Federal Register / Vol. 63, No. 150 /Wednesday, August 5, 1998 / Proposed Rules 41769

or by the private sector, of $100 million

or more in any one year, as required by

the Unfunded Mandates Reform Act of

1995 (2 U.S.C. 1532).

Executive Order 12612 (Federalism

Assessment)

This action will be analyzed in

accordance with the principles and

criteria contained in Executive Order

12612 to determine if this action has

sufficient federalism implications to

warrant the preparation of a federalism

assessment. Nothing in this document

directly preempts 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 of Federal programs and

activities do not apply to this program.

Paperwork Reduction Act

This action, if taken beyond the

ANPRM stage, would in all likelihood

impact existing collection of

information requirements for the

purposes of the Paperwork Reduction

Act of 1995 (49 U.S.C. 3501–3520).

Office of Management and Budget

(OMB) reviews and approvals would be

required if regulatory changes were

proposed and promulgated

National Environmental Policy Act

The agency will analyze this action

for purposes of the National

Environmental Policy Act of 1969 (42

U.S.C. 4321 et seq.) to determine

whether would have any effect on the

quality of the environment.

Regulation Identification Number

A regulatory identification number

(RIN) is assigned to each regulatory

action listed in the Unified Agenda of

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

49 CFR Part 390

Highway safety, Highways and roads,

Motor carriers, Motor vehicle

identification and marking, Reporting

and record keeping requirements.

49 CFR Part 391

Highways and roads, Motor carriers—

driver qualifications, Motor vehicle

safety, Reporting and record keeping

requirements.

49 CFR Part 392

Highway safety, Highways and roads,

Motor carriers—driving practices.

49 CFR Part 393

Highways and roads, Motor carriers,

Motor vehicle equipment, Motor vehicle

safety.

49 CFR Part 395

Global positioning systems, Highways

and roads, Highway safety, Motor

carriers—driver hours of service.

49 CFR Part 396

Highways and roads, Motor carriers,

Motor vehicle maintenance, Motor

vehicle safety.

(49 U.S.C. 31132, 31136, and 31502; and 49

CFR 1.48)

Issued: July 27, 1998.

Kenneth R. Wykle,

Federal Highway Administrator.

[FR Doc. 98–20920 Filed 8–4–98; 8:45 am]

BILLING CODE 4910–22–P

DEPARTMENT OF TRANSPORTATION

Federal Highway Administration

49 CFR Part 391

[FHWA Docket No. FHWA–98–3542]

RIN 2125–AC63

Physical Qualification of Drivers;

Medical Examination; Certificate

AGENCY: Federal Highway

Administration (FHWA), DOT.

ACTION: Notice of proposed rulemaking

(NPRM); request for comments.

SUMMARY: The FHWA is seeking

comments on a proposal to amend its

regulation governing the examination to

determine the physical condition of

drivers. The FHWA takes this action in

response to numerous requests from

medical examiners to update and

simplify the medical examination form

that is currently used. This proposed

action is intended to reduce the

incidence of errors on such forms and

to provide more uniform medical

examinations of commercial motor

vehicle (CMV) drivers under the Federal

Motor Carrier Safety Regulations

(FMCSRs). The current Federal physical

qualification standards tested by

medical examiners and recorded on the

form would not be revised in this

rulemaking. The FHWA is seeking

comments on the proposed form.

DATES: Written comments addressing

this rule must be received on or before

November 3, 1998.

ADDRESSES: Your signed, written

comments must refer to the docket

number appearing at the top of this

document and you must submit the

comments to the Docket Clerk, U.S.

DOT Dockets, Room PL–401, 400

Seventh Street, SW., Washington, D.C.

20590–0001. All comments received

will be available for examination at the

above address between 10 a.m. and 5

p.m., e.t., Monday through Friday,

except Federal holidays. Those desiring

notification of receipt of comments must

include a self-addressed, stamped

envelope or postcard.

FOR FURTHER INFORMATION CONTACT: Mrs.

Sandra Zywokarte, (202) 366–1790,

Office of Motor Carrier Standards, for

information regarding the rulemaking,

or Ms. Judith A. Rutledge, (202) 366–

0834, Motor Carrier Law Division,

Office of the Chief Counsel, for

information regarding legal issues.

Federal Highway Administration,

Department of Transportation, 400

Seventh Street, SW., Washington, D.C.

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

Internet users can access all

comments received by the U.S. DOT

Dockets, Room PL–401, by using the

universal resource locator (URL): http:/

/dms.dot.gov. It is available 24 hours

each day, 365 days each year. Please

follow the instructions online for more

information and help.

An electronic copy of this document

may be downloaded using a modem and

suitable communications software from

the Federal Register Electronic Bulletin

Board Service at (202)512–1661.

Internet users may reach the Federal

Register’s home page at: http://

www.nara.gov/nara/fedreg and the

Government Printing Office’s database

at: http://www.access.gpo.gov/suldocs.

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).

The importance of physical

qualification of commercial drivers was

recognized in 1939 when the first

regulatory medical standard was

established by the ICC. Those
41770 Federal Register / Vol. 63, No. 150 /Wednesday, August 5, 1998 / Proposed Rules

1The pilot projects were completed in January

1995, and a final report (see docket, FHWA–97–

2210) was submitted to the FHWA. On July 23,

1996, the FHWA announced (61 FR 38133) the first

meeting of a negotiated rulemaking advisory

committee under the Federal Advisory Committee

Act and the Negotiated Rulemaking Act to consider

the relevant issues and attempt to reach a consensus

in developing regulations governing the proposed

merger of the State-administered commercial

driver’s license procedures and the Federal driver

physical qualification requirements. For complete

information on the six pilot projects and the

regulations, published June 7, 1939,

required a driver to possess 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.

The first change to this standard was

initiated in 1952 and went into effect on

January 1, 1954. The Certificate of

Physical Evaluation required under the

1954 rule was slightly more specific

than the 1939 regulation, and also

required a physical examination form

and a doctor’s certificate. A second

revision made in 1964 amended the

standard to allow limb-amputee and

limb-impaired drivers, who were

otherwise eligible, to become medically

qualified through a waiver program. On

April 22, 1970, (35 FR 6458) in light of

discussions with the FHWA’s medical

advisors, the existing physical

qualification requirements were

substantially tightened by including

guidelines for evaluation of persons in

high-risk medical categories. This rule

also provided that the examining

physician be given full information

about the responsibilities of and the

exacting demands made on commercial

drivers. There have been no major

changes since then.

Current Medical Examination Form

The current form was adopted by the

DOT in 1970, recodified in 49 CFR part

391, and has undergone no changes

since that time. The physical

qualification regulations for drivers in

interstate commerce are found at 49 CFR

391.41. Section 391.43 contains

instructions to medical examiners for

performing physical examinations and

recording their findings.

The FHWA has received numerous

verbal and written requests from

physicians and other medical providers

who perform physical examinations of

CMV drivers engaged in interstate

commerce to make changes to the

medical form currently used under

§ 391.43(e). Medical practitioners have

indicated that the format, layout and

content of the current form are outdated,

difficult to use and contain

irrelevancies. For example, the health

history section of the form asks about a

history of fits, syphilis and gonorrhea,

and nervous stomach. Such inquiries

reflect outdated terminology, are vague,

or are not relative to a driver’s ability to

operate a CMV safely. Others have

suggested that the form is not adaptable

to current trends in documentation such

as electronic documentation. Given

these comments, the FHWA has decided

to initiate this proposed rulemaking

action.

Over the past two decades there have

been substantial changes in medical

technology and the technology,

operating practices and economics of

the motor carrier industry. These

changes have affected the lifestyles of

and, therefore, the physical and mental

demands placed on CMV drivers. The

FHWA agrees that the current form is

outdated and its continued use

problematic.

Methods and Considerations for

Developing a Revised Medical

Examination Form

The FHWA contracted with the

Association for the Advancement of

Automotive Medicine (AAAM) to

review and evaluate the current form,

and to help develop a revised form. In

order to assure that the revised form

would reflect the most current medical

concepts and be responsive to the needs

of the groups using the forms such as

the medical community and the

trucking industry, the AAAM convened

a working group to review the draft

form. This group included two

occupational health physicians, a motor

carrier and Federal and State

government representatives. A second

draft of the form was then submitted for

additional review by a correspondence

review group made up of medical

providers, State agency representatives,

motor carriers, FHWA field staff, and

other interested groups.

The form revision 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 the FHWA for

medical examiners.

Proposed Medical Examination Form

The proposed form, modeled on

physical examination forms in use

today, has been organized to gain

simplicity and efficiency, to reflect

current medical terminology and

examination components and to be a

self-contained document; that is, the

proposed form will, to the extent

possible, include all relevant

information necessary to conduct the

physical examination and certification.

The FHWA believes its proposed

revision to the form will enhance the

accuracy and efficiency of the

commercial driver physical

qualification process.

Consistent with accepted practices

regarding the order of the examination,

the first section of the proposed form

would be completed by the driver. This

section requests information on the

driver’s health history, seeking ‘‘yes’’ or

‘‘no’’ answers to a variety of medical

condition questions. Any ‘‘yes’’

response would require further

clarification by the driver. Once the

form is completed, the driver would be

required to sign it, affirming that all the

information contained therein 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

thereon. A result of such invalidation

could include revocation of the driver’s

commercial license by the issuing State.

The FHWA believes that the proposed

addition of a driver certification

requirement would discourage drivers

from omitting or falsifying medical

information and thereby would ensure

the accuracy and completeness of the

medical form and strengthen the overall

certification process.

The second section of the proposed

form covers the physical examination

and tests performed by the medical

examiner. The medical examiner is

provided with 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 proposed

form, thereby reducing the potential for

errors by the medical examiner. Missing

or inconsistent information on the

examination form has been a problem

according to anecdotal information

provided by the motor carrier industry

and other users of the form, and

according to information obtained from

six pilot demonstration programs to

verify the six States’ ability to merge the

medical process with the CDL licensing

process. 1
Federal Register / Vol. 63, No. 150 /Wednesday, August 5, 1998 / Proposed Rules 41771

negotiated rulemaking advisory committee

proceedings, see 59 FR 36338 (July 15,1994) and 61

FR 18713 (April 29, 1996).

Unlike the current physical

examination form, the proposed form

clearly indicates when numerical

readings must be recorded. Moreover,

since the physical qualification

regulations do not indicate acceptable

laboratory values for the presence of

protein, blood or sugar in the urine, the

proposed form places the medical

examiner on notice that the presence of

these substances in the urine may be an

indication for further testing to rule out

an underlying medical condition that

may be disqualifying. Space is also

provided for optional tests, such as an

electrocardiogram (ECG), an

echocardiogram, an exercise stress test

(EST) or a chest x-ray. In addition, a

complete physical examination must be

performed for each driver.

Although the ECG and EST are

considered optional, the FHWA is

proposing specific recommendations for

a baseline ECG at age 40, then every six

years until age 55, and then every two

years. In this proposal, the FHWA also

recommends that an EST be given to

asymptomatic individuals who are 45

years old or older and who either

exhibit two or more cardiac risk factors

or have a history of ischemic heart

disease. These recommendations were

developed during a 2-day conference on

cardiac disorders and commercial

drivers at the American College of

Cardiology in Bethesda, Maryland in

1986. The conference was convened to

assist the FHWA in developing a

systematic and scientific basis for

updating the cardiac standards for

commercial drivers. The final report

published in 1988 provided very

specific recommendations for qualifying

drivers with cardiovascular conditions

and for screening drivers for cardiac risk

factors. This cardiac conference

guidance has been extensively peer

reviewed and is being updated as

necessary. A copy of this cardiac

conference guidance is contained in the

docket for public inspection.

A full page of the proposed 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 proposed

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. The FHWA believes that

this information is valuable to the

medical examiner in making a

determination of physical qualification,

and that such information may not have

been provided to medical examiners in

the past because it was not included on

the current medical examination form.

This section also contains the FHWA’s

guidelines to help medical examiners

assess a driver’s physical qualification.

These guidelines are strictly advisory

and were established by the FHWA after

consultation with physicians, States,

and industry representatives.

In addition to the revisions to 49 CFR

391.43 proposed in this NPRM, the

FHWA is making technical corrections

to paragraphs (d) and (g) of that section.

The FHWA’s primary concern is to

enhance safety on the Nation’s

highways, not to unnecessarily limit the

employment opportunities of

individuals with physical impairments.

To the fullest extent possible, consistent

with its safety mandate and regulations,

the FHWA is interested in promoting

individual determinations of medical

qualification to operate a CMV. The

intent of this proposal is to facilitate

medical providers’ efforts to establish,

and document in a clear and

understandable way, the physical

qualification of a driver to operate a

CMV.

Consequently, the FHWA requests

comments from individuals, medical

providers, motor carriers, and all other

interested parties on the proposed

medical examination form. The

information should include, but need

not be limited to, information on how to

improve the proposed examination form

and instructions for performing and

recording physical examinations.

Rulemaking Analyses and Notices

All comments received before the

close of business on the comment

closing date indicated above will be

considered and will be available for

examination in the docket room at the

above address. Comments received after

the comment closing date will be filed

in the docket and will be considered to

the extent practicable, but the FHWA

may issue a final rule at any time after

the close of the comment period. In

addition to the late comments, the

FHWA will also continue to file in the

docket relevant information that

becomes available after the comment

closing date, and interested persons

should continue to examine the docket

for new material.

Executive Order 12866 (Regulatory

Planning and Review) and DOT

Regulatory Policies and Procedures

The FHWA has determined that the

proposed action, if implemented, would

not be 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 proposed rule would 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 date of publication of this

rulemaking in the Federal Register,

whichever occurs first. Allowing the use

of existing forms would avert

substantial monetary loss by motor

carriers, medical providers, and vendors

of forms that might otherwise result

from this rulemaking. Moreover, the

proposed action would facilitate

regulatory uniformity and result in

easier compliance with and enforcement

of the driver qualification requirements

of the FMCSRs. The proposed form

would, 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 FHWA believes

that this rulemaking would have a

positive economic impact. That is, time

and cost burdens on truck and bus

companies would not increase and,

indeed, such burdens on medical

examiners could actually decrease.

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

FHWA is evaluating the effects of this

proposal on small entities. The FHWA

believes that this proposed action, if

implemented, would 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

providers 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 date of

publication of this rulemaking in the

Federal Register. To the extent that the

proposed revised form would facilitate

compliance with driver qualification

requirements, the projected positive

economic impact is not expected to be

sufficiently significant to warrant a full

regulatory evaluation. The FHWA

intends to further evaluate the economic

consequences of this proposal on small

entities, however, in light of the
41772 Federal Register / Vol. 63, No. 150 /Wednesday, August 5, 1998 / Proposed Rules

comments received in response to this

notice of proposed rulemaking.

Unfunded Mandates Reform Act of

1995

The FHWA will analyze any proposed

rule to determine whether it would

result in the expenditure by State, local,

and tribal governments, in the aggregate,

or by the private sector, of $100 million

or more in any one year, as required by

the Unfunded Mandates Reform Act of

1995 (2 U.S.C. 1532).

Executive Order 12612 (Federalism

Assessment)

This proposed rulemaking, if

promulgated, would amend Part 391 of

the FMCSRs (Title 49, Code of Federal

Regulations) pertaining to the physical

qualification and examination of

drivers. This proposal has been

analyzed in accordance with the

principles and criteria contained in

Executive Order 12612. Nothing in this

proposal would preempt any State law

or regulation. This proposal would not

limit the policy making discretion of the

States. Therefore, the FHWA has

determined that this proposal does not

have sufficient federalism implications

to warrant the preparation of a separate

Federalism Assessment.

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

The information collection

requirements that would be imposed as

a result of this rulemaking are being

submitted to the OMB for approval in

accordance with the Paperwork

Reduction Act of 1995, 44 U.S.C. 3501–

3520. This rulemaking proposes a

revision of a form used to collect

medical information about drivers of

commercial motor vehicles (CMVs).

Title: Medical Qualifications

Requirements.

Affected Public: Approximately

400,000 motor carriers and 500,000

medical examiners.

Abstract: Medical examiners are

required to perform examinations of

CMV drivers who operate in interstate

commerce. The results must be recorded

substantially in accordance with the

instructions and the form found at 49

CFR 391.43. Medical examiners are also

required to fill out a medical certificate

upon completing an examination. The

certificate affirms that the driver is

medically qualified to drive a CMV in

interstate commerce.

Under 49 CFR 391.51 and 398.3,

motor carriers are required to retain the

medical examiner’s certificate in the

driver’s qualification file for 3 years.

Need: To ensure that only physically

qualified CMV drivers operate in

interstate commerce.

Requested Time Period of Approval:

The information collection for this item,

OMB Control Number, 2125–0080, was

last approved by OMB on September 2,

1997. It is valid through September 30,

2000.

Estimated Annual Burden: Based on

an estimate of 5,500,000 interstate CMV

drivers, the annual time burden upon

medical examiners and motor carriers

for examinations and recordkeeping

would be approximately 412,500 hours.

This is a decrease of 46,605 hours from

the burden under the previous form.

Comments are invited on any aspect

of the proposed collection of

information, including but not limited

to: (1) The necessity and utility of the

information collection for the proper

performance of the functions of the

FHWA; (2) the accuracy of the estimated

burden; (3) ways to enhance the quality,

utility, and clarity of the collected

information; and (4) ways to minimize

the collection burden without reducing

the quality of the collected information.

Regulation Identification Number

A regulation identification number

(RIN) is assigned to each regulatory

action listed in the Unified Agenda of

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: July 29, 1998.

Kenneth R. Wykle,

Federal Highway Administrator.

In consideration of the foregoing, the

FHWA proposes to amend title 49, CFR,

chapter III, part 391 as follows:

PART 391—QUALIFICATIONS OF

DRIVERS [REVISED]

1. The authority citation for part 391

continues to read as follows:

Authority: 49 U.S.C. 504, 31133, 31136,

and 31502; and 49 CFR 1.48.

2. Section 391.43 is amended in

paragraphs (d), (f), (g), and (h), to read

as follows:

§ 391.43 Medical examination; certificate

of physical qualification.

* * * * *

(d) Any driver authorized to operate

a commercial motor vehicle within an

exempt intracity zone pursuant to

§ 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.

(e) * * *

(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 (Insert date 12

months after the date of publication in

the Federal Register), 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
Federal Register / Vol. 63, No. 150 /Wednesday, August 5, 1998 / Proposed Rules 41773

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 appropriate, 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. The use of contact

lenses should be noted on the form and there

should be sufficient evidence of good

tolerance of and adaptation to their use.

Ears. Note evidence of any ear disease,

symptoms of aural vertigo, or Meuniere’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 (ssounding 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 (ECG), exercise stress test

(EST) and other tests are required when

findings so indicate. It is recommended that

a baseline ECG be done at age 40, then every

6 years until age 55, then every 2 years

thereafter, and an EST be done at age 45 if

the individual manifests one or more cardiac

risk factors or has a history of ischemic heart

disease.

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.

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 or severe

hemorrhoids. 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 limb waiver.’’ The

driver must then apply to the Regional

Director of Motor Carriers, in the region in

which the driver has legal residence, for a

limb waiver under § 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 § 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 (insert

date 12 months after the date of

publication in the Federal Register),

whichever occurs first.

[FR Doc. 98–20919 Filed 8–4–98; 8:45 am]

BILLING CODE 4910–22–C