FMCSA Medical Examiner Handbook

Federal Motor Carrier Safety Administration (FMCSA)

Medical Examiner Handbook

As of 2015 this Handbook is no longer in use

Table of Contents

Introduction .................................................................................................................................................. 7 Part I ? The Federal Motor Carrier Safety Administration (FMCSA) ............................................................ 8

About the FMCSA .................................................................................................................................... 8 FMCSA Mission Statement .................................................................................................................. 8

About the Office of Medical Programs ..................................................................................................... 8 The Office of Medical Programs Mission Statement ............................................................................ 8

About the National Registry of Certified Medical Examiners ................................................................... 9 The National Registry of Certified Medical Examiners Mission Statement .......................................... 9 The Medical Examiner ......................................................................................................................... 9 Medical Certification........................................................................................................................... 10

Privacy and the Medical Examination .................................................................................................... 10 Medical Examination Report Form..................................................................................................... 10 Medical Examiner's Certificate........................................................................................................... 11

Medical Regulations Summary .............................................................................................................. 11 Code of Federal Regulations -- LAW ................................................................................................ 11 Medical Standards/Advisory Criteria/Guidelines ................................................................................ 12 Medical Regulations Summary Table ................................................................................................ 12 Exemptions ........................................................................................................................................ 14

Important Definitions .............................................................................................................................. 14 Regulation Definitions ........................................................................................................................ 14

Part II - The Job of Commercial Driving ..................................................................................................... 16 FMCSA Regulates Interstate Commercial Operation ............................................................................ 16 Drivers................................................................................................................................................ 16 Vehicles.............................................................................................................................................. 16 Truck and Bus Companies................................................................................................................. 16 State Regulations............................................................................................................................... 17 The Driver and the Job of Commercial Driving ...................................................................................... 17 The Driver .......................................................................................................................................... 17 The Job of Commercial Driving.......................................................................................................... 18 FMCSA Commercial Driving Facts and Research ................................................................................. 20 Office of Analysis, Research, and Technology .................................................................................. 20

Part III - Medical Examination Guidelines .................................................................................................. 23 About 49 CFR 391.43 ............................................................................................................................ 23 Purpose of Interstate Commercial Driver Physical Examination........................................................ 23 Driver/Medical Examiner Relationship ................................................................................................... 23 Purpose of Physical Examination....................................................................................................... 23 The Issue Is Risk................................................................................................................................ 23 Consider Safety Implications.............................................................................................................. 24

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Medical Examiner Do's ...................................................................................................................... 24 Medical Examination Report Form - Overview ...................................................................................... 25

Driver Information............................................................................................................................... 26 Health History..................................................................................................................................... 27 Vision ................................................................................................................................................. 33 Hearing............................................................................................................................................... 34 Blood Pressure/Pulse......................................................................................................................... 36 Urinalysis............................................................................................................................................ 38 Physical Examination ......................................................................................................................... 39 Determine Certification Status ........................................................................................................... 43 Certify................................................................................................................................................. 44 Disqualify............................................................................................................................................ 48 Issue Medical Examiner's Certificate ................................................................................................. 49 Part IV - Physical Qualification Standards and Advisory Criteria ............................................................... 51 Physical Qualification Standards (Regulations) versus Advisory Criteria (Medical Guidelines) ............ 51 Ongoing Standards and Guidelines Review Process ............................................................................ 51 About 49 CFR 391.41 ............................................................................................................................ 52 Vision ..................................................................................................................................................... 52 Vision Regulation 49 CFR 391.41(b)(10) ........................................................................................... 52 Health History and Physical Examination .......................................................................................... 53 Certification and Documentation ........................................................................................................ 56 Hearing................................................................................................................................................... 59 Hearing Regulation 49 CFR 391.41(b)(11) ........................................................................................ 60 Health History and Physical Examination .......................................................................................... 60 Certification and Documentation ........................................................................................................ 62 Advisory Criteria/Guidance ................................................................................................................ 63 Hypertension .......................................................................................................................................... 64 Blood Pressure (BP) Regulations 49 CFR 391.41(b)(6) and 49 CFR 391.43(f) ................................ 65 Health History and Physical Examination .......................................................................................... 65 Advisory Criteria/Guidance ................................................................................................................ 67 Cardiovascular ....................................................................................................................................... 73 Cardiovascular Regulation 49 CFR 391.41(b)(4)............................................................................... 73 Health History and Physical Examination .......................................................................................... 74 Advisory Criteria/Guidance ................................................................................................................ 75 Respiratory (b)(5) ................................................................................................................................. 117 Respiratory Regulation 49 CFR 391.41(b)(5) .................................................................................. 118 Health History and Physical Examination ........................................................................................ 118 Advisory Criteria/Guidance .............................................................................................................. 120 Neurological (b)(7)(8)(9)....................................................................................................................... 136

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Neurological Regulations 49 CFR 391.41(b)(7)(8)(9) ...................................................................... 137 Health History and Physical Examination ........................................................................................ 138 Advisory Criteria/Guidance .............................................................................................................. 140 Musculoskeletal (b)(1)(2)(7) ................................................................................................................. 167 Musculoskeletal Regulations 49 CFR 391.41(b)(1)(2)(7)................................................................. 167 Health History and Physical Examination ........................................................................................ 168 Advisory Criteria/Guidance .............................................................................................................. 170 Diabetes Mellitus.................................................................................................................................. 172 Diabetes Mellitus Regulation 49 CFR 391.41(b)(3) ......................................................................... 173 Health History and Physical Examination ........................................................................................ 173 Advisory Criteria/Guidance .............................................................................................................. 175 Other Diseases .................................................................................................................................... 181 Other Diseases Regulation 49 CFR 391.41(b)(9) ............................................................................ 182 Health History and Physical Examination ........................................................................................ 182 Advisory Criteria/Guidance .............................................................................................................. 183 Psychological Disorders (b)(9) ............................................................................................................. 185 Psychological Regulation 49 CFR 391.41(b)(9)............................................................................... 186 Health History and Physical Examination ........................................................................................ 186 Advisory Criteria/Guidance .............................................................................................................. 189 Drug Abuse and Alcoholism................................................................................................................. 201 Drug Abuse and Alcoholism Regulations 49 CFR 391.41(b)(12)(13) .............................................. 202 Health History and Physical Examination ........................................................................................ 202 About 49 CFR 382 Alcohol and Drug Rules..................................................................................... 204 Advisory Criteria/Guidance .............................................................................................................. 205 Medications/Drug Use 49 CFR 391.41(b)(12) ..................................................................................... 208 Medications/Drug Use Regulation 49 CFR 391.41(b)(12) ............................................................... 208 Health History and Physical Examination ........................................................................................ 209 Advisory Criteria/Guidance .............................................................................................................. 211 Appendix A: Medical Examination Report Form ...................................................................................... 213 Medical Examination Report Form - Page 1 ........................................................................................ 213 Driver Information............................................................................................................................. 213 Health History................................................................................................................................... 213 Medical Examination Report Form - Page 2 ........................................................................................ 213 Vision ............................................................................................................................................... 213 Hearing............................................................................................................................................. 214 Blood Pressure/Pulse....................................................................................................................... 214 Urinalysis.......................................................................................................................................... 214 Medical Examination Report Form - Page 3 ........................................................................................ 215 Physical Examination ....................................................................................................................... 215

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Certification and Documentation ...................................................................................................... 215 Appendix B: Federal Exemption Programs .............................................................................................. 217

49 CFR 381.300 What is an exemption? ............................................................................................. 217 Federal Vision Exemption Program ..................................................................................................... 217

Qualified by Operation of 49 CFR 391.64: "Grandfathered" ............................................................ 217 Federal Diabetes Exemption Program ................................................................................................. 218

About the Federal Diabetes Exemption Program............................................................................. 218 Relevance to Driving ........................................................................................................................ 219 Health History and Physical Examination ........................................................................................ 219 Appendix C: Skill Performance Evaluation .............................................................................................. 223 Fixed Deficit of an Extremity ................................................................................................................ 223 Appendix D: Cardiovascular Recommendation Tables ........................................................................... 225 Preface................................................................................................................................................. 225 ANEURYSMS ...................................................................................................................................... 226 AORTIC CONGENITAL HEART DISEASE ......................................................................................... 227 AORTIC CONGENITAL HEART DISEASE (Continued)...................................................................... 228 AORTIC REGURGITATION................................................................................................................. 229 AORTIC STENOSIS ............................................................................................................................ 230 ATRIAL SEPTAL DEFECTS ................................................................................................................ 231 ATRIAL SEPTAL DEFECTS (Continued) ............................................................................................ 232 ATRIAL SEPTAL DEFECTS (Continued) ............................................................................................ 233 BUNDLE BRANCH BLOCKS AND HEMIBLOCKS.............................................................................. 234 CARDIOMYOPATHIES AND CONGESTIVE HEART FAILURE (CHF) .............................................. 235 COMMERCIAL DRIVERS WITH KNOWN CORONARY HEART DISEASE (CHD) ............................ 236 COMMERCIAL DRIVERS WITH KNOWN CORONARY HEART DISEASE (CHD) (Continued) ........ 237 COMMERCIAL DRIVERS WITHOUT KNOWN CORONARY HEART DISEASE (CHD) .................... 238 CONGENITAL HEART DISEASE ........................................................................................................ 239 CONGENITAL HEART DISEASE (Continued) .................................................................................... 240 CONGENITAL HEART DISEASE (Continued) .................................................................................... 241 CONGENITAL HEART DISEASE (Continued) .................................................................................... 242 CONGENITAL HEART DISEASE (Continued) .................................................................................... 243 HEART TRANSPLANTATION ............................................................................................................. 244 HYPERTENSION................................................................................................................................. 245 IMPLANTABLE DEFIBRILLATORS..................................................................................................... 246 MITRAL REGURGITATION ................................................................................................................. 247 MITRAL STENOSIS............................................................................................................................. 248 PACEMAKERS .................................................................................................................................... 249 PACEMAKERS (Continued) ................................................................................................................ 250 PACEMAKERS (Continued) ................................................................................................................ 251

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PERIPHERAL VASCULAR DISEASE ................................................................................................. 252 SUPRAVENTRICULAR TACHYCARDIAS .......................................................................................... 253 SUPRAVENTRICULAR TACHYCARDIAS (Continued) ...................................................................... 254 VALVE REPLACEMENT ..................................................................................................................... 255 VALVE REPLACEMENT (Continued).................................................................................................. 256 VENOUS DISEASE ............................................................................................................................. 257 VENTRICULAR ARRHYTHMIAS......................................................................................................... 258 VENTRICULAR ARRHYTHMIAS (Continued)..................................................................................... 259 VENTRICULAR SEPTAL DEFECTS ................................................................................................... 260

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Introduction

This handbook provides information and guidance to the medical examiner who performs the commercial driver medical examination. Determining driver medical fitness for duty is a critical element of the FMCSA safety program. Specialists, such as cardiologists and endocrinologists, may perform additional medical evaluation, but it is the medical examiner who decides if the driver is medically qualified to drive.

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Part I ? The Federal Motor Carrier Safety Administration (FMCSA)

About the FMCSA

On December 9, 1999, President Clinton signed into law the Motor Carrier Safety Improvement Act of 1999. This act transferred the Office of Motor Carriers from the Federal Highway Administration (FHWA) to establish the Federal Motor Carrier Safety Administration (FMCSA). FMCSA is one of nine U.S. Department of Transportation administrations. To learn more, visit the DOT Agencies Web page at .

FMCSA is headquartered in Washington, DC and employs people in all 50 States and the District of Columbia. FMCSA is led by an Administrator, Deputy Administrator, and Chief Safety Officer. The Office of Medical Programs is located under the Associate Administrator for Policy and Program Development.

FMCSA partners and customers are serviced by field organizations. The organizations consist of Field Operations, Service Centers, and State-level motor carrier division offices.

FMCSA activities contribute to ensuring safety in motor carrier operations through strong enforcement of safety regulations; targeting high-risk carriers and commercial motor vehicle drivers; improving safety information systems and commercial motor vehicle technologies; strengthening commercial motor vehicle equipment and operating standards; and increasing safety awareness.

FMCSA Mission Statement

"The Federal Motor Carrier Safety Administration (FMCSA) is focused on reducing crashes, injuries, and fatalities involving large trucks and buses."

In carrying out its safety mandate to reduce crashes, injuries, and fatalities involving large trucks and buses, FMCSA:

? Develops and enforces data-driven regulations that balance motor carrier (truck and bus

companies) safety with industry efficiency.

? Harnesses safety information systems to focus on higher-risk carriers in enforcing safety

regulations.

? Targets educational messages to carriers, commercial drivers, and the public. ? Partners with stakeholders including Federal, State, and local enforcement agencies, the motor

carrier industry, safety groups, and organized labor on efforts to reduce bus and truck-related crashes. To learn more about FMCSA, visit .

About the Office of Medical Programs

The Office of Medical Programs Mission Statement

"The mission of the Office of Medical Programs is to promote the safety of America's roadways through the promulgation and implementation of medical regulations, guidelines and policies that ensure commercial motor vehicle drivers engaged in interstate commerce are physically qualified to do so."

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