FMCSA Updates Medical Advisory Criteria and Revives the Medical Examiner's Handbook

In January 2024, the Federal Motor Carrier Safety Administration (FMCSA) replaced the guidance that certified medical examiners use when deciding whether a truck or bus driver is physically qualified. A final rule published on January 19, 2024 updated the Medical Advisory Criteria in Appendix A to 49 CFR part 391, and a companion notice published on January 22 announced a new edition of the Medical Examiner's Handbook (MEH).

Guidance, not new standards

FMCSA described both documents as guidance. The advisory criteria explain how examiners on the National Registry of Certified Medical Examiners should interpret and apply the existing physical qualification standards in 49 CFR 391.41. The agency said the criteria do not amend any regulation or create new requirements for examiners or drivers.

Because the criteria are interpretive, FMCSA said it was not legally required to take public comment. It chose to do so anyway, publishing a draft handbook with updated criteria in August 2022. The rule took effect on its publication date so that it would line up with the release of the revised handbook. The updated criteria replaced all earlier versions, and FMCSA said earlier versions should no longer be relied on.

The handbook returns

FMCSA first posted a Medical Examiner's Handbook in 2008. It withdrew that handbook in 2015, saying some of its content was obsolete or too prescriptive, and told examiners it should no longer be treated as agency guidance. The agency asked its Medical Review Board to help streamline a new version, removing directive language and outdated material.

The January 2024 edition replaced all previous editions. FMCSA said the advisory criteria in the handbook were identical to those in Appendix A, although they were arranged in the order an examiner usually conducts an exam rather than in the order of the regulations.

What changed after public comment

FMCSA received 67 comments on the 2022 draft, from drivers, carriers, examiners, medical and trade associations, safety groups and the National Transportation Safety Board. Some commenters wanted more specific testing guidance. FMCSA responded that setting specific test methods or lab values would require rulemaking.

The agency did make a number of clarifications. Among them, the handbook:

• stressed that a driver's right to a copy of the medical examination report does not depend on who paid for or requested the exam;
• noted that drivers may seek a second opinion from another examiner, but are expected to give both examiners the same medical information;
• stated that once an examiner starts an exam, the result must be reported to the National Registry even if the exam is not finished;
• clarified that a "determination pending" status does not extend the expiration date of a driver's current medical certificate;
• explained that the alternative vision standard applies only when the worse eye cannot be corrected to meet the distant acuity standard.

The handbook also reflected that medical certification under the old vision waiver study program, 49 CFR 391.64, was no longer available. FMCSA noted that certificates issued under that section became void as of March 22, 2023.

Where to find it

FMCSA said the criteria would be posted on its guidance portal and on the National Registry website, and that it expected to review the guidance within five years.

Archive: this article describes rules and events as of January 2024. Regulations may have changed since, so check the current rule before relying on it.