Waiting game

| February 16, 2009

Drivers can apply for two types of federal medical exemptions, but they should be prepared to wait for an answer.

Patience is a virtue, and if you are thinking about applying for a federal medical exemption, it’s a virtue you better have a lot of.

As a Type 2 diabetic, 43-year-old Top Line Express driver Richard Burwell has plenty of it. He says the exemption process itself is “not that bad. The big problem is the 180-day waiting period they take to sign the paperwork after the doctor signs it. They expect you to take that time off work.”

The diabetes exemption is one of two federal exemptions for which drivers can apply. The other is a vision exemption.

“Both the vision deficiencies and the diabetes mellitus exemptions were established by Congress,” says Federal Motor Carrier Safety Administration spokeswoman Kristin Schrader. “They are federal statutes. Some elements were expressly mandated by Congress, including publication of a driver’s application in the Federal Register for public comment and the period of approval once a completed application is received.”

A driver who is an insulin-dependent diabetic is precluded from passing the medical examination associated with CDL certification. So is one whose vision is impaired, with or without corrective lenses, beyond the 20/40 requirement of the same exam or who has a horizontal field of vision less than 70 degrees in either eye or is red-green colorblind. Exemptions provide a way around this restriction for those insulin-dependent diabetics who know how to properly manage their disease and drivers with corrected vision who prove they can safely operate a CMV as a result.

A driver interested in applying for either exemption must first cross the Ts and dot the Is associated with a small mountain of application paperwork. But what might be the biggest obstacle to receiving these exemptions is that many drivers either don’t realize they exist or think they wouldn’t qualify.

“Most drivers don’t know about the process,” says Dr. Ronald Rush, CEO of Highway Health Care and clinical director of MedXpress Health Care in Texarkana, Texas. “This is for several reasons. First, most drivers don’t attempt to navigate the system, so there are not many peers for them to go to for information. Second, the information that is available to the driver is limited.”

Burwell, who obtained his diabetes exemption in 2007, says he has encountered many other drivers on the road who take insulin “on the sly.” He says this is extremely dangerous – and illegal. “The problem is, if you’re involved in an accident – and it may not even be your fault – if they find out you’re taking insulin on the sly, the accident may end up being your fault, and you may end up getting charged with vehicular homicide because you weren’t supposed to be there in the first place.”

But, Burwell adds, the insulin exemption program is there, and it is helping drivers like him get back on the road. “There is hope, and a lot of guys aren’t even aware of this yet. I get into arguments with guys at truckstops all the time, when they’re saying, ‘You can’t drive with insulin!’ And I’m saying, ‘Yes, I can!’”

The diabetes exemption
To apply for a diabetes exemption, “a driver must be evaluated by an endocrinologist and an ophthalmologist or an optometrist, and those individuals must complete paperwork certifying that the individual meets the criteria in the diabetes exemption program,” says Katie Hathaway, a representative for the American Diabetes Association. “This includes things like a recent hemoglobin A1c test result and a recent eye exam.”

Submitted paperwork also must include the endocrinologist’s signed letterhead, with the doctor’s name, signature, date, medical license number and state of issue; a completed evaluation checklist; and any additional reports outlined in the checklist. The endocrinologist must provide additional information if the driver has a history of renal, cardiovascular or neurological disease.

“The process can be different for each person, but typically they should expect to wait about six months before they receive an exemption,” Hathaway says. “The agency is permitted to take up to 180 days by law, and it often takes this long.”

The process seems even more complicated – and drawn out – for diabetics who are changing from oral medication to insulin, are newly diagnosed or have other physical problems.

“The driver should also know that they need to be on insulin for a minimum period of time before they are even eligible to apply for the exemption,” Hathaway says.

According to FMCSA guidelines, “An individual diagnosed with diabetes mellitus who had been previously treated with oral medication and who now requires insulin should have at least a one-month period on insulin to establish stable control.” For a driver who is newly diagnosed with type 1 diabetes and required to take insulin, that waiting period extends to two months.

Additionally, FMCSA requires an A1c test, which helps demonstrate the driver’s ability to manage his or her glucose levels. The driver also should be able to show he or she has had no recurrent (two or more) hypoglycemic reactions resulting in a loss of consciousness, requiring assistance from another person or which occurred without warning in the last five years.

The vision exemption
For those interested in applying for a vision exemption, an exemplary driving record is key. To even qualify for the exemption, the driver must be able to prove he or she has been driving a CMV with the vision deficiency for the three-year period immediately preceding the date of the application (this requirement often can be met through intrastate driving, where medical rules vary). Also during that time, the driver must not have had any suspensions or revocations of the CDL, no involvement in an accident to which he or she contributed and/or for which he or she received a moving traffic violation citation, no convictions for a disqualifying offense or more than one serious traffic violation while driving a CMV during the three-year period and no more than two convictions for any other moving violation in a CMV.

The applicant must provide a slew of information on personal statistics, work history and present employment, copies of supporting documents proving that the driver has indeed been driving for the prior three years, as well as paperwork completed by a doctor.

As far as doctor visits, the driver “must have been examined by an ophthalmologist or an optometrist in the last three months,” according to FMCSA. The doctor must then submit a signed statement on letterhead that verifies the driver’s deficiency, how long he or she has had the deficiency and the date of the examination. It must identify the visual acuity of each eye, corrected and uncorrected, the field of vision of each eye and the driver’s ability to recognize the colors of traffic control signals.

The doctor must also state that in his or her medical opinion the driver can safely perform the driving tasks required to operate a CMV. The vision exemption is good for a two-year period and is renewable.


For more information:
Federal Motor Carrier Safety Administration, www.fmcsa.dot.gov
For info on the diabetes and vision exemption programs, in the top-right search box search “Driver Exemption Programs,” then click on the first result.

American Diabetes Association, www.diabetes.org

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