• Every driver of a CMV involved in interstate commerce must meet the mandatory conditions to be medically eligible.
• Physical qualification requirements for drivers are outlined in 13 standards.

The medical qualification requirements contained in 49 CFR Part 391 apply to all drivers of commercial motor vehicles (CMVs) involved in interstate commerce. A CMV is defined as follows:

• Has a gross vehicle weight or gross vehicle weight rating, or gross combination weight or gross combination weight rating, of 10,001 pounds or more;
• Is designed or used to transport more than eight passengers (including the driver) for compensation;
• Is designed to transport more than 15 people; or
• Transports hazardous materials of a type and quantity that require placarding.

States also have driver qualification requirements for intrastate operations, either by adopting the federal rules or by establishing their own rules.

How often are exams required?

A medical exam, conducted by a licensed medical examiner who is familiar with the regulations, is required if a driver:

• Has not been medically examined and physically qualified to drive a commercial motor vehicle (CMV),
• Has not had a medical exam in the past 24 months, or
• Has suffered a physical or mental disease or injury that affected the driver’s ability to drive a CMV.

What are the requirements?

The physical qualification requirements consist of the following 13 standards listed in 391.41(b):

• Has no loss of a foot, leg, hand, or arm, or has been granted a waiver pursuant to 391.49. (391.41(b)(1))
• Has no impairment of:
  • A hand or finger that interferes with prehension or power grasping; or
  • An arm, foot, or leg that interferes with the ability to perform normal tasks associated with operating a motor vehicle; or any other significant limb defect or limitation that interferes with the ability to perform normal tasks associated with operating a motor vehicle; or has been granted a waiver pursuant to 391.49. (391.41(b)(2))
• Has no established medical history or clinical diagnosis of diabetes mellitus currently treated with insulin for control, unless the person meets the requirements in 391.46. (391.41(b)(3))
• Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure. (391.41(b)(4))
• Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his or her ability to control and drive a motor vehicle safely. (391.41(b)(5))
• Has no current clinical diagnosis of high blood pressure likely to interfere with his or her ability to operate a motor vehicle safely. (391.41(b)(6))
• Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease that interferes with his or her ability to control and operate a motor vehicle safely. (391.41(b)(7))
• Has no established medical history or clinical diagnosis of epilepsy or any other condition that is likely to cause loss of consciousness or any loss of ability to control a motor vehicle. (391.41(b)(8))
• Has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his or her ability to drive a motor vehicle safely. (391.41(b)(9))
• Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber. (391.41(b)(10))
  • The alternative vision standard in 391.44 allows a driver to qualify for the vision portion of the exam based on vision in the better eye, if the person does not satisfy with both eyes, either the distant visual acuity standard with corrective lenses or the field of vision standard, or both, as noted above. The carrier must administer a road test if the driver uses the alternative vision standard for the first time unless the driver meets an exception in 391.44(d)(3).
• First perceives a forced whispered voice in the better ear at not less than 5 feet with or without the use of a hearing aid or, if tested by use of an audiometric device, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz with or without a hearing aid when the audiometric device is calibrated to American National Standard (formerly ASA Standard) Z24.5-1951. (391.41(b)(11))
• Does not use any drug or substance identified in 21 CFR 1308.11 Schedule I, an amphetamine, a narcotic, or other habit-forming drug; and does not use any non-Schedule I drug or substance that is identified in the other Schedules in 21 Part 1308 except when the use is prescribed by a licensed medical practitioner, as defined in 382.107, who is familiar with the driver’s medical history and has advised the driver that the substance will not adversely affect the driver’s ability to safely operate a commercial motor vehicle. (391.41(b)(12))
• Has no current clinical diagnosis of alcoholism. (391.41(b)(13))

Medical advisory criteria

The FMCSA provides “Medical Advisory Criteria” as guidelines to aid medical examiners in determining if drivers are qualified. These medical criteria are found in Appendix A to Part 391.