DOT Physical Requirements 2025: What Medical Examiners Need to Know

As a certified medical examiner, understanding the DOT physical requirements is fundamental to performing accurate examinations and making correct certification decisions. This guide covers the key standards you need to know.

Vision Requirements

Commercial drivers must meet specific vision standards to be certified:

• Distant visual acuity: At least 20/40 in each eye, with or without corrective lenses
• Distant binocular acuity: At least 20/40 with both eyes together
• Field of vision: At least 70 degrees in the horizontal meridian in each eye
• Color vision: Must be able to recognize traffic signal colors (red, green, amber)

Drivers who have had LASIK, PRK, or other refractive surgery may be certified if they meet the acuity standards post-surgery. Monocular drivers may qualify through the Federal Vision Exemption Program.

Hearing Requirements

The hearing standard requires that drivers can perceive a forced whispered voice at a distance of 5 feet or more, with or without a hearing aid. Alternatively, the driver must pass an audiometric test showing:

• Adequate hearing in the better ear
• Testing at 500 Hz, 1000 Hz, and 2000 Hz frequencies
• Average hearing loss no greater than 40 dB in the better ear (with or without hearing aid)

Blood Pressure and Hypertension Standards

Blood pressure is one of the most heavily tested areas on the NRCME exam. The certification guidelines are:

• Stage 1 (140–159 / 90–99): Certify for 1 year maximum; annual recertification required
• Stage 2 (160–179 / 100–109): One-time certificate for up to 1 year; must be treated and return with BP below Stage 2 to be recertified
• Stage 3 (180+ / 110+): Disqualify; driver should not be certified until BP is under better control
• Below 140/90: Certify for up to 2 years

These thresholds and certification periods are critical to memorize for the NRCME exam.

Diabetes Standards

Drivers with diabetes have specific requirements depending on their treatment:

• Diet or oral medication controlled: May be certified if well-controlled, with annual certification recommended
• Insulin-treated diabetes mellitus (ITDM): Requires a Federal Diabetes Exemption or an Insulin-Treated Diabetes Mellitus Assessment Form. Drivers must demonstrate stable control and adequate self-monitoring.

The examiner must evaluate the risk of hypoglycemic episodes and whether the driver can safely operate a CMV while managing their condition.

Neurological Conditions

Seizure disorders are generally disqualifying. A driver with a history of epilepsy or seizures must be seizure-free and off anti-seizure medication for a specified period (typically 8 years for epilepsy) and have a neurologist’s clearance to be considered for certification.

Conditions like stroke, TBI, and brain tumors require individual assessment based on recovery status, residual deficits, and risk of recurrence.

Respiratory Conditions

Obstructive sleep apnea (OSA) is increasingly important in DOT physicals. While there is no mandatory screening protocol from FMCSA, examiners should assess risk factors including BMI, neck circumference, reported sleepiness, and witnessed apneas. Drivers diagnosed with OSA must demonstrate compliance with treatment (typically CPAP) to be certified.

Musculoskeletal Conditions

Drivers must have sufficient muscle strength and range of motion to safely operate a CMV. Limb loss or impairment may require a Skill Performance Evaluation (SPE) certificate from FMCSA, demonstrating the driver can safely perform all required driving tasks.

Certification Periods

Based on your examination findings, you may issue certificates for the following periods:

• 2 years: Healthy driver with no significant medical conditions
• 1 year: Driver with a condition requiring annual monitoring (e.g., Stage 1 hypertension, well-controlled diabetes)
• Less than 1 year: Temporary certification for drivers needing short-term follow-up
• Disqualify: Driver does not meet minimum standards

Master These Standards for the NRCME Exam

The DOT physical requirements form the core of the NRCME certification exam. Knowing these standards thoroughly—especially the specific numbers, thresholds, and certification periods—is essential for passing.

Our NRCME practice question bank includes questions covering all of these standards, helping you apply your knowledge in an exam-like format.