The DOT physical requirements are the 13 standards in 49 CFR 391.41(b)(1) through (b)(13) [1]. Some are hard numeric floors, such as 20/40 vision in each eye, a 70-degree field in each eye, and hearing at 5 feet or an average loss of 40 decibels or less at 500 Hz, 1,000 Hz, and 2,000 Hz [1]. Others ask whether a condition is likely to interfere with safe CMV operation. At 6 weeks from recert, audit your records against both groups. The exam measures health. It does not reward a last-minute attempt to hide a problem.

What are all 13 DOT physical standards?

Here is the full list in the order used by 49 CFR 391.41(b). The paragraph numbers matter when you or your clinician are gathering records.

Paragraph Standard Plain driver English
(b)(1) Loss of limb A lost limb may require an SPE certificate to show you can perform the job safely [1].
(b)(2) Limb impairment An impaired arm, hand, leg, or foot is reviewed for control of the CMV, with an SPE path available when applicable [1].
(b)(3) Insulin-treated diabetes If diabetes is currently treated with insulin, you must follow the separate process in 49 CFR 391.46 [1][5].
(b)(4) Cardiovascular disease A qualifying heart or blood vessel condition cannot be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure [1].
(b)(5) Respiratory dysfunction Breathing problems cannot be likely to interfere with safe CMV control and driving [1].
(b)(6) High blood pressure The question is whether diagnosed high blood pressure is likely to interfere with safe operation [1].
(b)(7) Musculoskeletal and related disease Rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease must not impair safe operation [1].
(b)(8) Epilepsy or loss of consciousness No epilepsy diagnosis or other condition likely to cause loss of consciousness or loss of CMV control [1].
(b)(9) Mental and psychiatric conditions Mental, nervous, organic, functional, or psychiatric disease must not interfere with safe operation [1].
(b)(10) Vision At least 20/40 distant vision in each eye, at least 70 degrees of field in each eye, and recognition of red, green, and amber signals [1].
(b)(11) Hearing Forced whisper in the better ear at not less than 5 feet, or average loss of 40 decibels or less at the listed frequencies [1].
(b)(12) Drug use No Schedule I or other habit-forming drug use unless prescribed by a licensed practitioner familiar with your medical history [1].
(b)(13) Alcoholism No current clinical diagnosis of alcoholism [1].

The table is a self-audit, not a certification decision. The medical examiner applies the standard during the hands-on exam and record review.

Which DOT requirements are hard numbers?

Vision and hearing have the clearest fixed measurements. For vision, each eye must reach at least 20/40 Snellen, with or without corrective lenses. Each eye must have a horizontal field of at least 70 degrees, and you must recognize red, green, and amber traffic signals [1]. A licensed ophthalmologist or optometrist may perform the vision portion of the exam [2]. If your current glasses are scratched, outdated, or missing, fix that before the visit rather than finding out at the clinic.

Hearing has 2 routes. You must first perceive a forced whispered voice in the better ear at not less than 5 feet. Or, you can meet the audiometric route with an average hearing loss in the better ear of 40 decibels or less at 500 Hz, 1,000 Hz, and 2,000 Hz. A hearing aid may be used to meet the standard [1].

These numbers are floors written into the qualification standard. They are different from conditions where the examiner weighs symptoms, treatment, stability, and safe operation.

Which requirements depend on examiner judgment?

Blood pressure is the common example. The regulation says you cannot have a current clinical diagnosis of high blood pressure likely to interfere with operating a CMV safely. The regulation itself does not contain a numeric blood pressure cutoff [1]. The staging numbers come from examiner guidance.

Under the 2024 Medical Examiner's Handbook guidance, below 140/90 can support certification for the full period, up to a 2-year card. A reading of 140-159 systolic or 90-99 diastolic is tied to a 1-year card. A reading of 160-179 systolic or 100-109 diastolic can lead to a one-time 3-month certificate while treatment starts or is adjusted. Readings at or above 180 systolic or 110 diastolic disqualify a driver until blood pressure is controlled. Either number alone can place you in a stage [4].

Respiratory, cardiovascular, musculoskeletal, seizure, and mental health standards also use an interference-with-safe-operation test. A heart condition with syncope, dyspnea, collapse, or congestive cardiac failure is named in the cardiovascular standard [1]. A respiratory condition is a concern when it could affect control and driving [1]. This is examiner judgment, not a single federal cutoff.

How does insulin-treated diabetes change the process?

Insulin-treated diabetes does not use a federal exemption path now. The driver follows 49 CFR 391.46, and the treating clinician who manages and prescribes insulin completes and signs the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 [5]. The medical examiner then examines the driver at least annually and no later than 45 days after the treating clinician signs the form [5].

The record requirement affects the possible certificate length. With at least 3 months of electronic blood glucose self-monitoring records, an insulin-treated driver can be certified for up to 12 months. Without those records, the certificate can be up to 3 months while the record builds [5]. The 2018 final rule replaced the old federal diabetes exemption program with the MCSA-5870 assessment and regular exam process [6].

At 6 weeks out, do not leave this form for the exam morning. Ask the clinician who manages your insulin to complete the MCSA-5870, confirm the signature date, and book the medical examiner appointment inside the required 45-day window. The examiner still makes the certification decision.

What happens at the exam and who can issue the card?

The DOT physical must be performed by a medical examiner listed on the FMCSA National Registry of Certified Medical Examiners [2]. You can check the examiner before booking through the National Registry search. Roadworthy does not perform DOT exams, employ medical examiners, or issue med cards. It helps with the health work between exams.

The visit includes a health history review, blood pressure and pulse, vision and hearing checks, a urinalysis dipstick that screens specific gravity, protein, blood, and glucose, and a hands-on exam of body systems [4]. The findings go on Medical Examination Report Form MCSA-5875. A qualified driver receives Medical Examiner's Certificate Form MCSA-5876, the wallet card drivers call the DOT medical card or med card [2].

The maximum certification interval is 24 months, or 2 years, but an examiner can certify for less when a condition needs monitoring. Certificate length within the rules is examiner clinical judgment [3][4]. Drivers with insulin-treated diabetes under 391.46 or the alternative vision standard must be examined and certified every 12 months [3]. If a physical or mental injury or disease impairs your normal duties, you must be re-examined even if the current certificate has not expired [3].

For the broader exam process, see how the DOT medical exam works. If you want the conditions that can stop certification grouped in one place, use DOT physical disqualifying conditions. The main DOT physical hub has the related driver guides.

Which DOT physical requirements do not exist?

There is no BMI number in 49 CFR 391.41, and the Medical Examiner's Handbook sets no BMI trigger [1][4]. Weight can still matter indirectly when it connects to blood pressure, breathing, mobility, or another condition that affects safe driving. But a scale reading alone is not a qualification standard.

There is no A1C number in the qualification standards [1]. Diabetes is handled through the applicable standard and, for insulin-treated drivers, the MCSA-5870 process under 391.46 [5]. An A1C result may be part of your medical record, but the standard does not state an A1C cutoff.

There is also no FMCSA regulation that names sleep apnea [7]. FMCSA and FRA withdrew the sleep apnea rulemaking on August 8, 2017. The handbook sets no sleep apnea screening requirement and no BMI trigger. Whether sleep testing is needed before certification is examiner judgment under the respiratory standard [4][7]. That does not make breathing concerns irrelevant. It means the decision is based on the examiner's assessment, not an automatic federal sleep apnea rule.

What to do next

Written for a driver auditing the requirements 6 weeks before recert.

  1. Pull your current MCSA-5876 and mark the expiration date.
  2. Check the medical examiner in the FMCSA National Registry before booking.
  3. Test your glasses, contact lenses, hearing aid, and traffic-signal color recognition before the appointment.
  4. Start a home cuff log and bring it with your medication list if blood pressure is an issue.
  5. If you use insulin, ask the treating clinician to complete MCSA-5870 and confirm the 45-day exam window [5].
  6. Gather cardiac, respiratory, seizure, mental health, musculoskeletal, or limb records that explain current function and treatment.
  7. Book the exam with enough time to address a missing form or record before the current card expires.
  8. Read the DOT physical exam guide and the disqualifying-conditions guide before you arrive.

Sources

  1. Cornell Law School LII, 49 CFR 391.41, physical qualification standards, all 13 standards and numeric vision and hearing requirements, accessed 2026-08-01, https://www.law.cornell.edu/cfr/text/49/391.41
  2. Cornell Law School LII, 49 CFR 391.43, who performs the exam and the forms, examiner registry, MCSA-5875, MCSA-5876, and vision providers, accessed 2026-08-01, https://www.law.cornell.edu/cfr/text/49/391.43
  3. Cornell Law School LII, 49 CFR 391.45, who must be examined and when, certification intervals and re-examination rules, accessed 2026-08-01, https://www.law.cornell.edu/cfr/text/49/391.45
  4. FMCSA Medical Examiner's Handbook, 2024 edition, blood pressure staging, exam components, BMI, and sleep apnea guidance, accessed 2026-08-01, handbook-appendix
  5. Cornell Law School LII, 49 CFR 391.46, insulin-treated diabetes standard, MCSA-5870, records, and exam timing, accessed 2026-08-01, https://www.law.cornell.edu/cfr/text/49/391.46
  6. Federal Register via govinfo, diabetes standard final rule of September 19, 2018, replacement of the federal diabetes exemption process, accessed 2026-08-01, https://www.govinfo.gov/content/pkg/FR-2018-09-19/html/2018-20161.htm
  7. Federal Register via govinfo, withdrawal of the sleep apnea rulemaking, August 8, 2017, withdrawal of the proposed sleep apnea rulemaking, accessed 2026-08-01, https://govinfo.gov/content/pkg/FR-2017-08-08/html/2017-16451.htm
  8. FMCSA National Registry of Certified Medical Examiners, official search, examiner verification before booking, accessed 2026-08-01, https://nationalregistry.fmcsa.dot.gov/