Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders |
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William Bronrott
Federal Motor Carrier Safety Administration
January 15, 2013
[Federal Register Volume 78, Number 10 (Tuesday, January 15, 2013)]
[Notices]
[Pages 3069-3077]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-00709]
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DEPARTMENT OF TRANSPORTATION
Federal Motor Carrier Safety Administration
[Docket No. FMCSA-2006-24278, FMCSA-2006-25854, FMCSA-2008-0355, FMCSA
2010-0203, FMCSA-2011-0089]
Qualification of Drivers; Exemption Applications; Epilepsy and
Seizure Disorders
AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.
ACTION: Notice of final disposition.
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SUMMARY: FMCSA announces its decision to grant requests from 22
individuals for exemptions from the regulatory requirement that
interstate commercial motor vehicle (CMV) drivers have ``no established
medical history or clinical diagnosis of epilepsy or any other
condition which is likely to cause loss of consciousness or any loss of
ability to control a CMV.'' The regulation and the associated advisory
criteria published in the Code of Federal Regulations as the
``Instructions for Performing and Recording Physical Examinations''
have resulted in numerous drivers being prohibited from operating CMVs
in interstate commerce based on the fact that they have had one or more
seizures and are taking anti-seizure medication, rather than an
individual analysis of their circumstances by a qualified medical
examiner. The Agency concluded that granting exemptions for these CMV
drivers will provide a level of safety that is equivalent to or greater
than the level of safety maintained without the exemptions. FMCSA
grants exemptions that will allow these 22 individuals to operate CMVs
in interstate commerce for a 2-year period. The exemptions preempt
State laws and regulations and may be renewed.
DATES: The exemptions are effective January 15, 2013. The exemptions
expire on January 15, 2015.
FOR FURTHER INFORMATION CONTACT: Elaine M. Papp, Division Chief,
Physical Qualifications, Office of Medical Programs, (202) 366-4001,
fmcsamedical@dot.gov, FMCSA, Department of Transportation, 1200 New
Jersey Avenue SE., Room W64-224, Washington, DC 20590-0001. Office
hours are 8:30 a.m. to 5 p.m., e.t., Monday through Friday, except
Federal holidays.
SUPPLEMENTARY INFORMATION:
A. Electronic Access
You may see all the comments online through the Federal Document
Management System (FDMS) at: http://www.regulations.gov.
Docket: For access to the docket to read background documents or
comments, go to http://www.regulations.gov and/or Room W12-140 on the
ground level of the West Building, 1200 New Jersey Avenue, SE.,
Washington, DC, between 9 a.m. and 5 p.m., e.t., Monday through Friday,
except Federal holidays.
Privacy Act: Anyone may search the electronic form of all comments
received into any of DOT's dockets by the name of the individual
submitting the comment (or of the person signing the comment, if
submitted on behalf of an association, business, labor union, or other
entity). You may review DOT's complete Privacy Act Statement in the
Federal Register (73 FR 3316, January 17, 2008). This statement is also
available at http://Docketinfo.dot.gov.
B. Background
Under 49 U.S.C. 31136(e) and 31315, FMCSA may grant an exemption
from the safety regulations for a 2-year period if it finds ``such
exemption would likely achieve a level of safety that is equivalent to,
or greater than, the level that would be achieved absent such
exemption''. The statute also allows the Agency to renew exemptions at
the end of the 2-year period.
FMCSA grants 22 individuals an exemption from the regulatory
requirement in Sec. 391.41(b)(8) allowing individuals who take anti-
seizure medication to operate CMVs in interstate commerce for a 2-year
period. The Agency's decision on these exemption applications is based
on an individualized assessment of each applicant's medical
information, including the root cause of the respective seizure(s); the
length of time elapsed since the individual's last seizure; and each
individual's treatment regimen. In addition, the Agency reviewed the
applicant's driving record found in the CDLIS,\1\ for CDL holders, and
interstate and intrastate inspections recorderd in MCMIS.\2\ The Agency
acknowledges the potential consequences of a driver experiencing a
seizure while operating a CMV. However, the Agency believes the drivers
covered by the exemptions have demonstrated that they are unlikely to
have a seizure and their medical condition does not pose a risk to
public safety.
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\1\ Commercial Driver License Information System (CDLIS) is an
information system that allows the exchange of commercial driver
licensing information among all the States. CDLIS includes the
databases of fifty-one licensing jurisdictions and the CDLIS Central
Site, all connected by a telecommunications network.
\2\ Motor Carrier Management Information System (MCMIS) is an
information system that captures data from field offices through
SAFETYNET, CAPRI, and other sources. It is a source for FMCSA
inspection, crash, compliance review, safety audit, and registration
data.
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In reaching the decision to grant these exemption requests, the
Agency considered both current medical literature and information and
the 2007 recommendations of the Agency's Medical Expert Panel (MEP).
The Agency previously gathered evidence for potential changes to the
regulation by conducting a comprehensive review of scientific
literature that was compiled into the ``Evidence Report on Seizure
Disorders and Commercial Vehicle Driving'' (Evidence Report) [CD-ROM HD
TL230.3 .E95 2007]. The Agency then convened a panel of medical experts
in the field of neurology (MEP) on May 14-15, 2007, to review 49 CFR
391.41(b)(8) and the advisory criteria regarding individuals who have
experienced a seizure, and the 2007 Evidence Report. The Evidence
Report and the MEP recommendations are published on-line at http://www.fmcsa.dot.gov/rules-regulations/topics/mep/mep-reports.htm, under
Seizure Disorders, and are in the docket for this notice.
[[Page 3070]]
MEP Criteria for Evaluation
On October 15, 2007, the MEP issued the following recommended
criteria for evaluating whether an individual with epilepsy or a
seizure disorder should be allowed to operate a CMV.\3\ The MEP
recommendations are included in an appendix at the end of this notice
and in each of the previously published dockets.
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\3\ Engel, J., Fisher, R.S., Krauss, G.L., Krumholz, A., and
Quigg, M.S., ``Expert Panel Recommendations: Seizure Disorders and
Commercial Motor Vehicle Driver Safety,'' FMCSA, October 15, 2007.
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Epilepsy diagnosis. If there is an epilepsy diagnosis, the
applicant should be seizure-free for 8 years, on or off medication. If
the individual is taking anti-seizure medication(s), the plan for
medication should be stable for 2 years. Stable means no changes in
medication, dosage, or frequency of medication administration.
Recertification for drivers with an epilepsy diagnosis should be
performed every year.
Single unprovoked seizure. If there is a single unprovoked seizure
(i.e., there is no known trigger for the seizure), the individual
should be seizure-free for 4 years, on or off medication. If the
individual is taking anti-seizure medication(s), the plan for
medication should be stable for 2 years. Recertification for drivers
with a single unprovoked seizure should be performed every 2 years.
Single provoked seizure. If there is a single provoked seizure
(i.e., there is a known reason for the seizure), the Agency should
consider specific criteria that fall into the following two categories:
low-risk factors for recurrence and moderate-to-high risk factors for
recurrence.
Examples of low-risk factors for recurrence include
seizures that were caused by a medication; by non-penetrating head
injury with loss of consciousness less than or equal to 30 minutes; by
a brief loss of consciousness not likely to recur while driving; by
metabolic derangement not likely to recur; and by alcohol or illicit
drug withdrawal.
Examples of moderate-to-high-risk factors for recurrence
include seizures caused by non-penetrating head injury with loss of
consciousness or amnesia greater than 30 minutes, or penetrating head
injury; intracerebral hemorrhage associated with a stroke or trama;
infections; intracranial hemorrhage; post-operative complications from
brain surgery with significant brain hemorrhage; brain tumor; or
stroke.
The MEP report indicates individuals with moderate to high-risk
conditions should not be certified. Drivers with a history of a single
provoked seizure with low risk factors for recurrence should be
recertified every year.
Medical Review Board Recommendations and Agency Decision
FMCSA presented the MEP's findings and the Evidence Report to the
Medical Review Board (MRB) for consideration. The MRB reviewed and
considered the 2007 ``Seizure Disorders and Commercial Driver Safety''
evidence report and the 2007 MEP recommendations. The MRB recommended
maintaining the current advisory criteria, which provide that ``drivers
with a history of epilepsy/seizures off anti-seizure medication and
seizure-free for 10 years may be qualified to drive a CMV in interstate
commerce. Interstate drivers with a history of a single unprovoked
seizure may be qualified to drive a CMV in interstate commerce if
seizure-free and off antiseizure medication for a 5 year period or
more'' [Advisory criteria to 49 CFR 391.43(f)].
The Agency acknowledges the MRB's position on the issue but
believes relevant current medical evidence supports a less conservative
approach. The medical advisory criteria for epilepsy and other seizure
or loss of consciousness episodes was based on the 1988 ``Conference on
Neurological Disorders and Commercial Drivers'' (NITS Accession No.
PB89-158950/AS). A copy of the report can be found in the docket
referenced in this notice.
The MRB's recommendation treats all drivers who have experienced a
seizure the same, regardless of individual medical conditions and
circumstances. In addition, the recommendation to continue prohibiting
drivers who are taking anti-seizure medication from operating a CMV in
interstate commerce does not consider a driver's actual seizure history
and time since the last seizure. The Agency has decided to use the 2007
MEP recommendations as the basis for evaluating applications for an
exemption from the seizure regulation on an individual, case-by-case
basis.
C. Exemptions
Following individualized assessments of the exemption applications,
including a review of detailed follow-up information requested from
each applicant, FMCSA is granting exemptions from 49 CFR 391.41(b)(8)
to 22 individuals. Under current FMCSA regulations, all of the 22
drivers receiving exemptions from 49 CFR 391.41(b)(8) would have been
considered physically qualified to drive a CMV in interstate commerce
except that they presently take or have recently stopped taking anti-
seizure medication. Twenty of the twenty-two drivers receiving an
exemption currently take anti-seizure medication. For these 22 drivers,
the primary obstacle to medical qualification was the FMCSA Advisory
Criteria for Medical Examiners, based on the 1988 ``Conference on
Neurological Disorders and Commercial Drivers,'' stating that a driver
should be off anti-seizure medication in order to drive in interstate
commerce. In fact, the Advisory Criterion has little if anything to do
with the actual risk of a seizure and more to do with assumptions about
individuals who are taking anti-seizure medication.
Of the 22 drivers being granted an exemption, only two individuals
have an actual diagnosis of epilepsy. In each of these cases, the
treating physician's rationale in diagnosing epilepsy is unclear, as
the individual experienced only a single seizure. The two drivers
diagnosed with epilepsy both have been seizure-free for more than 21
years. Of the other twenty drivers, 5 have been seizure-free for more
than 20 years and 15 for more than 4 years. Seven of the total 20
drivers have had one provoked or unprovoked seizure from a head injury,
a medical procedure, or other known cause.
In addition to evaluating the medical status of each applicant,
FMCSA evaluated the crash and violation data for the 22 drivers, some
of whom currently drive a CMV in intrastate commerce. The Commercial
Drivers License Information System (CDLIS) and the FMCSA Motor Carrier
Management Information System (MCMIS) were searched for crash and
violation data on the 22 applicants. The CDLIS and MCMIS systems had
records on 13 of the applicants. The crash and violation history on
each individual driver is listed in his or her biographical profile.
These exemptions are contingent on the driver maintaining a stable
treatment regimen and remaining seizure-free during the 2-year
exemption period. The exempted drivers must submit annual reports from
their treating physicians attesting to the stability of treatment and
that the driver has remained seizure-free. The driver must undergo an
annual medical examination by a medical examiner, as defined by 49 CFR
390.5, following the FCMSA's regulations for the physical
qualifications for commercial motor vehicle drivers.
FMCSA published a notice of receipt of application and requested
public comment during a 30 day public comment period in a Federal
Register
[[Page 3071]]
notice for each of the applicants. A short summary of the applicants'
qualifications follows. A discussion of the comments received follows
in section D. Comments. For those applicants who were denied an
exemption, a notice will be published at a later date.
Docket FMCSA-2006-24278
On October 13, 2006, FMCSA published a notice of receipt of
exemption applications and requested public comment on four individuals
(71 FR 60606; Docket number FMCSA-2006-24278). The comment period ended
on November 13, 2006. Eight commenters responded to the Federal
Register notice. A discussion of the comments is presented later in
this document. FMCSA has determined that Wayne C. Sorenson, one of the
applicants, should be granted an exemption. The Agency will issue a
decision on the other drivers at a later date.
Wayne C. Sorenson. Mr. Sorenson is an intrastate CMV driver in
Minnesota. Mr. Sorenson should be granted an exemption because he meets
the MEP criteria of having no diagnosis of epilepsy, no seizures for
the last 4 years, and being on a stable medication regimen for longer
than 2 years. He first experienced seizures 17 years ago while
sleeping, which were the result of an adverse reaction to medication.
He has remained on a stable anti-seizure medication plan and has not
had a seizure in 16 years. Mr. Sorenson states that he has no other
diagnosed conditions, physical or psychological impairment, and no
history of strength, sensory, or coordination impairment that would
interfere with safe driving. Mr. Sorenson believes that he would
achieve a level of safety that is equivalent to the level of safety
obtained by complying with the regulation because he has remained
seizure-free for 16 years. Mr. Sorenson's driving record indicates an
administrative loss of privileges for a period of 45 days in the state
of Minnesota during 1994. He has no entries in MCMIS.
Docket FMCSA-2006-25854
On August 9, 2007, FMCSA published a notice of receipt of exemption
applications and requested public comments on nine individuals (72 FR
44916; Docket number FMCSA-2006-24854). The comment period ended on
September 10, 2007. Five comments were received. A discussion of the
comments is presented later in this document. Of the nine applicants,
FMCSA determined that the following four individuals should be granted
an exemption. The Agency will issue a decision on the other drivers at
a later date.
David L. Basso. Mr. Basso is an intrastate CMV driver in Ohio who
delivers to local grocery and convenience stores. Mr. Basso should be
granted an exemption because he meets the MEP criteria of having a
diagnosis of epilepsy, no seizures for the last 8 years, and being on a
stable medication regimen for longer than 2 years. He states that he
has a clinical diagnosis of epilepsy. His doctor certified that he has
been seizure-free since 1990 on his current dose of medication. Mr.
Basso believes that he would achieve a level of safety that is
equivalent to the level of safety obtained by complying with the
regulation because he has remained seizure-free since 1990. He has no
entries in CDLIS or MCMIS.
Dorothy Pokornowski. Ms. Pokornowski is an intrastate CMV driver in
Minnesota. Ms. Pokornowski should be granted an exemption because she
meets the MEP criteria of having a diagnosis of epilepsy, no seizures
for the last 8 years, and being on a stable medication regimen for
longer than 2 years. She was diagnosed with epilepsy at age 22. Her
doctor certified that she has been stable, with no seizure activity on
medication, since 1985. Her doctor stated that her anti-seizure
medication was changed in 2006 due to concerns about certain adverse
side effects. Ms. Pokornowski has seizure-free driving experience for
the past 26 years. FMCSA believes that she would reach a level of
safety that is equivalent to the level of safety obtained by complying
with the regulation because she continues to take her medication as
directed by her doctor and gets her blood levels checked every year.
She has one listing in CDLIS for a seat belt infraction not involving a
CMV in 1997 and one possible injury crash, non-CMV in 2010. She has no
entries in MCMIS.
Brian J. Porter. Mr. Porter is an intrastate CMV driver in
Pennsylvania. Mr. Porter should be granted an exemption because he
meets the MEP criteria of having no diagnosis of epilepsy, no seizures
for the last 4 years, and being on a stable medication regimen for
longer than 2 years. Mr. Porter states that he has been driving on the
east coast for approximately 14 years. His neurologist states that he
had a history of seizures but has not had any in the past 25 years. He
is currently taking anti-seizure medication. Mr. Porter believes that
he would achieve a level of safety that is equivalent to the level of
safety obtained by complying with the regulation because he has
remained seizure-free for 25 years. Mr. Porter's CDLIS record indicates
that he has 3 speeding violations (1999, all non-CMV) and 2 erratic
(unsafe) lane changes (1982, 2005), both non-CMV. He has an illegal
possession of alcohol, non-CMV, in 1989. He has no entries in MCMIS.
Michael W. Thomas. Mr. Thomas is an intrastate CMV driver in
Kansas. Mr. Thomas should be granted an exemption because he meets the
MEP criteria of having no diagnosis of epilepsy, no seizures for the
last 4 years, and being on a stable medication regimen for longer than
2 years. He was diagnosed with a seizure disorder in 1987. His doctor
certified he has been seizure-free for over 20 years. He is currently
taking an anti-seizure medication. His doctor certified that he is
compliant with his treatment and can safely operate any CMV he is
qualified to drive. Mr. Thomas has a state waiver from Kansas, and has
been crash-free throughout his 12 year commercial driving career. Mr.
Thomas believes that he would achieve a level of safety that is
equivalent to the level of safety obtained by complying with the
regulation because he has remained seizure-free for over 20 years
through stringent medical compliance using the same medication and
dosage. He has no entries in CDLIS or MCMIS.
Docket FMCSA-2008-0355
On December 10, 2008, FMCSA published a notice of receipt of
exemption applications and requested public comment on 15 individuals
(73 FR 75165; Docket number FMCSA-2008-0355). The comment period ended
on January 9, 2009. FMCSA received five comments. A discussion of the
comments is presented later in this document. Of the 15 applicants,
FMCSA determined that the following six individuals should be granted
an exemption. The Agency will issue a decision on the other drivers at
a later date.
Daniel Forth. Mr. Forth is an intrastate CMV driver in New York.
Mr. Forth should be granted an exemption because he meets the MEP
criteria of having no diagnosis of epilepsy, no seizures for the last 4
years, and being on a stable medication regimen for longer than 2
years. He was diagnosed with a seizure disorder in 1979, and is
currently taking an anti-seizure medication. His doctor certified that
he has been seizure-free for 31 years on his current dose of
medication. Mr. Forth believes that he would achieve a level of safety
that is equivalent to the level of safety obtained by complying with
the regulation because he has maintained medication control and has
[[Page 3072]]
remained seizure-free for 31 years. His CDLIS record indicates a
signaling violation in 1992 (vehicle unknown) and a possible injury
crash (vehicle unknown) in 1991. He has no entries in MCMIS. The Agency
would like to publish a correction to the 2008 notice. Mr. Forth was
published as having been seizure-free for 27 years with his current
dose of medications; however, he has maintained good medication control
and been seizure-free for 31 years.
Garry A. Gantle. Mr. Gantle is an intrastate CMV driver in Florida.
Mr. Gantle should be granted an exemption because he meets the MEP
criteria of having no diagnosis of epilepsy, no seizures for the last 4
years, and being on a stable medication regimen for longer than 2
years. He was diagnosed with a seizure disorder due to a head injury,
not epilepsy, in 1980. He had two seizures in 2000, related to another
medical condition, not epilepsy. In 2006, his anti-seizure medication
was changed. His neurologist certified that his seizure disorder is
well controlled. Mr. Gantle believes that he would achieve a level of
safety that is equivalent to the level of safety obtained by complying
with the regulation because he has remained seizure-free on anti-
seizure medication for 11 years. He has no entries in CDLIS or MCMIS.
Steve L. Hunsaker. Mr. Hunsaker is an intrastate CMV driver in
Idaho. Mr. Hunsaker should be granted an exemption because he meets the
MEP criteria of having a diagnosis of nocturnal seizures, no seizures
for the last 4 years, and being on a stable medication regimen for
longer than 2 years. He has a history of nocturnal seizures and is
currently taking an anti-seizure medication. His doctor certified that
he has been seizure-free for 22 years on his current dose of
medication. Mr. Hunsaker believes that he would achieve a level of
safety that is equivalent to the level of safety obtained by complying
with the regulation because he has maintained good medication control
and has remained seizure-free for 22 years. He has no entries in CDLIS
or MCMIS.
Shane Klementis. Mr. Klementis is an intrastate CMV driver in New
York. Mr. Klementis should be granted an exemption because he meets the
MEP criteria of having no diagnosis of epilepsy, no seizures for the
last 4 years, and being on stable medication for longer than 2 years.
He was diagnosed with a seizure in 1982 and is currently taking an
anti-seizure medication. His neurologist certified that his seizure
disorder is well controlled. Mr. Klementis believes that he would
achieve a level of safety that is equivalent to the level of safety
obtained by complying with the regulation because he has remained
seizure-free on anti-seizure medication for 21 years. His MCMIS record
lists one inspection infraction in 2009. He has no entries in CDLIS.
Scott M. Rohlinger. Mr. Rohlinger is an intrastate driver in
Wisconsin. Mr. Rohlinger should be granted an exemption because he
meets the MEP criteria of having no diagnosis of epilepsy, no seizures
for the last 4 years, and has been off medication for 4 years. He was
diagnosed with seizure disorder in 1987 and took anti-seizure
medication for 20 years. He discontinued his medication in 2007. Mr.
Rohlinger was involved in a motor vehicle crash that was linked to a
possible seizure episode 24 years ago. His doctor certified that there
were no seizure experiences prior to or following the event. Mr.
Rohlinger believes that he would achieve a level of safety that is
equivalent to the level of safety obtained by complying with the
regulation because he has remained seizure-free for 24 years. His
doctor certified that he may never have experienced a seizure. His
CDLIS record lists one property damage crash in 2007 (non-CMV). He has
no entries in MCMIS.
John B. Yates. Mr. Yates is an intrastate CMV driver in West
Virginia. Mr. Yates should be granted an exemption because he meets the
MEP criteria of having no diagnosis of epilepsy, no seizures for the
last 4 years, and being on stable medication for longer than 2 years.
He has a history of seizures, diagnosed in 1976, and is currently
taking an anti-seizure medication. According to his neurologist, his
last seizure was in 1982. Mr. Yates believes that he would achieve a
level of safety that is equivalent to the level of safety obtained by
complying with the regulation because he has not had a seizure in 29
years while on medication. His CDLIS record indicates 2 charges of
negligent driving not involving a CMV (1990, 1985) and one speeding
violation in 1988 (non-CMV). He has no entries in MCMIS.
Docket FMCSA-2010-0203
On July 2, 2010, FMCSA published a notice of receipt of exemption
applications and requested comments from the public on 17 individuals
(75 FR 38599; Docket number FMCSA-2010-0203). The comment period ended
on August 2, 2010. FMCSA received 6 comments. A discussion of the
comments is presented later in this document. Of the 17 applicants,
FMCSA determined that the following eight individuals should be granted
an exemption. The Agency will issue a decision on the other drivers at
a later date.
Bruce B. Baum. Mr. Baum is an intrastate CMV driver in New Mexico.
Mr. Baum should be granted an exemption because he meets the MEP
criteria of having no diagnosis of epilepsy, no seizures for the last 4
years, and being on a stable medication regimen for longer than 2
years. He experienced a single episode of a seizure in 1999 and is
currently taking an anti-seizure medication. His neurologist states
that he has been seizure-free since 2002. Mr. Baum believes that he
would achieve a level of safety that is equivalent to the level of
safety obtained by complying with the regulation because he has
remained seizure-free and compliant on medication for 7 years. He has
no entries in CDLIS or MCMIS.
Todd A. Davis. Mr. Davis is an intrastate CMV driver in Wisconsin.
Mr. Davis should be granted an exemption because he meets the MEP
criteria of having no diagnosis of epilepsy, no seizures for the last 4
years, and being on a stable medication regimen for longer than 2
years. He experienced a complex partial seizure in 2007 and is
currently taking an anti-seizure medication. His neurologist certified
that Mr. Davis has been seizure free for 4 years. Mr. Davis believes
that he would achieve a level of safety that is equivalent to the level
of safety obtained by complying with the regulation because he has
remained seizure-free and compliant with medication since 2007. He has
one 2010 CDLIS violation involving a non-injury crash with non-CMV
operation indicated. He has no entries in MCMIS.
James Dyer. Mr. Dyer is an intrastate CMV driver in Texas. Mr. Dyer
should be granted an exemption because he meets the MEP criteria of
having no diagnosis of epilepsy, no seizures for the last 4 years, and
being on no anti-seizure medication regimen for longer than 2 years. He
experienced a single seizure-like event in 2008. He has been off
medication for 3 years. His neurologist certified that Mr. Dyer has
been seizure-free for 4 years. Mr. Dyer believes that he would achieve
a level of safety that is equivalent to the level of safety obtained by
complying with the regulation because he has remained seizure-free
since 2008. He has no entries in CDLIS or MCMIS.
Christian E. Henry. Mr. Henry is an intrastate CMV driver in
Pennsylvania. Mr. Henry should be granted an exemption because he meets
the MEP criteria of having no diagnosis of
[[Page 3073]]
epilepsy, no seizures for the last 4 years, and being on a stable
medication regimen for longer than 2 years. He has a history of
seizures during medical procedures when he was a juvenile. His doctor
states that he has been seizure-free for 13-plus years on his current
dose of medication and is stable to drive. Mr. Henry believes that he
would achieve a level of safety that is equivalent to the level of
safety obtained by complying with the regulation because he has
remained seizure-free since 1998, has a safe driving record, and he is
compliant with his medication. He has no entries in CDLIS or MCMIS.
Henrietta M. Ketcham. Ms. Ketcham is an intrastate CMV driver in
New York. Ms. Ketcham should be granted an exemption because she meets
the MEP criteria of not having a diagnosis of epilepsy, no seizures for
the last 4 years, and being on a stable medication regimen for longer
than 2 years. She has a history of seizure disorder dating to 1992. She
experienced her last seizure in 2001 and is currently taking an anti-
seizure medication. Her doctor states that she has been seizure-free
for 10 years on her current dose of medication and remains stable. Ms.
Ketcham believes that she would achieve a level of safety that is
equivalent to the level of safety obtained by complying with the
regulation because she has maintained good medication control and has
remained seizure-free for 10 years. During 1990, she had one violation
listed in CDLIS for failing to obey a traffic control device (non-CMV)
and two possible injury crashes (vehicle unknown). She has no entries
in MCMIS.
Joseph A. Suhy. Mr. Suhy is an intrastate CMV driver in
Pennsylvania. Mr. Suhy should be granted an exemption because he meets
the MEP criteria of not having a diagnosis of epilepsy, no seizures for
the last 4 years, and being on a stable medication regimen for longer
than 2 years. He was diagnosed with a seizure disorder after a head
injury in 1986. His last seizure was in 1991 and at the time he was on
an anti-seizure medication. His anti-seizure medication was changed in
1991. He remains on this medication to date. His doctor states that he
has been seizure-free for 20 years. Mr. Suhy believes that he would
achieve a level of safety that is equivalent to the level of safety
obtained by complying with the regulation because he has remained
seizure-free and is compliant with treatment. He has no entries in
CDLIS or MCMIS.
Paul C. Warren. Mr. Warren is an intrastate CMV driver in Maine.
Mr. Warren should be granted an exemption because he meets the MEP
criteria of not having a diagnosis of epilepsy, no seizures for the
last 4 years, and being on a stable medication regimen for longer than
2 years. He was originally diagnosed with epilepsy in 2000. He
experienced his last seizure in 2002 and is currently taking an anti-
seizure medication. His neurologist states that he has been seizure-
free for 9 years and is compliant with treatment. Mr. Warren believes
that he would achieve a level of safety that is equivalent to the level
of safety obtained by complying with the regulation because he has a
history of safe driving in CMVs and has remained seizure-free for 9
years.
The Agency would like to publish a correction to the July 2, 2010,
notice. Mr. Warren was described as having been diagnosed with
epilepsy. His actual diagnosis is one of partial complex seizures and
he qualifies for an exemption based on having the seizure-free period
of 4 years recommended by the MEP. He has no entries in CDLIS or MCMIS.
Brian H. Wetzel. Mr. Wetzel is an intrastate CMV driver in
Missouri. Mr. Wetzel should be granted an exemption because he meets
the MEP criteria of not having a diagnosis of epilepsy, no seizures for
the last 4 years, and being on a stable medication regimen for longer
than 2 years. He was diagnosed with a seizure disorder after brain
surgery in 1976. He experienced his last seizure in 1995 and is
currently taking an anti-seizure medication. His neurologist's medical
opinion is that he has been seizure-free for 16 years and is safe to
drive. Mr. Wetzel believes that he would achieve a level of safety that
is equivalent to the level of safety obtained by complying with the
regulation because he has been seizure free for 16 years and is
compliant with treatment. He has no entries in CDLIS or MCMIS.
Docket FMCSA-2011-0089
On April 5, 2011, FMCSA published a notice of receipt of exemption
applications from 8 individuals, and requested comments from the public
(76 FR18822). The comment period ended on May 5, 2011. FMCSA received
two comments. A discussion of the comments is presented later in this
document. Of the 8 applicants published, the following 3 individuals
are being granted an exemption. The Agency will issue a decision on the
other drivers at a later date.
Donald Schutz. Mr. Schutz is an intrastate CMV driver in Ohio. Mr.
Schutz should be granted an exemption since he meets the MEP criteria
and would achieve a level of safety that is equivalent to the level of
safety obtained by complying with the regulation. He has remained
seizure-free for 9 years and has been on anti-seizure medication since
2002. He states that he was diagnosed with a brain tumor in 2002 and
that he suffered a seizure due to a tumor in July of that year. He had
brain surgery in November 2002 and the tumor was successfully removed.
Mr. Schutz has been taking anti-seizure medication since that time and
has had no further seizures. He has his medication levels checked often
by blood tests and remains compliant with his regimen. Mr. Schultz's
CDLIS report shows a non-CMV inability-to-control violation in 2002. He
has no entries in MCMIS.
Robin L. Sherwood. Mr. Sherwood is an intrastate CMV driver in
Idaho. Mr. Sherwood should be granted an exemption. He would achieve a
level of safety that is equivalent to the level of safety obtained by
complying with the regulation. He has remained seizure-free since 1997
and is compliant with his medication regimen for seizures. He states
that he had a seizure caused by a brain tumor in 1997 and that the
tumor was successfully removed during the same year. Mr. Sherwood has
taken anti-seizure medication since 1997 with no further seizure
activity. His doctor supports Mr. Sherwood's application for exemption
because of his successful surgery and medication compliance. His CDLIS
report states that he has a non-CMV speeding violation in 1991. He has
no entries in MCMIS.
Frank Eveland. Mr. Eveland is an intrastate CMV driver in
Wisconsin. Mr. Eveland should be granted an exemption. He meets the MEP
criteria and has remained seizure-free for 8 years. He has been on
anti-seizure medication since 2003. He was diagnosed with one
unprovoked seizure in 2003 and placed on anti-seizure medication at
that time. His physician states that Mr. Eveland has had no further
seizures and that his medication level is checked regularly by blood
tests. The doctor states that Mr. Eveland is safe to operate a motor
vehicle and that he is compliant with his medication. Mr. Eveland
believes he would achieve a level of safety that is equivalent to the
level of safety obtained by complying with the regulation because he
has maintained good medication control and has remained seizure-free
for 8 years. Mr. Eveland's CDLIS report states that he has a property
damage/non-injury crash in 2011, a non-CMV violation. He has no entries
in MCMIS.
[[Page 3074]]
D. Comments
In response to the five notices, FMCSA received 26 different
comments. Comments that relate specifically to applicants other than
the ones covered in this notice will be addressed in a subsequent
notice of denial of application.
Individual Assessment of Applicants for Exemption
On behalf of the Epilepsy Foundation, Brien J. Smith, MD, urged the
establishment of a thorough science-based process in reviewing
exemption requests, including consideration of each individual's level
of risk to public safety (FMCSA-2004-24278-0012). The Epilepsy
Foundation expressed concern that the current standard creates a
``blanket exclusion for persons with a history of recurrent seizures,
without distinction as to the type of seizure.'' The Epilepsy
Foundation asserted that the Americans with Disabilities Act of 1990,
42 U.S.C. 12101 et seq. (ADA), and Section 504 of the Rehabilitation
Act of 1973, 29 U.S.C. 701, et seq. (Rehabilitation Act), prohibit
blanket exclusions and require individualized assessments of fitness
and risk. Based on more recent medical knowledge and strides in
treatment of epilepsy, it called on FMCSA to eliminate its blanket
disqualification of persons with epilepsy seeking licenses to operate a
CMV. The Foundation recommended that FMCSA establish new guidelines for
licensing commercial drivers and give greater weight to the exemption,
including documentation on an individual's medication compliance
posture and the absence of other precipitating conditions.
FMCSA Response: FMCSA notes that the ADA permits the establishment
of regulations concerning minimum levels of physical qualifications for
CMV drivers, which may be tantamount to blanket exclusions.\4\
Notwithstanding the minimum qualification requirements, FMCSA agrees
with the Epilepsy Foundation that the general exemption process for CMV
drivers with disabilities allows FMCSA to consider new developments in
medicines or adaptations that reduce significantly the safety risk
created by certain medical conditions. While FMCSA is not initiating a
new exemption program, similar to the Agency's vision and diabetes
exemption programs, we are acknowledging advances in treatment of
individuals who have experienced a seizure.
---------------------------------------------------------------------------
\4\ The Conference Report specifically emphasized that the ADA
is not meant to ``override any legitimate medical standards
established by Federal, State or local law, or by employers for
applicants for safety or security positions, if the medical
standards are consistent with [the ADA].'' See Conference Report on
S.933, Americans with Disabilities Act: Joint Explanatory Statement
of the Committee of Conference, H.R. Rep. No. 596, 101st Cong., 2d
Sess. at 59 (1990), reprinted in 136 Cong. Rec. H 4582, 4597 (Daily
ed. July 12, 1990). In Albertson's Inc. v. Kirkingburg, 527 U.S.
555, (1999), the Supreme Court recognized that federal safety rules
may limit application of the ADA as a matter of law, citing the
Senate Labor and Human Resources Committee report on the ADA, which
stated that a ``person with a disability applying for or currently
holding a job subject to [Department of Transportation standards for
drivers] must be able to satisfy these physical qualifications
standards in order to be considered a qualified individual with a
disability under [the ADA].'' 527 U.S. at 573.
---------------------------------------------------------------------------
The Agency conducted a comprehensive literature review and convened
a panel of medical experts in epilepsy and neurology to address key
questions and make recommendations concerning new guidelines for CMV
drivers. FMCSA is conducting individualized case assessments of persons
seeking an exemption from Sec. 391.41(b)(8). The Agency seeks to
assess safety risks, medical history, and compliance to determine
whether there is a likelihood the individual will experience a seizure
while operating a CMV in interstate commerce on or off medication. The
goal is to ensure a minimal safety risk to the driver or the travelling
public.
No Exemptions for Epilepsy
Dr. Merris T. Young, MD, stated, ``I personally and professionally
feel that any allowance of individuals diagnosed with epilepsy to
operate such potentially dangerous equipment before such updated
medical information is available is unacceptable, because it would
place the public health and safety and significantly increased risk''
(FMCSA-2006-24278-0007).
FMCSA Response: The Agency believes that evaluating each
individual's medical history on a case-by-case basis and investigating
the past driving/violation record ensures an acceptable level of safety
for a driver who has not experienced a seizure for an extended period
of time. Drivers, who have been seizure-free, on or off medication for
at least four years, pose a minimal risk to public safety. The Agency
considered the 2007 Evidence Report and the 2007 MEP Recommendations to
determine the driver's level of risk for recurrence of seizure. The
Agency believes this data and information addresses Dr. Young's
concerns.
Concerns About Medical Examiners
Daniel M. Janiga, MD, a medical director for multiple companies
that hire drivers who require medical examiners' certificates,
indicated his concern that drivers may go ``doctor shopping'' to find a
medical examiner who will support their requests for exemptions (FMCSA-
2006-24278-0003). Because of the difficulty of managing seizure
disorders (for example, medications may lower seizure thresholds) and
monitoring drivers, he favored ``staying with our current rules/
guidelines'' until there are evidence-based studies on the effects of
``fatigue, medications such as Zyban, physical conditions such as sleep
apnea* * *'' on lowering seizure thresholds and how they relate to
driving accidents.
FMCSA Response: The Agency acknowledges Dr. Janiga's concern about
drivers who have experienced a seizure, take medication and fail to
share that information with their Medical Examiners. Allowing drivers
an option for an exemption, especially those who have not experienced a
seizure in several years, may decrease the number of drivers who fail
to disclose their medical history to the Medical Examiner. The MEP
recommendations provide a practical solution to protect both public
safety and the drivers, need for employment.
Inadequate Basis for the Exemption
Advocates for Highway and Auto Safety (Advocates) wrote that the
Agency's position that some drivers who are seizure free should be
granted exemptions is unsupported by ``medical research, statistical
data, legal decisions, or any published determination by the Secretary
of Transportation'' (FMCSA-2006-24278-0011). They stated that the
underlying rationale for exemptions from the current rule was not based
on recent scientific or medical studies and that the Agency had
presented no medical or other information on which it can make a
determination. In 2006, Advocates recommended waiting until
``convincing evidence [was] presented that medical authorities can
determine a shorter period is appropriate for some or all persons with
seizure histories.'' In a later comment, Advocates recommended that the
Agency update the driver physical and medical qualifications based on
current medical norms and science (FMCSA-2006-25854-0005). The FMCSA
notes that in requesting public comments for an exemption application,
the Agency did not offer opinions or views whether the exemption should
be granted or denied.
FMCSA Response: The Agency believes the Advocates' concerns were
appropriate based on information available to the Agency and the public
in 2006. However, the findings of the 2007 comprehensive literature
review
[[Page 3075]]
and the MEP recommendations provide current information that the Agency
considered in making the determination that an exemption would likely
achieve a level of safety that is equivalent to or greater than the
level achieved without the exemption. The Agency's advisory criteria
recommending the 10-year seizure-free/off medication period for driving
a CMV was established by a panel of neurologists in 1988. In 2007, the
MEP updated the information regarding treatment of seizure disorders
and the likelihood of seizure recurrence for a variety of seizure
disorders and situations. FMCSA believes that the current research and
information supersede the information presented by the panel of
neurologists in the 1988, ``Conference on Neurological Disorders and
Commercial Drivers.'' Also, the drivers covered by the exemptions have
been free of seizures for a period of four years to more than 20 years.
Inadequate Information About Individual Applicants
Advocates stated that ``unless the Agency can document that
individual applicants do not pose an increased safety risk when
operating a CMV, as compared with persons who have not had a seizure or
seizure history, then the Agency cannot grant exemptions'' (FMCSA-2006-
24278-0011). FMCSA is required by 49 U.S.C. 31315(b)(4) to publish a
notice and provide an opportunity for the public to comment on every
applicant for an exemption, irrespective of whether the Agency believes
the arguments offered by the applicant warrant the granting of an
exemption. In fact, the Agency reserves judgement until after the
notice and comment period. Advocates commented that ``the brief
statements presented in the notice for each applicant do not provide
the medical evidence based in individualized testing necessary to meet
the legal burden for granting exemptions.'' Advocates wrote that
``FMCSA has not developed any means for performing individualized
testing.''
Advocates stated that two of the applicants were diagnosed with
epilepsy and therefore should not be granted an exemption. Advocates
also noted difficulties with applicants in two notices including
``recent seizure events'' and the fact that some drivers continue to
take anti-seizure medication: ``Thus, they do not meet the current
requirements.''
Mr. Steven A. Tudor (FMCSA 2006-25854-0003) commented that three
drivers did not have their home States listed and that this would
preclude their States from knowing about the Federal Register listing.
FMCSA Response: In response to the Advocates comment regarding
medical evidence, FMCSA reviews each individual applicant, assesses the
driving record and the individual's medical condition, and determines
on a case-by-case basis the driver's risk to public safety. FMCSA is
not granting drivers with recent seizure events an exemption based on
the MEP recommendations. The Agency has made the decision to use the
more current 2007 MEP recommendations to grant exemptions on a case-by-
case basis rather than to judge all drivers by the criteria established
in the 1988 ``Conference on Neurological Disorders and Commercial
Drivers'' report. The Agency evaluated each individual's medical
condition, comparing it to the 2007 MEP. In addition, to ensure the
safest roads possible, the Agency researched each individual's driving
record. Further, we believe that each driver has shown evidence of
compliance with his or her treatment regimen. Thus, we believe that the
individuals listed above have a level of safety equivalent to those
drivers who do not suffer from a seizure disorder.
The Agency believes, however, that a driver who has not experienced
a seizure in years, should not be precluded from driving a CMV in
interstate commerce merely because he remains on anti-seizure
medication. Generally, the Agency does not preclude drivers with
medical conditions, other than seizure disorders, from operating a CMV
in interstate commerce merely because they are taking medication. In
addition, all drivers must be stable on the medication for 2 years,
which is a long enough period of time for the driver and his treating
physician to note any adverse reactions to the medication such as
excessive drowsiness. As mentioned in the background section, only
those drivers meeting the MEP criteria are being granted an exemption.
In response to Advocates' concern about the brevity of FMCSA's
statement on each seizure exemption applicant, the Agency does not post
all the medical information provided by the drivers. The Agency
provides information about the specific medical condition for which the
exemption is being sought. FMCSA summarizes the information for the
public's view, as we do for the Federal Register notices announcing
application requests for vision and diabetes exemptions from the rules.
FMCSA is consistent in the way that all medical exemptions are handled.
We have extensive documentation used to verify that the medical
condition for which the exemption is being sought is the only condition
to prevent the drivers from operating a CMV in interstate commerce. The
Agency provides a minimal amount of information to announce the
exemption request to protect the driver from unnecessary disclosure of
personal and medically confidential information.
In response to Mr. Tudor's comment, FMCSA added the home States to
the each driver's biographical statement in this Federal Register
notice.
MRB Criteria
Advocates expressed concerns that a coherent policy is needed which
addresses medical and physical qualifications of CMV drivers, and urged
a review of the current standards by the MRB (FMCSA-2006-25854-0005).
Advocates stated that the MRB should be the body that makes the
determination.
FMCSA Response: FMCSA's MRB is a Federal Advisory Committee whose
role is to provide scientific and medical advice to FMCSA on ongoing
medical issues, including the identification of appropriate physical
qualifications of CMV drivers, medical standards, and educational
curriculum for training medical examiners who certify that drivers meet
the physical qualification standards and functional tests for drivers
with disabilities. The MRB reviews all current FMCSA medical standards
and makes recommendations to FMCSA for new science-based standards and
guidelines to ensure that drivers operating CMVs in interstate
commerce, as defined in 49 CFR 390.5, are physically capable. Thus, the
MRB makes recommendations but the Agency is the deciding body,
determining which of the MRB's advice and recommendations to adopt, 49
U.S.C. 31149(a)(1) and (c)(1). The Agency does not believe it was
Congress's intent that the MRB serve as a medical certification review
board for each individual seeking an exemption.
Support for Applicants and the Exemptions
Lori A. Strom wrote in support of drivers who have been seizure-
free for a long time; she cited the 20-year safety record of her
husband, a CMV operator with a seizure disorder on seizure medication,
as a positive example (FMCSA-2006-25854-0006). Mr. Strom operates under
an intrastate exemption granted by the State of California. An
anonymous writer (FMCSA-2006-25854-0004) and Mr. V. Ross (FMCSA-2006-
25854-0002) both agreed that drivers exhibiting long-term control of
their seizure disorders (more than 5 years) should be granted
exemptions. Mr. Ross warned against giving
[[Page 3076]]
exemptions to drivers who had shown only short-term control. Pamela
Stern (FMCSA-2008-0355-0002), Eugene Dobrowolski (FMCSA-2008-0355-
0005), and Kelly Dobrowolski (FMCSA-2008-0355-0005) submitted letters
in support of driver John M. Dobrowolski's exemption application.
Mr. Michael W. Thomas, a CMV driver, wrote to support fair
treatment for drivers with controlled seizure disorders (FMCSA-2010-
0203-0002). He also stated that his application for exemption had not
been acted on by FMCSA. Mr. Todd Davis wrote in favor of his own
application and indicated that he has successfully complied with his
current medication regimen since 2007 (FMCSA-2010-0203-0004 and 0006).
Frankie Linn Eveland stated, ``I believe it is perfectly safe for these
individuals to operate a Commercial Vehicle with the current conditions
under complete control. It seems to be discrimination if this medical
condition needs special conditions'' (FMCSA-2010-0203-0007). An
anonymous commenter wrote in support of his own application (FMCSA-
2010-0203-0003), identifying only that he was an exemption applicant.
James Dyer commented about himself that ``according to my Neurologist,
I experienced a single seizure like event in 2008. I have been seizure-
free since and have been off anti-seizure medication since April 2009''
(FMCSA-2010-0203-0005).
Two commenters wrote in support of Mr. Robin Sherwood. Joe Helsley
commented that he has known Mr. Sherwood for 6 years and was his
employer (FMCSA-2011-0089-0002). He stated that Mr. Sherwood is a
reliable and responsible truck driver and confirmed that he has never
had any seizures while working for him. Mr. Dick Rankins commented that
Mr. Sherwood is an exemplary driver, was safe in carrying out his
duties, and that he would hire Mr. Sherwood at anytime due to his work
and reputation (FMCSA-2011-0089-0003).
FMCSA Response: FMCSA acknowledges support for these exemptions.
The Agency carefully reviewed all the comments about every individual.
Mr. Thomas' application was reviewed and published (72 FR 44916, Aug.
9, 2007); he is granted an exemption in this notice. Mr. Dyer has been
seizure free for 4 years and is granted an exemption in this notice.
Comments that relate specifically to applicants other than those
covered in this notice will be addressed in a subsequent notice.
Concerns About Discrimination and the ADA
Bonnie (no last name given) wrote that her husband had been
discriminated against and terminated by his employer because he has a
controlled seizure disorder (FMCSA-2008-0355-0007). She stated the need
to rewrite the rule on seizure disorders to eliminate ``loopholes''
allowing this practice. Doug Foster stated that the current standards
for exemption from the seizure rule are too high and that there is no
collected data about epilepsy-related crashes (FMCSA-2008-0355-0003).
Mr. Foster expressed concern that current rules may violate ADA
provisions regarding people with epilepsy or seizure disorders.
FMCSA Response: FMCSA believes that the individualized assessment
of exemption applicants established by this Federal Register notice,
using the 2007 MEP Recommendations, addresses the commenters' concerns
about discrimination while maintaining an equivalent level of public
safety. Regarding comments related to the ADA, we note that in passing
the ADA, Congress explicitly recognized that individuals must meet
minimum physical qualifications for operating CMVs in interstate
commerce. The Agency's current approach, articulated in this Federal
Register notice, nevertheless meets the spirit of the ADA by conducting
an individualized assessment of each exemption applicants' medical
history and the concomitant level of safety risk. The Agency's case-by-
case review of exemption applicants and its accompanying advisory
criteria provides the best assurance of drivers being treated fairly
while at the same time addressing public safety concerns. The Agency
used the best available data to support the recommendations.
E. Basis for Exemption
Under 49 U.S.C. 31136(e) and 31315, FMCSA may grant an exemption
from the epilepsy/seizure standard in 49 CFR 391.41(b)(8) if the
exemption is likely to achieve an equivalent or greater level of safety
than would be achieved without the exemption. Without the exemption,
applicants will continue to be restricted to intrastate driving. With
the exemption, applicants can drive in interstate commerce. Thus, the
Agency's analysis focuses on whether an equal or greater level of
safety is likely to be achieved by permitting each of these drivers to
drive in interstate commerce as opposed to restricting him or her to
driving in intrastate commerce.
Conclusion
The Agency is granting exemptions from the epilepsy standard, 49
CFR 391.41(b)(8), to 22 individuals based on a thorough evaluation of
each driver's qualifications, safety experience, and medical condition.
Safety analysis of information relating to these 22 applicants meets
the burden of showing that granting the exemptions would achieve a
level of safety that is equivalent to or greater than the level that
would be achieved without the exemption. By granting the exemptions,
the CMV industry will gain 22 highly trained and experienced drivers.
In accordance with 49 U.S.C. 31315, each exemption will be valid for 2
years with annual recertification required unless revoked earlier by
FMCSA. The exemption will be revoked if the following occurs: (1) The
person fails to comply with the terms and conditions of the exemption;
(2) the exemption has resulted in a lower level of safety than was
maintained prior to being granted; or (3) continuation of the exemption
would not be consistent with the goals and objectives of 49 U.S.C.
31136 and 31315.
FMCSA exempts the following 22 drivers for a period of 2 years with
annual medical certification required: Wayne C. Sorenson (MN); David L.
Basso (OH); Michael W. Thomas (KS); Garry W. Gantle (FL); Steve L.
Hunsaker (ID); John B. Yates (WV); Henrietta M. Ketcham (NY); Joseph A.
Suhy (PA); Dorothy Pokornowski (MN); Brian J. Porter (PA); Daniel Forth
(NY); Shane Klementis (NY); Scott M. Rohlinger (WI); Bruce B. Baum
(NM); Todd A. Davis (WI); James Dyer (TX); Christian E. Henry (PA);
Paul C. Warren (ME); Brian H. Wetzel (MO); Donald Schutz (OH); Robin L.
Sherwood (ID), and Frank Eveland (WI) from the prohibition of CMV
operations by persons with a clinical diagnosis of epilepsy or
seizures. If the exemption is still in effect at the end of the 2-year
period, the person may apply to FMCSA for a renewal under procedures in
effect at that time.
Appendix--MEP Opinion
The following is an exerpt from the ``Expert Panel
Recommendations: Seizure Disorders and Commercial Motor Vehicle
Driver Safety,'' presented to FMCSA on October 15, 2007.
Recommended Changes to Original Guidelines
The MEP recommended that FMCSA make substantial changes to the
current seizure disorder guidelines. These recommendations were
based on a combination of evidence provided by the Evidence Report
titled, ``Seizure Disorders and Commercial Motor
[[Page 3077]]
Vehicle Driver Safety'' and other sources. Below we present the
recommendations of the MEP and provide justification for these
recommendations.
Guideline 1: Fitness-to-drive certification of individuals with a
history of epilepsy
The MEP recommended that the current guidelines pertaining to
individuals who have a diagnosis of epilepsy (Appendix A) be
replaced with the following:
A history of epilepsy precludes an individual from
obtaining unconditional certification to drive a CMV for the
purposes of interstate commerce.
A history of epilepsy, however, should not
unconditionally exclude all individuals from driving a CMV;
conditional certification may be possible in some instances.
An individual with a history of epilepsy may obtain
conditional certification (or maintaining certification under
conditional status) to drive a CMV if that individual meets the
following criteria:
--Individual must have been seizure free for a minimum of 8 years on
or off anti-seizure medication; AND
--If all anti-seizure medications have been stopped, the individual
must have been seizure free for a minimum of 8 years from the time
of medication cessation; OR
--If still using anti-seizure medication, the individual must have
been on a stable medication regimen for a minimum of 2 years.
An individual with a history of epilepsy who has been
granted conditional certification to drive a CMV must be recertified
on an annual basis.
Guideline 2: Fitness-to-drive certification of individuals with a
history of a single unprovoked seizure
The MEP recommended that the current guideline pertaining to
individuals who have experienced a single, unprovoked seizure
(Appendix A) be replaced with the following guideline:
A history of experiencing a single unprovoked seizure
precludes an individual from obtaining unconditional certification
to drive a CMV for the purposes of interstate commerce.
A history of experiencing a single unprovoked seizure,
however, should not unconditionally exclude all individuals from
driving a CMV; conditional certification may be possible in some
instances.
An individual with a history of a single, unprovoked
seizure may obtain conditional certification (or maintaining
certification under conditional status) to drive a CMV if that
individual meets the following criteria:
--Individual must have been seizure free for a minimum of 4 years on
or off anti-seizure medication; AND
If all anti-seizure medications have been stopped, the
individual must have been seizure free for a minimum of 4 years from
the time of medication cessation; OR
If still using anti-seizure medication, the individual
must have been on a stable medication regimen for a minimum of 2
years.
An individual with a history of a single, unprovoked
seizure who has been granted conditional certification to drive a
CMV must be recertified on a biennial basis.
Guideline 3: Fitness-to-drive certification of individuals with a
history of a provoked seizure or seizures;
This category of seizure pertains to a provoked seizure.
Certification may be allowed if the individual is at low risk for
again encountering the factor that precipitated the seizure or of
having further seizures. Patients whose seizures are provoked by
sleep deprivation, photic or visual pattern stimulation will not be
considered for certification under this guideline, since these
patients may have underlying epilepsy. Conditional certification of
such individuals will be considered according to Guideline 1. The
MEP recommended that the current guideline pertaining to individuals
who have experienced a symptomatic seizure or seizures (Appendix A)
be replaced with the following guideline:
A history of experiencing a single provoked seizure
should not automatically preclude an individual from obtaining
unconditional certification to drive a CMV for the purposes of
interstate commerce.
Whether an individual with such a history can be
unconditionally certified requires an individual evaluation to
ascertain that the individual is at a sufficiently low recurrence
risk for again encountering the factor that precipitated the seizure
or of having further seizures.
Examples of low risk for recurrence include:
--A lidocaine-induced seizure during a dental appointment.
--A concussive seizure, loss of consciousness <=30 minutes, no
penetrating injury.
--A seizure due to syncope not likely to recur while driving.
--A seizure from an acute metabolic derangement not likely to recur.
--Drug withdrawal.
Conditional certification may be considered for
individuals with moderate-to-high risk factors for recurrence
provided that the following conditions are met:
--Individual must have been seizure free for a minimum of 8 years on
or off anti-seizure medication; AND
--If all anti-seizure medications have been stopped, the individual
must have been seizure free for a minimum of 8 years from the time
of medication cessation; OR
--If still using anti-seizure medication, the individual must have
been on a stable medication regimen for a minimum of 2 years.
An individual with a history of epilepsy who has been
granted conditional certification to drive a CMV must be recertified
on an annual basis.
Examples of seizure-provoking conditions that are at
moderate-to-high risk for further seizures, and therefore would
weigh against certification, include the following:
--Head injury with loss of consciousness or amnesia >= 30 minutes or
penetrating head injury.
--Intracerebral hemorrhage of any etiology, including stroke and
trauma.
--Brain infection: encephalitis, meningitis, abscess, cysticercosis.
--Stroke.
--Intracranial hemorrhage.
--Post-operative brain surgery with significant brain hemorrhage.
--Brain tumor.
Issued on: January 10, 2013.
William ``Bill'' Bronrott,
Deputy Administrator, for Federal Motor Carrier Safety Administration.
[FR Doc. 2013-00709 Filed 1-11-13; 4:15 pm]
BILLING CODE 4910-EX-P