Federal Register / Vol. 89, No. 13 / Friday, January 19, 2024 / Rules and Regulations 3577 

1Section 14(f) of DOT 2100.6A (Rulemaking and 

Guidance Procedures) states that it is DOT policy 

to encourage providing an opportunity for public 

comment on guidance documents, as public input 

can be very helpful in formulating and improving 

the guidance that DOT offers. 

■ a. Removing the amount ‘‘$23,714’’ 

and adding in its place the amount 

‘‘$24,483’’ wherever it appears; and 

■ b. Removing the amount ‘‘$237,268’’ 

and adding in its place the amount 

‘‘$244,958’’ wherever it appears. 

Appendix A to Part 1158 [Amended] 

■ 5. Amend appendix A to part 1158 by 

removing the amount ‘‘$23,714’’ and 

adding in its place the amount 

‘‘$24,483’’ and by removing the amount 

‘‘$237,268’’ and adding in its place the 

amount ‘‘$244,958’’ in the following 

places: 

■ a. In the last paragraph under the 

heading ‘‘Certification for Contracts, 

Grants, Loans, and Cooperative 

Agreements’’; and 

■ b. In the last paragraph under the 

heading ‘‘Statement for Loan Guarantees 

and Loan Insurance’’. 

Dated: January 16, 2024. 

Daniel Beattie, 

Director of Guidelines and Panel Operations. 

[FR Doc. 2024–00992 Filed 1–18–24; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF TRANSPORTATION 

Federal Motor Carrier Safety 

Administration 

49 CFR Part 391 

[Docket No. FMCSA–2022–0111] 

Qualifications of Drivers: Medical 

Advisory Criteria 

AGENCY: Federal Motor Carrier Safety 

Administration (FMCSA), Department 

of Transportation (DOT). 

ACTION: Final rule. 

SUMMARY: FMCSA updates the Medical 

Advisory Criteria published as an 

appendix in the Code of Federal 

Regulations (CFR). The appendix 

provides guidance for medical 

examiners listed on FMCSA’s National 

Registry of Certified Medical Examiners 

(National Registry) on the applicability 

and interpretation of the physical 

qualification standards for operators of 

commercial motor vehicles. The 

advisory criteria in the appendix are 

also intended to provide 

recommendations and information to 

assist medical examiners in applying 

the standards, basic information related 

to testing, and matters to consider when 

making a qualification determination. 

The updated Medical Advisory Criteria 

replace all previous versions of the 

criteria. 

DATES: This final rule is effective on 

January 19, 2024. 

FOR FURTHER INFORMATION CONTACT: Ms. 

Christine A. Hydock, Chief, Medical 

Programs Division, FMCSA, 1200 New 

Jersey Avenue SE, Washington, DC 

20590, (202) 366–4001, 

FMCSAmedical@dot.gov. If you have 

questions on viewing material in the 

docket, call Dockets Operations at (202) 

366–9826. 

SUPPLEMENTARY INFORMATION: 

I. Availability of Documents 

To view comments or any documents 

mentioned as being available in the 

docket, go to https://

www.regulations.gov/docket/FMCSA2022-0111/document and choose the 

document to review. To view 

comments, 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., 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. 

II. Legal Basis 

FMCSA has statutory authority under 

49 U.S.C. 31136(a)(3) and 

31149(c)(1)(A)(i)—delegated to the 

Agency by 49 CFR 1.87(f)—to establish 

regulations to ensure the physical 

condition of commercial motor vehicle 

operators is adequate to enable them to 

operate the vehicles safely. The 

guidance in the Medical Advisory 

Criteria is related to the physical 

qualification regulations required by 

those sections. 

The notice and comment rulemaking 

procedures of the Administrative 

Procedure Act (APA) do not apply to 

interpretative rules and general 

statements of policy (commonly called 

‘‘guidance’’) (5 U.S.C. 553(b)(A)). The 

Medical Advisory Criteria are 

interpretative rules that provide 

guidance, but do not amend any Agency 

regulation or establish any requirements 

for medical examiners or drivers not 

found in existing regulations. 

Accordingly, FMCSA was not required 

under the APA to solicit public 

comment on the criteria. Nevertheless, 

to ensure that the Medical Advisory 

Criteria provide clear, useful, and 

relevant information for stakeholders 

and as encouraged by DOT policy,1

FMCSA opted to make a draft of the 

criteria available for public review and 

comment (87 FR 50282 (Aug. 16, 2022)). 

Although FMCSA voluntarily provided 

an opportunity for public comment on 

the Medical Advisory Criteria, its 

decision to do so does not make 

applicable any of the other procedural 

requirements in the APA or most of the 

other statutes or executive orders that 

would apply if the opportunity for prior 

notice and public comment were 

required. 

Further, the APA does not require 

interpretive rules such as this to be 

published in the Federal Register with 

an effective date that is not less than 30 

days after publication (5 U.S.C. 

553(d)(2)). Therefore, this rule is 

effective on the date of publication in 

the Federal Register to coincide with 

the publication of the revised Medical 

Examiner’s Handbook (MEH). 

III. Background 

In 2000, FMCSA adopted a revised 

medical examination report that also 

contained the Agency’s guidelines to 

help medical examiners assess an 

individual’s physical qualifications. 

These guidelines, in the form of 

advisory criteria, were strictly advisory 

and were established after consultation 

with physicians, States, and industry 

representatives (65 FR 59363, 59364 

(Oct. 5, 2000)). Subsequently, when 

FMCSA revised the report form again, 

the medical advisory criteria were 

removed from the report form and 

published as Appendix A to 49 CFR part 

391 (80 FR 22790 (Apr. 23, 2015)). 

On August 16, 2022, FMCSA made 

available for public comment a revised 

and updated draft MEH, which included 

updates to the Medical Advisory 

Criteria (87 FR 50282). The goal of the 

updated Medical Advisory Criteria was 

to provide guidance for medical 

examiners to consider when making 

physical qualification determinations in 

conjunction with established best 

medical practices. Information that was 

outdated, obsolete, or no longer relevant 

was removed from the Medical 

Advisory Criteria. The Agency stated 

that the revised Medical Advisory 

Criteria would be included in the MEH 

and would also be published in 

Appendix A to 49 CFR part 391. The 

final version of the criteria would be 

identical in both publications. 

FMCSA notes that, as a procedural 

matter, a final rule is required by the 

Office of the Federal Register to change 

any text included in the CFR. This is so 

even if the CFR text changed is guidance 

in an interpretive rule, as is the case 

here. 


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3578 Federal Register / Vol. 89, No. 13 / Friday, January 19, 2024 / Rules and Regulations 

2See section 5203(a)(2)(A) and (a)(3) of the Fixing 

America’s Surface Transportation Act, Public Law 

114–94, 129 Stat. 1312, 1535 (Dec. 4, 2015). 

IV. New Regulatory Guidance

After consideration of the public

comments and further internal review, 

FMCSA has published a revised MEH 

that includes revisions to the Medical 

Advisory Criteria. A Federal Register 

notice about this publication of the 

MEH and the treatment of some of the 

public comments is being issued 

concurrently with this notice. The 

revised criteria included in the MEH are 

identical to the criteria published by 

this notice in Appendix A to 49 CFR 

part 391; although, the order of the 

criteria differs. The criteria in the MEH 

reflects the order in which a medical 

examiner typically conducts the 

physical qualification examination, 

while Appendix A organizes the criteria 

in the same order that the physical 

qualification standards appear in 49 

CFR 391.41(b). Consistent with previous 

practice, the Medical Advisory Criteria 

are advisory and are therefore 

considered guidance because they 

provide interpretations and 

recommendations for the physical 

qualification standards contained in the 

Federal Motor Carrier Safety 

Regulations. The updated Medical 

Advisory Criteria replace all previous 

versions of the criteria. Previous 

versions of the Medical Advisory 

Criteria should not be relied upon. 

V. Publication of the Regulatory

Guidance

Each guidance document issued by 

FMCSA must be published on a 

publicly accessible DOT internet 

website on the date of issuance (49 

U.S.C. 113 note).2 Accordingly, in 

addition to being available in this 

docket and the MEH, the Medical 

Advisory Criteria will be available in 

FMCSA’s Guidance Portal (https://

www.fmcsa.dot.gov/guidance). The 

criteria also will be available on 

FMCSA’s website at https://

www.fmcsa.dot.gov/regulations/ 

medical/medical-regulations-andguidance-resource-links and on the 

National Registry website at https://

nationalregistry.fmcsa.dot.gov/resourcecenter. 

FMCSA expects to review the 

guidance no later than 5 years after it is 

published and will consider at that time 

whether the guidance should be 

withdrawn, reissued, or incorporated 

into FMCSA’s regulations. 

VI. Regulatory Analysis

A. Regulatory Flexibility Act (Small

Entities)

Under the Regulatory Flexibility Act 

of 1980 (5 U.S.C. 601–612), FMCSA is 

not required to complete a regulatory 

flexibility analysis because, as discussed 

earlier in the Legal Basis section, this 

action is not subject to notice and public 

comment under section 553(b) of the 

APA. 

B. Assistance for Small Entities

In accordance with section 213(a) of

the Small Business Regulatory 

Enforcement Fairness Act of 1996 (Pub. 

L. 104–121, 110 Stat. 857, Mar. 29,

1996), FMCSA wants to assist small

entities in understanding this final rule

so they can better evaluate its effects on

themselves and participate in the

rulemaking initiative. If the final rule

will affect your small business,

organization, or governmental

jurisdiction and you have questions

concerning its provisions or options for

compliance; please consult the person

listed under the FOR FURTHER

INFORMATION CONTACT section of this

final rule.

C. Unfunded Mandates Reform Act of

1995

The Unfunded Mandates Reform Act 

of 1995 (2 U.S.C. 1531–1538) requires 

Federal agencies to assess the effects of 

their discretionary regulatory actions. In 

particular, the Act addresses actions 

that may result in the expenditure by a 

State, local, or Tribal government, in the 

aggregate, or by the private sector of 

$192 million (which is the value 

equivalent of $100 million in 1995, 

adjusted for inflation to 2022 levels) or 

more in any 1 year. This final rule will 

not result in such an expenditure. 

D. Paperwork Reduction Act

This final rule contains no new

information collection requirements 

under the Paperwork Reduction Act of 

1995 (44 U.S.C. 3501–3520). 

E. E.O. 13132 (Federalism) 

A rule has implications for federalism 

under section 1(a) of E.O. 13132 if it has 

‘‘substantial direct effects on the States, 

on the relationship between the national 

government and the States, or on the 

distribution of power and 

responsibilities among the various 

levels of government.’’ FMCSA has 

determined that this rule will not have 

substantial direct costs on or for States, 

nor will it limit the policymaking 

discretion of States. Nothing in this 

action preempts any State law or 

regulation. Therefore, this rule does not 

have sufficient federalism implications 

to warrant the preparation of a 

Federalism Impact Statement. 

F. Privacy Act

The Consolidated Appropriations Act,

2005 (Pub. L. 108–447, 118 Stat. 2809, 

3268, Dec. 8, 2004 (5 U.S.C. 552a note)), 

requires the Agency to conduct a 

privacy impact assessment of a 

regulation that will affect the privacy of 

individuals. Privacy impact assessments 

were completed when the physical 

qualification regulations relating to the 

guidance were adopted. The guidance in 

the Medical Advisory Criteria does not 

present any new privacy concerns that 

were not previously addressed in those 

assessments. Also, because this 

interpretive rule does not require the 

collection of personally identifiable 

information, the Agency is not required 

to conduct a privacy impact assessment. 

G. E.O. 13175 (Indian Tribal 

Governments) 

This rule does not have Tribal 

implications under E.O. 13175, 

Consultation and Coordination with 

Indian Tribal Governments, because it 

does not have a substantial direct effect 

on one or more Indian Tribes, on the 

relationship between the Federal 

Government and Indian Tribes, or on 

the distribution of power and 

responsibilities between the Federal 

Government and Indian Tribes. 

H. National Environmental Policy Act of

1969

FMCSA analyzed this rule pursuant to 

the National Environmental Policy Act 

of 1969 (42 U.S.C. 4321 et seq.) and 

determined this action is categorically 

excluded from further analysis and 

documentation in an environmental 

assessment or environmental impact 

statement under FMCSA Order 5610.1 

(69 FR 9680, Mar. 1, 2004), Appendix 2, 

paragraph 1.a. regarding guidance 

documents. 

List of Subjects in 49 CFR Part 391 

Alcohol abuse, Drug abuse, Drug 

testing, Highway safety, Motor carriers, 

Reporting and recordkeeping 

requirements, Safety, Transportation. 

For the reasons stated in the 

preamble, FMCSA amends 49 CFR part 

391, as follows: 

PART 391—QUALIFICATIONS OF 

DRIVERS AND LONGER 

COMBINATION VEHICLE (LCV) 

DRIVER INSTRUCTORS 

■ 1. The authority citation for part 391 

continues to read as follows:


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Federal Register / Vol. 89, No. 13 / Friday, January 19, 2024 / Rules and Regulations 3579 

Authority: 49 U.S.C. 504, 508, 31133, 

31136, 31149, 31502; sec. 4007(b), Pub. L. 

102–240, 105 Stat. 1914, 2152; sec. 114, Pub. 

L. 103–311, 108 Stat. 1673, 1677; sec. 215, 

Pub. L. 106–159, 113 Stat. 1748, 1767; sec. 

32934, Pub. L. 112–141, 126 Stat. 405, 830; 

secs. 5403 and 5524, Pub. L. 114–94, 129 

Stat. 1312, 1548, 1560; sec. 2, Pub. L. 115– 

105, 131 Stat. 2263; and 49 CFR 1.87. 

■ 2. In part 391, Appendix A is revised 

to read as follows: 

Appendix A to Part 391—Medical 

Advisory Criteria 

I. Introduction 

This appendix contains the Federal Motor 

Carrier Safety Administration’s 

recommendations and guidance in the form 

of Medical Advisory Criteria to help medical 

examiners assess a driver’s physical 

qualification. These recommendations and 

guidance are strictly advisory and do not 

have the force and effect of law. They were 

established after consideration of public 

comments and after consideration of 

recommendations from the Agency’s Medical 

Review Board. 

II. Interpretation of Medical Standards 

Since the issuance of the regulations for 

physical qualifications of commercial motor 

vehicle drivers, the Federal Motor Carrier 

Safety Administration has published 

recommendations and guidance called 

advisory criteria to help medical examiners 

in determining whether a driver meets the 

physical qualification standards for 

commercial driving. These recommendations 

have been derived from the Medical 

Examiner’s Handbook to provide information 

to medical examiners that is directly relevant 

to the physical qualification examination. 

A. Medical Advisory Criteria for 49 CFR 

391.41(b)(1) 

1. Only individuals with loss of all five 

fingers are considered to have loss of a hand 

under § 391.41(b)(1). 

2. Unless an individual possesses a skill 

performance evaluation certificate, loss of a 

foot, a leg, a hand, or an arm precludes 

physical qualification. Even if an individual 

has a prosthesis that replaces the foot, leg, 

hand, or arm, as applicable, certification is 

precluded without a skill performance 

evaluation certificate. 

3. An individual may be eligible for a skill 

performance evaluation certificate under 

§ 391.41(b)(1) or § 391.41(b)(2), or both. 

B. Medical Advisory Criteria for 49 CFR 

391.41(b)(2) 

1. Individuals with loss of fewer than all 

five fingers or any number of toes should be 

evaluated under § 391.41(b)(2) to determine 

whether there is an impairment, defect, or 

limitation of a hand or foot that interferes 

with the ability to perform normal tasks 

associated with operating a commercial 

motor vehicle. 

2. A skill performance evaluation 

certificate is only available under 

§ 391.41(b)(2) for impairment, defect, or 

limitation of a limb. A skill performance 

evaluation certificate is not available for 

impairment of the spine or torso that does 

not result in impairment, defect, or limitation 

of a limb. 

3. An individual may be eligible for a skill 

performance evaluation certificate under 

§ 391.41(b)(1) or § 391.41(b)(2), or both. 

C. Medical Advisory Criteria for 49 CFR 

391.41(b)(4) 

1. The phrase ‘‘has no current clinical 

diagnosis of’’ is specifically designed to 

encompass a clinical diagnosis of a current 

cardiovascular condition, or a cardiovascular 

condition that has not fully stabilized. The 

phrase ‘‘known to be accompanied by’’ is 

designed to include a clinical diagnosis of a 

cardiovascular disease that is accompanied 

by, or is likely to cause, symptoms of 

syncope, dyspnea, collapse, or congestive 

cardiac failure. 

2. Coronary artery bypass surgery and 

pacemaker implantation are remedial 

procedures and, thus, do not preclude 

medical certification. Implantable 

cardioverter-defibrillators are installed to 

address an ongoing underlying 

cardiovascular condition and are likely to 

cause syncope or collapse as a result of the 

underlying cardiovascular condition, as well 

as when they discharge. 

3. Anticoagulation therapy is a medical 

treatment, which can improve the health and 

safety of the individual, and should not, by 

its use alone, preclude certification of the 

individual. The emphasis should be on the 

underlying medical condition(s) that requires 

treatment and the general health of the 

individual. 

D. Medical Advisory Criteria for 49 CFR 

391.41(b)(5) 

1. Many conditions interfere with oxygen 

exchange and may interfere with the ability 

to control and drive a commercial motor 

vehicle safely. These include, but are not 

limited to, emphysema, chronic asthma, 

carcinoma, tuberculosis, chronic bronchitis, 

and obstructive sleep apnea. 

2. If the medical examiner detects a 

possible undiagnosed or inadequately treated 

respiratory dysfunction that may be likely to 

interfere with the individual’s ability to 

control and drive a commercial motor vehicle 

safely, the medical examiner should confer 

with the treating provider or should 

recommend that the individual be referred to 

a specialist for further evaluation and 

therapy. 

E. Medical Advisory Criteria for 49 CFR 

391.41(b)(6) 

1. An elevated blood pressure finding 

should be confirmed by at least two 

subsequent measurements. 

2. Hypertension alone is unlikely to 

interfere with the ability to operate a 

commercial motor vehicle safely; however, 

the likelihood increases when target organ 

damage, particularly cerebral vascular 

disease, is present. The guidance on the 

stages of hypertension below is based on the 

Federal Motor Carrier Safety 

Administration’s Cardiovascular Advisory 

Panel Guidelines for the Medical 

Examination of Commercial Motor Vehicle 

Drivers (October 2002), which adopted the 

sixth report of the Joint National Committee 

on Detection, Evaluation, and Treatment of 

High Blood Pressure (1997). 

3. Stage 1 hypertension corresponds to a 

systolic blood pressure of 140–159 mmHg 

and/or a diastolic blood pressure of 90–99 

mmHg. An individual with a blood pressure 

in this range is at low risk for a hypertensionrelated event that is likely to interfere with 

the ability to operate a commercial motor 

vehicle safely and may be medically certified 

to drive for a 1-year period. Certification 

examinations should be done annually 

thereafter and should be at or less than 140/ 

90. If less than 160/100 but greater than 140/ 

90 at the subsequent examinations, the 

individual may be given a one-time 

certification of 3 months to reduce the blood 

pressure to less than or equal to 140/90. 

4. A blood pressure of 160–179 systolic 

and/or 100–109 diastolic is considered Stage 

2 hypertension. A blood pressure in this 

range is an absolute indication for 

antihypertensive drug therapy. The 

individual may be given a one-time 

certification of 3 months to initiate or adjust 

antihypertensive drug therapy and to reduce 

the blood pressure to less than or equal to 

140/90. Provided treatment is well tolerated 

and the driver demonstrates a blood pressure 

value of 140/90 or less, the individual may 

be certified for 1 year. 

5. A blood pressure at or greater than 180 

(systolic) and 110 (diastolic) is considered 

Stage 3 and carries a high risk for an acute 

blood pressure-related event that is likely to 

interfere with the ability to operate a 

commercial motor vehicle safely. The 

individual should not be qualified, even for 

a short period, until the blood pressure is 

reduced to 140/90 or less and treatment is 

well tolerated. The individual may be 

certified for 6 months and biannually (every 

6 months) thereafter if at recheck blood 

pressure is 140/90 or less. 

6. Annual certification is recommended if 

the medical examiner does not know the 

severity of hypertension prior to treatment. 

7. Treatment includes non-pharmacologic 

and pharmacologic modalities as well as 

counseling to improve or eliminate the 

factors that contributed to the hypertension. 

Most antihypertensive medications also have 

side effects, such as somnolence or syncope. 

The importance of side effects must be 

evaluated on an individual basis and 

considering the underlying hypertension. 

Individuals should be alerted to the 

possibility that antihypertensive medications 

may interfere with the ability to operate a 

commercial motor vehicle safely. 

8. Medical certification for secondary 

hypertension is based on the above stages. 

Evaluation is warranted if an individual is 

persistently hypertensive on maximal or 

near-maximal doses of two to three 

pharmacologic agents. Some causes of 

secondary hypertension may be amenable to 

surgical intervention or specific 

pharmacologic treatment. 

F. Medical Advisory Criteria for 49 CFR 

391.41(b)(7) 

1. Once an individual has been diagnosed 

as having a rheumatic, arthritic, orthopedic, 

muscular, neuromuscular, or vascular 

disease, then the individual has an 

established history of that disease. 


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2. The medical examiner, when examining 

an individual, should consider the following: 

the nature and severity of the individual’s 

condition (such as sensory loss or loss of 

strength); the degree of limitation present 

(such as range of motion); the rate or stage 

of progression (symptoms may not be present 

initially but may manifest over time); and 

whether symptoms are likely to interfere 

with the ability to control and operate a 

commercial motor vehicle safely. 

3. If severe functional impairment exists, 

the individual does not physically qualify. In 

cases where more frequent monitoring is 

required, a Medical Examiner’s Certificate, 

Form MCSA–5876, for less than the 

maximum certification period may be issued. 

G. Medical Advisory Criteria for 49 CFR 

391.41(b)(8) 

1. Epilepsy is a chronic functional disease 

characterized by seizures or episodes that 

usually occur without warning, resulting in 

loss of voluntary control that may lead to loss 

of consciousness. Therefore, the following 

individuals are not physically qualified: 

• An individual who has a medical history 

of epilepsy or a seizure disorder, unless the 

individual satisfies the criteria described in 

paragraph 5 of the Medical Advisory Criteria 

for § 391.41(b)(8); 

• An individual who has a current clinical 

diagnosis of epilepsy or a seizure disorder; or 

• An individual who is taking antiseizure 

medication to prevent seizures. 

2. When an individual has had a single 

unprovoked episode of loss of consciousness 

(i.e., the cause is unknown or there is no 

clear provoking trigger) that is determined 

not to have been a seizure, the medical 

examiner may certify the individual if the 

medical examiner determines recurrence of 

loss of consciousness or loss of ability to 

control a commercial motor vehicle is 

unlikely and the individual is not taking 

antiseizure medication. The determination 

should be made on an individual basis by the 

medical examiner in consultation with the 

treating provider. Before certification is 

considered, it is recommended that a 6- 

month waiting period elapse from the time of 

the episode. 

3. When an individual has had a single 

unprovoked nonepileptic seizure (i.e., the 

cause is unknown or there is no clear 

provoking trigger) that was treated with 

antiseizure medication or left untreated, the 

medical examiner may certify the individual 

if the individual is both off antiseizure 

medication and seizure free for 5 years of 

more. 

4. When an individual has had a single 

provoked nonepileptic seizure or episode of 

loss of consciousness (i.e., there is a known 

medical condition or a clear provoking 

trigger that is reversible or avoidable, such as 

a drug reaction, alcohol or illicit drug 

withdrawal, high temperature, acute 

infectious disease, dehydration, or acute 

metabolic disturbance), the medical examiner 

may certify the individual if the individual 

has fully recovered, has no existing residual 

complications, and is not taking antiseizure 

medication and seizure recurrence and 

exposure to the provoking trigger in the 

future is unlikely. 

5. When an individual has a medical 

history of epilepsy or a seizure disorder, the 

medical examiner may certify the individual 

if the individual is both off antiseizure 

medication and seizure free for 10 years or 

more. 

6. If a medical examiner is unsure about 

whether to qualify an individual with a 

diagnosis of epilepsy or a seizure disorder, or 

a single nonepileptic seizure, the medical 

examiner may refer the individual to the 

Federal Motor Carrier Safety Administration 

for evaluation under the criteria for a Federal 

seizure exemption. 

H. Medical Advisory Criteria for 49 CFR 

391.41(b)(9) 

1. Emotional or adjustment disorders 

contribute directly to an individual’s level of 

memory, reasoning, attention, and judgment, 

and are often caused by physical disorders. 

A variety of functional disorders can cause 

drowsiness, dizziness, confusion, weakness, 

or paralysis that may lead to incoordination, 

inattention, or loss of functional control that 

may be likely to interfere with the ability to 

drive a commercial motor vehicle safely. 

Physical fatigue, headache, impaired 

coordination, recurring physical ailments, 

and chronic ‘‘nagging’’ pain may be present 

to such a degree that they may be likely to 

interfere with the ability to drive a 

commercial motor vehicle safely. Somatic 

and psychosomatic complaints should be 

thoroughly evaluated when examining an 

individual. 

2. The degree to which an individual is 

able to appreciate, evaluate, and adequately 

respond to environmental strain and 

emotional stress is critical when assessing an 

individual’s mental alertness and flexibility 

to cope with the stresses of commercial 

motor vehicle driving. 

3. It is unlikely that individuals who are 

highly susceptible to frequent states of 

emotional instability (e.g., due to 

schizophrenia, affective psychoses, paranoia, 

severe anxiety, or depressive neuroses) 

would satisfy the physical qualification 

standard. 

4. Careful consideration should be given to 

the side effects and interactions of 

medications in the overall qualification 

determination. Medications used to treat 

mental, nervous, organic, or functional 

disease or psychiatric disorder may be likely 

to interfere with the ability to drive a 

commercial motor vehicle safely. 

I. Medical Advisory Criteria for 49 CFR 

391.41(b)(11) 

1. Since the prescribed standard under the 

Federal Motor Carrier Safety Regulations is 

from the American National Standards 

Institute (ANSI), formerly the American 

Standards Association, it may be necessary to 

convert the audiometric results from the 

International Organization for 

Standardization (ISO) standard to the ANSI 

standard. To convert audiometric test results 

from ISO to ANSI, subtract 14 decibels (dBs) 

from the ISO result for 500 Hertz (Hz), 

subtract 10 dBs for 1,000 Hz, and subtract 8.5 

dBs for 2000 Hz. To average, add the readings 

for the 3 frequencies tested and divide by 3. 

2. For the whispered voice test, the 

individual should be stationed at least 5 feet 

from the medical examiner with the ear being 

tested turned toward the medical examiner. 

The other ear is covered. Using the breath 

that remains after a normal expiration, the 

medical examiner whispers words or random 

numbers such as 66, 18, 3, etc. The medical 

examiner should then ask the individual to 

repeat the words or sequence. The medical 

examiner should not use only sibilants (‘‘s’’ 

sounding materials). The opposite ear should 

be tested in the same manner. If the 

individual fails the whispered voice test in 

both ears, the audiometric test should be 

administered. 

3. If an individual does not meet the 

requirements with the use of a hearing aid 

and requires a Federal hearing exemption, 

the box for ‘‘Wearing hearing aid’’ should 

NOT be selected on either the Medical 

Examination Report Form, MCSA–5875, or 

Medical Examiner’s Certificate, Form MCSA– 

5876. Instead, only the box for accompanied 

by a hearing exemption is selected on the 

Medical Examination Report Form, MCSA– 

5875, and the Medical Examiner’s Certificate, 

Form MCSA–5876. 

4. To obtain an application for a hearing 

exemption, individuals who do not meet the 

Federal hearing standard may call (202) 366– 

4001, email fmcsahearingexemptions@

dot.gov, or go to https://www.fmcsa.dot.gov/ 

medical/driver-medical-requirements/newhearing-applicant-doc-email-version. 

J. Medical Advisory Criteria for 49 CFR 

391.41(b)(12) 

1. Federal law prohibits Schedule I drugs 

or substances listed on 21 CFR 1308.11 from 

being prescribed for any purpose. Therefore, 

a medical examiner cannot physically qualify 

an individual who uses Schedule I drugs or 

substances. 

2. A medical examiner may physically 

qualify an individual who uses an 

amphetamine, a narcotic, or other prescribed 

drug or substance listed on Schedules II 

through V in 21 CFR 1308.12 through 

1308.15 if the prescription exception is met. 

A drug or substance that is prescribed by a 

licensed medical practitioner who is licensed 

under applicable Federal, State, local, or 

foreign laws to prescribe controlled drugs 

and substances, is familiar with the 

individual’s medical history, and has advised 

the individual that the drug or substance will 

not adversely affect the individual’s ability to 

safely operate a commercial motor vehicle 

meets the prescription exception in 

§ 391.41(b)(12). 

3. One of the ways for the medical 

examiner to obtain the information that 

shows the prescription exception is satisfied 

is to request a written communication from 

the prescribing licensed medical practitioner 

who satisfies the regulation’s requirements. A 

voluntary form available on the Federal 

Motor Carrier Safety Administration’s 

website (391.41 CMV Driver Medication 

Form, MCSA–5895) may be used, with the 

individual’s consent, as an optional tool to 

obtain the required information. 

4. The medical examiner may request a 

non-Department of Transportation drug test 

to aid in the physical qualification 

determination, including when signs exist 

indicating the individual may not have 


ddrumheller on DSK120RN23PROD with RULES1
Federal Register / Vol. 89, No. 13 / Friday, January 19, 2024 / Rules and Regulations 3581 

disclosed use of a scheduled drug or 

substance. Use of a substance abuse 

professional, see 49 CFR 40.3 and 40.281, is 

not required as part of a non-Department of 

Transportation drug test. 

K. Medical Advisory Criteria for 49 CFR 

391.41(b)(13) 

1. The phrase ‘‘current clinical diagnosis 

of’’ alcoholism is specifically designed to 

encompass a current alcoholic illness or 

those instances where the individual’s 

physical condition has not fully stabilized. 

2. When in remission, the medical 

examiner may certify an individual who has 

a prior clinical diagnosis of alcoholism. 

3. The medical examiner may request a 

non-Department of Transportation alcohol 

test to aid in the physical qualification 

determination, including when the 

individual discloses excessive use of alcohol 

or the medical examiner observes signs of 

alcoholism. The use of a substance abuse 

professional, see 49 CFR 40.3 and 40.281, is 

not required. The medical examiner may 

request that individuals provide 

documentation from a professional qualified 

to conduct an alcohol use assessment that 

includes an opinion concerning whether a 

current clinical diagnosis of alcoholism is 

present or the individual is in remission 

prior to making a medical certification 

determination. 

Issued under authority delegated in 49 CFR 

1.87. 

Robin Hutcheson, 

Administrator. 

[FR Doc. 2024–00980 Filed 1–18–24; 8:45 am] 

BILLING CODE 4910–EX–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 679 

[RTID 0648–XD197] 

Fisheries of the Exclusive Economic 

Zone Off Alaska; Scallop Specification 

Process Flexibility 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Notice of agency decision. 

SUMMARY: The National Marine 

Fisheries Service (NMFS) announces the 

approval of Amendment 18 to the 

Fishery Management Plan (FMP) for the 

Scallop Fishery off Alaska (Scallop 

FMP). Amendment 18 revises timing 

requirements for the Stock Assessment 

and Fishery Evaluation (SAFE) report to 

allow more flexibility for non-annual 

assessments and to set scallop harvest 

specifications less frequently than on an 

annual basis. This will reduce the 

burden on staff and provide more time 

for the development of new stock 

assessment methods. Amendment 18 is 

intended to promote the goals and 

objectives of the Magnuson-Stevens 

Fishery Conservation and Management 

Act (Magnuson-Stevens Act), the 

Scallop FMP, and other applicable laws. 

DATES: The amendment was approved 

on January 11, 2024. 

ADDRESSES: Electronic copies of 

Amendment 18, the Analysis, and the 

Categorical Exclusion (CE) prepared for 

this action may be obtained from 

https://www.regulations.gov under the 

docket NOAA–NMFS–2023–0094. 

FOR FURTHER INFORMATION CONTACT: 

Megan Mackey, 907–586–7228. 

SUPPLEMENTARY INFORMATION: The 

Magnuson-Stevens Act requires that 

each regional fishery management 

council submit any FMP amendment it 

prepares to NMFS for review and 

approval, disapproval, or partial 

approval by the Secretary of Commerce 

(Secretary). The Magnuson-Stevens Act 

also requires that NMFS, upon receiving 

an FMP amendment, immediately 

publish a notice in the Federal Register 

announcing that the amendment is 

available for public review and 

comment. 

The Notice of Availability (NOA) for 

Amendment 18 was published in the 

Federal Register on November 3, 2023 

(88 FR 75535) with a 60-day comment 

period that ended on January 2, 2024. 

NMFS received one comment during the 

public comment period on the NOA. 

NMFS summarized and responded to 

this comment under Comments and 

Responses, below. 

NMFS determined that Amendment 

18 is consistent with the MagnusonStevens Act and other applicable laws, 

and the Secretary of Commerce 

approved Amendment 18 on January 11, 

2024. The November 3, 2023, NOA (88 

FR 75535) contains additional 

information on this action. No changes 

to Federal regulations are necessary to 

implement the Amendment. 

The scallop fishery in the exclusive 

economic zone off Alaska under the 

Scallop FMP is jointly managed by 

NMFS and the State of Alaska (State). 

The Council prepared the Scallop FMP 

under the authority of the MagnusonStevens Act (16 U.S.C. 1801 et seq.). 

Regulations governing U.S. fisheries and 

implementing the Scallop FMP appear 

at 50 CFR parts 600 and 679. 

The Scallop FMP delegates many 

management aspects of the scallop 

fishery to the State but maintains 

Federal oversight. This authority is 

limited by the Magnuson-Stevens Act 

and the FMP. While the FMP includes 

scallop stocks off the coast of Alaska, 

including weathervane scallop 

(Patinopecten caurinus), reddish scallop 

(Chlamys rubida), spiny scallop 

(Chlamys hastata), and rock scallop 

(Crassadoma gigantea), the weathervane 

scallop is the only commercially 

targeted stock at this time. Commercial 

fishing for weathervane scallops occurs 

in the Gulf of Alaska, Bering Sea, and 

waters off the Aleutian Islands. There is 

currently no formal stock assessment 

model for the scallop fishery. Instead, 

the State sets guideline harvest levels 

informed by data collected through the 

scallop fishery observer program and 

fishery-independent scallop dredge 

surveys. Standardized catch per unit 

effort indices are estimated to account 

for depth, month, vessel, bed, and 

season variations. 

Previously, the overfishing level 

(OFL) and acceptable biological catch 

(ABC) have been set based on the 

definition of optimal yield (OY). More 

recently, OFL and ABC have been based 

on the OY re-defined in 2012 

(Amendment 13), when OY was redefined as 0 to 1.29 million pounds (lb) 

(585 tons (t)) of shucked scallop meats 

to include estimated discards over the 

reference time frame. Annual 

specifications have been defined as: 

max OFL = OY, and ABC = 90 percent 

of OFL. Alaska scallop harvests have not 

exceeded OY in any year since it was 

first established. 

In the absence of stock-size estimates, 

the status of the scallop stock relative to 

its overfished state is unknown. 

Consistent with assessments since the 

2011–12 season, the 2022–23 OFL is set 

equal to the OY (1.284 million lb.; 582 

t) as defined in the Scallop FMP, and 

the 2022–23 ABC is set equal to the 

maximum ABC control rule value (90 

percent of OFL or 1.156 million lb.; 524 

t). Estimated total fishing removals 

(retained and discarded) for the 2021–22 

and 2022–23 seasons were 311,978 lb 

(141.5 t) and 345,690 lb (156.8 t) of 

shucked meats, respectively. These 

estimates are less than 30 percent of the 

ABC/annual catch limit and OFL; 

therefore, overfishing did not occur in 

2021–22 or 2022–23. 

Currently, the Scallop FMP requires 

the SAFE report to be created on an 

annual basis. The management 

measures in Amendment 18 will amend 

the FMP to allow flexibility for nonannual assessments. This will remove 

prescriptive language dictating that the 

SAFE report is produced on an annual 

basis. Amendment 18 will give the 

Council flexibility in modifying the 

assessment cycle with the potential to 

set multi-year specifications, based on a 

period of no more than 3 years, that best 

suit the needs of the stock. If a formal 


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