You failed your DOT physical. Now what?

Screen Shot 2021 03 17 At 1 02 34 Pm Headshot
Updated Jun 26, 2021

woman consulting with patient about eye examWhen a Certified Medical Examiner isn't up on current guidelines for CDL holders, it's possible a driver will fail a health exam for an invalid reason. Getting a second opinion is one way to handle that problem.A lot of commercial drivers are fearful of failing a DOT physical exam and rightfully so. As a Certified Medical Examiner (CME), I do not make a failure decision lightly, knowing drivers need a medical certificate to support themselves and their families. 

Some drivers are truly not healthy enough to be behind the wheel. Their conditions could pose a deadly risk to themselves and others on the road. So it’s no surprise that doctors who don’t follow their CME regulations risk anything from losing their licenses to being imprisoned.

However, the medical review process isn’t always clear-cut, so there can be cases where a failed driver should seek a second opinion.

trucking law logoThere are only a few regulations that CMEs must follow by law. These are qualifications covering vision, hearing, seizures and insulin use. In these areas, the CME has zero leeway in deciding to qualify a driver who does not meet certain benchmarks. For example, DOT law requires a driver to have 20/40 vision in each eye.

The majority of the DOT physical exam, though, doesn’t fall under those areas. Any questionable condition is left to the examiner's judgment, though usually with direction from approved guidelines.

For example, the Federal Motor Carrier Safety Administration’s Medical Review Board, with the help of national cardiology organizations, says that a driver who has a heart attack may return to driving after two months while meeting other medical criteria. Although these are guidelines, not regulations, FMCSA strongly suggests CMEs not to deviate from board guidance. 

There are rare circumstances where a CME might decide that a deviation is acceptable. These situations require significant documentation from the CME, as well as other supporting documentation. 

Unfortunately, there are CMEs who are not up to date with current guidelines or are simply ill-informed. Situations can arise where a driver meets the consensus guidelines for their medical condition, but for various reasons the CME refuses to certify them.

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I have come across this in my clinic. In some cases, a driver was failed by a CME using incorrect guidelines. Then after I saw the driver, reviewed their medication documentation and spoke with their treating physicians, they were certified.

For example, a CME might follow extremely outdated guidelines for a diabetic’s hemoglobin levels. Or a sleep study might suggest a driver has very mild sleep apnea.  The results don’t warrant mandating a CPAP device, but the CME thinks otherwise. A CME might automatically fail someone with only one good eye, deafness or a missing limb, not even considering the process for seeking a waiver for the condition. Such situations and others like them would merit getting a second opinion.

If a driver is failed by a CME, that failure is uploaded to the FMCSA national database. If a driver is later certified, that also will be uploaded and will override the previous exam.

Where drivers can run into problems is when they doctor-shop, fail the certification repeatedly, then suddenly pass. FMCSA, which is able to see all previous exams, will be suspicious and will contact the driver. Also, when a driver leaves in the middle of a DOT physical or does not complete one, this will be uploaded as an incomplete exam. Having multiple incomplete exams also sends up a red flag for FMCSA. 

Drivers have been prosecuted for failing to disclose medical histories in order to obtain certification. This is one of the worst things you can do. Chances are you will be caught and lose your driving career. You might even end up in prison.

Dr. Alexander E. Underwood

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