The NADME DOT certification training course states that the recommendation for DOT certification following a stroke is one year. One of our providers has since been told that the recommendation is 6 months…She wondering which is correct.
The recommended (not required) minimum waiting period for DOT physical after a stroke is one year for a stroke without risk for seizure, eg cerebellar or brainstem, but 5 yrs for cerebral stroke. Maximum recommended certification is one year. If you as the medical examiner feel a shorter certification is warranted, that is at your discretion, just document the reasoning for your decision in the comments section. There is no specific 6 mo provision.
Ref: FMCSA Medical Examiner Handbook
Embolic and Thrombotic Strokes
More than 3 million individuals have survived a stroke, and it is a major cause of long-term disability. Embolic and thrombotic cerebral infarctions are the most common forms of cardiovascular disease. Risk for complicating seizures is associated with the location of the lesions.
- Cerebellum and brainstem vascular lesions are not associated with an increased risk for seizures.
- Cortical and subcortical deficits are associated with an increased risk for seizures.
- Evaluation by a neurologist is necessary to confirm the area of involvement.
Drivers with embolic or thrombotic cerebral infarctions will have residual intellectual or physical impairments. Fatigue, prolonged work, and stress may exaggerate the neurological residuals from a stroke. Most recovery from a stroke will occur within 1 year of the event.
The neurological examination should include assessment of:
- Cognitive abilities.
- Judgment.
- Attention.
- Concentration.
- Vision.
- Physical strength and agility.
- Reaction time.
Waiting Period (recommended, not required)
For DOT Physical certification after a stroke:
Minimum — 1 year if not at risk for seizures (cerebellum or brainstem vascular lesions)
Minimum — 5 years if at risk for seizures (cortical or subcortical deficits)
NOTE: If more than one waiting period applies (because of multiple conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.
Decision
Maximum certification — 1 year
Recommend to certify if:
- The driver with a history of stroke has:
- Completed the appropriate waiting period.
- Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological testing.
- No neurological residuals or, if present, residuals of a severity that does not interfere with ability to operate a commercial motor vehicle.
- Clearance from a neurologist who understands the functions and demands of commercial driving.
Recommend not to certify if The driver:
- Has not completed the appropriate waiting period.
- Uses oral anticoagulant therapy because of the risks associated with excessive bleeding.
- Uses any other drug or combination of drugs that have potentially high rates of complications (e.g., depressing effects on the nervous system).
- Has residual intellectual or physical impairments that interfere with commercial driving.
- Does not have clearance from a neurologist who 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.
Follow-up
The driver should have an annual medical examination
Commercial Drivers and Family Members:
You must get trained and certified in order to perform DOT exams!
For course and CME credit information visit NADME.org
Click here to begin your
Do you have a DOT exam question? Comment below!
My risk management says its a federal guideline that I have to decertified. I had a stroke 6 months ago in April. My dr had me off for the req 1yr waiting l period. Why am I being asked to get decertified if my goal is to return to driving after the 1yr waiting period?
Paula, it’s not a federal guideline, it’s the law. A commercial driver with a medical condition which interferes with the job of commercial driving must undergo a new medical certification exam by a certified medical examiner.
The one year waiting period is a minimum recommended. It is up to 5 years for strokes with a risk of seizures.
My husband had a vertebral artery dissection due to injury. A tiny piece of clot then caused a stroke of cerebellum. This caused dizziness initially. He healed and is back to himself and feels completely fine. His neurologist released him to go back to work and even did a further reply for examiner stating that the risk of seizure is negligible, same as general population. Still he is denied by DOT examiner (a chiropractor). Now he is being told to resign from his job. I don’t quite understand if the waiting period is a recommended and not mandatory one year, why when all is considered he is still denied? Another physician told us that he does not agree that the one year waiting is mandatory in his case, and to come get an exam by him. However the employer will not accept this. They don’t want to even hear of a second opinion. How can an M.D. and a neurologist be trumped by a chiropractor?
The concern with strokes is risk of recurrence, loss of consciousness, neurological sequelae/after effects, and importantly, risk of seizure. A cerebellar stroke has low risk of seizure, as the neurologist indicates, similar to the general population. After a year waiting period, if all else is stable, a driver with cerebellar stroke would be eligible for recertification. This is recommendation or guideline, not a rule proscribed by FMCSA. In other words, it is up to the discretion of the medical examiner usually in concert with the treating neurology opinion, assuming they are knowledgeable regarding FMCSA regulations and guidelines.
A driver may seek a 2nd opinion from another certified medical examiner, but there are no rules requiring the employer to accept it. The driver may however wind up with a certification that is “good” for another employer.
I don’t disagree with frustration over an MD and neuro opinion not holding weight over a chiropractor.
If you are so inclined, we have a course on neurological conditions concerning commercial drivers you may wish to enroll in. It is geared for examiners, but perhaps you will find some useful information:
Scroll down to the neurological course: https://urgentcarementor.com/nrcme-seminar-series-single-episodes/
Had a blackout like headache while driving went to get check out by doctor and was told he wasn’t sure what it was and thought TIA ! But saw mild sinus infection, now dot doctor saying since first doctor stated possible TIA that I have to wait a year to be cleared ! With no proof of TIA and test that are clear now and no signs of TIA how can I get DOT to approve me to go back to work ? talked to a lot of people and sounds like it’s based on our DOT doctor provided by work !
The medical examiner will usually rely on a neurology opinion on whether a driver has suffered a stroke or TIA, often backed up by CT or MRI imaging. A driver may also request a 2nd opinion from another certified medical examiner. But the employer is not required to accept another opinion if contracted with a particular examiner.
Will a noticeable limp from a stroke disqualify me from a dot medical card
Many factors need to be considered after a stroke including among them risk of another stroke, seizure, severity of underlying diseases, effects of medications and muscular or neurological deficits, and how any or a combination of these factors affects the job of commercial driving and public safety.
Only a certified medical examiner can make that determination in any individual case.
I had a cerebellum stroke 4 months ago I’m perfectly fine I have paperwork from neurologists from hospital with no blood clot or other effects (results from cat scan and MRI with die) and also a return to work statement with no restrictions I didn’t get any side effects. I passed dot physical with flying colors but that dot dr at suncoast urgent care says it’s the law I have to wait a year but as I’m doing my research infact in is not a law it’s a recommendation but to the discretion of the dot dr doing physical. Also the stroke section does not include a cerebellum stroke in the talks all about other strokes. Please help me what are next steps I cant afford to stay out one year I I am willing to redo my physical in one year as recommended but I am perfectly fine with no side effects and the type of stroke i had i am not at seizure risk. Please help I could use any advise offered.
You are correct the one year waiting period is a recommendation or guideline, not a rule of law. It is up to the discretion of the medical examiner. It is a good recommendation due to risk of another stroke being highest in the first year, even when a driver seems to have improved from the first one. Often the examiner will rely on the neurology opinion if they are sure the neurologist has a complete understanding of the job of commercial driving. Drivers may also seek a second opinion from another certified medical examiner.
I’m an interested in getting my CDL. I’ve had a history of blood clots. The first one was in my leg, after a procedure. So I was put on Xeralto. Since the clot was provoked, my hematologist only had me on it for a few months. I had blood work done, no faceyor V, or anything. Weeks later, I started getting headaches, didn’t think anything of it. I passed out at work, had a seizure and was hospitalized for a week. Turns out, I had a cerebral infarction. My hematologist stated that my body is probably gonna keep clotting so I’m on blood thinners for life. I’ve had MRIs done and I do have lesions on my right side. I was hospitalized. I was on warafin and i had my blood checked, I was told my blood was too thin, do not take it for two days. I got a clot again, in my brain. That was in 2016. I haven’t had any problems, in a year in a half. It will be 2 years in October. Here it is now, 2018, I want to change careers and these past medical issues are coming up. I went by a truck driving school today and the medical examiner recommended I get a letter from my doctors staying I am stable while on blood thinners and why I had the one seizure in writing. Do you think I will be recommended to pass? What is your opinion, would you pass someone like me?
I can’t comment on your particular case, that’s between you and your examiner. BUT if a driver has had a seizure with stroke there is going to be a waiting period of at least 5 years and may need to be seizure free off anticonvulsant meds for 10 years before medical qualification. If on anticoagulants for cerebro-vascular disease, that is generally considered disqualifying due to the risk of stroke and seizure. I suggest someone in this situation pursue a career other than commercial driving.
I am a Family Physician but not a medical examiner. I have a truck driver patient who suffered a L MCA stroke (mild) last month. He is improving daily but does have residual weakness in his R hand, grip and still has a slight limp. He is asking me to say it is ok if he goes back to ‘team driving’ with his son due to the immense financial hardship the family is experiencing with him off the road. I do not believe I have any authority to ‘clear’ him even if I thought is was the right thing to do and certainly am very concerned that he would be compromising his health and the safety of others if he returned to driving now (or possibly ever). He has not consulted with a DOT examiner. What are your thoughts and is he (or am I) required to report this to the DOT/a DOT examiner (NY state).
You are correct in that only a certified medical examiner can clear a commercial driver. A driver with a cerebral stroke is at risk for seizure therefore would be at least 5 years waiting period without residuals, seizures or anti-seizure medication.
A commercial driver is required by law to get re-examined after such an incident by a certified examiner. Suspected violations can be reported to state DMVs or to the federal office of medical programs at fmcsamedical@dot.gov
My son had a mini stroke at 12 years old….he is now 37 and had NO issues throughout his life .he even joined the Marine Corp with no issue….now a dot doctor will not certify him…what is he to do? He already got two dot physicals….
Please advise
Get a 2nd opinion from another certified (DOT) medical examiner. If no seizures, no meds for over 10 years he should be fine unless there is an underlying condition still that the doctor was concerned about.
I had a stroke in my medulla June 2017. The affects of the stroke are on my right side. I have tone in my shoulders and a little in my wrist, but can move them (gaining more strength and radius as time progresses). I am not physically ready to return.. I’d like to minimize these issues as much as possible before doing so. My questions are, does this disqualify me and/or how can I find out what I need to be able to do and improve in order to pass the DOT physical.
If there is no risk for seizure there is a minimum one year waiting period (5 years if risk of seizure), then a medical examiner would need a neurology evaluation and recommendation in order to make a qualification determination. The driver would have to be free of neurological deficits which may interfere with safe operation of a commercial motor vehicle.
Had a very small TIA in August 2017 caused by A-FIB. Neurologist , Cardiologist and primary care doctors have cleared me and see no reason that I can not get recertified and go back to driving since the TIA was caused by A-FIB and is now under control. Is the one year wait still applicable or is this at the discretion of the medical examiner.
This falls under medical examiner discretion – guidelines call for a one year waiting period due to high recurrence rates.
went to both neurologist and mri.sent and was approved by dr.s to drive commercial vehicles.md mva flat refuse me at the 8 month mark.said come back after a year,oh and got to get released by Nero and mri.go figure.😬
Yup, at least a year, and in some cases 5 years is the recommended waiting period depending on the risk of seizure.
ok ,got released again,but now,cpap comes into the issue.gotta be compliant 22 days consecutive out of 30 days.20 day mark.2 more days.key word,never give up
A co-worker had a stroke, 3 months later Dr does some tests and after the results, will not give them a DOT medical card. Co-worker shops around and finds a chiropractor that signs off on the medical card. Aren’t only certified Drs supposed to be able to sign off on DOT medical card? How is a chiropractor qualified to evaluate a stroke victim? Is this illegal?
Thanks
In all states except NY, chiropractors may become certified medical examiners, that is the only way the chiropractor could sign off on a medical card. Strokes are generally disqualified for at least a year and usually up to 5 years, depending on the location, severity and risk of seizure.
Had a small stroke with no seizure risk. Very minimal physical issues that wouldn’t prevent safe driving (not noticeable unless I point them out). However, I still get dizzy turning my head side to side, so I haven’t gone to see the medical examiner yet. I drive school bus and want to know my kids are safe if I’m behind the wheel. My question is, if this dizziness never goes away (it’s been over 3 months and not improving at all), will I ever be allowed to drive my bus again? I realize I need to wait 1 yr, but assuming I’m still dizzy with head turning, does that disqualify me? Also, if they find a medicine to help with the dizziness, how will I know if the medicine is a disqualification in and of itself? -Thank you for your time in this matter!
Dizziness or vertigo is disqualifying. Your medical examiner will need to determine if any medications are likely to cause drowsiness or other side effects to be disqualifying.
Thank you for your prompt reply to my question. Although the answer is disappointing news, I would rather be safe than sorry. I started driving my little car again about a month ago (I’m in Utah) but I don’t have to turn my head like I do in a school bus. I’d rather be disappointed and not hurt anyone on the road, so I appreciate your answer. Thank you! ?
I had an intracranial hemorrhage which caused me to have a seizure 3 months ago. It was located on my left parietal lobe and it has since resolved. I’ve been on anti seizure medication just as a precaution and have had no seizures since. My prognosis is good and I’m feeling great, will I be able to get a commercial DL in the near future. Thanks so much.
As above, parietal lobe bleed with history/risk of seizure is minimum 5 year waiting period OFF anti-seizure medications.
My husband had a clot in his eye in May 2015. he is in very good health and was 56 years old. Retinal specialist sent him to neurologist to find out why he had this. MRI of his brain showed a VERY small scar in his left frontal lobe from TIA. We have NO idea when he had it as there were/are no signs or symptoms of any stroke or TIA physically or mentally. Sent him to blood specialist whom found he has Factor V Leiden mutation which CAN cause clotting disorder in 10% of people who have it. It is easily controlled with aspirin, so no anticlotting meds needed. He was off work for 12 months and DOT physician passed him, back to work for 9 months. Went back to same DOT physician again now to recertify, and this time she failed him, saying he needs to be off work for 5 years. He has had NO problems, no stroke/TIA or clots of any kind on a full adult aspirin a day. His blood specialist, general practitioner, neurologist AND a stroke specialist in University of WI all said they do not expect any more problems and all feel safe to send him back to work. The DOT physician claims she cannot find the FMCSA information that releases him back to work. So NOW what, before he looses his job….again? Where in FMCSA regulations can I fend the answers?
The 5 year recommendation is meant for those at risk of seizure or sudden incapacitation from certain types of stroke. TIA is usually one year. This is a complicated case and there is no “rule” per se, only recommendations the medical examiners can go by.
I’d be happy to look into this further, please consider a consultation here It would take at least an hour to evaluate, research, and provide you with the proper resources and documentation to assist your case.
I recently had a co-worker of mind who was put on light duty because the agency doctor believe she “POSSIBLY ” had a stroke while she was driving the bus based on the complaint my co-worker made about a slight headache and numbness,then after a series of test by her doctor there was never any indication she had stroke, now the agency won’t allow here back to work , so what can she do to get this matter resolved???????
It may be that her doctor feels she may have suffered a TIA – transient ischemic attack, which is sort of a warning sign for stroke. For DOT there is a year waiting period and then clearance from a neurologist knowledgeable about the job of commercial driving.
A driver may also seek a second opinion from another certified medical examiner, although in some states the employer may be contracted with a particular examiner or “agency” as you mention.
In the meantime a driver with a TIA should do everything possible to stay healthy – stop smoking, follow up diligently with cardiology and/or neurology and treat underlying heart disease or atrial fibrillation, cholesterol problems, get rid of excess weight – all these things may be helpful as there is a significant risk of stroke over the next year after a TIA.
I recently had a co-worker of mind who was put on light duty because the agency doctor believe she “POSSIBLY ” had a stroke while she was driving a bus based on the complaint my co-worker made,the after a serious of test by her doctor there never any indication she had stroke, now the agency won’t allow here back to work , so what can she do to get this matter resolved???????
The Stroke MEP Recommendations from January 8, 2009 mention the need for off-road tests to predict driving ability after a stroke (i.e., figure of Rey test, dot cancellation test, road sign recognition and square matrix tests) as well as the Motor-free Visual Perception Test. Are these tests performed by a neurologist or the medical examiner?
The recommendation further states the on-road evaluation should remain the gold standard for certification. Who conducts the on-road evaluation? And, is the test performed while driving a commercial motor vehicle?
Thank you!
These would not typically be performed by the medical examiner, they would rely on the neurologist to perform advanced post-stroke testing. On road evaluations are done by DMV – each state may have it’s own rules for this. The medical examiner would only be concerned with the exam showing no neurological deficits, appropriate waiting period, neurology evaluation and recommendation.
The dot regulation states that 1 year is a recommendation not an absolute rule so technically a driver can return to driving after having a Tia if the neurologist has taken a MRI and found no evidence of a stroke or brain damage even though the diagnosis was a CVA or Tia so the dot doctor can’t deny your medical card.
You are correct it is a recommendation, not a rule. However your statement “the DOT doctor can’t deny your medical card” is incorrect. It is the medical examiner’s discretion as to what information they are going to consider to make a final determination. Many, many times I have disagreed with a specialist or primary doctors’s opinion that a driver can return to work, especially when it was clear to me that the specialist did not fully appreciate the job of commercial driving.
Yes How long due you need to wait for a hymoratic stroke? It has been 3 mo since it happened, I am about to be cleared from all the drs? What are the steps I need to take to get back to driving? Never had any health issues just that one episode.
As in the article “The recommended (not required) minimum waiting period for DOT physical after a stroke is one year for a stroke without risk for seizure, eg cerebellar or brainstem, but 5 yrs for cerebral stroke. Maximum recommended certification is one year.” It does not matter if thrombotic or hemorrhagic, rather where it is located, e.g. risk of seizure, to wait 1 yr vs. 5 yrs. Only your medical examiner can determine that.
i recently had a coilling on a ceribal aneryesm.i then sufferd a tia two days later. i have since been cleared by two nerologist and passed a driver evaulation at the EDWIN SHAW occupational therapy center in Akron OHIO which i passed
Thanks for sharing your condition. After a TIA there should be a minimum of one year waiting period for commercial driving, even though one may be cleared for driving an automobile. It may be longer if there is risk of seizure due to the location of the bleed. This will be up to the medical examiner in consultation with the neurologist.
the medicalexaminer never consulted with a neurologist he just refused to issure my med card.just wondering if there is anything i can do to get back to work? can it be over turned?
You can always seek a second opinion from another certified examiner. Some employers don’t allow this, so check with yours. See if your neurologist is familiar with the DOT regs and recommendations to see if they feel you can drive commercially, then bring that to the examiner
How long do i have to wait after having a tia
The waiting period for a TIA without risk of seizure is one year.
I had a stroke over a year ago and my dot was suspend for a year,not they tell me i have to have a ct scan or a MRI even if i been strokeless over a year,who is responsible for the cost of the MRI or CT scan the company pays for all our physical and this extra stuff there doctor orderd they should pay for that also is there a rule they have to go bu?
Tim, thanks for your question. FMCSA/DOT does not address payment for exams or tests requested by the medical examiner. Sometimes it may be covered by your insurance. There is no rule to require employers to pay for any needed tests.