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FMCSA updates guidance for truck driver medical examiners

New handbook could be used to launch rulemaking on sleep apnea risks

New guidelines issued for truck driver medical qualifications. (Photo: Jim Allen/FreightWaves)

For the first time in seven years, physicians have reliable guidance they can use to help determine if commercial truck drivers are physically fit to operate their vehicles.

The Federal Motor Carrier Safety Administration on Tuesday published a draft of its new Medical Examiner’s Handbook (MEH). The handbook provides information on driver health requirements and guidelines used by medical examiners (MEs) listed on FMCSA’s National Registry of Certified Medical Examiners to interpret regulations on physical qualifications for commercial drivers.

An ME is licensed, certified, and/or registered in accordance with state laws and regulations to perform physical examinations and must also be knowledgeable of the physical and mental demands associated with operating a truck.

“Other health care professionals, such as treating providers and specialists, may provide additional medical information or consultation, but the ME ultimately decides whether the driver meets the physical qualification standards of FMCSA,” according to the agency.


FMCSA also emphasized that, unlike regulations, the recommendations and guidance in the handbook “do not have the force and effect of law and are not meant to bind MEs, drivers or the public in any way. Rather, such guidance itself is only advisory and not mandatory.”

FMCSA first posted the MEH on its website in 2008 but had to withdraw it in 2015 because some of the information was “obsolete or was prescriptive in nature,” according to FMCSA, and therefore MEs and training organizations were told not to consider the MEH as guidance to interpret federal regulations.

Potential for sleep apnea rulemaking

While federal regulations do not include specific requirements related to testing drivers for obstructive sleep apnea (OSA), “the big question is whether FMCSA will use [the MEH] as a potential launchpad for a formal rulemaking on OSA,” P. Sean Garney, co-director of Scopelitis Transportation Consulting, told FreightWaves.

To address the issue, FMCSA would have to go through a formal rulemaking process, Garney noted. In 2016, FMCSA and the Federal Railroad Administration (FRA) issued an advanced notice of proposed rulemaking on OSA, but the Trump administration withdrew the proposal in 2017. “The agencies believe that current safety programs and FRA’s rulemaking addressing fatigue risk management are the appropriate avenues to address OSA,” the agencies stated at the time.


Over the last decade, however, “there is a lot more data available on [OSA], and the industry’s take on the issue has evolved as well. The time could be right,” Garney said.

FMCSA addresses OSA in the handbook by providing a link to recommendations made in 2016 by the Medical Review Board, an advisory committee to the agency. It includes suggestions on risk factors, screening, testing and medical certification of drivers with OSA.

Comments on the draft handbook must be received on or before Sept. 30.

Click for more FreightWaves articles by John Gallagher.

64 Comments

  1. Tom Horton

    I’ve been driving over 30years, and every year it get harder and harder to keep doing what I excel at and love. They seem to want us off the road? I don’t understand how you are going to get your new things or even food if we don’t keep the wheels turning? I am all about safety and I eat decently on the road but it’s extremely tough and expensive. For those of you whom think it’s a “no brainer” try it some time. Oh but now to do that you have to pay $6000 to go to a school for 6 months, then go to dmv to finally get your license. In the mean time, you can try to get the bank to not foreclose on your home, or repo your car, feed your family, try to keep the lights on, pay your cell phone bill (because your gonna need it so you can talk to your family). Look, I’m not a doctor nor do I play one on tv or YouTube, I’m a Truck driver and I’m great at what I do. Moving freight for most everyone in the country is what I do best and I love it. Has anyone healthy started driving a truck? Try it and most will either quit or start not eating the right stuff. You see sometimes you are hundreds of miles before you find a place to get fuel, rest and of course a good meal (oh and find a place that will allow you to park).I would like to see someone in those ivory towers who make the rules try it? Bet they will come up with a million different reasons why they can’t buy they say they are smarter than us therefore they know better. Pretty soon they will need automated truck because they are slowly pushing us off the road. Man, I was really hoping to make it another 10years but it’s becoming very clear what people truly think about us. I’m saddened at that thought and it kills my spirit just thinking about it.

  2. James

    I quit otr because the regulations make it very hard to be profitable and safe. Rather than have Washington and the like pass rules and regulations that they think they understand but clearly do not they should ask reasonable responsible drivers for input, not just comment on rules they have made. They will not stop until the pain is felt nationwide

  3. Bernard Gosling

    I know Doctor some have very little English speaking skills looking for pay off just to pass you. They know they have you by the stones thanks to uncle Sam glad my time is up

  4. Lou Colon

    Well Now in NY has this idea you need a sleep study even though in 391.41 there is no law that says you need to do it. Forcing drivers out everyday while freight is piled up everywhere. Brilliant.

  5. Ron goodman

    So there is a major shortage of drivers in this country! So let’s make it so that there’s less drivers now….. Intelligence at its highest!!!
    Divers don’t get paid enough to jump through all of the hops the DOT already has! Bosses treat them like crap and don’t want to pay them!
    Just keep pushing people away from the industry!!!
    Good job!!!!

  6. Sue howell

    The FMCSA has absolutely no idea what’s going on out in the industry they purport to “regulate”. Coercion, 16 hr days, illegals, unscrupulous employers…safety? LOL..
    .

  7. Jim D.

    So the ME and its 20 something year old PAs will continue to bully and CYA they’re liability selves. Obvious to cost, consequences of they’re demands.
    After all sleep apnea testing and regulations are a growth industry for the medical arena. Jim D.

  8. James beauregard

    Federal government is going to run every driver off the road till Noone wants the job, the bs outweighs the pay these days and they keep pushing more drivers away from the profession, everything everyone has comes by truck and yet it will still be a surprise to them when they cripple the country and economy

Comments are closed.

John Gallagher

Based in Washington, D.C., John specializes in regulation and legislation affecting all sectors of freight transportation. He has covered rail, trucking and maritime issues since 1993 for a variety of publications based in the U.S. and the U.K. John began business reporting in 1993 at Broadcasting & Cable Magazine. He graduated from Florida State University majoring in English and business.