II. Approach: Absolute disqualifying conditions for certification
-
Seizure Disorder
- Does not include childhood Febrile Seizures
- No isolated Seizure in last 5 years (and last Seizure medication >5 years ago)
- No multiple Seizures in last 10 years (and last Seizure medication >10 years ago)
- No medications
- Refer questionable cases to Neurology
- Significant Hearing Loss
- Hearing Aid may be worn
- Screening with whispered voice
- Negative if heard at 5 feet in at least one ear
- Audiogram Evaluation (indicated for positive screen)
- Average Hearing Loss at 500, 1000, and 2000 Hz
- Calculate for better ear
- Add values together and divide by three
- Qualification requires 40 decibel average or less
- Average Hearing Loss at 500, 1000, and 2000 Hz
- Significant Vision Loss
- Vision correction may be used
- Binocular Vision is required
- Visual Acuity must be at least 20/40 in each eye
- Field of Vision must be 70 degrees in each eye
- Color Vision must recognize red, green and amber
III. Approach: Special Circumstances with Possible Disqualification
-
Diabetes Mellitus requiring Insulin Therapy is NO longer an absolute contraindication to DOT license in U.S. (as of 2018)
- Insulin treated Diabetes Mellitus who are on stable management may be DOT certified
- Other Diabetes Mellitus management not excluded
- Diet control
- Oral Hypoglycemic control
- Other management must result in good Glucose control
- Certify for one year at a time to ensure monitoring
- Extremity loss or Impairment
- Examples
- Amputation
- Fused or immobile knee or hip
- Partial limb paralysis
- Unqualified unless waiver received
- Waiver obtained by Director of Motor Carriers
- Examples
- Cardiovascular disease with risk of Syncope or CHF
- Asymptomatic and isolated Arrhythmia may be ok
- Cardiology evaluation recommended
- Consider additional testing
- Significant Respiratory Disease
- Oxygen therapy while driving is disqualifying
- Spirometry indicated for significant symptoms
- Spirometry findings requiring oxygenation assessment
- Forced Expiratory Volume (FEV1) <65% of predicted
- Forced Vital Capacity (FVC) <60% of predicted
- FEV1 to FVC Ration <65% of predicted
- Oxygenation assessment
- Arterial Blood Gas (ABG) indicated for O2 Sat <92%
- Disqualifying Arterial Blood Gas values
-
Obstructive Sleep Apnea
- Consider screening with Sleep Study all patients with BMI >30 to 33 mg/kg2
- Temporary certificate (e.g. 3 months) could be offered during evaluation
-
Uncontrolled Hypertension
- Maximum of 1 year for recertification once Blood Pressures have been identified as elevated
- Initial Blood Pressure (may take several readings)
- Disqualifying Blood Pressure: >180/110 mmHg
- Recertify for 6 months from date when <140/90 and then every 6 months
- Temporary Certification (3 months): >160/100 mmHg
- One time certificate for 3 months
- Recertify for 1 year when <140/90 mmHg
- Temporary Certification (3 months): >140/90
- One time certificate for 3 months
- Recertify for 1 year when <140/90 mmHg
- Disqualifying Blood Pressure: >180/110 mmHg
- Treated Hypertension
- Consider sudden collapse risk if end organ damage
- Certify for only one year at a time if <140/90 mmHg
- Disorders that alter driving ability or judgment
- Disqualification per physician assessment
- Examples
- Musculoskeletal, neurologic or vascular disease
- Narcolepsy (typically disqualifying with or without medication)
- Psychiatric illness
- Judgment or reality Perception affected
- Reaction time affected
- Psychotropic medications altering consciousness
- Consciousness altering substance use (disqualifying in most cases)
- Schedule I Drug (e.g. Amphetamine, Narcotic)
- Current Alcoholism
- Consider Substance Abuse counselor assessment
IV. Resources
- Federal Motor Safety Administration
- DOT Rules and regulations
- Medical Examiner Handbook