DOT Physical Disqualifying Conditions: Complete List for Medical Examiners

Knowing which conditions disqualify a commercial driver from certification is fundamental to performing DOT physicals and is heavily tested on the NRCME exam. This reference guide covers the major disqualifying conditions under FMCSA regulations.

Note: Some conditions are absolutely disqualifying, while others are conditionally disqualifying (the driver may be certified if specific criteria are met). Understanding this distinction is critical.

Vision Disqualifications

• Distant visual acuity worse than 20/40 in either eye (with or without correction)
• Field of vision less than 70 degrees in the horizontal meridian in either eye
• Inability to recognize traffic signal colors (red, green, amber)
• Exception: Monocular drivers may qualify through the Federal Vision Exemption Program

Hearing Disqualifications

• Cannot perceive a forced whispered voice at 5 feet (with or without hearing aid)
• Average hearing loss greater than 40 dB in the better ear at 500, 1000, and 2000 Hz
• Hearing aids are permitted for both tests

Cardiovascular Disqualifications

• Blood pressure at Stage 3 (180+ systolic or 110+ diastolic) — do not certify until controlled
• Recent myocardial infarction — waiting period required
• Unstable angina
• Heart failure with symptoms
• Implantable cardioverter-defibrillator (ICD) — generally disqualifying
• Aortic aneurysm exceeding size thresholds
• Recent cardiac surgery — waiting period required based on procedure

Neurological Disqualifications

• Epilepsy or seizure disorder — disqualifying unless seizure-free and off medication for 8+ years
• Any condition likely to cause loss of consciousness
• Recent stroke or TBI — requires evaluation of recovery and residual deficits
• Active brain tumor or intracranial pathology affecting function

Diabetes Disqualifications

• Insulin-treated diabetes without a Federal Diabetes Exemption or valid ITDM Assessment
• Uncontrolled diabetes with frequent hypoglycemic episodes
• Diabetes-related complications that impair driving ability (severe neuropathy, vision loss)
• Well-controlled non-insulin diabetes is generally not disqualifying

Respiratory Disqualifications

• Untreated or non-compliant obstructive sleep apnea with excessive daytime sleepiness
• Severe COPD or respiratory condition that interferes with safe driving
• Any respiratory condition causing oxygen desaturation that impairs function

Psychiatric and Substance Abuse Disqualifications

• Current clinical diagnosis of alcoholism — disqualifying
• Current use of a Schedule I controlled substance (e.g., marijuana, even if state-legal)
• Use of any substance that impairs driving ability
• Psychiatric condition (severe enough to interfere with safe driving)
• Certain psychiatric medications with sedating or impairing side effects

Musculoskeletal Disqualifications

• Loss of limb or limb impairment that prevents safe vehicle operation — may qualify with a Skill Performance Evaluation (SPE) certificate
• Insufficient muscle strength or range of motion to perform required driving tasks

Other Disqualifications

• Any condition that could interfere with the ability to safely operate a CMV — this is the catch-all provision that gives medical examiners discretion
• Use of methadone
• Certain anticoagulant medications (evaluated on a case-by-case basis)

Important Notes for the NRCME Exam

The exam frequently tests borderline cases where a condition might or might not be disqualifying based on specific details. Pay attention to the difference between “absolutely disqualifying” and “requires further evaluation.” Also remember that some disqualifications can be overcome through exemption programs (vision, diabetes) or SPE certificates (musculoskeletal).

Our NRCME practice tests includes scenarios across all these condition categories to help you practice making certification decisions.