A Department of Transportation (DOT) physical exam is required for commercial drivers. This exam helps confirm that drivers are physically and mentally able to safely operate commercial motor vehicles (CMVs). The goal is to protect both the driver and everyone else on the road.
However, many drivers do not pass their DOT physical on the first attempt. Health conditions, missing paperwork, or unmanaged medical issues can cause delays or disqualification.
This guide explains the 13 most common reasons drivers fail a DOT physical exam and shares practical steps drivers can take to improve their chances of passing.
Who Needs a DOT Physical Exam?
A DOT physical is required for drivers who operate commercial motor vehicles across state lines. This includes truck drivers, bus drivers, and other professional drivers.
You need a DOT physical if you drive:
A vehicle with a GVWR of 10,001 pounds or more
A vehicle that carries 16 or more passengers, including the driver
A vehicle that transports hazardous materials requiring DOT placards
Most drivers must renew their DOT medical card every two years. Drivers with certain medical conditions may need more frequent exams.
1. Vision Problems
Drivers must have at least 20/40 vision in each eye, with or without glasses or contacts. They must also have at least 70 degrees of peripheral vision in each eye.
Good vision is critical for reading signs, spotting hazards, and driving large vehicles with blind spots. Conditions like cataracts or glaucoma can make it difficult to meet DOT vision standards.
Regular eye exams and corrective lenses can help drivers stay compliant and pass their DOT exam.
2. Hearing Loss
Drivers must be able to hear a forced whisper from five feet away, with or without hearing aids.
Hearing is important for noticing sirens, horns, and warnings. Untreated hearing loss can reduce reaction time and increase accident risk.
Drivers with hearing aids should make sure their devices work properly and meet DOT requirements. Regular hearing tests help ensure continued eligibility.
3. High Blood Pressure
Blood pressure above 140/90 mmHg can lead to DOT exam failure.
High blood pressure increases the risk of heart attack, stroke, and sudden medical events. Drivers may qualify if their blood pressure is well controlled with medication or lifestyle changes.
Some drivers receive temporary certification and must return for re-evaluation once blood pressure improves.
4. Diabetes
Drivers with diabetes must show that their blood sugar is stable and well controlled.
Uncontrolled diabetes can cause dizziness, confusion, fainting, or loss of consciousness. These symptoms are dangerous while driving.
Drivers using insulin may need extra documentation showing proper management. Monitoring blood sugar, following treatment plans, and planning meals are essential for staying certified.
5. Heart Conditions
Heart conditions such as:
Heart attacks
Irregular heart rhythms
Heart failure
Stents or bypass surgery
require extra evaluation.
Drivers may need tests like EKGs or stress tests and clearance from a cardiologist. The goal is to ensure the heart condition does not cause sudden symptoms while driving.
6. Neurological Disorders
Conditions like epilepsy, migraines, or sciatica are reviewed carefully due to the risk of sudden symptoms.
Drivers with well-controlled conditions may still qualify if they provide documentation from a neurologist confirming stability.
Telemedicine allows many drivers to Treat Without Leaving Home, making it easier to manage neurological conditions while staying compliant with DOT requirements.
7. Respiratory Issues
Conditions such as:
Sleep apnea
COPD
Severe asthma
can affect alertness and oxygen levels.
Sleep apnea is especially common among drivers and often requires CPAP therapy. Drivers must show compliance with treatment to stay certified.
Pulmonary testing may be required to confirm safe breathing function during long shifts.
8. Musculoskeletal Problems
Drivers must be able to:
Climb into the cab
Turn the steering wheel
Perform inspections
Load or unload cargo
Chronic back pain, joint injuries, or limited mobility can affect certification.
Physical therapy, proper treatment, and ergonomic adjustments can help drivers maintain mobility and pass their DOT exam.
9. Psychological Disorders
Mental health conditions such as anxiety, depression, or PTSD are evaluated based on how well they are controlled.
Drivers must show their condition does not affect focus, judgment, or reaction time. Medications must not cause drowsiness or impairment.
Honest disclosure and proper treatment help drivers remain eligible.
10. Use of Certain Medications
Some medications may disqualify drivers, including:
Opioids
Sedatives
Certain anxiety or sleep medications
Drivers must disclose all medications. If a provider confirms the medication does not affect driving safety, certification may still be possible.
11. Sleep Apnea
Sleep apnea is one of the most common DOT disqualifiers.
Drivers must show effective treatment, usually with CPAP therapy, and provide proof of consistent use.
Telepsychiatry and telemedicine help drivers manage sleep apnea, track compliance, and attend follow-ups without disrupting work schedules.
12. Obesity
Obesity alone does not disqualify drivers, but it often contributes to:
High blood pressure
Diabetes
Heart disease
Sleep apnea
Weight management can reduce health risks and improve DOT exam outcomes. Even modest weight loss can make a difference.
13. Substance Abuse
Drug or alcohol abuse is an automatic disqualifier.
DOT exams include mandatory drug testing, and substances such as marijuana are prohibited under federal law, even if legal at the state level.
Drivers must complete rehabilitation programs before reapplying if substance abuse is identified.
Conclusion: Why Staying Healthy Matters
A DOT physical exam is about more than certification—it ensures drivers can safely handle the demands of the job.
Proactively managing health conditions helps drivers:
Pass DOT exams
Avoid delays
Stay safe on the road
Extend their driving careers
For transportation companies and drivers alike, staying healthy leads to better performance and fewer risks. Addressing these common issues early makes the DOT physical process smoother and less stressful.
