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INSTRUCTIONS TO THE MEDICAL EXAMINER

General Information

Federal Motor Carrier Safety Regulations

The purpose of this examination is to determine a driver's physical

-Advisory Criteria-

qualification to operate a commercial motor vehicle (CMV) in interstate

Diabetes

commerce according to the requirements in 49 CFR 391.41-49. Therefore,

Loss of Limb:

§391.41(b)(3)

the medical examiner must be knowledgeable of these requirements and

§391.41(b)(1)

A person is physically qualified to drive a commercial motor

guidelines developed by the FMCSA to assist the medical examiner in

vehicle if that person:

making the qualification determination. The medical examiner should be

Has no established medical history or clinical diagnosis of

Has no loss of a foot, leg, hand or an arm, or has been

familiar with the driver's responsibilities and work environment and is

diabetes mellitus currently requiring insulin for control.

granted a Skill Performance Evaluation (SPE) Certificate

Diabetes mellitus is a disease which, on occasion, can

referred to the section on the form, The Driver's Role.

pursuant to Section 391.49.

result in a loss of consciousness or disorientation in time

In addition to reviewing the Health History section with the driver and

and space. Individuals who require insulin for control have

conducting the physical examination, the medical examiner should discuss

Limb Impairment:

conditions which can get out of control by the use of too

common prescriptions and over-the-counter medications relative to the side

§391.41(b)(2)

much or too little insulin, or food intake not consistent with

A person is physically qualified to drive a commercial motor

effects and hazards of these medications while driving. Educate the driver

the insulin dosage. Incapacitation may occur from

vehicle if that person:

to read warning labels on all medications. History of certain conditions may

symptoms of hyperglycemic or hypoglycemic reactions

Has no impairment of: (i) A hand or finger which interferes

be cause for rejection, particularly if required by regulation, or may indicate

(drowsiness, semiconsciousness, diabetic coma or insulin

with prehension or power grasping; or (ii) An arm, foot, or leg

shock).

the need for additional laboratory tests or more stringent examination

which interferes with the ability to perform normal tasks

The administration of insulin is, within itself, a

perhaps by a medical specialist. These decisions are usually made by the

associated with operating a commercial motor vehicle; or (iii)

complicated process requiring insulin, syringe, needle,

medical examiner in light of the driver's job responsibilities, work schedule

Any other significant limb defect or limitation which interferes

alcohol sponge and a sterile technique. Factors related to

and potential for the conditions to render the driver unsafe.

with the ability to perform normal tasks associated with

long-haul commercial motor vehicle operations, such as

operating a commercial motor vehicle; or (iv) Has been

Medical conditions should be recorded even if they are not cause for

fatigue, lack of sleep, poor diet, emotional conditions,

granted a Skill Performance Evaluation (SPE) Certificate

denial, and they should be discussed with the driver to encourage

stress, and concomitant illness, compound the dangers,

pursuant to Section 391.49.

appropriate remedial care. This advice is especially needed when a

the FMCSA has consistently held that a diabetic who uses

A person who suffers loss of a foot, leg, hand or arm or

insulin for control does not meet the minimum physical

condition, if neglected, could develop into a serious illness that could affect

whose limb impairment in any way interferes with the safe

requirements of the FMCSRs.

driving.

performance of normal tasks associated with operating a

Hypoglycemic drugs, taken orally, are sometimes

If the medical examiner determines that the driver is fit to drive and is

commercial motor vehicle is subject to the Skill Performance

prescribed for diabetic individuals to help stimulate natural

also able to perform non-driving responsibilities as may be required, the

Evaluation Certification Program pursuant to section

body production of insulin. If the condition can be

391.49, assuming the person is otherwise qualified.

medical examiner signs the medical certificate which the driver must carry

controlled by the use of oral medication and diet, then an

With the advancement of technology, medical aids and

with his/her license. The certificate must be dated. Under current

individual may be qualified under the present rule. CMV

equipment modifications have been developed to compensate

drivers who do not meet the Federal diabetes standard

regulations, the certificate is valid for two years, unless the driver has

for certain disabilities. The SPE Certification Program

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

a medical condition that does not prohibit driving but does require

(formerly the Limb Waiver Program) was designed to allow

exemption.

more frequent monitoring. In such situations, the medical certificate

persons with the loss of a foot or limb or with functional

(See Conference Report on Diabetic Disorders and

should be issued for a shorter length of time. The physical examination

impairment to qualify under the Federal Motor Carrier Safety

Commercial Drivers and Insulin-Using Commercial Motor

should be done carefully and at least as complete as is indicated by the

Regulations (FMCSRs) by use of prosthetic devices or

Vehicle Drivers at:

equipment modifications which enable them to safely

attached form. Contact the FMCSA at (202) 366-1790 for further

)

operate a commercial motor vehicle. Since there are no medical

information (a vision exemption, qualifying drivers under 49 CFR 391.64,

aids equivalent to the original body or limb, certain risks are

etc.).

Cardiovascular Condition

still present, and thus restrictions may be included on individual

§391.41(b)(4)

SPE certificates when a State Director for the FMCSA determines

A person is physically qualified to drive a commercial

Interpretation of Medical Standards

they are necessary to be consistent with safety and public

Since the issuance of the regulations for physical qualifications of

motor vehicle if that person:

interest.

commercial drivers, the Federal Motor Carrier Safety Administration

Has no current clinical diagnosis of myocardial infarction,

If the driver is found otherwise medically qualified

angina pectoris, coronary insufficiency, thrombosis or any

(FMCSA) has published recommendations called Advisory Criteria to help

(391.41(b)(3) through (13)), the medical examiner must check

other cardiovascular disease of a variety known to be

on the medical certificate that the driver is qualified only if

medical examiners in determining whether a driver meets the physical

accompanied by syncope, dyspnea, collapse or congestive

accompanied by a SPE certificate. The driver and the employing

qualifications for commercial driving. These recommendations have been

cardiac failure.

motor carrier are subject to appropriate penalty if the driver

condensed to provide information to medical examiners that (1) is directly

The term "has no current clinical diagnosis of" is

operates a motor vehicle in interstate or foreign commerce

relevant to the physical examination and (2) is not already included in the

specifically designed to encompass: "a clinical diagnosis

without a curent SPE certificate for his/her physical disability.

of" (1) a current cardiovascular condition, or (2) a

medical examination form. The specific regulation is printed in italics and

cardiovascular condition which has not fully stabilized

it's reference by section is highlighted.

regardless of the time limit The term "known to be

Form 649-F - Medical Examination Report - Federal Motor Carrier Safety Administration Page 5

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