82498 Federal Register / Vol. 88, No. 225 / Friday, November 24, 2023 / Notices 

DEPARTMENT OF TRANSPORTATION 

Federal Motor Carrier Safety 

Administration 

[Docket No. FMCSA–2023–0141] 

Qualification of Drivers; Exemption 

Applications; Narcolepsy 

AGENCY: Federal Motor Carrier Safety 

Administration (FMCSA), Department 

of Transportation (DOT) 

ACTION: Notice of denial. 

SUMMARY: FMCSA announces its 

decision to deny the application from 

one individual who requested an 

exemption from the Federal Motor 

Carrier Safety Regulations (FMCSRs) 

prohibiting operation of a commercial 

motor vehicle (CMV) in interstate 

commerce by persons with either a 

clinical diagnosis of narcolepsy or any 

other condition that is likely to cause a 

loss of consciousness or any loss of 

ability to control a CMV. 

FOR FURTHER INFORMATION CONTACT: Ms. 

Christine A. Hydock, Chief, Medical 

Programs Division, FMCSA, DOT, 1200 

New Jersey Avenue SE, Room W64–224, 

Washington, DC 20590–0001, (202) 366– 

4001, fmcsamedical@dot.gov. Office 

hours are from 8:30 a.m. to 5 p.m. ET 

Monday through Friday, except Federal 

holidays. If you have questions 

regarding viewing materials in the 

docket, contact Dockets Operations, 

(202) 366–9826. 

SUPPLEMENTARY INFORMATION: 

I. Public Participation 

A. Viewing Comments 

To view comments go to 

www.regulations.gov. Insert the docket 

number (FMCSA–2023–0141) in the 

keyword box, and click ‘‘Search.’’ Next, 

sort the results by ‘‘Posted (NewerOlder),’’ choose the first notice listed, 

and click ‘‘Browse Comments.’’ If you 

do not have access to the internet, you 

may view the docket online by visiting 

Dockets Operations on the ground floor 

of the DOT West Building, 1200 New 

Jersey Avenue SE, Washington, DC 

20590–0001, between 9 a.m. and 5 p.m. 

ET Monday through Friday, except 

Federal holidays. To be sure someone is 

there to help you, please call (202) 366– 

9317 or (202) 366–9826 before visiting 

Dockets Operations. 

B. Privacy Act 

In accordance with 49 U.S.C. 

31315(b)(6), DOT solicits comments 

from the public on the exemption 

request. DOT posts these comments, 

without edit, including any personal 

information the commenter provides, to 

www.regulations.gov. As described in 

the system of records notice DOT/ALL 

14 (Federal Docket Management 

System), which can be reviewed at 

https://www.transportation.gov/ 

individuals/privacy/privacy-act-systemrecords-notices, the comments are 

searchable by the name of the submitter. 

II. Background 

On September 27, 2023, FMCSA 

published a notice announcing receipt 

of an application from one individual 

with a diagnosis of narcolepsy and 

requested comments from the public (88 

FR 66553). The individual requested an 

exemption from 49 CFR 391.41(b)(8) 

which prohibits operation of a CMV in 

interstate commerce by persons with 

either a clinical diagnosis of narcolepsy 

or any other condition that is likely to 

cause a loss of consciousness or any loss 

of ability to control a CMV. The public 

comment period ended on October 27, 

2023, and no comments were received. 

FMCSA has evaluated the eligibility 

of the applicant and concluded that 

granting an exemption would not 

provide a level of safety that would be 

equivalent to, or greater than, the level 

of safety that would be obtained by 

complying with § 391.41(b)(8). A 

summary of the applicant’s medical 

history related to the narcolepsy 

exemption request was discussed in the 

September 27, 2023, Federal Register 

notice and will not be repeated here. 

The Agency considered information 

from the 2009 Evidence Report, 

‘‘Narcolepsy (with and without 

cataplexy) and Commercial Motor 

Vehicle Driver Safety,’’ and the January 

2010 Medical Review Board (MRB) 

recommendation that individuals with 

narcolepsy be ineligible for a 

commercial driver’s license, even with 

treatment. A copy of the Evidence 

Report is included in the docket. 

Narcolepsy is a chronic neurological 

disorder caused by autoimmune 

destruction of hypocretin-producing 

neurons inhibiting the brain’s ability to 

regulate sleep-wake cycles normally. 

Persons with narcolepsy experience 

frequent excessive daytime sleepiness, 

comparable to how individuals without 

narcolepsy feel after 24 to 48 hours of 

sleep deprivation, as well as disturbed 

nocturnal sleep, which is often confused 

with insomnia. See National Institutes 

of Health Narcolepsy information at 

https://www.ninds.nih.gov/healthinformation/disorders/narcolepsy. 

The 2009 Evidence Report, 

‘‘Narcolepsy (with and without 

cataplexy) and Commercial Motor 

Vehicle Driver Safety,’’ addressed 

whether or not individuals with 

narcolepsy are at an increased risk for 

motor vehicle crashes; whether or not 

currently recommended treatments for 

narcolepsy reduce the risk for motor 

vehicle crashes; and the impact of 

various medication therapies for 

narcolepsy on driver safety. 

The evidence report reviewed studies 

from the available literature and 

evaluated outcomes on measures of 

Excessive Daytime Sleepiness (EDS), 

cataplexy, event rate, measures of 

cognitive and psychomotor function, 

and driving performance. The currently 

available direct and indirect evidence 

supports the contention that drivers 

with narcolepsy are at an increased risk 

for a motor vehicle crash when 

compared to otherwise similar 

individuals who do not have the 

disorder. The direct evidence from three 

crash studies conducted of non-CMV 

drivers showed that individuals with 

narcolepsy are at an increased risk for 

a crash compared to individuals who do 

not have narcolepsy. The indirect 

evidence from studies of driving tests 

and driving simulation examined factors 

associated with simulated driving 

outcomes such as driving performance, 

tracking error, fewer correct responses, 

and more instances of going out of 

bounds compared to healthy controls. 

While there are limitations in the 

quality of the studies that examined 

direct crash risk, both the direct and 

indirect studies showed a strong effect 

size and statistical significance. The 

American Academy of Sleep Medicine 

(AASM) and the European Federation of 

Neurological Societies recommend 

modafinil as the first treatment option 

and methylphenidate as the second 

treatment option. The AASM also 

recommends amphetamine, 

methamphetamine, or 

dextroamphetamine as alternative 

treatments. During literature searches, 

no studies that directly examined the 

impact of treatment with modafinil, 

armodafinil, sodium oxybate (used with 

narcolepsy with cataplexy), or antidepressants on crash risk or driving 

performance were identified. Therefore, 

conclusions regarding treatment with 

these medications on crash risk and 

driving performance could not be made. 

Currently available evidence suggests 

that amphetamines and/or 

methylphenidate are effective in 

improving symptoms of EDS in 

individuals with narcolepsy (quality of 

studies range from ‘‘moderate to low’’). 

However, these improvements do not 

result in levels of daytime sleepiness 

that can be considered to be normal in 

the vast majority of individuals. 

Therefore, conclusions regarding to the 

impact of treatment with amphetamines, 

methylphenidate, or other related 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 88, No. 225 / Friday, November 24, 2023 / Notices 82499 

stimulant drugs on cognitive and 

psychomotor function among 

individuals with narcolepsy could not 

be made. 

In January 2010, FMCSA’s MRB 

recommended that individuals with 

narcolepsy be ineligible for a 

commercial driver’s license, even with 

treatment. 

III. Discussion of Comments 

FMCSA received no comments in this 

proceeding. 

IV. Basis for Exemption Determination 

Under 49 U.S.C. 31136(e) and 

31315(b), FMCSA may grant an 

exemption from the FMCSRs for no 

longer than a 5-year period if it finds 

such exemption would likely achieve a 

level of safety that is equivalent to, or 

greater than, the level that would be 

achieved absent such exemption. 

The Agency’s decision regarding this 

exemption application is based on an 

individualized assessment of the 

applicant’s medical information, 

available medical and scientific data 

concerning narcolepsy, and any relevant 

public comments received. 

V. Conclusion 

The Agency has determined that the 

available medical and scientific 

literature and research provides 

insufficient data to enable the Agency to 

conclude that granting this exemption 

would achieve a level of safety 

equivalent to, or greater than, the level 

of safety maintained without the 

exemption. Therefore, the following 

applicant has been denied an exemption 

from the physical qualification 

standards in § 391.41(b)(8): 

Kevin Cunningham (TN) 

The applicant has, prior to this notice, 

received a letter of final disposition 

regarding their exemption request. The 

decision letter fully outlined the basis 

for the denial and constitute final action 

by the Agency. The name of the 

individual published in this notice 

summarizes the Agency’s recent denials 

as required under 49 U.S.C. 31315(b)(4). 

Larry W. Minor, 

Associate Administrator for Policy. 

[FR Doc. 2023–25919 Filed 11–22–23; 8:45 am] 

BILLING CODE 4910–EX–P 

DEPARTMENT OF TRANSPORTATION 

Federal Motor Carrier Safety 

Administration 

[Docket No. FMCSA–2023–0025] 

Qualification of Drivers; Exemption 

Applications; Hearing 

AGENCY: Federal Motor Carrier Safety 

Administration (FMCSA), Department 

of Transportation (DOT). 

ACTION: Notice of applications for 

exemption; request for comments. 

SUMMARY: FMCSA announces receipt of 

applications from 10 individuals for an 

exemption from the hearing requirement 

in the Federal Motor Carrier Safety 

Regulations (FMCSRs) to operate a 

commercial motor vehicle (CMV) in 

interstate commerce. If granted, the 

exemptions would enable these hard of 

hearing and deaf individuals to operate 

CMVs in interstate commerce. 

DATES: Comments must be received on 

or before December 26, 2023. 

ADDRESSES: You may submit comments 

identified by the Federal Docket 

Management System Docket No. 

FMCSA–2023–0025 using any of the 

following methods: 

• Federal eRulemaking Portal: Go to 

www.regulations.gov/, insert the docket 

number (FMCSA–2023–0025) in the 

keyword box and click ‘‘Search.’’ Next, 

choose the only notice listed, and click 

on the ‘‘Comment’’ button. Follow the 

online instructions for submitting 

comments. 

• Mail: Dockets Operations; U.S. 

Department of Transportation, 1200 

New Jersey Avenue SE, West Building 

Ground Floor, Washington, DC 20590– 

0001. 

• Hand Delivery: West Building 

Ground Floor, 1200 New Jersey Avenue 

SE, Washington, DC 20590–0001, 

between 9 a.m. and 5 p.m. ET Monday 

through Friday, except Federal 

Holidays. 

• Fax: (202) 493–2251. 

To avoid duplication, please use only 

one of these four methods. See the 

‘‘Public Participation’’ portion of the 

SUPPLEMENTARY INFORMATION section for 

instructions on submitting comments. 

FOR FURTHER INFORMATION CONTACT: Ms. 

Christine A. Hydock, Chief, Medical 

Programs Division, FMCSA, DOT, 1200 

New Jersey Avenue SE, Room W64–224, 

Washington, DC 20590–0001, (202) 366– 

4001, fmcsamedical@dot.gov. Office 

hours are 8:30 a.m. to 5 p.m. ET Monday 

through Friday, except Federal holidays. 

If you have questions regarding viewing 

or submitting material to the docket, 

contact Dockets Operations, (202) 366– 

9826. 

SUPPLEMENTARY INFORMATION: 

I. Public Participation 

A. Submitting Comments 

If you submit a comment, please 

include the docket number for this 

notice (Docket No. FMCSA–2023–0025), 

indicate the specific section of this 

document to which each comment 

applies, and provide a reason for each 

suggestion or recommendation. You 

may submit your comments and 

material online or by fax, mail, or hand 

delivery, but please use only one of 

these means. FMCSA recommends that 

you include your name and a mailing 

address, an email address, or a phone 

number in the body of your document 

so that FMCSA can contact you if there 

are questions regarding your 

submission. 

To submit your comment online, go to 

https://www.regulations.gov/docket/ 

FMCSA-2023-0025. Next, sort the results 

by ‘‘Posted (Newer-Older),’’ choose the 

only notice listed, click the ‘‘Comment’’ 

button, and type your comment into the 

text box on the following screen. Choose 

whether you are submitting your 

comment as an individual or on behalf 

of a third party and then submit. 

If you submit your comments by mail 

or hand delivery, submit them in an 

unbound format, no larger than 81⁄2 by 

11 inches, suitable for copying and 

electronic filing. 

FMCSA will consider all comments 

and material received during the 

comment period. 

B. Viewing Comments 

To view comments go to 

www.regulations.gov. Insert the docket 

number (FMCSA–2023–0025) in the 

keyword box and click ‘‘Search.’’ Next, 

choose the only notice listed, and click 

‘‘Browse Comments.’’ If you do not have 

access to the internet, you may view the 

docket online by visiting Dockets 

Operations on the ground floor of the 

DOT West Building, 1200 New Jersey 

Avenue SE, Washington, DC 20590– 

0001, between 9 a.m. and 5 p.m. ET 

Monday through Friday, except Federal 

holidays. To be sure someone is there to 

help you, please call (202) 366–9317 or 

(202) 366–9826 before visiting Dockets 

Operations. 

C. Privacy Act 

In accordance with 49 U.S.C. 

31315(b)(6), DOT solicits comments 

from the public on the exemption 

requests. DOT posts these comments, 

without edit, including any personal 

information the commenter provides, to 

www.regulations.gov. As described in 

the system of records notice DOT/ALL 


ddrumheller on DSK120RN23PROD with NOTICES1