For safety purposes, there are DOT disqualifying medical conditions which may take truckers off the road, but these conditions may not be a permanent roadblock for the driver or the employer. There are guidelines wherein discretion whether to grant certification or not. While it is not possible to list all the conditions, here are the primary ones.
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
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 considered as high blood pressure or hypertension, when blood pressure exceeds this level it moves progressively worse to hypertension stages.
- Stage 1: 130 to 139 systolic (top number) or 80 to 89 diastolic pressure (bottom number)
- 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.
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.
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.
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