Form 649-F - Medical Examination Report - Federal Motor Carrier Safety Administration Page 7

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Epilepsy
Mental Disorders
Vision
§391.41(b)(8)
§391.41(b)(9)
§391.41(b)(10)
A person is physically qualified to drive a commercial motor vehicle
A person is physically qualified to drive a commercial motor
A person is physically qualified to drive a commercial motor
if that person:
vehicle if that person:
vehicle if that person:
Has no established medical history or clinical diagnosis of epilepsy
Has no mental, nervous, organic or functional disease or
Has distant visual acuity of at least 20/40 (Snellen) in each eye
or any other condition which is likely to cause loss of
psychiatric disorder likely to interfere with ability to drive a motor
with or without corrective lenses or visual acuity separately
consciousness or any loss of ability to control a motor vehicle.
vehicle safely.
corrected to 20/40 (Snellen) or better with corrective lenses,
Epilepsy is a chronic functional disease characterized by
Emotional or adjustment problems contribute directly to an
distant binocular acuity of at least 20/40 (Snellen) in both eyes
seizures or episodes that occur without warning, resulting in loss of
individual's level of memory, reasoning, attention, and judgment.
with or without corrective lenses, field of vision of at least 70
voluntary control which may lead to loss of consciousness and/or
These problems often underlie physical disorders. A variety of
degrees in the horizontal meridian in each eye, and the ability to
seizures. Therefore, the following drivers cannot be qualified: (1) a
functional disorders can cause drowsiness, dizziness,
recognize the colors of traffic signals and devices showing
driver who has a medical history of epilepsy; (2) a driver who has a
confusion, weakness or paralysis that may lead to
standard red, green, and amber.
current clinical diagnosis of epilepsy; or (3) a driver who is taking
incoordination, inattention, loss of functional control and
The term "ability to recognize the colors of" is interpreted to
antiseizure medication.
susceptibility to accidents while driving. Physical fatigue,
mean if a person can recognize and distinguish among traffic
If an individual has had a sudden episode of a nonepileptic
headache, impaired coordination, recurring physical ailments
control signals and devices showing standard red, green and
seizure or loss of consciousness of unknown cause which did not
and chronic "nagging" pain may be present to such a degree
amber, he or she meets the minimum standard, even though he
require antiseizure medication, the decision as to whether that
that certification for commercial driving is inadvisable. Somatic
or she may have some type of color perception deficiency. If
person's condition will likely cause loss of consciousness or loss of
and psychosomatic complaints should be thoroughly examined
certain color perception tests are administered, (such as
ability to control a motor vehicle is made on an individual basis by
when determining an individual's overall fitness to drive.
Ishihara, Pseudoisochromatic, Yarn) and doubtful findings are
the medical examiner in consultation with the treating physician.
Disorders of a periodically incapacitating nature, even in the
discovered, a controlled test using signal red, green and amber
Before certification is considered, it is suggested that a 6 month
early stages of development, may warrant disqualification.
may be employed to determine the driver's ability to recognize
waiting period elapse from the time of the episode. Following the
Many bus and truck drivers have documented that "nervous
these colors.
waiting period, it is suggested that the individual have a complete
trouble" related to neurotic, personality, or emotional or
Contact lenses are permissible if there is sufficient evidence
neurological examination. If the results of the examination are
adjustment problems is responsible for a significant fraction of
to indicate that the driver has good tolerance and is well
negative and antiseizure medication is not required, then the driver
their preventable accidents. The degree to which an individual
adapted to their use. Use of a contact lens in one eye for
may be qualified.
is able to appreciate, evaluate and adequately respond to
distance visual acuity and another lens in the other eye for near
In those individual cases where a driver has a seizure or an
environmental strain and emotional stress is critical when
vision is not acceptable, nor telescopic lenses acceptable for
episode of loss of consciousness that resulted from a known
assessing an individual's mental alertness and flexibility to cope
the driving of commercial motor vehicles.
medical condition (e.g., drug reaction, high temperature, acute
with the stresses of commercial motor vehicle driving.
If an individual meets the criteria by the use of glasses or
infectious disease, dehydration or acute metabolic disturbance),
When examining the driver, it should be kept in mind that
contact lenses, the following statement shall appear on the
certification should be deferred until the driver has fully recovered
individuals who live under chronic emotional upsets may have
Medical Examiner's Certificate: "Qualified only if wearing
from that condition and has no existing residual complications, and
deeply ingrained maladaptive or erratic behavior patterns.
corrective lenses."
not taking antiseizure medication.
Excessively antagonistic, instinctive, impulsive, openly
CMV drivers who do not meet the Federal vision standard
Drivers with a history of epilepsy/seizures off antiseizure
aggressive, paranoid or severely depressed behavior greatly
may call (202) 366-1790 for an application for a vision
medication and seizure-free for 10 years may be qualified to drive
interfere with the driver's ability to drive safely. Those
exemption.
a CMV in interstate commerce. Interstate drivers with a history of
individuals who are highly susceptible to frequent states of
(See Visual Disorders and Commercial Drivers at:
a single unprovoked seizure may be qualified to drive a CMV in
emotional instability (schizophrenia, affective psychoses,
)
interstate commerce if seizure-free and off antiseizure medication
paranoia, anxiety or depressive neuroses) may warrant
for a 5-year period or more.
disqualification. Careful consideration should be given to the
Hearing
(See Conference on Neurological Disorders and Commercial
side effects and interactions of medications in the overall
§391.41(b)(11)
Drivers at:
qualification determination. See Psychiatric Conference Report
A person is physically qualified to drive a commercial motor
)
for specific recommendations on the use of medications and
vehicle if that person:
potential hazards for driving.
First perceives a forced whispered voice in the better ear at not
(See Conference on Psychiatric Disorders and Commercial
less than 5 feet with or without the use of a hearing aid, or, if
Drivers at:
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 ADA Standard) Z24.5-1951.
Since the prescribed standard under the FMCSRs is the
American Standards Association (ANSI), it may be necessary to
convert the audiometric results from the ISO standard to the
ANSI standard. Instructions are included on the Medical
Examination report form.
If an individual meets the criteria by using a hearing aid, the
driver must wear that hearing aid and have it in operation at all
times while driving. Also, the driver must be in possession of a
spare power source for the hearing aid.
For the whispered voice test, the individual should be
stationed at least 5 feet from the examiner with the ear being
tested turned toward the examiner. The other ear is covered.
Using the breath which remains after a normal expiration, the
examiner whispers words or random numbers such as 66, 18,

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