CDL Medical Requirements: Your Complete DOT Physical Exam Guide

Medical History Review

You'll fill out a health history form covering your past and current conditions, surgeries, medications, and symptoms. Be honest. Lying on this form can disqualify you and create legal problems down the road. The examiner will review your answers and ask follow-up questions.

Vision Test

Your vision is tested in three ways:

• Distance acuity: You need 20/40 or better in each eye, with or without corrective lenses. If you wear glasses or contacts, bring them — you'll be tested with them on.
• Peripheral vision: At least 70 degrees of horizontal field in each eye. This is measured with a standard field-of-vision test.
• Color recognition: You must be able to distinguish standard traffic signal colors — red, green, and amber.

If you need corrective lenses to meet the standard, your medical certificate will carry a "corrective lenses required" restriction. That's fine — it doesn't limit what you can drive.

Hearing Test

You have two ways to pass:

1. Whisper test: Hear a forced whisper at 5 feet or more, with or without a hearing aid.
2. Audiometry: Average hearing loss of 40 decibels or less at 500 Hz, 1,000 Hz, and 2,000 Hz.

Hearing aids are permitted. If you use one, bring it.

Blood Pressure and Pulse

This is the section that trips up the most drivers. The examiner takes your blood pressure and pulse, and the numbers determine how long your certificate lasts:

If you get a 3-month card, you'll need to show the examiner that your blood pressure is under control at your next visit — typically with medication and documentation from your primary care doctor.

Urinalysis

This is not a drug test. The urinalysis checks for protein, blood, and sugar in your urine — indicators of kidney problems, infections, or undiagnosed diabetes. Drug and alcohol testing is a separate process, typically required by your employer, not by the DOT physical.

Physical Examination

The examiner checks:

• Eyes, ears, mouth, and throat
• Heart and lungs (listening for murmurs, irregular rhythms, breathing issues)
• Abdomen (checking for hernias, organ enlargement, tenderness)
• Spine and musculoskeletal system (range of motion, strength)
• Neurological function (reflexes, coordination, balance)
• Hernia check

Medication and Condition Review

The examiner will ask about every medication you take and every medical condition you have. Certain medications can disqualify you or require further evaluation, including:

• Opioid pain medications
• Some anti-anxiety medications and sedatives
• Muscle relaxants
• Medications that carry warnings about operating heavy machinery

If you take a medication that could affect your ability to drive safely, the examiner may require a note from your prescribing doctor confirming you're safe to operate a commercial vehicle.

Diabetes

Having diabetes does not automatically disqualify you from holding a CDL. The rules depend on how your diabetes is managed:

• Diet and oral medication: Generally no issue if your blood sugar is well-controlled. The examiner will review your A1C and may ask for documentation from your doctor.
• Insulin-treated diabetes: You can still get a CDL. Since November 2018, there are two pathways:
  • MCSA-5870 form — A certified medical examiner on the National Registry can issue your certificate directly (up to 12 months at a time) using this form. No federal exemption needed. This is the faster, standard path for most drivers.
  • FMCSA Diabetes Exemption — The older federal exemption pathway. Reserve this for cases where the medical examiner won't certify under MCSA-5870. Requires extensive documentation and longer processing.

There is no hard A1C cutoff in the regulations, but an examiner may flag poorly controlled diabetes as a concern.

Sleep Apnea

Sleep apnea is not an automatic disqualifier, but it's one of the most common reasons drivers get flagged during the DOT physical. Examiners look at:

• BMI (body mass index)
• Neck circumference (17+ inches for men, 15.5+ for women is a screening trigger)
• Reported symptoms (daytime sleepiness, snoring, witnessed apnea)

If you're diagnosed with sleep apnea, you must show CPAP compliance — typically a report from your machine showing at least 4 hours of use on 70% of nights. If you're not compliant, the examiner can deny or shorten your certificate.

Heart Conditions

• Recent heart attack: You must wait at least 2 months after a heart attack and provide a cardiologist's clearance letter stating you're safe to drive.
• Heart surgery (bypass, stents, valve replacement): Same requirement — waiting period plus cardiologist clearance.
• Pacemaker or ICD: Generally permitted with documentation and regular follow-up.

Seizures and Epilepsy

A history of seizures is one of the hardest conditions to get past. The FMCSA standard requires:

• Seizure-free for 8 years, off anti-seizure medication — this is the specific FMCSA interstate standard (49 CFR 391.41). Some states may have different rules for intrastate-only drivers, but the federal standard is clear.
• Neurologist clearance

If you have a single seizure with a clear, non-recurring cause (like a medication reaction), you may still qualify with documentation. But epilepsy with ongoing seizures is generally disqualifying.

Missing Limbs

Missing or impaired limbs do not automatically disqualify you. The FMCSA offers the SPE (Skill Performance Evaluation) program — a waiver that allows drivers with missing or impaired limbs to drive commercially if they can demonstrate they can operate the vehicle safely.

The SPE process involves:

• A medical evaluation
• A driving test in the type of vehicle you'll operate
• Documentation of any prosthetic devices or vehicle modifications
• FMCSA review and approval (processing time: typically 3–6 months, though complex cases can take up to 12)

Psychiatric Conditions

The regulations focus on conditions that affect judgment, perception, or the ability to safely operate a vehicle. Certain psychiatric conditions may require evaluation. Use of Schedule I controlled substances — including marijuana, even in states where it's legal — is disqualifying under federal law.