Recent FMCSA Developments

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The Federal Motor Carrier Safety Administration has made a number of regulatory adjustments applicable to trucking companies and operators.
United States Food, Drugs, Healthcare, Life Sciences
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The Federal Motor Carrier Safety Administration has made a number of regulatory adjustments applicable to trucking companies and operators.

The FMCSA issued an updated Medical Examiner's Handbook effective January 22, 2024. The new edition includes updates to the Medical Advisory Criteria for medical examiners who perform physical qualification examinations of interstate commercial motor vehicle drivers. As the Medical Examiner's Handbook is a guidance document that does not separately establish or amend regulations, the FMCSA did not solicit comments from the public and industry regarding the changes.

The Federal Motor Carrier Safety Regulations in 49 CFR 391.41 through 391.49 provide basic driver physical qualification standards for interstate commercial motor vehicle operators. Medical examiners make their physical qualification determinations on a case-by-case basis and may consider the handbook, first published in 2008, in conducting their examinations. These guidelines were developed by the FMCSA's Medical Review Board.

Although industry commenters have requested more specificity in the handbook, the FMCSA explained that the standards are broadly stated and the handbook, being a guidance document only, should also be broad in scope. However, based on input from industry sources, the FMCSA clarified when an operator's consent is required for the medical examiner and the employer to request and receive protected health information and for operators to request a second opinion from another medical examiner if they choose. In addition, the FMCSA stated that medical examiners should check for inguinal hernias in all male operators.

The FMCSRs do not include requirements for medical examiners to screen operators for obstructive sleep apnea or to recommend that an operator be referred for obstructive sleep apnea testing. Nor do the regulations specify preferred diagnostic testing methods, treatment methods, or requirements for assessing compliance with treatment. The handbook at section instead states that when making a medical certification determination, the ME should consider the individual's responses to the questions about sleep disorders on the Medical Examination Report Form and readily identifiable risk factors for OSA identified during the physical examination. The multiple risk factors to consider include, but may not be limited to, history of a small airway, loud snoring, witnessed apneas, self-reported episodes of sleepiness during the major wake periods, obesity, high body mass index (BMI), large neck size, hypertension, cardiovascular disease, and a history of stroke, diabetes, or other co-morbid conditions.

The handbook states that the ME should consider recommending a sleep study if the operator was not evaluated previously. The FMCSRs do not include screening requirements, waiting periods, maximum certification periods, specific diagnostic procedures or treatment, specific diagnostic results, or requirements by which to assess compliance with OSA treatment. The handbook recommends additional guidance from the November 21, 2016 OSA advisory recommendations available at

Section of the handbook relating to obstructive sleep apnea rescinds and replaces the January 2015 FMCSA Bulletin to Medical Examiners and Training Organizations Regarding Obstructive Sleep Apnea.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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