What disqualifies you from a DOT physical?

The standards in 49 CFR 391.41(b) are the disqualifiers: missing or impaired limbs without a skill performance evaluation certificate, insulin-treated diabetes outside the 49 CFR 391.46 pathway, cardiovascular disease with risk of collapse, respiratory dysfunction, disqualifying high blood pressure, epilepsy or other loss-of-consciousness conditions, disqualifying psychiatric disorders, vision or hearing below the standard, Schedule I or non-prescribed habit-forming drug use, and a current clinical diagnosis of alcoholism. A driver who does not meet a standard may still qualify through a medical variance from FMCSA: an exemption letter or a skill performance evaluation certificate. The driver must carry a copy of the variance documentation while on duty.

What blood pressure fails a DOT physical?

The regulation itself sets no numeric blood pressure cutoff; 49 CFR 391.41(b)(6) requires only no current clinical diagnosis of high blood pressure likely to interfere with safe operation. Examiners apply FMCSA's advisory criteria on the Medical Examination Report, which guide certificate length for elevated readings, so no pass-fail number is recorded here.

Federal compliance

The DOT physical and medical card

Every interstate CMV driver must pass the DOT physical and hold a current medical certification before driving, and the exam must come from an examiner on FMCSA's National Registry. This page lays out each physical qualification standard, what happens at recertification, and the paperless flow CDL drivers now use, each fact cited to the regulation.

By Evan Reid, Founder of Haul Handbook · Updated Jul 22, 2026

Who needs it, and who examines

A person subject to 49 CFR part 391 must not operate a commercial motor vehicle unless medically certified as physically qualified to do so. Any person who has never been certified, and any driver whose last examination was more than 24 months ago, must be examined and certified; drivers with certain conditions recertify on a shorter schedule, and any driver whose ability has been impaired by injury or disease must be re-examined.

The medical examination must be performed by a medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. Two exceptions: a licensed ophthalmologist or optometrist may perform the vision portion, and a certified VA examiner examines only veteran operators. Find a listed examiner through FMCSA's National Registry search. An exam from a provider who is not on the registry does not count, no matter how thorough it was.

The examination is recorded on the Medical Examination Report Form, MCSA-5875. A driver found qualified is certified on the Medical Examiner's Certificate, Form MCSA-5876, the wallet card known as the medical card.

The physical qualification standards

These are the standards the examiner certifies against. Each row is the regulation's own test, condensed; the examiner applies it with FMCSA's advisory criteria.

Standard	What the rule requires
Limbs49 CFR 391.41(b)(1)-(2)	No loss of a foot, leg, hand, or arm, and no impairment of a hand, finger, arm, foot, or leg that interferes with prehension, power grasping, or normal driving tasks, unless the driver holds a skill performance evaluation certificate under 49 CFR 391.49.
Diabetes49 CFR 391.41(b)(3)	No established medical history or clinical diagnosis of diabetes mellitus currently treated with insulin for control, unless the driver meets the requirements of 49 CFR 391.46 (the insulin-treated diabetes standard, certified with an annual exam).
Cardiovascular49 CFR 391.41(b)(4)	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, dyspnea, collapse, or congestive cardiac failure.
Respiratory49 CFR 391.41(b)(5)	No established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely.
Blood pressure49 CFR 391.41(b)(6)	No current clinical diagnosis of high blood pressure likely to interfere with the ability to operate a commercial motor vehicle safely.
Musculoskeletal and vascular49 CFR 391.41(b)(7)	No established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which interferes with the ability to control and operate a commercial motor vehicle safely.
Epilepsy and loss of consciousness49 CFR 391.41(b)(8)	No established medical history or clinical diagnosis of epilepsy or any other condition likely to cause loss of consciousness or loss of ability to control a commercial motor vehicle.
Psychiatric49 CFR 391.41(b)(9)	No mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with the ability to drive a commercial motor vehicle safely.
Vision49 CFR 391.41(b)(10)	Distant visual acuity of at least 20/40 (Snellen) in each eye with or without corrective lenses, distant binocular acuity of at least 20/40, a field of vision of at least 70 degrees in the horizontal meridian in each eye, and the ability to recognize the colors of traffic signals showing standard red, green, and amber. Drivers who cannot meet the standard in the worse eye may qualify under the 49 CFR 391.44 vision standard with an annual exam.
Hearing49 CFR 391.41(b)(11)	First perceives a forced whispered voice in the better ear at not less than 5 feet, with or without a hearing aid, or an average hearing loss in the better ear of no more than 40 decibels at 500 Hz, 1,000 Hz, and 2,000 Hz on an audiometric test.
Drug use49 CFR 391.41(b)(12)	Does not use any Schedule I drug or substance, an amphetamine, a narcotic, or other habit-forming drug. A non-Schedule I controlled substance is allowed only when prescribed by a licensed medical practitioner familiar with the driver's history who has advised that it will not adversely affect safe operation.
Alcoholism49 CFR 391.41(b)(13)	No current clinical diagnosis of alcoholism.

A driver who does not meet a standard may still qualify through a medical variance from FMCSA: an exemption letter or a skill performance evaluation certificate. The driver must carry a copy of the variance documentation while on duty. A failed standard is therefore not always the end of the road; the diabetes, vision, and limb standards each have their own regulatory pathway back to qualification.

How long the card lasts

The outer limit is 24 months: a driver must be re-examined if not certified within the preceding 24 months. Shorter cycles apply by rule: drivers in an exempt intracity zone, insulin-treated diabetic drivers certified under 49 CFR 391.46, and drivers with a vision certificate under 49 CFR 391.44 must recertify every 12 months, and an examiner may issue a certificate for any shorter period medicine warrants.

Since June 23, 2025, an examiner who finds a driver not physically qualified must tell the driver, and must report the result to FMCSA; every certificate previously issued to that driver becomes invalid. An examiner may also delay the determination for up to 45 days to receive additional information, with the pending status reported to FMCSA.

The paperless CDL flow and self-certification

Since June 23, 2025, the paper flow is gone for CDL and CLP holders: the examiner's result reaches FMCSA electronically, FMCSA transmits the certificate information to the state licensing agency, and the state posts the medical qualification status to the driver's CDLIS record. CDL and CLP holders no longer need to carry the paper certificate, and the examiner furnishes a paper Form MCSA-5876 only to examined drivers who will not be operating vehicles that require a CDL or CLP. If electronic information and a paper certificate conflict, the electronic record controls.

Every CDL and CLP applicant and holder must certify one of four operating categories to the state: non-excepted interstate (the category requiring the medical examiner's certificate), excepted interstate, non-excepted intrastate, or excepted intrastate. A driver certifying non-excepted interstate who lets the medical certification lapse is posted not-certified on the CDLIS record, and the state initiates a CDL downgrade.

Timing matters for new drivers: the medical certification comes before CDL testing, because the state wants the medical status on file with the permit application. If you are still deciding on equipment, settle whether you need a CDL at all first; non-CDL interstate drivers still need the medical card, but the state self-certification step belongs to CDL holders. Carriers keep the certification in each driver qualification file, one of the records reviewed in the new entrant safety audit.

What the exam costs

FMCSA does not set, cap, or publish a price for the DOT physical. The exam is a private transaction with the certified examiner, and prices vary by clinic and market, so no dollar figure is recorded here rather than an invented range.

Because the price is set by the clinic, calling two or three registry-listed examiners near you is the only reliable way to compare. Occupational health clinics, urgent care locations, and some carrier terminals all perform the exam; what makes it valid is the examiner's registry listing, not the building.