The commercial driver is at an increased risk for developing acute deep vein thrombosis (DVT) due to long hours of sitting as part of the profession. DVT can be the source of pulmonary emboli that can cause gradual or sudden incapacitation or death. DVT is disqualifying for the driver until adequately treated.
Varicose veins with chronic venous insufficiency and leg ulcerations are the most common disorder of the lower extremities, affecting over 20 million people in the United States. Varicose veins do not medically disqualify the commercial driver.
Chronic thrombotic venous disease of the legs can also lead to pulmonary emboli. Venous insufficiency, venous stasis changes and stasis ulcers may be signs of untreated DVT and should be evaluated. Superficial phlebitis, although benign and self-limited, is often associated with DVT. If the driver is symptomatic, DVT should be excluded. A temporary certification while undergoing evaluation is reasonable unless there are symptoms of acute DVT. If they are subsequently found to have DVT upon testing, they are disqualified for a one month waiting period until adequately anti-coagulated.
Acute DVT needs to be treated adequately with anticoagulants, which decreases the risk of recurrent thrombosis by approximately 80%. The driver is disqualified for one month, then INR’s must be monitored monthly if on coumadin. It is up to the examiners’ discretion how to monitor this and temporary certification for 3 months may be considered to assess progress.
In the case of pulmonary embolism, there is a 3 month waiting period, then the driver must be assessed for adequate anticoagulation, with no other uncontrolled underlying cardiovascular disease.
Here is the table of recommendations for venous disease in the commercial driver: