HIGHWAY SAFETY

Selected Cases of 

Commercial Drivers 

with Potentially 

Disqualifying 

Impairments

Report to the Chairman, Subcommittee 

on Surface Transportation and Merchant 

Marine Infrastructure, Safety, and 

Security, Committee on Commerce, 

Science, and Transportation, U.S. Senate

November 2012

GAO-13-13

United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-13-13, a report to the 

Chairman, Subcommittee on Surface 

Transportation and Merchant Marine 

Infrastructure, Safety, and Security, 

Committee on Commerce, Science, and 

Transportation, U.S. Senate

November 2012

HIGHWAY SAFETY

Selected Cases of Commercial Drivers with 

Potentially Disqualifying Impairments

Why GAO Did This Study

Commercial vehicles such as tractor 

trailers and school buses must be 

operated by skilled drivers who are 

mentally and physically capable of 

performing their jobs safely. Prior GAO 

work has shown weaknesses in DOT’s 

oversight of CDLs, such as inadequate 

medical certifications for commercial 

drivers, potentially putting the public at 

risk.

GAO was asked to update its work on 

impaired commercial drivers. This 

report describes (1) key controls 

designed to prevent medically unfit or 

impaired commercial drivers from 

operating commercial vehicles and (2) 

examples of commercial drivers with 

potentially disqualifying impairments 

related to epilepsy, drugs, or alcohol. 

To identify key controls, GAO reviewed 

FMCSA policies and regulations, and 

interviewed officials. Cases were 

identified on the basis of FMCSA 

roadside-inspection data, DOT’s 

Commercial Driver License Information 

System (CDLIS), a national database 

of all commercial drivers, and SSA 

disability insurance files. From this 

analysis, GAO identified commercial 

drivers who were driving with an 

epilepsy diagnosis. GAO also 

randomly selected 100 individuals to 

determine whether the driver was 

receiving SSA disability benefits when 

the state issued or renewed the 

driver’s CDL. These cases cannot be 

generalized beyond those presented.

GAO provided a draft of this report to 

SSA and DOT. SSA did not have any 

comments. DOT provided technical 

comments, which have been 

addressed in the report, as 

appropriate.

What GAO Found

The Federal Motor Carrier Safety Administration (FMCSA), part of the Department of 

Transportation (DOT), has established a number of key controls designed to prevent 

commercial driver’s license (CDL) holders from operating commercial vehicles while 

impaired. First, drivers are required to undergo regular medical exams by a certified 

medical examiner. Second, employers are responsible for drug testing employees at 

various points of employment. Third, state and federal roadside-inspection programs 

are in place to identify impaired drivers and perform other safety checks. If these key 

controls are operating effectively, they will help identify commercial drivers who are

not capable of driving safely. However, GAO’s prior work has found that these 

controls were vulnerable to abuse or manipulation. The Moving Ahead for Progress in 

the 21st Century Act, enacted in July 2012, will require additional measures to ensure 

that disqualified drivers do not operate commercial vehicles, and could help address

some of these vulnerabilities. For example, the law requires DOT to implement a 

national clearinghouse of commercial-driver controlled-substance and alcohol test 

results by July 2014. DOT has also taken some actions, and now requires CDL 

holders to provide a copy of their medical certificates to the State licensing agency.

Matching CDL holders with Social Security Administration (SSA) disability files 

produced 204 commercial drivers who drove a commercial vehicle as recently as 

2011 despite having epilepsy, a disqualifying medical condition characterized by 

sudden seizures and unconsciousness. Thirty-one of these drivers were involved in 

accidents, demonstrating the threat to public safety posed by medically impaired 

drivers. GAO also identified 23 cases where state licensing agencies issued or 

renewed CDLs for drivers after they were, according to SSA records, diagnosed with 

epilepsy or had drug or alcohol dependence noted, which could also disqualify them 

from driving under DOT regulations (see examples below).

Examples of Commercial Drivers with Potential Driving Impairments

State

Potential driving 

impairment Details

MS Epilepsy, 

seizures, 

blackouts, poor 

vision, substance 

abuse

Holding an active CDL, this individual was approved for SSA disability 

benefits in June 2007. Although he informed SSA that he could not 

drive because of his condition, he renewed his CDL in Mississippi in 

2008. In 2009, medical professionals informed him that he should not 

be driving and that it was unsafe to hold a job. But again, he 

successfully renewed his CDL in August 2010. DOT records show that 

he was involved in a crash with a commercial vehicle in 2010. 

VA Psychosis, 

alcohol abuse, 

drug dependence

This driver began receiving SSA disability benefits in 2009 for 

psychosis. Alcohol abuse and drug dependence were also noted in 

SSA records. According to SSA files, a physician stated in 2009 the 

driver was unable to participate in employment or training activities due 

to paranoid schizophrenia. However, the driver later obtained a CDL. In 

October 2010, he refused to submit to an alcohol test while operating a 

commercial motor vehicle, which led to a driving-while-intoxicated 

conviction and permanent CDL suspension in February 2011.

Source: GAO

However, because DOT did not require state licensing agencies to maintain drivers’ 

medical certifications at the time of GAO’s review, it is unlikely that states knew of the 

drivers’ conditions. In fact, they were unable to provide medical certifications for any 

of the 23 individuals. States are now required to electronically store medical 

certificates for new and renewing CDL applicants and will be required to electronically 

maintain this information for all CDL holders by January 2014. Doing so could help 

prevent ineligible drivers from obtaining or renewing CDLs in the future.

View GAO-13-13. For more information, 

contact Cathleen A. Berrick at (202) 512-6722 

or BerrickC@gao.gov.
Page i GAO-13-13 Highway Safety

Letter 1 

Background 3

FMCSA Controls for Commercial Drivers Include Medical Exams, 

Drug and Alcohol Testing, and Roadside Inspections 5

Examples of Commercial Drivers with Disqualifying Impairments 

Related to Epilepsy, Drugs, or Alcohol 11

Contents 

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

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necessary if you wish to reproduce this material separately.
Page 1 GAO-13-13 Highway Safety

United States Government Accountability Office

Washington, DC 20548

November 30, 2012

The Honorable Frank R. Lautenberg

Chairman

Subcommittee on Surface Transportation and Merchant Marine 

 Infrastructure, Safety, and Security 

Committee on Commerce, Science, and Transportation

United States Senate

Dear Mr. Chairman:

Millions of Americans hold commercial driver’s licenses (CDL), allowing 

them to operate tractor trailers, school buses, cargo vans, or other 

commercial vehicles on our nation’s roads and highways. The Federal 

Motor Carrier Safety Administration (FMCSA) establishes regulations and 

oversees the safe operation of commercial vehicles, including preventing 

crashes, injuries, and fatalities. FMCSA partners with states to conduct 

roadside inspections and oversee CDLs in adherence to minimum federal 

requirements and guidance established by the Motor Carrier Safety 

Improvement Act of 1999.

Commercial vehicles—large, and sometimes transporting hazardous 

materials—must be operated by skilled drivers who are mentally and 

physically capable of performing their jobs safely—any impairment can 

pose significant dangers to the public. Therefore, FMCSA regulations 

require that commercial drivers be tested for drug and alcohol use and 

undergo medical fitness certifications. Drug and alcohol testing is required 

before employment, randomly while employed, and after an accident 

where the CDL driver was at fault. Physical examinations, including vision 

and hearing tests and a review of the driver’s medical history, must be 

conducted by a medical examiner at least every 2 years.

Over the past decade, the National Transportation Safety Board (NTSB) 

and others have reported gaps in enforcing drug and alcohol testing and 

medical fitness of commercial drivers. For example, the NTSB reported 

that commercial drivers could job-hop from one employer to another to 

hide their positive drug tests and that self-reporting positive drug test 

results would not effectively identify problem drivers. To address some of 

these gaps, in July 2012 the Moving Ahead for Progress in the 21st 

 
 

Page 2 GAO-13-13 Highway Safety

Century Act (MAP-21) was enacted into law,1

Given that new requirements are not due to be implemented until 2013, 

you asked us to describe (1) current key controls designed to prevent 

medically unfit or impaired commercial drivers from operating commercial 

vehicles and (2) examples of commercial drivers with potentially 

disqualifying impairments related to epilepsy, drugs, or alcohol.

which will require the 

implementation of additional measures to ensure that the highest-risk 

drivers do not operate commercial vehicles. For example, the law 

requires the Department of Transportation (DOT) to implement a national 

clearinghouse of commercial driver controlled-substance and alcohol test 

results by July 2014 and a national registry of medical examiners qualified 

to certify commercial driver fitness by July 2013.

To describe key controls, we reviewed FMCSA’s policies and regulations 

as well as legislation related to medical requirements and drug and 

alcohol testing for commercial drivers. We also reviewed prior GAO 

reports and other studies concerning the enforcement of drug and alcohol 

testing and medical fitness of commercial drivers. Further, we interviewed 

FMCSA officials about agency plans to improve the identification of these 

drivers. To examine cases of commercial drivers with potentially 

disqualifying impairments related to epilepsy, drugs, or alcohol, we 

matched data from the Social Security Administration’s (SSA) disability 

insurance database as of December 2010 to the Commercial Driver 

License Information System (CDLIS) as of 20112

To identify commercial drivers who had been involved in a crash or 

roadside inspection involving a commercial motor vehicle who had an 

impairment based on the severity of their epilepsy, we matched crash and 

inspection data from MCMIS with individuals who were receiving SSA 

disability benefits on the basis of an epilepsy impairment. We randomly 

and crash and 

inspection data from the FMCSA’s Motor Carrier Management Inspection 

System (MCMIS). Because the number of cases examined was not 

drawn from a statistical sample, none of our case selections provide 

information that can be generalized beyond the specific cases provided.

 

1

Pub. Law No. 112-141 (July 6, 2012).

2

DOT is the parent agency of FMCSA.
 

Page 3 GAO-13-13 Highway Safety

selected nine of these drivers for more in-depth review.3

We assessed the reliability of the data file that FMCSA and SSA provided 

by performing electronic data testing for errors in accuracy and 

completeness, reviewing existing information about the data and the 

system that produced the data, and interviewing agency officials 

knowledgeable about the data. We determined that the data were 

sufficiently reliable for the purposes of this report.

We used the 

CDLIS and SSA data to identify examples of individuals who renewed or 

obtained a new CDL with medical impairments related to epilepsy, drugs, 

or alcohol. We matched the Social Security number of CDL holders from 

CDLIS to individuals in the Social Security Administration (SSA) disability 

insurance files who were eligible for disability benefits. From this match, 

we extracted 13,281 individuals who had a primary or secondary 

impairment for epilepsy or where drug or alcohol dependence was noted 

in SSA’s electronic file. However, CDLIS includes drivers who have 

inactive CDLs, so we randomly made a nongeneralizable selection of 100 

individuals to identify drivers who had an active CDL at the time SSA 

determined their disability began. For these 100 cases, we obtained and 

reviewed individuals’ state driving records and SSA disability records, and 

requested CDL medical-examination reports and certificates from the 

respective states.

We conducted this performance audit from December 2010 to November 

2012 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on the audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

FMCSA establishes regulations for the physical and medical qualifications 

of CDL holders, develops standards to test and license commercial motor 

vehicle drivers, and enforces commercial motor vehicle safety 

regulations. Commercial drivers must be 21 years old to operate in 

interstate commerce, read English, have successfully completed a 

 

3

We originally selected a sample of 10 drivers, but one of the sampled cases did not 

receive SSA benefits and was subsequently removed from our review.

Background 
 

Page 4 GAO-13-13 Highway Safety

driver’s road test, be physically qualified to drive if operating in 

nonexcepted interstate commerce, and hold a current and valid CDL.4

Commercial drivers in intrastate commerce may operate commercial 

vehicles at 18 years old, if permitted by state law. They must also have no 

mental disease or psychiatric disorder that would interfere with their ability 

to safely drive a commercial vehicle, not use a controlled substance or 

habit-forming drug, and have no current clinical diagnosis of alcoholism. A 

commercial driver may use a legal non-Schedule I5

Violations for impaired drivers can result in a range of penalties against 

CDL holders. For example, a first conviction of driving under the influence 

of alcohol or a controlled substance, regardless of whether it occurs in a 

commercial or personal vehicle, results in immediate CDL suspension by 

the issuing state for 12 months. A second results in permanent 

suspension. Licensing states are required to maintain driver records 

showing convictions for disqualifying federal violations and are to 

disqualify commercial drivers convicted of those violations while driving a 

commercial vehicle. Information on CDL holders must be exchanged 

among states through a nationwide system. The CDLIS is a nationwide 

computer system that, among other things, enables state driver-licensing 

agencies to ensure that each commercial driver has only one driver’s 

license and one complete driver record. State driver-licensing agencies 

use CDLIS to complete various procedures, including transmitting out-ofstate convictions and transferring the driver record when a commercial 

driver’s license holder moves to another state.

drug or substance if 

the drug or substance is prescribed by a licensed medical practitioner 

who is familiar with the driver’s medical history, and has advised the 

driver that the prescribed substance or drug will not adversely affect the 

driver’s ability to safely operate a commercial motor vehicle.

 

4

Most commercial drivers operating in interstate commerce are nonexcepted drivers.

Excepted drivers include those who operate a commercial vehicle in interstate commerce: 

(1) as a federal, state, or local government employee; (2) to transport human corpses or 

sick and injured persons; (3) to respond during emergencies or other related activities 

while operating a fire truck or other rescue vehicles; (4) to transport migrant workers in 

most circumstances; (5) to transport propane heating fuel when responding to an 

emergency condition and to respond to a pipeline emergency condition; and (6) in certain 

instances, to transport farm machinery and supplies.

5

Schedule I substances have a high potential for abuse, and have no currently accepted 

medical use in treatment in the United States. Examples include heroin, lysergic acid 

diethylamide (LSD), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine 

(“ecstasy”). 
 

Page 5 GAO-13-13 Highway Safety

FMCSA has established a number of key controls that are designed to 

prevent CDL holders from operating commercial vehicles while impaired 

that generally cover three areas. First, drivers are required to undergo 

regular medical exams by a certified medical examiner to determine if a 

driver is physically qualified to operate a commercial vehicle. Second, 

employers are responsible for drug testing employees at various points of 

employment. Independent self-employed commercial vehicle operators 

are required to meet drug testing requirements by being enrolled in a 

random testing pool that includes other drivers and is managed by a 

consortium or third-party administrator that provides drug or alcohol 

testing services to DOT-regulated employers. Third, state and federal 

roadside-inspection programs are intended to identify impaired drivers 

and perform other safety checks. While our review did not evaluate 

whether these controls were working as intended, in prior work we have 

found that these controls were vulnerable to abuse or manipulation.6 With 

the enhanced statutory authority and direction provided by the MAP-21 

Act, DOT may be able to address some of these vulnerabilities. DOT is 

required to issue implementing regulations by July 2014.

FMCSA has established regulatory standards that require interstate 

commercial drivers to be examined and certified by a licensed medical 

examiner. The exams assess whether a driver meets minimum physical 

qualifications before obtaining a CDL. The exams are generally repeated 

at least every 2 years. Medical examiners must review the driver’s 

medical history; perform vision, hearing, blood pressure, and other such 

tests; and conduct a physical exam. The medical examiner must also 

determine that the driver does not use any drugs or controlled substances 

identified as a Schedule I drug. A CDL driver cannot use any nonSchedule I drug or controlled substance except when the drug or 

substance has been prescribed by a licensed medical provider who is 

familiar with the driver’s medical history and has determined that its use 

would not adversely affect the driver’s ability to operate a commercial 

vehicle. According to DOT, medical examiners do not give drivers drug or 

alcohol tests and largely base determinations on the physical examination 

and driver identification of prescribed medications, alcohol, or illegal drug 

use information included in the examination form.

 

6

GAO, Certification Process for Drivers with Serious Medical Conditions, GAO-08-826

(Washington, D.C.: June 30, 2008); Examples of Job Hopping by Commercial Drivers 

after Failing Drug Tests, GAO-08-829R (Washington, D.C.: June 30, 2008).

FMCSA Controls for 

Commercial Drivers 

Include Medical 

Exams, Drug and 

Alcohol Testing, and 

Roadside Inspections 

Medical Exams Are Used 

to Determine Drivers’ 

Physical Fitness to 

Operate a Commercial 

Motor Vehicle
 

Page 6 GAO-13-13 Highway Safety

If a medical examiner deems a driver fit to drive, the examiner must sign 

and date a medical certificate. The medical examiner also keeps a paper 

copy of the signed certificate and may provide another copy to the driver’s 

employer if requested. As of January 30, 2012, individuals renewing or 

applying for a CDL must submit a copy of their current medical certificate 

to their state licensing agency, making state licensing agencies 

responsible for ensuring that drivers have current medical certificates on 

file.7

Drivers with serious medical conditions can still meet DOT medical fitness 

requirements to safely operate a commercial vehicle and hold CDLs. 

Because medical determinations rely on subjective factors and patient 

self-reporting, it is not possible to systematically determine whether these 

drivers had disqualifying medical conditions. According to DOT, medical 

examiners are not required to review nor do they have access to SSA 

disability databases. Nonetheless, we issued a report in 2008 showing 

that 563,000 CDL holders were also eligible for full federal medical 

disability benefits.

 FMCSA does not maintain a copy or record of the medical 

certificates. 

8 This represented over 4 percent of all CDL holders in 

DOT’s CDLIS database. In our 2008 report, we detailed 15 examples of 

CDL holders receiving full disability benefits who did not undergo a 

careful medical evaluation required by FMCSA regulations. While not 

generalizable to all CDL holders, these examples included instances of 

forged medical certificates, false assertions on self-certifications, and 

medical examiners not following federal requirements in the determination 

of medical fitness for commercial drivers. The MAP-21 Act requires that 

DOT set up a national registry of medical examiners and seeks to ensure 

that medical certificates are provided to DOT and state licensing agencies 

electronically. According to DOT, FMCSA has taken regulatory steps to 

improve medical reviews and medical certification processes, including:9

• In December 2008, FMCSA published a final rule concerning the 

merger of the medical certification and CDL issuance and renewal 

process. The rule requires that drivers provide a copy of their medical 

certificates to the State licensing agency and that the State include 

 

7

49 C.F.R. § 383.71(h)(1).

8

GAO, Certification Process for Drivers with Serious Medical Conditions, GAO-08-826

(Washington, D.C.: June 30, 2008). 

9 73 Fed. Reg. 73096 (Dec 1, 2008).
 

Page 7 GAO-13-13 Highway Safety

the medical certification information on the electronic driving record. 

The medical certificate information could then be reviewed during a 

roadside inspection via a check of the driving record, such as through 

the CDLIS. In the instance of a driver who fails to renew his medical 

certificate on time, the States are required to downgrade the 

individual’s CDL so that he must not operate a commercial motor 

vehicle until a valid medical certificate has been submitted to the State 

licensing agency.

• In April 2012, FMCSA published a final rule establishing a National 

Registry of Certified Medical Examiners.10 The 2012 final rule 

provides requirements for all healthcare professionals responsible for 

issuing medical certificates for interstate truck and bus drivers to 

complete a training course on the Federal physical qualifications rules 

and to pass an examination to assess the examiners ability to apply 

the rules, and advisory criteria in a consistent manner when making 

the determination whether a driver meets the qualification standards. 

• FMCSA has announced its plans to initiate a new rulemaking that 

would enable the agency to require medical examiners on the 

National Registry to submit to the agency the medical certificate 

information on each individual who applies for a medical certificate. 

The agency would then have the ability to transmit to the state driver 

licensing agency the medical certificate. This process will significantly 

decrease the likelihood of drivers being able to falsify medical 

certificates. 

When implemented, these requirements could help improve the control 

vulnerabilities identified in our prior work by ensuring that proper medical 

reviews are conducted and medical certificates are prepared by qualified 

medical examiners. However, additional work would need to be 

conducted to assess their effectiveness.

FMCSA regulations also require CDL holders to undergo periodic drug 

and alcohol testing to identify unqualified drivers. Employers must test all 

CDL holders during preemployment screening; upon reasonable 

suspicion; randomly on a specific percentage; after a serious accident in 

which the driver was issued a traffic citation; and for all fatal accidents. In 

 

10 77 Fed. Reg. 24104 (April 20, 2012).

Drug and Alcohol Testing 

by Employers Is Designed 

to Identify Unqualified 

Drivers
 

Page 8 GAO-13-13 Highway Safety

addition, according to DOT, employers must request a wide range of 

information from drivers’ previous employers as disclosed by the driver on 

his or her application for employment and pertaining to the driver’s history 

in the DOT drug and alcohol testing program.

Each year, employers are also required to conduct random alcohol tests 

for at least 10 percent of their average number of driver positions, and 

random controlled substance or drug testing for at least 50 percent of 

their average number of driver positions. According to DOT, FMCSA may 

increase or decrease these percentages on the basis of self-reported 

drug and alcohol testing information from a sample of 2,000 employers.

FMCSA regulations follow Department of Health and Human Services 

(HHS) employee drug testing requirements according to the Omnibus 

Transportation Employee Testing Act of 1991.11

According to FMCSA regulations, the driver must be removed from 

safety-sensitive duty if the MRO reports a positive drug or alcohol test 

result to the driver’s employer. The driver cannot return to a safetysensitive function, such as operating a commercial vehicle, until he or she 

has completed the return-to-duty process, which includes being evaluated 

They use urine tests 

covering five categories of drugs: marijuana, cocaine, amphetamines 

(dexadrine, adderall), opiates (heroin, morphine, codeine), and 

phencyclidine (PCP). Each year, employers must conduct alcohol tests 

equal to at least 10 percent of the average number of CDL drivers. 

Alcohol tests of either the driver’s breath or saliva must be performed 

immediately before, during, or after the driver’s performance of safetysensitive duties such as operating a commercial vehicle. Drug tests are 

required to be analyzed by HHS-certified labs. All test results must be 

reviewed by a board-certified medical review officer (MRO) before being 

reported to the driver’s employer. The MRO will interview the driver to 

determine if there is a medical explanation for the driver’s use of the 

prohibited substance. If the driver provides appropriate documentation 

and the MRO determines that the driver has a legitimate medical reason 

for using the prohibited substance, the result is reported as negative to 

his or her employer. The MRO is required to report any safety concerns to 

the driver’s employer with regard to drug abuse and discuss the driver’s 

use of any prohibited substances with the prescribing physician.

 

11Title V of Pub. L. No. 102-143, 105 Stat. 917, 952 (Oct. 28, 1991).
 

Page 9 GAO-13-13 Highway Safety

by a substance-abuse professional, successfully complying with 

prescribed education or treatment, and passing a return-to-duty alcohol or 

drug test. FMCSA officials stated that follow-up testing to monitor the 

driver’s continued abstinence from drug use is also required. FMCSA 

regulations state that any driver, including independent self-employed 

operators who refuse to submit to a drug or alcohol test are not permitted 

to perform safety-sensitive functions until they complete a return-to-duty 

process.

FMCSA officials stated that the results of drug tests are not directly 

reported to FMCSA, but rather processed and maintained by the current 

employers. Officials noted that FMCSA audits CDL employers for 

compliance with FMCSA testing regulations.

In 2008, we reported examples of job hopping by commercial drivers who 

failed a drug test.12

The MAP-21 Act could help improve the control vulnerabilities identified 

by our prior work. Specifically, the law requires DOT to establish, operate, 

and maintain a national clearinghouse with records relating to the results 

of positive drug and alcohol tests of commercial drivers or instances of 

refused tests. Once the clearinghouse has been established, employers 

must request and review their CDL drivers’ records from the 

clearinghouse annually. The MAP-21 Act also requires DOT to develop a 

method to electronically notify an employer of each additional positive test 

result or other noncompliance.

After losing employment for a positive test, jobhoppers then test negative on a preemployment test for another carrier 

and return to duty. In each of the 19 cases of job hopping we reported in 

our 2008 report, the second employer stated that knowledge of a previous 

positive drug test would have disqualified the driver. Some of the19 

drivers operated trucks carrying hazardous materials for periods of a 

month to over a year. These 19 cases were not generalizable to the 

population of CDL holders.

 

12GAO-08-829R. 
 

Page 10 GAO-13-13 Highway Safety

FMCSA also conducts commercial vehicle and driver inspections as part 

of its roadside vehicle-inspection program. States can apply for Motor 

Carrier Safety Assistance Program grant funds for financial assistance in 

reducing the number and severity of crashes, injuries, and fatalities 

involving commercial vehicles. According to DOT, as a condition of 

receiving these funds, states must conduct these types of inspections. A 

software program is made available by FMCSA to identify which drivers 

or vehicles are recommended for inspection.

During an inspection, a FMCSA or state officer will generally examine the 

vehicle and its equipment, as well as the driver’s license, medical 

certificate, and whether the driver is under the influence of alcohol or a 

prohibited drug. According to DOT, enforcement officials may demand to 

see a driver’s medical certificate; however, they would not be able to 

make an independent assessment of the driver’s medical condition 

absent any obvious indications of a problem. The roadside inspector 

would also only be able to address epilepsy or drugs and alcohol if the 

driver exhibited certain signs. FMCSA officials stated that drivers found to 

be using or possessing drugs or alcohol are reported into the MCMIS 

system, and additional actions (such as arrests or “out of service” 

indications in which the driver is immediately placed out of service and 

prohibited from operating the vehicle) may occur. In fiscal year 2011, over 

3.5 million roadside inspections were conducted in which over 7 million 

violations were recorded, and of those violations, approximately 14 

percent resulted in an out-of-service violation in which the driver, motor 

vehicle, or motor carrier was placed out of service because of safety 

issues.13

In addition to the roadside-inspection program, FMCSA conducts annual 

drug and alcohol strike-force sweeps. During the 2012 2-week sweep, 

FMCSA identified 287 commercial drivers who did not adhere to federal 

drug and alcohol regulations and who now face possible monetary fines 

and disqualification from operating a commercial vehicle. FMCSA also 

identified 128 truck and bus companies who now face possible 

enforcement actions for violations such as hiring drivers who had tested 

positive for illegal drugs and not implementing a drug and alcohol testing 

program. By conducting these sweeps, FMCSA has taken positive steps 

to help remove drivers that pose a risk to public safety from the road.

 

13Drivers can be cited for multiple safety violations during a single roadside inspection.

States and FMCSA 

Conduct Roadside 

Inspections to Identify 

Impaired Drivers and 

Perform Safety Checks
 

Page 11 GAO-13-13 Highway Safety

We identified instances of drivers who operated—and sometimes 

crashed—commercial vehicles despite having medical conditions such as 

epilepsy. Epilepsy is a chronic disease characterized by seizures, loss of 

bodily control, and unconsciousness. We also found instances of state 

licensing agencies issuing or reissuing CDLs to commercial drivers with 

epilepsy or drug or alcohol dependence noted in their medical histories.

FMCSA recommendations state that a person with an established history 

or clinical diagnosis of epilepsy is not physically qualified to drive a 

commercial vehicle for interstate commerce if he or she is taking 

antiseizure medication or has had a history of epilepsy or seizures within 

the past 10 years. These recommendations also state that individuals 

who use a controlled substance or habit-forming drug or who have a 

clinical diagnosis of alcoholism are not physically qualified to drive a 

commercial vehicle. The MAP-21 Act requires medical-certificate 

information to be transmitted to DOT on a monthly basis and mandates 

that states establish and maintain the capability to receive an electronic 

copy of a medical examiner’s certificate for each CDL holder licensed in 

that state.

Out of millions of CDL holders, we identified 230 individuals who were in 

an accident or had a roadside inspection in a commercial motor vehicle at 

some point between 2008 and 2011, after they started receiving SSA 

disability benefits for epilepsy. Thirty-one of the 230 individuals we 

identified were involved in accidents while driving a commercial vehicle 

during this time. However, because DOT’s database of crashes does not 

identify whether the driver’s medical condition may have contributed to 

the accident, we could not determine the extent to which the epilepsy 

impairment actually caused the accident. We plan to refer these 230 

individuals to DOT for appropriate action as warranted. We randomly 

selected for further investigation 5 of the individuals involved in 

commercial vehicle accidents and 4 of the 199 drivers selected for an 

FMCSA roadside inspection to confirm that they were driving commercial 

vehicles.

Eight of these 9 drivers selected for further investigation obtained CDLs 

after their epilepsy impairment date, with at least 6 of the 8 drivers 

obtaining their license within 10 years of having a seizure, a physical 

Examples of 

Commercial Drivers 

with Disqualifying 

Impairments Related 

to Epilepsy, Drugs, or 

Alcohol 

Drivers Operated 

Commercial Vehicles 

Despite Medical 

Impairments Related to 

Epilepsy 
 

Page 12 GAO-13-13 Highway Safety

disqualification for obtaining a CDL.14

Examples of individuals who were driving commercial vehicles after being 

diagnosed with epilepsy include the following:

Eight of the drivers were still 

entitled to SSA benefits for epilepsy because SSA continued to determine 

that they could not work due to their impairment. In two of the cases that 

resulted in an accident, a health-care professional had noted in SSA 

documentation that the individual should not be driving. Because state 

driver’s license agencies nationwide only began requiring applicants’ 

presentation of a medical certificate after January 30, 2012, we were 

unable to obtain medical examination reports from all states or drivers 

and do not know whether their medical examiners were aware of their 

conditions. We plan to refer these 9 individuals to their state driver’s 

licensing agency for appropriate action as warranted.

• Crash after epilepsy impairment. According to SSA documentation, 

this individual suffered from epilepsy, seizures, blackouts, memory 

loss, vision problems, substance abuse, and affective mood disorder.

Holding an active CDL, he was approved for SSA disability benefits in 

December 2007. He informed SSA that he had been involved in an 

auto accident but had no idea how it occurred, and that he could no 

longer drive due to his condition. He added that he had been a truck 

driver since 1977, but due to his confusion, his employer had sent 

drivers after him on three different occasions. We did not receive a 

medical examination form or certificate for this individual from the 

state that issued his CDL and thus were unable to determine whether 

a medical examiner considered or was aware of the driver’s condition 

or whether a medical examination occurred. According to medical 

records contained in SSA documentation, medical professionals 

informed this individual in 2009 that he should not be driving and that 

it was unsafe to hold a job. However, he successfully renewed his 

CDL in August 2010. DOT records show that he was involved in a 

crash with a commercial vehicle 4 months later in December 2010. 

Because DOT’s database did not identify whether the driver’s medical 

condition may have contributed to the accident, we could not 

determine the extent to which the epilepsy impairment actually caused 

the accident.

 

14 For the other 2 drivers, we could not determine whether the individual had a seizure 

within 10 years of obtaining their license.
 

Page 13 GAO-13-13 Highway Safety

• Numerous accidents after epilepsy impairment. A Washington 

state agency noted in 1989 that this driver’s seizure disorder made it 

unsafe for him to drive any vehicle, commercial or otherwise. In 1990, 

SSA determined this individual was disabled due to epilepsy and 

organic brain syndrome, which is a decreased mental function due to 

a medical disease other than a psychiatric illness. According to a 

medical evaluation in this driver’s SSA disability file, he began 

suffering from seizures and blackouts after an auto accident in 1976 

but did not report them so he could continue driving tractor trailers. In 

2000, the driver reported to SSA that medication did not prevent his 

weekly seizures. Despite this, Washington state issued him a CDL in 

2002, 2005, and 2007. Washington state driving records reveal that 

he was involved in collisions in his commercial vehicle in 2005, 2006, 

and 2009. In 2009, a representative from this driver’s employer 

informed SSA that the individual had been driving a truck for 4 years, 

but was fired for being involved in too many accidents. SSA 

suspended this individual’s disability benefits from 2006 to 2009 while 

he was earning employment income. This individual surrendered his 

CDL in January 2012. Because DOT’s database did not identify 

whether the driver’s medical condition may have contributed to the 

accident, we could not determine the extent to which the epilepsy 

impairment actually caused the accidents.

From our random selection of 100 CDL holders, we identified 22 CDL 

holders who received SSA disability benefits where epilepsy, alcohol 

addiction, or drug dependence was a listed medical impairment and had 

CDLs issued or renewed after becoming eligible for those benefits.

Specifically, according to SSA’s disability database, 10 of the 22 

individuals had epilepsy or a seizure disorder identified as a medical 

impairment in their disability records. The remaining 12 had alcohol or 

drug dependence noted in their disability records.15

 

15Each of the drivers we identified with drug or alcohol dependence noted in SSA’s 

disability files also had another disabling condition noted in the files. Drug or alcohol 

dependence is not used as a basis to determine disability. 

According to DOT, 

FMCSA and the states do not obtain complete information on whether 

individuals are driving on the road, and we were not able to determine 

whether all of these individuals were actually driving a commercial vehicle 

after their CDLs were issued or renewed. We are referring any cases 

where an individual had a disqualifying impairment yet still had an active 

CDLs Were Issued or 

Reissued to Drivers with 

Impairments Related to 

Epilepsy, Drugs, and 

Alcohol 
 

Page 14 GAO-13-13 Highway Safety

CDL to the state driver’s licensing agency for appropriate action as 

warranted.

Examples of individuals who obtained or renewed a CDL license after 

SSA determined they were eligible for disability benefits include the 

following:

• CDL issued despite epilepsy impairment. This driver reported to 

SSA that he suffered from sudden seizures, sometimes daily, 

beginning in 1999. The driver reported having seizures as often as 

three times a week, taking 20 minutes to 2 hours to recover from each 

episode. According to medical documentation in the claimant’s SSA 

disability file, he was also resistant to antiseizure medication.

According to SSA documentation, the driver reported suffering from 

seizures as recent as 2008. The driver stated that he was unable to 

stand, walk, or sit for extended periods and that he suffered from 

memory loss, fatigue, and difficulty breathing. The driver was issued a 

new CDL by the state in November 2011 with endorsements allowing 

him to operate, among other things, school buses and passenger 

vehicles. To obtain this CDL, the driver certified to the state driver’s 

licensing agency that he did not have a physical condition preventing 

him for exercising reasonable and ordinary control of a motor vehicle. 

This individual continues to receive SSA disability benefits for epilepsy 

while holding an active CDL. We did not receive a medical 

examination form or certificate for this individual from the state that 

issued his CDL and thus were unable to determine whether a medical 

examiner considered or was aware of the driver’s condition or whether 

a medical examination occurred.16

• CDL issued and renewed despite epilepsy impairment. According 

to SSA documentation, this individual began receiving disability 

benefits for a seizure disorder in 2001 and informed SSA that he 

stopped driving when his seizures began in 1999. He suffered from 

seizures and unconsciousness. For example, according to SSA 

documentation he passed out while driving a truck and awoke while 

walking in the street with no recollection of what had occurred. SSA 

documents included a physician’s note stating that the driver was 

medically disabled from any form of gainful occupation due to a 

 

16According to DOT, most states do not require provision of the medical examination form 

on the state’s own authority.
 

Page 15 GAO-13-13 Highway Safety

diagnosis of intractable seizure disorder. Despite his medical history, 

he was issued a first-time CDL in 2005, which was renewed in 2009. 

When applying for his CDL, he certified to the state driver’s licensing 

agency that he did not have a condition that could cause a loss of 

consciousness. He continues to receive SSA disability benefits for 

seizures. We did not receive a medical examination form or certificate 

for this individual from the state that issued his CDL and thus were 

unable to determine whether a medical examiner considered or was 

aware of the driver’s condition or whether a medical examination 

occurred.

• CDL issued despite drug dependence. In 2005, this individual’s 

personal driver’s license was suspended for 12 months after a Driving 

While Intoxicated (DWI) conviction. According to SSA documentation, 

in 2007 he was diagnosed with psychosis, a history of alcohol abuse, 

and cannabis abuse following a mental-health hospitalization. He 

stated that his illness began to interfere with his work in 2006 and that 

he became unable to work in 2009. He began receiving SSA disability 

benefits the following year for functional psychiatric disorders. Drug 

dependency was also noted in his file. SSA documentation states that 

in January 2009, a physician noted that this individual was unable to 

participate in employment or training activities in any capacity due to 

paranoid schizophrenia. However, this individual obtained a CDL from 

Virginia in June 2010. We did not receive a medical examination form 

or certificate for this individual from the state that issued his CDL and 

thus were unable to determine whether a medical examiner 

considered or was aware of the driver’s condition or whether a 

medical examination occurred. In October 2010, he refused to submit 

to an alcohol test while operating a commercial motor vehicle. This 

refusal led to a DWI conviction and permanent CDL suspension in 

February 2011.

Since most state driver’s licensing agencies do not require a medical 

examination report to be presented to them, according to DOT, they were 

unable to provide these reports or medical certificates that we requested 

for 29 of the 30 individuals who had CDLs issued or renewed after 

becoming eligible for SSA benefits. We were therefore unable to 

determine whether medical examiners considered or were aware of each 

driver’s conditions or whether a medical examination occurred for these 

States Could Not Provide 

Medical Examination 

Certificates
 

Page 16 GAO-13-13 Highway Safety

individuals. While FMCSA regulations are meant to prevent an individual 

with these conditions from receiving or renewing a CDL, states were not 

required to obtain and maintain medical certifications or medical 

examination reports at the time of our review. According to DOT, only a 

few states on their own authority required CDL holders to provide either a 

medical examination report or medical certificate. As mentioned earlier, 

as of January 30, 2012, FMCSA requires states to electronically store 

medical certificates for new and renewing CDL applicants and are 

required to electronically post this information for all CDL holders to the 

state’s CDLIS driver records. States will also be required to report the 

date of the medical certification to the state’s CDLIS driver record. In 

addition, the MAP-21 Act requires medical certificate information to be 

transmitted to DOT on a monthly basis and mandates that states 

establish and maintain the capability to receive an electronic copy of a 

medical examiner’s certificate for each CDL holder licensed in that state 

who operates or intends to operate in interstate commerce. If these 

requirements are properly implemented and followed, they should help to 

prevent situations similar to these case studies from recurring.

We provided a draft copy of this report to SSA and DOT. SSA did not 

have any comments. DOT’s Director of Audit Relations, Office of the 

Secretary of Transportation, provided technical comments on the report, 

which have been incorporated as appropriate.

We are sending copies of this report to interested congressional 

committees, the Secretary of Transportation, the Commissioner of the

Social Security Administration and other interested parties. In addition, 

this report is also available at no charge on the GAO website at 

http://www.gao.gov. 

If you have any questions concerning this report, please contact me at 

(202) 512-6722 or BerrickC@gao.gov. Contact points for our Offices of 

Agency Comments and 

Our Evaluation
 

Page 17 GAO-13-13 Highway Safety

Congressional Relations and Public Affairs may be found on the last page 

of this report.

Sincerely yours,

Cathleen A. Berrick

Managing Director

Forensic Audits and Investigative Service

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