Evaluating Specific Conditions and Determining Qualification
Cardiovascular and hypertension
Look for disease likely to cause syncope, dyspnea, collapse, or congestive failure: recent myocardial infarction, unstable angina, significant arrhythmia, decompensated heart failure. An implantable cardioverter-defibrillator is generally disqualifying because of syncope risk; a pacemaker is evaluated for stability. Use FMCSA blood pressure stages, not newer cardiology thresholds: below 140/90 certify up to 24 months; stage 1 (140-159/90-99) one year; stage 2 (160-179/100-109) three months with recheck; stage 3 (180/110 or higher) not qualified, with a six-month certification possible after treatment if there is no end-organ damage.
Respiratory, neurologic, psychiatric, substance use
Untreated severe obstructive sleep apnea with daytime sleepiness interferes with driving; treated drivers are commonly certified for a year with adherence evidence. Epilepsy-two or more unprovoked seizures-is disqualifying; a single provoked seizure that resolves with treatment usually is not, and a single unprovoked seizure needs specialist evaluation. Stable psychiatric illness on non-sedating medication can be certified; current alcoholism is disqualifying, and a history requires documented recovery.
Endocrine, vision, hearing, musculoskeletal
Insulin-treated diabetes may be certified under 391.46 using the treating clinician's MCSA-5870 when severe hypoglycemia and unawareness are absent and self-monitoring is documented; certify for no more than 12 months. Non-insulin-treated diabetes is assessed for hypoglycemia risk and complications. Vision requires 20/40 each eye, a 70-degree field, and color recognition; failure in one eye requires a federal exemption. Hearing requires the whisper test or audiometric equivalent. Limb impairment is handled through an SPE certificate.
Worked example and traps
Blood pressure 166/102 is stage 2: issue a three-month certificate and require a recheck; 138/86 at recheck supports a one-year certificate. Traps: treating insulin as automatically disqualifying, using 130/80 as the threshold, or assuming a hearing aid disqualifies rather than creating a restriction.