What can disqualify you from a DOT physical?

Rules checked against the eCFR and FMCSA guidance on November 11, 2026 · Not medical advice

Federal rules list 13 physical qualification standards in 49 CFR 391.41(b). Failing one doesn't always end your driving career: several have an alternative standard, a federal exemption program, or a shorter certificate while a condition is treated.

The 13 standards, in plain language

To be qualified, a driver must:^[1]

1. Have no loss of a foot, leg, hand or arm, unless granted a Skill Performance Evaluation (SPE) certificate.
2. Have no hand, finger, arm, foot or leg impairment that interferes with gripping or with the normal tasks of driving, unless granted an SPE certificate.
3. Have no insulin-treated diabetes, unless the driver meets the separate insulin standard in 391.46.
4. Have no current diagnosis of heart attack, angina, coronary insufficiency, thrombosis, or other heart disease known to cause fainting, shortness of breath, collapse or heart failure.
5. Have no breathing (respiratory) disorder likely to interfere with safe driving.
6. Have no current diagnosis of high blood pressure likely to interfere with safe driving. See blood pressure rules.
7. Have no rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease that interferes with safe driving.
8. Have no history or diagnosis of epilepsy or any other condition likely to cause loss of consciousness or loss of control.
9. Have no mental, nervous, organic or psychiatric disorder likely to interfere with safe driving.
10. Meet the vision standard, or the alternative vision standard. See vision and hearing.
11. Meet the hearing standard.
12. Not use Schedule I drugs, amphetamines, narcotics or other habit-forming drugs; other controlled substances only if prescribed by a doctor who knows your history and has advised you they won't affect safe driving.
13. Have no current clinical diagnosis of alcoholism.

Many of these say "likely to interfere." That's a judgment call the certified medical examiner makes, using FMCSA guidance. FMCSA's guidance is advisory, not binding, so two examiners can reach different conclusions on borderline cases.^[2]

Paths if you don't meet a standard

• Vision in one eye: the alternative vision standard in 391.44, with an eye-doctor evaluation and a yearly exam.^[3]
• Insulin-treated diabetes: the 391.46 standard, with Form MCSA-5870 from your treating clinician and a yearly exam.^[4]
• Missing or impaired limbs: a Skill Performance Evaluation certificate under 391.49.^[5]
• Hearing or seizures: FMCSA runs exemption programs for drivers who don't meet those two standards. They apply to interstate driving only, and FMCSA says it decides within 180 days of a complete application.^[6]
• Treatable conditions like high blood pressure: the examiner can issue a shorter certificate, or hold the decision for up to 45 days while you get more records or tests.^[7]

Sources

1. 49 CFR 391.41, Physical qualifications for drivers (eCFR)
2. FMCSA Medical Examiner's Handbook, 2024 edition (PDF)
3. 49 CFR 391.44, Alternative vision standard (eCFR)
4. 49 CFR 391.46, Insulin-treated diabetes (eCFR)
5. 49 CFR 391.49, Alternative physical qualification standards for loss or impairment of limbs (eCFR)
6. FMCSA, Driver Exemptions (hearing and seizure)
7. 49 CFR 391.43, Medical examination (eCFR)

This guide summarizes federal rules for interstate commercial drivers. It isn't medical or legal advice, and your medical examiner makes the final decision. Disclaimer.