Qualification of Drivers; Application for Exemption; Implantable Cardioverter Defibrillator

Larry W. Minor
Federal Motor Carrier Safety Administration
January 29, 2014

[Federal Register Volume 79, Number 19 (Wednesday, January 29, 2014)]
[Notices]
[Pages 4806-4807]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-01691]


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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

[Docket No. FMCSA-2012-0081]


Qualification of Drivers; Application for Exemption; Implantable 
Cardioverter Defibrillator

AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.

ACTION: Notice of application for exemption; request for comments.

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SUMMARY: FMCSA has received applications from three individuals with 
implantable cardioverter defibrillators (ICDs) for an exemption from 
the cardiovascular disease standard in the Federal Motor Carrier Safety 
Regulations (FMCSRs). The Agency's current advisory criteria for the 
applicable FMCSR recommends that CMV drivers with ICDs should not be 
qualified due to the likelihood of causing a loss of ability to operate 
a commercial motor vehicle (CMV) safely. If granted, an exemption would 
allow these individuals with ICDs to operate a CMV in interstate 
commerce.

DATES: Comments must be received on or before February 28, 2014.

ADDRESSES: You may submit comments bearing the Federal Docket 
Management System (FDMS) Docket No. FMCSA-2012-0081 using any of the 
following methods:
     Federal eRulemaking Portal: Go to http://www.regulations.gov. Follow the on-line instructions for submitting 
comments.
     Mail: Docket Management Facility; U.S. Department of 
Transportation, 1200 New Jersey Avenue SE., West Building Ground Floor, 
Room W12-140, Washington, DC 20590-0001.
     Hand Delivery: West Building Ground Floor, Room W12-140, 
1200 New Jersey Avenue SE., Washington, DC, between 9 a.m. and 5 p.m., 
ET, Monday through Friday, except Federal Holidays.
     Fax: 1-202-493-2251.
    Instructions: Each submission must include the Agency name and the 
docket numbers for this notice. Note that all comments received will be 
posted without change to http://www.regulations.gov, including any 
personal information provided. Please see the Privacy Act heading below 
for further information.
    Docket: For access to the docket to read background documents or 
comments, go to http://www.regulations.gov at any time 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., ET, Monday through Friday, 
except Federal holidays. The FDMS is available 24 hours each day, 365 
days each year. If you want acknowledgment that we received your 
comments, please include a self-addressed, stamped envelope or postcard 
or print the acknowledgement page that appears after submitting 
comments on-line.
    Privacy Act: Anyone may search the electronic form of all comments 
received into any of our 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, etc.). 
You may review DOT's Privacy Act Statement for the FDMS published in 
the Federal Register on January 17, 2008 (73 FR 3316).

FOR FURTHER INFORMATION CONTACT: Charles Horan, Director, Office of 
Carrier, Driver, and Vehicle Safety Standards (202) 366-4001, 
fmcsamedical@dot.gov, FMCSA, Department of Transportation, 1200 New 
Jersey Avenue SE., Room W64-(306), Washington, DC 20590-0001. Office 
hours are from 8:30 a.m. to 5 p.m., Monday through Friday, except 
Federal holidays.

SUPPLEMENTARY INFORMATION: 

Background

    FMCSA has the authority to grant exemptions from the FMCSRs; 
pursuant to 49 U.S.C. 31315 and 31136(e) as amended by Section 4007 of 
the Transportation Equity Act for the 21st Century (TEA- 21) [Pub. L. 
105-178, June 9, 1998, 112 Stat. 107, 401]. On August 20, 2004, FMCSA 
published a final rule implementing the changes made by section 4007 
(69 FR 51589). The current regulations require FMCSA to publish a 
notice of each exemption request in the Federal Register. The Agency 
must provide the public with an opportunity to inspect the information 
relevant to the application, including any safety analyses that have 
been conducted. The Agency must also provide an opportunity for public 
comment on the request (49 CFR 381.315(a)).
    The Agency reviews the safety analyses and the public comments and 
determines whether granting the exemption would likely achieve a level 
of safety equivalent to or greater than the level that would be 
achieved by the current regulation (49 CFR 381.305). The decision of 
the Agency must be published in the Federal Register (49 CFR 
381.315(b)). If the Agency denies the request, it must state the reason 
for doing so. If the Agency decision is to grant the exemption, the 
notice must specify the person or class of persons receiving the 
exemption and the regulatory provision or provisions from which an 
exemption is granted. The notice must also specify the effective period 
of the exemption (up to 2 years) and explain the terms and conditions 
of the exemption. If granted, the exemption may be renewed (49 CFR 
381.315(c) and 381.300(b)).
    The three individuals included in this notice have each requested 
an exemption from the provisions of 49 CFR 391.41(b)(4), which applies 
to drivers who operate CMVs in interstate commerce, as defined in 49 
CFR 390.5. Section 391.41(b)(4) states that:

``. . . a person is physically qualified to drive a commercial motor 
vehicle if that person has no current clinical diagnosis of 
myocardial infarction, angina pectoris, coronary insufficiency, 
thrombosis, or any other cardiovascular disease of a variety known 
to be accompanied by syncope (temporary loss of consciousness due to 
a sudden decline in blood flow to the brain), dyspnea (shortness of 
breath), collapse, or congestive cardiac failure.''

    The FMCSA provides medical advisory criteria as recommendations for 
use by medical examiners in determining whether drivers with certain 
medical conditions, procedures, and/or treatments should be certified 
to operate CMVs in interstate commerce in accordance with the various 
physical qualification standards in 49 CFR part 391, subpart E. The 
advisory criteria are currently set out as part of the medical 
examination report published with 49 CFR 391.43. The advisory criteria 
for section 391.41(b)(4) provide that:

    The term ``has no current clinical diagnosis of'' is 
specifically designed to encompass: ``a clinical diagnosis of'' (1) 
a current cardiovascular condition, or (2) a cardiovascular 
condition which has not fully stabilized regardless of the time 
limit. The term ``known to be accompanied by'' is designed to 
include a clinical diagnosis of a cardiovascular disease (1) which 
is accompanied by symptoms of syncope, dyspnea, collapse or 
congestive cardiac failure; and/or (2) which is likely to cause 
syncope, dyspnea, collapse, or congestive cardiac failure. It is the 
intent of the FMCSRs to render unqualified, a driver who has a 
current cardiovascular disease which is accompanied by and/or likely 
to cause symptoms of syncope, dyspnea, collapse, or

[[Page 4807]]

congestive cardiac failure. However, the subjective decision of 
whether the nature and severity of an individual's condition will 
likely cause symptoms of cardiovascular insufficiency is on an 
individual basis and qualification rests with the medical examiner 
and the motor carrier.

    In the case of persons with ICDs, the underlying condition for 
which the ICD was implanted may place the driver at risk for syncope (a 
transient loss of consciousness) or other gradual or sudden 
incapacitation that may result in loss of ability to safely control a 
CMV. When an ICD deploys, the driver experiences a loss of ability to 
safely control a CMV. See the conference report on Cardiovascular 
Advisory Panel Guidelines for Medical Examination of Commercial Motor 
vehicle Drivers at 94-95 (2002).\1\
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    \1\ Now available at http://www.fmcsa.dot.gov/documents/cardio.pdf (retrieved July 22, 2013).
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Individual Applications for Exemption--Qualifications

James Dean

    Mr. Dean is a 53 year old CMV driver who holds a class A and a 
class D commercial driver's license (CDL) from the State of Wisconsin. 
He has driven a CMV for over 29 years. Mr. Dean had an ICD placed due 
to ventricular tachycardia and a low ejection fraction which improved. 
The device deployed in 2011. Mr. Dean would like to continue to drive a 
truck in interstate commerce.

Mark Steiner

    Mr. Steiner is a 64 year old CMV driver who holds a class A CDL 
from the state of Ohio. He has driven a CMV for 38 years. Mr. Steiner 
had angioplasty and stent placement after he had a heart attack while 
driving (first cardiac event in his life) in January 2012. The ICD was 
placed preventively in November 2012 after he completed cardiac 
rehabilitation. The device has not deployed. Mr. Steiner would like to 
continue to drive a truck in interstate commerce.

Craig Bohms

    Mr. Bohms is a 57 year old owner operator of a CMV who holds a 
class A commercial driver's license (CDL) from the State of Illinois. 
According to Mr. Bohms, following a heart attack in April 2013 he was 
implanted with an ICD. In an August 2013 letter that was submitted by 
Mr. Bohms electrophysiologist (EP) physician, he stated ``Mr. Bohms was 
implanted with an ICD as a preventative measure to protect him from 
possible ventricular tachycardia . . . from an EP standpoint, Mr. Bohms 
is able to drive and return to work without restrictions''. Mr. Bohms 
would like to continue to drive a truck in interstate commerce.

Request for Comments

    In accordance with 49 U.S.C. 31136(e) and 31315, FMCSA may grant an 
exemption if it makes a finding that the exemption ``would likely 
achieve a level of safety that is equivalent to or greater than that 
would be achieved absent such an exemption.'' FMCSA requests public 
comment from all interested persons on the exemption application 
described in this notice. In accordance with 49 U.S.C. 31315(b)(4), and 
49 CFR 381.315(b) and (d), the safety analysis or assessment, and other 
supporting information is available for examination and review. The 
Agency will consider all comments received before the close of business 
February 28, 2014. Comments will be available for examination in the 
docket at the location listed under the ADDRESSES section of this 
notice. The Agency will file comments received after the comment 
closing date in the public docket, and will consider them to the extent 
practicable. In addition to late comments, FMCSA will also continue to 
file, in the public docket, relevant information that becomes available 
after the comment closing date. Interested persons should monitor the 
public docket for new material.

    Issued on: January 10, 2014.
 Larry W. Minor,
 Associate Administrator for Policy.
[FR Doc. 2014-01691 Filed 1-28-14; 8:45 am]
BILLING CODE 4910-EX-P