General Information

The purpose of this examination is to determine a driver's physical qualification to operate a commercial motor vehicle (CMV) in interstate commerce according to the requirements in 49 CFR 391.41–49. Therefore, the medical examiner must be knowledgeable of these requirements and guidelines developed by the FMCSA to assist in making the qualification determination.

The medical examiner should be familiar with the driver's responsibilities and work environment and is referred to the section on the form, The Driver's Role. In addition to reviewing the Health History section with the driver and conducting the physical examination, the examiner should discuss common prescription and over-the-counter medications and their hazards while driving. Educate the driver to read warning labels on all medications.

Medical conditions should be recorded even if not cause for denial, and they should be discussed with the driver to encourage appropriate remedial care. If the examiner determines that the driver is fit to drive and perform non-driving responsibilities, the examiner signs and dates the medical certificate.

Interpretation of Medical Standards

The FMCSA provides Advisory Criteria to help medical examiners determine whether a driver meets the physical qualifications for commercial driving. The following summarizes key sections:

Loss of Limb: §391.41(b)(1)

A person is physically qualified if they:

• Have no loss of a foot, leg, hand, or arm, or
• Have been granted a Skill Performance Evaluation (SPE) Certificate pursuant to Section 391.49.

Limb Impairment: §391.41(b)(2)

A person is qualified if they have no impairment interfering with normal driving tasks, or have an SPE Certificate. Individuals with prosthetics or adaptive devices may still qualify.

Diabetes: §391.41(b)(3)

Qualified if the individual has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin. Oral medication–controlled diabetes may be acceptable.

For a diabetes exemption, contact FMCSA Diabetes Program or call (703) 448-3094.

Cardiovascular Condition: §391.41(b)(4)

Qualified if the person has no current diagnosis of myocardial infarction, angina, coronary insufficiency, thrombosis, or other cardiovascular disease likely to cause syncope, dyspnea, collapse, or congestive cardiac failure.

Mental Disorders: §391.41(b)(9)

A driver must have no mental, nervous, or psychiatric disorder likely to interfere with safe driving. Disorders such as schizophrenia, severe depression, or paranoia may warrant disqualification.

See Conference on Psychiatric Disorders and Commercial Drivers.

Vision: §391.41(b)(10)

• Must have distant visual acuity of at least 20/40 (Snellen) in each eye with or without correction.
• Field of vision of at least 70° in the horizontal meridian in each eye.
• Ability to recognize colors of traffic signals and devices (red, green, amber).

If corrective lenses are required, the certificate must state: "Qualified only if wearing corrective lenses."

For a vision exemption, call (703) 448-3094 or visit Visual Disorders and Commercial Drivers.

Hearing: §391.41(b)(11)

• Must perceive a forced whispered voice at 5 feet in the better ear, or
• Have an average hearing loss not greater than 40 decibels at 500–2000 Hz.

If using a hearing aid, the certificate must state: "Qualified only when wearing a hearing aid."

See Hearing Disorders and Commercial Motor Vehicle Drivers.

Drug Use: §391.41(b)(12)

A person is qualified if they do not use drugs or substances identified in 21 CFR 1308.11 (Schedule I), including amphetamines, narcotics, or habit-forming drugs.

• Non-Schedule I drugs may be used if prescribed by a practitioner familiar with the driver’s history and duties.
• This exception does not apply to methadone.

Recertification may require substance abuse evaluation, rehabilitation completion, and a negative drug test result.

See Conference on Neurological and Psychiatric Disorders.

Alcoholism: §391.41(b)(13)

A person is physically qualified if they have no current clinical diagnosis of alcoholism. If alcoholism is suspected, referral and treatment are required before recertification.

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