Appendix A to Part 391 Appendix A to Part 391—Medical Advisory Criteria

I. Introduction
This appendix contains the AgencyFederal Motor Carrier Safety Administration's guidelinesrecommendations and guidance in the form of Medical Advisory Criteria to help medical examiners assess a driver's physical qualification. These guidelinesrecommendations and guidance are strictly advisory and weredo establishednot afterhave consultationthe withforce physicians, States, and industryeffect representatives,of and,law. inThey somewere areas,established after consideration of recommendationspublic fromcomments theand Federalafter Motorconsideration Carrierof Safetyrecommendations Administrationfrom the Agency's Medical Review Board and Medical Expert Panels.
II. Interpretation of Medical Standards
Since the issuance of the regulations for physical qualifications of commercial motor vehicle drivers, the Federal Motor Carrier Safety Administration has published recommendations and guidance called Advisoryadvisory Criteriacriteria to help medical examiners in determining whether a driver meets the physical qualificationsqualification standards for commercial driving. These recommendations have been condensedderived from the Medical Examiner's Handbook to provide information to medical examiners that is directly relevant to the physical examinationqualification and is not already included in the Medical Examination Report Formexamination.
A. LossMedical ofAdvisory Limb:Criteria §for 49 CFR 391.41(b)(1)
A1. personOnly isindividuals physicallywith qualifiedloss toof driveall afive commercialfingers motorare vehicleconsidered ifto thathave person: Has no loss of a foot, leg, hand orunder an arm, or has been granted a Skills Performance Evaluation certificate pursuant to § 391.49.
B. Limb Impairment: § 391.41(b)(21).
12. AUnless personan isindividual physicallypossesses qualified to drive a commercialskill motorperformance vehicleevaluation ifcertificate, thatloss person: Has no impairment of:
(i) Aa hand or finger which interferes with prehension or power grasping; or
(ii) An arm, foot, ora leg, which interferes with the ability to perform normal tasks associated with operating a commercialhand, motor vehicle; or
(iii) Anyan otherarm significantprecludes limbphysical defectqualification. orEven limitationif whichan interferesindividual withhas the ability to perform normal tasks associated with operating a commercialprosthesis motorthat vehicle;replaces or
(iv)the Has been granted a Skills Performance Evaluation certificate pursuant to § 391.49.
2. A person who suffers loss of a foot, leg, hand, or arm, oras whoseapplicable, limbcertification impairmentis inprecluded anywithout waya interferesskill with the safe performance ofevaluation normal tasks associated with operating a commercial motor vehicle is subject to the Skills Performance Evaluation Certificate Program pursuant to § 391certificate.49, assuming the person is otherwise qualified.
3. WithAn theindividual advancementmay ofbe technology,eligible medical aids and equipment modifications have been developed to compensate for certain disabilities. The Skills Performance Evaluation Certificate Program (formerly the Limb Waiver Program) was designed to allow persons with the loss of a footskill orperformance limbevaluation orcertificate with functional impairment to qualify under the§ Federal Motor Carrier Safety Regulations by use of prosthetic devices or equipment modifications which enable them to safely operate a commercial motor vehicle391.41(b)(1) Since there are no medical aids equivalent to the original body or limb, certain risks are still present, and thus restrictions may be included on individual Skills Performance Evaluation certificates when a State Director for the Federal Motor Carrier Safety Administration determines they are necessary to be consistent with safety and public interest.
4. If the driver is found otherwise medically qualified (§ 391.41(b)(32) through (13)), theor medicalboth.
B. examiner must check on the Medical Examiner'sAdvisory CertificateCriteria that the driver is qualified only if accompanied by a Skills Performance Evaluation certificate. The driver and the employing motor carrier are subject to appropriate penalty if the driver operates a motor vehicle in interstate or foreign commerce without a current Skill Performance Evaluation certificate for his/her49 physicalCFR disability.
C. Diabetes: § 391.41(b)(32)
1. AIndividuals personwith isloss physicallyof qualifiedfewer tothan driveall afive commercialfingers motor vehicle if that person: Has no established medical history or clinicalany diagnosisnumber of diabetestoes mellitusshould currentlybe requiringevaluated insulinunder for§ control391.
41(b)(2.) Diabetesto mellitusdetermine iswhether athere diseaseis whichan impairment, on occasiondefect, can result in a loss of consciousness or disorientationlimitation in time and space. Individuals who require insulin for control have conditions which can get out of controla byhand the use of too much or toofoot littlethat insulin,interferes or food intake not consistent with the insulinability dosage.to Incapacitationperform maynormal occurtasks fromassociated symptomswith ofoperating hyperglycemica orcommercial hypoglycemicmotor reactions (drowsiness, semi consciousness, diabetic coma or insulin shock)vehicle.
32. TheA administrationskill ofperformance insulinevaluation certificate is, withinonly itself,available aunder complicated§ process391.41(b)(2) requiringfor insulinimpairment, syringedefect, needle,or alcohollimitation spongeof and a sterile techniquelimb. FactorsA relatedskill toperformance long-haulevaluation commercialcertificate motoris vehiclenot operations,available suchfor asimpairment fatigue, lack of sleep, poor diet, emotional conditions, stress, and concomitant illness, compound the dangers,spine theor Federaltorso Motor Carrier Safety Administration has consistently held that a diabetic who uses insulin for control does not meetresult thein minimumimpairment, physicaldefect, requirementsor limitation of thea Federal Motor Carrier Safety Regulationslimb.
43. HypoglycemicAn drugs, taken orally, are sometimes prescribed for diabetic individuals to help stimulate natural body production of insulin. If the condition can be controlled by the use of oral medication and diet, then an individual may be qualifiedeligible underfor thea presentskill rule.performance Commercialevaluation motorcertificate vehicleunder drivers§ who do not meet the Federal diabetes standard may call 391.41(202b)(1) 366-4001or for an application for a diabetes exemption.
D. Cardiovascular Condition: § 391.41(b)(42)
1. A person is physically qualified to drive a commercial motor vehicle if that person: Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis or anyboth.
C. otherMedical cardiovascularAdvisory diseaseCriteria offor a49 varietyCFR known to be accompanied by syncope, dyspnea, collapse or congestive cardiac failure391.41(b)(4)
21. The termphrase “has no current clinical diagnosis of” is specifically designed to encompass: “a clinical diagnosis of” a current cardiovascular condition, or a cardiovascular condition whichthat has not fully stabilized regardless of the time limit. The termphrase “known to be accompanied by” is designed to include a clinical diagnosis of a cardiovascular disease whichthat is accompanied by symptoms of syncope, dyspnea, collapse or congestive cardiac failure; and/or which is s likely to cause syncope, dyspnea, collapse or congestive cardiac failure.
3. It is the intent of the Federal Motor Carrier Safety Regulations to render unqualified, a driver who has a current cardiovascular disease which is accompanied by and/or likely to cause symptoms of syncope, dyspnea, collapse, or congestive cardiac failure.
2. However,Coronary theartery subjectivebypass decisionsurgery of whether the nature and severitypacemaker ofimplantation anare individual'sremedial conditionprocedures will likely cause symptoms of cardiovascular insufficiency is on an individual basis and, qualificationthus, restsdo withnot thepreclude medical examiner and the motor carriercertification. InImplantable thosecardioverter-defibrillators casesare whereinstalled thereto isaddress an occurrenceongoing ofunderlying cardiovascular insufficiencycondition (myocardialand infarction,are thrombosis,likely etc.),to itcause issyncope suggested before a driver is certified that he or shecollapse haveas a normalresult restingof andthe stressunderlying electrocardiogram,cardiovascular no residual complications and no physical limitationscondition, andas iswell takingas nowhen medicationthey likely to interfere with safe drivingdischarge.
43. CoronaryAnticoagulation arterytherapy bypass surgery and pacemaker implantation are remedial procedures and thus, not medically disqualifying. Implantable cardioverter defibrillators are disqualifying due to risk of syncope. Coumadin is a medical treatment, which can improve the health and safety of the driverindividual, and should not, by its use alone, medicallypreclude disqualifycertification of the commercial motor vehicle driverindividual. The emphasis should be on the underlying medical condition(s) whichthat requirerequires treatment and the general health of the driverindividual.
D. TheMedical FederalAdvisory MotorCriteria Carrier Safety Administration should be contacted at (202) 366-4001 for additional49 recommendationsCFR regarding the physical qualification of drivers on coumadin.
E. Respiratory Dysfunction: § 391.41(b)(5)
1. AMany personconditions isinterfere physicallywith qualifiedoxygen toexchange driveand amay commercial motor vehicle if that person: Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.
2. SinceThese a driver must be alert at all timesinclude, anybut change in his or her mental state is in direct conflict with highway safety. Even the slightest impairment in respiratory function under emergency conditions (when greater oxygen supply is necessary for performance) may be detrimental to safe driving.
3. There are manynot conditionslimited that interfere with oxygen exchange and may result in incapacitationto, including emphysema, chronic asthma, carcinoma, tuberculosis, chronic bronchitis, and obstructive sleep apnea.
2. If the medical examiner detects a possible undiagnosed or inadequately treated respiratory dysfunction, that inmay anybe way is likely to interfere with the driverindividual's ability to safely control and drive a commercial motor vehicle safely, the drivermedical mustexaminer beshould referredconfer towith athe specialisttreating forprovider further evaluation and therapy. Anticoagulation therapy for deep vein thrombosis and/or pulmonaryshould thromboembolismrecommend isthat notthe medicallyindividual disqualifyingbe oncereferred optimumto dosea isspecialist achieved,for providedfurther lowerevaluation extremity venous examinations remain normal and thetherapy.
E. treatingMedical physicianAdvisory givesCriteria afor favorable49 recommendation.
F.CFR Hypertension: § 391.41(b)(6)
1. AAn personelevated isblood physicallypressure qualifiedfinding toshould drivebe aconfirmed commercialby motorat vehicleleast iftwo thatsubsequent person:measurements.
2. HasHypertension noalone currentis clinicalunlikely diagnosis of high blood pressure likely to interfere with the ability to operate a commercial motor vehicle safely.
2. Hypertension alone is unlikely to cause sudden collapse; however, the likelihood increases when target organ damage, particularly cerebral vascular disease, is present. ThisThe regulatoryguidance criteriaon the stages of hypertension below is based on the Federal Motor Carrier Safety Administration's Cardiovascular Advisory Panel Guidelines for the Medical Examination of commercialCommercial motorMotor vehicleVehicle Drivers (October 2002), which usedadopted the Sixthsixth Reportreport of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1997).
3. Stage 1 hypertension corresponds to a systolic blood pressure of 140-159 mmHg and/or a diastolic blood pressure of 90-99 mmHg. TheAn driverindividual with a blood pressure in this range is at low risk for a hypertension-related acuteevent incapacitationthat is likely to interfere with the ability to operate a commercial motor vehicle safely and may be medically certified to drive for a one1-year period. Certification examinations should be done annually thereafter and should be at or less than 140/90. If less than 160/100 but greater than 140/90 at the subsequent examinations, certificationthe individual may be extendedgiven onea one-time forcertification of 3 months to reduce the blood pressure to less than or equal to 140/90.
4. A blood pressure of 160-179 systolic and/or 100-109 diastolic is considered Stage 2 hypertension,. andA theblood driverpressure isin notthis necessarilyrange unqualifiedis duringan evaluationabsolute andindication institutionfor ofantihypertensive treatmentdrug therapy. The driverindividual ismay be given a one-time certification of three3 months to reduceinitiate his or heradjust antihypertensive drug therapy and to reduce the blood pressure to less than or equal to 140/90. A blood pressure in this range is an absolute indication for anti-hypertensive drug therapy. Provided treatment is well tolerated and the driver demonstrates a blood pressure value of 140/90 or less, hethe orindividual she may be certified for one1 year from date of the initial exam. The driver is certified annually thereafter.
5. A blood pressure at or greater than 180 (systolic) and 110 (diastolic) is considered Stage 3, and carries a high risk for an acute blood pressure-related event that is likely to interfere with the ability to operate a commercial motor vehicle safely. The driverindividual mayshould not be qualified, even temporarilyfor a short period, until the blood pressure is reduced to 140/90 or less and treatment is well tolerated. The driverindividual may be certified for 6 months and biannually (every 6 months) thereafter if at recheck blood pressure is 140/90 or less.
6. Annual recertificationcertification is recommended if the medical examiner does not know the severity of hypertension prior to treatment. An elevated blood pressure finding should be confirmed by at least two subsequent measurements on different days.
7. Treatment includes nonpharmacologicnon-pharmacologic and pharmacologic modalities as well as counseling to reduceimprove otheror riskeliminate the factors that contributed to the hypertension. Most antihypertensive medications also have side effects, thesuch as somnolence or syncope. The importance of whichside effects must be judgedevaluated on an individual basis and considering the underlying hypertension. Individuals mustshould be alerted to the hazardspossibility ofthat theseantihypertensive medications whilemay driving.interfere Sidewith effectsthe ofability somnolenceto oroperate syncopea are particularly undesirable in commercial motor vehicle driverssafely.
8. SecondaryMedical certification for secondary hypertension is based on the above stages. Evaluation is warranted if patientan individual is persistently hypertensive on maximal or near-maximal doses of 2-3two to three pharmacologic agents. Some causes of secondary hypertension may be amenable to surgical intervention or specific pharmacologic diseasetreatment.
GF. Rheumatic,Medical Arthritic,Advisory Orthopedic,Criteria Muscular,for Neuromuscular49 orCFR Vascular Disease: § 391.41(b)(7)
1. A person is physically qualified to drive a commercial motor vehicle if that person: Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with the ability to control and operate a commercial motor vehicle safely.
2. Certain diseases are known to have acute episodes of transient muscle weakness, poor muscular coordination (ataxia), abnormal sensations (paresthesia), decreased muscular tone (hypotonia), visual disturbances and pain which may be suddenly incapacitating. With each recurring episode, these symptoms may become more pronounced and remain for longer periods of time. Other diseases have more insidious onsets and display symptoms of muscle wasting (atrophy), swelling and paresthesia which may not suddenly incapacitate a person but may restrict his/her movements and eventually interfere with the ability to safely operate a motor vehicle. In many instances these diseases are degenerative in nature or may result in deterioration of the involved area.
3. Once thean individual has been diagnosed as having a rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease, then he/shethe individual has an established history of that disease.
2. The physicianmedical examiner, when examining an individual, should consider the following: Thethe nature and severity of the individual's condition (such as sensory loss or loss of strength); the degree of limitation present (such as range of motion); the likelihoodrate ofor progressivestage limitationof progression (symptoms may not alwaysbe present initially but may manifest itself over time); and whether symptoms are likely to interfere with the likelihoodability ofto suddencontrol incapacitationand operate a commercial motor vehicle safely.
3. If severe functional impairment exists, the driverindividual does not physically qualify. In cases where more frequent monitoring is required, a certificateMedical Examiner's Certificate, Form MCSA-5876, for aless shorterthan periodthe ofmaximum timecertification period may be issued.
HG. Epilepsy:Medical §Advisory Criteria for 49 CFR 391.41(b)(8)
1. A person is physically qualified to drive a commercial motor vehicle if that person: 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 motor vehicle.
2. Epilepsy is a chronic functional disease characterized by seizures or episodes that usually occur without warning, resulting in loss of voluntary control whichthat may lead to loss of consciousness and/or seizures. Therefore, the following driversindividuals cannotare benot physically qualified:
(i)• AAn driverindividual who has a medical history of epilepsy;
or a seizure disorder, unless the individual satisfies the criteria described in paragraph 5 of the Medical Advisory Criteria for § 391.41(iib)(8);
• AAn driverindividual who has a current clinical diagnosis of epilepsy or a seizure disorder; or
(ii)• AAn driverindividual who is taking antiseizure medication to prevent seizures.
32. IfWhen an individual has had a suddensingle unprovoked episode of aloss nonepilepticof seizureconsciousness (i.e., the cause is unknown or lossthere ofis consciousnessno ofclear unknownprovoking causetrigger) whichthat didis determined not requireto antiseizurehave medicationbeen a seizure, the decisionmedical asexaminer tomay whethercertify thatthe person'sindividual conditionif willthe likelymedical causeexaminer determines recurrence of loss of consciousness or loss of ability to control a commercial motor vehicle is unlikely and the individual is not taking antiseizure medication. The determination should be made on an individual basis by the medical examiner in consultation with the treating physicianprovider. Before certification is considered, it is suggestedrecommended that a 6 -month waiting period elapse from the time of the episode.
3. FollowingWhen thean waitingindividual periodhas had a single unprovoked nonepileptic seizure (i.e., itthe cause is suggestedunknown or there is no clear provoking trigger) that thewas individualtreated havewith aantiseizure completemedication neurologicalor examination.left Ifuntreated, the resultsmedical ofexaminer may certify the examinationindividual areif negativethe andindividual is both off antiseizure medication isand notseizure required,free thenfor the5 driveryears mayof be qualifiedmore.
4. InWhen thosean individual caseshas wherehad a driversingle hasprovoked anonepileptic seizure or an episode of loss of consciousness that(i.e., resultedthere fromis a known medical condition (e.g.or a clear provoking trigger that is reversible or avoidable, such as a drug reaction, alcohol or illicit drug withdrawal, high temperature, acute infectious disease, dehydration, or acute metabolic disturbance), certificationthe shouldmedical beexaminer deferredmay untilcertify the driverindividual if the individual has fully recovered, from that condition and has no existing residual complications, and is not taking antiseizure medication.
5. Drivers with a history of epilepsy/seizures off antiseizure medication and seizure-free forrecurrence 10and yearsexposure may be qualified to drivethe aprovoking commercialtrigger motorin vehiclethe infuture interstateis commerceunlikely.
5. InterstateWhen driversan withindividual has a medical history of aepilepsy singleor unprovokeda seizure maydisorder, bethe qualifiedmedical toexaminer drivemay acertify commercialthe motorindividual vehicleif inthe interstateindividual commerceis ifboth seizure-free and off antiseizure medication forand aseizure 5-yearfree periodfor 10 years or more.
I6. MentalIf Disorders:a §medical 391.41(b)(9)
1.examiner A person is physicallyunsure qualifiedabout whether to drivequalify aan commercialindividual motorwith vehiclea ifdiagnosis thatof person:epilepsy Hasor noa mental,seizure nervousdisorder, organic or functionala diseasesingle ornonepileptic psychiatricseizure, disorderthe likelymedical toexaminer interferemay withrefer abilitythe individual to drivethe Federal Motor Carrier Safety Administration for evaluation under the criteria for a motorFederal vehicleseizure safelyexemption.
2H. Medical Advisory Criteria for 49 CFR 391.41(b)(9)
1. Emotional or adjustment problemsdisorders contribute directly to an individual's level of memory, reasoning, attention, and judgment., Theseand problemsare often underliecaused by physical disorders. A variety of functional disorders can cause drowsiness, dizziness, confusion, weakness, or paralysis that may lead to incoordination, inattention, or loss of functional control andthat susceptibilitymay be likely to accidentsinterfere whilewith drivingthe ability to drive a commercial motor vehicle safely. Physical fatigue, headache, impaired coordination, recurring physical ailments, and chronic “nagging” pain may be present to such a degree that certificationthey formay commercial driving is inadvisable. Somatic and psychosomatic complaints should be thoroughlylikely examinedto wheninterfere determiningwith anthe individual'sability overall fitness to drive. Disorders of a periodicallycommercial incapacitatingmotor nature,vehicle even in the early stages of development, may warrant disqualificationsafely.
3. ManySomatic bus and truckpsychosomatic driverscomplaints haveshould documentedbe thatthoroughly “nervousevaluated trouble”when relatedexamining toan neurotic, personality, or emotional or adjustment problems is responsible for a significant fraction of their preventable accidentsindividual.
2. The degree to which an individual is able to appreciate, evaluate, and adequately respond to environmental strain and emotional stress is critical when assessing an individual's mental alertness and flexibility to cope with the stresses of commercial motor vehicle driving.
43. WhenIt examiningis theunlikely driver, it should be kept in mind that individuals who live under chronic emotional upsets may have deeply ingrained maladaptive or erratic behavior patterns. Excessively antagonistic, instinctive, impulsive, openly aggressive, paranoid or severely depressed behavior greatly interfere with the driver's ability to drive safely. Those individuals who are highly susceptible to frequent states of emotional instability (e.g., due to schizophrenia, affective psychoses, paranoia, severe anxiety, or depressive neuroses) maywould warrantsatisfy disqualificationthe physical qualification standard.
4. Careful consideration should be given to the side effects and interactions of medications in the overall qualification determination.
J. Vision:Medications §used 391.41(b)(10)
1. A person is physically qualified to drivetreat a commercial motor vehicle if that person: Has distant visual acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lensesmental, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lensesnervous, field of vision of at least 70 degrees in the horizontal meridian in each eyeorganic, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber.
2. The term “ability to recognize the colors of” is interpreted to mean if a person can recognize and distinguish among traffic control signals and devices showing standard red, green and amber, he or shefunctional meetsdisease the minimum standard, even though he or shepsychiatric maydisorder have some type of color perception deficiency. If certain color perception tests are administered, (such as Ishihara, Pseudoisochromatic, Yarn) and doubtful findings are discovered, a controlled test using signal red, green and amber may be employedlikely to determineinterfere with the driver's ability to recognizedrive these colors.
3. Contact lenses are permissible if there is sufficient evidence to indicate that the driver has good tolerance and is well adapted to their use. Use of a contact lens in one eye for distance visual acuity and another lens in the other eye for near vision is not acceptable, nor telescopic lenses acceptable for the driving of commercial motor vehiclesvehicle safely.
4I. If an individual meets the criteria by the use of glasses or contact lenses, the following statement shall appear on the Medical Examiner'sAdvisory Certificate:Criteria “Qualified only if wearing corrective lenses.” commercial motor vehicle drivers who do not meet the Federal vision standard may call (202) 366-4001 for an49 applicationCFR for a vision exemption.
K. Hearing: § 391.41(b)(11)
1. A person is physically qualified to drive a commercial motor vehicle if that person: First perceives a forced whispered voice in the better ear at not less than 5 feet with or without the use of a hearing aid, or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to American National Standard (formerly ADA Standard) Z24.5-1951.
2. Since the prescribed standard under the Federal Motor Carrier Safety Regulations is from the American National Standards Institute (ANSI), formerly the American Standards Association, it may be necessary to convert the audiometric results from the International Organization for Standardization (ISO) standard to the AmericanANSI National Standards Institute standard. InstructionsTo areconvert includedaudiometric ontest theresults Medicalfrom ExaminationISO Reportto Form.
3.ANSI, Ifsubtract an14 individualdecibels meets(dBs) from the criteriaISO byresult usingfor a500 hearingHertz aid(Hz), thesubtract driver10 mustdBs wearfor that1,000 hearingHz, aid and havesubtract it8.5 indBs operationfor at2000 all times while drivingHz. AlsoTo average, add the driverreadings mustfor bethe in3 possessionfrequencies oftested aand sparedivide powerby source for the hearing aid3.
42. For the whispered voice test, the individual should be stationed at least 5 feet from the medical examiner with the ear being tested turned toward the medical examiner. The other ear is covered. Using the breath whichthat remains after a normal expiration, the medical examiner whispers words or random numbers such as 66, 18, 3, etc. The medical examiner should then ask the individual to repeat the words or sequence. The medical examiner should not use only sibilants (“s” sounding materials). The opposite ear should be tested in the same manner.
5. If the individual fails the whispered voice test in both ears, the audiometric test should be administered.
3. If an individual meetsdoes not meet the criteriarequirements bywith the use of a hearing aid, theand followingrequires statementa mustFederal appearhearing onexemption, the Medicalbox Examiner'sfor Certificate “QualifiedWearing only when wearing a hearing aid.”
L. Drugshould Use:NOT §be 391.41(b)(12)
1.selected Aon personeither isthe physicallyMedical qualifiedExamination toReport driveForm, aMCSA-5875, commercial motor vehicle if that person does not use any drug or substanceMedical identifiedExaminer's inCertificate, 21Form CFR 1308MCSA-5876.11, an amphetamineInstead, aonly narcotic,the orbox otherfor habit-formingaccompanied drug.by A driver may use a non-Schedulehearing Iexemption drug or substance that is identifiedselected inon the otherMedical SchedulesExamination inReport 21Form, CFRMCSA-5875, partand 1308the ifMedical theExaminer's substanceCertificate, orForm drugMCSA-5876.
4. isTo prescribedobtain byan application for a licensedhearing medicalexemption, practitionerindividuals who:
(i) Isdo familiarnot withmeet the driver'sFederal medicalhearing history,standard andmay assignedcall duties; and
(ii202) Has366-4001, advisedemail thefmcsahearingexemptions@dot.gov, driver that the prescribed substance or druggo willto not adversely affect the https://www.fmcsa.dot.gov/medical/driver's-medical-requirements/new-hearing-applicant-doc-email-version.
J. abilityMedical toAdvisory safelyCriteria operatefor a49 commercialCFR motor vehicle391.41(b)(12)
21. ThisFederal exceptionlaw doesprohibits notSchedule applyI todrugs methadone.or Thesubstances intentlisted ofon the21 medicalCFR certification1308.11 processfrom isbeing toprescribed medicallyfor evaluateany apurpose. driverTherefore, toa ensuremedical thatexaminer thecannot driverphysically hasqualify noan medicalindividual conditionwho whichuses interferesSchedule withI thedrugs safeor performancesubstances.
2. ofA drivingmedical tasksexaminer onmay aphysically publicqualify road.an Ifindividual awho driver uses an amphetamine, a narcotic, or any other habit-formingprescribed drug, itor maysubstance belisted causeon forSchedules theII driverthrough toV bein found21 medicallyCFR unqualified1308.12 Ifthrough a1308.15 driverif usesthe aprescription Scheduleexception Iis met. A drug or substance, itthat willis beprescribed causeby fora thelicensed drivermedical topractitioner bewho foundis medicallylicensed unqualified.under Motorapplicable carriersFederal, areState, encouragedlocal, toor obtainforeign alaws practitioner'sto writtenprescribe statementcontrolled aboutdrugs theand effectssubstances, onis transportationfamiliar safetywith of the useindividual's ofmedical ahistory, particularand drug.
3.has Aadvised testthe forindividual controlledthat substancesthe isdrug notor requiredsubstance aswill partnot ofadversely thisaffect biennialthe certificationindividual's process.ability Theto Federalsafely Motoroperate Carriera Safetycommercial Administrationmotor orvehicle meets the driver'sprescription employerexception shouldin be§ contacted391.41(b)(12).
3. directlyOne forof informationthe onways controlledfor substancesthe andmedical alcoholexaminer testingto underobtain Partthe 382information ofthat shows the FMCSRs.
4.prescription Theexception termis “uses”satisfied is designed to encompassrequest instancesa ofwritten prohibitedcommunication drugfrom usethe determinedprescribing bylicensed amedical physicianpractitioner throughwho establishedsatisfies medicalthe meansregulation's requirements. ThisA mayvoluntary orform mayavailable noton involvethe bodyFederal fluidMotor testingCarrier Safety Administration's website (391.41 IfCMV bodyDriver fluidMedication testingForm, takesMCSA-5895) placemay be used, positivewith testthe resultsindividual's shouldconsent, beas confirmedan byoptional atool secondto testobtain ofthe greaterrequired specificityinformation.
4. The termmedical “habit-forming”examiner ismay intendedrequest toa includenon-Department anyof Transportation drug ortest medicationto generallyaid recognizedin asthe capablephysical ofqualification becoming habitualdetermination, andincluding whichwhen maysigns impairexist indicating the user'sindividual abilitymay tonot operatehave adisclosed commercialuse motorof vehiclea safely.
5.scheduled Thedrug driveror issubstance. medicallyUse unqualifiedof fora thesubstance durationabuse ofprofessional, thesee prohibited49 drug(s)CFR use40.3 and until40.281, ais secondnot examinationrequired showsas thepart driverof isa freenon-Department fromof theTransportation prohibited drug(s) usetest.
K. RecertificationMedical mayAdvisory involveCriteria afor substance49 abuseCFR evaluation,391.41(b)(13)
1. theThe successfulphrase completion“current clinical diagnosis of” aalcoholism drugis rehabilitationspecifically program,designed andto encompass a negativecurrent drugalcoholic testillness result.or Additionally,those giveninstances thatwhere the certificationindividual's periodphysical iscondition normallyhas twonot yearsfully stabilized.
2. When in remission, the medical examiner hasmay thecertify optionan toindividual certifywho forhas a periodprior ofclinical lessdiagnosis thanof 2alcoholism.
3. yearsThe if this medical examiner determinesmay morerequest frequenta monitoringnon-Department isof required.
M.Transportation Alcoholism:alcohol §test 391.41(b)(13)
1.to Aaid personin isthe physicallyphysical qualifiedqualification todetermination, driveincluding awhen commercialthe motorindividual vehiclediscloses ifexcessive thatuse person:of Hasalcohol noor currentthe clinicalmedical diagnosisexaminer observes signs of alcoholism.
2. The termuse “current clinical diagnosis of” isa specificallysubstance designedabuse toprofessional, encompasssee a49 currentCFR alcoholic40.3 illnessand or40.281, thoseis instancesnot whererequired. theThe individual'smedical physicalexaminer conditionmay hasrequest notthat fullyindividuals stabilized,provide regardlessdocumentation offrom thea timeprofessional element.qualified Ifto conduct an individualalcohol showsuse signsassessment ofthat havingincludes an alcohol-useopinion problem,concerning hewhether ora shecurrent shouldclinical bediagnosis referredof toalcoholism ais specialist.present Afteror counselingthe and/orindividual treatment,is hein orremission sheprior mayto bemaking considereda formedical certification determination.
[8089 FR 228223579, AprJan. 2319, 20152024]