80 FR 16495 - Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders

DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration

Federal Register Volume 80, Issue 59 (March 27, 2015)

Page Range		16495-16497
FR Document		2015-07053

FMCSA announces its decision to grant requests from 4 individuals for exemptions from the regulatory requirement that interstate commercial motor vehicle (CMV) drivers have ``no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a CMV.'' The regulation and the associated advisory criteria published in the Code of Federal Regulations as the ``Instructions for Performing and Recording Physical Examinations'' have resulted in numerous drivers being prohibited from operating CMVs in interstate commerce based on the fact that they have had one or more seizures and are taking anti-seizure medication, rather than an individual analysis of their circumstances by a qualified medical examiner. The Agency concluded that granting exemptions for these CMV drivers will provide a level of safety that is equivalent to or greater than the level of safety maintained without the exemptions. FMCSA grants exemptions that will allow these 4 individuals to operate CMVs in interstate commerce for a 2-year period. The exemptions preempt State laws and regulations and may be renewed.

Federal Register, Volume 80 Issue 59 (Friday, March 27, 2015)

[Federal Register Volume 80, Number 59 (Friday, March 27, 2015)]
[Notices]
[Pages 16495-16497]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-07053]


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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

[Docket No. FMCSA-2014-0213]


Qualification of Drivers; Exemption Applications; Epilepsy and 
Seizure Disorders

AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.

ACTION: Notice of final disposition.

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SUMMARY: FMCSA announces its decision to grant requests from 4 
individuals for exemptions from the regulatory requirement that 
interstate commercial motor vehicle (CMV) drivers have ``no established 
medical history or clinical diagnosis of epilepsy or any other 
condition which is likely to cause loss of consciousness or any loss of 
ability to control a CMV.'' The regulation and the associated advisory 
criteria published in the Code of Federal Regulations as the 
``Instructions for Performing and Recording Physical Examinations'' 
have resulted in numerous drivers being prohibited from operating CMVs 
in interstate commerce based on the fact that they have had one or more 
seizures and are taking anti-seizure medication, rather than an 
individual analysis of their circumstances by a qualified medical 
examiner. The Agency concluded that granting exemptions for these CMV 
drivers will provide a level of safety that is equivalent to or greater 
than the level of safety maintained without the exemptions. FMCSA 
grants exemptions that will allow these 4 individuals to operate CMVs 
in interstate commerce for a 2-year period. The exemptions preempt 
State laws and regulations and may be renewed.

DATES: The exemptions are effective March 27, 2015. The exemptions 
expire on March 27, 2017.

FOR FURTHER INFORMATION CONTACT: Charles A. Horan, III, Director, 
Office of Carrier, Driver and Vehicle Safety, (202) 366-4001, 
[email protected], FMCSA, Department of Transportation, 1200 New 
Jersey Avenue SE., Room W64-224, Washington, DC 20590-0001. Office 
hours are 8:30 a.m. to 5 p.m., e.t., Monday through Friday, except 
Federal holidays.

SUPPLEMENTARY INFORMATION:

A. Electronic Access

    You may see all the comments online through the Federal Document 
Management System (FDMS) at: http://www.regulations.gov.
    Docket: For access to the docket to read background documents or 
comments, go to http://www.regulations.gov and/or Room W12-140 on the 
ground level of the West Building, 1200 New Jersey Avenue SE., 
Washington, DC, between 9 a.m. and 5 p.m., e.t., Monday through Friday, 
except Federal holidays.
    Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits 
comments from the public to better inform its rulemaking process. DOT 
posts these comments, without edit, including any personal information 
the commenter provides, to www.regulations.gov, as described in the 
system of records notice (DOT/ALL-14 FDMS), which can be reviewed at 
www.dot.gov/privacy.

B. Background

    Under 49 U.S.C. 31136(e) and 31315(b), FMCSA may grant an exemption 
from the safety regulations for a 2-year period if it finds ``such 
exemption would likely achieve a level of safety that is equivalent to 
or greater than the level that would be achieved absent such 
exemption.'' The statute also allows the Agency to renew exemptions at 
the end of the 2-year period.
    FMCSA grants 4 individuals an exemption from the regulatory 
requirement in Sec.  391.41(b)(8), to allow these individuals who take 
anti-seizure medication to operate CMVs in interstate commerce for a 2-
year period. The Agency's decision on these exemption applications is 
based on an individualized assessment of each applicant's medical 
information, including the root cause of the respective seizure(s), the 
length of time elapsed since the individual's last seizure, and each 
individual's treatment regimen. In addition, the Agency reviewed each 
applicant's driving record found in the Commercial Driver's License 
Information System (CDLIS) \1\ for commercial driver's license (CDL) 
holders, and interstate and intrastate inspections recorded in Motor 
Carrier Management Information System (MCMIS).\2\ For non-CDL holders, 
the Agency reviewed the driving records from the State licensing 
agency. The Agency acknowledges the potential consequences of a driver 
experiencing a

[[Page 16496]]

seizure while operating a CMV. However, the Agency believes the drivers 
covered by the exemptions granted here have demonstrated that they are 
unlikely to have a seizure and their medical condition does not pose a 
risk to public safety.
---------------------------------------------------------------------------

    \1\ Commercial Driver License Information System (CDLIS) is an 
information system that allows the exchange of commercial driver 
licensing information among all the States. CDLIS includes the 
databases of fifty-one licensing jurisdictions and the CDLIS Central 
Site, all connected by a telecommunications network.
    \2\ Motor Carrier Management Information System (MCMIS) is an 
information system that captures data from field offices through 
SAFETYNET, CAPRI, and other sources. It is a source for FMCSA 
inspection, crash, compliance review, safety audit, and registration 
data.
---------------------------------------------------------------------------

    In reaching the decision to grant these exemption requests, the 
Agency considered both current medical literature and information and 
the 2007 recommendations of the Agency's Medical Expert Panel (MEP). 
The Agency previously gathered evidence for potential changes to the 
regulation at 49 CFR 391.41(b)(8) by conducting a comprehensive review 
of scientific literature that was compiled into the ``Evidence Report 
on Seizure Disorders and Commercial Vehicle Driving'' (Evidence Report) 
[CD-ROM HD TL230.3 .E95 2007]. The Agency then convened a panel of 
medical experts in the field of neurology (the MEP) on May 14-15, 2007, 
to review 49 CFR 391.41(b)(8) and the advisory criteria regarding 
individuals who have experienced a seizure, and the 2007 Evidence 
Report. The Evidence Report and the MEP recommendations are published 
on-line at http://www.fmcsa.dot.gov/rules-regulations/topics/mep/mep-reports.htm, under Seizure Disorders, and are in the docket for this 
notice.

MEP Criteria for Evaluation

    On October 15, 2007, the MEP issued the following recommended 
criteria for evaluating whether an individual with epilepsy or a 
seizure disorder should be allowed to operate a CMV.\3\ The MEP 
recommendations are included in previously published dockets.
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    \3\ Engel, J., Fisher, R.S., Krauss, G.L., Krumholz, A., and 
Quigg, M.S., ``Expert Panel Recommendations: Seizure Disorders and 
Commercial Motor Vehicle Driver Safety,'' FMCSA, October 15, 2007.
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    Epilepsy diagnosis. If there is an epilepsy diagnosis, the 
applicant should be seizure-free for 8 years, on or off medication. If 
the individual is taking anti-seizure medication(s), the plan for 
medication should be stable for 2 years. Stable means no changes in 
medication, dosage, or frequency of medication administration. 
Recertification for drivers with an epilepsy diagnosis should be 
performed every year.
    Single unprovoked seizure. If there is a single unprovoked seizure 
(i.e., there is no known trigger for the seizure), the individual 
should be seizure-free for 4 years, on or off medication. If the 
individual is taking anti-seizure medication(s), the plan for 
medication should be stable for 2 years. Stable means no changes in 
medication, dosage, or frequency of medication administration. 
Recertification for drivers with a single unprovoked seizure should be 
performed every 2 years.
    Single provoked seizure. If there is a single provoked seizure 
(i.e., there is a known reason for the seizure), the Agency should 
consider specific criteria that fall into the following two categories: 
Low-risk factors for recurrence and moderate-to-high risk factors for 
recurrence.
     Examples of low-risk factors for recurrence include 
seizures that were caused by a medication; by non-penetrating head 
injury with loss of consciousness less than or equal to 30 minutes; by 
a brief loss of consciousness not likely to recur while driving; by 
metabolic derangement not likely to recur; and by alcohol or illicit 
drug withdrawal.
     Examples of moderate-to-high-risk factors for recurrence 
include seizures caused by non-penetrating head injury with loss of 
consciousness or amnesia greater than 30 minutes, or penetrating head 
injury; intracerebral hemorrhage associated with a stroke or trauma; 
infections; intracranial hemorrhage; post-operative complications from 
brain surgery with significant brain hemorrhage; brain tumor; or 
stroke.
    The MEP report indicates individuals with moderate to high-risk 
conditions should not be certified. Drivers with a history of a single 
provoked seizure with low risk factors for recurrence should be 
recertified every year.

Medical Review Board Recommendations and Agency Decision

    FMCSA presented the MEP's findings and the Evidence Report to the 
Medical Review Board (MRB) for consideration. The MRB reviewed and 
considered the 2007 ``Seizure Disorders and Commercial Driver Safety'' 
evidence report and the 2007 MEP recommendations. The MRB recommended 
maintaining the current advisory criteria, which provide that ``drivers 
with a history of epilepsy/seizures off anti-seizure medication and 
seizure-free for 10 years may be qualified to drive a CMV in interstate 
commerce. Interstate drivers with a history of a single unprovoked 
seizure may be qualified to drive a CMV in interstate commerce if 
seizure-free and off anti-seizure medication for a 5 year period or 
more'' [Advisory criteria to 49 CFR 391.43(f)].
    The Agency acknowledges the MRB's position on the issue but 
believes relevant current medical evidence supports a less conservative 
approach. The medical advisory criteria for epilepsy and other seizure 
or loss of consciousness episodes was based on the 1988 ``Conference on 
Neurological Disorders and Commercial Drivers'' (NITS Accession No. 
PB89-158950/AS). A copy of the report can be found in the docket 
referenced in this notice.
    The MRB's recommendation treats all drivers who have experienced a 
seizure the same, regardless of individual medical conditions and 
circumstances. In addition, the recommendation to continue prohibiting 
drivers who are taking anti-seizure medication from operating a CMV in 
interstate commerce does not consider a driver's actual seizure history 
and time since the last seizure. The Agency has decided to use the 2007 
MEP recommendations as the basis for evaluating applications for an 
exemption from the seizure regulation on an individual, case-by-case 
basis.

C. Exemptions

    Following individualized assessments of the exemption applications, 
including a review of detailed follow-up information requested from 
each applicant, FMCSA is granting exemptions from 49 CFR 391.41(b)(8) 
to 4 individuals. Under current FMCSA regulations, all of the 4 drivers 
receiving exemptions from 49 CFR 391.41(b)(8) would have been 
considered physically qualified to drive a CMV in interstate commerce 
except that they presently take or have recently stopped taking anti-
seizure medication. For these 4 drivers, the primary obstacle to 
medical qualification was the FMCSA Advisory Criteria for Medical 
Examiners, based on the 1988 ``Conference on Neurological Disorders and 
Commercial Drivers,'' stating that a driver should be off anti-seizure 
medication in order to drive in interstate commerce. In fact, the 
Advisory Criteria have little if anything to do with the actual risk of 
a seizure and more to do with assumptions about individuals who are 
taking anti-seizure medication.
    In addition to evaluating the medical status of each applicant, 
FMCSA evaluated the crash and violation data for the 4 drivers, some of 
whom currently drive a CMV in intrastate commerce. The CDLIS and MCMIS 
were searched for crash and violation data on the 4 applicants. For 
non-CDL holders, the Agency reviewed the driving records from the State 
licensing agency.
    These exemptions are contingent on the driver maintaining a stable 
treatment regimen and remaining seizure-free during the 2-year 
exemption period. The exempted drivers must submit annual reports from 
their treating physicians attesting to the stability of treatment and 
that the driver

[[Page 16497]]

has remained seizure-free. The driver must undergo an annual medical 
examination by a medical examiner, as defined by 49 CFR 390.5, 
following the FCMSA's regulations for the physical qualifications for 
CMV drivers.
    FMCSA published a notice of receipt of application and requested 
public comment during a 30-day public comment period in a Federal 
Register notice for each of the applicants. A short summary of the 
applicants' qualifications and a discussion of the comments received, 
if any, follows this section. For applicants who were denied an 
exemption, a notice will be published at a later date.

D. Comments

Docket # FMCSA-2014-0213

    On August 12, 2014, FMCSA published a notice of receipt of 
exemption applications and requested public comment on six individuals 
(79 FR 47174; Docket number FMCSA-2014-19076). The comment period ended 
on September 11, 2014. No commenters responded to this Federal Register 
notice. Of the six applicants, two were denied. The Agency has 
determined that the following four applicants should be granted an 
exemption.
Lee H. Anderson
    Mr. Anderson is a 41 year-old driver in Massachusetts. He has a 
history of seizures and has remained seizure free since 2002. He takes 
anti-seizure medication with the dosage and frequency remaining the 
same since that time. If granted an exemption, he would like to drive a 
CMV. His physician states he is supportive of Mr. Anderson receiving an 
exemption.
Gary A. Combs, Jr.
    Mr. Combs is a 38 year-old driver in Kentucky. He has a history of 
one seizure in 2006 due to a brain tumor which was removed in 2006 and 
has remained seizure free since that time. He does not take anti-
seizure medication. If granted an exemption, he would like to drive a 
CMV. His physician states he is supportive of Mr. Combs receiving an 
exemption.
Roland K. Mezger
    Mr. Mezger is a 41 year-old driver in Pennsylvania. He has a 
history of juvenile epilepsy and has remained seizure free since 1997. 
He takes anti-seizure medication with the dosage and frequency 
remaining the same since that time. If granted the exemption, he would 
like to drive a CMV. His physician states he is supportive of Mr. 
Mezger receiving an exemption.
Robert Thomas, Jr.
    Mr. Thomas is a 47 year-old driver in North Carolina. He has a 
history of seizures and has remained seizure free since 1999. He takes 
anti-seizure medication with the dosage and frequency remaining the 
same since that time. If granted the exemption, he would like to drive 
a CMV. His physician states that he is supportive of Mr. Thomas 
receiving an exemption.

E. Basis for Exemption

    Under 49 U.S.C. 31136(e) and 31315(b), FMCSA may grant an exemption 
from the epilepsy/seizure standard in 49 CFR 391.41(b)(8) if the 
exemption is likely to achieve an equivalent or greater level of safety 
than would be achieved without the exemption. Without the exemption, 
applicants will continue to be restricted to intrastate driving. With 
the exemption, applicants can drive in interstate commerce. Thus, the 
Agency's analysis focuses on whether an equal or greater level of 
safety is likely to be achieved by permitting each of these drivers to 
drive in interstate commerce as opposed to restricting the driver to 
driving in intrastate commerce.

Conclusion

    The Agency is granting exemptions from the epilepsy standard, 49 
CFR 391.41(b)(8), to 4 individuals based on a thorough evaluation of 
each driver's safety experience, and medical condition. Safety analysis 
of information relating to these 4 applicants meets the burden of 
showing that granting the exemptions would achieve a level of safety 
that is equivalent to or greater than the level that would be achieved 
without the exemption. By granting the exemptions, the interstate CMV 
industry will gain 4 highly trained and experienced drivers. In 
accordance with 49 U.S.C. 31315(b)(1), each exemption will be valid for 
2 years, with annual recertification required unless revoked earlier by 
FMCSA. The exemption will be revoked if the following occurs: (1) The 
person fails to comply with the terms and conditions of the exemption; 
(2) the exemption has resulted in a lower level of safety than was 
maintained prior to being granted; or (3) continuation of the exemption 
would not be consistent with the goals and objectives of 49 U.S.C. 
31136 and 31315.
    FMCSA exempts the following 4 drivers for a period of 2 years with 
annual medical certification required: Lee Anderson (MA); Gary Combs, 
Jr. (KY); Roland Mezger (PA); and Robert Thomas, Jr. (NC) from the 
prohibition of CMV operations by persons with a clinical diagnosis of 
epilepsy or seizures. If the exemption is still in effect at the end of 
the 2-year period, the person may apply to FMCSA for a renewal under 
procedures in effect at that time.

    Issued on: March 20, 2015.
Larry W. Minor,
 Associate Administrator for Policy.
[FR Doc. 2015-07053 Filed 3-26-15; 8:45 am]
 BILLING CODE 4910-EX-P

Federal Register / Vol. 80, No. 59 / Friday, March 27, 2015 / Notices 16495

requirements. This determination is DEPARTMENT OF TRANSPORTATION comments, go to http://
effective on March 20, 2015. www.regulations.gov and/or Room
Federal Motor Carrier Safety W12–140 on the ground level of the
FAA’s determination on an airport
Administration West Building, 1200 New Jersey Avenue
operator’s noise exposure maps is
[Docket No. FMCSA–2014–0213] SE., Washington, DC, between 9 a.m.
limited to a finding that the maps were
and 5 p.m., e.t., Monday through Friday,
developed in accordance with the
Qualification of Drivers; Exemption except Federal holidays.
procedures contained in appendix A of Privacy Act: In accordance with 5
FAR Part 150. Such determination does Applications; Epilepsy and Seizure
Disorders U.S.C. 553(c), DOT solicits comments
not constitute approval of the from the public to better inform its
applicant’s data, information or plans, AGENCY: Federal Motor Carrier Safety rulemaking process. DOT posts these
or a commitment to approve a noise Administration (FMCSA), DOT. comments, without edit, including any
compatibility program or to fund the ACTION: Notice of final disposition. personal information the commenter
implementation of that program. If provides, to www.regulations.gov, as
questions arise concerning the precise SUMMARY: FMCSA announces its
described in the system of records
relationship of specific properties to decision to grant requests from 4
notice (DOT/ALL–14 FDMS), which can
noise exposure contours depicted on a individuals for exemptions from the
be reviewed at www.dot.gov/privacy.
regulatory requirement that interstate
noise exposure map submitted under
commercial motor vehicle (CMV) B. Background
section 47503 of the Act, it should be
drivers have ‘‘no established medical Under 49 U.S.C. 31136(e) and
noted that the FAA is not involved in history or clinical diagnosis of epilepsy
any way in determining the relative 31315(b), FMCSA may grant an
or any other condition which is likely exemption from the safety regulations
locations of specific properties with to cause loss of consciousness or any
regard to the depicted noise contours, or for a 2-year period if it finds ‘‘such
loss of ability to control a CMV.’’ The exemption would likely achieve a level
in interpreting the noise exposure maps regulation and the associated advisory
to resolve questions concerning, for of safety that is equivalent to or greater
criteria published in the Code of Federal than the level that would be achieved
example, which properties should be Regulations as the ‘‘Instructions for
covered by the provisions of section absent such exemption.’’ The statute
Performing and Recording Physical also allows the Agency to renew
47506 of the Act. These functions are Examinations’’ have resulted in exemptions at the end of the 2-year
inseparable from the ultimate land use numerous drivers being prohibited from period.
control and planning responsibilities of operating CMVs in interstate commerce FMCSA grants 4 individuals an
local government. These local based on the fact that they have had one exemption from the regulatory
responsibilities are not changed in any or more seizures and are taking anti- requirement in § 391.41(b)(8), to allow
way under Part 150 or through FAA’s seizure medication, rather than an these individuals who take anti-seizure
review of noise exposure maps. individual analysis of their medication to operate CMVs in
Therefore, the responsibility for the circumstances by a qualified medical interstate commerce for a 2-year period.
detailed overlaying of noise exposure examiner. The Agency concluded that The Agency’s decision on these
contours onto the map depicting granting exemptions for these CMV exemption applications is based on an
properties on the surface rests drivers will provide a level of safety that individualized assessment of each
exclusively with the airport operator is equivalent to or greater than the level applicant’s medical information,
that submitted those maps, or with of safety maintained without the including the root cause of the
those public agencies and planning exemptions. FMCSA grants exemptions respective seizure(s), the length of time
agencies with which consultation is that will allow these 4 individuals to elapsed since the individual’s last
required under section 47503 of the Act. operate CMVs in interstate commerce seizure, and each individual’s treatment
The FAA has relied on the certification for a 2-year period. The exemptions regimen. In addition, the Agency
by the airport operator, under section preempt State laws and regulations and reviewed each applicant’s driving
may be renewed. record found in the Commercial Driver’s
150.21 of FAR Part 150, that the
DATES: The exemptions are effective License Information System (CDLIS) 1
statutorily required consultation has
been accomplished. March 27, 2015. The exemptions expire for commercial driver’s license (CDL)
on March 27, 2017. holders, and interstate and intrastate
Copies of the full noise exposure map FOR FURTHER INFORMATION CONTACT:
documentation and of the FAA’s inspections recorded in Motor Carrier
Charles A. Horan, III, Director, Office of Management Information System
evaluation of the maps are available for Carrier, Driver and Vehicle Safety, (202) (MCMIS).2 For non-CDL holders, the
examination at the following locations: 366–4001, fmcsamedical@dot.gov, Agency reviewed the driving records
Federal Aviation Administration, 2601 FMCSA, Department of Transportation, from the State licensing agency. The
Meacham Boulevard, Fort Worth, Texas; 1200 New Jersey Avenue SE., Room Agency acknowledges the potential
Alexandria International Airport, Scott W64–224, Washington, DC 20590–0001. consequences of a driver experiencing a
Gammel, Manager, 1611 Arnold Drive, Office hours are 8:30 a.m. to 5 p.m., e.t.,
Alexandria, LA 71303. Questions may Monday through Friday, except Federal 1 Commercial Driver License Information System
be directed to the individual named holidays. (CDLIS) is an information system that allows the
above under the heading FOR FURTHER SUPPLEMENTARY INFORMATION:
exchange of commercial driver licensing
information among all the States. CDLIS includes
mstockstill on DSK4VPTVN1PROD with NOTICES

INFORMATION CONTACT.
A. Electronic Access the databases of fifty-one licensing jurisdictions and
Issued in Fort Worth, Texas, March 20, the CDLIS Central Site, all connected by a
2015. You may see all the comments online telecommunications network.
through the Federal Document 2 Motor Carrier Management Information System
Ignacio Flores, (MCMIS) is an information system that captures
Management System (FDMS) at: http://
Manager, Airports Division. data from field offices through SAFETYNET,
www.regulations.gov. CAPRI, and other sources. It is a source for FMCSA
[FR Doc. 2015–07085 Filed 3–26–15; 8:45 am] Docket: For access to the docket to inspection, crash, compliance review, safety audit,
BILLING CODE 4910–13–P read background documents or and registration data.

VerDate Sep<11>2014 20:59 Mar 26, 2015 Jkt 235001 PO 00000 Frm 00137 Fmt 4703 Sfmt 4703 E:\FR\FM\27MRN1.SGM 27MRN1

16496 Federal Register / Vol. 80, No. 59 / Friday, March 27, 2015 / Notices

seizure while operating a CMV. dosage, or frequency of medication epilepsy and other seizure or loss of
However, the Agency believes the administration. Recertification for consciousness episodes was based on
drivers covered by the exemptions drivers with a single unprovoked the 1988 ‘‘Conference on Neurological
granted here have demonstrated that seizure should be performed every 2 Disorders and Commercial Drivers’’
they are unlikely to have a seizure and years. (NITS Accession No. PB89–158950/AS).
their medical condition does not pose a Single provoked seizure. If there is a A copy of the report can be found in the
risk to public safety. single provoked seizure (i.e., there is a docket referenced in this notice.
In reaching the decision to grant these known reason for the seizure), the The MRB’s recommendation treats all
exemption requests, the Agency Agency should consider specific criteria drivers who have experienced a seizure
considered both current medical that fall into the following two the same, regardless of individual
literature and information and the 2007 categories: Low-risk factors for medical conditions and circumstances.
recommendations of the Agency’s recurrence and moderate-to-high risk In addition, the recommendation to
Medical Expert Panel (MEP). The factors for recurrence. continue prohibiting drivers who are
Agency previously gathered evidence • Examples of low-risk factors for taking anti-seizure medication from
for potential changes to the regulation at recurrence include seizures that were operating a CMV in interstate commerce
49 CFR 391.41(b)(8) by conducting a caused by a medication; by non- does not consider a driver’s actual
comprehensive review of scientific penetrating head injury with loss of seizure history and time since the last
literature that was compiled into the consciousness less than or equal to 30 seizure. The Agency has decided to use
‘‘Evidence Report on Seizure Disorders minutes; by a brief loss of consciousness the 2007 MEP recommendations as the
and Commercial Vehicle Driving’’ not likely to recur while driving; by basis for evaluating applications for an
(Evidence Report) [CD–ROM HD metabolic derangement not likely to exemption from the seizure regulation
TL230.3 .E95 2007]. The Agency then recur; and by alcohol or illicit drug on an individual, case-by-case basis.
convened a panel of medical experts in withdrawal.
• Examples of moderate-to-high-risk C. Exemptions
the field of neurology (the MEP) on May
14–15, 2007, to review 49 CFR factors for recurrence include seizures Following individualized assessments
391.41(b)(8) and the advisory criteria caused by non-penetrating head injury of the exemption applications,
regarding individuals who have with loss of consciousness or amnesia including a review of detailed follow-up
experienced a seizure, and the 2007 greater than 30 minutes, or penetrating information requested from each
Evidence Report. The Evidence Report head injury; intracerebral hemorrhage applicant, FMCSA is granting
and the MEP recommendations are associated with a stroke or trauma; exemptions from 49 CFR 391.41(b)(8) to
published on-line at http:// infections; intracranial hemorrhage; 4 individuals. Under current FMCSA
www.fmcsa.dot.gov/rules-regulations/ post-operative complications from brain regulations, all of the 4 drivers receiving
topics/mep/mep-reports.htm, under surgery with significant brain exemptions from 49 CFR 391.41(b)(8)
Seizure Disorders, and are in the docket hemorrhage; brain tumor; or stroke. would have been considered physically
for this notice. The MEP report indicates individuals qualified to drive a CMV in interstate
with moderate to high-risk conditions commerce except that they presently
MEP Criteria for Evaluation should not be certified. Drivers with a take or have recently stopped taking
On October 15, 2007, the MEP issued history of a single provoked seizure anti-seizure medication. For these 4
the following recommended criteria for with low risk factors for recurrence drivers, the primary obstacle to medical
evaluating whether an individual with should be recertified every year. qualification was the FMCSA Advisory
epilepsy or a seizure disorder should be Criteria for Medical Examiners, based
allowed to operate a CMV.3 The MEP Medical Review Board on the 1988 ‘‘Conference on
recommendations are included in Recommendations and Agency Decision Neurological Disorders and Commercial
previously published dockets. FMCSA presented the MEP’s findings Drivers,’’ stating that a driver should be
Epilepsy diagnosis. If there is an and the Evidence Report to the Medical off anti-seizure medication in order to
epilepsy diagnosis, the applicant should Review Board (MRB) for consideration. drive in interstate commerce. In fact, the
be seizure-free for 8 years, on or off The MRB reviewed and considered the Advisory Criteria have little if anything
medication. If the individual is taking 2007 ‘‘Seizure Disorders and to do with the actual risk of a seizure
anti-seizure medication(s), the plan for Commercial Driver Safety’’ evidence and more to do with assumptions about
medication should be stable for 2 years. report and the 2007 MEP individuals who are taking anti-seizure
Stable means no changes in medication, recommendations. The MRB medication.
dosage, or frequency of medication recommended maintaining the current In addition to evaluating the medical
administration. Recertification for advisory criteria, which provide that status of each applicant, FMCSA
drivers with an epilepsy diagnosis ‘‘drivers with a history of epilepsy/ evaluated the crash and violation data
should be performed every year. seizures off anti-seizure medication and for the 4 drivers, some of whom
Single unprovoked seizure. If there is seizure-free for 10 years may be currently drive a CMV in intrastate
a single unprovoked seizure (i.e., there qualified to drive a CMV in interstate commerce. The CDLIS and MCMIS were
is no known trigger for the seizure), the commerce. Interstate drivers with a searched for crash and violation data on
individual should be seizure-free for 4 history of a single unprovoked seizure the 4 applicants. For non-CDL holders,
years, on or off medication. If the may be qualified to drive a CMV in the Agency reviewed the driving records
individual is taking anti-seizure interstate commerce if seizure-free and from the State licensing agency.
medication(s), the plan for medication
mstockstill on DSK4VPTVN1PROD with NOTICES

off anti-seizure medication for a 5 year These exemptions are contingent on
should be stable for 2 years. Stable period or more’’ [Advisory criteria to 49 the driver maintaining a stable
means no changes in medication, CFR 391.43(f)]. treatment regimen and remaining
The Agency acknowledges the MRB’s seizure-free during the 2-year exemption
3 Engel, J., Fisher, R.S., Krauss, G.L., Krumholz,
position on the issue but believes period. The exempted drivers must
A., and Quigg, M.S., ‘‘Expert Panel
Recommendations: Seizure Disorders and
relevant current medical evidence submit annual reports from their
Commercial Motor Vehicle Driver Safety,’’ FMCSA, supports a less conservative approach. treating physicians attesting to the
October 15, 2007. The medical advisory criteria for stability of treatment and that the driver

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Federal Register / Vol. 80, No. 59 / Friday, March 27, 2015 / Notices 16497

has remained seizure-free. The driver Robert Thomas, Jr. CMV operations by persons with a
must undergo an annual medical Mr. Thomas is a 47 year-old driver in clinical diagnosis of epilepsy or
examination by a medical examiner, as North Carolina. He has a history of seizures. If the exemption is still in
defined by 49 CFR 390.5, following the seizures and has remained seizure free effect at the end of the 2-year period, the
FCMSA’s regulations for the physical since 1999. He takes anti-seizure person may apply to FMCSA for a
qualifications for CMV drivers. medication with the dosage and renewal under procedures in effect at
FMCSA published a notice of receipt that time.
frequency remaining the same since that
of application and requested public Issued on: March 20, 2015.
time. If granted the exemption, he
comment during a 30-day public
comment period in a Federal Register would like to drive a CMV. His Larry W. Minor,
notice for each of the applicants. A short physician states that he is supportive of Associate Administrator for Policy.
summary of the applicants’ Mr. Thomas receiving an exemption. [FR Doc. 2015–07053 Filed 3–26–15; 8:45 am]
qualifications and a discussion of the E. Basis for Exemption BILLING CODE 4910–EX–P
comments received, if any, follows this
Under 49 U.S.C. 31136(e) and
section. For applicants who were denied
31315(b), FMCSA may grant an DEPARTMENT OF TRANSPORTATION
an exemption, a notice will be
exemption from the epilepsy/seizure
published at a later date.
standard in 49 CFR 391.41(b)(8) if the Federal Motor Carrier Safety
D. Comments exemption is likely to achieve an Administration
Docket # FMCSA–2014–0213 equivalent or greater level of safety than
[Docket No. FMCSA–2014–0215]
would be achieved without the
On August 12, 2014, FMCSA exemption. Without the exemption, Qualification of Drivers; Exemption
published a notice of receipt of applicants will continue to be restricted Applications; Epilepsy and Seizure
exemption applications and requested to intrastate driving. With the
public comment on six individuals (79 Disorders
exemption, applicants can drive in
FR 47174; Docket number FMCSA– interstate commerce. Thus, the Agency’s AGENCY: Federal Motor Carrier Safety
2014–19076). The comment period analysis focuses on whether an equal or Administration (FMCSA), DOT.
ended on September 11, 2014. No greater level of safety is likely to be ACTION: Notice of final disposition.
commenters responded to this Federal achieved by permitting each of these
Register notice. Of the six applicants, drivers to drive in interstate commerce SUMMARY: FMCSA announces its
two were denied. The Agency has as opposed to restricting the driver to decision to grant requests from 8
determined that the following four driving in intrastate commerce. individuals for exemptions from the
applicants should be granted an regulatory requirement that interstate
exemption. Conclusion commercial motor vehicle (CMV)
The Agency is granting exemptions drivers have ‘‘no established medical
Lee H. Anderson
from the epilepsy standard, 49 CFR history or clinical diagnosis of epilepsy
Mr. Anderson is a 41 year-old driver or any other condition which is likely
391.41(b)(8), to 4 individuals based on
in Massachusetts. He has a history of to cause loss of consciousness or any
a thorough evaluation of each driver’s
seizures and has remained seizure free loss of ability to control a CMV.’’ The
safety experience, and medical
since 2002. He takes anti-seizure regulation and the associated advisory
condition. Safety analysis of
medication with the dosage and criteria published in the Code of Federal
information relating to these 4
frequency remaining the same since that Regulations as the ‘‘Instructions for
applicants meets the burden of showing
time. If granted an exemption, he would Performing and Recording Physical
that granting the exemptions would
like to drive a CMV. His physician states Examinations’’ have resulted in
achieve a level of safety that is
he is supportive of Mr. Anderson numerous drivers being prohibited from
receiving an exemption. equivalent to or greater than the level
that would be achieved without the operating CMVs in interstate commerce
Gary A. Combs, Jr. exemption. By granting the exemptions, based on the fact that they have had one
the interstate CMV industry will gain 4 or more seizures and are taking anti-
Mr. Combs is a 38 year-old driver in
highly trained and experienced drivers. seizure medication, rather than an
Kentucky. He has a history of one
In accordance with 49 U.S.C. individual analysis of their
seizure in 2006 due to a brain tumor
31315(b)(1), each exemption will be circumstances by a qualified medical
which was removed in 2006 and has
valid for 2 years, with annual examiner. The Agency concluded that
remained seizure free since that time.
recertification required unless revoked granting exemptions for these CMV
He does not take anti-seizure
earlier by FMCSA. The exemption will drivers will provide a level of safety that
medication. If granted an exemption, he
be revoked if the following occurs: (1) is equivalent to or greater than the level
would like to drive a CMV. His
The person fails to comply with the of safety maintained without the
physician states he is supportive of Mr.
terms and conditions of the exemption; exemptions. FMCSA grants exemptions
Combs receiving an exemption.
(2) the exemption has resulted in a that will allow these 8 individuals to
Roland K. Mezger lower level of safety than was operate CMVs in interstate commerce
Mr. Mezger is a 41 year-old driver in maintained prior to being granted; or (3) for a 2-year period. The exemptions
Pennsylvania. He has a history of continuation of the exemption would preempt State laws and regulations and
may be renewed.
mstockstill on DSK4VPTVN1PROD with NOTICES

juvenile epilepsy and has remained not be consistent with the goals and
seizure free since 1997. He takes anti- objectives of 49 U.S.C. 31136 and 31315. DATES: The exemptions are effective
seizure medication with the dosage and FMCSA exempts the following 4 March 27, 2015. The exemptions expire
frequency remaining the same since that drivers for a period of 2 years with on March 27, 2017.
time. If granted the exemption, he annual medical certification required: FOR FURTHER INFORMATION CONTACT:
would like to drive a CMV. His Lee Anderson (MA); Gary Combs, Jr. Charles A. Horan, III, Director, Office of
physician states he is supportive of Mr. (KY); Roland Mezger (PA); and Robert Carrier, Driver and Vehicle Safety, (202)
Mezger receiving an exemption. Thomas, Jr. (NC) from the prohibition of 366–4001, fmcsamedical@dot.gov,

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Document Created: 2015-12-18 11:36:08
Document Modified: 2015-12-18 11:36:08

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
Action		Notice of final disposition.
Dates		The exemptions are effective March 27, 2015. The exemptions expire on March 27, 2017.
Contact		Charles A. Horan, III, Director, Office of Carrier, Driver and Vehicle Safety, (202) 366-4001, [email protected], FMCSA, Department of Transportation, 1200 New Jersey Avenue SE., Room W64-224, Washington, DC 20590-0001. Office hours are 8:30 a.m. to 5 p.m., e.t., Monday through Friday, except Federal holidays.
FR Citation		80 FR 16495

80 FR 16495 - Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders

DEPARTMENT OF TRANSPORTATIONFederal Motor Carrier Safety Administration

Federal Register Volume 80, Issue 59 (March 27, 2015)

DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration