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The Medical Examiner’s Handbook Through The Years

Update: Medical Examiner’s Handbook 2024 Edition

Original post from June 1, 2023:

Holy confusion, Batman! Which version of the Medical Examiner’s Handbook should I use? Answer: the most current one. But there’s a lot more to that answer.

The Medical Examiner’s Handbook is published by the FMCSA. The original Medical Examiner’s Handbook – published prior to 2015 – was 260 pages, and often specified that drivers with certain conditions should not be certified. Beginning in 2015, the FMCSA marked that version of the Handbook as “NO LONGER IN USE” but did not offer an updated version. In 2019, the FMCSA published the next version: this was marked “DRAFT” and was 78 pages. Successive “DRAFT” versions were published in 2020 (77 pages), 2021 (114 pages), and 2022 (122 pages).

The general direction that the FMCSA has taken since 2014 is to encourage Medical Examiners to consider most certification decisions based on a case-by-case evaluation of the driver’s medical conditions, rather than simply determining certification based on a specific diagnosis. The language in the pre-2015 version often said what the Medical Examiner should or should not do. That version listed many conditions as disqualifying. Examples include hypertrophic cardiomyopathy, peripheral neuropathy, use of methadone, and many others. Since then, the FMCSA has clarified that there are only 2 conditions that are disqualifying by regulation – hearing loss and seizures/epilepsy – and has also clarified that all other conditions must be assessed on a case-by-case basis. Despite this updated guidance, the FMCSA does still indicate that drivers with a current diagnosis of alcoholism should be disqualified, as should drivers who use a Schedule I substance, although the FMCSA never states that these are disqualifying “by regulation”.

Despite these exceptions, the direction the FMCSA is taking is clear: the FMCSA is tasking Medical Examiners to make individualized assessments of drivers’ medical conditions and not to rely on a cookbook approach. This trend is also reflected in the elimination of the vision and diabetes regulations, which previously required the FMCSA to make driver certification assessments for exemptions/waivers, but now require Medical Examiners to make those certification assessment using the alternative qualification process for drivers with monocular vision and insulin-treated diabetes mellitus.

For more information, contact Federal Motor Carrier Safety Administration,
Medical Program at or by phone: (202) 366-4001.

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Certified Medical Examiners on the National Registry are required to be recertified no sooner than 9 years and no later than 10 years from the date of issuance of their medical examiner certification credential. Recertification requires that providers complete an accredited training program such as ours and pass the in-person national NRCME certification examination.

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