Medical Examiner Handbook open for review

August 16, 2022

Mark Schremmer


A draft of the Federal Motor Carrier Safety Administration’s Medical Examiner Handbook is available for review.

FMCSA’s notice of proposed regulatory guidance, which features the latest draft of the handbook, published in the Federal Register on Tuesday, Aug. 16.

The public will have through Sept. 30 to comment on the proposed handbook.

The goal of the updated handbook is to provide information about regulatory requirements and guidance for medical examiners to consider.

FMCSA’s latest draft is 116 pages and covers such topics as driver examination forms, physical qualifications for commercial drivers, the medical certification process, recording the examination, and medical variances.

The first version of the handbook was posted on FMCSA’s website in 2008 to provide guidance to medical examiners on the physical qualification standards in the regulations.

In 2015, the handbook was pulled down from public view after the Owner-Operator Independent Drivers Association and others complained that the handbook created confusion for certified medical examiners on what was regulation and what was guidance. The old version was about 250 pages, included pictures of crash photos, and reminded certified medical examiners that they could be fined.

Sleep apnea

One source of controversy with the old handbook was with how some medical examiners were applying the guidance for obstructive sleep apnea. FMCSA doesn’t have any regulations specifically regarding the condition.

“The Federal Motor Carrier Safety Regulations do not include requirements for medical examiners to screen commercial motor vehicle drivers for obstructive sleep apnea or provide requirements regarding whether to refer a driver for obstructive sleep apnea testing,” the latest version of the handbook states. The (regulations) also do not include preferred diagnostic testing methods, preferred treatment methods, or requirements by which to assess compliance for obstructive sleep apnea treatment.”

When making a medical certification determination, the handbook says an examiner may consider responses from the driver and readily identifiable risk factors for obstructive sleep apnea.

Some of the risk factors:

  • History of a small airway
  • Loud snoring
  • Witnessed apneas
  • Self-reported episodes of sleepiness during the major wake periods
  • Obesity, high body mass index
  • Large neck size
  • Hypertension
  • Cardiovascular disease
  • History of stroke, diabetes, or other co-morbid conditions

According to the handbook, the examiner may consider referring the driver for a sleep study if he or she observes multiple risk factors for moderate-to-severe obstructive sleep apnea.

OOIDA reaction

The Owner-Operator Independent Drivers Association said the handbook appears to do a better job focusing on regulations. However, concerns remain that the sleep apnea section could create confusion and lead examiners to needlessly direct drivers to undergo a costly sleep study.

“At first glance, the updated handbook generally improves upon differentiating between regulations and guidance,” said Jay Grimes, OOIDA’s director of federal affairs. “However, some sections, such as the one for obstructive sleep apnea, remain overly reliant on recommendations instead of approved regulatory standards.”


The public will have 45 days to provide feedback on the handbook. To comment, go to the website and enter Docket No. FMCSA-2022-0111.

The Association is actively reviewing the handbook and will submit comments.

“OOIDA will be thoroughly reviewing the document to ensure there is sufficient clarity and consistency with regulations so that all qualified individuals can receive medical certifications,” Grimes said. “We will submit our feedback to the agency in the coming weeks.” LL