80 FR 35577 - Medical Examiner's Certification Integration; Correction

DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration

Federal Register Volume 80, Issue 119 (June 22, 2015)

FMCSA makes corrections to a rule that appeared in the Federal Register on April 23, 2015 (80 FR 22790). In that rule, FMCSA amended the Federal Motor Carrier Safety Regulations (FMCSRs) to require certified medical examiners (MEs) performing physical examinations of commercial motor vehicle (CMV) drivers to use a newly developed Medical Examination Report (MER) Form, MCSA-5875, in place of the current MER Form and to use Form MCSA-5876 for the Medical Examiner's Certificate (MEC); and report results of all CMV drivers' physical examinations performed (including the results of examinations where the driver was found not to be qualified) to FMCSA by midnight (local time) of the next calendar day following the examination. That final rule was a follow-on rule to the Medical Certification Requirements as Part of the CDL rule final rule, published on December 1, 2008, and the National Registry of Certified Medical Examiners final rule, published on April 20, 2012.

[Federal Register Volume 80, Number 119 (Monday, June 22, 2015)]
[Rules and Regulations]
[Pages 35577-35596]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-15161]


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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

49 CFR Parts 383, 384 and 391

[Docket No. FMCSA-2012-0178]
RIN 2126-AB40


Medical Examiner's Certification Integration; Correction

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

ACTION: Final rule; correction.

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SUMMARY: FMCSA makes corrections to a rule that appeared in the Federal 
Register on April 23, 2015 (80 FR 22790). In that rule, FMCSA amended 
the Federal Motor Carrier Safety Regulations (FMCSRs) to require 
certified medical examiners (MEs) performing physical examinations of 
commercial motor vehicle (CMV) drivers to use a newly developed Medical 
Examination Report (MER) Form, MCSA-5875, in place of the current MER 
Form and to use Form MCSA-5876 for the Medical Examiner's Certificate 
(MEC); and report results of all CMV drivers' physical examinations 
performed (including the results of examinations where the driver was 
found not to be qualified) to FMCSA by midnight (local time) of the 
next calendar day following the examination. That final rule was a 
follow-on rule to the Medical Certification Requirements as Part of the 
CDL rule final rule, published on December 1, 2008, and the National 
Registry of Certified Medical Examiners final rule, published on April 
20, 2012.

DATES: Effective June 22, 2015.

FOR FURTHER INFORMATION CONTACT: Charles A. Horan, III, Director, 
Carrier, Driver, & Vehicle Safety Standards, Federal Motor Carrier 
Safety Administration, 1200 New Jersey Avenue SE., Washington, DC 
20590-0001, by telephone at (202) 366-4001 or via email at 
[email protected].

SUPPLEMENTARY INFORMATION: In FR Doc. 2015-09053, published on 
Thursday, April 23, 2015 80 FR (22790) the following corrections are 
made.

Corrections to the Preamble

    1. On page 22798, in the third column, in FMCSA's response to 
comment number 8. Voiding the MEC, the first sentence under the heading 
``FMCSA Response'' is corrected to read as follows:

    As explained in both the National Registry final rule (77 FR at 
24108) and in the NPRM in this rulemaking (78 FR at 27348), under 
the authority granted by 49 U.S.C. 31149(c)(2), FMCSA may void an 
MEC issued to a CMV driver if it finds either that a Medical 
Examiner has issued a certificate to a driver ``who fails to meet 
the applicable standards at the time of the examination'' or ``that 
a Medical Examiner has falsely claimed to have completed training in 
physical and medical examination standards.''

    2. Beginning on page 22810, in the third column, and continuing on 
page 22811, in the first column, in Sec.  383.73, paragraphs 
(a)(2)(vii), (b)(5), (o)(1)(i)(A), and (o)(1)(ii)(A) are corrected to 
read as follows:

Sec.  383.73 State procedures

    (a) * * *
    (2) * * *
    (vii)(A) Before June 22, 2018, for drivers who certified their type 
of driving according to Sec.  383.71(b)(1)(i) (non-excepted interstate) 
and, if the CLP applicant submits a current medical examiner's 
certificate, date-stamp the medical examiner's certificate, and post 
all required information from the medical examiner's certificate to the 
CDLIS driver record in accordance with paragraph (o) of this section.
    (B) On or after June 22, 2018, for drivers who certified their type 
of driving according to Sec.  383.71(b)(1)(i) (non-excepted interstate) 
and, if FMCSA provides current medical examiner's

[[Page 35578]]

certificate information electronically, post all required information 
matching the medical examiner's certificate to the CDLIS driver record 
in accordance with paragraph (o) of this section.
    (b) * * *
    (5)(i) Before June 22, 2018, for drivers who certified their type 
of driving according to Sec.  383.71(b)(1)(i) (non-excepted interstate) 
and, if the CDL holder submits a current medical examiner's 
certificate, date-stamp the medical examiner's certificate and post all 
required information from the medical examiner's certificate to the 
CDLIS driver record in accordance with paragraph (o) of this section.
    (ii) On or after June 22, 2018, for drivers who certified their 
type of driving according to Sec.  383.71(b)(1)(i) (non-excepted 
interstate) and, if FMCSA provides current medical examiner's 
certificate information electronically, post all required information 
matching the medical examiner's certificate to the CDLIS driver record 
in accordance with paragraph (o) of this section.
* * * * *
    (o) * * *
    (1) * * *
    (i) * * *
    (A) Post the driver's self-certification of type of driving under 
Sec.  383.71(b)(1) to the CDLIS driver record;
* * * * *
    (ii) * * *
    (A) Post the driver's self-certification of type of driving under 
Sec.  383.71(b)(1) to the CDLIS driver record;
* * * * *

Part 391 Authority [Corrected]

    3. On page 22812, in the first column, the authority citation for 
part 391 is corrected to read as follows:

    Authority: 49 U.S.C. 504, 508, 31133, 31136, 31149 and 31502; 
sec. 4007(b), Pub. L. 102-240, 105 Stat, 1914, 2152; sec. 114, Pub. 
L. 103-311, 108 Stat. 1673, 1677; sec. 215, Pub. L. 106-159, 113 
Stat. 1748, 1767; and 49 CFR 1.87.

    4. On page 22812, beginning at the top of the second column and 
continuing at the top of the third column, in Sec.  391.23, paragraphs 
(m)(2)(i) and (m)(3) are corrected to read as follows:

Sec.  391.23 Investigation and inquiries.

* * * * *
    (m) * * *
    (2) Exception. For drivers required to have a commercial driver's 
license under part 383 of this chapter:
    (i) Beginning January 30, 2015, using the CDLIS motor vehicle 
record obtained from the current licensing State, the motor carrier 
must verify and document in the driver qualification file the following 
information before allowing the driver to operate a CMV:
    (A) The type of operation the driver self-certified that he or she 
will perform in accordance with Sec.  383.71(b)(1) of this chapter.
    (B)(1) Beginning on May 21, 2014, and ending on June 22, 2018, that 
the driver was certified by a medical examiner listed on the National 
Registry of Certified Medical Examiners as of the date of medical 
examiner's certificate issuance.
    (2) If the driver has certified under paragraph (m)(2)(i)(A) of 
this section that he or she expects to operate in interstate commerce, 
that the driver has a valid medical examiner's certificate and any 
required medical variances.
    (C) Exception. Beginning on January 30, 2015 and until June 22, 
2018, if the driver provided the motor carrier with a copy of the 
current medical examiner's certificate that was submitted to the State 
in accordance with Sec.  383.73(b)(5) of this chapter, the motor 
carrier may use a copy of that medical examiner's certificate as proof 
of the driver's medical certification for up to 15 days after the date 
it was issued.
* * * * *
    (3) Exception. For drivers required to have a commercial learner's 
permit under part 383 of this chapter:
    (i) Beginning July 8, 2015, using the CDLIS motor vehicle record 
obtained from the current licensing State, the motor carrier must 
verify and document in the driver qualification file the following 
information before allowing the driver to operate a CMV:
    (A) The type of operation the driver self-certified that he or she 
will perform in accordance with Sec.  383.71(b)(1) and (g) of this 
chapter.
    (B)(1) Until June 22, 2018, that the driver was certified by a 
medical examiner listed on the National Registry of Certified Medical 
Examiners as of the date of medical examiner's certificate issuance.
    (2) If the driver has a commercial learner's permit and has 
certified under paragraph (m)(3)(i)(A) of this section that he or she 
expects to operate in interstate commerce, that the driver has a valid 
medical examiner's certificate and any required medical variances.
    (C) Until June 22, 2018, if the driver provided the motor carrier 
with a copy of the current medical examiner's certificate that was 
submitted to the State in accordance with Sec.  383.73(a)(5) of this 
chapter, the motor carrier may use a copy of that medical examiner's 
certificate as proof of the driver's medical certification for up to 15 
days after the date it was issued.
    (ii) Until July 8, 2015, if a driver operating in non-excepted, 
interstate commerce has no medical certification status information on 
the CDLIS MVR obtained from the current State driver licensing agency, 
the employing motor carrier may accept a medical examiner's certificate 
issued to that driver, and place a copy of it in the driver 
qualification file before allowing the driver to operate a CMV in 
interstate commerce.
    5. Beginning on page 22812, in the third column, and continuing to 
page 22821, in the third column, in Sec.  391.43, paragraphs (f), 
(g)(5)(ii), and (h) are corrected to read as follows:

Sec.  391.43 Medical examination; certificate of physical examination.

* * * * *
    (f)(1) Until December 22, 2015, the medical examination shall be 
performed, and its results shall be recorded, substantially in 
accordance with the following instructions and examination form.

Instructions for Performing and Recording Physical Examinations

    The medical examiner must be familiar with 49 CFR 391.41, Physical 
qualifications for drivers, and should review these instructions before 
performing the physical examination. Answer each question ``yes'' or 
``no'' and record numerical readings where indicated on the physical 
examination form.
    The medical examiner must be aware of the rigorous physical, 
mental, and emotional demands placed on the driver of a commercial 
motor vehicle. In the interest of public safety, the medical examiner 
is required to certify that the driver does not have any physical, 
mental, or organic condition that might affect the driver's ability to 
operate a commercial motor vehicle safely.
    General information. The purpose of this history and physical 
examination is to detect the presence of physical, mental, or organic 
conditions of such a character and extent as to affect the driver's 
ability to operate a commercial motor vehicle safely. The examination 
should be conducted carefully and should at least include all of the 
information requested in the following form. History of certain 
conditions may be cause for rejection. Indicate the need for further 
testing and/or require evaluation by a specialist. Conditions may be 
recorded which do not, because of their character or degree, indicate 
that certification of physical fitness should be denied. However, these 
conditions should be discussed with the driver and he/she should be 
advised to take the

[[Page 35579]]

necessary steps to insure correction, particularly of those conditions 
which, if neglected, might affect the driver's ability to drive safely.
    General appearance and development. Note marked overweight. Note 
any postural defect, perceptible limp, tremor, or other conditions that 
might be caused by alcoholism, thyroid intoxication or other illnesses.
    Head-eyes. When other than the Snellen chart is used, the results 
of such test must be expressed in values comparable to the standard 
Snellen test. If the driver wears corrective lenses for driving, these 
should be worn while driver's visual acuity is being tested. If contact 
lenses are worn, there should be sufficient evidence of good tolerance 
of and adaptation to their use. Indicate the driver's need to wear 
corrective lenses to meet the vision standard on the Medical Examiner's 
Certificate by checking the box, ``Qualified only when wearing 
corrective lenses.'' In recording distance vision use 20 feet as 
normal. Report all vision as a fraction with 20 as the numerator and 
the smallest type read at 20 feet as the denominator. Monocular drivers 
are not qualified to operate commercial motor vehicles in interstate 
commerce.
    Ears. Note evidence of any ear disease, symptoms of aural vertigo, 
or Meniere's Syndrome. When recording hearing, record distance from 
patient at which a forced whispered voice can first be heard. For the 
whispered voice test, the individual should be stationed at least 5 
feet from the examiner with the ear being tested turned toward the 
examiner. The other ear is covered. Using the breath which remains 
after a normal expiration, the examiner whispers words or random 
numbers such as 66, 18, 23, etc. The examiner should not use only 
sibilants (s-sounding test materials). The opposite ear should be 
tested in the same manner. If the individual fails the whispered voice 
test, the audiometric test should be administered. For the audiometric 
test, record decibel loss at 500 Hz, 1,000 Hz, and 2,000 Hz. Average 
the decibel loss at 500 Hz, 1,000 Hz and 2,000 Hz and record as 
described on the form. If the individual fails the audiometric test and 
the whispered voice test has not been administered, the whispered voice 
test should be performed to determine if the standard applicable to 
that test can be met.
    Throat. Note any irremediable deformities likely to interfere with 
breathing or swallowing.
    Heart. Note murmurs and arrhythmias, and any history of an enlarged 
heart, congestive heart failure, or cardiovascular disease that is 
accompanied by syncope, dyspnea, or collapse. Indicate onset date, 
diagnosis, medication, and any current limitation. An electrocardiogram 
is required when findings so indicate.
    Blood pressure (BP). If a driver has hypertension and/or is being 
medicated for hypertension, he or she should be recertified more 
frequently. An individual diagnosed with Stage 1 hypertension (BP is 
140/90-159/99) may be certified for one year. At recertification, an 
individual with a BP equal to or less than 140/90 may be certified for 
one year; however, if his or her BP is greater than 140/90 but less 
than 160/100, a one-time certificate for 3 months can be issued. An 
individual diagnosed with Stage 2 (BP is 160/100-179/109) should be 
treated and a one-time certificate for 3-month certification can be 
issued. Once the driver has reduced his or her BP to equal to or less 
than 140/90, he or she may be recertified annually thereafter. An 
individual diagnosed with Stage 3 hypertension (BP equal to or greater 
than 180/110) should not be certified until his or her BP is reduced to 
140/90 or less, and may be recertified every 6 months.
    Lungs. Note abnormal chest wall expansion, respiratory rate, breath 
sounds including wheezes or alveolar rales, impaired respiratory 
function, dyspnea, or cyanosis. Abnormal finds on physical exam may 
require further testing such as pulmonary tests and/or x-ray of chest.
    Abdomen and Viscera. Note enlarged liver, enlarged spleen, abnormal 
masses, bruits, hernia, and significant abdominal wall muscle weakness 
and tenderness. If the diagnosis suggests that the condition might 
interfere with the control and safe operation of a commercial motor 
vehicle, further testing and evaluation is required.
    Genital-urinary and rectal examination. A urinalysis is required. 
Protein, blood or sugar in the urine may be an indication for further 
testing to rule out any underlying medical problems. Note hernias. A 
condition causing discomfort should be evaluated to determine the 
extent to which the condition might interfere with the control and safe 
operation of a commercial motor vehicle.
    Neurological. Note impaired equilibrium, coordination, or speech 
pattern; paresthesia; asymmetric deep tendon reflexes; sensory or 
positional abnormalities; abnormal patellar and Babinski's reflexes; 
ataxia. Abnormal neurological responses may be an indication for 
further testing to rule out an underlying medical condition. Any 
neurological condition should be evaluated for the nature and severity 
of the condition, the degree of limitation present, the likelihood of 
progressive limitation, and the potential for sudden incapacitation. In 
instances where the medical examiner has determined that more frequent 
monitoring of a condition is appropriate, a certificate for a shorter 
period should be issued.
    Spine, musculoskeletal. Previous surgery, deformities, limitation 
of motion, and tenderness should be noted. Findings may indicate 
additional testing and evaluation should be conducted.
    Extremities. Carefully examine upper and lower extremities and note 
any loss or impairment of leg, foot, toe, arm, hand, or finger. Note 
any deformities, atrophy, paralysis, partial paralysis, clubbing, 
edema, or hypotonia. If a hand or finger deformity exists, determine 
whether prehension and power grasp are sufficient to enable the driver 
to maintain steering wheel grip and to control other vehicle equipment 
during routine and emergency driving operations. If a foot or leg 
deformity exists, determine whether sufficient mobility and strength 
exist to enable the driver to operate pedals properly. In the case of 
any loss or impairment to an extremity which may interfere with the 
driver's ability to operate a commercial motor vehicle safely, the 
medical examiner should state on the medical certificate ``medically 
unqualified unless accompanied by a Skill Performance Evaluation 
Certificate.'' The driver must then apply to the Field Service Center 
of the FMCSA, for the State in which the driver has legal residence, 
for a Skill Performance Evaluation Certificate under Sec.  391.49.
    Laboratory and other testing. Other test(s) may be indicated based 
upon the medical history or findings of the physical examination.
    Diabetes. If insulin is necessary to control a diabetic driver's 
condition, the driver is not qualified to operate a commercial motor 
vehicle in interstate commerce. If mild diabetes is present and it is 
controlled by use of an oral hypoglycemic drug and/or diet and 
exercise, it should not be considered disqualifying. However, the 
driver must remain under adequate medical supervision.
    Upon completion of the examination, the medical examiner must date 
and sign the form, provide his/her full name, office address and 
telephone number. The completed medical examination form shall be 
retained on file at the office of the medical examiner.
BILLING CODE 4910-EX-C

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    (2) On and after December 22, 2015, the medical examination shall 
be performed, and its results shall be recorded on the Medical 
Examination Report Form, MCSA-5875, set out below:

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    (g) * * *
    (4) Beginning December 22, 2015, if the medical examiner finds that 
the determination of whether the person examined is physically 
qualified to operate a commercial motor vehicle in accordance with 
Sec.  391.41(b) should be delayed pending the receipt of additional 
information or the conduct of further examination in order for the 
medical examiner to make such determination, he or she must inform the 
person examined that the additional information must be provided or the 
further examination completed within 45 days, and that the pending 
status of the examination will be reported to FMCSA.
    (5) * * *
    (ii) Beginning on June 22, 2015, if the medical examiner does not 
perform a medical examination of any driver who is required to be 
examined by a medical examiner listed on the National Registry of 
Certified Medical Examiners during any calendar month, the medical 
examiner must report that fact to FMCSA, via a secure FMCSA-designated 
Web site, by the close of business on the last day of such month.
    (h)(1) Until December 22, 2015, the medical examiner's certificate 
shall be substantially in accordance with the following form.
[GRAPHIC] [TIFF OMITTED] TR22JN15.016


[[Page 35596]]


    (2) On and after December 22, 2015, the medical examiner's 
certificate shall be completed in accordance with the following Form 
MCSA-5876, Medical Examiner's Certificate.
[GRAPHIC] [TIFF OMITTED] TR22JN15.017

* * * * *

    Issued under the authority delegated in 49 CFR 1.87 on: June 12, 
2015.
Larry W. Minor,
Associate Administrator for Policy.
[FR Doc. 2015-15161 Filed 6-19-15; 8:45 am]
 BILLING CODE 4910-EX-P