45 days and must be taken to your DOT physical for consideration by the medical examiner. You may also be required to provide previous vision records. Those qualified under the alternative vision standard must be reassessed every 12 months.
Every two years, unless you have applied for a medical exemption or have a potential DOT disqualifying medical condition, in which case it may be every 12 months or less.
The medical examiner may not certify you if you have a DOT disqualifying medical condition. However, many conditions are assessed based on the individual, while objective medical disqualifications for CDL drivers can sometimes be reversed through exemptions granted by FMCSA.
This depends on whether your disqualifying medical condition is permanent. Medical disqualifications for CDL drivers can be reassessed if your condition improves,
Potential DOT disqualifying medical conditions include vision and hearing impairments, epilepsy or seizure disorders, fainting spells, uncontrolled hypertension, heart conditions, respiratory conditions, diabetes, high-blood pressure, sleep disorders, psychiatric disorders, alcoholism and drug abuse. The majority of these are assessed based on the individual, so if you suffer from any of these it does not necessarily mean you will fail the physical.
If you have Stage 3 hypertension (BP higher than 180 systolic and 110 diastolic), you are considered high risk and will fail the DOT physical. You can retest if you reach a stable 140/90. If you have Stage 1 hypertension (140–159 systolic and/or 90–99 diastolic), you may be certified for a 12-month period. Those with Stage 2 hypertension (160–179 systolic and/or 100–109 diastolic) may be given a one-time certification of three-months to reduce their BP to 140/90, after which they may be granted a 12-month certification.
Previously, insulin-treated diabetes was a blanket DOT disqualifying medical condition. In November 2018, standards were revised to permit insulin use in CMV drivers with insulin-treated diabetes mellitus, providing a medical certification is acquired every 12 months and certain physical requirements are met.
Inadequate vision is considered a DOT disqualifying medical condition. To pass the physical, you are required to have 20/40 vision in each eye and both eyes together, with or without glasses or contact lenses, and a field of vision of at least 70 degrees in both eyes. The DOT physical also requires you to be able to distinguish signal and traffic light colors (red, green, and amber). If you are unsure whether you meet these requirements, you must obtain a Vision Evaluation Report from a licensed ophthalmologist or optometrist covering visual acuity, field of vision and recognition of colors prior to your DOT physical.
Poor hearing sometimes causes medical disqualifications for CDL drivers. To pass the DOT physical hearing exam, you must be able to hear a harsh whisper in your better ear from at least five feet away, with or without a hearing aid. If you fail this test, you will be referred for an audiometry test.
Heart conditions that may disqualify you from a DOT physical include: myocardial infarction, or a heart attack; chest pain caused by heart disease; coronary insufficiency causing reduced blood flow; congestive heart failure; arrhythmias (irregular heart rhythm); thrombosis, or blood clot—or risks of blood clots, and other stroke risks; uncontrolled hypertension; and cardiovascular diseases that have led to a collapse, congestive cardiac failure, dyspnea or syncope. Angina pectoris and coronary artery bypass will not necessarily disqualify you, so long as your condition is stable. If you fail your physical due to a heart condition, you can usually retake it once you are given the go ahead by your cardiologist.
If you have a diagnosis of vertigo, to pass the DOT physical it must not be uncontrolled vertigo and you must have been symptom-free for at least two months, with a diagnosis of Benign Positional Vertigo or Vestibulopathy (acute or chronic). If you are treating your vertigo with benzodiazepine or phenothiazines, you would be disqualified. If you are using antihistamines, the medical examiner will determine if they are causing sedation that could impact your driving.
While there is no set list of medications that disqualify you from passing the DOT physical, methadone, anti-seizure medication in some cases, narcotics and habit-forming drugs (including marajuana, regardless of prescriptions or legality in your state), controlled substances, and prescription medication without a proper prescription may all disqualify you.
As you can see from this overview, the DOT physical is carefully designed to ensure CDV drivers do not have any medical conditions that could impact their ability to drive safely. The rules have been updated in recent years to account for nuances in individual medical conditions, and in many cases a failed DOT physical does not mean you can’t try again once your disqualifying conditions have improved.
In the end, it is down to you to ensure you are acting as safely as possible on the road. Be sure to answer medical questions honestly, alert the licensing authority if there is any change in your health, and ensure you maintain healthy eating and sleeping patterns.