Frequently Asked Questions


  1. I hear there are new changes happening as of April 20, 2016. How will those changes impact me?


Let’s start with the NEW form that is now required. You can download and print and fill by hand or you can fill the writeable PDF file. Be sure to click on the NEW form and NOT the old form. You can access that form by following this link:


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


There are specific details regarding changes to all of the driver examination forms included in the sample forms that are located in the Resource Center of the National Registry Website. Look for the highlighted in yellow all changes made to the driver examination forms as a result of the Medical Examiner’s Certification Integration final rule.


These changes include:


  1. What should I expect during the DOT Physical Examination?



  1. Is there a mandatory BMI (Body Mass Index) cut-off?


There are NOmandatoryBMI parameters. However, when the Medical Examiner performs the physical exam, the BMI will play a role in some decision making process. The big concern is how an elevated BMI can impact or increase the risk for potential sleep apnea, for example.


Given the new push by DOT to screen for this very serious condition, drivers who are able to get a sleep study done should get one done for the following reasons. First, if you are at high risk, then see it as an investment in your health. Sleep apnea, for example, affects the cardiovascular system tremendously. Second, if a medical examiner thinks you might be at risk for sleep apnea and you have been screened for it and found not to have it, then you can bring that documentation and not have to be put in a 45-day pending status. If during those 45 days your medical certificate card were to expire, you can’t drive.


  1. Is it true that the first thing you will do is measure my neck?


Unlike some clinics, we do not measure your neck first thing. We will certainly evaluate the entire picture. Neck size is just part of many factors that have to be looked at during a physical.


  1. What about the Sleep Apnea issues?


The Department of Transportation has very specific Regulations and Recommendations. Remember,regulations are absolutes. Recommendations are items that are strongly recommended be taken into account when certifying a driver. The bottom line is the doctor makes the final decision based on the DOT guidelines and the medical evaluation with the driver. When it comes to sleep apnea, there are no regulations that say you must have a sleep study done if you are to continue to drive. However, if your doctor determines that there is a high risk, he or she will recommend you get one and give you a limited timed card until you get the evaluation done. You are entitled to a second opinion by another medical examiner (certified by the National Registry) who will charge you for a physical exam as well.


Remember, you can still drive if you have sleep apnea. While FMCSA regulations do not specifically address sleep apnea, they do prescribe that a person with a medical history or clinical diagnosis of any condition likely to interfere with their ability to drive safely cannot be medically qualified to operate a commercial motor vehicle in interstate commerce. However, once successfully treated, a driver may regain their “medically-qualified- to-drive” status. It is important to note that most cases of sleep apnea can be treated successfully.


Remember, there are 3 levels of sleep apnea (Mild, Moderate, Severe). The potentially disqualifying level of sleep apnea is moderate to severe, which interferes with safe driving. The medical examiner must qualify and determine a driver’s medical fitness for duty. Attached is the following screening tool that might help you see how at risk you are for sleep apnea.

First In Health, Inc.
6645 NE 78
thCourt C-10
Portland, OR 97218
Phone: (503) 978-1100 Fax: (503) 978-1119
www.firstinhealthinc.com


Patient Name ________________________________
Height_________ Weight________________
Age __________ Gender _______________

STOP-BANG Sleep Apnea Questionnaire

STOP

Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?

Yes

No

Do you often feel TIRED, fatigued, or sleepy during daytime?

Yes

No

Has anyone OBSERVED you stop breathing during your sleep?

Yes

No

Do you have or are you being treated for high blood PRESSURE?

Yes

No

BANG

BMI more than 35kg/m2?

Yes

No

AGE over 50 years old?

Yes

No

NECK circumference > 16 inches (40cm)?

Yes

No

GENDER: Male?

Yes

No


Total Score



High Risk of OSA: 5-8 Yes Answers
Intermediate Risk of OSA: 3-4 Yes Answers
Low Risk of OSA: 0-2 Yes Answers

Comments: ____________________________________________________________________________
______________________________________________________________________________________

Patient Signature____________________________________ Date ___________________




  1. When should I go see my PCP (Primary Healthcare Provider)?


Our recommendation is that if you have any chronic conditions, you visit your primary care provider BEFORE you visit us. As part of the standard of care, you should be visiting your doctor at least once a year, especially if you have an ongoing chronic condition. The new rules set forth by the D.O.T. is shifting the “burden of proof” onto the driver to show that in fact they are being monitored by a doctor. We recommend you make an appointment with your doctor at least 1 month before your medical card expires. That way, you can bring all the necessary documentation that will be reviewed by the Medical Examiner. Here are some the most common examples of the necessary documentations that ought to be brought.



  1. What happens if I use insulin?


Waiting Period- Minimum- 1 month, if the driver with diabetes was previously diagnosed and on treatment that did not include the use of insulin.


Waiting period- Minimum- 2 months, if the driver with diabetes is newly diagnosed and was not on prior treatment.


Maximum certification- 1 year. 


Recommend to certify if:

Meets all other physical qualification requirements of 49 CFR 391.41(b) except for use of insulin and:





  1. What are the rules with pacemakers and defibrillators?


Drivers are allowed to drive if they have a pacemaker. Drivers are NOT allowed to drive with a defibrillator. Drivers are NOT allowed to drive if they have an implantable combination pacemaker/defibrillator.


  1. What if my blood pressure is over 140/90?


The blood pressure guidelines, although previously part of the Medical Examination Report, are now part of the Medical Advisory Criteria. So, if the driver’s blood pressure is one or two greater than 140/90, can the doctor qualify the driver? The blood pressure guidelines are not, nor have they ever been, regulatory in nature. The FMCSA leaves blood pressure criteria decisions up to the discretion of the doctor to determine driver qualification. If a driver has hypertension and/or is being medicated for hypertension, he or she should be “recertified more frequently”.




  1. I had a heart attack several years ago, what must I know before I get a new medical card?


Depending on when you had a heart attack there are different waiting periods, further monitoring and testing. Below is a chart with the different waiting periods for what you might have been diagnosed. Please consult this table and bring the appropriate documentation at your next DOT physical examination.



  1. What happens if I can see 20/50 (or worse) only out of one eye, but with both eyes I have 20/20 vision?


The regulations for vision are pretty clear. There has to be a distant visual acuity of at least 20/40 in EACHeye with or without corrective lenses. In the past, drivers could return and just have their eyes checked with the new glasses and be done. Now, the FMCSA has ruled that if all of the other sections of the examination are met, but your eye(s) need corrective lenses, you must return and get a new head to toe physical examination. Again, it is important that you have those evaluations done BEFORE your card expires, otherwise you pay for the initial physical and for the follow-up physical.


  1. Recommended Minimum Waiting Periods and other Monitoring and Testing Requirements-


Below is a list of conditions and their waiting periods. Find the one that you have been diagnosed with and see what the waiting period is for that corresponding condition. As always, we recommend you bring all the medical documentation you might have with you. If you are not sure what applies to you, please gives us a call and we will help you navigate the requirements.


Cardiovascular Disease


Abdominal Aortic Aneurysm (AAA)

Waiting Period: Three months for post-surgical repair of an aneurysm.

OK to certify if: If AAA is less than 4 cm and the driver is asymptomatic. The AAA is 4 to 5 cm and the driver and the driver has no symptoms andhas a clearance from a cardiovascular specialist.

Not OK to certify if: If patient has symptoms, regardless of size of AAA. Driver was told to have surgery, regardless of size of aneurysm. If AAA is 4 to 5 cm and the driver does not have clearance from cardiovascular specialist. The AAA is greater than 5 cm or the size has increased 0.5 cm during a 6 month period, regardless of size.

Monitoring/Testing:Ultrasound is recommended to monitor change in size. When post-surgical treatment includes anticoagulant therapy, the driver should meet monitoring guidelines.

Maximum certification period: 1 year.


Other Aneurysms

Waiting Period: 3 months after surgery.

OK to certify if: Effective surgical repair of the aneurysm. Clearance from a cardiovascular specialist.

Not OK to certify if: N/A

Monitoring/Testing:Annual cardiac tests and consultation to adequately assess driver fitness for duty.

Maximum certification period: 1 year





Anticoagulant therapy (Coumadin): Underlying cardiovascular condition

Waiting Period: 1 month stabilized.

OK to certify if: Stabilized on medications for at least 1 month. Provides a copy of INR. Has at least monthly INR monitoring.

Not OK to certify if: INR is not being monitored. INR is not therapeutic. Underlying disease is disqualifying.

Monitoring/Testing:Monthly INR.

Maximum certification period: 1 year.


Aortic Stenosis

Waiting Period: 3 months if post-surgery.

OK to certify if: Mild aortic stenosis is asymptomatic. Moderate aortic stenosis is asymptomatic and the driver has no disqualifying findings and/or conditions. Severe aortic stenosis has been surgically repaired and meets all aortic valve repair surgical guidelines.

Not OK to certify if: If the driver has moderate aortic stenosis with one or more of the following: Angina, Heart Failure, Atrial Fibrillation, Left Ventricle Dysfunction with Ejection Fraction less than 50%, the driver has severe aortic stenosis regardless of symptoms of Left Ventricular function.

Monitoring/Testing:Echocardiography repeated every: 5 years if mild. 1 to 2 years if moderate.

Maximum certification period: 1 year







Mitral Regurgitation

Waiting Period: Minimum 3 months if post-surgical repair.

OK to certify if: Mild or moderate mitral regurgitation if asymptomatic, normal Left Ventricular size and function, normal pulmonary artery pressure. Severe mitral regurgitation that is asymptomatic. Surgical valve repair, is asymptomatic, and has clearance from a cardiologist.

Not OK to certify if: the driver has mild, moderate or severe mitral regurgitation and has: Symptoms, less than 6 METS on Bruce Protocol, Ruptured chordae or flail leaflet, atrial fibrillation, left ventricle dysfunction, embolism (thrombosis), pulmonary hypertension.

Monitoring/Testing:Moderate mitral regurgitation should have an annual echocardiography. Severe mitral regurgitation should have an Exercise Tolerance Test (ETT) and echocardiography every 6 to 12 months.

Maximum certification period: 1 year


Mitral Stenosis

Waiting Period: 4 weeks if post-percutaneous balloon mitral valve valvotomy. 3 months if post-surgical valve repair.

OK to certify if: Stenosis that is asymptomatic. Moderate stenosis that is asymptomatic. Severe stenosis and a clearance from cardiologist that understand effects of those specific procedures on a driver.

Not OK to certify if: The driver has severe mitral stenosis, until successfully treated.

Monitoring/Testing:Depends on the development and severity of symptoms. These should be performed at least annually: Chest X-Ray, electrocardiogram, 2 dimensional echocardiography with Doppler or other mitral stenosis severity assessment.

Maximum certification period: 1 year. 





Pacemaker

Waiting Period: If underlying disease is: Sinus node dysfunction, or Atrioventricular block: 1 month. If neurocardiogenic syncope, or hypertensive carotid sinus with syncope: At least 3 months.

OK to certify if: documentation indicating the presence of a functioning pacemaker, documentation indicating completion of routine pacemaker checks, and no disqualifying disease.

Not OK to certify if: An implantable cardiac defibrillator/pacemaker combination device, or a disqualifying underlying disease.

Monitoring/Testing:

Maximum certification period: 1 year.


Peripheral Vascular Disease

Waiting Period: At least 3 months after surgery. If amputation, then must have Skill Performance Evaluation (SPE).

OK to certify if: If the driver has no disqualifying cardiovascular disease.

Not OK to certify if: If the driver has pain at rest.

Monitoring/Testing:N/A

Maximum certification period: 1 year.

Post Heart Transplant

Waiting Period: Minimum 1 year post transplant.

OK to certify if: Is asymptomatic, tolerates medications, and has clearance from a cardiologist.

Not OK to certify if: As the medical examiner, you believe that the nature and severity of the medical endangers the health and safety of the driver and the public.

Monitoring/Testing:Re-evaluation and recertification every 6 months.

Maximum certification period: 6 months.


Post-Acute Myocardial Infarction

Waiting Period: Minimum 2 months.

OK to certify if: Tolerate medications, has a satisfactory ETT, has a LVEF greater than or equal to 40%.

Not OK to certify if: Rest angina or change in angina pattern within 3 months of examination. Ischemic changes on ECG. Intolerance to cardiovascular therapy.

Monitoring/Testing:Clearance from a cardiovascular specialist. Biennial Exercise Tolerance Test.

Maximum certification period: 1 year.

Post-Aortic Valve Repair

Waiting Period: Minimum 3 months.

OK to certify if: Meets asymptomatic aortic or aortic regurgitation qualification requirement and has clearance from a cardiologist.

Not OK to certify if: The driver has thrombo-embolic complications.

Monitoring/Testing:Two-dimensional echocardiography with Doppler should be performed prior to discharge. Additional monitoring and testing should be based on aortic regurgitation severity.

Maximum certification period: 1 year.


Post-CABG Surgery (By-pass)

Waiting Period: Minimum 3 months regardless of type of CABG surgery performed... OK to certify if: Is asymptomatic. Tolerates medications with no orthostatic symptoms. Has a LVEF greater than or equal than 40%. Release from cardiologist to drive. Has a healed sternum.

Not OK to certify if: Is symptomatic, has orthostatic symptom side effects from medication, has an LVEF less than 40%. Is examined and is not approved by a cardiologist for medical fitness to drive. Sternum has not healed.

Monitoring/Testing:Because of risk of re-occlusion over time, five years post-CABG surgery the driver should obtain: annual ETT, imaging stress test if indicated.

Maximum certification period: 1 year.

Post-Mitral Valve Repair for Mitral Regurgitation

Waiting Period: 3 months after repair.

OK to certify if: The driver does not have symptoms and meets the underlying, mild, moderate, or severe mitral regurgitation recommendations. The driver should also have clearance from cardiovascular specialist.

Not OK to certify if: If the driver has thromboembolic complications, atrial fibrillation, or pulmonary hypertension.

Monitoring/Testing:Additional tests and/or consultation as needed.

Maximum certification period: 1 year.


Post-Percutaneous Balloon Mitral Valvotomy

Waiting Period: 4 weeks.

OK to certify if: Asymptomatic, has cardiologist clearance, has not experienced clotting complications, and has experienced no pulmonary hypertension.

Not OK to certify if: Has thrown a clot. Pulmonary hypertension (Pulmonary pressure greater than 50 % of systemic blood pressure).

Monitoring/Testing:Annual cardiology evaluation which should include: history physical examination, electrocardiogram, chest x-ray, two-dimensional echocardiography with Doppler performed after the procedure and prior to discharge. The frequency of repeat echo-Doppler examination is variable.

Maximum certification period: 1 year.

Post-Percutaneous Coronary Intervention

Waiting Period: Minimum 1 week.

OK to certify if: Is asymptomatic at examination. Tolerates medications, has no injury to the vascular access site. Note- Initially certify for up to 6 months. Recertify for up to 1 year if ETT are satisfactory.

Not OK to certify if: Incomplete healing or complication at vascular site. Rest angina. ECG changes.

Monitoring/Testing:Following initial certification, the driver should have an ETT 3 to 6 months post-percutaneous coronary intervention and bring results to a 6-month follow up examination.

Maximum certification period: 1 year.

Post-Prosthetic Valve Replacement

Waiting Period: 3 months after valve replacement.

OK to certify if: Has no symptoms and has clearance from a cardiovascular specialist.

Not OK to certify if: Has a persistent symptom, Left Ventricular dysfunction (ejection fraction less than 40%), thromboembolic complications, atrial fibrillation, pulmonary hypertension, or inadequate anticoagulation base on monthly INR checks.

Monitoring/Testing:If treatment includes anticoagulant therapy, the driver should meet INR monitoring guidelines. Echocardiography is appropriate if there are concerns about prosthetic valve dysfunction, perivalvular leaks, new murmurs, or LV function. ETT may be required to assess work capacity.

Maximum certification period: 1 year.

Post-Surgical Commissurotomy

Waiting Period: Minimum 3 months.

OK to certify if: Is asymptomatic. Has clearance for cardiovascular specialist. Has experienced no thromboembolic complications. Has no pulmonary hypertension. Meets the certification recommendations for the underlying condition.

Not OK to certify if: The driver has thromboembolic complications (clots). Pulmonary hypertension. Pulmonary pressure greater than 50 % of systemic blood pressure.

Monitoring/Testing:Annual cardiology evaluation which should include: Electrocardiogram, chest x-ray, two-dimensional echocardiography with Doppler performed after the procedure and prior to the frequency of repeat Echo-Doppler examination is variable and depends upon the initial peri-procedural outcome and the occurrence of symptoms.

Maximum certification period: 1 year.



Post-Surgical Repair of Aneurysm

Waiting Period: 3 months post-surgical repair

OK to certify if: The driver is asymptomatic, and has a clearance from a cardiovascular specialist.

Not OK to certify if: A cardiovascular specialist has made recommendation for surgical repair of an aneurysm, but has not had the surgical repair.

Monitoring/Testing:If it includes anticoagulant therapy, the driver should meet the monitoring guidelines, which are the monthly INRs.

Maximum certification period: 1 year.

Pulmonary Emboli

Waiting Period: 3 months with no pulmonary embolism.

OK to certify if: Appropriate long-term treatment. No other disqualifying cardiovascular disease.

Not OK to certify if: The driver has symptoms.

Monitoring/Testing:When PE treatment includes anti-coagulant therapy, the driver should meet monitoring guidelines (INRs).

Maximum certification period: 1 year.


Pulmonary Valve Stenosis

Waiting Period: Minimum 1 month if post-balloon valvuloplasty. Minimum 3 months if post-surgical valvotomy.

OK to certify if: If the driver has: Mild or Moderate pulmonary valve stenosis. Pulmonary valve stenosis corrected by surgical valvotomy or balloon valvuloplasty.

Not OK to certify if: If the driver has: Symptoms of dyspnea, palpitations, or syncope.

Monitoring/Testing:Complete echocardiogram

Maximum certification period: 1 year.


Severe Aortic Regurgitation

Waiting Period: 3 months if post-aortic valve repair.

OK to certify if: No symptoms are present. Normal Left Ventricular function. If LV dilation meets certain criteria. Driver should bring copy of echocardiogram to determine DOT required parameters.

Not OK to certify if: If the driver is symptomatic. If driver is unable to achieve workload greater than 6 METS on Bruce Protocol. Has LVEF fraction less than 50%. Driver is to provide echocardiogram results.

Monitoring/Testing:Echocardiography repeated every: 6 to 12 months depending on Left ventricle End Diastolic Dilation (LVEDD) and Left end Systolic Dilation (LVESD).

Maximum certification period: 6 months if not surgically repaired. 1 year if post-aortic valve repair.


Stable Angina

Waiting Period: 3 months with no rest angina or change in angina pattern.

OK to certify if: Has stable angina. Is asymptomatic. Tolerates medications. Has a satisfactory Exercise Tolerance Test (ETT).

Not OK to certify if: the driver has had unstable angina within 3 months of examination.

Monitoring/Testing:Evaluation from a cardiologist. Biennial Exercise Tolerance Test.

Maximum certification period: 1 year.


Supraventricular Arrhythmias

Waiting Period:

OK to certify if: if driver has heart rate that is controlled. Treatment prevention of emboli that is effective and tolerated. No underlying disease that is disqualifying. Clearance from a cardiovascular specialist who understands the functions and demands of commercial driving.

Not OK to certify if: The condition causes loss of consciousness, compromised cerebral function or sudden death resuscitation.

Monitoring/Testing:Comply with anticoagulant therapy guidelines, when appropriate. Have annual evaluation by a cardiologist.

Maximum certification period: 1 year


Thoracic Aneurysm

Waiting Period: At least 3 months after surgery.

OK to certify if: A thoracic aneurysm is less than 3.5 cm. A surgically repaired thoracic aneurysm. The driver meets post-surgical repair of aneurysm guidelines including: Complete surgical repair waiting period and clearance from cardiologist.

Not OK to certify if: the driver has a thoracic aneurysm greater than 3.5 cm

Monitoring/Testing:An annual medical exam to monitor that aneurysm is not growing beyond the 3.5 cm limit.

Maximum certification period: 1 year


Ventricular Arrhythmias (VT)

Waiting Period: At least 1 month after initiating drug or other therapy and the diagnosis is: Coronary Heart Disease, Right ventricular outflow VT, or Left ventricular VT from an unknown cause.

OK to certify if: Not showing symptoms. Driver has an identified, non-disqualifying cardiac cause, and has a clearance from a cardiovascular specialist.

Not OK to certify if: Driver is showing symptoms. Has sustained VT, Has Non Sustaining VT, LVEF less than 40% or has a diagnosis of hypertrophic cardiomyopathy, long QT interval syndrome, or Brugada syndrome.

Monitoring/Testing:Should have an annual evaluation by a cardiologist

Maximum certification period: 1 year.


Summary of Neurological Waiting Periods Seizure Waiting Periods


The driver must complete the minimum waiting period seizure free and off anticonvulsant medication



Diagnosis

Waiting Period

History of epilepsy

Viral encephalitis with early seizures

10 years

Single unprovoked seizure

No identified acute change

May be distant cause (possible earlier return to driving if normal neurological examination by a specialist in epilepsy, and the driver has a normal electroencephalogram


5 years

Acute seizure with acute structural central nervous system insult

2 years

Acute seizure with acute systemic/metabolic illness

Based on risk of recurrence of primary condition.


Moderate traumatic brain injury (TBI) with early seizures

Stroke with risk of seizures

Intracerebral or subarachnoid hemorrhage with risk of seizures



5 years

Moderate TBI without early seizures

Surgically removed supratentorial or spinal tumors

2 years

Transient ischemic attack (TIA)

Intracerebral or subarachnoid hemorrhages with no risk for seizures

Surgically-repaired arteriovenous malformations/aneurysm with no risk for seizures

Surgically removed infratentorial meningioma, acoustic neuromas, pituitary adenomas, and benign spinal tumors or other benign extra axial tumors with no risk of seizures.

Infection of the central nervous system (e.g. bacterial meningitis, viral encephalitis without early seizures).

1 year