What Conditions Require Medical Clearance?

When is medical clearance needed?
Medical clearance from your treating provider may be required for numerous medical conditions such as, but not limited to:

• The treatment of depression, PTSD, Anxiety, Bi-polar disorder, Anger management and other mental disorders.
• All heart related conditions, such as having a heart attack, having heart surgeries or a stent, an irregular heart rate, a valve problem in your heart, having a blood clot.
• Many lung and breathing problems such as COPD, or emphysema, tuberculosis, collapsed lung, sleep apnea.
• For current treatment of medical conditions that may have limitations such as back injuries, following surgery for things like removing a gall bladder, or appendix and other problems.
• For the use of all narcotic medications such as hydrocodone, tramadol etc.
• For any other medical condition or its treatment that the medical examiner is concerned about driver or public safety.
• For many neurologic conditions such as a single episode of seizure from a known cause (such as a high temperature), after head injuries, with brain infections or brain surgeries.
• If you have a positive drug or alcohol test, or if in your examination you are determined to, or admit to drug or alcohol abuse, you must see a DOT approved Substance Abuse Professional (SAP).
  
  

Regulations and Guidance – Medical Clearance

1. A single episode of seizure resultant from a known cause (high fever, medication reaction etc.) – Always requires medical clearance.
2. Mental disorders – Such as anxiety, depression, PTSD, anger management, Bi-polar disorder always need medical clearance. See sections on waiting periods, medications and disqualifying conditions.
3. Drug and alcohol abuse – Any driver that admits to, is in treatment for or is positive on a random drug or alcohol test, must have clearance from a “Substance Abuse Professional” (SAP) prior to being re-considered for driving. See sections on medications and disqualifying conditions.
4. Eye disorders – Best practice decision based on history and examination findings. Specific conditions such as Macular degeneration, glaucoma, cataracts, diabetic retinopathy and aphakia are mentioned in the regulation. Remember, an optometrist and/or ophthalmologist may sign the form (vision standard, under regulations, 49 CFR 491.41 (b)(10)). See sections on disqualifying conditions, waivers and exemptions.
5. Cardiovascular conditions – Always require medical clearance. Includes Ischemic heart disease such as heart attack, Stent, angina; valvular conditions, cardiomyopathies, and congestive heart failure, cardiac arrhythmias including pace makers, congenital heart problems, peripheral vascular disease, including intermittent claudication that is asymptomatic at rest, DVT (Deep Vein Thrombosis) and pulmonary embolism, AAA (Aortic Abdominal Aneurysm). See sections on disqualifying medical conditions, waiting periods, required medical testing.
6. Respiratory conditions – For Sleep apnea, and all chronic, not well controlled or potentially incapacitation conditions (episodic nature and progression). Please refer also to sections, dealing with required medical testing for those specific requirements which will also help your decision making process. Clearance required on a case by case basis.
7. Diabetes – Will need confirmation annually of medical management, the latest A1c that meets that demonstrates that the condition is well managed, confirmation that there is no diabetic retinopathy and neuropathy. See sections on certification times, required testing, disqualifying medical conditions, medications.
8. Kidney, GU, GI, Hematologic, Neoplastic disorders – Best Practices decision. Clearance sought in all chronic and potentially incapacitating conditions. Consideration given to severity, progression and episodic nature, and treatment including side effects of medications. See sections on disqualifying medical conditions.
9. Orthopedic – Such as back and neck problems, shoulder injuries, other arm problems, hip and leg problems and injuries. Best practice decision with consultation recommended when there exists a current limitation or disability. See section on Skill Performance Examinations.
10. Neurologic – Advised for all chronic and /or potentially progressive disease that are not disqualifying. Required for non-epileptic single episode seizure, cerebrovascular event, tumor, vascular malformation, infection of CNS and TBI. See sections on medications, disqualifying conditions, and waiting periods.

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 medical testing.