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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.
Grandfathering for certain drivers participating in vision the waiver study program. 49 CFR 391.64 Provides the requirements for being exempted from the vision standard through prior participation in a certain waiver study program.

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.

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.

Last updated: Thursday, November 18, 2021