DOT examiner

• Downward displacement of the tricuspid valve
• Medical examiner should not certify CMV driver until diagnosis is confirmed and treatment  has been shown to be adequate, effective, safe, and driver is stable
• Certification if:
• Asymptomatic
• mild tricuspid anomaly
• mild cardiac enlargement
• mild right ventricular dysfunction
• MAX certification 1 year

• Disqualify:
• Dyspnea, palpitation, paradoxical embolism
• more than mild cardiac enlargment
• atrial spetal defect, ventricular septal defect, pulmonary valve stenosis
• more than mild right ventricular dysfunction
• more than moderate tricuspid valve regurgitation
• symptomatic arrhythmia or accessory conduction pathway
• right to left shunt or left to right shunt with pulmonary to systemic flow ratio of >1.5:1

Disqualified

• MC male:Female 3:1
• Ultrasound detects
• 5% patients with coronary disease
• 10% patients with cerebrovascular disease
• 20% patients with peripheral vascular disease
• FMCSA recommends disqualification if aneurysm is lager than 5.0 centimeters
• Certify if asymptomatic and cleared by vascular specialist
• MAX certification is 1 year
• Drivers may be certified 3 months after surgical repair and if cleared by cardiovascular specialist
• AAA <4cm rarely ruptures

Disqualified

Do not certify

• The FMCSA recommends disqualification if aneurysm is more than 3.5 centimeters
• Certified 3 months after surgical repair

• a obstructive vascular disease of lower extermities
• develops in 7%-9% of persons with Peripheral vascular disease
• Strong predictor for CVD
• Certify driver for 1 year if there is not other diqualifying CVD
• Certification is annually 
• Rest pain is disqualifying
• Certification following surgery: waiting period 3 months
• relief of symptoms
• MAX certification 1 year
• no other CVD disqualifiers

• Recommend not to certify driver with DVT who is ineffectively treated 
• Can be certified is there is not acute DVT
• Treatment includes:
• Anticoagulant therapy

• Certification: post heart transplant
• waiting period of 1 year
• some may be cleared for CMV by their transplant team before 1 year
• Recommend Certification: 
• if asymptomatic
• tolerates medication
• no signs of transplant rejection
• meets all other qualification requirements
• has clearance from cardiovascular specialist

• increased risk for pulmonary emboli
• MAX certification is 2 years:
• certified if no symptoms
• driver should have biennial medical examination
• chronic venous disease can cause stasis changes/ ulcers

• Examiner should not certify driver until the etiology is confirmed and treatment has been shown to be adequate, effective, safe, and driver is stable
• MAX certification 2 years:
• certify driver who is otherwise medically qualified
• not certifying driver with coexisteing DVT who does not meet the DVT guidelines

• Varicose veins do not medically disqualify the commercial driver
• MAX certification 2 years

140-159/90-99

If the driver has no hx of HTN, is not on any trx the certify with ONE YEAR CARD.

3 months ONE TIME ONLY

DISQUALIFY. Patient must provide evidence of blood pressure control.

160-179/100-109

One time for 3 months.

At recheck the driver's BP must be under 140/90 or they are disqualified until they provide evidence of BP control.

>= 180/110

DISQUALIFY.

At recheck, the driver's BP must be <190/90. The driver will be certified 6 months.

After 6 months, the examiner makes cert. decisions on case by case basis wether a longer cert. appropriate.

• -Echo to determine severity
• -Symptoms
• -Left ventricle status (LVEF)
• -Pulmonary HTN (Pressure >=50% systemic systolic BP)
• -ETT (>6 METS)
• -Effort intolerance
• -Frequency and symptoms associated with arrhytmias

• DISQUALIFY
• - Echo required for diagnosis

DISQUALIFY

Asymptomatic; No ventricular arrhythmias; LVEF 40% to 50%.

• -Symptomatic
• or
• -Ventricular arrhythmias with LVEF <50%
• or
• -LVEF <40%

tolerating meications with no SEs, card clearance, RR controlled, no underlying disease

-demonstrate at least 20/40 visual acuity in each eye with or w/o correction

-demonstrate at least 70 degrees peripheral vision in each eye

• -demonstrate ability to distinguish b/w red/green/amber colors (Ishihara test)
• *can qualify w/ colorblind if distinguish traffic control signals

• -demonstrate binocular vision
• *use of contact lenses in 1 eye for distance & 1 eye for near vision --> disqualified

-use of corrective lenses MUST be noted on certificate*

• -must first perceive a whispered voice > or = 5 ft. from the provider (with or w/o a hearing aid)
• OR
• -demonstrate average hearing loss in the better ear < or = 40 dB at 500, 1000, and 2000 Hz

-use of a hearing aid MUST be noted on certificate*

-BP 161-180/91-104 --> qualify x 3 mos

-BP < or = to 160 and/or 90 w/in 3 mos --> then qualify x 1 year (document Rx, BP control)

-BP > 180 and/or 104 --> *disqualified* until reduced to then qualify x 3 mos

-BP < or = 160 and/or 90 w/in 3 mos --> qualify x 6 mos (document Rx, BP control)

person is physically qualified to drive a CMV if that person has no current clinical diagnosis of high blood pressure likely to interfere with their ability to operate a CMV

A current diagnosis of hypertension exists if a driver has hypertension and/or being medicated for hypertension.

Stage 1 hypertension  certified 1 year

>140/90 but <160/100 a one time certification of 3 months

Examples of primary conditions that may lead to secondary hypertension included pheochromocytoma, primary aldosteronism, renovascular disease, and unilateral renal parenchymal disease

If amenable to surgical intervention waiting period is 3 months, after surgical correction MAX certification 1 year

“A person is physically qualified to drive a commercial motor vehicle if that person has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his or her ability to control and drive a commercial motor vehicle safely.”

• Activities that precipitate shortness of breath
• Experience shortness of breath only with exertion or at rest
• Number of flights of stairs able to climb
• Orthopnea
• Dyspnea
• Current limitation(s.)

• Diagnosis and date of respiratory diseaseonset
• Medication(s), including dose and frequency and effectiveness in treating the respiratory condition, as well as side effects that might interfere with safedriving
• Current limitation(s)
• History of emergency room visits or hospitalizations, use of supplemental oxygen, inhalers and other medications
• Presence of an occupational /environmental exposure to allergens
• Smoke? If yes, how much and for how long
• Necessary steps to correct the condition as soon as possible, particularly if the untreated condition could result in a more serious illness that might affect driving

• antihistamines
• sympathomimeticagents
• bronchodilators
• anti-inflammatorymedications
• antibiotics

The maximum period for which a driver with a pulmonary disease should be certified is up to two years though shorter certification intervals are recommended for drivers with certain pulmonary conditions.

At the re-certification examination, the examiner should review the driver’s frequently used medications and treatments for a respiratory disorder

Certification: Treatment should be adequate, effective, and safe and the driver is stable. The symptoms can be treated with non-sedating antihistamines or with local steroid sprays that do not interfere with driving ability.

Maximum certification—two years

• Recommend not certifying the driver if there is a complication or if treatment impairs function:
• severe conjunctivitis affecting vision
• inability to keep eyes open
• photophobia
• uncontrollable sneezing fits
• sinusitis with severe headaches
• medications that cause sedation or other side effects that interfere with safe driving

In general second generation antihistamines are not sedating. The FAA permits pilots to use Fexofenadine (Allegra), Loratadine (Claritin) and Desloratadine (Clarinex). The driver should learn to read prescription labels.

• FMCSA states:
• The driver should abstain from medication for 12 hours prior to operating a CMV vehicle.
• Individualsresponsible for the driver work schedules should relieve affected drivers from duty until proper treatment for the illness has been

Include systemic anaphylaxis and acute upper airway obstruction induced by allergens, genetic deficiencies or unknown mechanisms. This includes stinging insect allergy that may cause acute anaphylaxis.

Recommend certifying the driver if the nature and severity of the medical condition and the preventive or treatment regimen do not endanger the health and safety of either the driver or the public. Preventive measures include carrying an epinephrine injection device in the truck cab and immunotherapy

MAX CERT: 2 years

due to deficiency of a serum protein that controls complement. It may result in an acute, life-threatening airway obstruction or severe abdominal pain requiring urgent medical attention.



Certification: Recommend certifying the driver with a history of an allergy-related life- threatening condition who has an effective treatment regimen and successful preventive measures. Certification may be up to two years.

MAX CERT: 2yrs

Common disease marked by reversible airway obstruction.

Driver can be disqualified if there is ongoing, uncontrolled, symptomatic asthma, including status asthmaticus, severe coughing spells and cough syncope; high dose steroids with adverse behavioral effects; or significant impairment of pulmonary function with a forced expiratory volume less than 65 percent and a p02 less than 65 millimeters mercury.

The examiner should not certify the driver until treatment has been shown to be adequate, effective, and safe and the driver is stable.

MAX CERT: 2YR

Immune-mediated granulomatous, interstitial pneumonitis that may present as an acute, recurrent, subacute or chronic illness that is variously manifested by dyspnea, cough and fever.

Recommend certifying the CMV driver if the nature and severity of the medical condition does not endanger the health and safety of the driver and the public.

MAX CERT: 2YRS

• Recommend not certifying the driver with:
• hypoxemia at rest
• chronic respiratory failure
• a history of continuing cough with cough syncope

• Tests include:
• Spirometry with forced expiratory volume in the first second of expiration (FEV1) ,forced vital capacity (FVC), and calculated FEV1/FVC ratio

• Recommend not certifying the driver when the ABG measurements show:
• Partial pressure of arterial oxygen (PaO2) lessthan:
• 65 millimeters of mercury (mmHg) at altitudes below 5,000
• 60 mm Hg at altitudes above 5,000feet

Partial pressure of arterial carbon dioxide (PaCO2) greater than 45 mmHg at any altitude Abnormal lung function may require additional evaluation

MAX CERT:2YRS

• Kyphosis
• Kyphoscoliosis
• Pectus excavatum
• Ankylosingspondylitis
• Massiveobesity
• Recent thoracic/upper abdominal surgery orinjury

• Recommend not certifying the driver who has;
• Hypoxemia atrest
• Chronic respiratory failure
• A history of continuing cough with cough syncope

MAX CERT: 2YRS

Certification: Recommend certifying the CMV driver if the nature and severity of the medical condition does not endanger the health and safety of the driver or the public.

• Recommend not certifying a driver who:
• has hypoxemia atrest
• has chronic respiratoryfailure
• has a history of continuing Ccough with coughsyncope
• does not meet spirometrycriteria
• is in an unstable condition

MAX CERT: 1yr

Recommend certifying the driver if the condition’s nature and severity does not endanger the health and safety of the driver and the public.

• Recommend not certifying the driver who has:
• Hypoxemia atrest
• Chronic respiratory failure
• History of continuing cough with cough syncope

MAX CERT: 2YRS

• Recommend certifying the CMV driver who:
• Is asymptomatic without chest pain or SOB
• Has no disqualifying underlying lung disease
• Has confirmed resolution of the single spontaneous pneumothorax
• Has successful pleurodesis and meets acceptable pulmonary parameter

• The medical examiner should supplement information requested on the form. The examiner should ask the same questions he/she would of any individual being assessed for neurological concerns.
• Diagnosis, Onsetdate
• Treating provider contactinfo
• Numbness,weakness
• Headaches
• Cognitive issues, memory
• Emotionaleffects
• Current limitations, hospitalizations, ongoing treatmentincluding;
• Medication(s) dose, frequency,effects:
• Anticonvulsants
• Antiplateletdrugs
• CNSstimulants/depressants

• The medical examiner should supplement information requested on the form. The examiner should ask the same questions he/she would of any individual being assessed for neurological concerns.
• Diagnosis, Onsetdate
• Treating provider contactinfo
• Numbness,weakness
• Headaches
• Cognitive issues, memory
• Emotionaleffects
• Current limitations, hospitalizations, ongoing treatmentincluding;
• Medication(s) dose, frequency,effects:
• Anticonvulsants
• Antiplateletdrugs
• CNSstimulants/depressants
• Additional Neurologic Testing.

• Check if the driver has any of the following signs:
• Abnormal finger-to-nose test
• Positive Romberg
• Gait disorder
• Radicular signs

• Additional Indicators of Neurological Disease:
• Does an abnormal finding suggest a condition that might interfere with the safe operation of a commercial motorvehicle?
• Does the driver have signs of undiagnosed neurological disease?

• Static Neurological Conditions: Cerebrovasculardiseases
• Transient Ischemic Attack
• Stroke (thrombotic or embolic)
• Aneurysm or AV malformation

This is a focal neurological dysfunction reflecting inadequate blood supply to one portion of the brain. It lasts more than a few seconds, but usually less than 30 to 40 minutes

• Certification after TIA
• Waiting period minimum — one year
• Maximum certification — one year

• Thrombotic strokes and embolic strokes are the most common forms of cerebrovascular disease. In the U.S., there are an estimated 780,000 stroke cases per year.
• third leading cause of death and a major cause of long-term disability in the U.S.

• Causes of stroke
• Large artery atherosclerosis
• Cardiac embolus
• Small artery or lacunar infarct, often related to hypertension or diabetes mellitus
• Cause is unknown in one-third of cases

A thrombotic stroke is associated with large cerebral artery atherosclerosis and is the most common cause of stroke in persons 45 to 65 years of age.

Intracerebral hemorrhage results from bleeding into the substance of the brain. It is often caused by a ruptured ArterioVenous Malformation (AVM)

Subarachnoid hemorrhage is caused by bleeding into the space around the brain. The subarachnoid hemorrhage is often from a ruptured aneurysm.

Certification after stroke

Recommend not certifying the driver who has not completed the appropriate waiting period.

FMCSA recommends: Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological testing.

Minimum—The waiting period is 1 year if there is no seizure risk (cerebellum or brainstem lesion)

Minimum— The waiting period is five years if there is a seizure risk. This includes one year for the stroke and four more years for the risk of seizure (cortical or subcortical deficits).

Maximum certification—one year

• Congenital Myopathies are a group of disorders that have specific, well-defined structural alterations of the muscle fibers. It may be progressive or non-progressive. These disorders include:
• Central coredisease
• Centronuclearmyopathy
• Congenital musculardystrophy
• Rod (nemaline)myopathy
• Recommend not certifying a driver with a diagnosis of congenital
• Inflammatory Myopathies are acquired muscle diseases. These disorders include:
• Dermatomyositis
• Inclusion body myositis
• Polymyositis

Not certifying a driver with this condition

• epilepsy
• CNS malignant tumors
• uncontrolled vertigo
• Meniere's disease
• Motor neuron disease (ALS)
• Narcolepsy
• Nonfunctioning labyrinth/ Labyrinithe fistula
• Huntington's disease
• Wilson's disease
• Dementias
• Migraines that cause neurologic deficits
• Current alcoholism or drug abuse
• Active Psychosis
• Major psychiatric disorders
• Amnestic problems
• Aphasia/ Alexia
• Cranial neuralgia
• Diplopia/ Oscillipsia
• Constructive apraxia
• Frontal lobe disorders
• Chronic cluster headaches
• Hemineglect or Hemianopia

• Multiplesclerosis
• Peripheralneuropathies
• Myopathies
• Neuromuscular jointdisorders
• Benign braintumors
• Dyskinesias
• Treatabledementias
• Cerebellarataxias

• Dementia
• Motor neurondisease
• Malignant CNStumors
• Huntington’sdisease
• Wilson’s disease

Progressive decline in mental functioning that can interfere with memory, language, spatial functions, higher order perceptual functions, problem solving, judgment, behavior, and emotional functions.

Neurology guidelines recommend disqualification of an individual with a diagnosis of dementia.

Disqualified: Primary or metastatic malignant tumors of the nervous system.

Many drivers can safely return to driving after a surgical procedure on the brain

• Waiting period is one year post-surgical removal for:
• Infratentorial meningiomas
• Acoustic neuromas
• Pituitary adenomas
• Spinal benign tumors
• Benign extra-axial tumors
• Waiting period is Two years post-surgical removal for:
• Benign supratentorial tumors
• Spinal tumors
• Since meningiomas may be multiple, examination must show no recurrence or new tumors. Evaluation should be performed by a neurologist who understands the functions and demands of commercial

• Recommend certifying the driver who:
• completed min. 1yr waiting period
• Is stable, with no neurological deficit or a non-disqualifying non-progressive
• Has no tumor on

The driver should have annual certification. 1yr

A person is physically qualified to drive a CMV if that person (b)(8) has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a commercial motor vehicle.


FMCSA defines epilepsy as two or more unprovoked seizures

• Certification with Epilepsy
• Current advisory criteria states that “some drivers with a history of epilepsy and off all anti- seizure medication and seizure free for 10 years may be qualified to drive a CMV in interstate commerce.”

• Maximum certification is one year
• Recommend not certifying the driver:
• Who has not completed the minimum waiting period seizure free and off anticonvulsant medication
• Who does not have clearance from a neurologist who specializes in epilepsy and understands the functions and demands of commercial driving

• Recommend certifying a CMV driver if the underlying systemic metabolic dysfunction has been corrected and the driver has no risk of recurrence of the primary 
• Driver should have at least biennial neurologic

Febrile seizures occur in 2 percent to 5 percent of U.S. children before 5 years of age and seldom occur after five years of age.

• Waiting period—None
• Maximum certification — two years

TBI is defined as an insult to the brain caused by an external physical force. TBI is classified both by the depth of dural penetration and the duration of loss of consciousness.

Certification: Two years seizure free and off anti-convulsant medications.

• Severe Head Injury (disqualify)
• Dural penetration with loss of consciousness for more than 24 hours
• Based upon the risk for unprovoked seizures, the driver should not be considered for certification.

• Moderate Head Injury
• Loss of consciousness for more than 30 minutes, but less than 24 hours.

• Waiting period:
• Five years off anticonvulsant medication if with early seizures,
• Two years off anticonvulsant medication if there are no early seizures.
• Maximum certification—one year

Is not associated with any increase in risk for subsequent unprovoked seizures. Drivers should be certified to operate a commercial vehicle.

Without early seizures, individuals should be considered qualified to obtain a license to operate a commercial vehicle after a one year seizure-free period off anticonvulsant medication.

With early seizures should be considered qualified to obtain a license to operate a commercial vehicle after a five year seizure free interval off anticonvulsant medication.

Without early seizures, drivers should be considered qualified to obtain a license to operate a commercial vehicle after one year seizure free off anticonvulsant medication.

With early seizures, individuals should not be considered qualified to obtain a license to operate a commercial vehicle for the first 10 years following such an infection.

• An estimated 23 million persons have severe migraine headaches. They occur in 18 percent of females and 6 percent of males.
• Tension-type headaches
• Cluster headaches
• Post-traumatic head injury syndrome
• Headaches associated with substances or withdrawal
• Cranial neuralgias
• Atypical facial pain

Certification Criteria:

• The decision to certify a driver with headaches is based on the medical examiner’s determination that the nature and severity of the medical condition of the driver does not endanger the health and safety of the driver and the public. This includes:
• Not taking medications that interfere with safe driving
• Not incapacitated by headaches
• No neurological complications
• Maximum certification — 2 years

Waiting period:                            Diagnosis:


10yrs                            HX of Epilepsy, Viral encephalitis with early seizure

5YR      single unprovoked seizure; bacterial meningitis,                                                        early seizure; moderate TBI with early seizure;                                                          stroke w risk of seizure; intracerebral or                                                                    subarachnoid hemorrhage w risk of seizure

2YR                                            seizure w acute structural insult to central nervous                                                      system; moderate TBI without early seizure;                                                              surgically removed supratentorial or spinal tumor

1YR                                             TIA; stroke; intracerebral or subarachnoid                                                                 hemorrhage w no risk of seizure; surgically                                                               repaired arteriovenous malformation/aneurysm w                                                       no risk of seizure; surgically removed infratentorial                                                    meningioma or acoustic neuromas, pituitary                                                              adenomas, or benign spinal tumors/ extraaxial                                                          turmor w no risk for seizures; bacterial meningitis                                                      w/out early seizure; Viral encephalitis w/out early seizures

A person is physically qualified to drive a commercial motor vehicle if that person; has no loss of a foot, leg, hand, or arm, or has been granted a Skill Performance Evaluation (SPE) Certificate pursuant to Section 391.49.

• A person is physically qualified to drive a commercial motor vehicle if that person has no impairment of:
• A hand or finger which interferes with prehension or power grasping,
• Anarm, foot, or leg which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle,
• Any other significant limb defect or limitation which interferes with the ability to perform normal tasks associated with operating a commercial motor vehicle,
• Has been granted a Skill Performance Evaluation (SPE) certificate pursuant to Section 49.

A person is physically qualified to drive a commercial motor vehicle if that person: Has no established medical history or clinical diagnosis of a rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with his/her ability to control and operate a commercial motor vehicle safely.

A driver may be certified if a musculoskeletal disease or deficit does not interfere with his/her driving ability and the ability to perform required non-driving tasks.

"Check the body systems for abnormalities" under this system should include checking for loss or impairment of leg, foot, toe, arm, hand, finger,perceptible limp, deformities, atrophy, weakness, paralysis, clubbing, edema, hypotonia, insufficient grasp and prehension in upper limb to maintain steering wheel grip, and insufficient mobility and strength in lower limb to operate pedals properly.

“Check the body systems for abnormalities” should include evidence of previous surgery, deformities, limitation of motion, tenderness.

• Additional examination and evaluation criteria:
• Examine the driver's neck and note range of motion
• Examine the driver’s spine and note painful motion
• Kyphosis,scoliosis 

• The CMV driver should be assessed for his/her physical ability to perform driving and non-driving tasks that require:
• Agility
• Balance
• Coordination
• Dexterity
• Flexibility
• Range of motion
• Repetitive motion
• Strength

• Additional examination and evaluation criteria:
• Use of orthotics
• Mobility
• Posture while bearing his/her weight
• Signs of pain
• Surgical scars

• Document if available:
• A current Skill Performance Evaluation (SPE)certificate
• Prior Diagnostic tests and/or referrals
• Encourage the driver with a non-disqualifying condition to seek care to prevent or delay possible future disqualification. The examiner can discuss how the condition can affect his/her ability to operate a CMV.
• Discuss prescriptions and Over-The-Counter (OTC) agents used to treat musculoskeletal conditions.
• Discuss side effects of medication that can interfere with safe
• Explain rationale for delaying or potentially disqualifying
• Discuss abnormal findings with the driver and document the discussion
• Advise the driver about dietary and lifestyle choices that may influence his/her musculoskeletal condition.

• FMCSA has no specific musculoskeletal weight, strength or mobility guidelines for:
• Lifting
• Pushing
• Pulling
• Bending

391.41(b)(1) or (b)(2). In the case of any loss or impairment to an extremity which may interfere with the driver's ability to operate a commercial motor vehicle safely, the medical examiner should state on the medical certificate “medically unqualified unless accompanied by a skill performance evaluation certificate.” As a general rule, the SPE is applied “from the wrist up and from the ankle up.”


The driver is evaluated by either an orthopedic surgeon or physiatrist. The driver then applies for a skill performance certification to the Field Service Center of the FMCSA in the state in which the driver has legal residence. The driver may be required to have an examiner representing FMCSA assess his/her ability to perform the required driving and non-driving tasks.


 SPE is a one-time exam, the driver must have a fixed deficit or amputation. The driver is evaluated with the prosthesis and cab adaptations. The FMCSA issues the SPE certification for two years.

November 19, 2018, allows, for the first time, drivers with insulin-treated diabetes mellitus to be certified by a medical examiner to drive.

• Diagnosed with DM: 21 million people
• Undiagnosed but with DM: 8.1 million
• Total: 29.1 million 

Type 1: 5-10%; lack of insulin production; must receive insulin replacement therapy to survive

Type 2: 90-95%; adult onset; blood glucose protective counter-regulatory mechanisms are preserved for years; diet and oral hypoglycemic medication

• Laboratory diagnosis:
• Hemoglobin A1c >5%
• Fasting glucose > 126 mg% (no caloric intake for 8hours)
• 2 hour plasma glucose during oral glucose tolerance test > 200mg%
• With symptoms of hyperglycemia random blood glucose >200mg%

November 19, 2018, allows, for the first time, drivers with insulin-treated diabetes mellitus to be certified by a medical examiner to drive.

• Diagnosed with DM: 21 million people
• Undiagnosed but with DM: 8.1 million
• Total: 29.1 million 

Type 1: 5-10%; lack of insulin production; must receive insulin replacement therapy to survive

Type 2: 90-95%; adult onset; blood glucose protective counter-regulatory mechanisms are preserved for years; diet and oral hypoglycemic medication

• Laboratory diagnosis:
• Hemoglobin A1c >5%
• Fasting glucose > 126 mg% (no caloric intake for 8hours)
• 2 hour plasma glucose during oral glucose tolerance test > 200mg%
• With symptoms of hyperglycemia random blood glucose >200mg%

• Date of original diagnosis
• prescription medication and OTC medication, supplements 
• Side effect which may be potentially disqualifying
• treating clinician and there address and phone number
• other endocrine disorders (thyroid disorders)
• weight disorders ( unexplained loss or gain, obesity) 
• current physical limitations
• REVIEW: blood glucose control, complication of DM, routine monitoring of blood glucose level, history of fainting; dizziness; or LOC, frequency of hypoglycemic/hyperglycemic episodes

• Diabetic retinopathy
• Macular degeneration
• Peripheral neuropathy

A dip urinalysis is a requirement of the CMV driver examination. The examiner or a trained assistant must record the urinalysis result on the form, and note:

• Specificgravity
• Protein
• Blood
• Glucose

• Glycosuria may:
• Detect drivers with undiagnosed DM Identify drivers with poorly controlled DM

Proteinuria may indicate glomerular damage from DM or other diseases.

There is a 19% increased crash risk among all drivers with diabetes

Diabetes is associated with accelerated atherosclerosis of the coronary arteries, cerebral arteries, and the peripheral arteries. Cerebrovascular disease can cause Transient Ischemic Attacks (TIAs and strokes.

Individuals with DM have a two-to fourfold increased risk for Cardiovascular Disease (CVD which is the leading cause of death among individuals with DM. Diabetes mellitus is a "coronary heart disease risk- equivalent condition." The risk for a coronary event over the next 10 years is the same as a person with CAD. In addition, 22 percent of individuals with type 2 DM have silent myocardial ischemia.

Nephropathy: 20-40% of diabetics

• Eyes: 
• Retinopathy and macular edema are common Macular degeneration
• Unstable proliferative retinopathy is disqualifying

Autonomic neuropathy

reported that elevated blood glucose is an essential component in the development of vascular complications from diabetes. In the DCCT, intensive therapy reduced hemoglobin A1c from 9.0 percent to 7.1 percent (normal less than 6.1 percent). Intensive therapy reduced the risk of vascular complications by 50 percent to 75 percent.

The symptoms associated with acute hyperglycemia include fatigue, lethargy, sluggishness and acute and transient cognitive disruption.

Symptoms may begin around 280 milligram percent to 300 milligram percent but are more likely to occur with sustained plasma glucose elevations over 400 milligram percent. The sudden onset of symptoms from acute hyperglycemia is unlikely.

• Fasting blood glucose not > 200mg% or
• Non-fasting glucose not > 235mg% or
• HbA1c not > 10%

rapid heart rate, sweating, weakness and hunger. FMCSA defines a severe hypoglycemic reaction as one that results in:

• Seizure,or
• Loss of consciousness,or
• Need of assistance from another person or
• Impaired cognitive function occurring without

• Glucagon secretion
• Sympatho-adrenal response

Type 1 diabetics lack counter-regulatory protection.

An A1c less than 7 percent may not be appropriate for drivers with a history of severe hypoglycemia, limited life expectancy, advanced, micro/macrovascular complications, extensive co-morbid conditions, long-standing diabetes or a treatment goal difficult to attain.

• A seizure
• Loss of consciousness or
• Need of assistance from another

maximum 2-year certification period for non-Insulin Treated Diabetic drivers is appropriate.

• Do not to certify if the driver with Non-Insulin-Treated Diabetes Mellitus has had one disqualifying hypoglycemic episode within the last 12 months, or 2 within the last 5 years. To review, a disqualifying hypoglycemic episode is one that results in:
• A seizure
• Loss of consciousness or
• Need of assistance from another

The certified medical examiner must receive the form and begin the medical examination no later than 45 days after the date on the signed form; however, the medical certification determination does not need to be completed within 45 days. The Medical Examiner must retain this form as part of the Medical Examination Report Form.

12 months, meaning an annual or more frequent exam by a certified medical examiner.

Drivers with Insulin-treated diabetes mellitus must provide to the treating clinician at least the preceding 3 months of electronic blood glucose self-monitoring records while being treated with insulin to be eligible for the maximum 12-month certification.

If a driver does not provide the 3 months of records, the medical examiner has discretion to grant the driver up to but not more than a 3-month certification, to allow time for the individual to collect the necessary records

• Has orthostatic
• Has a diagnosis of Peripheral
• Has Loss of position
• Has Loss of pedal
• Has a diagnosis of severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. These advanced stages of diabetic retinopathy present a serious risk to visual function, the safe operation of a CMV, and public

HbA1c > 10% is an indicator of poor blood glucose control


The Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, asks has the driver have an HbA1C measured intermittently over the last 12 months, with the most recent measure within the preceding 3 months, and, if so, to attach the most recent result. The Agency notes that the lack of HgbA1C data does not automatically disqualify an individual from being medically certified.

"A person is physically qualified to drive a commercial motor vehicle if that person has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his/her ability to drive a commercial motor vehicle safely."

• Additional questions to ask to supplement information requested on the form may include:
• Have you ever thought of hurting yourself or hurting or killing other people?
• Have you ever thought of suicide?
• Have you ever attempted suicide, including using a vehicle like a car or truck?
• Do you ever get into fights?
• Do you ever have problems with your concentration or memory?
• Have you ever heard voices that other people don't seem to hear or that weren't really there?
• Have you ever seen things that weren't really there?
• Have you ever been hospitalized for psychiatric problems?
• Are you taking any medication for anxiety?
• Have you ever used a medication for a purpose other than that for which it was prescribed?

• Tremor
• Signs of alcoholism, problem drinking, or drug abuse
• Enlarged liver, enlarged spleen

• Abnormalities in posture or tremor
• Overall appearance
• Demeanor
• Inappropriate dress
• Threatening behavior
• Flat emotional affect or no emotional expression

• Suspiciousness
• Evasiveness
• Hostility
• Distractibility
• Unusual or bizarre ideas
• Signs of auditory or visual hallucinations

• Plan a travel route
• Inspect the operating condition of a tractor and/or trailer
• Monitor and adjust to a complex driving situation
• Maneuver through crowded areas
• Quickly alter the course of the vehicle to avoid obstacles
• Sustain vigilance and attention
• React quickly to an unexpected problem while driving
• Problem solve, communicate, exercise good judgment, and behave appropriately in both normal and emergency situations
• The medical examiner should assess evidence that the driver
• Is not compromised by fatigue or sudden, incapacitating psychological symptoms
• Has sustained mental alertness and physical endurance
• Has no cognitive impairment
• - orientation
• - intellect
• - memory
• - obsessions
• - dishonesty
• - omission of important information
• - comprehension and interaction
• - circumstantial/tangential speech

Medications to treat psychological disorders have effects and side effects that can render a driver unsafe. Consider side effects of other medications the driver is taking and their interactions with the psychopharmacologic medication. Examiner may use impairment produced by 0.04% blood alcohol concentration as a benchmark.

• Do Not Certify the Driver
• There is general agreement to disqualify a driver with an active psychosis;
• This condition presents an unacceptable risk for commercial driving and is disqualifying. An actively psychotic individual may behave unpredictably. Delusions or hallucinations may lead to violent behavior. They may hear voices and may receive a command to do

There is less agreement as the disorders become less serious;

• Schizophrenia
• Manic – depressive disorder
• Depression
• Neuroses
• Personality Disorder
• Adjustment Disorder
• Personality traits and characteristics

Because a mental disorder may have varying impact on an individual driver’s ability to function, certification is not based on the diagnosis alone.



 Waiting period

Do not certify the driver until the medication has been shown to be adequate, effective, and safe, and the driver is stable

Maximum certification — 1 year

• Recommend not certifying the driver who has a disqualifying underlying condition or treatment side effects that interfere with safe driving.

• Characteristics of schizophrenia include:
• Psychosis (e.g., hearing voices or experiencing delusional thoughts), negative or deficit symptoms (e.g., loss of motivation, apathy, or reduced emotional expression)
• Compromised cognition, judgment, and/or attention
• Increased risk for suicide

• Related conditions include:
• Schizophreniform disorder
• Brief reactive psychosis
• Schizoaffective disorder
• Delusional disorder

• Waiting period:
• Minimum is 6 months symptom free if the CMV driver suffered a brief reactive psychosis or a schizophreniform disorder
• Minimum is 1 year symptom free for any other psychotic disorder

Risperdal, Zyprexa, Seroquel, Geodon, Abilify

These disorders are characterized by (1) pervasiveness of affect and (2) symptoms that interfere with their ability to function socially and occupationally.


The two major mood disorders are bipolar disorder and depressive disorder.

• individuals with one or more manic episodes usually have one or more depressive episodes:
• The manic episodes may have a sudden or gradual onset
• The mood may be excessively elevated, expansive, or irritable
• Judgment is frequently diminished during a manic episode
• There is an increased risk of substance abuse
• Some episodes may present with delusions or hallucinations

• Depression
• Symptoms of a depressive episode include loss of interest and motivation, poor sleep, appetite disturbance, fatigue, poor concentration, and indecisiveness

•  
• Severe depression is characterized by:
• Depressed or irritable mood
• Loss of interest or pleasure, social withdrawal, and loss of motivation,
• Poor sleep, appetite disturbance, fatigue, poor concentration, and indecisiveness,

• Psychosis, hallucinations and delusions may develop, but are less common in depression than in manic episodes
• Severe psychomotor retardation or agitation, significant cognitive impairment (especially poor concentration and attention), poor judgment, suicidal thoughts or behavior

Mood Disorder waiting period:

• Minimum is 6 months symptom free following a nonpsychotic major depression unaccompanied by suicidalbehavior
• Minimum is 1 year symptom free following a severe depressive episode, a suicide attempt, or a manicepisode
• Certification is 1 year maximum

• Who is asymptomatic, has lithium levels in the therapeutic range, and has no impairment that interferes with safe driving
• With an annual medical examinations

• Recommend not certifying a driver who has:
• A disqualifying psychological condition or symptoms
• Lithium levels that are not in the therapeutic range