So, again, we're going to move on to something completely different. This is a very broad category and so there. There's the form. Have you, do you have or have you ever had? Important question. It's amazing how people think, you know, that part doesn't apply to them. Now, so that, here's the regulation. Again, you can't have these things, which interferes with your ability to operate a commercial vehicle. So, that covers a lot of territory. This is now, so for the regulation to the MAC, they really don't have a lot other than, this is kind of a, and Natalie can correct me if she interprets it differently, but basically once an individual has been diagnosed with something, then you have it, right? That generally applies to just about anything. I don't know why they single it out for these particular, this particular set of disorders, but I see this a lot with, you know, blood pressure and cholesterol. They check no, but they're taking antihypertensives or lipid lowering drugs, and I'm like, well, why'd you check no? Well, because I don't have it anymore. I got, I take medicine for it. They're not trying to be jerks, okay? They're just, that's just the way they think. Explain, patience, and you'll go a long way to keeping your guys happy and driving safely. They're much more likely to tell you things when they don't perceive an adversarial relationship, for whatever that's worth. Again, do a physical, do a history and physical. You know, yeah, maybe they do have a condition, but is it going to interfere with their ability to control and operate the motor vehicle safely, okay? If they're missing the tip of their left or right middle finger, that's probably not going to interfere. So you have to make that, make that determination. And again, this is the medical advisory criteria. It's codified. It's not regulation, but it's codified. So, again, it's permitted, but at your own risk. If they, and basically they're saying it's a severe impairment, they don't qualify. You got to fail them, right? They recommend failing them. But you, and also it is permissible for giving somebody a shorter term certificate if you think that they, you know, do your risks evaluation. They're just, it's just kind of common sense. So, now, this is, now we move to the handbook. So, again, recall that there are, it's not as simple as keeping the truck between the dashy line on the left and the solid line on the right, okay? There's a lot more to it than that. Driving and non-driving tasks. Putting tire chains on. Crawling underneath that vehicle. How many shoulder injuries have you seen in your practice from somebody cranking the landing gear down? And, you know, hooking up brake lines. Crawling inside. Some drivers have to handle the load. So, again, the other thing is, when you certify them, you certify them to drive any vehicle on the road. I get this a lot. Well, doc, I just drive a pickup truck with a trailer that's just over the weight limit. I'm never going to drive a tractor trailer. It doesn't matter. I don't care if you're a mechanic and you have to be able to drive the truck from one lot to the other to get it fixed and on that, on the way, you drive on a public street. Other than that, you never drive. Too bad. You all have to meet the same standard. And that's the expectation of FMCSA. You have to certify everyone as if they're driving an 80,000-pound tractor trailer from here to California and they're not going to be home for three weeks. Yeah, there's a big difference between that and the guy who drives a package car for UPS. You certify them the same. Because they can take that truck from UPS, that certificate, and leave UPS and go drive for Schneider completely to do the job. And you can't put a restriction on that. So again, you can't put restrictions on there, on any fiscal restrictions like no bending, no twisting, no lifting, no carrying more than 10 pounds, et cetera. This is very valuable information that's in the handbook. It outlines very, it's a job description. How cool is that? An actual job description for a commercial driver. You should know this. You should understand this is what your, this is the job description that you're required to certify these people against, right? So it covers all this. This is very handy to give to a specialist regardless of what you're asking questions about. These are the job demands. Can they do this in your opinion? On with more. So this is all in the handbook. Again, this is suggestions. You're not required to do any of these. You can use a dynamometer you can have them grab your hands. I don't because I don't wash their hands, but you can do whatever you want. Some people use an old blood pressure cuff, you know, whatever. Can they grip the steering wheel? This is the implication there. And again, like I said, give the job description to the specialist if you're going after them, right? That's great that that's in the handbook. I have that on a piece of paper that I give to them. I just copy and paste. So now, oh, there's one other. Oh, by the way, yes, you have to do a hernia check. Yes, you have to do a physical exam. Sorry, it's in the handbook. It's not in here. It doesn't really fit in any specific spot, but it is specifically mentioned in the handbook. You have to do a hernia exam. I cannot tell you how many times I have a say, well, I've never had to do that before. And he's not lying. It's because people aren't doing their job. It's just part of the deal. If you don't want to do that, then don't do these exams. It's part of the deal. And it's not up to you. It's not your opinion whether they need an exam. You need to do it. All right, neuromuscular disease. Again, they're kind of doing some basic medical education stuff here. You should already know this. You should be familiar with this. The bottom line is case-by-case basis. So they are talking a little bit here about MS and Parkinson's. Those are progressive diseases, right? But treatment has changed. Treatment's advanced. And the bottom line is case-by-case. Typically, with progressive stuff like this, my recommendation is some significant due diligence and maybe some additional testing. Again, this is more educational stuff. If you don't know this kind of stuff. Now, this is just the tip of the iceberg. This is not an, you know, again, they're telling you just enough to be dangerous. Okay, so again, this is the handbook. General considerations. They're telling you to do a history and physical. And in that exam, doesn't interfere with their ability to operate. Keep in mind, steering wheel's bigger. A lot more hand controls. You got to be able to turn. You got to be able to, you know, I had a guy that had ankylosing spondylitis that could do this. And he was really pissed when I disqualified him. I'm like, dude, how do you check your mirrors? Okay, because his disease had progressed to the point where he essentially had no mobility in his spine. Is treatment adequate, safe, and stable? We've seen that before. This is, again, not FMCSA official guidance. That's why it's in red and say don't, you know. I would argue that the treatment of all of these things has changed significantly in the interval 14 to 16 years that this, since these were made. But they are available to you for your consideration. I use them as a starting point, but not as an end point in my practice. You use them how you want. It's not on the test. It's not required. It's not official. Now, what do you do with a guy that doesn't meet that standard, right? He's missing an arm or he's missing a leg. They have this cool limb loss part of the regulation, okay? So again, you can't drive if you've lost a foot, a hand, an arm, unless you have an SBE, called a skill performance certificate. Skill performance evaluation certificate, sorry. It's actually an SBEC. Skill performance evaluation. So basically, you can't have something that interferes with your ability to operate the vehicle, prehension, power grasp, et cetera, that interferes with your ability to drive, or you have a skill performance evaluation certificate, which is basically a way that a driver can demonstrate to the FMCSA that despite their limb loss, they are not impaired. They can still function and operate a commercial vehicle. It's a demonstration, okay? So now, from the regulations to the MAC, they do say, they just clarify, you have to lose all five fingers to consider loss of a hand. I would, again, you know. So what they're telling you there is, somebody who's just lost a few fingers, they're probably not going to do an SBE on, read between the lines. So if you've lost all but your pinky finger, you're probably not going to be able to grip the steering wheel well, but they still don't consider it to be an amputation of their hand. So they're probably not going to. All right? So again, and then they're reminding you, unless they have this skill performance evaluation certificate, if they have an amputation, essentially, you don't get qualified, okay? And again, you can't, just because they have a prosthesis doesn't mean that they're qualified. They have to have the skill performance certificate. They can be eligible for it, but that's it. So, and again, back to the hand and fingers. An individual who's lost fewer than five fingers or any number of toes should be evaluated under 391.41. Basically, that's your call now. They're not going to do an SBE on that. That's the, they're not saying that in so many words, but that's what it means. Oh, by the way, do you make them take their shoes and socks off when you do a physical? I had a guy that had a complete foot prosthetic. Unless you made him take his shoes and socks off, you would have never known. Just FYI. It is not also available. This is still the medical advisory criteria. They're basically telling you the rules. They're not going to consider doing an SBE for somebody who has a spine injury or other torso injury. This is a limb impairment issue. So if they've got, like my gentleman with ankylosing spondylitis would not be eligible for an SBE. Okay. Oh, gotcha. Okay. Yeah. Good point. So for the videotape, what Natalie was saying back there is if you lose all five fingers, they have to have an SBE. If they lose less than that, they can be considered for an SBE. You can certify them and require an SBE, but you don't have to. But if I've lost all other fingers, you have to. Does that clarify that a little bit? I apologize for that. The other thing is this is really for people with fixed permanent, like the vision defect, fixed permanent defect. Somebody that's got carpal tunnel and they can't grip their steering wheel, they're not eligible for an SBE. They've got to get the carpal tunnel fixed. Okay. There's a big difference between somebody with a, or a progressive disorder, right? Somebody who's got a little bit of alarm weakness because of their MS, but their MS is still progressing and it's still getting worse or maybe getting better. They're not eligible for an SP. It's a fixed permanent defect, okay? Very much like monocular vision, the alternative vision standard. They can't have their eye fixed. It's permanent. Same here. So when should you actually send someone through that process? If they've had a rotator cuff injury that they've healed from, but they have a fixed defined range of motion that's not included, do they need to go through that process? So if you determine that, yes. If you do not feel that their range of motion is sufficient and it's permanent, it's not going to get worse, it's not going to get better. You really should talk to your orthopedist first. They don't have to, but you could require them to. But if they've lost a limb, if they've lost, they have a BKA or then they have to go. So your prosthetic that you said, your foot prosthetic, you automatically have to go. He has to go. He had to go. Otherwise it's a judgment call. If it's something else that's not an amputation, a limb loss, with or without a prosthetic, it's a judgment call. But again, it's got to be a fixed permanent defect. It can't be a temporary. Does it offer some protection to the individual to pursue that process? I mean, is there an advantage to the driver to actually have it if they know they have a fixed and stable shoulder range of loss of motion of their shoulder, for example, that it does make it a little difficult to climb into the cab or what have you? No. They still are expected to meet all the requirements of an Occo commercial motor vehicle operator. Again, you're kind of asking for an exemption, right? It's not a full exemption. That's not what this is. But you're basically saying, this person doesn't really meet the standards of 391.41. So we need to have them physically evaluated to see they actually can do it. They're saying they can do it. I'm not so sure they can. Because they have an amputation, they require this evaluation. Or because they have this fixed permanent defect, they might need to do that. But do your homework first. Don't send somebody for an SP that doesn't have a fixed permanent defect that can be made improvement. So let's say, for example, the orthopedic surgeon says, yeah, we can fix your rotator cuff. Well, I don't want surgery. I'm not going to get it fixed. That might be a little bit of a gray area there. I don't know that that person would qualify. Because there's an option to them. They declined it. And it could be fixed to make them more functional. You don't have to do anything other than mark the certificate. That's the point of this slide. They go online and apply for it. You don't have any forms to complete for this. It's unlike some of the other issues. Again, in the handbook, if they have lost ham and require a prosthesis, they still should demonstrate to you that they can do their job. It only applies to the limb. This is just a reiteration of stuff. They still have to be, in all other respects, qualified. You can certify them up to 24 months. That's all they have. If they have other issues. Generally, if you're only going to certify them for three months, get them through those issues first. Because it's going to take them a while to get this process done. Then again, the employer's responsible. Like before, if they drive without it, it's not your problem. They're not going to come back after you. If you mark the certificate appropriately, that's the driver and the carrier's responsibility to make sure that they do that. Here's what it looks like on both the 5875, the long form. They have to be accompanied by this certificate. This is what it looks like on the 76, which is the card. Check those boxes. Check one there. You've got to check that one there. Check that one there. You've got to check that one there. Again, the employer's responsible for verifying it. The driver's responsible. Sometimes those are the same thing. The Canadian thing. This is for reference. I'm going to summarize this really quick. USA, Canada, Mexico have a reciprocity agreement. A commercial driver that is examined and licensed in Canada as a commercial driver, not just a regular driver, does not require an exam in the United States. They're considered equivalent. That's the same for Mexico. A driver who is commercially licensed in Mexico and has passed their medical requirement is considered to be the same as here. This just goes through some background on ... because there's some differences between Canada and the US. This is just here for your reference. It's not here to be tested on this, but it does bring up one other thing. If you reveal 391.41, hopefully you already have before coming here, but if you didn't, there is no English speaking requirement in the medical section. That's going to cover that? You're going to cover that? Okay, then I'm not going to say any more. What does that make? That I'm not going to say any more, because that happens all the time. Questions about that? Sir? Yeah. If, as the gentleman had said, if somebody has a ... for example, he gave a rotator injury, and they have to perform all of these tasks, how do you verify that? Is that the lawyer's responsibility to test them for that, or how do you get confirmed that he can do all that? What do you do? It depends. You're the examiner. You have to ensure that they can do that, so you have to look at their job description, just like you would if you were certifying somebody to go work as a lineman. The employer sends them in for a pre-placement physical, says, I want this guy to be a firefighter. Can he or she perform the jobs of a firefighter? Here's the job description. You're looking at that job description, you're looking at them, and you're like, hmm, they have to be able to crank down a landing gear on a thing, but their arm doesn't work that good. I'm not so sure I can certify this person. What's the next step? Get an opinion from a specialist. Other options might be putting them through a functional capacity evaluation. That's kind of pricey and expensive and time-consuming, but use your diagnostic tools. Then again, it ultimately comes down to your clinical judgment. Again, if it's a fixed permanent defect that's not remutable, you can send them off for an SPE. You don't have to unless they have the true amputation. Who does the SPE? FMCSA. Does it still require an orthopedic consult? There's a process. There is a process that you don't have to be involved with. You just direct them to the website. Certainly, you can print that stuff and give it to them in the office if you'd like. They handle all that, and they bring the packet, turn it in, and then FMCSA takes it from there. Really, my question actually stems from, I run a work-hardening program. I had this guy that had a humeral fracture and a rotator cuff tear. He did really well in my work-hardening program. Solid median physical demand, really strong, but he had a fixed defect. Now, fortunately, I don't like to, on my work-hardening people, I don't also like to be the judge for their medical card, so I send them to someone else to be the judge. But he was a case that, were I to see him, he had a fixed defect, but was really functional. So I was wondering, for his protection, would it be in his interest to go through the process to have it? Now, his medical examiner is a chiropractor. One second. Yeah. You guys have a question. I'm going to mute the question and get the question so it gets on the tape. Sure. So the question is whether or not, even though the medical examiner feels that the driver is qualified, even with a defect, should they still get an SPE for some type of liability protection? Okay. This is not a protection question. Correct. Okay? This is, as Mike said, two pieces, and I want to kind of start back just to make sure. I had a hard time understanding the SPE stuff myself. You have an individual who has a loss of five fingers, which equals loss of a hand. You have a person who has a loss of an arm. That person needs an SPE to be qualified. A person who's missing three fingers, two fingers, one finger, it's up to the medical examiner to determine, does this person have impairment? No, they do not. You can certify them with nothing. Yes, they do. They need the SPE. So that's kind of the breakdown on that. As far as for their protection, it's up to the medical examiner to make the determination, do they have full range of motion or range of motion sufficient to? Answer is yes, no need for an SPE. Answer is no, then the SPE It's not a protection or not protection thing for the examiner or for the driver. So the examiner was a chiropractor, did not look at range of motion and cleared him anyway. I advised him that it would be in his interest to sort of get us through that process, but the examiner didn't request it, so I didn't get involved. In whose interest? I think that's what I was trying to understand. The driver's interest or the chiropractor's interest? Well, I mean, it's also in the motor carrier's interest to know that they truly qualify. Again, whose motor carrier does not make a certification determination. It's the medical examiner that makes that. It's not the employee that's going to be benefited by it. It's not, you know, it's the examiner's decision of do you think and do you maybe think because the chances are for a rotator cuff, they may or may not grant an SPE because it really is whether that's a fixed defect. So. Yeah. The chiropractor cleared him. I'm just going to tell you this. I'm going to tell you this. I like that's what we sort of think about it because everybody looks at things differently. I'm just going to tell you this. You're going to run into people, regardless of the initials after their name, you're going to run into people that doesn't matter what the initials are after their name, chiropractor, DDS, PT, DP team, whatever, that you're going to disagree with their certification decision. That's too bad. At the end of the day, it's whether your name's on it or not. You're not law enforcement. We're not law enforcement. We're not playing Pokemon. We're not going to catch them all. Okay. So it's just at the end of the day, as long as you can go to bed at night knowing that you did the right thing and you're comfortable with that decision and you're comfortable with that person driving a tractor trailer next to your 16-year-old that just learned how to drive, then you've done the best you can. But yeah, at the end of the day, I run into it all the time. You see people that, you know, I used to belong to a very large practice nationwide that that was a constant problem. You know, a guy would go to one clinic, get certified, and go to another clinic and an examiner would say, no, I'm not going to certify you. And the employer gets on the phone with my boss and yells, you know, what the hell? You know, I sent him on to Dr. X and Dr. X certified him and Dr. Y said, drop dead. What's going on? I'm like, and nobody was wrong. So it's very frustrating for drivers. It's frustrating for motor carriers. It's frustrating for everybody. But at the same time, it's the system we have. And I usually tell people in those cases, well, call your congressman. I don't know what else to tell you. This is the way the system is. People are using their medical judgment. Medicine is both an art and a science. And the worst we learn every day. Okay. Anyways, a couple of questions. Reporting people who don't meet. You have an examiner who qualifies somebody who shouldn't be. You can notify FMCSA if it is clearly a violation of the regulations. Somebody has a seizure disorder, but again, did the driver tell that second examiner, I have a seizure disorder? So you can do it, but it doesn't mean that you should. As far as making the decision, there is no right or wrong in almost every single case. Okay. Do I think this is a fixed defect? Yeah. The chiropractor may think it can get better. Maybe the PT thinks it can get better. Maybe the nurse practitioner feels like it definitely can't get any better. I mean, there's not an absolute. And the question though is, can they do that job? Is there enough range of motion to do the job? That's where the medical examiner makes that decision. Okay.

FMCSA

medical evaluations

safety standards

skill performance evaluation

neuromuscular diseases

reciprocity agreements