What Conditions Require Medical Testing?

Required Testing:

• For diabetes, you will need an A1c and annual eye exam demonstrating that there is no diabetic retinopathy.
• If you have a high sugar level in your urine sample during the exam, you will be required to see your family doctor and have a blood test to determine if you have diabetes.
• For all cardiac problems, including if you have suffered a heart attack, had a stent, suffer angina, have an irregular heartbeat, a valve problem, and more. Testing frequency varies, from being required every year, to every two years.
• If you are on a blood thinner such as Coumadin or Warfarinor any other blood thinner that requires medical monitoring with regular blood work.
• For sleep apnea, you will need a compliance report for CPAP use.
• If you have had a collapsed lung you will need an x-ray.
• If you have had or currently suffer from Tuberculosis (TB), you will need an x-ray.
• If you do not pass the whisper test during the exam, you will need to go for audiometric testing.
• For many other medical conditions to demonstrate that your medical condition is stable and that you are safe to operate a commercial motor vehicle.

Regulations and Guidance – Medical Testing

1. Diabetes – A1c (Normal 4 to 6.5, a 10 however equates to 300 mb/dl which is low risk!). Any 10 or below would be certifiable. See sections on Regulations and Guidance, Certification periods, Disqualifying Conditions, Required medical clearance.
2. Cardiac conditions
   
   1. ETT – Required for all Ischemic heart disease. An abnormal ETT is defined as an inability to exceed 6 METS (beyond completion of Stage II or 6 minutes) on a standard Bruce protocol or the presence of Ischemic symptoms and/or signs (e.g. characteristic angina pain or a 1mm ST depression or elevation in 2 or more leads), inability to exceed 85% of age-predicted maximal heart rate, or ventricular dysrrythmia. Must be done biennially except for PCI after 5 years, then must be done annually. (5-1:8)
   2. ECG (EKG) – for all cardiac conditions. Minimum ejection fraction (or left ventricular ejection fraction) of 40%. (5-1:6 through 5-1:27)
   3. Alcohol Abuse – CAGE questionnaire. (9-1:28)
   4. Anticoagulation therapy – INR (aka prothrombin time), must be done monthly, and maintain 2 to 3 and be stable (optimum normal values at 0.8 to 1.2).
   5. Respiratory conditions – See also sections on Regulations and Guidance, Certification times, Disqualifying conditions, waiting periods.
      
      1. OSA (sleep Apnea)
         1. Sleep study – Used to diagnose and comply with annual testing requirements.
            
            1. Epworth
            2. Sleep latency test
            3. Wakefullness test
            4. CPAP compliance report – required annually, must be at least 70% daily use, 4 hours per night.
         2. Any respiratory condition that will lead to decreased oxygen intake (examples include COPD, emphysema, interstitial lung diseases, chronic infectious diseases such as TB etc.)
            
            1. Pulmonary Function Test – FEV1 minimum 65%, FVC minimum 60%, FEV1/FVC ratio minimum 65%.
            2. Pulse Oximetry – Minimum 92%
            3. ABG’s (Arterial Blood Gases blood test) – Minimum 65%.
         3. Mental disorders – When there is a concern for cognitive ability, a Folsteins test or MMSE is required (aka Mini-Mental State Exam). See sections on medical clearance, waiting periods, medications, certifications times.
         4. Hearing – See also sections on Regulations and guidance.
            
            1. Whisper test – perceives whispered voice at 5 feet in at least 1 ear.
            2. Audiometric test – Must have at least less than or equal to 40 db or better of the average at 500 Hz, 1000 Hz and 2000 hz.
         5. UA – Required on all exams! (3-1:9 through 3-1:14)
            
            1. Specific Gravity – Normal 1.005 to 1.030 (optimum is 1.020).
            2. Protein – Negative
            3. Blood – Negative
            4. Glucose – Negative

Obtain a medical clearance letter specific to your condition or treatment. Go to the Pass My Physical Q&A to find out what is needed before you go.

Continue to what conditions require waiting periods.