Doc Levi Chiropractic, PLLC
Dr. Levi Merritt DC, NBC-HWC, CPT

     Information Regarding DOT Physical Exams for Drivers

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Prior to your DOT physical examination, it's essential to understand that the following information may be required. This information is vital for ensuring your physical qualification to drive a commercial vehicle under DOT regulations. Please be prepared to provide accurate and thorough information during your examination.

 

Filling Out the Forms and Getting Started

 

Grey highlights - indicates a FORM to be used.

Yellow highlights - actions you may need to perform, depending on certain health conditions, PRIOR to being examined.

Purple highlights - indicates when exemptions or certificates are to be utilized.

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Before the physical examination begins, drivers must fill out section 1 of the Form MCSA-5875, Medical Examination Report Form. Also called “the long form.” The form is usually available at the location where you get your physical.

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When filling out the form…

• Drivers are to use their name as it appears on their current driver’s license.

• Drivers are to use the current address to which they live, even if it differs from what is on the driver’s license.

• It is recommended (but not required) that if drivers take medications, they bring a list of the medications they take to the exam. The list should include the medicine, dosages, and what conditions the medicine is treating.

 

Drivers can see a Medical Examiner from any state, not just the state in which their driver’s license was issued. Be considerate (geographically speaking) of the Medical Examiner you choose. Upon examination, you may be: qualified, disqualified, given a shortened interval certificate, or put in determination pending status. Regardless, the medical examiner (ME) will submit the results of your exam electronically to the FMCSA.The results cannot be overridden by another ME. If you need to follow up with the ME for any reason to satisfy physical exam requirements, it needs to be the same ME you saw initially (or at least the same practice location).

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The Exam

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Section 2 of the Examination Report, is to be performed by the medical examiner.

The exam includes the following:

1. Blood pressure

2. Urinalysis (non-drug)

3. Visual screening

4. Hearing screening

5. General physical examination

 

Physical Requirements for Drivers

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There are 13 standards overall. 4 being non-discretionary.

A non-discretionary standard indicates that the medical examiner MUST follow the regulation or guideline and may not vary from this: the 4 non-discretionary standards are: vision, hearing, insulin use, and seizure disorders.

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1. Vision

2. Hearing

3. Use of Insulin/Diabetes

4. Epilepsy/Seizure Disorders

5. Loss of Limb

6. Limb Impairment

7. Cardiovascular Conditions

8. Respiratory Dysfunction

9. Hypertension

10. Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease

11. Mental Disorders

12. Drug Use

13. Alcoholism

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1.  Vision  – The driver must be 20/40 in both eyes, and in each eye independently, using a standard Snellen chart. If they do not meet the requirement, they must be disqualified, unless they have one eye that meets the standard.

If the standard in both eyes is not met, the driver is to use the Vision Evaluation Report, Form MCSA–5871  which must be filled out by either an ophthalmologist or optometrist. If initial certification is needed using this “alternative vision standard”, the driver must have their vision examination done and return for a new physical examination within 45 days of having the Vision Evaluation Report completed. For re-certification, if using this alternative standard, the vision examination and report must be completed to, and done 45 days within, coming in for your DOT Physical Exam.

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2. Hearing  – The driver must pass the whisper test, or an audiometric test (with an average hearing loss of less than or equal to 40 db measured at 500 Hz, 1000 Hz and 2000 Hz) in one ear. If they do not meet the above criteria, they may apply for a hearing exemption. Exemptions are not given by the medical examiner, only the FMCSA can grant an exemption.

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3. Use of Insulin/Diabetes – If you take insulin to manage your diabetes, you must to do two things PRIOR to your examination.

• Have 3 months of blood glucose self-monitoring records (electronic, not hand written), and present them to your treating clinician (the Doctor that prescribes your insulin).

• The driver must have the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 filled out and completed by his/her treating clinician (the Doctor that prescribes your insulin).

• Once the treating clinician signs the form, the driver has 45 days in which to submit this to the medical examiner during their DOT physical.

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4.  Seizure Disorders/Epilepsy – Disqualifying - The FMCSA definition of epilepsy is 2 events, or the use of anti-seizure medication for the purpose of controlling seizures. Drivers may apply for a seizure exemption. Again, you must apply to the FMCSA for exemptions. The exemption is good for 2 years, but the driver must be re-examined annually.

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5. Loss of Limb.

A person who suffers loss of a foot, leg, hand or arm or whose limb impairment in any way interferes with the safe performance of normal tasks associated with operating a commercial motor vehicle is subject to the Skills Performance Evaluation Certificate Program (SPE), assuming the person is otherwise qualified. A loss of finger/s or toe/s does not necessarily indicate a need for SPE, as long as the driver can perform the essential functions related to driving.

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6. Limb Impairment

An individual meets the physical requirements for operating a commercial motor vehicle if they do not have:

• Impairment in any hand or finger that hinders grasping or power;

• Impairment in any arm, foot, or leg that impedes the performance of typical tasks involved in driving a commercial motor vehicle; or

• Any other substantial limb defect or limitation that obstructs the performance of typical tasks associated with operating a commercial motor vehicle.

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7. Cardiovascular Conditions

• For cardiac conditions, most will be certified for 1 year.

• Pace-makers are acceptable, under the following conditions.

  • Drivers need to bring in documentation indicating the presence of a functioning pacemaker and completion of routine pacemaker checks. And also obtain clearance from a cardiologist. 

•  “Clearance” is not defined by the FMCSA, and there isn’t a specific form they use. Generally speaking, a medical clearance will specify whether or not the employee is medically fit to perform the essential job functions of their position.If your doctor (for example a cardiologist) does not have a specific medical clearance form, you can use the Medical Release Opinion Form, which can be found here at … https://dotphysicaldoctor.com/pcp-medical-release/

• Acute Myocardial Infarction (heart attack) - Need clearance by a cardiologist and Exercise Tolerance Tests every two years at a minimum. Waiting periods apply.

• Percutaneous Coronary Intervention (stent placement) – same requirements as heart attack.

• Coronary Artery Bypass Grafting (CABG) Surgery – same requirements as heart attack.

• Conditions that cannot be certified include:

  • Driver has ICD, ICD/Pacemaker, Hypertrophic cardiomyopathy, Restrictive cardiomyopathy

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8.  Respiratory Dysfunction

•  Most are 2-year certifications. Notable exceptions are:  

Cystic fibrosis, Pulmonary Hypertension, Treated Obstructive Sleep Apnea (1-year certifications).

• Sleep apnea: A driver may be certified initially for up to 1 year if the following conditions are met:

  • The driver must document PAP (positive airway pressure, sometimes called CPAP) use for a time period > 30 consecutive days (minimum records requirement – initial certification), and

  • The driver’s PAP use records must demonstrate > 4 hours per night use on 70% of nights (minimum compliance standard).

• A driver may be re-certified for up to 1 year if the following conditions are met:

  • The driver must document PAP use for a time period no less than the number of days between the expiration of the driver’s previous medical card and the time at which they receive their medical exam, and

  • The driver’s PAP use records must demonstrate > 4 hours per night use on 70% of nights (minimum compliance standard)

• Q: How do I get my PAP compliance report? You can obtain your PAP usage reports a couple different ways:

  • Your doctor - Your doctor will need access to the appropriate software and can access your unit remotely using your name, device serial number, or email.

  • Directly from the company that supplied the PAP machine.

  • You must bring this report with you PRIOR to your examination for re-certification.

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9.  Hypertension (High Blood Pressure)

• I'll keep it short and sweet:  Get your blood pressure under 140/90.

• Ways to keep your blood pressure in check before the exam can be found here: https://konexial.com/5-ways-lower-blood-pressure-now-next-dot-physical/

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10. Rheumatic, Arthritic, Orthopedic, Muscular, Neuromuscular or Vascular Disease

• The waiting periods and certification periods for neurologic disorders varies widely.

• Here are some conditions that cannot be certified :

  • Severe Traumatic Brain Injury

  • Malignant CNS Tumor or Metastatic CNS Tumor

  • Driver has a diagnosis of epilepsy (The FMCSA defines epilepsy as 2 or more unprovoked seizures)

  • Driver has diagnosis of Narcolepsy or Idiopathic Hypersomnia

  • Driver has diagnosis of Dementia

  • Diagnosis of Restless leg syndrome (RLS) with Excessive daytime sleepiness (EDS)

  • Diagnosis of Myotonia, Isaac’s syndrome, Myasthenia Gravis, or Stiff-man syndrome

  • Diagnosis of: Metabolic Muscle Disease; Motor Neuron Disease; Muscular Dystrophy; Neuromuscular Junction Disorder

• Parkinsons and Multiple Sclerosis may be certified.

  • Clearance by Neurologist required.

  • Re-evaluations every 6 months by neurologist - recertification every 6 months

  • Medications must be well tolerated.

• Non-Insulin Treated Diabetes Mellitus

  • A diagnosis of peripheral neuropathy, proliferative retinopathy, or severe non-proliferative retinopathy is typically disqualifying.

  • Peripheral neuropathy - in rare cases where the neuropathy is so minimal so as not to interfere with safe CMV driving, the examiner does have discretion to certify. The concern is related to position or pedal sensation.

    • Position sensation – the ability to know where your foot and toes are in space, without looking at them.

    • Pedal sensation – that ability to feel your foot against a surface, the gas and brake pedals for example.

• Chronic Kidney Disease - Stage 5 and/or on hemodialysis or peritoneal dialysis is typically disqualifying.

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11.  Mental Disorders

• Medical clearance from treating mental health specialist recommended for all psychiatric diagnoses.

• Most can be certified for up to 1 year.

• Psychological Disqualifying  Criteria:

  • Active psychosis.

  • Use of First-Generation Antidepressant (see Drug Use section).

  • Substantially compromised judgment.

  • Prominent Attentional difficulties.

  • Suicidal behavior or ideation.

  • Personality disorder that is repeatedly manifested by overt, inappropriate acts.

  • Treatment Side effects that interfere with safe driving.

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12.  Drug Use

• Substance abuse/positive drug test - For qualification, driver must present with documentation of clearance by Substance Abuse Professional and completion of any recommended counseling and rehabilitation, and has a negative drug test.

• Any schedule 1 drug, including Marijuana, is disqualifying.

  • Schedule 1 drugs: https://www.ecfr.gov/current/title-21/chapter-II/part-1308/subject-group-ECFRf62f8e189108c4d/section-1308.11

  • Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, LSD, marijuana,  ecstasy, methaqualone, and peyote. https://www.dea.gov/drug-information/drug-scheduling

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Specific drugs of concern:

• Methadone – if used for treatment of addiction, the prescribing doctor MUST indicate that the driver is in remission and there are no side effects that would interfere with the safe operation of CMV. If used for pain control, MUST obtain medical clearance as well.

• Antabuse, Suboxone, Naltrexone, and other drugs prescribed for alcohol and drug abuse - the prescribing doctor MUST indicate that the driver is in remission and there are no side effects that would interfere with the safe operation of CMV. Clearance is required.

• Chantix - (smoking cessation medication) - disqualifying without medical clearance from prescribing provider. Must obtain written clearance that indicates that the driver suffers no side effects that could interfere with the safe operation of a CMV.

• Benzodiazepines  (Xanax, Klonopin, Ativan, Valium, Halcion, etc.…) – Typically disqualifying. In rare circumstances the medical examiner may decide that a driver taking a benzodiazepine should be certified. Medical Clearance required.

  • Buspirone (Buspar) - Buspar is a non-sedating anxiolytic and therefore not disqualifying.

• Neuroleptics (anti-psychotic medications) – Typically disqualifying.  (Abilify, Haldol, Seroquel, Zeprexa, Symbyaz).

• Use of First-Generation Anti-depressants:

  • Tricyclic’s and MAOI’s, as well as all the atypical anti-depressants are considered 1st generation and typically disqualifying.

    • Tricyclics -

      • Adapin (Doxepin)

      • Anafranil (Clominpramine)

      • Elavil (Amitriptyline, Typtozol)

      • Norpramin (Desipramine)

      • Tofranil (Imipramine)

      • Vivactil (Protriptline).

    • MAOI’s (Monoamine Oxidase Inhibitors) -

      • Nardil (Phenelzine)

      • Parnate (Tranylcypromine)

• Only 2nd generation antidepressants will qualify with medical clearance . The FMCSA considers SSRI’s and SNRI’s as second generation only.

  • SSRI’s (Selective Serotonin Reuptake Inhibitors) –

    • Celexa (Citalopram)

    • Lexapro (Escitalopram oxalate)

    • Paxil (Proxetine)

    • Prozac (Fluoxitine)

    • Zoloft (Sertraline).

  • SNRI’s (Selective Norepinephrine Reuptake Inhibitors) –

    • Cymbalta (Duloxetine)

    • Effexor (Venlafaxine)

    • Pristiq (Desvenlafaxine).

• Special considerations (requires clearance) –

  • Driver’s taking Wellbutrin (Buproprion), a unicyclic anti-depressant, may be qualified.

  • Driver is taking amitriptyline, 25mg (lowest dose) only at night, they may be qualified.

  • Mirtazapine (Remeron) – a tetracyclic anti-depressive medication, has sedating effects. Driver should consider abstaining if they wish to continue driving.

  • If the driver is taking Lithium, a mood stabilizer that is commonly prescribed for bipolar disorder, they may be qualified for up to one year if their lithium levels are within therapeutic range. Needs monitoring.

  • Trazodone is an antidepressant that belongs to a group of drugs called serotonin receptor antagonists and reuptake inhibitors (SARIs) – Certifiable if driver abstains for 8 hours before vehicle operation.

• Sleep aids – (Ambien, Sonata, and Lunesta, for example) may only be used if they are NOT the extended-release formulations.

  • Modafinil (Provigil) – used to treat excessive sleepiness – 6 week waiting period - Certifiable for up to 1 year if medication is well tolerated.

• Antihistamines – If the driver is using a sedating (first-generation) anti-histamine, there is a 12-hour waiting period after last use before vehicle operation.  Otherwise, the driver may be certified for up to two years. Examples of 1st generation anti-histamines include:

  • Brompheniramine (Children’s Dimetapp Cold)

  • Dimenhydrinate (Dramamine)

  • Diphenhydramine (Benadryl, Nytol, Sominex)

  • Doxylamine(Vicks NyQuil, Tylenol Cold and Cough Nighttime)

• Muscle relaxers (Baclofen and Flexeril, for example) - a 12-hour waiting period since last use of baclofen is recommended before operating a CMV.

• Prescribed Narcotic (opioid and opiate medications) (Including Tramadol) - the FMCSA’s Medical Review Board has recommended that the driver must not use the narcotic for a minimum of 8 hours (if using short-acting narcotics) or 12 hours (if using long-acting narcotics) before driving a CMV.

  • Codeine, Morphine, Oxycodone, Hydrocodone, Tramadol etc…

• Anticoagulants –  (Warfarin) – driver must have monthly INR reporting. The international normalised ratio (INR) blood test tells you how long it takes for your blood to clot. It is used to test clotting times in people taking warfarin. Your doctor will use your INR result to work out what dose of warfarin you should take.

  • The FMCSA, to date, has provided no guidance on the new novel oral anticoagulants. A 12-month certification period would be appropriate as this is what is recommended for anticoagulation with warfarin. Examples include:

    • Eliquis (apixaban)

    • Pradaxa (dabigatran)

    • Xarelto (rivaroxaban)

• CNS Stimulant for ADHD (e.g. Ritalin, Adderall) – Needs clearance from prescribing physician.

• Medications (to treat seizures)  - a driver taking these or any medications FOR SEIZURES cannot be qualified.

  • Lamotrigine (Lamictal)

  • Gabapentin (Neurontin)

  • Levetiracetam (Keppra, Spritam)

  • Phenytoin (Dilantin)

  • Zonisamide (Zonegran)

  • Carbamazepine (Tegretol)

  • Oxcarbazepine (Trileptal)

  • Valproic acid derivatives

  • Topiramate (Topamax)

  • Phenobarbital

 

***If you are unsure if a medication you take may be disqualifying,  take the 391.41 CMV DRIVER MEDICATION FORM to your prescribing physician prior to your DOT physical examination. Have the physician fill out the form and sign it, and bring it with you to your exam.***

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13.  Alcoholism

• The driver cannot be certified, per regulation, if there is a current clinical diagnosis of alcoholism. The phrase “current clinical diagnosis of" alcoholism is specifically designed to encompass a current alcoholic illness or those instances where the driver's physical condition has not fully stabilized. When in remission, the medical examiner may certify a driver who has a prior clinical diagnosis of alcoholism.

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Miscellaneous

• “Determination Pending” status can be used by medical examiners for drivers who present with a medical condition that requires additional information before making a final decision on certification. This status can be assigned for a maximum of 45 days. During this time, the driver may continue to operate a CMV . (The use of Determination Pending does not however extend the current expiration date listed on the current certificate). Once an examiner obtains the requested information a final decision is made. . If the driver does not provide the requested information within the required 45 days of a “Determination Pending” certificate, then the driver will automatically be disqualified by the FMCSA.

• Shortened certification intervals may be for 1-month or 3-months. These shortened certification periods are typically used to allow for the driver to continue to drive (if the medical examiner considers them safe) and obtain additional information such as medical clearance or required testing.

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Concluding Remarks

This document does not include every scenario which may affect a driver’s physical qualifications to drive a CMV.

 

In summary,

• The 4 non-discretionary standards MUST be followed.

• Some conditions have waiting periods. These waiting periods usually begin after a treatment regimen has been initiated (medications, surgery, etc...) The waiting periods MUST be followed.

• The rest of the standards are guidelines. These guidelines will be considered, but there is wiggle room.

• Only Schedule 1 drugs are absolutely disqualifying.  If you are prescribed a medication that is typically disqualifying, or you are unsure if the medication will be cause for concern,  the best course of action is to take the CMV Driver Medication Form, MCSA-5895 form to your prescribing doctor, have them fill it out and sign, and bring it with you to your physical.

 

If you have questions, contact me at https://www.doclevi.com/contact.

Call 304-840-2820.

Or email at DocLeviChiropractic@yahoo.com. 

 

You can find more information through the following links:

FMCSA Forms

• https://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-applications-and-forms

Code of Federal Regulations

• https://www.ecfr.gov/current/title-49/subtitle-B/chapter-III/subchapter-B/part-391?toc=1

• https://www.ecfr.gov/current/title-49/subtitle-B/chapter-III/subchapter-B/part-391/appendix-Appendix%20A%20to%20Part%20391

Commercial Driver’s License (WV)

• https://transportation.wv.gov/DMV/Motor-Carriers/CDL/Pages/default.aspx

 

PDF version of this page can be found here.

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