Occupational Medicine

DOT Driver Exam

 Medical conditions requiring additional information

Affordacare strives to provide you with quality service while you prepare for your required DOT exam. The following information will help expedite your medical certification so that we may assist you though this process and get you on your way!

April 2016 Summary of Changes As announced on 23 April 2015, DOT/FMCSA has implemented important changes related to all DOT medical exams forms as well as significant changes to physical exam certification processes and dates. These changes are effective and permanent as of 20 April 2016 and are summarized BELOW.

DOT PHYSICAL EXAMS/INFORMATION FOR DRIVERS

 Driver Documentation

Before you request a DOT physical, please review the DOT information so you are aware of current requirements BEFORE we begin the DOT exam. Once we begin your exam, per DOT regulations, we cannot stop the exam. The information below highlights the most common health problems associated with DOT medical certification or recertification and the required documentation in order to clear the driver.

Documentation in support of the health concern should be brought to the DOT exam /appointment and be presented at the time of the exam. Having the documentation at the time of the first exam will help expedite the process and save you and/or your company money as well as minimize any period of non-certification.

If you have any of the conditions noted below (note that this list is not all-inclusive) and do not have the required documentation at the time of the exam, you will not pass the exam on the first visit. Affordacare is providing this information to assist you with the documentation needed for the most common health problems associated with DOT medical certification or recertification.

Note: The medications/diseases listed below may require a safety letter from the driver’s Primary Care Provider (PCP) indicating the prescribed medication(s) is tolerated and/or that the disease condition is treated/stable and that you have no side effects which would interfere with driving a Commercial Motor Vehicle. The information below highlights information needed for the most common health problems associated with DOT medical certification or recertification.

Vision

Your vision must be 20/40 or better in each eye and in both eyes together or you will be disqualified. You may use vision correction (glasses or contact lenses) to meet the standards. Ensure that you meet the DOT Vision standards before you come to your exam. If you come to the exam and do not meet vision standards, you will be disqualified and will need a complete, new DOT PE once you have your vision within standards, even if it has been 1 day since you were disqualified.

Hearing Requirements

To pass your hearing test, you must be able to hear a harsh whisper in your best ear, at no less than 5 feet, with or without a hearing aid. If you fail this basic hearing test, you’ll be referred for an audiometry test which will further determine if you are safe to drive. In most cases, you’ll be able to get a hearing correction device and then pass your DOT Physical. If you need a hearing aid, you must wear it at all times while driving. You’ll only fail the hearing test if you are completely deaf and cannot pass the whisper test even with hearing aids.

Blood Pressure Requirements

High blood pressure is an extremely common health problem, and the DOT medical exam uses it as a key health indicator. If your blood pressure is 140/90 or below, you’ll pass the DOT physical blood pressure requirements with flying colors. Between 140/90 and 179/109, you may need to have a medical exam more frequently or be given a temporary medical card and be asked to reduce your blood pressure within a 3-month period.

Urine Sample

 Testing for protein, blood and sugar that may indicate underlying health problems.

Sleep Apnea

Using a CPAP -Your Medical Examiner may require a letter from the doctor treating you for sleep apnea, stating that your current CPAP works properly, is used regularly and that the CPAP treatment is effectively controlling his/her sleep apnea. Alternatively, your provider may accept a report indicating your on-going use of your CPAP machine. In general, it is expected that you use your CPAP machine at least 70% of the nights for an average of 4 hours or more for each night used in order to meet Federal recommendations.

History of Asthma or COPD

If you have a history of lung disease (COPD/Emphysema) or have symptoms of shortness of breath, chronic cough, chest tightness and/or wheezing or have current asthma, the Medical Examiner may require you to bring a letter from your PCP or specialist indicating that your disease is well-controlled and the use of any medications will not have a negative effect on your ability to operate a Commercial Vehicle. This letter will be kept on file at Affordacare and must be updated at least every 3 years and anytime there has been a change in the driver’s condition or medication.

Diabetes Mellitus

Diabetes that is treated with insulin requires the Driver to obtain https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/2022-03/Insulin-Treated%20Diabetes%20Mellitus%20Assessment%20Form%20MCSA-5870.pdf

MCSA 5870 Form completed by their prescribing physician.

If the you have diet-controlled diabetes or diabetes that needs non-insulin medications, the Medical Examiner may require you to bring a letter from your PCP or specialist that includes a list of the non-insulin medications that you are taking and that the medications are well tolerated and will not interfere with your ability to drive a Commercial Vehicle. The letter should state how frequently you are monitored for glucose control and effectiveness of treatment. Your physician must verify that you have had no severe hypoglycemic reactions in the last 12 months as well as include the date and results of your last hemoglobin A1C level, which must be within the past 6 months. If you have any complications from diabetes (example: renal, cardiovascular or neurological concerns), you will need a clearance letter from the appropriate specialist. You may need a letter from your eye doctor or the doctor treating you for your diabetes, stating the date of your last eye exam and that there is no retinopathy. Unstable proliferative or unstable non-proliferative retinopathy is disqualifying.

Obesity

Although there are no current disqualifying rules for being overweight FMCSA guidelines consider a Body Mass Index of over 40 as being at risk for Obstructive sleep Apnea. The examiner could evaluate your neck size which is a risk factor and recommend a sleep study based on BMI, neck size and other medical conditions that put a driver at risk for Obstructive Sleep Apnea.

Cardiovascular Disease

If you have a history of a heart attack, angina or are post-PCI (angioplasty with a stent): you will need a letter from your cardiologist stating that you are cleared to drive a Commercial Motor Vehicle with no restrictions. DOT requires you to have an exercise stress test every 2 years. You will need to bring a copy of your stress test results to the exam. If any of the above has occurred in the past year, a copy of your most recent Echocardiogram is also required. You must have at least 40% LVEF in order to meet DOT standards.

History of Cardiac Bypass Surgery (CABG):

Your cardiologist must send a letter, indicating what procedure was performed, date of procedure, medication(s) including dose and frequency of your medication(s), including if you are on anticoagulant therapy. This letter must also state that you have no restrictions to operating a Commercial Motor Vehicle (CMV). You must provide the results of your last Exercise Tolerance Test (ETT-stress test) since having Bypass and your most recent ECHO (heart ultra sound test). You must have at least 40% LVEF in order to meet DOT standards.

Anticoagulant Therapy

If you are taking warfarin (Coumadin) for any reason, please bring a copy of your most recent INR results to your DOT exam. You will need a letter from your PCP stating what the medical condition is which requires you to take Coumadin. The letter must state that you have your INR level monitored at least monthly. This letter is required to be updated annually. If you are taking any other anticoagulant for any reason, you will need a letter from your PCP stating what the medical condition is which requires you to take the anticoagulant. The letter must state that you are tolerating the medication well and have no significant side effects or complications. This letter will be kept on file at Affordacare and must be updated at least every 3 years and anytime there has been a change in the driver’s condition or medication.

Anticonvulsant Medication

If you are taking Topamax, Neurontin (gabapentin) or other seizure medication for other than a seizure disorder (example: chronic pain or migraine prophylaxis), you must have a letter from the doctor prescribing the medication stating that the medication is not being prescribed for seizure. Also, the doctor’s note must indicate what the condition is that you take the medication for; that the condition is stable; and that any side effects you may be experiencing would not interfere with safe operation (driving) of a Commercial Motor Vehicle. This letter will be kept on file at Affordacare and must be updated at least every 3 years and anytime there has been a change in the driver’s condition or medication.

 Mental Health Conditions

If you are being treated for any mental health condition and/or using any medication listed below under “Antidepressants” or “Antipsychotics” you must have a letter with clearance from a mental health specialist, such as a psychiatrist or psychologist, who understands the functions and demands of commercial driving and states that you are compliant with your treatment program and are tolerating your medication(s)/treatment without disqualifying side effects (e.g., sedation or impaired coordination).

Maximum Certificate Length Per Affordacare standards, which are based on FMCSA guidance, a maximum certificate of ONE-YEAR is issued for drivers with any history of the following health conditions and/or medication.

• High blood pressure
• Diabetes (no insulin) (see requirements above) • cardiovascular disease (see requirements above)
• Heart Surgery (see requirements above)
• Any of the following Specific medications:

Note: Use of any of these medications requires a letter from the driver’s prescribing physician, stating the reason the medication is being used, that the medication is effective, well-tolerated and the driver does not suffer any significant side-effects that would affect safe operation of a Commercial Motor Vehicle. This letter must be updated at least every 3 years and anytime there has been a change in the driver’s condition or medication.

1. Antidepressants Pristiq, Cymbalta, Effexor, Effexor XR, Celexa, Lexapro, Prozac, Serafim, Paxil, Paxil CR, Zoloft, others at the discretion of the Medical Examiner.

Letter may be required. SEE ABOVE

2. Antipsychotics Abilify, Abilify Discmelt, Saphris, Zyprexa, Zyprexa, Zydis, Seroquel, Seroquel XR, Risperdal, Risperdal M- Tabs, Geodon, Symbyax, Nardil, ESAM, Parnate, others at the discretion of the Medical Examiner. Letter required-SEE ABOVE

3. Lithium Note: use of lithium requires a letter from the driver’s prescribing physician, SEE ABOVE

4. Warfarin/Coumadin: Driver must have an annual letter from their PCP or specialist that states: 1) Driver has been regulated on Warfarin/Coumadin with a stable International Normalized Ratio (INR) for at least 1 month prior to certification (or recertification); and 2) Driver has their INR monitored at least monthly thereafter. 3) INR is maintained within the target range, based on the underlying condition.

Driver will need an ANNUAL letter from his/her PCP stating the medical condition is for which they need to take Warfarin/Coumadin and state that the driver’s medication use and underlying medical condition do not interfere with the safe driving of a Commercial Motor Vehicle.

5. Other anticoagulant: (includes Plavix (clopidogrel, Pradaxa (dabigatran), Eliquis (apixaban), and Xaralto (rivaroxaban)) Driver will need letter from their PCP stating what the medical condition is which requires the driver to take the anticoagulant. The letter must state that the driver is tolerating the medication well and has no significant side effects or complications as well as state that the driver’s medication use and underlying medical conditions do not interfere with the safe driving of a Commercial Motor Vehicle. This letter must be updated at least every 3 years and anytime there has been a change in the driver’s condition or medication.

6. Amphetamines/CNS stimulants: Use of any CNS stimulant requires a letter from the driver’s prescribing physician stating the reason the medication is being used, that the medication is effective, well-tolerated and the driver does not suffer any significant side-effects that would affect safe operation of a Commercial Motor Vehicle. This letter must be updated at least every 3 years and anytime there has been a change in the driver’s condition or medication. Note: Narcolepsy is a disqualifying medical condition.

7. Sedating Benzodiazepines and/or Sleep aids the chronic use of sedating benzodiazepines and/or other anxiolytics or sleep aids has been shown to increase the risk of motor vehicle crashes. The certification of drivers who use these medications chronically is controversial and carries known increased risk. Affordacare has made a corporate decision to not certify drivers who use these medications chronically. Additionally, individuals who take benzodiazepines and/or sleep aids for any length of time should not be allowed to drive until the medication has cleared from their system (at least 7 half-lives of that drug and any active metabolites).

8. Provigil: Use of Provigil is generally disqualifying for DOT certification. Note: the underlying condition that requires use of these or any other medications may be disqualifying. Be advised that any other disease state or medication use may result in a certification restricted to a maximum of one year (or less) based upon the decision of

Note: the underlying condition that requires use of these or any other medications may be disqualifying. Be advised that any other disease state or medication use may result in a certification restricted to a maximum of one year (or less) based upon the decision of the Medical Examiner on a case-by-case basis. the Medical Examiner on a case-by-case basis.

What to Bring:

• DRIVERS LISCNESE
• MEDICATION LIST WITH DOSAGES
• LETTERS FROM TREATING PHYSICIANS AS INDICATED IN THE ABOVE INFORMATION
• GLASSES/CONTACTS/HEARING DEVICE
• MEDICAL RECORDS (CPAP COMPLIANCE/BLOOD SUGAR READINGS/A1C)

                              Day of the Examination:

• Take your medications as prescribed
• Be prepared to give a urine sample
• Avoid overuse of stimulants that raise blood pressure (caffeine/energy drinks/smoking)
• Wear light clothing

UPDATED AUGUST 2022