|
|---|
|
Qualifications of Drivers: Medical Advisory Criteria Publication: Federal Register Agency: Federal Motor Carrier Safety Administration Byline: Robin Hutcheson Date: 19 January 2024 Subjects: American Government  , Driver Licensing, Safety
|
[Federal Register Volume 89, Number 13 (Friday, January 19, 2024)]
[Rules and Regulations]
[Pages 3577-3581]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-00980]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration
49 CFR Part 391
[Docket No. FMCSA-2022-0111]
Qualifications of Drivers: Medical Advisory Criteria
AGENCY: Federal Motor Carrier Safety Administration (FMCSA), Department
of Transportation (DOT).
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: FMCSA updates the Medical Advisory Criteria published as an
appendix in the Code of Federal Regulations (CFR). The appendix
provides guidance for medical examiners listed on FMCSA's National
Registry of Certified Medical Examiners (National Registry) on the
applicability and interpretation of the physical qualification
standards for operators of commercial motor vehicles. The advisory
criteria in the appendix are also intended to provide recommendations
and information to assist medical examiners in applying the standards,
basic information related to testing, and matters to consider when
making a qualification determination. The updated Medical Advisory
Criteria replace all previous versions of the criteria.
DATES: This final rule is effective on January 19, 2024.
FOR FURTHER INFORMATION CONTACT: Ms. Christine A. Hydock, Chief,
Medical Programs Division, FMCSA, 1200 New Jersey Avenue SE,
Washington, DC 20590, (202) 366-4001, FMCSAmedical@dot.gov. If you have
questions on viewing material in the docket, call Dockets Operations at
(202) 366-9826.
SUPPLEMENTARY INFORMATION:
I. Availability of Documents
To view comments or any documents mentioned as being available in
the docket, go to https://www.regulations.gov/docket/FMCSA-2022-0111/document and choose the document to review. To view comments, click
``Browse Comments.'' If you do not have access to the internet, you may
view the docket online by visiting Dockets Operations on the ground
floor of the DOT West Building, 1200 New Jersey Avenue SE, Washington,
DC 20590-0001, between 9 a.m. and 5 p.m., Monday through Friday, except
Federal holidays. To be sure someone is there to help you, please call
(202) 366-9317 or (202) 366-9826 before visiting Dockets Operations.
II. Legal Basis
FMCSA has statutory authority under 49 U.S.C. 31136(a)(3) and
31149(c)(1)(A)(i)--delegated to the Agency by 49 CFR 1.87(f)--to
establish regulations to ensure the physical condition of commercial
motor vehicle operators is adequate to enable them to operate the
vehicles safely. The guidance in the Medical Advisory Criteria is
related to the physical qualification regulations required by those
sections.
The notice and comment rulemaking procedures of the Administrative
Procedure Act (APA) do not apply to interpretative rules and general
statements of policy (commonly called ``guidance'') (5 U.S.C.
553(b)(A)). The Medical Advisory Criteria are interpretative rules that
provide guidance, but do not amend any Agency regulation or establish
any requirements for medical examiners or drivers not found in existing
regulations. Accordingly, FMCSA was not required under the APA to
solicit public comment on the criteria. Nevertheless, to ensure that
the Medical Advisory Criteria provide clear, useful, and relevant
information for stakeholders and as encouraged by DOT policy,\1\ FMCSA
opted to make a draft of the criteria available for public review and
comment (87 FR 50282 (Aug. 16, 2022)). Although FMCSA voluntarily
provided an opportunity for public comment on the Medical Advisory
Criteria, its decision to do so does not make applicable any of the
other procedural requirements in the APA or most of the other statutes
or executive orders that would apply if the opportunity for prior
notice and public comment were required.
---------------------------------------------------------------------------
\1\ Section 14(f) of DOT 2100.6A (Rulemaking and Guidance
Procedures) states that it is DOT policy to encourage providing an
opportunity for public comment on guidance documents, as public
input can be very helpful in formulating and improving the guidance
that DOT offers.
---------------------------------------------------------------------------
Further, the APA does not require interpretive rules such as this
to be published in the Federal Register with an effective date that is
not less than 30 days after publication (5 U.S.C. 553(d)(2)).
Therefore, this rule is effective on the date of publication in the
Federal Register to coincide with the publication of the revised
Medical Examiner's Handbook (MEH).
III. Background
In 2000, FMCSA adopted a revised medical examination report that
also contained the Agency's guidelines to help medical examiners assess
an individual's physical qualifications. These guidelines, in the form
of advisory criteria, were strictly advisory and were established after
consultation with physicians, States, and industry representatives (65
FR 59363, 59364 (Oct. 5, 2000)). Subsequently, when FMCSA revised the
report form again, the medical advisory criteria were removed from the
report form and published as Appendix A to 49 CFR part 391 (80 FR 22790
(Apr. 23, 2015)).
On August 16, 2022, FMCSA made available for public comment a
revised and updated draft MEH, which included updates to the Medical
Advisory Criteria (87 FR 50282). The goal of the updated Medical
Advisory Criteria was to provide guidance for medical examiners to
consider when making physical qualification determinations in
conjunction with established best medical practices. Information that
was outdated, obsolete, or no longer relevant was removed from the
Medical Advisory Criteria. The Agency stated that the revised Medical
Advisory Criteria would be included in the MEH and would also be
published in Appendix A to 49 CFR part 391. The final version of the
criteria would be identical in both publications.
FMCSA notes that, as a procedural matter, a final rule is required
by the Office of the Federal Register to change any text included in
the CFR. This is so even if the CFR text changed is guidance in an
interpretive rule, as is the case here.
[[Page 3578]]
IV. New Regulatory Guidance
After consideration of the public comments and further internal
review, FMCSA has published a revised MEH that includes revisions to
the Medical Advisory Criteria. A Federal Register notice about this
publication of the MEH and the treatment of some of the public comments
is being issued concurrently with this notice. The revised criteria
included in the MEH are identical to the criteria published by this
notice in Appendix A to 49 CFR part 391; although, the order of the
criteria differs. The criteria in the MEH reflects the order in which a
medical examiner typically conducts the physical qualification
examination, while Appendix A organizes the criteria in the same order
that the physical qualification standards appear in 49 CFR 391.41(b).
Consistent with previous practice, the Medical Advisory Criteria are
advisory and are therefore considered guidance because they provide
interpretations and recommendations for the physical qualification
standards contained in the Federal Motor Carrier Safety Regulations.
The updated Medical Advisory Criteria replace all previous versions of
the criteria. Previous versions of the Medical Advisory Criteria should
not be relied upon.
V. Publication of the Regulatory Guidance
Each guidance document issued by FMCSA must be published on a
publicly accessible DOT internet website on the date of issuance (49
U.S.C. 113 note).\2\ Accordingly, in addition to being available in
this docket and the MEH, the Medical Advisory Criteria will be
available in FMCSA's Guidance Portal (https://www.fmcsa.dot.gov/guidance). The criteria also will be available on FMCSA's website at
https://www.fmcsa.dot.gov/regulations/medical/medical-regulations-and-guidance-resource-links and on the National Registry website at https://nationalregistry.fmcsa.dot.gov/resource-center.
---------------------------------------------------------------------------
\2\ See section 5203(a)(2)(A) and (a)(3) of the Fixing America's
Surface Transportation Act, Public Law 114-94, 129 Stat. 1312, 1535
(Dec. 4, 2015).
---------------------------------------------------------------------------
FMCSA expects to review the guidance no later than 5 years after it
is published and will consider at that time whether the guidance should
be withdrawn, reissued, or incorporated into FMCSA's regulations.
VI. Regulatory Analysis
A. Regulatory Flexibility Act (Small Entities)
Under the Regulatory Flexibility Act of 1980 (5 U.S.C. 601-612),
FMCSA is not required to complete a regulatory flexibility analysis
because, as discussed earlier in the Legal Basis section, this action
is not subject to notice and public comment under section 553(b) of the
APA.
B. Assistance for Small Entities
In accordance with section 213(a) of the Small Business Regulatory
Enforcement Fairness Act of 1996 (Pub. L. 104-121, 110 Stat. 857, Mar.
29, 1996), FMCSA wants to assist small entities in understanding this
final rule so they can better evaluate its effects on themselves and
participate in the rulemaking initiative. If the final rule will affect
your small business, organization, or governmental jurisdiction and you
have questions concerning its provisions or options for compliance;
please consult the person listed under the FOR FURTHER INFORMATION
CONTACT section of this final rule.
C. Unfunded Mandates Reform Act of 1995
The Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1531-1538)
requires Federal agencies to assess the effects of their discretionary
regulatory actions. In particular, the Act addresses actions that may
result in the expenditure by a State, local, or Tribal government, in
the aggregate, or by the private sector of $192 million (which is the
value equivalent of $100 million in 1995, adjusted for inflation to
2022 levels) or more in any 1 year. This final rule will not result in
such an expenditure.
D. Paperwork Reduction Act
This final rule contains no new information collection requirements
under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520).
E. E.O. 13132 (Federalism)
A rule has implications for federalism under section 1(a) of E.O.
13132 if it has ``substantial direct effects on the States, on the
relationship between the national government and the States, or on the
distribution of power and responsibilities among the various levels of
government.'' FMCSA has determined that this rule will not have
substantial direct costs on or for States, nor will it limit the
policymaking discretion of States. Nothing in this action preempts any
State law or regulation. Therefore, this rule does not have sufficient
federalism implications to warrant the preparation of a Federalism
Impact Statement.
F. Privacy Act
The Consolidated Appropriations Act, 2005 (Pub. L. 108-447, 118
Stat. 2809, 3268, Dec. 8, 2004 (5 U.S.C. 552a note)), requires the
Agency to conduct a privacy impact assessment of a regulation that will
affect the privacy of individuals. Privacy impact assessments were
completed when the physical qualification regulations relating to the
guidance were adopted. The guidance in the Medical Advisory Criteria
does not present any new privacy concerns that were not previously
addressed in those assessments. Also, because this interpretive rule
does not require the collection of personally identifiable information,
the Agency is not required to conduct a privacy impact assessment.
G. E.O. 13175 (Indian Tribal Governments)
This rule does not have Tribal implications under E.O. 13175,
Consultation and Coordination with Indian Tribal Governments, because
it does not have a substantial direct effect on one or more Indian
Tribes, on the relationship between the Federal Government and Indian
Tribes, or on the distribution of power and responsibilities between
the Federal Government and Indian Tribes.
H. National Environmental Policy Act of 1969
FMCSA analyzed this rule pursuant to the National Environmental
Policy Act of 1969 (42 U.S.C. 4321 et seq.) and determined this action
is categorically excluded from further analysis and documentation in an
environmental assessment or environmental impact statement under FMCSA
Order 5610.1 (69 FR 9680, Mar. 1, 2004), Appendix 2, paragraph 1.a.
regarding guidance documents.
List of Subjects in 49 CFR Part 391
Alcohol abuse, Drug abuse, Drug testing, Highway safety, Motor
carriers, Reporting and recordkeeping requirements, Safety,
Transportation.
For the reasons stated in the preamble, FMCSA amends 49 CFR part
391, as follows:
PART 391--QUALIFICATIONS OF DRIVERS AND LONGER COMBINATION VEHICLE
(LCV) DRIVER INSTRUCTORS
0
1. The authority citation for part 391 continues to read as follows:
[[Page 3579]]
Authority: 49 U.S.C. 504, 508, 31133, 31136, 31149, 31502; sec.
4007(b), Pub. L. 102-240, 105 Stat. 1914, 2152; sec. 114, Pub. L.
103-311, 108 Stat. 1673, 1677; sec. 215, Pub. L. 106-159, 113 Stat.
1748, 1767; sec. 32934, Pub. L. 112-141, 126 Stat. 405, 830; secs.
5403 and 5524, Pub. L. 114-94, 129 Stat. 1312, 1548, 1560; sec. 2,
Pub. L. 115-105, 131 Stat. 2263; and 49 CFR 1.87.
0
2. In part 391, Appendix A is revised to read as follows:
Appendix A to Part 391--Medical Advisory Criteria
I. Introduction
This appendix contains the Federal Motor Carrier Safety
Administration's recommendations and guidance in the form of Medical
Advisory Criteria to help medical examiners assess a driver's
physical qualification. These recommendations and guidance are
strictly advisory and do not have the force and effect of law. They
were established after consideration of public comments and after
consideration of recommendations from the Agency's Medical Review
Board.
II. Interpretation of Medical Standards
Since the issuance of the regulations for physical
qualifications of commercial motor vehicle drivers, the Federal
Motor Carrier Safety Administration has published recommendations
and guidance called advisory criteria to help medical examiners in
determining whether a driver meets the physical qualification
standards for commercial driving. These recommendations have been
derived from the Medical Examiner's Handbook to provide information
to medical examiners that is directly relevant to the physical
qualification examination.
A. Medical Advisory Criteria for 49 CFR 391.41(b)(1)
1. Only individuals with loss of all five fingers are considered
to have loss of a hand under Sec. 391.41(b)(1).
2. Unless an individual possesses a skill performance evaluation
certificate, loss of a foot, a leg, a hand, or an arm precludes
physical qualification. Even if an individual has a prosthesis that
replaces the foot, leg, hand, or arm, as applicable, certification
is precluded without a skill performance evaluation certificate.
3. An individual may be eligible for a skill performance
evaluation certificate under Sec. 391.41(b)(1) or Sec.
391.41(b)(2), or both.
B. Medical Advisory Criteria for 49 CFR 391.41(b)(2)
1. Individuals with loss of fewer than all five fingers or any
number of toes should be evaluated under Sec. 391.41(b)(2) to
determine whether there is an impairment, defect, or limitation of a
hand or foot that interferes with the ability to perform normal
tasks associated with operating a commercial motor vehicle.
2. A skill performance evaluation certificate is only available
under Sec. 391.41(b)(2) for impairment, defect, or limitation of a
limb. A skill performance evaluation certificate is not available
for impairment of the spine or torso that does not result in
impairment, defect, or limitation of a limb.
3. An individual may be eligible for a skill performance
evaluation certificate under Sec. 391.41(b)(1) or Sec.
391.41(b)(2), or both.
C. Medical Advisory Criteria for 49 CFR 391.41(b)(4)
1. The phrase ``has no current clinical diagnosis of'' is
specifically designed to encompass a clinical diagnosis of a current
cardiovascular condition, or a cardiovascular condition that has not
fully stabilized. The phrase ``known to be accompanied by'' is
designed to include a clinical diagnosis of a cardiovascular disease
that is accompanied by, or is likely to cause, symptoms of syncope,
dyspnea, collapse, or congestive cardiac failure.
2. Coronary artery bypass surgery and pacemaker implantation are
remedial procedures and, thus, do not preclude medical
certification. Implantable cardioverter-defibrillators are installed
to address an ongoing underlying cardiovascular condition and are
likely to cause syncope or collapse as a result of the underlying
cardiovascular condition, as well as when they discharge.
3. Anticoagulation therapy is a medical treatment, which can
improve the health and safety of the individual, and should not, by
its use alone, preclude certification of the individual. The
emphasis should be on the underlying medical condition(s) that
requires treatment and the general health of the individual.
D. Medical Advisory Criteria for 49 CFR 391.41(b)(5)
1. Many conditions interfere with oxygen exchange and may
interfere with the ability to control and drive a commercial motor
vehicle safely. These include, but are not limited to, emphysema,
chronic asthma, carcinoma, tuberculosis, chronic bronchitis, and
obstructive sleep apnea.
2. If the medical examiner detects a possible undiagnosed or
inadequately treated respiratory dysfunction that may be likely to
interfere with the individual's ability to control and drive a
commercial motor vehicle safely, the medical examiner should confer
with the treating provider or should recommend that the individual
be referred to a specialist for further evaluation and therapy.
E. Medical Advisory Criteria for 49 CFR 391.41(b)(6)
1. An elevated blood pressure finding should be confirmed by at
least two subsequent measurements.
2. Hypertension alone is unlikely to interfere with the ability
to operate a commercial motor vehicle safely; however, the
likelihood increases when target organ damage, particularly cerebral
vascular disease, is present. The guidance on the stages of
hypertension below is based on the Federal Motor Carrier Safety
Administration's Cardiovascular Advisory Panel Guidelines for the
Medical Examination of Commercial Motor Vehicle Drivers (October
2002), which adopted the sixth report of the Joint National
Committee on Detection, Evaluation, and Treatment of High Blood
Pressure (1997).
3. Stage 1 hypertension corresponds to a systolic blood pressure
of 140-159 mmHg and/or a diastolic blood pressure of 90-99 mmHg. An
individual with a blood pressure in this range is at low risk for a
hypertension-related event that is likely to interfere with the
ability to operate a commercial motor vehicle safely and may be
medically certified to drive for a 1-year period. Certification
examinations should be done annually thereafter and should be at or
less than 140/90. If less than 160/100 but greater than 140/90 at
the subsequent examinations, the individual may be given a one-time
certification of 3 months to reduce the blood pressure to less than
or equal to 140/90.
4. A blood pressure of 160-179 systolic and/or 100-109 diastolic
is considered Stage 2 hypertension. A blood pressure in this range
is an absolute indication for antihypertensive drug therapy. The
individual may be given a one-time certification of 3 months to
initiate or adjust antihypertensive drug therapy and to reduce the
blood pressure to less than or equal to 140/90. Provided treatment
is well tolerated and the driver demonstrates a blood pressure value
of 140/90 or less, the individual may be certified for 1 year.
5. A blood pressure at or greater than 180 (systolic) and 110
(diastolic) is considered Stage 3 and carries a high risk for an
acute blood pressure-related event that is likely to interfere with
the ability to operate a commercial motor vehicle safely. The
individual should not be qualified, even for a short period, until
the blood pressure is reduced to 140/90 or less and treatment is
well tolerated. The individual may be certified for 6 months and
biannually (every 6 months) thereafter if at recheck blood pressure
is 140/90 or less.
6. Annual certification is recommended if the medical examiner
does not know the severity of hypertension prior to treatment.
7. Treatment includes non-pharmacologic and pharmacologic
modalities as well as counseling to improve or eliminate the factors
that contributed to the hypertension. Most antihypertensive
medications also have side effects, such as somnolence or syncope.
The importance of side effects must be evaluated on an individual
basis and considering the underlying hypertension. Individuals
should be alerted to the possibility that antihypertensive
medications may interfere with the ability to operate a commercial
motor vehicle safely.
8. Medical certification for secondary hypertension is based on
the above stages. Evaluation is warranted if an individual is
persistently hypertensive on maximal or near-maximal doses of two to
three pharmacologic agents. Some causes of secondary hypertension
may be amenable to surgical intervention or specific pharmacologic
treatment.
F. Medical Advisory Criteria for 49 CFR 391.41(b)(7)
1. Once an individual has been diagnosed as having a rheumatic,
arthritic, orthopedic, muscular, neuromuscular, or vascular disease,
then the individual has an established history of that disease.
[[Page 3580]]
2. The medical examiner, when examining an individual, should
consider the following: the nature and severity of the individual's
condition (such as sensory loss or loss of strength); the degree of
limitation present (such as range of motion); the rate or stage of
progression (symptoms may not be present initially but may manifest
over time); and whether symptoms are likely to interfere with the
ability to control and operate a commercial motor vehicle safely.
3. If severe functional impairment exists, the individual does
not physically qualify. In cases where more frequent monitoring is
required, a Medical Examiner's Certificate, Form MCSA-5876, for less
than the maximum certification period may be issued.
G. Medical Advisory Criteria for 49 CFR 391.41(b)(8)
1. Epilepsy is a chronic functional disease characterized by
seizures or episodes that usually occur without warning, resulting
in loss of voluntary control that may lead to loss of consciousness.
Therefore, the following individuals are not physically qualified:
An individual who has a medical history of epilepsy or
a seizure disorder, unless the individual satisfies the criteria
described in paragraph 5 of the Medical Advisory Criteria for Sec.
391.41(b)(8);
An individual who has a current clinical diagnosis of
epilepsy or a seizure disorder; or
An individual who is taking antiseizure medication to
prevent seizures.
2. When an individual has had a single unprovoked episode of
loss of consciousness (i.e., the cause is unknown or there is no
clear provoking trigger) that is determined not to have been a
seizure, the medical examiner may certify the individual if the
medical examiner determines recurrence of loss of consciousness or
loss of ability to control a commercial motor vehicle is unlikely
and the individual is not taking antiseizure medication. The
determination should be made on an individual basis by the medical
examiner in consultation with the treating provider. Before
certification is considered, it is recommended that a 6-month
waiting period elapse from the time of the episode.
3. When an individual has had a single unprovoked nonepileptic
seizure (i.e., the cause is unknown or there is no clear provoking
trigger) that was treated with antiseizure medication or left
untreated, the medical examiner may certify the individual if the
individual is both off antiseizure medication and seizure free for 5
years of more.
4. When an individual has had a single provoked nonepileptic
seizure or episode of loss of consciousness (i.e., there is a known
medical condition or a clear provoking trigger that is reversible or
avoidable, such as a drug reaction, alcohol or illicit drug
withdrawal, high temperature, acute infectious disease, dehydration,
or acute metabolic disturbance), the medical examiner may certify
the individual if the individual has fully recovered, has no
existing residual complications, and is not taking antiseizure
medication and seizure recurrence and exposure to the provoking
trigger in the future is unlikely.
5. When an individual has a medical history of epilepsy or a
seizure disorder, the medical examiner may certify the individual if
the individual is both off antiseizure medication and seizure free
for 10 years or more.
6. If a medical examiner is unsure about whether to qualify an
individual with a diagnosis of epilepsy or a seizure disorder, or a
single nonepileptic seizure, the medical examiner may refer the
individual to the Federal Motor Carrier Safety Administration for
evaluation under the criteria for a Federal seizure exemption.
H. Medical Advisory Criteria for 49 CFR 391.41(b)(9)
1. Emotional or adjustment disorders contribute directly to an
individual's level of memory, reasoning, attention, and judgment,
and are often caused by physical disorders. A variety of functional
disorders can cause drowsiness, dizziness, confusion, weakness, or
paralysis that may lead to incoordination, inattention, or loss of
functional control that may be likely to interfere with the ability
to drive a commercial motor vehicle safely. Physical fatigue,
headache, impaired coordination, recurring physical ailments, and
chronic ``nagging'' pain may be present to such a degree that they
may be likely to interfere with the ability to drive a commercial
motor vehicle safely. Somatic and psychosomatic complaints should be
thoroughly evaluated when examining an individual.
2. The degree to which an individual is able to appreciate,
evaluate, and adequately respond to environmental strain and
emotional stress is critical when assessing an individual's mental
alertness and flexibility to cope with the stresses of commercial
motor vehicle driving.
3. It is unlikely that individuals who are highly susceptible to
frequent states of emotional instability (e.g., due to
schizophrenia, affective psychoses, paranoia, severe anxiety, or
depressive neuroses) would satisfy the physical qualification
standard.
4. Careful consideration should be given to the side effects and
interactions of medications in the overall qualification
determination. Medications used to treat mental, nervous, organic,
or functional disease or psychiatric disorder may be likely to
interfere with the ability to drive a commercial motor vehicle
safely.
I. Medical Advisory Criteria for 49 CFR 391.41(b)(11)
1. Since the prescribed standard under the Federal Motor Carrier
Safety Regulations is from the American National Standards Institute
(ANSI), formerly the American Standards Association, it may be
necessary to convert the audiometric results from the International
Organization for Standardization (ISO) standard to the ANSI
standard. To convert audiometric test results from ISO to ANSI,
subtract 14 decibels (dBs) from the ISO result for 500 Hertz (Hz),
subtract 10 dBs for 1,000 Hz, and subtract 8.5 dBs for 2000 Hz. To
average, add the readings for the 3 frequencies tested and divide by
3.
2. For the whispered voice test, the individual should be
stationed at least 5 feet from the medical examiner with the ear
being tested turned toward the medical examiner. The other ear is
covered. Using the breath that remains after a normal expiration,
the medical examiner whispers words or random numbers such as 66,
18, 3, etc. The medical examiner should then ask the individual to
repeat the words or sequence. The medical examiner should not use
only sibilants (``s'' sounding materials). The opposite ear should
be tested in the same manner. If the individual fails the whispered
voice test in both ears, the audiometric test should be
administered.
3. If an individual does not meet the requirements with the use
of a hearing aid and requires a Federal hearing exemption, the box
for ``Wearing hearing aid'' should NOT be selected on either the
Medical Examination Report Form, MCSA-5875, or Medical Examiner's
Certificate, Form MCSA-5876. Instead, only the box for accompanied
by a hearing exemption is selected on the Medical Examination Report
Form, MCSA-5875, and the Medical Examiner's Certificate, Form MCSA-
5876.
4. To obtain an application for a hearing exemption, individuals
who do not meet the Federal hearing standard may call (202) 366-
4001, email fmcsahearingexemptions@dot.gov, or go to https://www.fmcsa.dot.gov/medical/driver-medical-requirements/new-hearing-applicant-doc-email-version.
J. Medical Advisory Criteria for 49 CFR 391.41(b)(12)
1. Federal law prohibits Schedule I drugs or substances listed
on 21 CFR 1308.11 from being prescribed for any purpose. Therefore,
a medical examiner cannot physically qualify an individual who uses
Schedule I drugs or substances.
2. A medical examiner may physically qualify an individual who
uses an amphetamine, a narcotic, or other prescribed drug or
substance listed on Schedules II through V in 21 CFR 1308.12 through
1308.15 if the prescription exception is met. A drug or substance
that is prescribed by a licensed medical practitioner who is
licensed under applicable Federal, State, local, or foreign laws to
prescribe controlled drugs and substances, is familiar with the
individual's medical history, and has advised the individual that
the drug or substance will not adversely affect the individual's
ability to safely operate a commercial motor vehicle meets the
prescription exception in Sec. 391.41(b)(12).
3. One of the ways for the medical examiner to obtain the
information that shows the prescription exception is satisfied is to
request a written communication from the prescribing licensed
medical practitioner who satisfies the regulation's requirements. A
voluntary form available on the Federal Motor Carrier Safety
Administration's website (391.41 CMV Driver Medication Form, MCSA-
5895) may be used, with the individual's consent, as an optional
tool to obtain the required information.
4. The medical examiner may request a non-Department of
Transportation drug test to aid in the physical qualification
determination, including when signs exist indicating the individual
may not have
[[Page 3581]]
disclosed use of a scheduled drug or substance. Use of a substance
abuse professional, see 49 CFR 40.3 and 40.281, is not required as
part of a non-Department of Transportation drug test.
K. Medical Advisory Criteria for 49 CFR 391.41(b)(13)
1. The phrase ``current clinical diagnosis of'' alcoholism is
specifically designed to encompass a current alcoholic illness or
those instances where the individual's physical condition has not
fully stabilized.
2. When in remission, the medical examiner may certify an
individual who has a prior clinical diagnosis of alcoholism.
3. The medical examiner may request a non-Department of
Transportation alcohol test to aid in the physical qualification
determination, including when the individual discloses excessive use
of alcohol or the medical examiner observes signs of alcoholism. The
use of a substance abuse professional, see 49 CFR 40.3 and 40.281,
is not required. The medical examiner may request that individuals
provide documentation from a professional qualified to conduct an
alcohol use assessment that includes an opinion concerning whether a
current clinical diagnosis of alcoholism is present or the
individual is in remission prior to making a medical certification
determination.
Issued under authority delegated in 49 CFR 1.87.
Robin Hutcheson,
Administrator.
[FR Doc. 2024-00980 Filed 1-18-24; 8:45 am]
BILLING CODE 4910-EX-P