Who Is Exempt From a DOT Medical Card?

by Pride Transport | Feb 23, 2024

Medical conditions such as high blood pressure, heart attacks, hearing impairment, seizures, vision loss, and others can greatly impact the ability of a person to drive safely. For that reason, the United States Department of Transportation and the Federal Motor Carrier Safety Administration (FMCSA) require all drivers to pass or be exempted from the DOT medical examination and hold an approved medical certificate (or card) to show they’re healthy enough to be behind the wheel. 

If you don’t think you can pass the DOT exam, you may qualify for an exemption if you live with a stable health condition. Here’s what you need to know. 

What Is a DOT Medical Card? 

A DOT medical certification is a document that shows that a commercial driver is capable of performing their role as a truck driver and has demonstrated the appropriate mental, emotional, and physical fitness required. 

The general requirements for DOT medical cards state that you must complete your DOT physical examination with a licensed medical examiner approved by the Federal Motor Carrier Safety Administration (FMCSA). Some of the acceptable medical examiners may include:

  • Advanced practice nurses (APN)
  • Physician assistants (PA)
  • Doctors of osteopathy (DO)
  • Doctors of medicine (DM)
  • Doctors of chiropractic (DC)

During the examination, the medical provider will look for signs of any underlying health conditions that could negatively impact your ability to drive safely. The provider will:

  • Ask you about your medical history, taking notes on if you’ve had surgery, the kinds of medications you take, and any health problems you have. They will also ask about any substance abuse issues or failed drug tests. 
  • Discuss any current symptoms you’re dealing with. 
  • Perform a hands-on physical that looks at your blood pressure, vision, height, weight, lungs and chest, back and spine, and other parts of the body. As a part of this physical assessment, extra attention is placed on examining the nervous and circulatory systems including your reflexes, lymphatic system, veins, and arteries.
  • Request a urine sample for urinalysis. A urinalysis checks for conditions such as prediabetes or diabetes. 
  • Ask if you snore. If so, they may request that you take a sleep apnea test.

Most people go through this examination every 24 months to help encourage good health and to take preventative steps if their health is in decline. Maintaining good health while driving a commercial vehicle is imperative for your health and safety as well as the safety of others on the road. 

female truck driver pulling truck door open

DOT Exemptions for Medical Conditions

Certain conditions will require you to get an exemption to drive a commercial vehicle. With these conditions, you may need to have DOT examinations more often than every 24 months. 


It is possible to get and keep your commercial driver’s license with diabetes, but you will need to show that it is well controlled. Both those with type 1 and type 2 can get an exemption if they show that their condition is controlled with (or without) insulin. 

You will need to submit several forms and extensive documentation to show your condition won’t negatively affect your ability to drive. Some of the requirements you’ll need to meet include:

  • Being on insulin for a minimum of 30 to 60 days
  • Not having a history of a severe hypoglycemic episode within the last year 
  • Not having a history of more than one severe hypoglycemic episode within the last five years
  • Documentation of current diabetes education
  • A completed application with support from an approved endocrinologist
  • Driving interstate
  • Not driving for local, state, county, or federal employers

It’s important that you can show you have stable control over your blood sugar levels and understand how to monitor and manage your condition. 

On top of these requirements, you will need to show that your eyes have not been negatively impacted by diabetes and that your field of vision is greater than 70 degrees in both eyes. If you have diabetic retinopathy or other related conditions, they should be stable. Additionally, your visual acuity should be at least 20/40 in each eye.

With diabetes, you won’t be able to get more than a year’s approval to drive, and you may have a limited qualification of up to three months while on insulin.

The FMCSA has produced the New Diabetes Standard Overview Webinar with more information about driving with diabetes.


Vision-Related Conditions

There are many conditions that can affect your eyesight. Good vision is imperative on the roads, though, as not being able to see clearly could impact your reaction times and lead to a collision. 

The standard DOT examination requires you to have 20/40 vision in each eye and a 70-degree field of vision. It’s also important that you can differentiate between red and green traffic lights and other traffic control colors. 

You can get a vision exemption if you can’t pass the standard DOT examination. Each exemption is good for a maximum of two years. 

Some of the criteria you’ll need to meet include:

  • Holding a valid license that shows you have maintained your license for three years or longer in your state of residence
  • Having at least three years of commercial motor vehicle experience (and the experience should have occurred immediately before the date you applied for your exemption)
  • Driving for at least 10 hours a week
  • Having a safe driving record
  • Having a vision deficiency that is present for at least three years
  • Having stable vision
  • Meeting FMCSA vision standards in the eye with better vision

To find out more about driving commercially with visual impairments, you can watch or listen to the “New Vision Standard Overview Webinar” from the FMCSA.

Hearing Impairment

Being able to hear what’s going on around you can help you avoid serious mistakes on the road. You’ll be asked to pass the DOT physical exam’s hearing test. The test does allow you to use hearing aids for the “forced whisper” test. 

During this test, the medical examiner says a two-syllable word approximately five feet away from you. You’ll be asked to repeat it. If you cannot, you’ll have to pass an audiometer test instead. 

You can find more about the FMCSA’s requirements through the
Federal Hearing Exemption Application.


Those with seizure disorders may be able to keep their license to drive commercial vehicles even if they cannot pass the DOT exam. However, doing so will be difficult and take time. The FMCSA requires proof that you have been seizure-free for at least eight years (either with or without medication). If you switch your treatment and go off medication, you will need to be seizure-free for eight years from that date. Additionally, the plan for your medications should be consistent for at least two years (meaning you don’t change your dose, frequency, or the medication itself during that time). 

For more details, read Federal Seizure Exemption Application at the FMCSA’s website.

Exemptions for Different Roles in the Trucking Industry

If you fail the DOT exam, your CDL may be downgraded to a standard license, which will limit your ability to drive large trucks. However, there are plenty of alternative routes that you can take to stay within the trucking industry, and different roles that may be better suited to you. 

Some of these opportunities could include, but are not limited to: 

  • Safety manager
  • Dispatcher
  • Freight broker
  • Sales person
  • Marketing manager
  • Administrator

Move Forward With Your Career With Pride

Whether you’re able to pass your DOT exam or need an exemption, getting your CDL opens up a world of opportunities. To find a role and start your career, check our open roles and drive with Pride.

pride transport driver smiling out of truck

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