DOT physical requirements: what they check and why drivers fail
Almost nobody loses a CDL to a dramatic diagnosis. Cards get shortened or pulled over blood pressure, undiagnosed sleep apnea and uncontrolled blood sugar — three things that are entirely manageable with a doctor, and entirely unmanaged when a driver has no coverage.
Blood pressure is the number that decides your certification length
This is the single most consequential part of the exam, and most drivers do not realise that blood pressure does not simply pass or fail — it sets how long your card lasts. The FMCSA guidance a certified medical examiner works from breaks it into stages:
The practical consequence is that a driver at 152/94 who could have been at 132/84 on a $12 generic prescription just traded a two-year card for a one-year card, and will be back in the examiner's office in twelve months with the same problem. Once reduced below 140/90, a stage 3 driver can generally be certified again but on a six-month cycle rather than two years.
Blood pressure is also the most improvable item on this entire page. It responds to medication that costs very little, and the barrier is almost never the drug — it is having a doctor to prescribe and monitor it, which is what a health plan actually buys you.
Sleep apnea: not a regulation, but it ends careers anyway
There is no separate federal rule dedicated to obstructive sleep apnea. What exists is the examiner's obligation to certify only drivers who can operate safely, and untreated OSA with excessive daytime sleepiness does not meet that bar. Examiners screen using the factors in front of them: body mass index, neck circumference, reported snoring and witnessed apnea, high blood pressure, and airway assessment.
If you are referred for a sleep study, that is not the end of your career — it is a detour. Drivers diagnosed with OSA are routinely certified once they are on treatment and can document adherence, commonly understood as using CPAP at least four hours a night on 70% of nights. The machine reports the data automatically.
The important part for coverage: a medically necessary sleep study and CPAP equipment are generally covered health plan benefits. They are not covered by occupational accident policies, which respond only to work-related injury. A driver relying on occ/acc alone is paying for a sleep study out of pocket at a moment when he is already off the road.
Diabetes and blood sugar
Insulin-treated diabetes stopped being an automatic disqualification. Under the current pathway, a treating clinician completes the insulin-treated diabetes assessment form, and the certified medical examiner can certify the driver for up to twelve months if blood sugar is stable and well managed. What still disqualifies is instability — severe hypoglycaemic episodes, or a driver with no recent clinical management at all.
Urinalysis at the exam checks for protein, blood and sugar. A driver who has never been diagnosed and shows sugar in the urine at the exam is in a much worse position than one whose condition is documented, treated and stable, because the examiner has nothing to certify against.
Vision and hearing
Vision requires at least 20/40 acuity in each eye and both together, with or without correction, plus at least 70 degrees of peripheral vision in the horizontal meridian in each eye, and the ability to recognise the colours of traffic signals. Glasses and contacts are fine. Drivers who cannot meet the standard in one eye have a federal vision exemption pathway rather than an automatic end to the career.
Hearing is tested by the forced whisper test at five feet in at least one ear, or by audiometry if that is inconclusive. Hearing aids are permitted, and a driver who passes with aids must wear them while driving.
What the exam covers, and what your health plan covers
The DOT physical itself is an employment-required examination, not treatment, so health plans generally do not pay for it — we cover that in detail in does health insurance cover DOT physicals. What a plan does pay for is everything that determines the outcome: the primary care visit, the blood pressure medication, the sleep study, the CPAP, the diabetes management, the eye exam.
That is the honest case for coverage in this trade. Not that insurance pays for your physical. That being uninsured for two years between physicals is how a driver arrives at the exam with a problem nobody has been treating.
If you are an owner-operator: subsidy eligibility is based on net income after business deductions, not gross settlements — which is why many drivers who assume they earn too much actually qualify for help. See plans for owner-operators.
This page describes the standards a certified medical examiner works from and is general information, not medical advice. Your examiner makes the certification decision, and guidance is updated from time to time — confirm current requirements with your examiner or on the FMCSA National Registry.
DOT physical questions
What blood pressure do you need to pass a DOT physical?
Under 140/90 gets you the full certification, up to 24 months. Between 140/90 and 159/99 you can receive a one-time 12-month certificate. From 160/100 to 179/109 it is a one-time three-month certificate. At 180/110 or above you are disqualified until it comes down, and can then generally be certified on a six-month cycle.
Can you get a CDL medical card with sleep apnea?
Yes. There is no rule barring drivers with obstructive sleep apnea. What disqualifies is untreated apnea with daytime sleepiness. Drivers on CPAP who can document adherence - commonly at least four hours a night on 70% of nights, which the machine records automatically - are routinely certified.
Will my health insurance pay for a sleep study?
A medically necessary sleep study and CPAP equipment are generally covered health plan benefits, subject to your deductible and plan rules. They are not covered by occupational accident policies, which respond only to work-related injury.
Can I drive a truck if I take insulin?
Yes, under the current pathway. Your treating clinician completes the insulin-treated diabetes assessment, and a certified medical examiner can certify you for up to twelve months when blood sugar is stable and well managed. Severe hypoglycaemic episodes are what cause problems, not insulin itself.
What are the vision requirements for a DOT physical?
At least 20/40 in each eye and both together, with or without correction, at least 70 degrees of peripheral vision horizontally in each eye, and the ability to recognise traffic signal colours. Glasses and contacts are permitted. A federal vision exemption programme exists for drivers who cannot meet the standard in one eye.
How long is a DOT medical card valid?
Up to 24 months at maximum. Shorter certifications - twelve months, six months or three months - are issued when a condition needs monitoring, most commonly elevated blood pressure or diabetes.
Does health insurance pay for the DOT physical itself?
Generally no, because it is an employment-required examination rather than treatment. What your plan covers is everything that determines whether you pass: the primary care visits, the blood pressure medication, the sleep study, the CPAP and the diabetes management.
Keep your card. Get covered.
A licensed VS Health Benefits advisor will find a plan that gives you a real doctor and affordable prescriptions — the two things that keep a two-year card. Free, and we work with drivers every day.
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