FMCSA CERTIFICATION SUMMARY -...

FMCSA CERTIFICATION SUMMARY !!!!

�1

TABLE OF CONTENT !VISION……………………………………………….…………………. 4 !HEARING………………………………………….…………………… 4 !CARDIOVASCULAR………………………………………………… 5 Abdominal Aor,c Aneurysm (AAA)………………………….……… 5 Acute Deep Vein Thrombosis (DVT)………………………………… 5 Chronic Thrombo,c Venous Disease……………………….……… 6 Intermi@ent Claudica,on……………………………………………..… 6 Aneurysms…………………………………………………………..…………. 6 Peripheral Vascular Disease (PVD)………………………..………… 6 Pulmonary Emboli………………………………………………..………… 7 Superficial Phlebi,s……………………………………………….……..… 7 Thoracic Aneurysm…………………………………………….…………… 7 Varicose Veins………………………………………………………………… 7 Implantable Cardioveter-‐Defibrillators (ICD)…………………… 8 Pacemakers………………………………………………………….………… 8 Supraventricular Arrhythmias………………………………………… 9 Ventricular Arrhythmias…………………………………………….…… 10 Post-‐Acute Myocardial Infarc,on………………….………………… 10 Angina Pectoris-‐-‐Stable Angina………………………………….…… 11 CHD Risk factors…………………………………………………..………… 11 Coronary Artery Bypass GraTing Surgery……..………………… 12 Heart Failure……………………………………………………………..…… 12 Percutaneous Coronary Interven,on……………………….……… 13 Congenital Heart Disease: Ebstein Anomaly…………………… 13 Heart Transplanta,on…………………………………………….……… 14 Hypertrophic Cardiomyopathy……………………..………………… 14 Restric,ve Cardiomyopathy………………………………….………… 14 Syncope…………………………………………………………………..……… 14 Aor,c Regurgita,on……………………………….……………………… 15 Severe Aor,c Regurgita,on…………….……………………………… 16

Aor,c Stenosis……………………………………………………..………… 17 Aor,c Valve Repair………………………………….……………………… 17 Mitral Regurgita,on…………………………….………………………… 18 Mitral Stenosis………………………………………………………..……… 18 Post-‐Percutaneous Balloon Mitral Valvotomy.………………… 18 Post-‐Surgical Commissurotomy……………………………….……… 19 Mitral Valve Prolapse……………………………………………..……… 19 Prosthe,c Valves……………………………………………….…………… 20 Pulmonary Valve Stenosis…………………….………………………… 21 !!HYPERTENSION……………………………..……….………… 22 Stage 1 Hypertension……………………………………………………… 22 Stage 2 Hypertension……………………………………………………… 22 Stage 3 Hypertension……………………………………………………… 23 Secondary Hypertension…………………….…………………………… 23 !!RESPIRATORY……………….……………………………….……… 24 An,histamine Therapy…………………………………………………… 24 Allergic Rhini,s…………………………………………………….………… 24 Allergy-‐Related Life-‐Threatening Condi,on.…………………… 25 Asthma…………………………………………………………………..……… 25 Hypersensi,vity Pneumoni,s…………….…………………………… 25 Chronic Obstruc,ve Pulmonary Disease…….…………………… 26 Chronic Sleep Disorders…….………………………………….………… 26 Infec,ous Respiratory Diseases………………….…………………… 27 Atypical Tuberculosis…….………………………………………..……… 27 Pulmonary Tuberculosis…………………………….…………………… 28 Chest Wall Deformi,es…….…………………………..………………… 28 Cys,c Fibrosis…….…………………………………………..……………… 29 Inters,,al Lung Disease…….…………………………………………… 29 Pneumothorax…….…………………………………………….…………… 29 Cor Pulmonale…….……………………………………………….………… 30 Pulmonary Hypertension………………………………………………… 31

�2

NEUROLOGICAL…….…………………………………….…..…… 32 An,convulsant Therapy…….…………………………….……………… 32 An,coagulant Therapy…….……………………………..……………… 32 Acute seizures: structural insult to the brain.………………..… 33 Acute seizures: systemic metabolic illness…….………………… 33 Childhood febrile seizures…….………………………………………… 34 Epilepsy…….……………………………………………………….…………… 34 Headaches…….……………………………………………..………………… 34 Single Unprovoked Seizure……………………………………………… 35 Ver,go and Dizziness…….………………………………..……………… 35 Infec,ons of the Central Nervous System…….…………….…… 35 Autonomic Neuropathy…….…………………………………….……… 36 Condi,ons Associated with Abnormal Muscle Ac,vity.…… 36 Congenital Myopathies……………………………..…………………… 36 Metabolic Muscle Diseases…….………………………….…………… 36 Motor Neuron Diseases…….………………………………….………… 37 Muscular Dystrophies…….…………………………………….………… 37 Neuromuscular Junc,on Disorders…………….…………………… 37 Peripheral Neuropathies…….……………………………………..…… 37 Central Nervous System Tumors…….…………….………………… 37 Demen,a…….………………………………………………………….……… 38 Embolic and Thrombo,c Strokes…….…………….………………… 38 Intracerebral and Subarachnoid Hemorrhages.……………… 38 Transient Ischemic A@ack…….………………………………………… 39 Trauma,c Brain Injury (TBI)…….…………………..………………… 39 !!MUSCULOSKELETAL…….…………………..…………………… 40 Fixed Deficit of an Extremity…………………………………………… 40 Autonomic Neuropathy…….…………………………….……………… 40 Condi,on associated with abnormal muscle ac,vity….…… 40 Congenital Myopathies…….……………………………………….…… 41

Metabolic Muscle Disease…….………………………………..……… 41 Motor Neuron Disease…….……………………………………..……… 41 Neuromuscular Junc,on Disorders…….…………………………… 41 !!DIABETES MELLITUS…….…………………………..…..……… 42 Nephropathy…….……………………………………………………….…… 42 Incre,n Mime,c Therapy………………………..……………………… 43 Insulin Therapy…….………………………………………………………… 43 Oral Hypoglycemics…………………………………..…………………… 44 !!OTHER DISEASES…….…………………………..………………… 44 Hernia…….……………………………………………………………………… 44 !!PSYCHOLOGICAL…….……………………………………..……… 45 Adult A@en,on Deficit Hyperac,vity Disorder (ADHD).…… 45 Bipolar Mood Disorder…….…………………………………..………… 45 Major Depression…….…………………………………………..………… 46 Personality Disorders……………………………………………………… 46 Schizophrenia and Related Psycho,c Disorders……….……… 47 An,psycho,c Therapy…….……………………………………………… 47 Electroconvulsive Therapy (ECT)…….……………….……………… 48 Anxioly,c and Seda,ve Hypno,c Therapy…….……..………… 48 An,depressant Therapy…….…………………………………………… 49 Lithium Therapy…….……………………………………….……………… 49 Central Nervous System S,mulant Therapy…….……………… 49 !DRUG ABUSE AND ALCOHOL…….……………………..…… 50 Alcoholism…….……………………………………………………..………… 50 Drug Abuse…….…………………………………………….………………… 50 !!!

�3

!Vision

Condi&on Wai&ng period Cer&fica&on Period

Has distant visual acuity and distant binocular acuity of at least 20/40 (Snellen)

Maximum two years

Field of vision at least 70meridian in each eye

Maximum two years

Ability to recognize colors of traffic signals Maximum two years

Driver has monocular and applies for Federal Vision Exemp&on

Maximum one year

Hearing


Benign posi&onal ver&go Minimum two months Maximum two years

Acute and chronic peripheral ves&bulopathy Minimum two months Maximum two years

Uncontrolled ver&go Do not cer&fy

Meniere’s Disease Do not cer&fy

Labyrinthine Fistula Do not cer&fy

Nonfuncitoning Fistula Do not cer&fy

�4

Cardiovascular


No current diagnosis of Myocardial Infarc&on, Angina Pectoris, Coronary Insufficiency, or Thrombosis

Maximum two years

Abdominal Aor3c Aneurysm (AAA)


AAA is <4 cm; driver is asymptoma&c One year

AAA is >4 cm and <5cm; driver is asymptoma&c One year

AAA is surgically repaired Minimum three months One year

AAA symptoms present with driver Do not cer&fy

AAA is recommended for surgical repair Do not cer&fy

AAA is >4 cm and <5cm; does not have medical clearance

Do not cer&fy

AAA has increased by more than 0.5 cm during a 6 month period.

Do not cer&fy

Acute Deep Vein Thrombosis (DVT)


No residual, acute DVT One year

Ineffec&vely treated DVT Do not cer&fy

�5

Chronic Thrombo3c Venous Disease


Has no symptoms Two years

Condi&on endanger the health and safety of the driver and the public

Do not cer&fy

IntermiCent Claudica3on


Surgery provides relief of symptoms Minimum three months Maximum One year

Driver has pain at rest Do not cer&fy

Aneurysms


Surgical repair of aneurysm and meets guidelines Minimum three months One year

Drive is recommended for surgical repair of aneurysm but procedure has not been performed

Do not cer&fy

Peripheral Vascular Disease (PVD)


No other cardiovascular disease Minimum three months One year

Driver has pain at rest Do not cer&fy

Drive is recommended for surgical repair of aneurysm; procedure has not been performed

Do not cer&fy

�6

Pulmonary Emboli


Appropriate long term treatment Minimum three months One year

No other disqualifying cardiovascular disease One year

Symptoms are present Do not cer&fy

Superficial Phlebi3s

Condi&on Cer&fica&on Period

Driver is medically qualified Two years

Coexis&ng DVT Do not cer&fy

Thoracic Aneurysm


Aneurysm less than 3.5 cm One year

Surgically repaired aneurysm Minimum three months One year

Aneurysm greater than 3.5 cm Do not cer&fy

Varicose Veins


No complica&ons exist Two years

Severity of the condi&on endangers the health and safety driver and the public

Do not cer&fy

�7

Implantable Cardioveter-‐Defibrillators (ICD)


Driver has ICD Do not cer&fy

Driver has ICD/pacemaker combina&on device Do not cer&fy

Pacemakers


Post-‐ pacemaker implant for sinus node dysfunc&on

Minimum one month Maximum one year

Post-‐pacemaker implant for AV block Minimum one month Maximum one year

Post-‐pacemaker implant for Neurocardiogenic syncope

Minimum three months Maximum one year

Post-‐pacemaker implant for Hypersensi&ve caro&d sinus with syncope


Driver has documenta&on indica&ng the presence of a func&oning pacemaker

Maximum one year

Driver has documenta&on indica&ng the comple&on fo rou&ne pacemaker checks

Maximum one year

No disqualifying disease Maximum one year

Driver has an implantable cardiac defibrillator/pacemaker combina&on device

Do not cer&fy

Driver has an underlying disease Do not cer&fy

�8

Supraventricular Arrhythmias


An&coagulated adequately with diagnosis of atrial fibrilla&on


An&coagulated adequately following thoracic surgery


Post-‐isthmus abla&on and diagnosis is atrial flucer


Asymptoma&c with Atrioventricular nodal reentrant tachycardia diagnosis


Asymptoma&c with Atrioventricular nodal reentrant tachycardia and Wolff-‐Parkinson-‐White syndrome diagnosis


Asymptoma&c with Atrial tachycardia diagnosis Minimum one month Maximum one year

Junc&onal tachycardia Minimum one month Maximum one year

Driver has controlled heartbeat Maximum one year

Treatment for preven&on of emboli that is effec&ve and tolerated

Maximum one year

No underlying disease that is disqualifying Maximum one year

Condi&on causes loss of consciousness Do not cer&fy

Compromised cerebral func&on Do not cer&fy

Sudden death resuscita&on Do not cer&fy

�9

Ventricular Arrhythmias


Drug or other therapy and diagnosis is Coronary heart disease


Drug or other therapy and diagnosis is Right Ventricular ouflow VT


Drug or other therapy and diagnosis is Idiopathic leg ventricular VT


Driver is asymptoma&c Maximum one year

Has an iden&fied non-‐disqualifying cardiac cause Maximum one year

Drive is symptoma&c Do not cer&fy

Has sustained VT Do not cer&fy

Has NSVT, LVEF less than 0.40 Do not cer&fy

Has a diagnosis of Hypertrophic cardiomyopathy Do not cer&fy

Has a diagnosis of Long QT interval syndrome Do not cer&fy

Has a diagnosis of Brugada syndrome Do not cer&fy

Post-‐Acute Myocardial Infarc3on


Driver is asymptoma&c Minimum two months Maximum one year

Driver tolerates medica&ons Minimum two months Maximum one year

Driver has sa&sfactory exercise tolerance test (ETT)

Minimum two months Maximum one year

�10

Post-‐Acute Myocardial Infarc,on con,nue..

Has a res&ng leg ventricular ejec&on frac&on (LVEF) greater than or equal to 40%

Minimum two months Maximum one year

Rest angina or change in angina pacern within 3 months of examina&on

Do not cer&fy

Ischemic changes on rest electrocardiogram Do not cer&fy

Intolerance to cardiovascular therapy Do not cer&fy

Angina Pectoris-‐-‐Stable Angina


Driver has stable angina Minimum 3 months Maximum one year

Driver is asymptoma&c Minimum 3 months Maximum one year

Drive tolerates medica&ons Minimum 3 months Maximum one year

Has sa&sfactory exercise tolerance test (ETT) Minimum 3 months Maximum one year

Unstable angina is present within 3 months examina&on

Do not cer&fy

CHD Risk factors


Nature and severity of the medical condi&on of the driver does not endanger the health and safety of the driver and the public

Maximum one year

Nature and severity of the medical condi&on of the driver endangers the health and safety of the driver and the public

Do not cer&fy

�11

Coronary Artery Bypass GraRing Surgery


Driver is asymptomatc Minimum three months Maximum one year

Tolerates cardiovascular medica&ons with no orthosta&c symptoms


Has a LVEF greater than or equal to 40% Minimum three months Maximum one year

Has a healed sternum Minimum three months Maximum one year

Driver is symptoma&c Do not cer&fy

Driver has orthosta&c symptom sides effects from cardiovascular medica&on

Do not cer&fy

Has LVEF less than 40% Do not cer&fy

Has sternum that has not healed Do not cer&fy

Heart Failure



Driver tolerates medica&on Maximum one year

Driver ETT results greater than 6 METs Maximum one year

Has a LVEF greater than or equal to 40% Maximum one year

Has symptoma&c HF Do not cer&fy

Is asymptoma&c with LVEF less than or equal to 50% and has ventricular arrhythmias

Do not cer&fy

�12

Percutaneous Coronary Interven3on


Post procedure Minimum one week Maximum one year


Driver tolerates medica&ons Maximum one year

Drive has no injury to the vascular access site Maximum one year

Incomplete healing or complica&on at vascular access site

Do not cer&fy

Angina at rest Do not cer&fy

Ischemic Electrocardiogram (ECG) changes Do not cer&fy

Congenital Heart Disease: Ebstein Anomaly



Driver has mile tricuspid anomaly Maximum one year

Driver has mild cardiac enlargement Maximum one year

Driver has mild right ventricular dysfunc&on Maximum one year

Moderate or severe anomaly Do not cer&fy

Intracardiac lesion Do not cer&fy

Driver has a shunt Do not cer&fy

Driver has symptoma&c arrhythmia Do not cer&fy

Driver has accessory conduc&on pathway Do not cer&fy

�13

Heart Transplanta3on


Post transplant Minimum one year Maximum six months

Driver is asymptoma&c Maximum six months

Driver tolerates medica&ons Maximum six months

Driver has no signs of transplant rejec&on Maximum six months

The nature and severity of the medical condi&on endangers the health and safety of the driver and the public.

Do not cer&fy

Hypertrophic Cardiomyopathy


Posi&ve diagnosis Do not cer&fy

Restric3ve Cardiomyopathy


Posi&ve diagnosis Do not cer&fy

Syncope


The driver has been treated for symptoma&c disease

Maximum one year


�14

Syncope con,nue…

Driver tolerates medica&ons Maximum one year

Driver is at low risk for syncope/near syncope Maximum one year

Driver experiences syncope as consequence of a disease process

Do not cer&fy

Driver is at high risk for syncope/near synocpe, regardless of the underlying heart disease

Do not cer&fy

Aor3c Regurgita3on


Mild Aor&c regurgita&on; asymptoma&c Maximum one year

Moderate Aor&c regurgita&on; normal LV fun&on Maximum one year

Driver has symptoms Do not cer&fy

Driver has moderate aor&c regurgita&on with abnormal LV func&on

Do not cer&fy

Echocardiography repeated ever 2 to 3 years when cer&fied with mild or moderate aor&c regurgitaion

Do not cer&fy !!!!!!!!!!

�15

Severe Aor3c Regurgita3on


Post-‐aor&c valve repair Minimum three months

Not surgically repaired and the driver has: • No symptoms. • Normal LV func&on. • LV dilata&on: • LV end-‐diastolic dimension (LVEDD) less

than or equal to 60 mm. • LV end-‐systolic dimension (LVESD) less

than or equal to 50 mm. • The driver who has had surgical repair for

severe aor&c regurgita&on and meets guidelines for post-‐aor&c valve repair may be recer&fied for 1 year.

Maximum six months

Post-‐aor&c valve repair and the driver has: • No symptoms. • Normal LV func&on. • LV dilata&on: • LV end-‐diastolic dimension (LVEDD) less

than or equal to 60 mm. • LV end-‐systolic dimension (LVESD) less

than or equal to 50 mm. • The driver who has had surgical repair for

severe aor&c regurgita&on and meets guidelines for post-‐aor&c valve repair may be recer&fied for 1 year.

Maximum one year

Driver is symptoma&c Do not cer&fy

Driver is unable to achiever workload greater than 6 METS on Bruce protocol

Do not cer&fy

�16

Severe Aor,c Regurgita,on con,nue…

Driver has reduced LVEF <50% Do not cer&fy

Has LV dila&on LVEDD >70mm or LVESD >55mm Do not cer&fy

Aor3c Stenosis


Post surgical repair Three months Maximum one year

Asymptoma&c mild aor&c stenosis Maximum one year

Asymptoma&c moderate aor&c stenosis Maximum one year

Surgically repaired severe aor&c stenosis Maximum one year

Angina Do not cer&fy

Heart Failure Do not cer&fy

Atrial fibrilla&on Do not cer&fy

Leg ventricular dysfunc&on; ejec&on frac&on<50%

Do not cer&fy

Thromboembolism Do not cer&fy

Severe aor&c stenosis Do not cer&fy

Aor3c Valve Repair


Post Aor&c Valve Repair Minimum three months Maximum one year

Thromboembolic complica&ons Do not cer&fy

�17

Mitral Regurgita3on


Post-‐ surgical commisurotomy Minimum 3 months Maximum one year

Asymptoma&c mild or moderate mitral regurgita&on, normal LV size and func&on, normal pulmonary artery pressure.

Maximum one year

Asymptoma&c severe mitral regurgita&on Maximum one year

Mitral Stenosis


Post-‐percutaneous balloon mitral valvotomy Minimum 4 weeks Maximum one year

Post-‐surgical commissurotomy Minimum 3 months Maximum one year

Asymptoma&c mild mitral stenosis Maximum one year

Asymptoma&c moderate mitral stenosis Maximum one year

Severe mitral stenosis and a clearance from a cardiovascular specialist

Maximum one year

Unsuccessfully treated severe Mitral Stenosis Do not cer&fy

Post-‐Percutaneous Balloon Mitral Valvotomy

Condi&on Wai&ng Period Cer&fica&on Period

Driver is asymptoma&c Minimum four weeks Maximum one year

Has clearance from a cardiovascular specialist Minimum four weeks Maximum one year

Driver has no thromboembolic complica&ons Minimum four weeks Maximum one year

Driver has no pulmonary hypertension Minimum four weeks Maximum one year

�18

Post-‐Percutaneous Balloon Mitral Valvotomy con,nue…


Pulmonary hypertension Do not cer&fy

Post-‐Surgical Commissurotomy


Driver is asymptoma&c Minimum 3 months Maximum one year

Has clearance from a cardiovascular specialist Minimum 3 months Maximum one year

No thromboembolic complica&ons Minimum 3 months Maximum one year

No pulmonary hypertension Minimum 3 months Maximum one year

Thrombolic complica&ons Do not cer&fy


Mitral Valve Prolapse


Severity of the condi&on does not endanger the health and safety of the drive or the public

Maximum one year

Has symptoms or reduced effort Do not cer&fy

Ruptured or chordate or flail leaflet Do not cer&fy

Systemic emboli Do not cer&fy


Syncope or ventricular tachycardia Do not cer&fy

�19

Mitral Valve Prolapse con,nue…

Sever mitral regurgita&on or LV dysfunc&on Do not cer&fy

Post-‐Mitral Valve repair Minimum 3 months Maximum one year

Prosthe3c Valves


Post-‐Prosthe&c Valve Replacement Minimum three months Maximum one year


Has clearance from a cardiovascular specialist Maximum one year

Persistent symptoms Do not cer&fy

LV dysfunc&on with EF of <40% Do not cer&fy




Inadequate an&coagula&on Do not cer&fy !!!!!!!

�20

Pulmonary Valve Stenosis


Post-‐Balloon valvuloplasty Minimum one month Maximum one year

Post-‐Surgical valvotomy Minimum three months Maximum one year

Symptoms of dyspnea, palpita&ons, or syncope. Do not cer&fy

Pulmonary valve peak gradient greater than 50 mm Hg in the presence of a normal cardiac output.

Do not cer&fy

Right ventricular pressure greater than 50% systemic pressure.

Do not cer&fy

More than mild right ventricular hypertrophy or dysfunc&on noted by echocardiography.

Do not cer&fy

More than moderate pulmonary valve regurgita&on noted by echocardiography.

Do not cer&fy

Main pulmonary artery diameter more than 5 cm noted by echocardiography or other imaging modality.

Do not cer&fy!!!!!

�21

Hypertension

Stage 1 Hypertension


No history of hypertension Maximum one year

No use of an&hypertensive medica&on Maximum one year

Driver has a one year cer&ficate for untreated stage 1 hypertension

Maximum 3 months

No prescrip&on for an&hypertensive medica&on Maximum 3 months

Driver has a one-‐&me, three-‐month cer&ficate for elevated Burke Proper&es >140/90

Do not cer&fy

A history of Stage 3 hypertension and Burke Proper&es >140/90

Do not cer&fy

BP > 180/110 Do not cer&fy



BP of >160/100 but <180/110; no history of hyptertension; no use of an&hypertensive medica&ons

One &me for three months

Driver has a one-‐&me, three-‐month cer&ficate and BP greater than 140/90

Do not cer&fy

History of stage 3 hypertension and BP >140/90 Do not cer&fy

BP >180/110 Do not cer&fy

�22



History of Stage 3 hypertension Maximum of 6 months

BP of 180/110 or greater Do not cer&fy

Secondary Hypertension


Post-‐surgical correc&on; BP <140/90 Three months Maximum one year

Medical condi&on of the driver does not endanger the health and safety of the driver and the public.

Do not cer&fy!!!!!!!!!!!!!

�23

Respiratory

An3histamine Therapy


Treatment does not endanger the health and safety of the driver and the public

Abstain for 12 hours before vehicle opera&on

Maximum two years

Treatment interferes with driving ability Do not cer&fy

Allergic Rhini3s



Maximum two years

Severe conjunc&vi&s affec&ng vision Do not cer&fy

Inability to keep eyes open Do not cer&fy

Photophobia Do not cer&fy

Uncontrollable sneezing fits Do not cer&fy

Sinusi&s with severe headaches Do not cer&fy

Medica&ons that cause seda&on or other side effects

Do not cer&fy !!!!!!!

�24

Allergy-‐Related Life-‐Threatening Condi3ons



Maximum two years

There is no effec&ve treatment regimen Do not cer&fy

There is no successful preven&ve measures Do not cer&fy

Asthma



Maximum two years

Con&nual, uncontrolled, symptoma&c asthmas Do not cer&fy

Significant impairment of pulmonary func&on Do not cer&fy

Hypersensi3vity Pneumoni3s



Maximum two years

Medical condi&on of the driver endangers the health and safety of the driver and the public.

Do not cer&fy !!!!

�25

Chronic Obstruc3ve Pulmonary Disease



Maximum two years

Hypoxemia at rest Do not cer&fy

Chronic respiratory failure Do not cer&fy

History of con&nuing cough with cough syncope Do not cer&fy

Chronic Sleep Disorders

Beginning CPAP Minimum one month Maximum one year

Post surgical treatment Minimum three months Maximum one year

Successful nonsurgical therapy with: • Mul&ple sleep latency tes&ng values within

the normal range. • Resolu&on of apneas confirmed by repeated

sleep study during treatment. • Con&nuous successful nonsurgical therapy

for 1 month. • Compliance with con&nuing nonsurgical

therapy. • Resolu&on of symptoms following

comple&on of post-‐surgical wai&ng period.

Maximum one year !!!!!!!!!!!!!!!

�26

Chronic Sleep Disorders con,nue…

The driver has: • Hypoxemia at rest. • Untreated symptoma&c OSA. • Narcolepsy. • Primary (idiopathic) alveolar hypoven&la&on

syndrome. • Idiopathic central nervous system

hypersomnolence. • Restless leg syndrome associated with EDS.

Do not cer&fy

Infec3ous Respiratory Diseases



Maximum two years


Do not cer&fy

Atypical Tuberculosis


Disease remains rela&vely stable, there is normal lung func&on

Maximum two years

Extensive pulmonary dysfunc&on Do not cer&fy

Weakness and Fa&gue Do not cer&fy

Adverse reac&on to medical treatment Do not cer&fy !

�27

Pulmonary Tuberculosis


Driver is no longer contagious Maximum two years

Streptomycin therapy is complete without affec&ng hearing or balance

Maximum two years

Compliant with an&tubercular therapy Maximum two years

Advance TB with respiratory insufficiency Do not cer&fy

Chronic TB Do not cer&fy

Non compliance with an&tubercular or streptomycin therapy

Do not cer&fy

Residual eighth cranial nerve damage affec&ng balance or hearing

Do not cer&fy

Chest Wall Deformi3es



Maximum two years



Con&nuing cough with cough syncope Do not cer&fy

�28

Cys3c Fibrosis



Maximum two years




Not met spirometry parameters Do not cer&fy

Condi&on unstable Do not cer&fy

Inters33al Lung Disease



Maximum two years




Pneumothorax


Asymptoma&c without chest pain or shortness of breath

Maximum two years

No disqualifying underlying disease Maximum two years

�29

Pneumothorax con,nue…

Confirmed resolu&on of the single spontaneous pneumothorax

Maximum two years

Successful pleurodesis and meets acceptable pulmonary parameters

Maximum two years

Not met cer&fica&on parameters Do not cer&fy

Two or more spontaneous pneumothoraces on one side; no successful surgical procedure has been done to prevent recurrence

Do not cer&fy




Cor Pulmonale



Maximum two years

Dyspnea at rest Do not cer&fy

Dizziness Do not cer&fy

Hypotension Do not cer&fy

Par&al pressure of arterial oxygen (PaOarterial blood greater than 65 millimeters of mercury (mm Hg).

Do not cer&fy !!

�30

Pulmonary Hypertension



Maximum one year

Dyspnea at rest Do not cer&fy

Dizziness Do not cer&fy

Hypotension Do not cer&fy

Par&al pressure of arterial oxygen (PaOarterial blood greater than 65 millimeters of mercury (mm Hg).

Do not cer&fy !!!!!!!!

�31

Neurological

An3convulsant Therapy



Maximum two years

An&convulsant medica&ons are used to control or prevent seizures

Do not cer&fy

An3coagulant Therapy


Stabilized on medica&on Minimum one month Maximum one year

Has monthly INR monitoring Maximum one year

Unmonitored INR Do not cer&fy

INR is not therapeu&c Do not cer&fy

Presence of underlying neurological condi&on Do not cer&fy !!!!!!!!!!

�32

Acute seizures: structural insult to the brain


Seizure free and off an&convulsant medica&on: • Mild insult without early seizures. • Stroke without risk for seizures. • Intracerebral or subarachnoid hemorrhage

without risk for seizures.

Minimum one year Maximum one year

Seizure free and off an&convulsant medica&on: • Moderate insult without early seizures. • Mild insult with early seizures

Minimum two years Maximum one year

Seizure free and off an&convulsant medica&on: • Moderate insult with early seizures. • Stroke with risk for seizures. • Intracerebral or subarachnoid hemorrhage

with risk for seizures.

Minimum five years Maximum one year

Not completed minimum wai&ng period seizure and an&convulsant medica&on free

Do not cer&fy

Does not have clearance from a neurologist Do not cer&fy

Acute seizures: systemic metabolic illness


Underlying systemic metabolic dysfunc&on has been corrected

Maximum two years

Driver has no disqualifying risk of recurrence of the primary condi&on

Maximum two years


Do not cer&fy

�33

Childhood febrile seizures


History of seizures is limited to childhood Maximum two years


Do not cer&fy

Epilepsy


Off of an&convulsant medica&on and seizure free

Minimum 10 years Maximum two years

Clinical diagnosis or medical history of epilepsy Do not cer&fy

Driver takes an&convulsant medica&on because of a medical history of seizures

Do not cer&fy

Headaches



Maximum two years


Do not cer&fy !!!!!

�34

Single Unprovoked Seizure


Driver is off an&convulsant medica&on and has clearance from a neurologist specializing in epilepsy

Minimum five years Maximum one year

Ver3go and Dizziness


Benign posi&onal ver&go; symptom free Minimum two months Maximum two years

Acute and chronic peripheral ves&bulopathy Minimum two months Maximum two years


Maximum two years

Benign posi&onal ver&go; has been symptoma&c Do not cer&fy

Meniere’s disease Do not cer&fy

Labynnithine fistula Do not cer&fy

Nonfunc&oning labynniths Do not cer&fy

Infec3ons of the Central Nervous System


Bacterial meningi&s without early seizures Minimum one year Maximum two years

Viral encephali&s without early seizures Minimum one year Maximum two years

Bacterial meningi&s with early seizures Minimum five years Maximum two years

Viral encephali&s with early seizures Minimum ten years Maximum two years

CNS infec&on is present Do not cer&fy

�35

Autonomic Neuropathy



Maximum two years

Presence of cardiovascular autonomic neuropathy

Do not cer&fy

Condi3ons Associated with Abnormal Muscle Ac3vity



Maximum two years

Diagnosis of Myotonia, Isaac’s syndrome, or S&ff-‐man syndrome

Do not cer&fy

Congenital Myopathies


Any diagnosis of Congenital Myopathy Do not cer&fy

Metabolic Muscle Diseases


Any diagnosis of Metabolic Muscle Disease Do not cer&fy

�36

Motor Neuron Diseases


Any diagnosis of Motor Neuron Disease Do not cer&fy

Muscular Dystrophies


Any diagnosis of Muscular Dystrophy Do not cer&fy

Neuromuscular Junc3on Disorders


Any diagnosis of Neuromuscular Junc&on Disorders

Do not cer&fy

Peripheral Neuropathies


Any diagnosis of Peripheral Neuropathy Do not cer&fy

Central Nervous System Tumors


Post-‐surgical removal of: • Infratentorial meningiomas. • Acous&c neuromas. • Pituitary adenomas. • Spinal benign tumors. • Benign extra-‐axial tumors.


Post-‐surgical removal of: • Benign supratentorial tumors. • Spinal tumors.

Minimum two years Maximum one year

�37

Central Nervous System Tumors con,nue…

Driver has primary or metasta&c malignant tumors or benign nervous system tumors

Do not cer&fy

Demen3a


Any diagnosis of demen&a Do not cer&fy

Embolic and Thrombo3c Strokes


Not at risk for seizures Minimum one year Maximum one year

At risk for seizures Minimum five years Maximum one year

Use of oral an&coagulant Do not cer&fy

Use of any drug that may have high rates of complica&ons

Do not cer&fy

Presence of residual intellectual or physical impairments

Do not cer&fy

Intracerebral and Subarachnoid Hemorrhages


Not at risk for seizures Minimum one year Maximum one year

At risk for seizures Minimum five years Maximum one year



Do not cer&fy

�38

Intracerebral and Subarachnoid Hemorrhages con,nue…

Presence of residual intellectual or physical impairments

Do not cer&fy

Transient Ischemic ACack


Any Transient Ischemic Acack Minimum one year Maximum one year



Do not cer&fy

Trauma3c Brain Injury (TBI)


Moderate TBI without early seizures Minimum two years Maximum one year

Mild TBI with early seizures Minimum two years Maximum one year

Mild TBI without early seizures Maximum two years

Moderate TBI with early seizures Minimum five years Maximum one year

Severe TBI with or without early seizures Do not cer&fy !!!!!!!!

�39

Musculoskeletal

Fixed Deficit of an Extremity


Any fixed deficit of an extremity Maximum two years with SPE

A fixed deficit that affects the torso Do not cer&fy

Not providing proof of SPE cer&fica&on Do not cer&fy

Limb impairment caused by a progressive disease

Do not cer&fy

Autonomic Neuropathy



Maximum two years

Cardiovascular autonomic neuropathy causing res&ng tachycardia or orthosta&c blood pressures

Do not cer&fy

Condi3on associated with abnormal muscle ac3vity



Maximum two years

There is a present diagnosis of Myotonia, Isaac’s syndrome or S&ff-‐man syndrome

Do not cer&fy !

�40

Congenital Myopathies


Any diagnosis of Congental Myopathy Do not cer&fy

Metabolic Muscle Disease


Any diagnosis of Metabolic Muscle Disease Do not cer&fy

Motor Neuron Disease


Any diagnosis of Motor Neuron Disease Do not cer&fy

Neuromuscular Junc3on Disorders


Any diagnosis of Neuromuscular Junc&on Disorder


�41

Diabetes Mellitus


Has a treatment plan that manages the disease; does not include insulin usage or interfere with safe driving

Maximum two years

Previous 12 months, experienced a hypoglycemic reac&on resul&ng in: • Seizure. • Loss of consciousness. • Need of assistance from another person. • Period of impaired cogni&ve func&on that

occurred without warning.

Do not cer&fy

Previous five years, had two or more disqualifying hypoglycemic reac&ons

Do not cer&fy

Loss of posi&on or pedal sensa&on Do not cer&fy

Res&ng tachycardia or orthosta&c hypotension Do not cer&fy

A diagnosis of peripheral neuropathy or prolifera&ve re&nopathy

Do not cer&fy

Nephropathy


Driver has a treatment plan that manages the disease

Maximum cer&fica&on two years


Do not cer&fy

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Incre3n Mime3c Therapy


Meets all physical qualifica&on standards Maximum one year


Do not cer&fy

Insulin Therapy


Previous diagnosis and on treatment that di not include the use of insulin

Minimum one month Maximum one year if there is a Federal diabetes exemp&on

Newly diagnosed and on no prior treatment Minimum two months Maximum one year if there is a Federal diabetes exemp&on

Driver uses insulin Do not cer&fy

Previous 12 months, experienced a hypoglycemic reac&on resul&ng in: • Seizure. • Loss of consciousness. • Need of assistance from another person. • Period of impaired cogni&ve func&on that

occurred without warning.

Do not cer&fy

Previous five years, had two or more disqualifying hypoglycemic reac&ons

Do not cer&fy

Loss of posi&on or pedal sensa&on Do not cer&fy

Res&ng tachycardia or orthosta&c hypotension Do not cer&fy

A diagnosis of peripheral neuropathy or prolifera&ve re&nopathy

Do not cer&fy

�43

Oral Hypoglycemics


Driver should have a treatment plan that does not include the use of insulin

Maximum one year

Medical condi&on of the driver endangers the health and safety of the driver and the public

Do not cer&fy

Other Diseases

Hernia



Maximum two years

Medical condi&on of the driver endangers the health and safety of the driver and the public

Do not cer&fy !!!

�44

Psychological

Adult ACen3on Deficit Hyperac3vity Disorder (ADHD)


Driver complies with and tolerates treatment Maximum one year

Driver has an ac&ve psychosis or other prominent nega&ve symptoms such as: • Substan&ally compromised judgment. • Acen&onal difficul&es. • Suicidal behavior or idea&on. • Personality disorder that is repeatedly

manifested by overt, inappropriate acts.

Do not cer&fy

Bipolar Mood Disorder


Symptom free following a nonpsycho&c major depression unaccompanied by suicidal behavior

Minimum six months Maximum one year

Symptom free following a severe depressive episode, a suicide or a manic episode


Tolerates treatment without disqualifying side effects

Maximum one year

Driver has prominent nega&ve symptoms: • Substan&ally compromised judgment. • Acen&onal difficul&es. • Suicidal behavior or idea&on. • Personality disorder repeatedly manifested

by overt inappropriate acts. • Ac&ve psychosis

Do not cer&fy

�45

Major Depression


Symptom free following a nonpsycho&c major depression unaccompanied by suicidal behavior


Symptom free following a severe depressive episode, a suicide or a manic episode


Complies with and tolerates treatment Maximum one year



Do not cer&fy

Personality Disorders





Do not cer&fy

�46

Schizophrenia and Related Psycho3c Disorders


Brief reac&ve psychosis or schizophreniform disorder


Free of any other psycho&c disorder Minimum one year Maximum one year




Do not cer&fy

Any diagnosis of schizophrenia Do not cer&fy

An3psycho3c Therapy



Maximum one year

Treatment side effects interfere with safe driving Do not cer&fy !!!!!!

�47

Electroconvulsive Therapy (ECT)


Symptom free following a course of ECT Minimum six months Maximum one year


Driver under goes maintenance ECT Do not cer&fy

Treatment side effects interfere with safe driving Do not cer&fy

Anxioly3c and Seda3ve Hypno3c Therapy


The driver uses: • Hypno&c, if the medica&on is:

• Short-‐ac&ng (half-‐life of less than 5 hours).

• The lowest effec&ve dose. • Used for a short period of &me (less

than 2 weeks). • Non-‐seda&ng anxioly&c.

Maximum two years

Driver uses seda&ng anxioly&c Do not cer&fy

Driver has symptoms or side effects that interfere with safe driving


�48

An3depressant Therapy



Maximum one year

Driver uses a first genera&on an&depressant Do not cer&fy

Has treatment effects or side effects that interfere with safe driving

Do not cer&fy

Lithium Therapy



Driver has lithium levels within the therapeu&c range

Maximum one year

Driver has no impairment that interferes with safe driving

Maximum one year

Driver has disqualifying symptoms Do not cer&fy

Lithium levels that are not in the therapeu&c range Do not cer&fy

Central Nervous System S3mulant Therapy


No drug induced impairment Maximum one year

No tendency to increase the dose Maximum one year

Treatment side effects that interpere with safe driving

Do not cer&fy

�49

MedPro 2014 | 757-419-3700 | 100 Constitution Drive, Virginia Beach, VA 23462

Drug Abuse and Alcohol

Alcoholism


No residual disqualifying physical impairment Maximum two years

Successful comple&on counseling or treatment Maximum two years

No disqualifying alcohol-‐related disorders Maximum two years

Current clinical diagnosis of alcoholism Do not cer&fy

Signs of alcoholic illness or con-‐compliance with DOT alcohol conduct guidelines

Do not cer&fy

Drug Abuse


No residual disqualifying physical impairment Maximum two years

Successful comple&on counseling or treatment Maximum two years

Driver uses controlled substances Do not cer&fy

Amphetamines or narco&cs Do not cer&fy

Driver uses any habit-‐forming drug for which the excep&on guidelines do not apply

Do not cer&fy

Driver uses Methadone Do not cer&fy

Driver uses Marijuana Do not cer&fy

�50

FMCSA CERTIFICATION SUMMARY -...

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