Commercial Driver Medical Examination| Rules and Regulations

Controversies Loom over 2016 Obstructive Sleep Apnea Recommendations


3/8/2016:   After recommendations from the National Transportation and Safety Board the FMCSA and FRA jointly published an Advanced Notice of Proposed Rulemaking on Obstructive Sleep Apnea.  The purpose was to collect data and information concerning the prevalence of moderate to severe obstructive sleep apnea  in highway and rail workers and it’s impact on safety.

8/22/2016-8/23/2016:  The FMCSA Medical Review Board (MRB) met to review more than 600 comments that were submitted from medical professionals and organizations, labor, industry and safety organization as well as reviewing it’s own previously published 2012 Report on OSA in  preparation for the recommendations that the MRB would be making to the Motor Carrier Safety Advisory Committee (MCSAC).  Preliminary recommendations made were referral for diagnostic studies for OSA in drivers with a BMI greater than or equal to 40 or a BMI of 33-39 who meet 3 of 11 risk factors.

10/24/2016-10/25/2016:   The MRB and the Motor Carrier Safety Advisory Commitee (MCSAC) agreed on recommendations.  It is up to the FMCSA at a later meeting to decide whether or not to adopt any of the recommendations made to it by the MRB and MCSAC.   If adopted, drivers with BMI equal to or greater than 40 OR with BMI 33-39 and 3 of 11 risk factors can receive conditional certifications and undergo testing.  If they are found to have OSA, they would need to undergo treatment.

Summary of Reccomendations

Any driver with a Body Mass Index (BMI) of 40 or more will require testing.

For those with a BMI of 33-39 the MRB recommended that they have at least 3 of 11 risk factors listed below to require testing.

  • Male or post menaupausal women
  • Age 42 or older
  • Loud snoring
  • Witnessed apnea
  • Mallampati Class 3 or 4
  • Neck size greater than 17 in men or 15.5 in women
  • Micrognathia or retrognathia
  • Hypertension
  • History of stroke, coronary artery disease (CAD) or arrythmia
  • Type 2 diabetes
  • Hypothyroidism



FMCSA qualification standards forbid individuals from receiving a medical examiner’s certificate if they have a respiratory dysfunction likely to interfere with their ability to control a commercial vehicle.

391.41 (b) (5)

  • A person is physically qualified to drive a commercial vehicle if that person has no established history or clinical diagnosis of a respiratory disorder likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.


To remind medical examiners and training organizations of this, on January 2015 FMCSA issued FMCSA Bulletin to Medical Examiners and Training Organizations Regarding Obstructive Sleep Apnea osa-bulletin-to-mes-and-training-organizations-01122015.

Medical examiners are expected to use their medical training and knowledge when evaluating commercial drivers.  Excessive sleepiness while driving can be due to a variety of reasons from fatigue, medication side effects, shift work disorder, systemic illness, non-compliance with prescribed treatment and many other conditions that may or may not be related to OSA.   Bottom line, whether or not FMCSA issues official guidelines for OSA, it is expected that medical examiners will continue to properly evaluate commercial drivers for any condition that may affect ability to operate a commercial vehicle as per 391.41 Physical Qualification for Drivers.

4 replies »

  1. Great summary here. My only concern is the use of the phrase conditional certification. If this is a verbatim from the MRB and the MCSAC I would have hoped that they would use language consistent with the certification process. By that I mean either say certification for a shorter period of time or determination pending. Conditional is too vague in my opinion. Conditional on what? Do they mean conditional as in only certified if the driver does something? If the answer here is yes then that sounds like a determination pending status. Or conditional as in for a shorter period of time? That is what I would likely do, of course depending on the actual clinical scenario.

    • Thanks for your comment and you are correct that the term as I used here was vague. Conditional certification was meant to be used here in broader terms, as in less than the standard 2 years or biennial certification period. So depending on the clinical scenario as you stated, it can mean a shorter period of certification (i.e. 3 months or 1 year). It was not meant to describe the 45 day pending status when you do not issue certification right away while awaiting medical records or other documentation from the driver.

  2. Good points on using available resources and good judgement on this and other conditions whether or not FMCSA issues an actual rule. Too many times I hear of examiners getting pressured by drivers and clients to NOT screen/test/obtain consults because there is no specific “rule” yet on sleep apnea or other conditions. There is plenty of evidence based literature, expert panel reports and MRB-MCSAC recommendations to support these evaluations.