The Department of Transportation (DOT) physical examination is a mandatory assessment for commercial motor vehicle (CMV) drivers. This comprehensive medical review ensures drivers are medically qualified to operate heavy vehicles safely on public roads, preventing medical events that could lead to a loss of control. The standards are set by the Federal Motor Carrier Safety Administration (FMCSA) in its regulations. Failing to meet these minimum physical or mental standards results in the denial of a Medical Examiner’s Certificate, which is necessary for interstate commercial driving.
Required Vision and Hearing Standards
Failure to meet specific sensory requirements often results in disqualification from the DOT physical. For vision, a driver must have distant visual acuity of at least 20/40 in each eye, with or without corrective lenses. They must also have a field of vision of at least 70 degrees horizontally in each eye and demonstrate the ability to recognize traffic signal colors.
If a driver has a vision deficiency in one eye, they may be eligible for an alternative vision standard. This allows qualification if they meet all other physical standards and complete a vision evaluation form (MCSA-5871) signed by an ophthalmologist or optometrist. For hearing, a driver must be able to perceive a forced whisper at 5 feet, with or without a hearing aid. Alternatively, a driver qualifies if they pass an audiometric test showing an average hearing loss no greater than 40 decibels in the better ear at 500 Hz, 1,000 Hz, and 2,000 Hz.
Cardiovascular and Metabolic Disqualifications
Cardiovascular health is a significant focus, as sudden cardiac events pose a risk to public safety. Uncontrolled high blood pressure (hypertension) is a common reason for failure, with certification periods depending on severity.
Hypertension Stages
Drivers with Stage 1 hypertension (140–159 systolic and/or 90–99 diastolic) receive a 12-month certificate.
Those with Stage 2 (160–179 systolic and/or 100–109 diastolic) are given a one-time, three-month certificate to lower blood pressure.
Stage 3 hypertension (180 systolic and/or 110 diastolic or higher) results in temporary disqualification until blood pressure is reduced below 140/90.
A history of a heart condition, such as a Myocardial Infarction (MI) or Coronary Artery Bypass Graft (CABG), requires documentation of recovery and medical clearance from a cardiologist. Following such events, drivers must take at least a two-month break from driving duties. They must also pass an Exercise Tolerance Test and have an acceptable Ejection Fraction for recertification. The presence of an Automated Implantable Cardioverter Defibrillator (AICD) is disqualifying for interstate commercial driving due to the risk of incapacitation.
Metabolic disorders, particularly Diabetes Mellitus, can lead to disqualification if not properly managed. Insulin-treated diabetes is no longer an automatic disqualifier, but drivers must comply with specific monitoring protocols for certification. The driver must maintain a stable insulin regimen and proper control, assessed by a certified medical examiner. The examiner reviews an Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870), completed by the treating clinician and valid for a maximum of 12 months.
Neurological and Musculoskeletal Impairments
Neurological conditions that cause a loss of consciousness or the inability to control a commercial vehicle are disqualifying. A diagnosis of epilepsy or any condition likely to cause a seizure or syncope prevents medical certification. For a driver with a history of a single unprovoked seizure, guidelines suggest a five-year seizure-free and off-medication period before consideration for a certificate.
Conditions causing vertigo or chronic dizziness that could interfere with driving control are disqualifying. Musculoskeletal impairments that affect the ability to safely perform driving tasks also result in failure. These tasks include gripping the steering wheel, operating foot pedals, or securing cargo. This includes severe impairment from crippling arthritis or the loss of a limb.
Drivers with a missing or impaired arm, hand, foot, or leg may still qualify to drive interstate commerce if they obtain a Skill Performance Evaluation (SPE) Certificate. The SPE certificate acts as a federal variance, requiring the driver to demonstrate the ability to safely operate a CMV using the impairment and any necessary adaptive equipment. The process involves a medical evaluation and a driving test to verify functional capacity.
Substance Use and Mental Health Concerns
Substance use is a strict area of disqualification. The use of any drug listed in Schedule I of the Controlled Substances Act is an automatic failure, including marijuana, regardless of state law, as the DOT physical adheres to federal law. The use of amphetamines, narcotics, or other habit-forming drugs is also disqualifying unless prescribed by a licensed medical practitioner who confirms it will not adversely affect CMV operation.
A current diagnosis of alcoholism is a disqualifying condition. Certain prescribed medications, such as high-dose opioids or benzodiazepines, cause temporary disqualification because they can impair judgment or cause excessive drowsiness. The medical examiner must consider the side effects of any medication to ensure it does not compromise the driver’s ability to perform safety-sensitive functions.
Severe or unstable psychiatric conditions that are unmanaged or could lead to unsafe driving behavior are grounds for disqualification. This includes conditions such as severe psychosis, bipolar disorder, or severe depression, if they interfere with concentration, attention, or decision-making. The diagnosis of a mental health condition is not an automatic failure, but the medical examiner assesses whether the condition or its treatment impairs the driver’s fitness for duty.