Physical qualifications for drivers

The medical oversight of interstate truck drivers (i.e., commercial vehicle operators) has been regulated by the Federal Motor Carrier Safety Administration (FMCSA) for years and in many cases, also regulated by individual states for intrastate truck drivers.

However, there is little oversight of “non-commercial” drivers. With the aging workforce, this issue is a growing concern. Organizations operating motor vehicles for their business needs should be concerned about the health of their drivers, whether regulated or non-regulated. This report discusses the current requirements for regulated drivers and addresses the need for a medical evaluation program for non-regulated operators of motor vehicles.

Introduction

Driving requires the proper orchestration of sensory/perceptual, cognitive, and motor activities to be performed successfully. Research has shown that certain medical conditions negatively affect one or more of these activities, thereby increasing the safety risk of drivers who suffer from them. The extent of the overall impact of medically impaired drivers is not known because of a lack of data on the number of licensed drivers with high-risk medical conditions or on the number of accidents in which a driver’s medical condition was a contributory factor.

The medical oversight of interstate truck drivers (i.e., commercial vehicle operators) has been regulated by the FMCSA for years and in many cases, also regulated by individual states for some of intrastate truck drivers. However, there is little oversight of “non-commercial” drivers. With the aging workforce, this issue is a growing concern. To obtain a driver’s license, a person needs to demonstrate visual acuity and typically self-reports medical conditions that the state has deemed a problem. Often, vision is not rechecked for an extended period of time, if it is ever rechecked, and little is done to supervise other medical impairments that are not self-reported by the driver or reported by the driver’s physician.

Organizations operating motor vehicles for their business needs, whether regulated or non-regulated, should be concerned about the health of their drivers. This report discusses the current requirements for regulated drivers and addresses the need for a medical evaluation program for non-regulated operators of motor vehicles.

Regulated drivers

Motor carriers subject to the FMCSA regulations are required to have their drivers pass a medical evaluation before driving a regulated commercial motor vehicle (CMV) and be reevaluated every two years. Many states have adopted the FMCSA requirements for certain classes of intrastate drivers.

Drivers must be medically examined and certified in accordance with the regulations. However, the regulations do not prevent a motor carrier, or state, from establishing policies that are more stringent than the safety regulations.

Physical qualifications

FMCSA regulations (49CFR391.41) provide that a regulated CMV driver is deemed to be physically qualified to operate a commercial motor vehicle (CMV) if the driver:

• Has no loss of a foot, a leg, a hand, or an arm, or has been granted a skill performance evaluation certificate.
• Has no impairment of a hand or finger that interferes with prehension or power grasping.
• Has no impairment of an arm, foot, or leg that interferes with the ability to perform normal tasks associated with operating a CMV.
• Has no other significant limb defect or limitation which interferes with the ability to perform normal tasks associated with operating a CMV, or has been granted a skill performance evaluation certificate.
• Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control.
• Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure.
• Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a CMV safely.
• Has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a CMV safely.
• Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease, which interferes with his/her ability to control and operate a CMV safely.
• Has no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a CMV.
• Has no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with his/her ability to drive a CMV safely.
• Has distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses, distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without corrective lenses, field of vision of at least 70° in the horizontal Meridian in each eye, and the ability to recognize the colors of traffic signals and devices showing standard red, green, and amber.
• Can perceive a forced whispered voice, in the better ear, at not less than five feet. (1.5 m) with or without the use of a hearing aid or; if 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 Institute (formerly ASA Standard) Z24.5 - 1951.
• Does not use a controlled substance that is identified in 21 CFR 1308.11, Schedule I, an amphetamine, a narcotic, or any other habit-forming drug. (Exception. A driver may use such a substance or drug, if the substance or drug is prescribed by a licensed medical practitioner who is familiar with the driver's medical history and assigned duties and has advised the driver that the prescribed substance or drug will not adversely affect the driver's ability to safely operate a CMV.)
• Has no current clinical diagnosis of alcoholism.

The FMCSA does provide waiver and exemption programs that permit some drivers to be exempted from certain medical requirements, including:

The Federal Diabetes and Vision Exemption Programs

The Federal Diabetes and Vision Exemption Programs have specific requirements, as well as requests for hearing and seizure exemptions. These requests may include medical exams, employment history, driving experience, and motor vehicle records, which must be submitted with the application. The Agency will make a final decision within 180 days of receipt of the complete application. https://www.fmcsa.dot.gov/medical/driver-medical-requirements/driver-exemption-programs

Skill Performance Evaluation Certificate Program

The Skill Performance Evaluation (SPE) program is for CMV drivers who drive in interstate commerce. The SPE certification allows drivers with missing or impaired limbs to drive CMVs across state lines if they have been fitted with (and are wearing) the right prosthetic device and the driver can demonstrate the ability to drive the truck safely by completing on-and off-road activities. If the driver passes the driving test, he or she will receive an SPE certificate. https://www.fmcsa.dot.gov/medical/driver-medical-requirements/skill-performance-evaluation-certificate-program

Medical examiners

The physical examination must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners (https://www.fmcsa.dot.gov/national-registry-certified-medical-examiners-search). A licensed optometrist may perform the parts of the medical examination that pertain to visual acuity, field of vision, and the ability to recognize colors. Medical examiners must be knowledgeable of the specific physical and mental demands associated with operating a CMV and the medical requirements of the FMCSA, including the medical regulatory criteria prepared by the FMCSA as guidelines to aid the medical examiner in making the qualification determination, and be proficient in the use of the medical protocols necessary to adequately perform the required medical examination.

Any driver authorized to operate a CMV within an exempt intracity zone must furnish the medical examiner with a copy of the medical findings that led to the issuance of the first certificate of medical examination that allowed the driver to operate a CMV wholly within an exempt intracity zone. Exempt intracity zones are typically the area surrounding large cities.

The medical examination must be performed, and its results must be recorded, substantially in accordance with the FMCSA’s instructions and examination form, entitled "Medical Examination Report (MER) Form, MCSA-5875", which is available from FMCSA at https://www.fmcsa.dot.gov/regulations/medical/medical-examination-report-form-commercial-driver-medical-certification.

Medical examiner’s certificate

If the medical examiner finds that the person he/she examined is physically qualified to drive a CMV, the medical examiner must complete a medical examiner's certificate, which is substantially in accordance with FMCSA’s form, and furnish a copy to the person who was examined. The certificate is entitled the "Medical Examiner's Certificate (MEC), Form MCSA-5876" and is available from the FMCSA at https://www.fmcsa.dot.gov/regulations/medical/medical-examiners-certificate-commercial-driver-medical-certification.

Effective June 22, 2018, FMSCA no longer requires the regulated CMV drivers to carry a copy of a medical examiner's certificate indicating that he/she is physically qualified to drive a CMV. Instead, the physician issuing the medical examiner's certificate is required to transmit a copy of the certificate to FMCSA. States will be able to access those certificates to verify drivers eligibility to operate a CMV. However, some states require the driver to supply a copy of the certificate directly to the state and/or to carry a copy of a medical examiner's certificate.

Vision and Diabetes Exemption Program

Exemptions from the vision or diabetes requirements are granted on a very limited basis and the drivers receiving an exemption are required to show that granting of the exemption will likely achieve a level of highway safety equivalent to, or greater than, the level if no exemption was required. Because of the additional risk, drivers requesting exemptions are held to a higher standard regarding accident involvement and traffic violations than a driver who meets the normal physical criteria. Exemptions are issued for a maximum of two years, but may be renewed at the option of the FMCSA.

Any driver operating under a limited exemption from the vision or diabetes requirements must furnish the medical examiner with a copy of the required annual medical findings of the endocrinologist, ophthalmologist, or optometrist. If the medical examiner finds the driver qualified under the limited exemption, such fact shall be noted on the medical examiner's certificate. Drivers in these programs must be medically examined at least annually.

Details of the FMCSA driver exemption programs for diabetes and vision can be obtained from FMCSA at http://www.fmcsa.dot.gov/rules-regulations/topics/medical/exemptions.htm.

Non-regulated drivers

Companies operating non-commercial motor vehicle fleets (e.g., sales, local pick-up and delivery, intrastate [non-regulated]) should consider the physical qualifications of their drivers, since all operators of motor vehicles need to be physically and mentally capable of performing required driving tasks to assure their own safety, as well as that of the general public. Physicians generally are not required to report health conditions, which might affect a person’s ability to drive, to regulatory agencies. As a result, individual drivers of non-commercial vehicles are left to decide if their medical condition is serious enough to curtail their driving.

Companies should ensure that their drivers meet at least minimum physical requirements to avoid unnecessary liability resulting from vehicle crashes. Ideally, the physical requirements should be outlined in the driver’s job description (e.g., needs to frequently lift and carry boxes weighing up to 50 lbs). The physical fitness of the driver should be considered before hiring, but only after the driver has been offered a job. A company should arrange for physical examinations with individual physicians or industrial clinics. The company should provide the medical examiner with an outline of the requirements of the job, so that it can be determined whether the applicant is qualified for the position. In addition to checking a driver's physical condition before hiring, periodic physical examinations should be required and arranged for by the company. Reexaminations may indicate the onset of a problem and, therefore, allow appropriate corrective measures to be taken.

Guidelines for physical requirements

A company should never assume a person’s driver’s license equates to a well-qualified, healthy driver. As detailed in the section Regulated Drivers, the FMCSA prescribes minimum physical requirements for regulated commercial drivers and requires a physical examination every two years. These criteria can be used by the non-commercial operator as well.

Any physical requirements must relate to the job performed and be applied equally to all drivers. In addition, as required by the American with Disabilities Act (ADA), physical qualifications must be carefully considered to avoid discriminating against a qualified, but disabled applicant/employee. The employer must determine if the driver will pose a "direct threat" to health or safety as a result of a physical condition and must also consider if the physical problem could be eliminated or reduced below the level of a "direct threat" by reasonable accommodation.

Firms should check with legal counsel before establishing a physical qualification program. While federally mandated physical standards for truck drivers do not appear to be preempted by the ADA’s regulations, state (even when adopting the federal requirements) and individual company requirements might be subjected to closer scrutiny to ensure that they do not discriminate. Qualified industrial medical clinics should be familiar with the FMCSA regulations and be able to help craft appropriate physical criteria for drivers to meet the needs of the company.

If the driver can show the ability to operate the vehicle safely, it should not affect their qualification to operate a vehicle for the company. For insulin-dependent diabetics and drivers with vision in only one eye, applying the same criteria that the FMCSA uses in their exemption program would seem reasonable in most jurisdictions.

References

1. Federal Motor Carrier Safety Regulations. 49 CFR 391. U.S. Department of Transportation. July 2018. <https://www.fmcsa.dot.gov/regulations/title49/b/5/3>
2. National Institute for Occupational Safety and Health. Older Drivers in the Workplace: How Employers and Workers Can Prevent Crashes. Cincinnati, OH: Dept. of Health and Human Services, 2016. July 5, 2018. <https://www.cdc.gov/niosh/docs/2016-116/>

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