|This site provides
detailed information, direction and support for professional drivers who
have jeopardized DOT medical certification issues.
FMCSA - Medical
The Code of Federal Regulations (CFR) is the codification of the general
and permanent rules published in the Federal Register by the executive
departments and agencies of the Federal government. It is divided into 50
titles that represent broad areas subject to Federal regulation. Title 49
Each title is divided into chapters, which usually bear the name of the
issuing agency. Chapter III of Title 49 is "Federal Motor Carrier Safety
Administration, Department of Transportation."
Each chapter is further subdivided into parts that cover specific
regulatory areas. Part 391 is Qualifications of Drivers and Longer
Combination Vehicle (LCV) Driver Instructors. Large parts may be
subdivided into subparts. Subpart E of Part 391 is Physical Qualifications
Parts are organized in sections. Citations for the CFRs include the title,
part, and section numbers (e.g., 49 CFR 391.41). When the title is
understood, the citation may just include the part and section (e.g.,
The CFR (Regulations) are law and must be followed.
Medical Standards/Advisory Criteria/Guidelines
Standards or Federal Motor Carrier Safety Regulations (FMCSRs) are legal
requirements for interstate commercial vehicles, drivers, and motor
FMCSA provides medical guidelines or advisory criteria to assist in the
evaluation of medical fitness to operate a commercial bus or truck. These
guidelines are based on expert review and considered best practice. The
examiner may or may not choose to use these recommended guidelines. When
the certification decision does not conform with the recommendations, the
reason(s) for not following the medical guidelines should be included in
49 CFR 391.41
Describes the physical qualification requirements for drivers. The 13
standards are used to determine driver medical fitness for duty. Four of
the standards: vision, hearing, epilepsy, and diabetes mellitus have
objective disqualifiers that do not depend on medical examiner clinical
interpretation. These standards are the "non-discretionary" standards. For
the other nine "discretionary" standards, the medical examiner makes a
clinical judgment in accordance with the physical qualification
requirements for driver certification.
49 CFR 391.43
Describes the responsibilities of the medical examiner, including general
instructions for performing the medical examination, a description of
driver tasks and work environment, medical advisory criteria, the sample
Medical Examination Report form, and the medical examiner's certificate.
49 CFR 391.45
Identifies who must have the commercial motor vehicle (CMV) driver
49 CFR 391.47
Describes the process for conflict resolution when there is a disagreement
between the primary care provider for the driver and the medical examiner
for the motor carrier concerning driver qualifications.
49 CFR 391.49
Describes the Skill Performance Evaluation (SPE) Certification Program,
which is an alternative physical qualification standard for the driver
with a fixed musculoskeletal deficit of an extremity who cannot physically
qualify to drive under §391.41(b)(1) or (b)(2). The driver must be
otherwise qualified to drive a CMV and meet the provisions of the
The first program to address fixed musculoskeletal deficits was created
and administered by the Interstate Commerce Commission (ICC) in 1964 and
was known as the Handicapped Driver Waiver Program. See Skill Performance
Evaluation Certification Program (SPE) History.
49 CFR 391.62
Describes limited exemptions for intra-city zone drivers.
49 CFR 391.64
Describes grandfathering for certain drivers who participated in vision
and diabetes waiver study programs. These drivers may be certified as long
as they continue to meet the provisions outlined in 49 CFR 391.64 and
continue to meet all other qualification standards.
49 CFR 390
general information and definitions.
49 CFR 40
Includes regulations for medical review officers and substance abuse
professionals, including drug and alcohol testing procedures.
An exemption provides temporary regulatory relief from one or more of the
FMCSRs for commercial drivers. Relief from a regulation is for 2 years and
may be renewed. Currently, FMCSA has two medical Driver Exemption
Federal Vision Exemption Program (1998).
Diabetes Exemption Program (September 2003).
The medical examiner cannot issue an exemption. The role of the medical
examiner is to determine if the driver is "otherwise qualified." As part
of the application procedure, the driver must obtain a medical
examination, whereby the medical examiner determines whether the driver is
"otherwise qualified" if accompanied by the Federal vision or diabetes
exemption. Both Federal exemptions require the driver to have an annual
medical examination for maintenance and renewal of the exemption.
For Assistance with FMCSA Exemptions or other
medical issues, see www.truckmed.com