What disqualifies you from a DOT physical? Blood pressure, sleep apnea, medications, vision and diabetes

How certificate length works

• The longest a medical card can last is 24 months. Examiners can issue shorter cards when a condition needs watching.^[3] Source: 49 CFR 391.45: Persons who must be medically examined and certified (opens in a new tab)
• Insulin-treated diabetes and the alternative vision standard both cap the card at 12 months.^[3] Source: 49 CFR 391.45: Persons who must be medically examined and certified (opens in a new tab)
• Every result, including "not qualified" and "determination pending," is reported to FMCSA. A pending exam gives you 45 days to get the examiner what they asked for.^[2] Source: 49 CFR 391.43: Medical examination; certificate of physical examination (opens in a new tab)

Blood pressure limits and card length

FMCSA's Medical Advisory Criteria (Appendix A to Part 391, Jan. 2024) and its hypertension FAQ give examiners these ranges. They're guidance, not law, and the examiner confirms an elevated reading with at least two more measurements.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)^[11] Source: Federal Register: Qualifications of Drivers; Medical Examiner's Handbook Regulatory Guidance (2024-01056) (opens in a new tab)

Sources: Appendix A to Part 391, section E^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab), and FMCSA hypertension FAQ^[9] Source: FMCSA: What is the effect on driver certification based on FMCSA hypertension stages? (opens in a new tab).

Sleep apnea

• There's no FMCSA sleep apnea rule. FMCSA says the regulations set no screening requirement, waiting period, maximum card length, required test or treatment, or compliance standard for obstructive sleep apnea.^[10] Source: FMCSA: Medical Examiner's Handbook, 2024 Edition (PDF) (opens in a new tab)
• Sleep apnea falls under the respiratory standard, which covers breathing problems likely to interfere with safe driving. If the examiner suspects untreated or under-treated apnea, they're advised to talk with your doctor or refer you to a specialist.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• FMCSA's 2024 handbook says treated moderate-to-severe sleep apnea doesn't stop you from being certified. Whether your treatment is working is the examiner's call.^[10] Source: FMCSA: Medical Examiner's Handbook, 2024 Edition (PDF) (opens in a new tab)
• For drivers diagnosed with moderate-to-severe sleep apnea, the handbook tells examiners to consider whether treatment has been shown to be adequate, effective, safe and stable. No federal rule sets a required CPAP hours-per-night figure.^[10] Source: FMCSA: Medical Examiner's Handbook, 2024 Edition (PDF) (opens in a new tab)

Medications (including ADHD meds, opioids and marijuana)

• Schedule I drugs disqualify you, period. They can't legally be prescribed, so an examiner can't qualify a driver who uses them.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• Marijuana: since April 28, 2026, DEA has listed marijuana in an FDA-approved product or under a state medical marijuana license in Schedule III. All other marijuana, including recreational use, is still Schedule I.^[12] Source: DEA: Rescheduling of FDA-Approved Products Containing Marijuana From Schedule I to Schedule III, 91 FR 22714 (Federal Register) (opens in a new tab)
• A state medical card isn't a prescription. DOT's drug-testing office says state-dispensed marijuana isn't an FDA-approved drug and "cannot be prescribed." A state card or doctor's recommendation doesn't explain away a positive DOT drug test.^[13] Source: DOT ODAPC: Part 40 Q&A on §§ 40.137, 40.141, 40.151 (marijuana) (opens in a new tab)
• FMCSA hasn't changed its examiner guidance. As of Oct. 23, 2026, it hasn't published new guidance on marijuana. Its 2024 handbook says a driver who uses marijuana can't be qualified, even where the state allows medical use.^[10] Source: FMCSA: Medical Examiner's Handbook, 2024 Edition (PDF) (opens in a new tab)
• DOT still tests for marijuana. DOT's drug-testing office also says marijuana use "is not compatible with safety-sensitive functions."^[13] Source: DOT ODAPC: Part 40 Q&A on §§ 40.137, 40.141, 40.151 (marijuana) (opens in a new tab)
• Schedule II–V drugs, like amphetamine-based ADHD meds (Adderall), opioids or benzodiazepines, aren't an automatic fail. The examiner may qualify you if the prescriber knows your medical history and has told you the drug won't affect safe driving.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• Examiners can ask the prescriber for that in writing. FMCSA's optional 391.41 CMV Driver Medication Form (MCSA-5895) is one way, used with your consent.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• The examiner can also order a non-DOT drug test as part of the exam.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• See our pages on the medication form and the optional prescription check.

Diabetes (insulin-treated and not)

• Non-insulin diabetes (diet, pills or non-insulin injectables) has no separate federal standard. The examiner looks at it as part of the overall exam.^[1] Source: 49 CFR 391.41: Physical qualifications for drivers (eCFR) (opens in a new tab)
• Insulin-treated diabetes is allowed under 49 CFR 391.46. Your treating clinician has to fill out the ITDM Assessment Form (MCSA-5870), and you see the examiner within 45 days after they sign it.^[4] Source: 49 CFR 391.46: Insulin-treated diabetes mellitus (opens in a new tab)
• You're not qualified if your insulin regimen isn't stable or your diabetes isn't controlled. Severe non-proliferative or proliferative diabetic retinopathy disqualifies you permanently.^[4] Source: 49 CFR 391.46: Insulin-treated diabetes mellitus (opens in a new tab)
• To get the full 12-month card, you need at least 3 months of electronic glucose-meter records. Without them, the card can't run past 3 months.^[4] Source: 49 CFR 391.46: Insulin-treated diabetes mellitus (opens in a new tab)
• A severe low after you're certified (one where you needed help, passed out, had a seizure or went into a coma) stops you from driving until your clinician clears you on a new MCSA-5870.^[4] Source: 49 CFR 391.46: Insulin-treated diabetes mellitus (opens in a new tab)
• More on the diabetes standard.

Vision and hearing

• Vision standard: at least 20/40 in each eye and both eyes together, with or without glasses or contacts. You also need at least 70° of horizontal field in each eye and must be able to tell red, green and amber signals apart.^[1] Source: 49 CFR 391.41: Physical qualifications for drivers (eCFR) (opens in a new tab)
• Alternative vision standard: if one eye doesn't meet the acuity or field standard, you may still qualify. An eye doctor fills out a Vision Evaluation Report (MCSA-5871) and you're examined at least once a year. First-timers usually need a road test.^[5] Source: 49 CFR 391.44: Alternative vision standard (opens in a new tab)
• Under the alternative standard you're still not qualified if your better eye misses 20/40 and 70°, you can't tell signal colors, or the vision problem isn't stable.^[5] Source: 49 CFR 391.44: Alternative vision standard (opens in a new tab)
• Hearing standard: you have to hear a forced whisper at 5 feet in your better ear, or average no worse than a 40-decibel loss on an audiometer, with or without a hearing aid.^[1] Source: 49 CFR 391.41: Physical qualifications for drivers (eCFR) (opens in a new tab)
• If you can't meet the hearing standard even with an aid, you can apply for an FMCSA hearing exemption.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• See our pages on the vision standard and the grandfathering provision.

Seizures and other conditions with exemptions

• Epilepsy or seizure disorder: under the 2024 criteria, the examiner may certify you if you've been off seizure medication and seizure-free for 10 years or more. If you're currently diagnosed or taking seizure meds to prevent seizures, you're not qualified.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• One unprovoked seizure that wasn't epilepsy: you may be certified after 5 years off medication and seizure-free. After one provoked seizure, like a drug reaction or dehydration, you may be certified once you've fully recovered with no lasting complications, you're off seizure medication, and another seizure or the trigger is unlikely.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• If the examiner isn't sure, they can refer you to FMCSA's federal seizure exemption program. See our page on epilepsy exemption applications.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• Heart: you're not qualified with a current diagnosis of heart disease that comes with fainting, shortness of breath, collapse or heart failure. Bypass surgery and pacemakers don't by themselves rule you out. An implanted defibrillator (ICD) is treated as likely to cause fainting or collapse.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• Missing or impaired limbs: an FMCSA Skill Performance Evaluation (SPE) certificate can qualify you.^[7] Source: 49 CFR 391.49: Alternative standards for loss or impairment of limbs (SPE) (opens in a new tab)
• Alcoholism: a current diagnosis disqualifies you. If it's in remission, the examiner may certify you.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• Mental health: conditions and medications are judged on whether they're likely to affect safe driving. The examiner looks at side effects too.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)

If you're not qualified: options

• A "not qualified" result is reported to FMCSA and voids any card you already had. You need a new exam before you can be certified again.^[2] Source: 49 CFR 391.43: Medical examination; certificate of physical examination (opens in a new tab)
• Fix the cause and re-test. The usual path is treatment, like bringing your blood pressure down or getting your seizure-free time, then a new exam with your records.
• Go through a special standard or exemption: ITDM (391.46), alternative vision (391.44), SPE for limbs (391.49), or FMCSA hearing and seizure exemptions.^[8] Source: Appendix A to Part 391: Medical Advisory Criteria (opens in a new tab)
• Formal disagreement: if your examiner and your carrier's examiner disagree, either side can ask FMCSA to decide under 49 CFR 391.47. That takes an impartial specialist's report, and you're treated as disqualified while FMCSA reviews it.^[6] Source: 49 CFR 391.47: Resolution of conflicts of medical evaluation (opens in a new tab)
• Our CDL medical card guide covers how the exam and electronic reporting work.