Recommend not to certify if: The driver: Has not completed the minimum waiting period seizure free and off anticonvulsant medication. Does not have clearance from a neurologist who specializes in epilepsy and understands the functions and demands of commercial driving. Monitoring/Testing You may on a case-by-case basis obtain additional tests and/or consultation to adequately assess driver medical fitness for duty. The driver should have at least biennial medical examinations. Vertigo and Dizziness The normal ability to maintain balance and orientation while operating a commercial motor vehicle (CMV) depends upon peripheral nervous system (PNS) sensory input from three major systems and the appropriate motor integration in the central nervous system (CNS). The three PNS sensory systems are vestibular, visual, and proprioception. Inappropriate interactions of these systems or interactions within the CNS may produce an unsafe degree of vertigo or dizziness that endangers the health and safety of the driver and the public. The most common medications used to treat vertigo are antihistamines, benzodiazepines, and phenothiazines. Use of either benzodiazepines or phenothiazines for the treatment of vertigo would render the driver medically unqualified. Special consideration should be given to the possible sedative side effects of antihistamines. The medical examiner should determine if these drugs produce sedation in the individual driver. Waiting Period Minimum 2 months asymptomatic with diagnosis of: — Benign positional vertigo. Acute and chronic peripheral vestibulopathy. Decision Maximum certification 2 years — Recommend to certify if: The driver has a diagnosis of: Benign positional vertigo and has completed the appropriate symptom-free waiting period.
Recommend not to certify if: The driver: Has not completed the minimum waiting period seizure free and off anticonvulsant medication. Does not have clearance from a neurologist who specializes in epilepsy and understands the functions and demands of commercial driving. Monitoring/Testing You may on a case-by-case basis obtain additional tests and/or consultation to adequately assess driver medical fitness for duty. The driver should have at least biennial medical examinations. Vertigo and Dizziness The normal ability to maintain balance and orientation while operating a commercial motor vehicle (CMV) depends upon peripheral nervous system (PNS) sensory input from three major systems and the appropriate motor integration in the central nervous system (CNS). The three PNS sensory systems are vestibular, visual, and proprioception. Inappropriate interactions of these systems or interactions within the CNS may produce an unsafe degree of vertigo or dizziness that endangers the health and safety of the driver and the public. The most common medications used to treat vertigo are antihistamines, benzodiazepines, and phenothiazines. Use of either benzodiazepines or phenothiazines for the treatment of vertigo would render the driver medically unqualified. Special consideration should be given to the possible sedative side effects of antihistamines. The medical examiner should determine if these drugs produce sedation in the individual driver. Waiting Period Minimum — 2 months asymptomatic with diagnosis of: Benign positional vertigo. Acute and chronic peripheral vestibulopathy. Decision Maximum certification — 2 years Recommend to certify if: The driver has a diagnosis of: Benign positional vertigo and has completed the appropriate symptom-free waiting period.
proposed-changes-medical-examiners-handbook.docx