80 FR 36399 - Denial of Exemption Applications; Epilepsy and Seizure Disorders

DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration

Federal Register Volume 80, Issue 121 (June 24, 2015)

Page Range		36399-36400
FR Document		2015-15520

FMCSA announces the denial of 8 individuals' applications for exemptions from the rule prohibiting persons with a clinical diagnosis of epilepsy or any other condition that is likely to cause a loss of consciousness or any loss of ability to operate a commercial motor vehicle (CMV) from operating CMVs in interstate commerce. The reason for each of the denials is listed after the individual's name.

Federal Register, Volume 80 Issue 121 (Wednesday, June 24, 2015)

[Federal Register Volume 80, Number 121 (Wednesday, June 24, 2015)]
[Notices]
[Pages 36399-36400]
From the Federal Register Online [www.thefederalregister.org]
[FR Doc No: 2015-15520]

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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

[Docket No. FMCSA-2015-0115]

Denial of Exemption Applications; Epilepsy and Seizure Disorders

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

ACTION: Notice of denial of applications for seizure exemptions.

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SUMMARY: FMCSA announces the denial of 8 individuals' applications for
exemptions from the rule prohibiting persons with a clinical diagnosis
of epilepsy or any other condition that is likely to cause a loss of
consciousness or any loss of ability to operate a commercial motor
vehicle (CMV) from operating CMVs in interstate commerce. The reason
for each of the denials is listed after the individual's name.

FOR FURTHER INFORMATION CONTACT: Charles A. Horan, III, Director,
Office of Carrier, Driver and Vehicle Safety, (202) 366-4001, or via
email at fmcsamedical@dot.gov, or by letter to FMCSA, Room W64-113,
Department of Transportation, 1200 New Jersey Avenue SE., Washington,
DC 20590-0001. Office hours are from 8:30 a.m. to 5 p.m., Monday
through Friday, except Federal holidays.

SUPPLEMENTARY INFORMATION:

Background

Under 49 U.S.C. 31315 and 31136(e), FMCSA may grant an exemption
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 statutes allow the
Agency to renew exemptions at the end of the 2-year period. The 8
individuals listed in this notice have requested an exemption from the
epilepsy and seizure disorder standard in 49 CFR 391.41(b)(8), which
applies to drivers who operate CMVs as defined in 49 CFR 390.5, in
interstate commerce. Section 391.41(b)(8) states that a person is
qualified physically to drive a CMV if that person has no established
medical history or clinical diagnosis of epilepsy or any other
condition which is likely to cause the loss of consciousness or any
loss of ability to control a CMV.
In order to make an evidence-based decision, FMCSA conducted a
comprehensive review of scientific literature and convened a panel of
medical experts in the field of neurology to evaluate key questions
regarding seizure and anti-seizure medication related to the safe
operation of a CMV. Previously, the Agency gathered evidence for
decision making concerning potential changes to the regulation by
conducting a comprehensive review of scientific literature that was
compiled into a report entitled, ``Evidence Report on Seizure Disorders
and Commercial Vehicle Driving'' (Evidence Report) [CD-ROM HD TL230.3
.E95 2007]. The Agency then convened a MEP in the

[[Page 36400]]

field of neurology 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/medical/driver-medical-requirements/driver-medical-fitness-duty under
reports and are in the docket for this notice. In reaching the
determination to grant or deny exemption requests for individuals who
have experienced a seizure, the Agency considered both current medical
literature and information and the 2007 recommendations of the Agency's
Medical Expert Panel (MEP).

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.\1\ The MEP
recommendations are included in an appendix at the end of this notice
and in each of the previously published dockets.
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\1\ 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; or 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 that 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 current relevant 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 of
Neurological Disorders and Commercial Driving'' (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. The disposition of applications announced in this notice applies
the 2007 MEP recommendations.

Denials and Reasons

The following drivers were listed previously in Federal
Register Notice FMCSA-2015-0115 published on May 8, 2015:
Henry A. Freiburger--Mr. Freiburger has a history of epilepsy. His
last seizure was in 2002. His anti-seizure medication was discontinued
for a brief period in 2014. He does not meet the MEP guidelines at this
time.
Timothy K. Jameson--Mr. Jameson has a history of epilepsy. His last
seizure was in 2010. He takes anti-seizure medication. He does not meet
the MEP guidelines at this time.
Matthew J. Murphy--Mr. Murphy has a history of seizure disorder.
His last seizure was in 2013. He takes anti-seizure medication. He does
not meet the MEP guidelines at this time.
David Joe Patterson--Mr. Patterson underwent a craniotomy for
aneurysm in 1988, has no history of seizure or loss of consciousness
and has never taken anti-seizure medication since 1988. He does not
meet the MEP guidelines at this time.
Charles E. Sprenger--Mr. Sprenger has a history of seizure related
to a brain tumor. The tumor was removed in 2008. He discontinued his
anti-seizure medication in 2013. He does not meet the MEP guidelines at
this time.
Michael E. Tuttle--Mr. Tuttle has a history of epilepsy. His last
seizure was February 2008. He takes anti-seizure medication. He does
not meet the MEP guidelines at this time.
Mohammad S. Warrad--Mr. Warrad has a history of seizures. His last
seizure was in 1999. His anti-seizure medication was changed in March
2014. He does not meet the MEP guidelines at this time.
Tyler David Williams--Mr. Williams has a history of epilepsy. His
last seizure was in 2009. He takes anti-seizure medication. He does not
meet the MEP guidelines at this time.

Issued on: June 17, 2015.
Larry W. Minor,
Associate Administrator for Policy.
[FR Doc. 2015-15520 Filed 6-23-15; 8:45 am]
BILLING CODE 4910-EX-P

36400 Federal Register / Vol. 80, No. 121 / Wednesday, June 24, 2015 / Notices

field of neurology on May 14–15, 2007, caused by a medication; by non- operating a CMV in interstate commerce
to review 49 CFR 391.41(b)(8) and the penetrating head injury with loss of does not consider a driver’s actual
advisory criteria regarding individuals consciousness less than or equal to 30 seizure history and time since the last
who have experienced a seizure and the minutes; by a brief loss of consciousness seizure. The Agency has decided to use
2007 Evidence Report. The Evidence not likely to recur while driving; by the 2007 MEP recommendations as the
Report and the MEP recommendations metabolic derangement not likely to basis for evaluating applications for an
are published on-line at http:// recur; or by alcohol or illicit drug exemption from the seizure regulation
www.fmcsa.dot.gov/medical/driver- withdrawal. on an individual, case-by-case basis.
medical-requirements/driver-medical- • Examples of moderate-to-high-risk The disposition of applications
fitness-duty under reports and are in the factors for recurrence include seizures announced in this notice applies the
docket for this notice. In reaching the caused by non-penetrating head injury 2007 MEP recommendations.
determination to grant or deny with loss of consciousness or amnesia
exemption requests for individuals who greater than 30 minutes or penetrating Denials and Reasons
have experienced a seizure, the Agency head injury; intracerebral hemorrhage • The following drivers were listed
considered both current medical associated with a stroke or trauma; previously in Federal Register Notice
literature and information and the 2007 infections; intracranial hemorrhage; FMCSA–2015–0115 published on May 8,
recommendations of the Agency’s post-operative complications from brain 2015:
Medical Expert Panel (MEP). surgery with significant brain Henry A. Freiburger—Mr. Freiburger
hemorrhage; brain tumor; or stroke. has a history of epilepsy. His last
MEP Criteria for Evaluation The MEP report indicates that seizure was in 2002. His anti-seizure
On October 15, 2007, the MEP issued individuals with moderate to high-risk medication was discontinued for a brief
the following recommended criteria for conditions should not be certified. period in 2014. He does not meet the
evaluating whether an individual with Drivers with a history of a single MEP guidelines at this time.
epilepsy or a seizure disorder should be provoked seizure with low risk factors
Timothy K. Jameson—Mr. Jameson
allowed to operate a CMV.1 The MEP for recurrence should be recertified
has a history of epilepsy. His last
recommendations are included in an every year.
seizure was in 2010. He takes anti-
appendix at the end of this notice and
Medical Review Board seizure medication. He does not meet
in each of the previously published
Recommendations and Agency Decision the MEP guidelines at this time.
dockets.
Epilepsy diagnosis. If there is an FMCSA presented the MEP’s findings Matthew J. Murphy—Mr. Murphy has
epilepsy diagnosis, the applicant should and the Evidence Report to the Medical a history of seizure disorder. His last
be seizure-free for 8 years, on or off Review Board (MRB) for consideration. seizure was in 2013. He takes anti-
medication. If the individual is taking The MRB reviewed and considered the seizure medication. He does not meet
anti-seizure medication(s), the plan for 2007 ‘‘Seizure Disorders and the MEP guidelines at this time.
medication should be stable for 2 years. Commercial Driver Safety’’ evidence David Joe Patterson—Mr. Patterson
Stable means no changes in medication, report and the 2007 MEP underwent a craniotomy for aneurysm
dosage, or frequency of medication recommendations. The MRB in 1988, has no history of seizure or loss
administration. Recertification for recommended maintaining the current of consciousness and has never taken
drivers with an epilepsy diagnosis advisory criteria, which provide that anti-seizure medication since 1988. He
should be performed every year. ‘‘drivers with a history of epilepsy/ does not meet the MEP guidelines at
Single unprovoked seizure. If there is seizures off anti-seizure medication and this time.
a single unprovoked seizure (i.e., there seizure-free for 10 years may be Charles E. Sprenger—Mr. Sprenger
is no known trigger for the seizure), the qualified to drive a CMV in interstate has a history of seizure related to a brain
individual should be seizure-free for 4 commerce. Interstate drivers with a tumor. The tumor was removed in 2008.
years, on or off medication. If the history of a single unprovoked seizure He discontinued his anti-seizure
individual is taking anti-seizure may be qualified to drive a CMV in medication in 2013. He does not meet
medication(s), the plan for medication interstate commerce if seizure-free and the MEP guidelines at this time.
should be stable for 2 years. Stable off anti-seizure medication for a 5 year Michael E. Tuttle—Mr. Tuttle has a
means no changes in medication, period or more’’ [Advisory criteria to 49 history of epilepsy. His last seizure was
dosage, or frequency of medication CFR 391.43(f)]. February 2008. He takes anti-seizure
administration. Recertification for The Agency acknowledges the MRB’s medication. He does not meet the MEP
drivers with a single unprovoked position on the issue but believes guidelines at this time.
seizure should be performed every 2 current relevant medical evidence Mohammad S. Warrad—Mr. Warrad
years. supports a less conservative approach. has a history of seizures. His last seizure
Single provoked seizure. If there is a The medical advisory criteria for was in 1999. His anti-seizure
single provoked seizure (i.e., there is a epilepsy and other seizure or loss of medication was changed in March 2014.
known reason for the seizure), the consciousness episodes was based on He does not meet the MEP guidelines at
Agency should consider specific criteria the 1988 ‘‘Conference of Neurological this time.
that fall into the following two Disorders and Commercial Driving’’ Tyler David Williams—Mr. Williams
categories: Low-risk factors for (NITS Accession No. PB89–158950/AS). has a history of epilepsy. His last
recurrence and moderate-to-high risk A copy of the report can be found in the seizure was in 2009. He takes anti-
factors for recurrence. docket referenced in this notice. seizure medication. He does not meet
• Examples of low-risk factors for
tkelley on DSK3SPTVN1PROD with NOTICES

The MRB’s recommendation treats all the MEP guidelines at this time.
recurrence include seizures that were drivers who have experienced a seizure
the same, regardless of individual Issued on: June 17, 2015.
1 Engel,J., Fisher, R.S., Krauss, G.L., Krumholz, medical conditions and circumstances. Larry W. Minor,
A., and Quigg, M.S., ‘‘Expert Panel Associate Administrator for Policy.
Recommendations: Seizure Disorders and
In addition, the recommendation to
Commercial Motor Vehicle Driver Safety,’’ FMCSA, continue prohibiting drivers who are [FR Doc. 2015–15520 Filed 6–23–15; 8:45 am]
October 15, 2007. taking anti-seizure medication from BILLING CODE 4910–EX–P

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Document Created: 2015-12-15 14:09:03
Document Modified: 2015-12-15 14:09:03

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 denial of applications for seizure exemptions.
Contact		Charles A. Horan, III, Director, Office of Carrier, Driver and Vehicle Safety, (202) 366-4001, or via email at [email protected], or by letter to FMCSA, Room W64-113, Department of Transportation, 1200 New Jersey Avenue SE., Washington, DC 20590-0001. Office hours are from 8:30 a.m. to 5 p.m., Monday through Friday, except Federal holidays.
FR Citation		80 FR 36399

80 FR 36399 - Denial of Exemption Applications; Epilepsy and Seizure Disorders

DEPARTMENT OF TRANSPORTATIONFederal Motor Carrier Safety Administration

Federal Register Volume 80, Issue 121 (June 24, 2015)

DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration