73394 Federal Register / Vol. 79, No. 237 / Wednesday, December 10, 2014 / Notices 

of these 10 applicants has requested 

renewal of the exemption and has 

submitted evidence showing that the 

vision in the better eye continues to 

meet the requirement specified at 49 

CFR 391.41(b)(10) and that the vision 

impairment is stable. In addition, a 

review of each record of safety while 

driving with the respective vision 

deficiencies over the past two years 

indicates each applicant continues to 

meet the vision exemption 

requirements. These factors provide an 

adequate basis for predicting each 

driver’s ability to continue to drive 

safely in interstate commerce. 

Therefore, FMCSA concludes that 

extending the exemption for each 

renewal applicant for a period of two 

years is likely to achieve a level of safety 

equal to that existing without the 

exemption. 

IV. Public Participation and Request for 

Comments 

FMCSA encourages you to participate 

by submitting comments and related 

materials. 

Submitting Comments 

If you submit a comment, please 

include the docket number for this 

notice (FMCSA–2000–7006; FMCSA– 

2012–0280), indicate the specific 

section of this document to which each 

comment applies, and provide a reason 

for each suggestion or recommendation. 

You may submit your comments and 

material online or by fax, mail, or hand 

delivery, but please use only one of 

these means. FMCSA recommends that 

you include your name and a mailing 

address, an email address, or a phone 

number in the body of your document 

so the Agency can contact you if it has 

questions regarding your submission. 

To submit your comment online, got 

to http://www.regulations.gov and put 

the docket number, ‘‘FMCSA–2000– 

7006; FMCSA–2012–0280’’ in the 

‘‘Keyword’’ box, and click ‘‘Search.’’ 

When the new screen appears, click on 

‘‘Comment Now!’’ button and type your 

comment into the text box in the 

following screen. Choose whether you 

are submitting your comment as an 

individual or on behalf of a third party 

and then submit. If you submit your 

comments by mail or hand delivery, 

submit them in an unbound format, no 

larger than 81⁄2 by 11 inches, suitable for 

copying and electronic filing. If you 

submit comments by mail and would 

like to know that they reached the 

facility, please enclose a stamped, selfaddressed postcard or envelope. FMCSA 

will consider all comments and material 

received during the comment period 

and may change this notice based on 

your comments. 

Viewing Comments and Documents 

To view comments, as well as any 

documents mentioned in this preamble 

as being available in the docket, go to 

http://www.regulations.gov and in the 

search box insert the docket number, 

‘‘FMCSA–2000–7006; FMCSA–2012– 

0280’’ in the ‘‘Keyword’’ box and click 

‘‘Search.’’ Next, click ‘‘Open Docket 

Folder’’ button choose the document 

listed to review. If you do not have 

access to the Internet, you may view the 

docket online by visiting the Docket 

Management Facility in Room W12–140 

on the ground floor of the DOT West 

Building, 1200 New Jersey Avenue SE., 

Washington, DC 20590, between 9 a.m. 

and 5 p.m., e.t., Monday through Friday, 

except Federal holidays. 

Issued on: December 1, 2014. 

Larry W. Minor, 

Associate Administrator for Policy. 

[FR Doc. 2014–28956 Filed 12–9–14; 8:45 am] 

BILLING CODE 4910–EX–P 

DEPARTMENT OF TRANSPORTATION 

Federal Motor Carrier Safety 

Administration 

[Docket No. FMCSA–2014–0212] 

Qualification of Drivers; Exemption 

Applications; Epilepsy and Seizure 

Disorders 

AGENCY: Federal Motor Carrier Safety 

Administration (FMCSA), DOT. 

ACTION: Notice of final disposition. 

SUMMARY: FMCSA announces its 

decision to grant requests from 5 

individuals for exemptions from the 

regulatory requirement that interstate 

commercial motor vehicle (CMV) 

drivers have ‘‘no established medical 

history or clinical diagnosis of epilepsy 

or any other condition which is likely 

to cause loss of consciousness or any 

loss of ability to control a CMV.’’ The 

regulation and the associated advisory 

criteria published in the Code of Federal 

Regulations as the ‘‘Instructions for 

Performing and Recording Physical 

Examinations’’ have resulted in 

numerous drivers being prohibited from 

operating CMVs in interstate commerce 

based on the fact that they have had one 

or more seizures and are taking antiseizure medication, rather than an 

individual analysis of their 

circumstances by a qualified medical 

examiner. The Agency concluded that 

granting exemptions for these CMV 

drivers will provide a level of safety that 

is equivalent to or greater than the level 

of safety maintained without the 

exemptions. FMCSA grants exemptions 

that will allow these 5 individuals to 

operate CMVs in interstate commerce 

for a 2-year period. The exemptions 

preempt State laws and regulations and 

may be renewed. 

DATES: The exemptions are effective 

December 10, 2014. The exemptions 

expire on December 12, 2016. 

FOR FURTHER INFORMATION CONTACT: 

Elaine M. Papp, Division Chief, Physical 

Qualifications, Office of Medical 

Programs, (202) 366–4001, 

fmcsamedical@dot.gov, FMCSA, 

Department of Transportation, 1200 

New Jersey Avenue SE., Room W64– 

224, Washington, DC 20590–0001. 

Office hours are 8:30 a.m. to 5 p.m., e.t., 

Monday through Friday, except Federal 

holidays. 

SUPPLEMENTARY INFORMATION: 

A. Electronic Access 

You may see all the comments online 

through the Federal Document 

Management System (FDMS) at: http:// 

www.regulations.gov. 

Docket: For access to the docket to 

read background documents or 

comments, go to http://

www.regulations.gov and/or Room 

W12–140 on the ground level of the 

West Building, 1200 New Jersey Avenue 

SE., Washington, DC, between 9 a.m. 

and 5 p.m., e.t., Monday through Friday, 

except Federal holidays. 

Privacy Act: In accordance with 5 

U.S.C. 553(c), DOT solicits comments 

from the public to better inform its 

rulemaking process. DOT posts these 

comments, without edit, including any 

personal information the commenter 

provides, to www.regulations.gov, as 

described in the system of records 

notice (DOT/ALL–14 FDMS), which can 

be reviewed at www.dot.gov/privacy. 

B. Background 

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

31315(b), FMCSA may grant an 

exemption from the safety regulations 

for a 2-year period if it finds ‘‘such 

exemption would likely achieve a level 

of safety that is equivalent to or greater 

than the level that would be achieved 

absent such exemption.’’ The statute 

also allows the Agency to renew 

exemptions at the end of the 2-year 

period. 

FMCSA grants 5 individuals an 

exemption from the regulatory 

requirement in § 391.41(b)(8), to allow 

these individuals who take anti-seizure 

medication to operate CMVs in 

interstate commerce for a 2-year period. 

The Agency’s decision on these 

exemption applications is based on an 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 237 / Wednesday, December 10, 2014 / Notices 73395 

1Commercial Driver License Information System 

(CDLIS) is an information system that allows the 

exchange of commercial driver licensing 

information among all the States. CDLIS includes 

the databases of fifty-one licensing jurisdictions and 

the CDLIS Central Site, all connected by a 

telecommunications network. 

2 Motor Carrier Management Information System 

(MCMIS) is an information system that captures 

data from field offices through SAFETYNET, 

CAPRI, and other sources. It is a source for FMCSA 

inspection, crash, compliance review, safety audit, 

and registration data. 

3Engel, J., Fisher, R.S., Krauss, G.L., Krumholz, 

A., and Quigg, M.S., ‘‘Expert Panel 

Recommendations: Seizure Disorders and 

Commercial Motor Vehicle Driver Safety,’’ FMCSA, 

October 15, 2007. 

individualized assessment of each 

applicant’s medical information, 

including the root cause of the 

respective seizure(s), the length of time 

elapsed since the individual’s last 

seizure, and each individual’s treatment 

regimen. In addition, the Agency 

reviewed each applicant’s driving 

record found in the Commercial Driver’s 

License Information System (CDLIS) 1

for commercial driver’s license (CDL) 

holders, and interstate and intrastate 

inspections recorded in Motor Carrier 

Management Information System 

(MCMIS).2 For non-CDL holders, the 

Agency reviewed the driving records 

from the State licensing agency. The 

Agency acknowledges the potential 

consequences of a driver experiencing a 

seizure while operating a CMV. 

However, the Agency believes the 

drivers covered by the exemptions 

granted here have demonstrated that 

they are unlikely to have a seizure and 

their medical condition does not pose a 

risk to public safety. 

In reaching the decision to grant these 

exemption requests, the Agency 

considered both current medical 

literature and information and the 2007 

recommendations of the Agency’s 

Medical Expert Panel (MEP). The 

Agency previously gathered evidence 

for potential changes to the regulation at 

49 CFR 391.41(b)(8) by conducting a 

comprehensive review of scientific 

literature that was compiled into the 

‘‘Evidence Report on Seizure Disorders 

and Commercial Vehicle Driving’’ 

(Evidence Report) [CD–ROM HD 

TL230.3 .E95 2007]. The Agency then 

convened a panel of medical experts in 

the field of neurology (the MEP) on May 

14–15, 2007, to review 49 CFR 

391.41(b)(8) and the advisory criteria 

regarding individuals who have 

experienced a seizure, and the 2007 

Evidence Report. The Evidence Report 

and the MEP recommendations are 

published on-line at http://

www.fmcsa.dot.gov/rules-regulations/

topics/mep/mep-reports.htm, under 

Seizure Disorders, and are in the docket 

for this notice. 

MEP Criteria for Evaluation 

On October 15, 2007, the MEP issued 

the following recommended criteria for 

evaluating whether an individual with 

epilepsy or a seizure disorder should be 

allowed to operate a CMV.3 The MEP 

recommendations are included in 

previously published dockets. 

Epilepsy diagnosis. If there is an 

epilepsy diagnosis, the applicant should 

be seizure-free for 8 years, on or off 

medication. If the individual is taking 

anti-seizure medication(s), the plan for 

medication should be stable for 2 years. 

Stable means no changes in medication, 

dosage, or frequency of medication 

administration. Recertification for 

drivers with an epilepsy diagnosis 

should be performed every year. 

Single unprovoked seizure. If there is 

a single unprovoked seizure (i.e., there 

is no known trigger for the seizure), the 

individual should be seizure-free for 4 

years, on or off medication. If the 

individual is taking anti-seizure 

medication(s), the plan for medication 

should be stable for 2 years. Stable 

means no changes in medication, 

dosage, or frequency of medication 

administration. Recertification for 

drivers with a single unprovoked 

seizure should be performed every 2 

years. 

Single provoked seizure. If there is a 

single provoked seizure (i.e., there is a 

known reason for the seizure), the 

Agency should consider specific criteria 

that fall into the following two 

categories: Low-risk factors for 

recurrence and moderate-to-high risk 

factors for recurrence. 

• Examples of low-risk factors for 

recurrence include seizures that were 

caused by a medication; by nonpenetrating head injury with loss of 

consciousness less than or equal to 30 

minutes; by a brief loss of consciousness 

not likely to recur while driving; by 

metabolic derangement not likely to 

recur; and by alcohol or illicit drug 

withdrawal. 

• Examples of moderate-to-high-risk 

factors for recurrence include seizures 

caused by non-penetrating head injury 

with loss of consciousness or amnesia 

greater than 30 minutes, or penetrating 

head injury; intracerebral hemorrhage 

associated with a stroke or trauma; 

infections; intracranial hemorrhage; 

post-operative complications from brain 

surgery with significant brain 

hemorrhage; brain tumor; or stroke. 

The MEP report indicates individuals 

with moderate to high-risk conditions 

should not be certified. Drivers with a 

history of a single provoked seizure 

with low risk factors for recurrence 

should be recertified every year. 

Medical Review Board 

Recommendations and Agency Decision 

FMCSA presented the MEP’s findings 

and the Evidence Report to the Medical 

Review Board (MRB) for consideration. 

The MRB reviewed and considered the 

2007 ‘‘Seizure Disorders and 

Commercial Driver Safety’’ evidence 

report and the 2007 MEP 

recommendations. The MRB 

recommended maintaining the current 

advisory criteria, which provide that 

‘‘drivers with a history of epilepsy/

seizures off anti-seizure medication and 

seizure-free for 10 years may be 

qualified to drive a CMV in interstate 

commerce. Interstate drivers with a 

history of a single unprovoked seizure 

may be qualified to drive a CMV in 

interstate commerce if seizure-free and 

off anti-seizure medication for a 5 year 

period or more’’ [Advisory criteria to 49 

CFR 391.43(f)]. 

The Agency acknowledges the MRB’s 

position on the issue but believes 

relevant current medical evidence 

supports a less conservative approach. 

The medical advisory criteria for 

epilepsy and other seizure or loss of 

consciousness episodes was based on 

the 1988 ‘‘Conference on Neurological 

Disorders and Commercial Drivers’’ 

(NITS Accession No. PB89–158950/AS). 

A copy of the report can be found in the 

docket referenced in this notice. 

The MRB’s recommendation treats all 

drivers who have experienced a seizure 

the same, regardless of individual 

medical conditions and circumstances. 

In addition, the recommendation to 

continue prohibiting drivers who are 

taking anti-seizure medication from 

operating a CMV in interstate commerce 

does not consider a driver’s actual 

seizure history and time since the last 

seizure. The Agency has decided to use 

the 2007 MEP recommendations as the 

basis for evaluating applications for an 

exemption from the seizure regulation 

on an individual, case-by-case basis. 

C. Exemptions 

Following individualized assessments 

of the exemption applications, 

including a review of detailed follow-up 

information requested from each 

applicant, FMCSA is granting 

exemptions from 49 CFR 391.41(b)(8) to 

5 individuals. Under current FMCSA 

regulations, all of the 5 drivers receiving 

exemptions from 49 CFR 391.41(b)(8) 

would have been considered physically 

mstockstill on DSK4VPTVN1PROD with NOTICES

73396 Federal Register / Vol. 79, No. 237 / Wednesday, December 10, 2014 / Notices 

qualified to drive a CMV in interstate 

commerce except that they presently 

take or have recently stopped taking 

anti-seizure medication. For these 5 

drivers, the primary obstacle to medical 

qualification was the FMCSA Advisory 

Criteria for Medical Examiners, based 

on the 1988 ‘‘Conference on 

Neurological Disorders and Commercial 

Drivers,’’ stating that a driver should be 

off anti-seizure medication in order to 

drive in interstate commerce. In fact, the 

Advisory Criteria have little if anything 

to do with the actual risk of a seizure 

and more to do with assumptions about 

individuals who are taking anti-seizure 

medication. 

In addition to evaluating the medical 

status of each applicant, FMCSA 

evaluated the crash and violation data 

for the 5 drivers, some of whom 

currently drive a CMV in intrastate 

commerce. The CDLIS and MCMIS were 

searched for crash and violation data on 

the 5 applicants. For non-CDL holders, 

the Agency reviewed the driving records 

from the State licensing agency. 

These exemptions are contingent on 

the driver maintaining a stable 

treatment regimen and remaining 

seizure-free during the 2-year exemption 

period. The exempted drivers must 

submit annual reports from their 

treating physicians attesting to the 

stability of treatment and that the driver 

has remained seizure-free. The driver 

must undergo an annual medical 

examination by a medical examiner, as 

defined by 49 CFR 390.5, following the 

FCMSA’s regulations for the physical 

qualifications for CMV drivers. 

FMCSA published a notice of receipt 

of application and requested public 

comment during a 30-day public 

comment period in a Federal Register 

notice for each of the applicants. A short 

summary of the applicants’ 

qualifications and a discussion of the 

comments received follows this section. 

For applicants who were denied an 

exemption, a notice will be published at 

a later date. 

D. Comments 

Docket #FMCSA–2014–0212 

On July 8, 2014, FMCSA published a 

notice of receipt of exemption 

applications and requested public 

comment on six individuals (79 FR 

38663; Docket number FMCSA–2014– 

15955). The comment period ended on 

August 7, 2014. One commenter 

responded to this notice expressing 

interest in getting information about the 

requirements of applying for a seizure 

exemption. Of the eight applicants, 

three were denied. The Agency has 

determined that the following five 

applicants should be granted an 

exemption. 

Ruben Alcantar 

Mr. Alcantar is a 39 year-old driver in 

Oregon. He has a history of a single 

seizure in 1992 and has remained 

seizure free since that time. He takes 

anti-seizure medication with the dosage 

and frequency remaining the same since 

1992. If granted the exemption, he 

would like to drive a CMV. His 

physician states that he is supportive of 

Mr. Alcantar receiving an exemption. 

Peter Bender 

Mr. Bender is a 58 year-old class A 

CDL holder in Minnesota. He has a 

history of seizure and has remained 

seizure free since 1996. He takes antiseizure medication with the dosage and 

frequency remaining the same since that 

time. If granted an exemption, he would 

like to drive a CMV. His physician states 

he is supportive of Mr. Bender receiving 

an exemption. 

Terry Hamby 

Mr. Hamby is a 44 year-old class A 

CDL holder in North Carolina. He has a 

history of seizure and has remained 

seizure free since 1981. He takes antiseizure medication with the dosage and 

frequency remaining the same since that 

time. If granted the exemption, he 

would like to drive a CMV. His 

physician states that he is supportive of 

Mr. Hamby receiving an exemption. 

Louis Lerch 

Mr. Lerch is a 62 year-old class A CDL 

holder in Iowa. He has a history of 

seizure and has remained seizure free 

since 1978. He takes anti-seizure 

medication with the dosage and 

frequency remaining the same since 

2007. If granted the exemption, he 

would like to drive a CMV. His 

physician states that he is supportive of 

Mr. Lerch receiving an exemption. 

Angel Velez-Cruz 

Mr. Velez-Cruz is a 30 year-old class 

B CDL holder in New Jersey. He has a 

history of seizure and has remained 

seizure free since 2004. He takes antiseizure medication with the dosage and 

frequency remaining the same since 

2009. If granted the exemption, he 

would like to drive a CMV. His 

physician states that he is supportive of 

Mr. Velez-Cruz receiving an exemption. 

E. Basis for Exemption 

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

31315(b), FMCSA may grant an 

exemption from the epilepsy/seizure 

standard in 49 CFR 391.41(b)(8) if the 

exemption is likely to achieve an 

equivalent or greater level of safety than 

would be achieved without the 

exemption. Without the exemption, 

applicants will continue to be restricted 

to intrastate driving. With the 

exemption, applicants can drive in 

interstate commerce. Thus, the Agency’s 

analysis focuses on whether an equal or 

greater level of safety is likely to be 

achieved by permitting each of these 

drivers to drive in interstate commerce 

as opposed to restricting the driver to 

driving in intrastate commerce. 

Conclusion 

The Agency is granting exemptions 

from the epilepsy standard, 49 CFR 

391.41(b)(8), to 5 individuals based on 

a thorough evaluation of each driver’s 

safety experience, and medical 

condition. Safety analysis of 

information relating to these 5 

applicants meets the burden of showing 

that granting the exemptions would 

achieve a level of safety that is 

equivalent to or greater than the level 

that would be achieved without the 

exemption. By granting the exemptions, 

the interstate CMV industry will gain 5 

highly trained and experienced drivers. 

In accordance with 49 U.S.C. 

31315(b)(1), each exemption will be 

valid for 2 years, with annual 

recertification required unless revoked 

earlier by FMCSA. The exemption will 

be revoked if the following occurs: (1) 

The person fails to comply with the 

terms and conditions of the exemption; 

(2) the exemption has resulted in a 

lower level of safety than was 

maintained prior to being granted; or (3) 

continuation of the exemption would 

not be consistent with the goals and 

objectives of 49 U.S.C. 31136 and 31315. 

FMCSA exempts the following 5 

drivers for a period of 2 years with 

annual medical certification required: 

Ruben Alcantar (OR); Peter Bender 

(MN); Terry Hamby (NC); Louis Lerch 

(IA); and Angel Velez-Cruz (NJ) from the 

prohibition of CMV operations by 

persons with a clinical diagnosis of 

epilepsy or seizures. If the exemption is 

still in effect at the end of the 2-year 

period, the person may apply to FMCSA 

for a renewal under procedures in effect 

at that time. 

Issued on: December 1, 2014. 

Larry W. Minor, 

Associate Administrator for Policy . 

[FR Doc. 2014–28952 Filed 12–9–14; 8:45 am] 

BILLING CODE 4910–EX–P 

mstockstill on DSK4VPTVN1PROD with NOTICES