Medical Prerequisites for an FHWA Waiver

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The American Diabetes Association has suggested a series of medical prerequisites for all commercial vehicle waiver applicants. The prerequisites are intended to ensure that people with diabetes who are issued waivers “will not be contrary to public interest and will be consistent with the safe operation of commercial vehicles.” The conditions, listed below, focus on applicants’ ability to prove they do not suffer from severe hypoglycemia, hypoglycemic unawareness, or retinopathy, and to demonstrate their willingness and capability to properly monitor and manage their disease.

Medical Prerequisites

1) Provide a board-certified or board-eligible endocrinologist with a complete medical history (including the date of commencing insulin use, all hospitalizations, consultation notes for diagnostic exams, special studies regarding diabetes, and follow-up reports), and reports of any hypoglycemic insulin reactions within the last three years.

2) Have received a complete medical exam from a board certified or board eligible endocrinologist after July, 29, 1993, including:

  • fasting blood studies and urinalysis within the last 6 months,
  • and insulin doses, diet, smoking and alcohol use, and other medications taken.

3) Submit a signed statement by the endocrinologist declaring that:

  • the endocrinologist is familiar with the applicant’s medical history during past three years,
  • the applicant has been using insulin for three years prior to the date of the application,
  • the applicant does not have severe hypoglycemia (defined as, “episodes of altered consciousness requiring the assistance of another person to regain control”),
  • the applicant does not have hypoglycemic unawareness (defined as, “the inability to recognize the early symptoms of hypoglycemia such as sweating, anxiety, forceful heartbeat and light-headedness”),
  • the applicant has not had an incident of hypoglycemia within the past three years that has resulted in any change in mental status deemed by the endocrinologist to have been detrimental to safe driving,
  • that the applicant’s diabetes will not adversely affect his or her ability to operate a CMV (Commercial Motor Vehicle),
  • that the applicant has been educated in diabetes and its management, understands the proper procedures necessary to manage his or diabetes and any complications that might arise,
  • and that the applicant has demonstrated the ability and willingness to properly monitor and manage his or her diabetes.

4) Submit a separate signed statement from an examining ophthalmologist that the applicant has been examined after July 29, 1993, and does not have unstable proliferative diabetic retinopathy, and has stable visual acuity (at least 20/40 vision) in each eye, with or without corrective lenses.

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