Cdl Physical Examination Form (Page 6 of 8) in pdf

disabilities. The SPE Certification Program

dyspnea, collapse or congestive cardiac failure.

Certification examinations should be done annually

(formerly the Limb Waiver Program) was designed

It is the intent of the FMCSRs to render

thereafter and should be at or less than 140/90. If

to allow persons with the loss of a foot or limb or

unqualified a driver who has a current cardiovascular

less than 160/100, certification may be extended

with functionai impairment to qualify under the

disease which is accompanied by and/or likely to cause

one time for 3 months.

Federal Motor Carrier Safety Regulations (FMCSRs)

symptoms of syncope, dyspnea, collapse, or congestive

A blood pressure of 160-179 systolic

by use of prosthetic devices or equipment

cardiac failure. However, the subjective decision of

and/or 100-109 diastolic is considered Stage 2

modifications which enable them to safely operate

whether the nature and severity of an individual’s

hypertension, and the driver is not necessarily

a commercial motor vehicle. Since there are no

condition will likely cause symptoms of cardiovascular

unqualified during evaluation and institution of

medical aids equivalent to the original body or limb,

insufficiency is on an individual basis and qualification

treatment. The driver is given a one time

certain risks are still present, and thus restrictions

rests with the medical examiner and the motor carrier. In

certification of three months to reduce his or her

may be included on individual SPE certificates when

those cases where there is an occurrence of

blood pressure to less than or equal to 140/90. A

a State Director for the FMCSA determines they are

cardiovascular insufficiency (myocardial infarction,

blood pressure in this range is an absolute

necessary to be consistent with safety and public

thrombosis, etc.) it is suggested before a driver is certified

indication for anti-hypertensive drug therapy.

interest.

that he/she have a normal resting and stress

Provided treatment is well tolerated and the driver

If the driver is found otherwise medically

electrocardiogram (ECG), no residual complications and

demonstrates a BP value of 140/90 or less, he or

qualified (391.41(b)(3) through (13)), the medical

no physical limitations, and is taking no medication likely

she may be certified for one year from date of the

examiner must check on the medical certificate that

to interfere with safe driving.

initial exam. The driver is certified annually

the driver is qualified only if accompanied by a SPE

Coronary artery bypass surgery and pacemaker

thereafter.

certificate. The driver and the employing motor carrier

implantation are remedial procedures and thus, not

A blood pressure at or greater than 180

are subject to appropriate penalty if the driver

unqualifying. Implantable cardioverter defibrillators are

(systolic) and 110 (diastolic) is considered Stage 3,

operates a commercial motor vehicle in interstate or

disqualifying due to risk of syncope. Coumadin is a

high risk for an acute BP-related event. The driver

foreign commerce without a current SPE certificate

medical treatment which can improve the health and

may not be qualified, even temporarily, until

for his/her physical disability.

safety of the driver and should not, by its use, medically

reduced to 140/90 or less and treatment is well

disqualify the commercial driver. The emphasis should

tolerated. The driver may be certified for 6 months

Diabetes: 391.41(b)(3)

be on the underlying medical condition(s) which require

and biannually (every 6 months) thereafter if at

A person is physically qualified to drive a

treatment and the general health of the driver. The

recheck BP is 140/90 or less.

commercial motor vehicle if that person:

FMCSA should be contacted at (202) 366-1790 for

Annual recertification is recommended if

Has no established medical history or clinical

additional recommendations regarding the physical

the medical examiner does not know the severity of

diagnosis for diabetes mellitus currently requiring

qualifications of drivers on coumadin.

hypertension prior to treatment.

insulin for control.

NOTE: See Conference on Cardiac Disorders and

An elevated blood pressure finding

Diabetes mellitus is a disease which, on occasion,

Commercial

Drivers

should be confirmed by at least two subsequent

can result in a loss of consciousness or disorientation

measurements on different days.

in time and space. Individuals who require insulin

Treatment includes nonpharmacologic

for control have conditions which can get out of

Respiratory Dysfunction: 391.41(b)(5)

and

pharmacologic modalities as well as

control by the use of too much or too little insulin, or

A person is physically qualified to drive a

counseling to reduce other risk factors. Most

food intake not consistent with the insulin dosage.

commercial motor vehicle if that person:

antihypertensive medications also have side

Incapacitation may occur from symptoms of

Has no established medical history or clinical diagnosis of

effects, the importance of which must be judged on

hyperglycemic

hypoglycemic

reactions

a respiratory dysfunction likely to interfere with ability to

an individual basis. Individuals must be alerted to

(drowsiness, semiconsciousness, diabetic coma or

control and drive a commercial motor vehicle safely.

the hazards

of these medications while driving.

insulin shock).

Since a driver must be alert at all times, any

Side effects of somnolence or syncope are

The administration of insulin is, within itself,

change in his/her mental state is in direct conflict with

particularly undesirable in commercial drivers.

a complicated process requiring insulin, syringe,

highway safety. Even the lightest impairment in respiratory

Secondary hypertension is based on the

needle, alcohol sponge and a sterile technique.

function under emergency conditions (when greater

above stages. Evaluation is warranted if patient is

Factors related to long-haul commercial motor vehicle

oxygen supply is necessary for performance) may be

persistently hypertensive on maximal or near-

operations, such as fatigue, lack of sleep, poor diet,

detrimental to safe driving.

maximal doses of 2-3 pharmacological agents.

emotional conditions, stress, and concomitant illness,

There are many conditions that interfere with

Some causes of secondary hypertension may be

compound the dangers. The FMCSA has consistently

oxygen exchange and may result in incapacitation,

amenable to surgical intervention or specific

held that a diabetic who uses insulin for control does

including emphysema, chronic asthma, carcinoma,

pharmacologic disease.

not meet the minimum physical requirements of the

tuberculosis, chronic bronchitis and sleep apnea. If the

NOTE: See Cardiovascular Advisory Panel

FMCSRs.

medical examiner detects a respiratory dysfunction, that in

Guidelines for the Medical Examination of

Hypoglycemic drugs, taken orally, are

any way is likely to interfere with the driver’s ability to safely

Commercial

Motor

Vehicle

Drivers

at:

sometimes prescribed for diabetic individuals to

control and drive a commercial motor vehicle, the driver

help stimulate natural body production of insulin. If

must be referred to a specialist for further evaluation and

the condition can be controlled by the use of oral

therapy. Anticoagulation therapy for deep vein thrombosis

Rheumatic, Arthritic, Orthopedic, Muscular,

medication and diet, then an individual may be

and/or pulmonary thromboembolism is not unqualifying once

Neuromuscular

Vascular

Disease:

qualified under the present rule. CMV drivers who

optimum dose is achieved, provided lower extremity

391.41(b)(7)

do not meet the Federal diabetes standard may call

venous examinations remain normal and the treating

A person is physically qualified to drive

(202) 366-1790 for an application for a diabetes

physician gives a favorable recommendation.

a commercial motor vehicle if that person:

exemption.

NOTE: See conference on pulmonary/respiratory

Has no established medical history or clinical

NOTE: See Conference Report on Diabetic Disorders

disorders

and

commercial

drivers

at:

diagnosis of rheumatic, arthritic, orthopedic,

and Commercial Drivers and Insulin- Using

muscular, neuromuscular or vascular disease

Commercial

Motor Vehicle Drivers at: http://

which interferes with ability to control and operate a

Hypertension: 391.41(b)(6)

commercial motor vehicle safely

A person is physically qualified to drive a

Certain diseases are known to have

Cardiovascular Condition: 391.41(b)(4)

commercial motor vehicle if that person:

acute episodes of transient muscle weakness, poor

A person is physically qualified to drive a

Has no current clinical diagnosis of high blood pressure

muscular

coordination (ataxia), abnormal

commercial motor vehicle if that person: Has no

likely to interfere with ability to operate a commercial motor

current clinical diagnosis of myocardial infarction,

sensations (paresthesia), decreased muscular tone

vehicle.

angina pectoris, coronary insufficiency, thrombosis

(hypotonia), visual disturbances and pain which

Hypertension alone is unlikely to cause sudden

or any other cardiovascular disease of a variety

may be suddenly

incapacitating. With each

collapse; however, the likelihood increases when target

known to be accompanied by syncope, dyspnea,

recurring episode, these symptoms may become

organ damage, particularly cerebral vascular disease, is

collapse or congestive cardiac failure.

more pronounced and remain for longer periods of

present. This regulatory criteria is based on FMCSA’s

The

term “has no current clinical

time. Other diseases have more insidious onsets

Cardiovascular Advisory Guidelines for the Examination of

diagnosis of” is specifically designed to encompass:

and display symptoms of muscle wasting (atrophy),

CMV Drivers, which used the Sixth Report of the Joint

“a clinical diagnosis of” (1) a current cardiovascular

swelling and paresthesia which may not suddenly

National Committee on Detection, Evaluation, and

condition, or (2) a cardiovascular condition which has

incapacitate a person but may restrict his/her

Treatment of High Blood Pressure (1997).

not fully stabilized regardless of the time limit. The

movements and eventually interfere with the ability

Stage 1 hypertension corresponds to a systolic

term “known to be accompanied by” is defined to

to safely operate a motor vehicle. In many

BP of 140-159mmHg and/or a diastolic BP of 90-99mmHg.

include: a clinical diagnosis of a cardiovascular

instances these diseases are degenerative in

The driver with a BP in this range is at low risk for

disease (1) which is accompanied by symptoms of

nature or may result in deterioration of the involved

hypertension-related acute incapacitation and may be

syncope, dyspnea, collapse or congestive cardiac

area.

medically certified to drive for a one-year period.

failure; and/or (2) which is likely to cause syncope,

Cdl Physical Examination Form Page 6

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