The Medical Examiner (ME) should note any abnormalities with posture, limps, or tremors, as well as making note of the driver’s emotional state and overall appearance. The medical examiner should be looking for potential adverse impact on safe driving.

If the driver is markedly overweight, the ME will consider the clinical and safety implications when integrated with all other findings. The driver’s BMI should be considered in the totality of the clinical picture to determine if sleep apnea is or may be present.

The DOT Medical Examiner will also look for signs of current alcohol or drug abuse. If those are noted, the CDL Physical examiner must refer the driver to a Substance Abuse Professional for evaluation.

Conditions of the mouth and throat must be evaluated to determine whether the condition or treatment requires long-term follow-up and monitoring to ensure that the disease is stabilized, and whether the treatment is effective and well-tolerated. Please DO NOT have any chewing tobacco in your mouth and PLEASE rinse your month before seeing the doctor.

The DOT physician must examine the heart for murmurs, extra sounds, enlargement, and a pacemaker or implantable cardioverter defibrillator. The ME will also check the lower extremities for pitting edema and other signs of cardiac disease. Having a defibrillator is disqualifying.

If the ME finds any abnormalities that indicate the driver may have a current cardiovascular disease accompanied by and/or likely to cause symptoms of loss of consciousness, difficulty breathing, collapse, or congestive cardiac failure, a cardiologist clearance will be required.
Work restrictions are not permitted. The DOT Physical/Fitness for Duty Examination is an all-or-none examination. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified.

The Medical Examiner must examine the lungs and chest for abnormal chest wall expansion, respiratory rate, and breath sounds including wheezes or alveolar rales. The ME will also check for impaired respiratory function and cyanosis or bluing of the skin and nail beds. Clubbing of the fingers is an indicator pulmonary disease.

The DOT physician must check for enlarged liver and spleen, masses, bruits, hernia, and significant abdominal wall muscle weakness. The ME will check for tenderness and listen for abnormal bowel sounds.

The DOT physician must check for abnormal pulse and amplitude, carotid or arterial bruits, and varicose veins. The ME should also check for pulses in the distal extremities.

The DOT physician must check for hernias. Specifically, the ME will evaluate any hernia that causes the driver discomfort to determine the extent to which the condition might interfere with the ability of the driver to operate a CMV safely. Further testing and evaluation may be required. NOTE: A driver who has not provided a urine specimen CANNOT be certified.

The DOT physician must check for fixed deficits of the extremities caused by loss, impairment, or deformity of an arm, hand, finger, leg, foot, or toe.

The ME will ensure that the driver has sufficient ability to grasp objects in the upper limbs to maintain steering wheel grip, as well as sufficient mobility and strength in the lower extremities to operate pedals properly.

Signs of progressive musculoskeletal conditions, such as atrophy, weakness, or loss of muscle tone consistent with Muscular Dystrophy and other conditions will be evaluated. The ME will also look for signs of clubbing or edema that may indicate the presence of an underlying heart, lung, or vascular condition.

The DOT physician must check the entire musculoskeletal system for previous surgery, deformities, limitations of motion, and tenderness. The ME will want to know if the driver has a diagnosis or signs of a condition known to be associated with acute episodes of transient muscle weakness, poor muscular coordination, abnormal sensations, decreased muscular tone, and/or pain.

NOTE: Drivers confined to a wheelchair are not necessarily disqualified, but an SPE will be indicated.

The DOT physician must examine the driver for impaired equilibrium, coordination, and speech pattern. The driver must not have signs of loss of balance. Reflexes should be symmetrical, and the foot reflex, also known as Babinski’s reflex should not be present. The driver will also be evaluated for loss of sensation and positional abnormalities.

Sleep apnea and sleep studies continue to be a hot topic with regard to DOT Physicals and in the trucking industry. There are many misleading rumors about which drivers should get a sleep apnea test. Don’t worry, Dr. Fern is up to date on all the FMCSA guidelines and does not send everyone for this exam. Ever driver is examined on an individual basis.

If Dr. Fern determines that a sleep study is needed, he uses 2 companies that allow you to take the test at home and the cost is very reasonable.

Here is a link to FMCSA about sleep Apnea: https://www.fmcsa.dot.gov/driver-safety/sleep-apnea/driving-when-you-have-sleep-apnea

What is Sleep Apnea? Simply put, sleep apnea is a condition where the body is deprived of oxygen, or oxygen to the body is reduced during sleep due to the slowing or cessation of breathing. This often results in daytime sleepiness.

Symptoms of Sleep Apnea:

• Waking up not feeling refreshed
• Abnormal daytime sleepiness, including falling asleep at inappropriate times
• Erectile dysfunction
• Weight gain (Sleep decreases/inhibits cortisol production; cortisol produces belly fat);
• Decreased cognition including memory loss, short attention span, and poor judgment;
• Personality changes including depression, and irritability.
• Loud snoring, periods of not breathing (apnea)