DOT Examination

1. Approach: Absolute disqualifying conditions for certification
   1. Seizure disorder
      1. Does not include childhood Febrile Seizures
      2. No isolated Seizure in last 5 years (and last Seizure medication >5 years ago)
      3. No multiple Seizures in last 10 years (and last Seizure medication >10 years ago)
      4. No medications
      5. Refer questionable cases to Neurology
   2. Significant Hearing Loss
      1. Hearing Aid may be worn
      2. Screening with whispered voice
         1. Negative if heard at 5 feet in at least one ear
      3. Audiogram Evaluation (indicated for positive screen)
         1. Average Hearing Loss at 500, 1000, and 2000 Hz
            1. Calculate for better ear
            2. Add values together and divide by three
         2. Qualification requires 40 decibel average or less
   3. Significant Vision Loss
      1. Vision correction may be used
      2. Binocular vision is required
      3. Visual Acuity must be at least 20/40 in each eye
      4. Field of vision must be 70 degrees in each eye
      5. Color vision must recognize red, green and amber
2. Approach: Special Circumstances with Possible Disqualification
   1. Diabetes Mellitus requiring Insulin Therapy is NO longer an absolute contraindication to DOT license in U.S. (as of 2018)
      1. Insulin treated Diabetes Mellitus who are on stable management may be DOT certified
         1. http://www.diabetes.org/assets/pdfs/living/know-your-rights/fmcsa-final-rule-faq.pdf
      2. Other Diabetes Mellitus management not excluded
         1. Diet control
         2. Oral Hypoglycemic control
      3. Other management must result in good Glucose control
         1. Certify for one year at a time to ensure monitoring
   2. Extremity loss or Impairment
      1. Examples
         1. Amputation
         2. Fused or immobile knee or hip
         3. Partial limb paralysis
      2. Unqualified unless waiver received
         1. Waiver obtained by Director of Motor Carriers
   3. Cardiovascular disease with risk of Syncope or CHF
      1. Asymptomatic and isolated arrhythmia may be ok
      2. Cardiology evaluation recommended
         1. Myocardial Infarction or Angina
         2. Cardiac arrhythmia
            1. Tachycardia
            2. Bradycardia
      3. Consider additional testing
         1. Holter Monitoring
         2. Exercise Stress Test
   4. Significant Respiratory Disease
      1. Oxygen therapy while driving is disqualifying
      2. Spirometry indicated for significant symptoms
      3. Spirometry findings requiring oxygenation assessment
         1. Forced Expiratory Volume (FEV1) <65% of predicted
         2. Forced Vital Capacity (FVC) <60% of predicted
         3. FEV1 to FVC ration <65% of predicted
      4. Oxygenation assessment
         1. Arterial Blood Gas (ABG) indicated for O2 Sat <92%
         2. Disqualifying Arterial Blood Gas values
            1. PaO2 <65 mmHg
            2. PaCO2 >45 mmHg
   5. Obstructive Sleep Apnea
      1. Consider screening with Sleep Study all patients with BMI >30 to 33 mg/kg2
      2. Temporary certificate (e.g. 3 months) could be offered during evaluation
   6. Uncontrolled Hypertension
      1. Maximum of 1 year for recertification once Blood Pressures have been identified as elevated
      2. Initial Blood Pressure (may take several readings)
         1. Disqualifying Blood Pressure: >180/110 mmHg
            1. Recertify for 6 months from date when <140/90 and then every 6 months
         2. Temporary Certification (3 months): >160/100 mmHg
            1. One time certificate for 3 months
            2. Recertify for 1 year when <140/90 mmHg
         3. Temporary Certification (3 months): >140/90
            1. One time certificate for 3 months
            2. Recertify for 1 year when <140/90 mmHg
      3. Treated Hypertension
         1. Consider sudden collapse risk if end organ damage
         2. Certify for only one year at a time if <140/90 mmHg
   7. Disorders that alter driving ability or judgment
      1. Disqualification per physician assessment
      2. Examples
         1. Musculoskeletal, neurologic or vascular disease
         2. Narcolepsy (typically disqualifying with or without medication)
         3. Psychiatric illness
            1. Judgment or reality perception affected
            2. Reaction time affected
            3. Psychotropic medications altering consciousness
         4. Consciousness altering substance use (disqualifying in most cases)
            1. Schedule I Drug (e.g. Amphetamine, Narcotic)
            2. Current Alcoholism
               1. Consider Substance Abuse counselor assessment
3. Resources
   1. Federal Motor Safety Administration
      1. http://www.fmcsa.dot.gov
   2. DOT Rules and regulations
      1. http://www.fmcsa.dot.gov/rules-regulations/rules-regulations.htm
   3. Medical Examiner Handbook
      1. http://nrcme.fmcsa.dot.gov/mehandbook/mehandbook.aspx
4. References
   1. Hartenabaum (2010) Am Fam Physician 81(8): 975-80 [PubMed]
   2. Pommerenke (1998) Am Fam Physician 58(2):415-26 [PubMed]