Commercial Driver Medical Examination| Rules and Regulations

Update on Sleep Apnea and Insulin Treated Diabetes Proposed Rules.

The joint FMCSA/FRA ANPRM Rule on Obstructive Sleep Apnea (OSA) has been withdrawn.   According to FMCSA, after reviewing all the public comments there was not enough information to support moving forward at this time.   The purpose of the ANPRM was to evaluate the prevalence and consequence of moderate to severe OSA in safety sensitive personnel in transportation.  The notice of withdrawal can be found at:

There is no indication if the ANPRM will be reinstated in the near future.   However, some drivers are taking this as indication that medical examiners can not evaluate drivers for OSA.  That could not be further from the truth.  However, the withdrawal of the ANPRM will probably serve to create more confusion in an already highly contentious arena.   Rule or no rule the responsible medical examiner would be wise to remember the following:

49 CFR 391.41 (b) (5) states that individuals who operate in interstate commerce are prohibited from receiving a medical examiner’s certificate if they have an:

“established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his or her ability to control and drive a commercial motor vehicle safely”

That applies to any respiratory dysfunction and not just OSA.


Another rule, to amend the diabetes standard for insulin treated diabetes is still in play.  FMCSA is requesting comments on a proposed revised form called “Insulin Treated Diabetes Assessment Form”.   The form would be completed by the driver’s treating clinician and sent to the medical examiner who would determine if an insulin treated driver is safe to operate a commercial vehicle in interstate commerce.   This rule would replace the current Diabetes Exemption Program and allow determination of fitness to drive to be made by the medical examiner in consultation with the driver’s treating clinician.  Comments on the new form is due by September 27, 2017 and can be submitted at:

Two significant recent announcements.   One rule is withdrawn and another continues forward.  What does this add up to?   Actually, either way, more responsibility and more work for medical examiners, as it should be!  The recent Mayo-ATRI survey cited a major concern for motor carriers that of “unqualified” or “incompetent” medical examiners, which ranked third as most important issue of concern by all the motor carrier respondents.  Look, not all driver certifications are going to be easy or straightforward.  For those not so easy certifications, the overall competence of a medical examiner, and the examiner’s diligence and resourcefulness are all very important factors that will improve certification determinations.   Since medical examiners do not all have similar medical training and qualifications, backgrounds, specializations, and experiences, knowing one’s limitations and when to seek help is not only the right thing to do in difficult cases, but the professional and responsible thing.   Many resources are available through the FMCSA, and various occupational medicine publications and Listservs for medical examiners to consult others and each other.   What is clear, rule or no rule, Medical Examiner Handbook or no Handbook, there is no room for mediocrity, and the standards that exist such as 49 CFR 391.41 (b) (5) are purposely “broad” for a reason, and should be followed.