Living with Diabetes
Commercial Drivers' Licenses
History
For many years, federal law prohibited anyone with insulin-treated diabetes from operating a commercial motor vehicle in “interstate commerce” (this includes not only when the driver is crossing state lines but when the goods or people being carried are on their way to or from another state). These rules were based on diabetes medicine dating to the 1970s, rather than current diabetes science and management. While some states permitted those who use insulin to drive within their state under a medical waiver, that only allowed a few qualified people to maintain jobs in commercial driving.
The American Diabetes Association worked hard for many years to eliminate this blanket ban and get the U.S. Department of Transportation through the Federal Motor Carrier Safety Administration (FMCSA) to institute a system of individual assessment – where each potential driver would be assessed based on how diabetes affected him or her. In 2003, the Diabetes Exemption Program was born, establishing a system of individual assessment.
Read the comments filed by the American Diabetes Association on the proposed exemption program and the inclusion of a “three year rule” in the program:
- Comments of the American Diabetes Association on the Federal Motor Carrier Safety Admininstration's Proposal to Issue Exemptions to Individuals with Insulin-Treated Diabetes (PDF) (2001)
- Additional Comments of the American Diabetes Association on the Proposed Exemption Program (PDF) (2002)
Read the American Diabetes Association’s press release concerning the establishment of the Diabetes Exemption Program:
- “Exemption Program for Insulin-Treated Commercial Drivers Ends Blanket Ban,” (PDF) (September 2003)
Diabetes Exemption Program
The Diabetes Exemption Program was a big step forward, but it contained a provision that required individuals to have three years of commercial driving experience while using insulin in order to even be eligible for an exemption – a big Catch 22 since it was impossible to gain this driving experience in many states, and nearly impossible in others. This “three year rule” was not necessary to ensure safety, since the program contained over fifty other medical and safety provisions. Further, it was opposed by FMCSA’s own Expert Medical Panel. Out of the hundreds of individuals who applied for an exemption, only four received one due to the difficulty of meeting the three year requirement. Thus, ADA continued the fight to obtain an effective system of individual assessment, turning back to Capitol Hill for help.
- Federal Register Notice Announcing the Diabetes Exemption Program, (PDF) Federal Register vol. 68, page 52331, Sept. 3, 2003
- Diabetes Exemption Program Application - visit the Federal Motor Carrier Safety Administration Web site to download an application for a commercial driver's license exemption
- Chart of Safety & Medical Screenings, Operating Guidelines, and Monitoring & Accountability Provisions of the Diabetes Exemption Program (PDF) (updated October 2007)
- 708 exemptions have been granted to date (updated 7/28/08)
Legislation
In the summer of 2005, Congress passed and the President signed the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy of Users (SAFETEA-LU), which required that FMCSA amend the exemption program to eliminate the three year requirement and institute the recommendations of the Expert Medical Panel. FMCSA did so, but at the same time it issued a notice that it would only allow those with an A1C between 7 and 10 to obtain an exemption. Yet again, ADA went to bat to eliminate a nonsensical provision. As of now, the provision is still on the books, but FMCSA has committed in writing to not using it as an absolute criteria.
- Public Law 109-59: The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) (PDF) – Section 4129, Operation of Commercial Motor Vehicles by Individuals Who Use Insulin to Treat Diabetes Mellitus.
- Federal Motor Carrier Safety Administration Revises Diabetes Exemption Program, (PDF) Federal Register volume 70, page 67777, Nov. 8, 2005
Read the letter to FMCSA (PDF) from Drs. Michael Brennan, George Grunberger, Edward Horton and Christopher Saudek, members of the FMCSA Diabetes Expert Medical Panel, regarding the use of an A1c requirement:
ADA issued a press release regarding the new law passed by Congress:
- “Congress Passes Transportation Legislation Affecting Commercial Drivers Who Use Insulin,” (PDF) (August 1, 2005)
Medical Review Board & Diabetes Panel
In early 2006, as required by a separate provision of SAFETEA-LU, FMCSA established a Medical Review Board (MRB) to provide advice and recommendations to the agency on the physical qualification standards for diabetes and about a dozen other medical conditions. The five-member MRB consists of physicians with specialties in occupational medicine, medical toxicology, neurology, orthopedic surgery, and sleep medicine. The agency also convened a diabetes panel to review evidence specific to commercial driving and diabetes.
- Announcement of Establishment of the Federal Motor Carrier Safety Administration Medical Review Board, (PDF) Federal Register volume 70, page 57642, Oct. 3, 2005
The diabetes panel members – all board certified endocrinologists who treat people with diabetes – met for three days in August 2006 and presented recommendations to the MRB concerning the safety of commercial driving by people with diabetes. The panel unanimously agreed that people with diabetes do not pose an unacceptable risk for a motor vehicle crash and recommended that the agency adopt regulations that do not restrict an individual’s ability to operate a commercial motor vehicle based on diabetes or insulin use. The panel also recommended that the treating physician as well as an agency-appointed endocrinologist be involved in the decision whether to certify the individual for interstate commercial driving.
Read the panel’s report to the MRB:
- Expert Panel Commentary and Recommendations: Diabetes and Commercial Motor Vehicle Driver Safety, (PDF) (Sept. 8, 2006)
The panel presented these recommendations to the MRB in a public meeting in November 2006. At their July 26, 2007 public meeting, the MRB issued its recommendations about the diabetes standard to the agency, including a recommendation that insulin-treated commercial drivers be certified for interstate driving – outside the current exemption process – if they meet certain medical criteria similar to what is currently required for a diabetes exemption. Unfortunately, the MRB also recommended restricting insulin-treated commercial drivers from operating vehicles transporting passengers or hazardous materials. The American Diabetes Association strongly opposes this aspect of the MRB’s recommendation.
Rulemaking
In conjunction with the requirements of SAFETEA-LU to conduct an evaluation of the physical qualification requirements in the Federal Motor Carrier Safety Regulations and to establish a Medical Review Board to provide guidance and recommendations on this process, in March 2006 FMCSA issued an Advance Notice of Proposed Rulemaking (ANPRM) (PDF) concerning possible revision to the diabetes standard. The ANPRM announced the agency’s intention to consider amending the physical qualification standards to allow the operation of commercial motor vehicles in interstate commerce by individuals with insulin-treated diabetes – without needing to first obtain an exemption from FMCSA.
The American Diabetes Association submitted extensive comments in response to the ANPRM:
- Comments of the American Diabetes Association on the FMCSA Advance Notice of Proposed Rulemaking, (PDF) June 2006
In light of the MRB’s recommendations to the agency, the next step is for FMCSA to undertake the rulemaking process. It is possible that it will adopt the MRB recommendations in whole or in part. The rulemaking process will take several years, during which time ADA will continue to work to ensure that people who are qualified to drive commercial vehicles – ALL commercial vehicles – are allowed to do so and are not discriminated against because of diabetes.
State Waiver Programs
Many states have medical waiver programs that allow a person with insulin-treated diabetes who meets the state’s criteria to operate intrastate commercial vehicles. Contact your state Department of Transportation, Department of Motor Vehicles, or Secretary of State’s office to find out whether this is an option in your state and what requirements you must meet.
School Bus Licenses
Some states may have restrictions on who may drive school buses. School buses are primarily regulated by the states, unless they are being operated in interstate commerce. In two related cases brought by the U.S. Department of Justice, Arizona and North Carolina were prohibited from refusing to hire a person with diabetes to drive a school bus based solely on the person’s diagnosis of diabetes.
Read about these cases:
- Arizona, North Carolina Lift Diabetic Driver Ban, Micheal J. Sniffen, 1998
- Settlement Agreement between the United States of America and the North Carolina Department of Motor Vehicles, July 28, 1998
Commercial Driving Resources
Questions and Answers about diabetes and commercial driving, federal regulations, the Diabetes Exemption Program, and the new law:
- Frequently Asked Questions About Commercial Driver’s Licenses (updated Nov. 2006)
U.S. Department of Transportation, Federal Motor Carrier Safety Administration
1200 New Jersey Avenue, SE
Suite W60-300
Washington, DC 20590
Phone: 1-800-832-5660
Website: http://www.fmcsa.dot.gov
FMCSA Medical Review Board: http://mrb.fmcsa.dot.gov
703-998-0189, ext. 237
Federal Motor Carrier Safety Regulations, Physical Qualifications Requirements
Code of Federal Regulations, vol. 49, section 391.41
(49 C.F.R. 391.41)
Updated 10/16/08
