Lithium is used for mental health disorders and requires regular lab work. Coumadin is an anticoagulant that requires a monthly INR value of 2-3. Xarelto is an anticoagulant that does not require lab monitoring. Montelukast (Singulair) is used for the treatment of allergies.

It is not uncommon for a driver with diabetes to have hyperglycemia. In most cases, high blood glucose levels have minimal short-term effect on individuals. Symptoms of hypoglycemia include a rapid heartbeat, shaking, sweating, confusion, dizziness, and syncope. Untreated hypertension causes organ damage but unless the individual has stage 3 hypertension, they are not at risk for incapacitation. Hyperhidrosis (excessive sweating) is by far the least concerning of these conditions.

The medical examiner should be concerned about the spasticity and the possibility of a medical condition causing progressive musculoskeletal imbalance. Deep tendon reflexes of the achilles, patellar, and biceps tendons should be checked to determine level of spasticity. If notable, the driver should be referred to a neurologist prior to being certified.

Monovision is disqualifying. It is when one eye is corrected for far vision and the other is for near vision, often resulting in blurry vision. Monocular vision is when one eye meets the vision standard but the other does not. Studies have shown that drivers with monocular vision are just as safe as those with normal vision. Technically, the first condition listed would be considered monocular vision. Provided the driver meets the vision standard in the other eye, they could be certified using the alternate vision standard. Finally, drivers are not required to pass the Ishihara test. They simply must be able to distinguish between traffic signal colors red, amber, and green.

Auscultation of a bruit over the abdomen is indicative of an abdominal aortic aneurysm. 90% of aneurysms detectable on exam are greater than 6cm in diameter and are at high risk of rupturing. There are many factors that may cause a pulse of 118bpm and if this is their normal rate, it warrants further investigation. However, it is not likely to be the cause of incapacitation. A HbA1c of 11% indicates that the driver’s diabetes is not well controlled, but it is extremely unlikely for this level of hyperglycemia to cause incapacitation.

There are numerous variations of colorblindness, and the driver is only required to be able to distinguish between signal red, amber, and green. Since they cannot distinguish between the traffic signal colors, they must be disqualified. A federal vision exemption no longer exists.

Due to the fact that the hernia is non-reducible and symptomatic before certification an evaluation should be obtained.

Although Medical Examiners are not required to determine whether a driver understands English well enough to drive (that is the Motor Carrier's responsibility), they are responsible to determine if the driver understands well enough for the medical exam to be performed.  In this case, the driver does not understand English well enough for a proper medical exam to be performed.  A remedy would be for an interpreter to be present during the medical exam.

It is recommended that an individual obtain an ETT 4-6 weeks post MI and then every 2 years after that. To pass an ETT, an individual must exceed 6 METs. Also, a driver with a history of a respiratory disease must have recent results of a pulmonary function test.

This is Stage 3 hypertension.  The driver is disqualified until their blood pressure is less than or equal to 140/90 at which time, they will have a maximum certification of 6 months from the date of this examination.

FMCSA has not adopted a standard cervical range of motion guideline for drivers.  However, drivers must be able to view both mirrors.  The driver can rotate the thoracic or lumbar spine as needed to see both mirrors and if otherwise qualified can be certified for up to 2 years.

The ME should consider disqualifying an individual with a second spontaneous pneumothorax on the same side is until successful surgical treatment is rendered.

Lithium levels above 1.5mEq/L can cause diarrhea, muscle weakness, poor coordination, and vomiting. When levels rise above 2mEq/L, an individual can experience blurred vision, dizziness, and tinnitus.

For drivers that check the box for illegal drug use, the responsibility of the ME is to determine if they are still using marijuana.  Rarely is marijuana physically addicting, it is usually a choice.  If a driver is a regular marijuana user, they will test positive for marijuana for up to 8 weeks.  If they recently smoked a single joint, they would have a low concentration or will have a negative result after a week.