By Dr. Lawrence Earl
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I get more questions about recertification after a stroke than any other condition regarding DOT exams. Evaluation by a neurologist is necessary to confirm the area of involvement. The risk of complicating seizures is associated with the location of the lesions. Seizure risk is the overriding concern when making a recertification determination.
- Cerebellum and brainstem vascular lesions ARE NOT associated with an increased risk for seizures.
- Cortical and subcortical deficits ARE associated with an increased risk for seizures.
A transient ischemic attack (TIA) is a temporary neurological event reflecting inadequate blood supply to one portion of the brain. The risk of a recurrent event, TIA or stroke, is highest in the first few weeks to months after a TIA. Anticoagulant and anti-seizure medications are commonly prescribed after these events.
When making recertification determinations, drivers should have a normal physical and be cleared by a neurologist knowledgeable in commercial driving. Drivers should have normal neuro-ophthalmological and neurocognitive testing and should:
- Be free of neurological residuals or have minimal symptoms that will not interfere with safe driving.
- Be seizure-free.
- Not be taking any anti-seizure medication, anti-coagulants, or any other medications that may impair driving.
- Have completed the appropriate waiting periods seizure-free and anti-seizure medication-free.
The minimum waiting periods are one year for TIA, cerebellar, and brainstem stroke and five years for cortical and sub-cortical stroke due to the risk of seizure. The maximum certification is one year.
Case Examples:
“I had a stroke six months ago. Why am I being asked to get decertified if my goal is to return to driving after the one-year waiting period?” Any driver with a new medical condition that interferes with commercial driving is required by federal statute to obtain a new medical certification. The driver is automatically “decertified” after such a condition.
This driver believes she may automatically return to commercial driving after waiting one year. Only the medical examiner can determine if the driver has met the appropriate waiting period and is now medically qualified based on the exam, documentation of the type and location of the stroke, neurological consultation report, and many other factors.
“Will a noticeable limp from a stroke disqualify me from a DOT medical card?” Many factors need to be considered after a stroke: seizure, risk of another stroke, severity of underlying diseases, effects of medications, muscular or neurological deficits, and how any or a combination of these affects commercial driving and public safety. Only a certified medical examiner can make that determination.
“I am a family physician but not a medical examiner. I have a truck driver patient who suffered a stroke. He is improving but has residual weakness in his right hand and a slight limp. He is asking me to say it is ok if he goes back to ‘team driving’ with his son due to the financial hardship the family is experiencing.” Only a certified medical examiner can clear a commercial driver.
A driver with a cerebral stroke is at risk for the seizure; it would be at least a year’s waiting period without residuals, seizures, or anti-seizure medication. A commercial driver is required by law to get re-examined after such an incident by a certified examiner.
Suspected violations can be reported at fmcsamedical@dot.gov.
