Medical Regulations and Guidance Resource Links

About the Tables

This document provides quick access through links to the Federal Motor Carrier Safety Regulations relevant to the physical qualification of interstate commercial motor vehicle (CMV) drivers as well as other available resources including Medical Review Board taskings and recommendations, and evidence reports.

Regulations vs. Guidance

Established under the Agency’s statutory authority, FMCSA’s safety regulations concerning the physical qualifications of drivers are legally binding on those subject to their provisions. FMCSA has the authority to compel compliance with regulations. These regulations ensure uniform application of the law and how the laws must be followed.

In addition, FMCSA provides medical guidance to Medical Examiners (MEs) in the form of advisory criteria, bulletins, interpretations of the regulations, and guidelines. Medical guidance assists MEs in applying the regulations governing the physical qualifications of interstate CMV drivers. Often, this guidance is based on input from medical expert panels or is derived from clinical best practices. Unlike regulations, recommendations and other guidance do not have the force and effect of law and are not meant to bind the public in any way. Rather, such guidance is strictly advisory, not mandatory, and intended solely to clarify existing requirements under the regulations or FMCSA policies. The public (including MEs) is free to choose whether or not to utilize such guidance or recommendations as a basis for decision-making.

Federal Motor Carrier Safety Regulations

The links below include sections from the Federal Motor Carrier Safety Regulations (FMCSRs) that are applicable to the physical qualification of interstate commercial motor vehicle (CMV) drivers.

Title	Citation	Description
National Registry of Certified Medical Examiners
Scope.	49 CFR 390.101	Overview of 49 CFR 390.101-115.
Eligibility requirements for medical examiner certification.	49 CFR 390.103	Provides requirements for becoming a certified medical examiner on the National Registry.
Medical examiner training programs.	49 CFR 390.105	Provides requirements for training organizations and lists the core curriculum.
Medical examiner certification testing.	49 CFR 390.107	Provides the criteria that testing organizations must meet.
Issuance of the FMCSA medical examiner certification credential.	49 CFR 390.109	Describes when a medical examiner will receive certification, and the length of certification.
Requirements for continued listing on the National Registry of Certified Medical Examiners.	49 CFR 390.111	Provides requirements for medical examiners to maintain their certification and listing on the National Registry.
Reasons for removal from the National Registry of Certified Medical Examiners.	49 CFR 390.113	Provides reasons a medical examiner may be removed from the National Registry.
Procedure for removal from the National Registry of Certified Medical Examiners.	49 CFR 390.115	Describes the methods of removal from the National Registry, and the accompanying process for each method.
Medical Examiner Certification Requirements for Qualified Department of Veterans Affairs Examiners
Medical examiner certification for qualified Department of Veterans Affairs examiners.	49 CFR 390.123	Provides requirements for becoming a certified Veteran Affairs (VA) medical examiner on the National Registry.
Qualified VA examiner certification training.	49 CFR 390.125	Provides requirements for qualified VA examiner certification training.
Qualified VA examiner certification testing.	49 CFR 390.127	Provides requirements for qualified VA examiner certification testing.
Issuance of the FMCSA medical examiner certification credential.	49 CFR 390.129	Describes when a VA medical examiner will receive certification, and the length of certification.
Requirements for continued listing of a certified VA medical examiner on the National Registry of Certified Medical Examiners.	49 CFR 390.131	Provides requirements for VA medical examiners to maintain their certification and listing on the National Registry.
Reasons for removal of a certified VA medical examiner from the National Registry of Certified Medical Examiners.	49 CFR 390.133	Provides reasons a VA medical examiner may be removed from the National Registry.
Procedure for removal of a certified VA medical examiner from the National Registry of Certified Medical Examiners.	49 CFR 390.135	Describes the methods of a VA medical examiner removal from the National Registry, and the accompanying process for each method.
Physical Qualifications and Examinations
Physical qualifications for drivers.	49 CFR 391.41	States which drivers must carry a medical certificate, and sets out the physical qualification standards.
Medical examination; certificate of physical examination.	49 CFR 391.43	States who may conduct examinations, which forms must be used to record results, how long to retain forms, and when to report to FMCSA.
Persons who must be medically examined and certified.	49 CFR 391.45	States who must be examined by a certified medical examiner listed on the National Registry.
Physical qualification standards for an individual with diabetes mellitus treated with insulin for control.	49 CFR 391.46	Provides the requirements for drivers with diabetes mellitus who are treated with insulin for control.
Resolution of conflicts of medical evaluation.	49 CFR 391.47	Provides the requirements to apply for resolution of a conflict between a driver’s and motor carrier’s medical examiners.
Alternative physical qualification standards for the loss or impairment of limbs.	49 CFR 391.49	Provides the requirements for drivers seeking a Skill Performance Evaluation (SPE) Certificate, and that drivers with an SPE Certificate may be medically qualified.
Limited Exemptions
Limited exemptions for intra-city zone drivers.	49 CFR 391.62	Provides the requirements for drivers to be exempted from the age restriction and certain physical standards.

Guidance

The links below are provided as a resource for information sharing and do not constitute regulatory standards; rather, they provide the ME medical information to consider when making a physical qualification determination.

The evidence reports included in the links below reflect the views of the authors, who are responsible for the facts and accuracy of the data presented at the time the expert reports were originally released. The contents do not reflect the official policy of FMCSA.

Title	Topic	Date	Description
Medical Advisory Criteria
MRB Task 16-02 Letter Report	Medical Advisory Criteria	December 13, 2016	Medical Review Board’s (MRB) recommended revisions to the Medical Advisory Criteria.
Appendix A to Part 391--Medical Advisory Criteria	Medical Advisory Criteria	April 23, 2015	Published as an appendix to part 391 of the CFR, contains non-regulatory guidance to assist medical examiners.
Sleep Disorders
Final MRB Task 16-01 Letter Report from Motor Carrier Safety Advisory Committee (MCSAC) and MRB	Sleep Disorders	November 21, 2016	MRB recommendations regarding comments received on Advanced Notice of Proposed Rulemaking (ANPRM) on obstructive sleep apnea.
MRB Task 16-01 Draft Letter Report	Sleep Disorders	August 26, 2016	MRB recommendations to the ANPRM on obstructive sleep apnea.
Draft Task 16-01 Discussion Notes	Sleep Disorders	August 23, 2016	Draft discussion notes and MRB recommendations on obstructive sleep apnea.
Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety: Updated Review	Sleep Disorders	November 30, 2011	Evidence report synthesizing research conducted since the 2007 evidence report on obstructive sleep apnea.
Obstructive Sleep Apnea and Commercial Motor Vehicle Driver Safety	Sleep Disorders	November 21, 2007	Evidence report presenting findings regarding obstructive sleep apnea and commercial drivers.
Medication/Drug Use
MRB Discussion on U.S. Food and Drug Administration (FDA) Warnings on Narcotics and Benzodiazepines and Incorporation Into Medical Examiner Forms	Medication/Drug Use	October 25, 2016	MRB discussion notes and recommendations regarding FDA warnings on narcotics and benzodiazepines.
Federal Register Notice on 391.41 CMV Driver Medication Form, MCSA-5895	Medication/Drug Use	July 8, 2016	Federal Register notice announcing the 391.41 CMV Driver Medication Form, MCSA-5895.
MRB and MCSAC Joint Task 14-3: Schedule II Controlled Substances and CMV Drivers	Medication/Drug Use	December 16, 2014	Final revised MRB recommendations on Schedule II substances and commercial drivers.
MRB Task 13-01: Schedule II Controlled Substances and Commercial Motor Vehicle Drivers	Medication/Drug Use	October 13, 2014	Draft revisions to MRB recommendations on Schedule II controlled substances and commercial drivers.
MRB Task 13-1 Recommendations	Medication/Drug Use	October 22, 2013	MRB recommendations on Schedule II substances and commercial drivers.
Licit Schedule II Drug Use and Commercial Motor Vehicle Driver Safety	Medication/Drug Use	October 21, 2006	Evidence report presenting findings regarding medication/drug use and commercial drivers.
Public-Private Partnerships
MCSAC Task 15-3: Recommendations to the Agency on the Structure, Content, and Methods for Determining the Effectiveness of a Public-Private Partnership to Promote CMV Driver Wellness	Public-Private Partnerships	August 10, 2016	MCSAC draft discussion notes and recommendations on public-private partnership activities.
MCSAC and MRB Task 15-3: Recommendations to the Agency on the Structure, Content, and Methods for Determining the Effectiveness of a Public-Private Partnership to Promote CMV Driver Wellness	Public-Private Partnerships	September 21-22, 2015	MCSAC and MRB draft discussion notes and recommendations on public-private partnerships.
Diabetes
MRB Task 21-2: Draft MRB Recommendations to the Agency regarding the proposed Non-Insulin-Treated Diabetes Mellitus Assessment Form	Diabetes	May 19-20, 2021	Draft MRB recommendations regarding the proposed Non-Insulin-Treated Diabetes Mellitus Assessment Form
MRB Task 15-1: Recommendations on the Disposition of Public Comments from Medical Professionals and Associations to FMCSA’s Notice of Proposed Rulemaking (NPRM) on Insulin-Dependent Drivers of Commercial Motor Vehicles (CMVs) with Diabetes Mellitus	Diabetes	September 1, 2015	MRB recommendations regarding comments on the Notice of Proposed Rulemaking (NPRM) on insulin-treated drivers of commercial motor vehicles with diabetes mellitus.
Diabetes and Commercial Motor Vehicle Driver Safety	Diabetes	May 27, 2011	Evidence report with updated information regarding diabetes and commercial drivers.
Diabetes and Commercial Motor Vehicle Driver Safety	Diabetes	September 8, 2006	Evidence report presenting findings regarding diabetes and commercial drivers.
Vision
MRB Task 21-1: MRB Recommendations to the Agency regarding the Proposed Alternative Vision Standard and Vision Evaluation Report Form	Vision	May 19-20, 2021	MRB recommendations regarding proposed alternative vision standard and Vision Evaluation Report Form.
MRB Task 15-2: Recommendations on Potential Regulatory Actions Concerning Vision Standards for Interstate CMV Drivers	Vision	September 1, 2015	MRB recommendations on FMCSA’s vision standards for CMV drivers.
Vision and Commercial Motor Vehicle Driver Safety	Vision	June 6, 2008	Evidence report presenting findings regarding vision and commercial drivers.
Hearing
Cochlear Implants and Commercial Motor Vehicle Driver Safety	Hearing	October 29, 2010 Revised January 14, 2011	Targeted evidence report presenting findings regarding cochlear implants and commercial drivers.
Hearing, Vestibular Function, and Commercial Driver Safety	Hearing	August 26, 2008	Evidence report presenting findings regarding hearing and vestibular disorders and commercial drivers.
Traumatic Brain Injury
Traumatic Brain Injury and Commercial Motor Vehicle Driver Safety	Traumatic Brain Injury	March 30, 2009	Draft evidence report presenting findings regarding traumatic brain injury and commercial drivers.
Stroke
Stroke and Commercial Motor Vehicle Driver Safety	Stroke	September 15, 2008	Executive summary to evidence report presenting findings regarding stroke and commercial drivers.
Psychiatric Disorders
Psychiatric Disorders and Commercial Motor Vehicle Driver Safety	Psychiatric Disorders	August 29, 2008	Evidence report presenting findings regarding psychiatric disorders and commercial drivers.
Movement Disorders
Parkinson’s Disease, Multiple Sclerosis, and Commercial Motor Vehicle Driver Safety	Movement Disorders	June 3, 2009	Evidence report presenting findings regarding Parkinson’s disease, multiple sclerosis, and commercial drivers.
Musculoskeletal Disorders
Musculoskeletal Disorders and Commercial Motor Vehicle Driver Safety	Musculoskeletal Disorders	May 29, 2009	Evidence report presenting findings regarding musculoskeletal disorders and commercial drivers.
Seizures
Seizure Disorder and Medical Certification of Commercial Motor Vehicle Driver Safety (2019)	Seizures	March 2019	Update to 2007 evidence report presenting findings regarding seizures and commercial drivers.
Seizure Disorders and Commercial Motor Vehicle Driver Safety	Seizures	November 30, 2007	Evidence report presenting findings regarding seizures and commercial drivers.
Expert Panel Recommendations – seizure disorders		October 15, 2007	Expert panel recommendations regarding seizure disorders and commercial driver safety
Kidney Disease
Chronic Kidney Disease and Commercial Motor Vehicle Driver Safety	Kidney Disease	November 5, 2007	Evidence report presenting findings regarding kidney disease and commercial drivers.
Cardiovascular Disease
Research White Paper - Implantable Cardio Defibrillators and the Impact of a Shock to the Patient when Deployed	ICD	December 17, 2014	White paper regarding research on implantable cardio defibrillators and the impact of a shock to the patient when deployed.
Expert Panel Recommendations – Cardiovascular disease	Cardiovascular Disease	June 5, 2013	Expert Panel Recommendations - Medical Examiner Physical Qualification Standards and Clinical Guidelines for Cardiovascular Disease and Commercial Motor Vehicle Driver Safety
Cardiovascular Disease and Commercial Motor Vehicle Driver Safety	Cardiovascular Disease	April 27, 2007	Evidence report presenting findings regarding cardiovascular disease and commercial drivers.
Skill Performance Evaluation (SPE) Certificate
Krusen Study on Limb Prosthetics	SPE	April 1977	Study regarding limb prosthetics for the SPE certificate program.
FMCSA Research Projects
Research Brief - Examining the Seizure Standard for Commercial Motor Vehicle Drivers	Seizure	June 1, 2023	Research brief regarding the study on the seizure standard.
Examining the Seizure Standard for Commercial Motor Vehicle Drivers	Seizure	June 1, 2023	Evidence Reports, Systematic Review, and Medical Expert Panel Report regarding the seizure standard.
Effect of the Length of Medical Certification on Safety	Research	February 1, 2023	Study to evaluate the relationship between the duration of CMV drivers’ medical certification and crash and/or violation risk.

Last updated: Thursday, November 2, 2023

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