The FMCSA “rules” regulating the medical certification of a driver fall into 13 “standards” or regulations pursuant to 49 CFR 391.41. Of the 13 medical standards, four are considered “non-discretionary.” These four are insulin-dependent diabetes, epilepsy, vision, and hearing. They are non-discretionary in that the examiner doesn’t have to use any judgment regarding these conditions.
There are specific, objective criteria to determine qualification under these four standards. The driver either uses insulin or doesn’t, has epilepsy or not, and meets objective vision and hearing requirements or doesn’t. All of these have federal exemption programs. The remainder are considered“discretionary.” These all require some judgment on the part of the examiner, but some are “more discretionary” than others.
For example, FMCSA has convened medical expert panels to review the literature regarding the impact of certain conditions on driving and crash risk and make recommendations regarding medical conditions not otherwise addressed in the standards. Other reliable sources of information such as published specialty guidelines and best practices may also be used by medical examiners to help make a reasonable certification determination. Discretionary “BUT” The standards that have well-accepted expert panel review and other recommendations are discretionary, BUT you pretty much want to follow these recognized guidelines. These include the standards for:
• Loss of a hand or foot (need an SPE)
• Impairment of hand or foot
• Cardiovascular (recommendation tables)
•Hypertension (It’s discretionary!)
• Schedule 1 drugs (Not really discretionary, right?)
• Alcoholism
Truly Discretionary
These require the most judgment from the examiner, some more than others. These remaining three standards are:
• Respiratory (COPD, sleep apnea, and PFTs in smokers – always controversial)
• Rheumatic, arthritic, orthopedic, neurological, or vascular conditions
• Mental, nervous, organic, or functional conditions
Often in addition to considering the underlying condition, medications and other treatments may have side effects that interfere with the safe operation of a commercial vehicle. There are very good guidelines for sleep apnea and almost became a separate rule before it was recently derailed. I often get the question about ordering PFTs in smokers over 35 – a guideline, not a rule. Most arthritic and orthopedic conditions don’t wind up being disqualifying. There are many guidelines regarding neurologic disorders, particularly for seizures and conditions like MS and Parkinson’s. Likewise, patients with outright psychosis, schizophrenia, and severe bipolar depression are generally disqualified. Many other conditions with lots of medication issues require considerable examiner judgment.
Summary
Aside from the “non-discretionary” standards that must be followed and referred to apply for a federal exemption if appropriate, the other nine standards are considered discretionary and up to the certified examiner to use their judgment to make a qualification determination. Some of those remaining standards are“more discretionary” than others. Examiners should be familiar with accepted best practices to assist in these determinations.
More Info and Ongoing DOT Examiner Education
Questions about this or other DOT topics?
Email learl@naohp.com or join our monthly seminar: urgentcarementor.com/nrcme-seminar/?ref=10 ←
