[Federal Register Volume 65, Number 194 (Thursday, October 5, 2000)]
[Rules and Regulations]
[Pages 59363-59380]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-25337]



[[Page 59363]]

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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

49 CFR Part 391

[FMCSA Docket No. 98-3542 (formerly FHWA Docket No. 98-3542)]
RIN 2126-AA06 (formerly 2125-AC63)


Physical Qualification of Drivers; Medical Examination; 
Certificate

AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.

ACTION: Final rule.

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SUMMARY: This document updates and simplifies the medical examination 
form that is currently used to determine the physical qualification of 
commercial motor vehicle (CMV) drivers operating in interstate 
commerce. The FMCSA takes this action in response to numerous requests 
from medical examiners to update and simplify the medical examination 
form that is currently used. This action is intended to reduce the 
incidence of errors on such forms and to provide more uniform medical 
examinations of CMV drivers engaged in interstate commerce. The current 
Federal physical qualification standards tested by medical examiners 
and recorded on the form will not be revised in this rulemaking.

DATES: November 6, 2000.

FOR FURTHER INFORMATION CONTACT: For information about the rulemaking, 
Ms. Sandra Zywokarte, Office of Bus and Truck Standards and Operations, 
(202) 366-2987; for information about legal issues related to this 
notice, Ms. Judith Rutledge, Office of the Chief Counsel, (202) 366-
2519, FMCSA, Department of Transportation, 400 Seventh Street, SW., 
Washington, DC 20590. Office hours are from 7:45 a.m. to 4:15 p.m., 
e.t., Monday through Friday, except Federal holidays.

SUPPLEMENTARY INFORMATION:

Electronic Access

    An electronic copy of this document may be downloaded using a 
computer, modem and suitable communications software from the 
Government Printing Office's Electronic Bulletin Board Service at (202) 
512-1661. Internet users may reach the Office of the Federal Register's 
home page at: http://www.nara.gov/fedreg and the Government Printing 
Office's web page at http://www.access.gpo.gov/nara.

Background

    The authority to require medical certification of CMV driver 
qualification was originally granted to the Interstate Commerce 
Commission (ICC) in the Motor Carrier Act of 1935. The authority was 
transferred to the DOT in 1966 and is currently codified at 49 U.S.C. 
31502(b). On October 9, 1999, the Secretary of Transportation 
transferred the motor carrier safety functions performed by the Federal 
Highway Administration (FHWA) to the Office of Motor Carrier Safety, a 
new office created in the DOT. This transfer was performed pursuant to 
section 338 of the DOT and Related Agencies Appropriations Act, 2000, 
Public Law 106-69, 113 Stat. 986, as amended by Public Law 106-73, 113 
Stat. 1046. The Motor Carrier Safety Improvement Act of 1999, Public 
Law 106-159, 113 Stat. 1748, transferred the functions to the Federal 
Motor Carrier Safety Administration (FMCSA). As a result of the 
transfer of functions, the FMCSA now administers the driver physical 
qualification standards and examinations in 49 CFR Part 391.
    The first physical qualification standard for CMV drivers was 
published by the ICC in 1939. It required a driver to have the 
following minimum qualifications:

    Good physical and mental health; good eyesight; adequate 
hearing; no addiction to narcotic drugs; and no excessive use of 
alcoholic beverages or liquors.

    Over the next three decades, other physical qualification 
regulations were promulgated by the ICC, but most were not clearly 
defined until 1970, after the creation of the DOT. On April 22, 1970 
(35 FR 6458), the existing physical qualification requirements were 
substantially tightened, based upon discussions with our agency's 
medical advisors. This rule required a driver to have a physical 
examination every 2 years, included guidelines for evaluation of 
persons in high-risk medical categories, and provided that the 
examining physician be given full information about the 
responsibilities of and the exacting demands made on CMV drivers. There 
have been no major changes since then.

Current Medical Examination Form

    The current form, at 49 CFR 391.43(f), has remained unchanged since 
it was adopted by the DOT in 1970. As a result, our agency has received 
numerous requests to make changes to the current medical examination 
form. Physicians and other medical providers have indicated that the 
format, layout and content of the current form are outdated, difficult 
to use, or irrelevant.
    Additionally, substantial changes in medical technology and the 
technology, operating practices, and economics of the motor carrier 
industry have affected the lifestyles of and, therefore, the physical 
and mental demands placed on CMV drivers. Having agreed that the 
current medical form is outdated and its continued use problematic, we 
decided to initiate rulemaking to revise the form.

Medical Examination Form Revision Process

    We contracted with the Association for the Advancement of 
Automotive Medicine (AAAM) to review and evaluate the current form and 
develop a revised form. The process was defined and limited by several 
norms. The underlying physical qualification standards tested by 
medical providers and recorded on the form would not be revised in this 
rulemaking. In addition, the instructions for performing and recording 
physical examinations found in 49 CFR 391.43 would be revised only to 
the extent necessary to ensure that instructions to medical examiners 
are understandable and consistent with the information provided on the 
proposed medical examination form and guidance materials established by 
us for medical examiners.
    To ensure that the revised form reflected the most current medical 
concepts and was responsive to the needs of the groups using the forms, 
the AAAM convened a working group to serve as reviewers of the draft 
form. The review panel members included two occupational health 
physicians, a motor carrier, two State motor vehicle administration 
officials and our agency representatives. A second draft of the form 
was then submitted to a correspondence advisory group, providing a more 
comprehensive review process. This larger group of reviewers was made 
up of medical providers, motor carriers, State motor vehicle agency 
representatives, Canadian motor transport officials, our agency field 
staff, and other interested groups.

Revised Medical Examination Form

    The revised form, modeled after physical examination forms in use 
today, has been organized to (1) gain simplicity and efficiency, (2) 
reflect current medical terminology and examination components and (3) 
be a self-contained document (i.e., the form will, to the extent 
possible, include all relevant information necessary to conduct the 
physical examination and certification).
    Consistent with accepted practices regarding the order of the 
examination, the first section of the examination form is completed by 
the driver. This section requests information on the driver's

[[Page 59364]]

health history, seeking ``yes'' or ``no'' answers to a variety of 
medical condition questions. Any ``yes'' response requires further 
clarification by the driver. Once this section is completed, the driver 
is required to sign the form, affirming that all the information 
contained in this section is accurate and complete. An additional 
statement indicates that inaccurate, false, or missing information may 
invalidate both the examination and any Medical Examiner's Certificate 
issued based on it.
    The second section of the examination form covers the physical 
examination and tests that are performed by the medical examiner. The 
medical examiner is provided information on both the relevant Federal 
physical qualification standards and the tests required to measure 
compliance with those standards. The Federal standards and guidelines 
for evaluation of a driver's vision, hearing, and blood pressure are 
included in this section of the form, thereby reducing the potential 
for errors by the medical examiner.
    Unlike the current physical examination form, the revised form 
clearly indicates when numerical readings must be recorded. Space is 
also provided on the form for recording any optional tests which the 
medical examiner considers necessary to evaluate a driver's physical 
qualification.
    A full page of the revised form is devoted to instruction and 
recordation of the medical examiner's findings. The medical certificate 
is also provided, and must be completed by the medical examiner if he 
or she finds that the driver meets all the Federal physical 
qualification requirements.
    The third section of the revised form not only sets forth the 
Federal physical qualification standards found at 49 CFR 391.41, but 
also contains more detailed information for the medical examiner 
regarding the driver's role and the types of duties he or she may face 
as a result of his or her employment. This section also contains the 
agency's guidelines to help medical examiners assess a driver's 
physical qualification. These guidelines are strictly advisory and were 
established after consultation with physicians, States, and industry 
representatives.
    In addition to the revisions to 49 CFR 391.43 in the final rule, we 
are making technical corrections to paragraphs (d) and (g) of that 
section, to paragraphs (b)(1) and (b)(2)(ii) under Sec. 391.41 and 
paragraph (d)(2) under Sec. 391.49.
    The FMCSA's primary concern is to enhance highway safety, rather 
than to unnecessarily limit employment opportunities for individuals 
with physical impairments. The intent of the final rule is to 
facilitate medical providers' efforts to establish and document the 
physical qualification of a driver to operate a CMV by promoting 
reliable and understandable determinations of medical qualification.

Comments

    On August 5, 1998, we published an NPRM rulemaking (63 FR 41769) 
seeking comments on our proposed medical examination form. We invited 
individuals, medical providers, motor carriers, and other interested 
parties to provide comments on how to improve our proposed examination 
form and instructions for performing and recording physical 
examinations. Forty-six public comments addressing the notice were 
received and have been considered in our final decision to amend 
Federal regulations governing the examination to determine the physical 
qualification of CMV drivers engaged in interstate commerce.
    We received comments from 23 physicians, 8 employers of truck 
drivers, 4 State motor vehicle administrations, 1 State enforcement 
agency, 1 Canadian motor vehicle agency, 3 trucking associations, 1 
motor coach association, 1 trade association, 1 nursing association, 1 
medical association and 2 advocacy groups. The majority of the comments 
supported the proposed medical examination form with suggestions for 
additions and deletions to the form. One comment completely opposed the 
proposal. Some comments offered suggestions for additions or deletions 
without indicating support for the form. Others suggested changes to 
the Federal physical qualification standards tested by medical 
examiners and recorded on the form.
    Although most comments were generally supportive, a number of 
comments strongly opposed providing space on the proposed form for 
recording the results of such optional tests as an electrocardiogram 
(ECG) and exercise stress test (EST). Still others expressed concerns 
that the form has too many pages. These comments and others will be 
discussed in detail below by section, and in accordance with the order 
of the examination.

Discussion of Comments

Driver's Information

    Comments directed to this section of the examination form suggested 
format changes for recording and denoting certain information on the 
form. The FMCSA has considered these comments and modified the form as 
follows: The format for recording the date of birth on the form will 
show month, day and year and the area code will be denoted by 
parentheses. The agency has also added another category, other, to the 
area on the form denoting the class of license held by the driver. This 
change is provided to accommodate non-CDL licensed drivers.

Health History

    This section of the form received a number of comments suggesting 
additions or deletions of information and changes to the format. The 
Alabama Power Company, J.B. Hunt Transport, Inc., the Maryland Motor 
Vehicle Administration, the Wisconsin Department of Transportation and 
the Ministry of Transportation and Highways in British Columbia 
expressed support for the inclusion of a driver certification statement 
affirming that the information provided by the driver is accurate and 
complete. The American Association of Occupational Health Nurses 
(AAOHN) and the Maryland Motor Vehicle Administration indicated that 
the agency's statement that encourages the medical examiner to discuss 
health history information with the driver is not strong enough and the 
discussion should be required. Dr. Ellison Wittels commented that ``the 
medical examiner needs to comment on any ``yes'' answer and address the 
severity of the problem.'' Comments from Dr. Wittles and the AAOHN 
indicated that more space should be allotted for the medical examiner's 
review of the health history. Dr. John A. Hansen agreed that there is 
inadequate space on the proposed form for the medical examiner's 
``impression and opinion,'' and indicated that too much space is 
allocated to driver's comments and the listing of their medications. In 
fact, Dr. Hansen suggests that, in general, the format of the proposed 
form is ``excessive.''
    The American College of Occupational and Environmental Medicine 
(ACOEM) believes that the ``expanded medical history section assists 
the [medical] examiner in making a thorough evaluation,'' but questions 
whether any of the conditions listed in the health history are likely 
to interfere with the driver's ability to safely operate a CMV. The 
ACOEM also expressed concerns over the potential for breaching 
confidential medical information.
    The Owner Operator Independent Drivers Association, Inc., (OOIDA) 
an international trade association representing the interests of 
independent owner-operators and

[[Page 59365]]

professional truck drivers, supports the overall goals of the proposal. 
However, the OOIDA raised concerns regarding the amount and relevancy 
of information solicited under the health history section and the 
confidentiality of medical information of drivers. The OOIDA believes 
that vague terminology and a lack of understanding of medical terms and 
conditions on the part of drivers will unjustly result in a driver 
being determined medically unqualified. Therefore, the OOIDA suggests 
that the medical examiner complete the health history section. The 
OOIDA also expressed concern that information in this section which it 
views as ``unnecessary and irrelevant'' would be used by employers for 
purposes other than the intended medical certification. Finally, the 
OOIDA opposes the requirement for a driver certification statement 
suggesting that such a requirement will not prevent drivers from 
falsifying or omitting information if a ``yes'' response would result 
in the driver being found medically unqualified.
    The AHAS commented that the ``FHWA could significantly improve 
highway safety by promoting increased definitive diagnoses and 
treatment of apnea'' and noted that ``many preliminary diagnoses of 
apnea are made on the basis of selfreport.'' The FMCSA believes the 
information on sleep disorders in this section will help elicit 
information from the driver regarding any history of sleep disorders 
and thereby, facilitate the identification and treatment of such 
disorders.
    The FMCSA has considered the comments to this section and modified 
the form as follows: The two questions regarding hospitalization and 
serious illness in the last 5 years have been combined into one 
question that reads: ``any illness or injury in the last 5 years.'' A 
box has been added to indicate when medications are taken for nervous 
or psychiatric disorders. The section on sleep disorders was modified 
to include ``pauses in breathing while asleep'' and to substitute 
``loud snoring'' for severe snoring. The term ``severe'' has been 
dropped from the health history because it is too subjective. Under the 
section on diabetes, the term ``pills'' was substituted for 
``medication.'' The condition ``pleurisy'' has been deleted from the 
form because it is non-specific and non-discriminating.
    The format for this section has been modified to increase the space 
allotted for the medical examiner's comments. As a result, the space 
allocated for the driver's comments has been reduced. The statement 
encouraging the medical examiner to discuss the health history with the 
driver has been modified and expanded to address the use of 
prescription and over-the-counter medications. The statement now reads: 
the medical examiner must review and discuss with the driver any 
``yes'' answers and potential hazards of medications, including over-
the-counter medications, while driving.
    The FMCSA's modification of the information in the health history 
is limited because this information has previously been subject to 
several levels of review and subsequent changes by the medical 
community and other interested groups.
    Although the health history section has been expanded, the FMCSA 
believes that this information is necessary and relevant. Having this 
information will assist the medical examiner in conducting a thorough 
evaluation and facilitate the determination as to the likelihood that 
an individual has a condition that would interfere with the safe 
operation of a CMV.
    The FMCSA agrees with the comments that the confidentiality of 
medical information is an important issue and takes the position that 
medical information is best maintained by the medical examiner. In 
fact, the Medical Examiner's Certificate at 49 CFR 391.43(h) carries a 
statement indicating that the completed medical examination is on file 
in the office of the medical examiner. Although the FMCSRs do not 
require that the completed medical examination form be provided to the 
employer, the FMCSA does not prohibit employers from obtaining copies 
of the form. The FMCSA does not believe this is a problem since 
employers must comply with applicable State and Federal laws regarding 
the privacy and maintenance of employee medical information.
    The agency maintains that the driver certification statement 
requirement would discourage an individual from omitting or falsifying 
information as someone is likely to pause and consider his/her action 
before signing such a statement. This is especially so since the 
deliberate omission or falsification of information may invalidate the 
examination and any Medical Examiner's Certificate issued based on it.
    The agency did not adopt the suggestion of one comment to allow 
medical examiners to complete the health history since this is not the 
usual process for completion of a health history. However, to ensure 
involvement by the medical examiner, the FMCSA has made the review and 
discussion of any ``yes'' responses with the driver mandatory.

Testing: Vision and Hearing

    The majority of comments to this section were suggestions for 
amending the actual vision and hearing standards which is beyond the 
scope of this rulemaking. The FMCSA will consider these comments in its 
ongoing review of physical qualification requirements and in any future 
rulemakings to amend the standards under Sec. 391.41. The agency is 
considering, under a separate notice, a rule change regarding field of 
vision, an area of concern raised in several of the comments. This 
proposed change is based on a recent review and the recommendations 
from an expert panel of ophthalmologists. (See Frank C. Berson, M.D., 
Mark C. Kuperwaser, M.D., Lloyd Paul Aiello, M.D., and James W. 
Rosenberg, M.D., ``Visual Requirements and Commercial Drivers,'' 
October 16, 1998, filed in the docket.)
    The FMCSA has considered the comments to these sections and 
modified the form as follows: A single box designating ``corrective 
lens'' has been added to the form. The four boxes designating 
``glasses'', ``contact lenses'', ``right lens'' and ``left lens'' on 
the proposed form have been deleted. Several comments indicated 
confusion over which box to check if an individual wore both glasses 
and contact lenses. The word ``individual'' has been substituted for 
the word ``patient'' under the section for recording numerical readings 
for hearing testing.

Testing: Blood Pressure/Pulse Rate

    There were relatively few comments on this section and the majority 
of them focused on the need for additional space on the form. Several 
comments suggested the need for additional space on the form to record 
both the pulse rate and the quality of the pulse. Other comments 
suggested space for recording the second reading of the blood pressure 
since the instructions indicate that the medical examiner should take 
at least two readings to confirm an individual's blood pressure. 
Finally, two comments suggested changes to the recommended thresholds 
for acceptable blood pressures.
    The FMCSA has considered the comments to this section and modified 
the form as follows: The space allocated for the pulse rate has been 
enlarged to accommodate the recording of both the pulse rate and the 
quality of the pulse. The recommendation for space for recording a 
second blood pressure reading was not adopted because the medical 
examiner is not limited to just two readings and the possibility exists

[[Page 59366]]

that several readings may be necessary to establish a fixed blood 
pressure. Only the fixed blood pressure should be recorded on the form. 
Any change to the threshold value for an acceptable blood pressure is 
outside the scope of this rulemaking. The FMCSA is considering a review 
and update of its recommendations regarding blood pressure.

Testing: Laboratory and Other Test Findings

    This was clearly one of the most commented on sections in the 
proposal. The majority of the comments were opposed to including space 
on the form for recording the optional tests, ECG and EST. Those 
opposing or having serious concerns over this issue include: the ATA, 
the OOIDA, the National Automobile Dealers Association, the Georgia 
Motor Trucking Association, DSI Transport, Inc., Houston Industries, 
Inc., the Illinois State Police, Dr. Russell J. Green, Medical Director 
for Hillcrest Health Works, and Dr. Ellison H. Wittels. The OOIDA, 
Houston Industries, Inc., and Dr. Wittels also recommended that the 
Echocardiogram and chest x-ray be deleted from the form. Their 
opposition was based on the following concerns: (1) The efficacy of 
these tests to detect coronary artery disease (CAD) and predict future 
coronary events in asymptomatic individuals is unsupported, (2) 
optional tests would increase the costs for all parties, and (3) the 
appearance of the optional tests on the form will be misinterpreted as 
mandatory requirements.
    The FMCSA believes that the concerns of the ATA, the OOIDA and 
others regarding the recommendations for and recordation of the 
optional tests, ECG and EST, on the examination form have merit. 
According to the information (See part A.l. on ``Screening for 
Asymptomatic Coronary Artery Disease,'' by the U.S. Preventive Services 
Task Force's ``Guide to Clinical Preventive Services,'' 2nd ed., 
Baltimore: Williams & Wilkins, December 1995, in the docket as appendix 
1 to the ATA's comment) submitted by Dr. Donald Whorton (on behalf of 
the ATA) and Dr. Richard Moore, it seems that the benefits of screening 
to identify asymptomatic CAD are unproven. The evidence summarized in 
the Guide indicated that the use of a resting ECG for screening for 
asymptomatic CAD showed limited sensitivity and specificity. Relative 
to the first quality, it was reported that 29 percent of patients with 
clinically proven CAD had a normal resting ECG (a sensitivity of 71 
percent). The evidence presented also indicated that one-third to one-
half of patients with normal coronary arteries had positive findings 
(poor specificity in the 50 to 67 percent range). Moreover, the Guide 
gave evidence that the predictive value of the resting ECG was low. 
Prospective studies found that symptomatic CAD develops in 3 to 15 
percent of persons with abnormal ECG findings and that most coronary 
events occur in persons without resting ECG abnormalities. Based on 
these findings, routine ECG testing is not an efficient approach for 
detecting CAD or predicting future events.
    While exercise ECG is more accurate than resting ECG in detecting 
CAD and predicting future coronary events, the Guide reported that its 
sensitivity and predictive values do not promote comprehensive 
endorsement as a screening test. For example, most patients with 
asymptomatic CAD do not have positive exercise results (poor 
sensitivity). Relative to prediction, although asymptomatic persons 
with a positive result on an exercise ECG are more likely to experience 
an event than those with a negative result, long-term studies have 
shown that only one to eleven percent will suffer an acute myocardial 
infarction or sudden death. The majority of events will occur with a 
negative test result. Thus, the less than desirable qualities of 
exercise ECG do not allow it to enjoy a broad endorsement as a 
screening tool and, in addition, it is more expensive than the resting 
ECG.
    Notwithstanding this lack of evidence to support screening for 
asymptomatic CAD, the FMCSA believes that screening individuals in 
certain occupations, such as truck and bus drivers, may be justified 
because of possible benefits to public safety. However, since the FMCSA 
is not aware of any studies which have addressed the efficacy of 
screening these individuals to detect asymptomatic CAD, it proposes to 
establish a panel of medical experts to review and make recommendations 
for amending the agency's standards and guidelines for qualifying 
commercial drivers with cardiac conditions, and for screening drivers 
for cardiac risk factors.
    The FMCSA has considered the comments to this section and modified 
the form as follows: Space will be provided for describing and 
recording any optional tests which the medical examiner considers 
necessary to assess a driver's physical qualification. However, 
references to specific tests (ECG, EST, echocardiogram, and chest x-
ray) in this section have been removed. This will eliminate the 
potential for such optional tests to be misinterpreted as mandatory 
requirements and allow more space for the medical examiner to describe, 
record and comment on any optional test conducted as part of the 
examination.
    Although the FMCSA has not adopted the recommendations of the 
Parents Against Tired Truckers (P.A.T.T.) to require the eight question 
Epworth Sleep Disorder Test as part of the physical examination, the 
agency recognizes and shares P.A.T.T.'s concerns that excessive day-
time sleepiness as a result of untreated sleep apnea can affect a 
driver's ability to perform safely. The FMCSA has ongoing research to 
evaluate the prevalence and performance of a population of CMV drivers 
with sleep apnea. An extension of this research involves the 
development and evaluation of a screening tool for identifying drivers 
with sleep apnea. Moreover, the FMCSA's 1991 report, ``Pulmonary/
Respiratory Conditions and Commercial Drivers,'' provides specific 
recommendations for qualifying CMV drivers with sleep apnea. This 
report may be obtained from the National Technical Information Service, 
by calling 1-800-553-6847 and identifying the report by title and 
``PB'' number (PB91-236455), or by going to: http://www.fmcsa.dot.gov/rulesregs/medreports.htm.

Physical Examination

    This section of the form received a number of comments suggesting 
additions or deletions of information and changes to the format. There 
was unanimous agreement among those commenting that the recording of 
height and weight in centimeters and kilograms may be problematic and a 
source of errors and, therefore, should be recorded in inches and 
pounds. Other comments indicated that the ``yes'' and ``no'' columns 
which answer the question, ``Is driver's ability to safely operate a 
commercial motor vehicle affected?'' may be confusing as the usual 
procedure is to check ``yes'' if there are underlying abnormalities and 
then comment on whether they present a safety risk. A number of 
comments indicated that routine rectal and pelvic examinations are not 
appropriate or relevant to driver safety and should be eliminated. The 
AAOHN indicated that more space should be allotted for the medical 
examiners comments to ``yes'' answers under this section and 
recommended expanding the section on certification status to include 
the status of individuals who meet the standard and qualify for a 2-
year medical

[[Page 59367]]

certificate. The proposed form indicated that this section should be 
completed only if the driver does not qualify for a 2-year certificate.
    The FMCSA has considered the comments to this section and modified 
the form as follows: The directions for completing this section appear 
in one location on the form and now read: Check ``yes'' if there are 
any abnormalities. Check ``no'' if the body system is normal. Discuss 
any ``yes'' answers in detail in the space below, and indicate whether 
it would affect the driver's ability to operate a commercial motor 
vehicle safely. Enter applicable item number before each comment. If 
organic disease is present, note that it has been compensated for. 
Height and weight will be recorded on the form in inches and pounds as 
the medical community has indicated that it is more comfortable with 
these units of measurement. References to both the pelvic or rectal 
examination have been dropped from the form, and as a result, the 
reference to hemorrhoids was dropped too. The term ``abnormal'' has 
been dropped because it is too subjective and the term ``weakness'' has 
been substituted for semi-paralysis. Several comments were not adopted 
as they addressed areas extensively discussed by medical providers and 
other interested parties during the development of this rule.
    The instructions for completing the section on the certification 
status has been modified and reads: Note Certification Status Here. 
Additional boxes have been added to indicate (1) when a driver meets 
the standards in 49 CFR 391.41 and qualifies for a 2-year medical 
certificate, and (2) when the certification is conditionally met under 
the FMCSRs (e.g., when wearing corrective lenses, a hearing aid or when 
accompanied by a waiver/exemption/skill performance evaluation (SPE) 
certificate). The handicapped driver waiver form has been replaced by a 
skill performance evaluation certificate. See 65 FR 25285 (May 1, 2000) 
for more detailed information.

Medical Examiner's Certificate

    The replica of the Medical Examiner's Certificate that appeared on 
the proposed form under item number 7 ``Physical Examination'' has been 
removed to allow more space on the form. This will accommodate the 
information added to the section on Certification Status and provide 
significantly more space for the medical examiner's comments under this 
section.
    The box on the Medical Examiner's Certificate titled, ``Name 
(Print)'' has been changed and reads: Medical Examiner's Name (Print). 
This was done to clarify whose name is to be entered in the box. 
Another box on the Certificate which indicates that a driver is 
qualified only when accompanied by a waiver has been modified and 
reads: accompanied by a ________________ waiver/exemption. The term 
``exemption'' has been added to be consistent with the terminology in 
49 U.S.C. 31315 and 31136(e) regarding the granting of waivers and 
exemptions. A box has been added to indicate that a driver is qualified 
only when carrying an SPE certificate.

Instructions to the Medical Examiner

    The majority of the comments directed to this section of the form 
were favorable and support the concept of a self-contained form which 
ensures the medical examiner access to the applicable medical 
standards, guidelines and other useful information including the role 
and duties of both the medical examiner and driver. For example, not 
all medical examiners, as suggested in one comment, are aware of 
existing guidance which allows medical examiners to issue medical 
certificates for periods less than 2 years in cases where drivers are 
qualified, but may have conditions which require more frequent 
monitoring.
    A number of comments opposed the inclusion in this section of the 
recommendations to conduct optional ECG and EST tests. They cited the 
lack of evidence to support such screening, costs versus benefits, and 
the potential for the optional tests to be misinterpreted as mandatory.
    The FMCSA has considered the comments to this section of the form 
and made the following modifications. The recommendations for 
evaluating cardiac risk factors and conducting the optional baseline 
ECG and EST tests have been removed from the Instructions to the 
Medical Examiner (Advisory Criteria) on the form and from the 
Instructions for Performing and Recording Physical Examinations, Heart, 
at 49 CFR 391.43 (f). However, these recommendations have been and are 
currently available to assist medical examiners in making physical 
qualification determinations, and are found in the FMCSA's conference 
report, ``Cardiac Conditions and Commercial Drivers.'' This report may 
be obtained from the National Technical Information Service, by calling 
1-800-553-6847, and identifying the report by title and ``PB'' number 
(PB88-233960), or by going to: http://www.fmcsa.dot.gov/rulesregs/medreports.htm. Moreover, as previously indicated, the FMCSA plans to 
establish a medical panel to review its cardiac standards and 
guidelines for qualifying commercial drivers. As part of the review, 
the panel will be asked to address the issue of screening CMV drivers 
for CAD. Other modifications to this section were either editorial in 
nature or changes to update information to be consistent with current 
FMCSA guidelines.
    Several comments recommended designating or certifying medical 
examiners to ensure more uniform evaluations for fitness to operate 
CMVs. This issue is being addressed under a separate rulemaking which 
proposes to link the driver physical qualification determinations with 
the CDL process.

Format of the Examination Form

    In general, comments on the format were favorable. J.B. Hunt 
Transport, Inc. stated, ``placing applicable FHWA guidance directly on 
the proposed form * * * is an effective way to insure the medical 
examiner is aware of the specific regulation.'' The ATA stated, 
``FHWA's revised medical examination form, coupled with the above 
discussed ATA recommendations, will help serve as an adequate means to 
provide consistency and completeness.'' The ATA recommended that the 
FHWA permit motor carriers the flexibility to reformat the form to 
fewer pages, provided that the content of the form remains the same, 
and allow the form to be maintained electronically. The AHAS commented, 
``Advocates believes that, taken as a whole, both the form itself and 
the supplementary guidance that the agency wants to provide in order to 
guide health care providers will be substantial improvements over the 
present form. We agree with FHWA that the use of this form with its 
added guidance to practitioners could have a positive economic impact 
by resulting in more careful screening of commercial drivers to detect 
health conditions that could prove to be a safety risk both for drivers 
and for the occupants of other vehicles sharing the road with large 
trucks and buses.''
    Other comments indicated that the form has too many pages and 
questioned whether medical examiners would read them. The ACOEM 
commented, ``It is unlikely that expanding explanations from one side 
of a page to four sides will drastically increase the quality.'' The 
Federal Express Corporation believes ``the proposed three page form 
unnecessarily adds to the paperwork burden of medical examiners and 
motor carriers.'' Schneider National did not comment specifically on 
the proposed form, but

[[Page 59368]]

included a copy of its physical exam form which Schneider considers 
both ``comprehensive'' and ``helpful'' in determining driver fitness. 
The Schneider form includes a 3-page physical exam form, 1-page 
driver's job description and 2 pages of instructional/informational 
materials, for a total of 6 pages.
    The FMCSA believes the format of its examination form achieves the 
agency's overall objectives of accuracy and efficiency, and to be a 
self-contained document. Although the FMCSA has concluded that the new 
form would not increase cost and time burdens, it has adopted the ATA's 
recommendation to allow motor carriers and others to reformat the form, 
including an electronic version, so long as it remains a self-contained 
form and incorporates all of the information in 49 CFR 391.43(f), as 
amended in this rulemaking.
    In addition to the revisions to 49 CFR 391.43 in this final rule, 
the FMCSA has made technical corrections to paragraphs (c)(1), (d) and 
(g) of that section. We are also making technical corrections to 49 CFR 
391.41, paragraphs (b)(1) and (b)(2)(ii) and finally, to 49 CFR 391.49, 
paragraph (d)(2).
    The FMCSA's primary concern is to enhance highway safety, not to 
unnecessarily limit employment opportunities for individuals with 
physical impairments. Consistent with its safety mandate and 
regulations, the FMCSA is interested in promoting individual 
determinations of medical qualification to operate a CMV. The revised 
medical examination form is intended to facilitate medical examiners' 
efforts to establish and document the physical qualifications of a 
driver to operate a CMV by promoting reliable and understandable 
determinations of physical qualification.

Executive Order 12866 (Regulatory Planning and Review) and DOT 
Regulatory Policies and Procedures

    The FMCSA has determined that this action is not a significant 
regulatory action under Executive Order 12866 or significant under the 
regulatory policies and procedures of the DOT. It is anticipated that 
the economic impact of this final rule will be minimal because the use 
of existing printed supplies of the forms addressed in this action will 
be allowed until the forms are depleted, or until 12 months after the 
effective date of this rulemaking, whichever occurs first. Allowing the 
use of existing forms will avert substantial monetary loss by motor 
carriers, medical providers, and vendors of forms that might otherwise 
result from this rulemaking. Moreover, users of the examination form 
have the flexibility to reformat the form to fewer pages, including an 
electronic version so long as it remains a self-contained form and 
incorporates all of the information in 49 CFR 391.43(f), as amended in 
this rulemaking. According such flexibility will have the potential to 
reduce costs. This action will facilitate regulatory uniformity and 
result in easier compliance with and enforcement of the driver 
qualification requirements of the FMCSRs. This form will, to the extent 
possible, include all relevant information necessary to establish and 
record the physical qualification of a driver to operate a CMV. As a 
result, the FMCSA believes that this rulemaking will have a positive 
economic impact. Therefore, a full regulatory evaluation is not 
required.

Regulatory Flexibility Act

    In compliance with the Regulatory Flexibility Act, 5 U.S.C. 601-
612, the FMCSA has evaluated the effects of this final rule on small 
entities. The FMCSA believes that this action will not have a 
significant economic impact on a substantial number of small entities 
or the nation's economy because it would allow individual small 
carriers, medical examiners and vendors of the form to use the forms 
they now have on hand until those supplies have been depleted, or until 
12 months after the effective date of this rulemaking. Additionally, 
users of the forms will have the flexibility to reformat the forms to 
less pages, including an electronic version, so long as it remains a 
self-contained form and incorporates all of the information in 49 CFR 
391.43(f), as amended in this rulemaking. To the extent that this final 
rule will facilitate compliance with driver qualification requirements, 
the projected positive economic impact is not expected to be 
sufficiently significant to warrant a full regulatory evaluation. 
Accordingly, the FMCSA certifies that this action will not have a 
significant economic impact on a substantial number of small entities.

Unfunded Mandates Reform Act of 1995

    The FMCSA has determined that this rulemaking will not result in 
the expenditure by State, local and tribal governments, or by the 
private sector, in the aggregate of $100 million or more in any one 
year, as required by the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 
15e32).

Executive Order 13132 (Federalism)

    This action has been analyzed in accordance with the principles and 
criteria contained in Executive Order 13132 dated August 4, 1999, and 
it has been determined this action does not have a substantial direct 
effect or sufficient federalism implications on States that would limit 
the policymaking discretion of the States. Nothing in this document 
directly prempts any State law or regulation.

Executive Order 12372 (Intergovernmental Review)

    Catalog of Federal Domestic Assistance Program Number 20.217, Motor 
Carrier Safety. The regulations implementing Executive Order 12372 
regarding intergovernmental consultation on Federal programs and 
activities do not apply to this program.

National Environmental Policy Act

    The agency has analyzed this action for the purposes of the 
National Environmental Policy Act of 1969, as amended (42 U.S.C. 4321 
et seq.), and has determined that this action will not have any effect 
on the quality of the environment.

Paperwork Reduction Act of 1995

    Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501, et 
seq.), Federal agencies must obtain approval from the Office of 
Management and Budget (OMB) for each collection of information they 
conduct, sponsor, or require through regulations. The FMCSA has 
determined that this final rule will affect collection of information 
requirements for the purposes of the PRA because it revises a form 
associated with a currently-approved information collection covered by 
OMB Approval No. 2126-0006, entitled Medical Qualification 
Requirements. Interested parties were invited to provide comments 
regarding the form revision in an NPRM which was issued on August 5, 
1998. Comments which were received are discussed above in Discussion of 
Comments. Because the current information collection is due to expire 
on September 30, 2000, it has been submitted to OMB for a three-year 
renewal. The renewal request, which includes a revised estimate of 20 
minutes to complete and document the medical examination, is more 
accurate. The FMCSA is not making any additional revisions to the 
information collection as a result of this final rule.

Regulation Identification Number

    A regulation identification number (RIN) is assigned to each 
regulatory action listed in the Unified Agenda of

[[Page 59369]]

Federal Regulations. The Regulatory Information Service Center 
publishes the Unified Agenda in April and October of each year. The RIN 
contained in the heading of this document can be used to cross 
reference this action with the Unified Agenda.

List of Subjects in 49 CFR Part 391

    Driver qualifications-physical examinations, Highway safety, Motor 
carriers, Reporting and recordkeeping requirements, Safety, 
Transportation.

    Issued on: September 19, 2000.
Clyde J. Hart, Jr.,
Acting Deputy Administrator, Federal Motor Carrier Safety 
Administration.
    In consideration of the foregoing, the FMCSA amends title 49, CFR, 
chapter III, part 391 as set forth below:

PART 391--QUALIFICATIONS OF DRIVERS [AMENDED]

    1. The authority citation for part 391 continues to read as 
follows:

    Authority: 49 U.S.C. 322, 504, 31133, 31136, and 31502; and 49 
CFR 1.73.

    2. Section 391.41 is amended by revising paragraphs (b)(1) and 
(b)(2)(ii) to read as follows:


Sec. 391.41  Physical qualifications for drivers.

* * * * *
    (b) * * *
    (1) Has no loss of a foot, a leg, a hand, or an arm, or has been 
granted a skill performance evaluation certificate pursuant to 
Sec. 391.49;
    (2) * * *
    (ii) An arm, foot, or leg which interferes with the ability to 
perform normal tasks associated with operating a commercial motor 
vehicle; or any other significant limb defect or limitation which 
interferes with the ability to perform normal tasks associated with 
operating a commercial motor vehicle; or has been granted a skill 
performance evaluation certificate pursuant to Sec. 391.49.
* * * * *

    3. Section 391.43 is amended by revising paragraphs (c)(1), (d), 
(f), (g) and (h) to read as follows:


Sec. 391.43  Medical examination; certificate of physical 
qualification.

* * * * *
    (c) * * *
    (1) Be knowledgeable of the specific physical and mental demands 
associated with operating a commercial motor vehicle and the 
requirements of this subpart, including the medical advisory criteria 
prepared by the FHWA as guidelines to aid the medical examiner in 
making the qualification determination; and
* * * * *
    (d) Any driver authorized to operate a commercial motor vehicle 
within an exempt intracity zone pursuant to Sec. 391.62 of this part 
shall furnish the examining medical examiner with a copy of the medical 
findings that led to the issuance of the first certificate of medical 
examination which allowed the driver to operate a commercial motor 
vehicle wholly within an exempt intracity zone.
* * * * *
    (f) The medical examination shall be performed, and its results 
shall be recorded, substantially in accordance with the following 
instructions and examination form. Existing forms may be used until 
current printed supplies are depleted or until November 6, 2001, 
whichever occurs first.

Instructions for Performing and Recording Physical Examinations

    The medical examiner must be familiar with 49 CFR 391.41, 
Physical qualifications for drivers, and should review these 
instructions before performing the physical examination. Answer each 
question ``yes'' or ``no'' and record numerical readings where 
indicated on the physical examination form.
    The medical examiner must be aware of the rigorous physical, 
mental, and emotional demands placed on the driver of a commercial 
motor vehicle. In the interest of public safety, the medical 
examiner is required to certify that the driver does not have any 
physical, mental, or organic condition that might affect the 
driver's ability to operate a commercial motor vehicle safely.
    General information. The purpose of this history and physical 
examination is to detect the presence of physical, mental, or 
organic conditions of such a character and extent as to affect the 
driver's ability to operate a commercial motor vehicle safely. The 
examination should be conducted carefully and should at least 
include all of the information requested in the following form. 
History of certain conditions may be cause for rejection. Indicate 
the need for further testing and/or require evaluation by a 
specialist. Conditions may be recorded which do not, because of 
their character or degree, indicate that certification of physical 
fitness should be denied. However, these conditions should be 
discussed with the driver and he/she should be advised to take the 
necessary steps to insure correction, particularly of those 
conditions which, if neglected, might affect the driver's ability to 
drive safely.
    General appearance and development. Note marked overweight. Note 
any postural defect, perceptible limp, tremor, or other conditions 
that might be caused by alcoholism, thyroid intoxication or other 
illnesses.
    Head-eyes. When other than the Snellen chart is used, the 
results of such test must be expressed in values comparable to the 
standard Snellen test. If the driver wears corrective lenses for 
driving, these should be worn while driver's visual acuity is being 
tested. If contact lenses are worn, there should be sufficient 
evidence of good tolerance of and adaptation to their use. Indicate 
the driver's need to wear corrective lenses to meet the vision 
standard on the Medical Examiner's Certificate by checking the box, 
``Qualified only when wearing corrective lenses.'' In recording 
distance vision use 20 feet as normal. Report all vision as a 
fraction with 20 as the numerator and the smallest type read at 20 
feet as the denominator. Monocular drivers are not qualified to 
operate commercial motor vehicles in interstate commerce.
    Ears. Note evidence of any ear disease, symptoms of aural 
vertigo, or Meniere's Syndrome. When recording hearing, record 
distance from patient at which a forced whispered voice can first be 
heard. For the whispered voice test, the individual should be 
stationed at least 5 feet from the examiner with the ear being 
tested turned toward the examiner. The other ear is covered. Using 
the breath which remains after a normal expiration, the examiner 
whispers words or random numbers such as 66, 18, 23, etc. The 
examiner should not use only sibilants (s-sounding test materials). 
The opposite ear should be tested in the same manner. If the 
individual fails the whispered voice test, the audiometric test 
should be administered. For the audiometric test, record decibel 
loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average the decibel loss at 
500 Hz, 1,000 Hz and 2,000 Hz and record as described on the form. 
If the individual fails the audiometric test and the whispered voice 
test has not been administered, the whispered voice test should be 
performed to determine if the standard applicable to that test can 
be met.
    Throat. Note any irremediable deformities likely to interfere 
with breathing or swallowing.
    Heart. Note murmurs and arrhythmias, and any history of an 
enlarged heart, congestive heart failure, or cardiovascular disease 
that is accompanied by syncope, dyspnea, or collapse. Indicate onset 
date, diagnosis, medication, and any current limitation. An 
electrocardiogram is required when findings so indicate.
    Blood pressure (BP). If a driver has hypertension and/or is 
being medicated for hypertension, he or she should be recertified 
more frequently. An individual diagnosed with mild hypertension 
(initial BP is greater than 160/90 but below 181/105) should be 
certified for one 3-month period and should be recertified on an 
annual basis thereafter if his or her BP is reduced. An individual 
diagnosed with moderate to severe hypertension (initial BP is 
greater than 180/104) should not be certified until the BP has been 
reduced to the mild range (below 181/105). At that time, a 3-month 
certification can be issued. Once the driver has reduced his or her 
BP to below 161/91, he or she should be recertified every 6 months 
thereafter.
    Lungs. Note abnormal chest wall expansion, respiratory rate, 
breath sounds including wheezes or alveolar rales, impaired 
respiratory function, dyspnea, or cyanosis. Abnormal finds on 
physical exam may require further testing such as pulmonary tests 
and/or x-ray of chest.

[[Page 59370]]

    Abdomen and Viscera. Note enlarged liver, enlarged spleen, 
abnormal masses, bruits, hernia, and significant abdominal wall 
muscle weakness and tenderness. If the diagnosis suggests that the 
condition might interfere with the control and safe operation of a 
commercial motor vehicle, further testing and evaluation is 
required.
    Genital-urinary and rectal examination. A urinalysis is 
required. Protein, blood or sugar in the urine may be an indication 
for further testing to rule out any underlying medical problems. 
Note hernias. A condition causing discomfort should be evaluated to 
determine the extent to which the condition might interfere with the 
control and safe operation of a commercial motor vehicle.
    Neurological. Note impaired equilibrium, coordination, or speech 
pattern; paresthesia; asymmetric deep tendon reflexes; sensory or 
positional abnormalities; abnormal patellar and Babinski's reflexes; 
ataxia. Abnormal neurological responses may be an indication for 
further testing to rule out an underlying medical condition. Any 
neurological condition should be evaluated for the nature and 
severity of the condition, the degree of limitation present, the 
likelihood of progressive limitation, and the potential for sudden 
incapacitation. In instances where the medical examiner has 
determined that more frequent monitoring of a condition is 
appropriate, a certificate for a shorter period should be issued.
    Spine, musculoskeletal. Previous surgery, deformities, 
limitation of motion, and tenderness should be noted. Findings may 
indicate additional testing and evaluation should be conducted.
    Extremities. Carefully examine upper and lower extremities and 
note any loss or impairment of leg, foot, toe, arm, hand, or finger. 
Note any deformities, atrophy, paralysis, partial paralysis, 
clubbing, edema, or hypotonia. If a hand or finger deformity exists, 
determine whether prehension and power grasp are sufficient to 
enable the driver to maintain steering wheel grip and to control 
other vehicle equipment during routine and emergency driving 
operations. If a foot or leg deformity exists, determine whether 
sufficient mobility and strength exist to enable the driver to 
operate pedals properly. In the case of any loss or impairment to an 
extremity which may interfere with the driver's ability to operate a 
commercial motor vehicle safely, the medical examiner should state 
on the medical certificate ``medically unqualified unless 
accompanied by a Skill Performance Evaluation Certificate.'' The 
driver must then apply to the Field Service Center of the FMCSA, for 
the State in which the driver has legal residence, for a Skill 
Performance Evaluation Certificate under Sec. 391.49.
    Laboratory and Other Testing. Other test(s) may be indicated 
based upon the medical history or findings of the physical 
examination.
    Diabetes. If insulin is necessary to control a diabetic driver's 
condition, the driver is not qualified to operate a commercial motor 
vehicle in interstate commerce. If mild diabetes is present and it 
is controlled by use of an oral hypoglycemic drug and/or diet and 
exercise, it should not be considered disqualifying. However, the 
driver must remain under adequate medical supervision.
    Upon completion of the examination, the medical examiner must 
date and sign the form, provide his/her full name, office address 
and telephone number. The completed medical examination form shall 
be retained on file at the office of the medical examiner.

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    (g) If the medical examiner finds that the person he/she examined 
is physically qualified to drive a commercial motor vehicle in 
accordance with Sec. 391.41(b), the medical examiner shall complete a 
certificate in the form prescribed in paragraph (h) of this section and 
furnish one copy to the person who was examined and one copy to the 
motor carrier that employs him/her.
    (h) The medical examiner's certificate shall be substantially in 
accordance with the following form. Existing forms may be used until 
current printed supplies are depleted or until November 6, 2001, 
whichever occurs first.
BILLING CODE 4910-22-P
[GRAPHIC] [TIFF OMITTED] TR05OC00.021


[[Page 59380]]




Sec. 391.49  [Amended]

    4. Section 391.49 is amended in paragraph (d)(2) by revising the 
erroneous reference ``Sec. 391.43(e)'' to read ``Sec. 391.43(h)''.

[FR Doc. 00-25337 Filed 10-4-00; 8:45 am]
BILLING CODE 4910-22-C