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FMCSA updates guidance for truck driver medical examiners

New handbook could be used to launch rulemaking on sleep apnea risks

For the first time in seven years, physicians have reliable guidance they can use to help determine if commercial truck drivers are physically fit to operate their vehicles.

The Federal Motor Carrier Safety Administration on Tuesday published a draft of its new Medical Examiner’s Handbook (MEH). The handbook provides information on driver health requirements and guidelines used by medical examiners (MEs) listed on FMCSA’s National Registry of Certified Medical Examiners to interpret regulations on physical qualifications for commercial drivers.

An ME is licensed, certified, and/or registered in accordance with state laws and regulations to perform physical examinations and must also be knowledgeable of the physical and mental demands associated with operating a truck.

“Other health care professionals, such as treating providers and specialists, may provide additional medical information or consultation, but the ME ultimately decides whether the driver meets the physical qualification standards of FMCSA,” according to the agency.

FMCSA also emphasized that, unlike regulations, the recommendations and guidance in the handbook “do not have the force and effect of law and are not meant to bind MEs, drivers or the public in any way. Rather, such guidance itself is only advisory and not mandatory.”

FMCSA first posted the MEH on its website in 2008 but had to withdraw it in 2015 because some of the information was “obsolete or was prescriptive in nature,” according to FMCSA, and therefore MEs and training organizations were told not to consider the MEH as guidance to interpret federal regulations.

Potential for sleep apnea rulemaking

While federal regulations do not include specific requirements related to testing drivers for obstructive sleep apnea (OSA), “the big question is whether FMCSA will use [the MEH] as a potential launchpad for a formal rulemaking on OSA,” P. Sean Garney, co-director of Scopelitis Transportation Consulting, told FreightWaves.

To address the issue, FMCSA would have to go through a formal rulemaking process, Garney noted. In 2016, FMCSA and the Federal Railroad Administration (FRA) issued an advanced notice of proposed rulemaking on OSA, but the Trump administration withdrew the proposal in 2017. “The agencies believe that current safety programs and FRA’s rulemaking addressing fatigue risk management are the appropriate avenues to address OSA,” the agencies stated at the time.

Over the last decade, however, “there is a lot more data available on [OSA], and the industry’s take on the issue has evolved as well. The time could be right,” Garney said.

FMCSA addresses OSA in the handbook by providing a link to recommendations made in 2016 by the Medical Review Board, an advisory committee to the agency. It includes suggestions on risk factors, screening, testing and medical certification of drivers with OSA.

Comments on the draft handbook must be received on or before Sept. 30.

Click for more FreightWaves articles by John Gallagher.


  1. I have had 3 sleep studies done due to an ME saying I have OSA but they come back negative. I find it funny that the ME always knows the exact place you should go to have one done. I always find my own.

  2. Just the fact that the Dr’s assistant puts these masks on us says the Dr. Is not putting their reps. On the line. That says alot!

  3. One of the reasons I retired the other was ELD s. Nothing worse than lying in bed unable to sleep waiting to hit 4 hours of compliance so I could rip the mask off and sleep normally. When I could sleep with the mask I would wake up with a dry mouth probably not good for the gums

  4. I think the idea of requiring drivers to wear a cap is ridiculous. Truck drivers go through enough bullcrap as it is without all the extra nonsense. It’s funny that they claim there’s a shortage in drivers, but how will the fill the gap. Adding more restrictions only adds to the problem.

    1. Most federal regulations are nothing but money grabbers they treat drivers and companies like slot machines let’s see how much we can get out of them this year hmmm well that wasn’t enough so let’s change things around and get more.

  5. My mother thought she had a loss of sleep due to sleep apnea, what’s the doctor gave her a sleep study and decided that she had apnea. Put her on a CPAP machine. Then her nose dried out, she got bronchitis, then she got pneumonia, and then they had to add oxygen to the CPAP machine. As the future would hold for my mother her lungs got so dependent on that CPAP machine pushing air into her lungs that she grew into not being able to breathe on her own. Now my mother who was a nurse all of her life is disabled completely at home sitting on portable oxygen machines while she’s just sitting in the living room she can’t beg to have enough air in her lungs independently just to walk to the restroom. We’re talking about a completely independent woman who is now due to Big Pharma some guys invention of a CPAP machine and lobbyists in Congress goddess machine on the market now he’s pushing it on everyone else so if everyone has to have one he’s a billionaire and we’re all dependently strapped to machines in order to get a breath of life. So before we go making any rash decisions we may have to look at the overwhelming evidence that the CPAP machines have been recalled all over the nation drivers and people sitting at home all alike are facing chronic lung diseases and needs for transplants of lung surgeries that are overwhelming selfish public will not vow to be an organ donor for these people or any others. So before you try to make choices with an American Life think about what they did in the old days you lived you breathe and you died just like everyone else the way God intended. Maybe government and man should stand aside and let God decide it’s time we all let God decide

  6. To me I think using a cpap machine would cause a person to get less sleep. Having something on face would drive me crazy and I probably just end of ripping it off in the middle of the night.

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John Gallagher

Based in Washington, D.C., John specializes in regulation and legislation affecting all sectors of freight transportation. He has covered rail, trucking and maritime issues since 1993 for a variety of publications based in the U.S. and the U.K. John began business reporting in 1993 at Broadcasting & Cable Magazine. He graduated from Florida State University majoring in English and business.