As a medical examiner, it is important for you to distinguish between medical standards (49 CFR 391.41) and medical guidelines. Regulations/standards are laws and must be followed. Whereas guidelines, such as advisory criteria and medical conference reports are recommendations. While not law, the guidelines are intended as best practices for medical examiners.

Guidelines have been issued by the Federal Motor Carrier Safety Administration (FMCSA) to provide you with additional information and are based on medical literature. If you choose not to follow the guidelines, the reason(s) for the variation should be documented. You are responsible for determining if the commercial motor vehicle (CMV) driver is medically qualified and is safe to drive under the Federal Motor Carrier Safety Regulations (FMCSRs).

The physical qualification regulations for CMV drivers in interstate commerce are found at Section 391.41(b) of the FMCSRs.

The advisory criteria under 391.41 are instructions to medical examiners performing medical examinations found in Section 391.43 and are recommendations. They are accessible on the FMCSA Web site at Medical Advisory Criteria for Evaluation Under 49 CFR Part 391.41.

FMCSA has published medical conference reports as recommendations to assist medical examiners to determine whether a driver is qualified under Section 391.41(b). The conference reports may be accessed on the FMCSA Web site at Medical Conference Reports.

FMCSA has an ongoing process for reviewing all Federal medical standards and guidelines used to determine driver medical fitness for duty.

To ensure that these regulations and guidelines are evidence-based, FMCSA uses a number of methods for gathering medical data, including, but not limited to:

• Agency expert analyses of Federal data and other relevant international, national, and State data.
• Interagency, national, and international regulatory analyses.
• Evidence reports.
• Medical Expert Panels (MEPs).
• Medical Review Board (MRB), a committee established in accordance with the Federal Advisory Committee Act.

First, FMCSA formulates questions relating to a specific medical condition and the associated impact on driving. FMCSA then gathers information through a systematic review of the available scientific literature. The findings are summarized in evidence reports that reflect current diagnostic and therapeutic medical advances.

For some topics, FMCSA convenes an MEP. The members of the MEP vary according to the specific topic and panel expertise. The task of the MEP is to provide an opinion for consideration by FMCSA.

Evidence report executive summaries and MEP opinions are posted on the FMCSA Web site at Reports — How Medical Conditions Impact Driving.

The MRB meets three to four times each year on specific topics. The MRB independently reviews evidence reports and if an MEP was convened, also reviews the MEP opinion. The MRB deliberates and proposes recommendations for consideration by FMCSA.

MRB proceedings and public meetings schedule are posted on the MRB Web site.

FMCSA considers the evidence reports, the MEP opinion, and the recommendations from the MRB when reviewing medical standards and guidelines. FMCSA also considers other factors such as feasibility and impact. FMCSA posts information regarding proposed changes to the current standards and guidelines on the FMCSA Medical Programs Web page. Proposed changes to guidelines will accompany the standards as guidance and are subject to public notice-and-comment rulemaking.

This Medical Examiner Handbook will be updated as new standards and guidelines are approved by FMCSA.