FMCSA Medical Review Board Advances Plan for Drivers with Monocular Vision

FMCSA vision exemption program and Drivers with Monocular Vision

Last week, the Federal Motor Carrier Safety Administration’s (FMCSA) Medical Review Board approved a proposal to eliminate the exemption process for commercial motor vehicle (CMV) drivers with monocular vision.

When finalized, the amendment would permit an individual who cannot meet either the current distant visual acuity or field of vision standard or both, in one eye to be physically qualified to operate a commercial motor vehicle in interstate commerce under specified conditions.

Currently, a driver who does not have a correctable 20/40 vision in both their left and right eyes, by wearing prescription glasses or contact lenses, would be disqualified from operating a CMV in interstate commerce unless they received a vision exemption.

Specific automatic medically disqualified conditions can be found under 49 CFR Part 391.41.

The current standard requires drivers to have:

  • A distant visual acuity of at least 20/40 (Snellen) in each eye without corrective lenses or visual acuity separately corrected to 20/40 (Snellen) or better with corrective lenses.
  • A distant binocular acuity of at least 20/40 (Snellen) in both eyes with or without
    corrective lenses.
  • A field of vision of at least 70 degrees in the horizontal Meridian in each eye.
  • The ability to recognize the colors of traffic signals and devices showing standard red,
    green, and amber.

FMCSA vision exemption program

The current FMCSA vision exemptionprogram is for monocular vision.

The waiver currently in place has been granting drivers with vision in only one eye since 1998 and is estimated that over 2,500 interstate drivers hold an FMCSA vision exemption.

The vision exemption is issued for a maximum of 2 years and is renewable. Provisions of the vision exemption include an annual medical exam and an eye exam by an ophthalmologist or an optometrist.

At the annual recertification exam, the driver should present the current vision exemption and a copy of the specialist’s eye exam report. The medical examiner will certify the qualified driver, usually for one year, and issue a medical exam certificate with the vision exemption marked on the form.

The driver is responsible to carry both the vision exemption and the medical exam certificate while driving and keeping both current and up to date.

What is changing with the FMCSA vision exemption program?

An alternative vision standard would involve a two-step process for physical qualification.

  1. A prospective driver seeking physical qualification would obtain a vision evaluation from an ophthalmologist or optometrist. The findings would provide specific medical information and opinions on a proposed Vision Evaluation Report.
  2. A medical examiner would perform an examination and determine whether the individual meets the proposed vision standard along with FMCSA’s physical qualification standards. If the medical examiner determines that the individual meets the physical qualification standards, the medical examiner could issue a Medical Examiner’s Certificate for a maximum of 12 months.

With some limited exceptions, individuals initially physically qualified under the alternative standard would be required to complete a road test by a prospective employer motor carrier before operating a CMV in interstate commerce.

The approved proposal would grandfather provision for drivers currently operating under the vision waiver study program.

Why choose CNS for my DOT physical?

CNS offers DOT physical exams on-site at our Lititz, PA location with our Certified Medical Examiner (CME). For more flexibility, we offer mobile DOT physicals to companies that qualify. Find out if your company qualifies now.

We are efficient in scheduling appointments and respect your time, preventing you from having long wait times in crowded waiting rooms. We also have competitive rates, and we understand your budget and operating costs as a driver and/or company.

The CNS Occupational Medicine staff is experienced and friendly, and our CMEs are professionals that will effectively evaluate your status.

For more information, contact us at 888.260.9448 or

CDL Driver Preparation for a DOT Physical Exam and Possible Disqualifications

What to bring for a DOT Physical Exam?

The entire process for getting a DOT physical goes much smoother for both the examiner and the driver when drivers are prepared for the physical exam. 

Department of Transportation (DOT) physical exams ensure that drivers are in good health to do their job safely. The federal regulations require all drivers of commercial motor vehicles (CMVs) to pass a physical to obtain a DOT medical card.

A DOT physical, also called a CDL physical, is a test of your general health, mental and emotional well-being and are required for drivers at trucking, construction, local delivery, waste and recycling, moving, passenger transportation, distribution, and other companies.

If you are scheduled for a DOT Physical Exam you will need to bring your current driver’s license, updated address card (if applicable), and your current medical card.

In addition, if you are being treated by a medical provider for any of the below conditions, additional information may be needed for qualification and we recommend that it be brought along with you.


What can you expect during the DOT physical exam?

Once you arrive to the exam location, paperwork will need to be completed for the exam.

A urine sample will be collected that will check for blood, protein, and sugar in your urine. This sample is not for a drug screen.

A nurse will see you and the following will be performed: 

  • height and weight
  • eye exam
  • hearing exam
  • blood pressure and pulse
  • oxygen saturation
  • temperature
  • body mass index, and
  • neck circumference

Next you will see the medical examiner for your physical and determination. If any additional information is needed, you will be given instructions and will have 45 days to have the documentation faxed or brought in for review.


Are there automatic health disqualifications for a CDL driver?

Yes, there are five main automatic disqualifications for specific medical conditions. According to federal regulations under 49 CFR 391.4, the five conditions are:

  1. hearing loss,
  2. vision loss,
  3. epilepsy,
  4. insulin use to treat diabetes, and
  5. use of any habit-forming drugs, including narcotics and amphetamines.

Regarding vision loss, if you do not have a correctable 20/40 vision in both your eyes, then you will be disqualified medically. Correctable vision are glasses or contacts and will be noted during the exam.

Drivers can receive diabetes and vision exemptions to drive a CMV safely.

The vision exemption is issued for a maximum of two years and is renewable but requires an annual medical and eye exam by an ophthalmologist or optometrist. The motor carrier is responsible for ensuring that the driver has the required documents before driving a CMV and the driver is responsible for carrying both the current vision exemption and current medical certificate while driving.

Some other temporary disqualifications include cardiovascular issues and psychological disorders.

Cardiovascular disqualification requires the CMV driver “to exhibit higher than acceptable likelihood of acute incapacitation from a cardia event, resulting in increased risk to the safety and health of the driver and the public.” Examiners will explain why you might be temporarily or permanently disqualified from getting a medical certificate.

Some psychological or personality disorders can directly affect memory, reasoning, attention, and judgement. “Disorders of a periodically incapacitating nature, even in the early stages of development, may warrant disqualification.”

When disqualification is made, the driver may be given steps to help fix the condition and possibly be restored to medical fitness of duty.

The examiner may also include a recommended waiting period before the examiner can authorize qualification. The driver will be disqualified from driving a CMV until the required steps and additional exam authorizes qualification.

Drivers who take any prescribed medications:

Drivers need to bring a complete list of prescribed medications, doses, and the providers contact information.


Additional information to bring to a DOT physical exam

Drivers who have diabetes:

Drivers need to bring a copy of their last lab work which includes fasting blood sugar and HGA1C. Results should be from within the last 4 months. If they have a journal of your finger sticks, have that available for the exam. Those who are using insulin, please call into the office for further instructions.

Drivers who have high blood pressure:

Drivers who are being treated for high blood pressure should have the last visit note from their provider regarding their high blood pressure and blood pressure readings. Drivers should have blood work not older than 6 months (routine blood work done on High blood pressure patients, creatinine, BUN, fasting glucose, Electrolytes and ECG if 1 year or less old).

A complete list of medications used to control high blood pressure and any at home readings should be available for review during the exam.

Drivers who are required to wear eyeglasses, contact lenses, or hearing devices:

Drivers should be sure to have their glasses with them or contact lenses in place, and hearing devices for the exam.

Drivers who have heart related issues, past or current:

Drivers will need to bring documentation from their cardiologist that reviews medical history, lab work and cardiac testing. In some cases, the driver may need to bring the results of a recent ECHO cardiogram, stress test or any other required testing that has been completed within the past 1-2 years. Please call the office for further instructions and the cardiac clearance form that your provider will need to complete.

Drivers with sleep apnea:

Drivers that are currently using a CPAP machine for sleep apnea will need to bring in a printout of their usage for the last 365 days that shows usage compliance greater than 4 hours; at least 70% of the time, per night. If you have questions regarding this, please call the office for further instructions.

Drivers who are under mental health treatment:

Some mental health treatment requires medications that need to be reviewed by the medical examiner.  A special form may need to be completed by the treating provider before determination can be made on the safety of operating a CMV. Please call the office for further instructions and to obtain the proper forms to have completed.

Drivers who have recently completed a SAP program:

Drivers who have completed a SAP Program need to bring their clearance forms and any documentation that shows verification of completion. For additional questions, please contact the office.


Why choose CNS for my DOT physical?

CNS offers DOT physical exams at our location in Lititz, PA with our Certified Medical Examiner (CME), and we also have mobile DOT physicals available. We know your time and money is valuable, which is why we have flexible availability during the week and the weekend.

We are efficient in scheduling appointments and respect your time, preventing you from having long wait times in crowded waiting rooms. We also have competitive rates, and we understand your budget and operating costs as a driver and/or company.

The CNS Occupational Medicine staff is experienced and friendly, and our CMEs are professionals that will effectively evaluate your status.

For more information, contact us at 888.260.9448 or

OSHA Required Medical Tests: Audiometric and Respiratory

Audiometric and Respiratory Testing: OSHA Required Medical Tests

Audiometric and respiratory testing may be required for employment under OSHA 29 CFR

Occupational Safety and Health Administration (OSHA) and Mine Safety and Health Administration (MSHA) require pre-employment and annual medical testing for workers in various industries, including oil and gas, trucking, manufacturing, and more to ensure safe and healthy working conditions.

When it comes to employment, there are many different types of exams and testing that may be required under OSHA rules. The most common physical exams include:

  • work fitness assessment
  • fitness-for-duty exam
  • pre-employment physicals

Beyond exams, there are important occupational health tests that may be required for employment under OSHA 29 CFR, which include:

  • audiometric testing and
  • pulmonary function testing or respiratory testing

What is Audiometric Testing?

Audiometric testing is a test of a person’s ability to hear sounds and assists in monitoring an employee’s hearing over time and is OSHA required if the work environment provided by the employer meets certain guidelines.

An audiometric testing follow-up program should indicate whether the employer’s hearing conservation program is preventing hearing loss and needs to be managed by a licensed or certified audiologist, otolaryngologist, or other physician. Both professionals and trained technicians may conduct audiometric testing.

There are two types of audiograms required in the hearing conservation program, which include, baseline and annual audiograms.

Baseline audiograms

The employer must retain the original baseline audiogram for the length of the employee’s employment. The professional may decide to revise the baseline audiogram if the employee’s hearing improves. This will ensure that the baseline reflects actual hearing thresholds to the extent possible.

Annual audiograms

Annual audiograms must be provided within 1 year of the baseline. It is important to test workers’ hearing annually to identify deterioration in their hearing ability as early as possible. This enables employers to initiate protective follow-up measures before hearing loss progresses.

Employers must compare annual audiograms to baseline audiograms to determine whether the audiogram is valid and whether the employee has lost hearing ability or experienced a standard threshold shift (STS). An STS is an average shift in either ear of 10 dB or more at 2,000, 3,000, and 4,000 hertz.

What are employer OSHA requirements?

Under the OSH law, employers are required to maintain a safe workplace for all employees. Failure to do so can lead to serious fines and penalties.

Employers must:

  1. make audiometric testing available to all employees exposed to an action level of 85dB (decibels) or above, measured as an 8-hr time weighted average (TWA).
  2. maintain a Hearing Conservation Program to include monitoring, testing, follow-up, training and recordkeeping (regardless of the number of employees).document and keep noise exposure measurement records for 2 years and maintain records of audiometric test results for the duration of the affected employee’s employment.
    • Audiometric test records must include:
      • the employee’s name
      • job classification,
      • date
      • examiner’s name
      • date of the last acoustic or exhaustive calibration
      • measurements of the background sound pressure levels in audiometric test rooms, and
      • the employee’s most recent noise exposure measurement.

We provide baseline, periodic, and exit audiograms, as well as any follow-up testing and training at the employer’s request. Testing will be performed by trained technicians and the program will be overseen by an Audiologist or Physician.

Occupational Medicine: Free Company Analysis

Our Occupational Medicine Specialists can provide a free health analysis of your company. We will help determine what tests are necessary for your company.

What is Pulmonary Function Testing (PFT) or Respiratory Testing?

A pulmonary function test or respiratory test is OSHA-mandated to determine if an employee can safely and effectively wear a respirator to protect the health of the employee against breathing airborne contaminants.

Before your employees use a respirator or are fit-tested, they must be medically evaluated and cleared by a licensed healthcare professional using a “Respirator Medical Evaluation Questionnaire.”

Employers must select a physician or other licensed healthcare professional (PLHCP), such as a registered nurse or physician’s assistant, to perform the medical evaluation and evaluate your health, specific job description, respirator type, and workplace conditions.

Some conditions that could prevent you from using a respirator include:

  • heart conditions
  • lung disease, and
  • psychological conditions, such as claustrophobia

An employees responses to the medical questionnaire are confidential and may not be shared with your employer.

When required by the PLHCP, additional follow-up testing may include a medical exam, additional questionnaire, PFT, EKG, chest x-ray, blood draw and urine sample.

What is Spirometry Testing?

Some occupational and personal exposures can accelerate this loss of function over time. Beyond the respirator medical evaluation, a spirometry breathing test shows how well you can move air in and out of your lungs. Periodic spirometry testing can be used to detect such accelerated losses.

Under OSHA 29 CFR PFT, spirometry testing is required in conjunction with the respirator fit test under certain circumstances to measure respiratory function.

Spirometry testing may be performed on workers who perform jobs that may cause exposure to possible lung hazards, are physically demanding, or require wearing a respirator. Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing and is required for some workers by OSHA standards.

Before conducting spirometry testing, technician should interview the worker, review medical records, and possibly consult with the PLHCP to identify health conditions that may prevent the worker from safely performing maximal efforts in a spirometry test.

All respiratory testing will be performed by a PLHCP and/or trained technician and will provide you and your employer with a written recommendation (with no confidential information) that includes:

  • If you are medically able to wear the respirator and any medical limitations for using one;
  • If any follow-up medical evaluations are needed; and
  • A statement that the doctor or licensed healthcare professional has provided you with a copy of their written recommendation.

You must be re-evaluated when:

  • Reported medical signs or symptoms, such as a heart condition, lung disease, or claustrophobia;
  • A physician or licensed healthcare professional, supervisor, or the respirator program administrator informs your employer that you need to be re-evaluated;
  • The respiratory protection program indicates a need for you to be re-evaluated; or
  • A change occurs in workplace conditions that increases the burden on you while using the respirator.

>>> Learn more about Occupational Medicine <<<

Occupational Medicine Services

Employer OSHA and Occupational Medicine testing

We are able to assist with your OSHA and Occupational Medicine needs, no matter your company size.

Individual and combined services are available:

  • Audiograms, respiratory and hazwoper physicals
  • DOT and non-DOT drug and alcohol consortiums
  • Drug and alcohol testing programs
  • Exposure testing and medical surveillance
  • Mobile Health Clinic available for on-site services
  • OSHA compliant physicals and exams
  • Pre-hire screenings
  • Pre-employment and DOT physicals
  • School bus driver physical exams
  • Vaccinations and flu shots
  • Workplace injury treatment and management

The goal of our best-in-class medical examiners is to keep workers safe and healthy on the job, creating long term health and wellness, allowing you to continue the production that keeps your business running.

For more information, contact us at 888.260.9448 or

Related News

Now Offering DOT CDL Physical Exams

CNS is now offering appointments for DOT medical card exams. The service will be provided at CNS headquarters, located at 38 Copperfield Circle, Lititz PA 17543 as well as onsite exams across PA for fleets. The service will also extend to PA School Bus medical exams.

Exam appointments can be scheduled Tuesdays and Thursdays as well as the 1st and 3rd Saturdays of each Month.

CNS has hired, John Reel, PA-C, MPAS, as our new Certified DOT Medical Examiner.     DOT CDL Physical Exams

John has 35 years of experience in emergency medicine, general surgery, family practice, pulmonary medicine, internal medicine, occupational medicine and urgent care. John was named one of 50 Physician Assistants Who Make A Difference Today by the National Commission of Certified Physician Assistants Health Foundation in 2017.


Schedule an exam today! or by calling 717.625.0280 Option 2

FMCSA: Medical Examiners To Begin Using Revised Medical Forms April 20

The Federal Motor Carrier Safety Administration (FMCSA) reminds Medical Examiners that physical exams must be completed using the revised versions of Medication Examination Report Form (MCSA-5875) and Medical Examiner’s Certificate Form (MCSA-5876) on April 20, 2medical_symbol(4)016.

In April 2015, FMCSA published it’s Medical Examiner’s Certification Integration final rule, requiring the revised use of the forms. However, in December 2015, FMCSA announced a 120-day grace period to “ensure that Medical Examiner’s had sufficient time to become familiar with the new forms and to program electronic medical records systems.”

Need more information? Contact us today!