§391.41 Physical qualifications for drivers

Part 391 — Qualifications of drivers

Question 1: Who is responsible for ensuring that medical certifications meet the requirements?

Guidance: Medical certification determinations are the responsibility of the medical examiner. The motor carrier has the responsibility to ensure that the medical examiner is informed of the minimum medical requirements and the characteristics of the work to be performed. The motor carrier is also responsible for ensuring that only medically qualified drivers are operating CMVs in interstate commerce.

Question 2: Do the physical qualification requirements of the FMCSRs infringe upon a person’s religious beliefs if such beliefs prohibit being examined by a licensed doctor of medicine or osteopathy?

Guidance: No. To determine whether a governmental regulation infringes on a person’s right to freely practice his religion, the interest served by the regulation must be balanced against the degree to which a person’s rights are adversely affected. Biklen v. Board of Education, 333 F. Supp. 902 (N.D.N.Y. 1971) aff’d 406 U.S. 951 (1972).

If there is an important objective being promoted by the requirement and the restriction on religious freedom is reasonably adapted to achieving that objective, the requirement should be upheld. Burgin v. Henderson, 536 F.2d 501 (2d. Cir. 1976). Based on the tests developed by the courts and the important objective served, the regulation meets Constitutional standards. It does not deny a driver his First Amendment rights.

Question 3: What are the physical qualification requirements for operating a CMV in interstate commerce?

Guidance: The physical qualification regulations for drivers in interstate commerce are found at §391.41. Instructions to medical examiners performing physical qualification examinations of these drivers are found at §391.43.

The qualification standards cover 13 areas, which directly relate to the driving function. All but two of the standards require a judgment by the medical examiner. A person’s qualification to drive is determined by a medical examiner who is knowledgeable about the driver’s functions and whether the driver’s physical condition is adequate to enable the driver to operate the vehicle safely. In the case of hearing and epilepsy, the current standards are absolute, providing no discretion to the medical examiner. However, drivers who do not meet the current requirements may apply for an exemption as provided by 49 CFR part 381.

Question 4: May the medical examiner restrict a driver’s duties?

Guidance: No. The only conditions a medical examiner may impose upon a driver otherwise qualified involve the use of corrective lenses or hearing aids, securement of a waiver or limitation of driving to exempt intracity zones (see §391.43(g)). A medical examiner who believes a driver has a condition not specified in §391.41 that would affect his ability to operate a CMV safely should refuse to sign the examiner’s certificate.

Question 5: If an interstate driver tests positive for alcohol or controlled substances under part 382, must the driver be medically re-examined and obtain a new medical examiner’s certificate to drive again?

Guidance: The driver is not required to be medically re-examined or to obtain a new medical examiner’s certificate provided the driver is seen by an SAP who evaluates the driver, does not make a clinical diagnosis of alcoholism, and provides the driver with documentation allowing the driver to return to work. However, if the SAP determines that alcoholism exists, the driver is not qualified to drive a CMV in interstate commerce. The ultimate responsibility rests with the motor carrier to ensure the driver is medically qualified and to determine whether a new medical examination should be completed.

Question 6: Is the use of coumadin, an anticoagulant, an automatic disqualification for drivers operating CMVs in interstate commerce?

Guidance: No. Although the Department of Transportation's 1987 ‘‘Conference on Cardiac Disorders and Commercial Drivers’’ recommended that drivers who are taking anticoagulants not be allowed to drive, the FMCSA has not adopted a rule to that effect. The medical examiner and treating specialist may, but are not required to, accept the Conference recommendations. Therefore, the use of coumadin is not an automatic disqualification, but a factor to be considered in determining the driver’s physical qualification status.

Question 7: Are U.S. or Canadian licensed CMV drivers permitted to operate cross-border in a CMV if they have been medically qualified with insulin-treated diabetes mellitus?

Guidance: Yes. On September 24, 2019, the medical reciprocity agreement between the U.S. and Canada was amended to remove the prohibition for cross-border operation for CMV drivers with insulin-treated diabetes mellitus, provided a U.S. driver has been physically qualified by a medical examiner based on the updated medical qualification standard.

FMCSA recommends U.S. CMV drivers with ITDM follow the updated procedures to be physically qualified by a medical examiner and then contact their licensing agencies to have the restriction (generally code “V”) removed from their physical license and driver’s record.

https://www.fmcsa.dot.gov/international-programs/canada/removal-operating-prohibition-commercial-drivers-insulin-treated

FMCSA recommends Canadian CMV drivers with ITDM contact their licensing agencies to determine the requirements to have the restriction (generally code “W”) removed from their physical license and driver’s record.

https://www.fmcsa.dot.gov/international-programs/canada/removal-operating-prohibition-commercial-drivers-insulin-treated-0

Question 8: Is a Canadian driver with a limb impairment required to wear a prosthesis while operating in the United States?

Guidance: Yes, if the driver is required to wear the prosthesis in Canada while driving, it is also required in the United States. If there is a question, enforcement officials can contact the appropriate Canadian provincial/territorial licensing agency to determine if a prosthetic device is required.

Question 9: Can a Canadian driver apply for a Skill Performance Evaluation (SPE) certificate to drive in the United States?

Guidance: The reciprocity agreement between the United States and Canada does not permit drivers who do not meet the medical fitness requirements of Canada to drive in the United States. Both countries agree that Canadian drivers who do not meet the medical provisions in the National Safety Code of Canada but have a waiver by one of the Canadian Provinces or territories would not be qualified to operate a CMV in the United States. The National Safety Code states that a driver must wear a prosthesis and demonstrate his/her ability in an on-road test. Some of the Canadian provinces have not adopted the National Safety Code.

If a driver has no prosthesis when entering the United States., the driver is not qualified to operate here.

It is not necessary for a Canadian driver to apply for a Skill Performance Evaluation certificate to drive in the United States. A valid commercial driver’s license issued by a Canadian Province or Territory is proof of medical fitness to drive. If a Canadian driver is required to wear prosthesis, the driver must wear the prosthesis while operating a commercial vehicle in the U.S. If a driver has no prosthesis when entering the U.S., the driver is not qualified to operate here.

Question 10: Will a U.S. driver currently holding a SPE certificate issued by the FMCSA for a limb impairment be able to drive in Canada?

Guidance: The FMCSA changed the term “waiver” previously used in 49 CFR 391.49 (and other sections) to “Skills Performance Evaluation (SPE) certificate”. A U.S. driver with an SPE certificate, which is not a waiver but an alternative physical qualification, will be allowed to operate in Canada. The driver must have met the requirements of 49 CFR 391.49 to be issued an SPE certificate and must carry the appropriate documentation whenever on duty.

Question 11: How will enforcement officials know that a limb-impaired Canadian driver has demonstrated their ability to driver a commercial motor vehicle in accordance with the National Safety Code (NSC) standards?

Guidance: The fact that the driver possesses a valid Canadian commercial driver’s license, with the proper class for the vehicle configuration being operated, is proof that the driver demonstrated his/her ability to drive a commercial motor vehicle.

Question 12: I operate a CMV in the United States but reside outside of the United States. Can I use my foreign medical certificate?

Guidance: Yes, if you are a resident of Mexico or Canada. Drivers certified in Canada are certified to drive in the United States, providing they meet U.S. requirements. For Mexican drivers, the medical examination is part of the Licencia Federal. It is not necessary for Mexican drivers to carry a separate medical certifying document.

A CMV operator from Canada or Mexico who has been issued a valid commercial driver’s license by a Canadian Province or the Mexican Licencia Federal is no longer required to have a medical certificate. The driver’s medical exam is part of the driver’s license process and is proof of medical fitness to drive in the United States. However, Canadian and Mexican drivers who have epilepsy or who are hearing-and-vision impaired are not qualified to drive CMVs in the United States. Furthermore, Canadian drivers who do not meet the medical fitness provisions of the Canadian National Safety Code for Motor Carriers but who have been issued a waiver by one of the Canadian Provinces or Territories are not qualified to drive CMVs in the United States. Similarly, Mexican drivers who do not meet the medical fitness provision of The Licencia Federal de Conductor but who have been issued a waiver by The Licencia Federal de Conductor are not qualified to drive CMVs in the United [States].

Question 13:Do all Canadian drivers need to carry the medical certification when driving a CMV in the United States?

Guidance: No, only Canadian Class 5, Alberta Class 3, New Brunswick Class 3 and Ontario Classes D and G Canadian CMV drivers are required to carry proof of medical qualifications when operating in the United States.

Question 14:Does the legalization of the use and possession of marijuana by a State, or other country that has drivers who operate in the United States, change the treatment of marijuana use under federal regulations applicable to drivers operating a commercial motor vehicle (CMV) (as defined in 49 CFR § 390.5)?

Guidance: No. Marijuana, including a mixture or preparation containing marijuana, continues to be classified as a Schedule I controlled substance by the Drug Enforcement Administration (DEA) in 21 CFR § 1308.11. Under the Federal Motor Carrier Safety Regulations (FMCSRs), a person is not physically qualified to drive a CMV if he or she uses any Schedule I controlled substance such as marijuana. (See 49 CFR §§ 391.11(b)(4) and 391.41(b)(12)). In addition to the physical qualification requirements, the FMCSRs prohibit a driver from being in possession of or under the influence of any Schedule I controlled substance, including marijuana, while on duty, and prohibit motor carriers from permitting a driver to be on duty if he or she possesses, is under the influence of, or uses a Schedule I controlled substance. (See 49 CFR §§ 392.2 and 392.4). Legalization of marijuana use by States and other jurisdictions also has not modified the application of U.S. Department of Transportation (DOT) drug testing regulations in 49 CFR parts 40 and 382. (See https://www.transportation.gov/odapc/medical-marijuana-notice and https://roar-assets-auto.rbl.ms/documents/76279/odapc-notice-recreational-mj.pdf

Question 15:Can a driver meet the qualification standards under 49 CFR § 391.41(b)(12) if using medical marijuana recommended by a licensed medical practitioner in the United States or another country?

Guidance: No. Marijuana, including a mixture or preparation containing marijuana, continues to be classified as a Schedule I controlled substance by the Drug Enforcement Administration (DEA) in 21 CFR § 1308.11. Under the Federal Motor Carrier Safety Regulations (FMCSRs), a person is not physically qualified to drive a CMV if he or she uses any Schedule I controlled substance such as marijuana. (See 49 CFR §§ 391.11(b)(4) and 391.41(b)(12)). Accordingly, a driver may not use marijuana even if is recommended by a licensed medical practitioner.

Question 16:Will Canadian drivers with limb impairments be required to obtain a waiver from FMCSA to drive in the United States?

Guidance: No, the National Safety Code (NSC) Medical Standards for Drivers and the FMCSR have been deemed equivalent with respect to limb impairments contained in 49 CFR 391.49. To obtain a Canadian provincial/territorial license, such drivers must be fitted with a prosthetic device as appropriate, and must have demonstrated their ability to operate the vehicle.

Question 17: What is the effect on driver certification based on FMCSA hypertension stages?

Guidance: A driver with a diagnosis of hypertension on treatment should have at least an annual certification.

A CMV driver with a Blood pressure (BP) <140/90 may be certified for 2 years.

First time BP elevated:

Stage 1 - BP 140-159/90-99 Certification Period 1 year

Stage 2 - BP 160-179/100-109 Certification Period 3 months as one time certification. Within the 3 months, if the blood pressure is below 140/90, the driver may receive 1 year certification.

Stage 3 - BP Reading >180/110 Disqualified. When the blood pressure is less than 140/90, the driver can be certified at 6 month intervals.

Question 18: When is audiometry required?

Guidance: A medical examiner may require a driver to have an audiometry test. If the driver fails the whisper test, the driver must pass an audiometer test to be qualified to drive a CMV.

Office audiometry is not able to test a person with a hearing aid. The person needs to be referred for accurate testing.