Summary of requirements
Prohibitions. Individuals may not drive a CMV if they:
- Have lost a foot, leg, hand, or arm, and have not been granted a skill performance evaluation (SPE) certificate;
- Have an impairment of a hand, finger, arm, foot, or leg that interferes with their ability to perform normal tasks associated with driving a CMV; and have not been granted an SPE certificate;
- Have diabetes requiring insulin for control (unless the requirements in 391.46 are met);
- Have heart disease, which causes chest pain, fainting, or shortness of breath;
- Have chest or breathing problems like chronic asthma, emphysema, and chronic bronchitis;
- Have high blood pressure likely to interfere with driving;
- Have loss of movement or feeling in part of their body;
- Have any sickness which is likely to cause loss of consciousness or any loss of ability to control a CMV;
- Have any mental problems likely to interfere with the ability to drive a CMV safely;
- Have poor vision that affects the ability to see objects that are far away (glasses or contact lenses may be used to correct vision), objects to the side, or traffic signal colors (driving is not allowed if the individual can see with only one eye), however, the alternative vision standard effective March 22, 2022, allows CMV drivers to be qualified for the vision portion of the exam, if they do not meet the vision standard in the worse eye when specified conditions and vision criteria are met in the better eye with or without corrective lenses;
- Have poor hearing (must be able to hear a loud whispered voice in the better ear at not less than five feet with or without the use of a hearing aid or, pass a hearing test on a doctor’s testing machine);
- Use certain drugs and dangerous substances, except that such a substance or drug may be used if the substance or drug is prescribed by a licensed medical practitioner who is familiar with the individual’s medical history and who has advised the driver that the prescribed substance or drug will not adversely affect the driver’s ability to safely operate a CMV; and
- Have a current clinical diagnosis of alcoholism.
Exception. If a driver has lost a limb or has a limb impairment the driver and the driver’s motor carrier may submit an application for a SPE certificate to the FMCSA. The letter of application must include several items including a description of the vehicle(s) the driver applicant intends to drive and the type of operation the driver will be working for.
Medical exam. Medical exams are required:
- Prior to the first time a driver operates a CMV;
- Once every 24 months after the initial exam;
- Once every 12 months if the driver:
- Exclusively operates within an exempt intracity zone,
- Has diabetes mellitus treated with insulin for control, and has met the requirements in 391.46.
- When a driver’s ability to operate a CMV is impaired by a physical or mental disease; and
- Beginning June 23, 2025, when a medical examiner determines that a driver is not physically qualified to operate a CMV and this is reported to FMCSA, resulting in the invalidation of all medical certificates previously issued to the driver.
The medical exam must be performed by a medical examiner who is certified by the Federal Motor Carrier Safety Administration (FMCSA) and listed on the National Registry of Certified Medical Examiners (NRCME).
Military veterans enrolled in the Department of Veterans Affairs (VA) health care system may have the medical exam performed by a certified VA medical examiner listed on the NRCME.
A licensed optometrist may perform the visual portion of the exam.
Medical examiner’s certificate. If the medical examiner finds that a driver is physically qualified to drive a CMV, the medical examiner will fill out a medical examiner’s certificate.
Beginning June 23, 2025, if the medical examiner finds that the CDL driver is physically qualified to drive a CMV, the medical examiner will electronically transmit a completed CMV Driver Medical Examination Results Form to the FMCSA. FMCSA will provide the state with an electronic copy of the medical examiner’s certificate. Upon receiving this information, the state will post a medical qualification status of “certified” on the driver’s MVR.
Beginning June 23, 2025, if the medical examiner finds that the driver is not physically qualified to drive a CMV, the medical examiner must inform the driver examined that the driver is not physically qualified, and that information will be reported to FMCSA. All medical examiner’s certificates previously issued to the driver are not valid.
If there is a conflict between the medical certification information provided electronically by FMCSA and the paper copy of the medical examiner’s certificate, the electronic certification is considered the correct document.
Delay. If the medical examiner finds that the determination of whether the driver is physically qualified to drive a CMV should be delayed pending the receipt of additional information or further examination, the medical examiner must inform the driver that the additional information must be provided within 45 days and that the pending status of the examination will be reported to FMCSA.
Diabetes Mellitus treated with insulin. A driver with diabetes mellitus that is treated with insulin for control, is physically qualified to drive a commercial motor vehicle if the driver:
- Meets all of the other physical qualification standards in 391.41, or has an exemption or skill performance evaluation (SPE) certificate.
- Before going for a physical exam, a driver with diabetes mellitus that is treated with insulin for control must be evaluated by the driver’s treating clinician.
- The treating clinician will evaluate the driver and complete an Insulin-Treated Diabetes Mellitus Assessment Form (MCSA–5870).
- Has a medical examination performed by a medical examiner who meets the requirements.
- The medical exam must take place within 45 days after the treating clinician signs and dates the form.
- The medical examiner must receive a completed Insulin-Treated Diabetes Mellitus Assessment Form (MCSA–5870), signed and dated by the treating clinician.
- It is the medical examiner’s responsibility to determine whether the driver meets the physical qualification standards in 391.41 to operate a commercial motor vehicle.
- The driver may be granted a medical examiner’s certificate that is valid for up to 12 months.
Alternative vision standard. FMCSA published the alternative vision standard final rule with an effective date of March 22, 2022, for CMV drivers who do not meet the vision standard in the worse eye. If specified conditions and vision criteria are met, the driver can qualify for the vision portion of the DOT exam based on the vision in the better eye with or without corrective lenses.
To be qualified for the alternate vision standard (391.44(b)(10(ii)), the driver must:
- Have in the better eye a field of vision of at least 70 degrees in the horizontal meridian and vision of at least 20/40 with or without corrective lenses;
- Be able to recognize the colors of traffic signals with red, green, and amber;
- Have a stable vision deficiency; and
- Have had sufficient time for the vision to be stable.
The steps to meet the alternate standard are:
- An ophthalmologist or optometrist must evaluate the driver;
- The ophthalmologist or optometrist completes the new Vision Evaluation Report Form MCSA-5871;
- Not more than 45 days from the date on the MCSA-5871, the certified medical examiner performs a DOT exam and determines if the driver meets the alternative vision standard, as well as FMCSA’s other medical qualification standards;
- If determined to be medically qualified, the driver receives a Medical Examiner’s Certificate (MEC), Form MCSA-5876, for a maximum of 12 months; and
- Subject to limited exceptions, drivers qualified under the alternate standard for the first time must pass an employer-administered road test per 391.31 before operating in interstate commerce.
This final rule eliminates the need for the current Federal vision exemption program and the grandfather provision in 391.64. Individuals currently qualified under the grandfather provision and exemption holders have one year after the effective date of this rule to comply.
Recordkeeping.
- The driver will be given the original medical examiner’s certificate to keep and a copy will be sent to the motor carrier (if requested by the motor carrier) to be placed in the driver’s qualification file.
- If the driver qualifies for a medical examiner’s certificate because of an SPE certificate or other FMCSA-issued medical variance (exemption letter), the driver must carry a copy of the document while on duty.
- The medical examiner must keep the original (paper or electronic) copy of the driver’s medical examination report and a copy or electronic version of the driver’s medical examination certificate for at least three years from the date of the examination.
- The medical examiner must keep the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA–5870), signed and dated by the treating clinician, as part of the medical exam report form.
- The motor carrier will be required to obtain and maintain a motor vehicle record (MVR) and place it in the driver’s qualification file.
Exceptions.
- A CDL holder who has submitted a medical examiner’s certificate to the appropriate state licensing agency will no longer need to carry a copy of the medical examiner’s certificate. Until June 23, 2025, a driver may carry a copy of the current medical examiner’s certificate for up to 15 days from the date it was issued as proof of medical certification.
- If a CDL driver has submitted the medical examiner’s certificate to the appropriate state licensing agency, the motor carrier will not be required to place the original or a copy of the medical examiner’s certificate in the driver’s qualification file.
