DOT Physical Requirements: The 391.41 Standards (2026)

The DOT physical measures you against a fixed federal standard — 49 CFR 391.41. This page describes each standard and the process for it. It cannot tell you whether you personally qualify; only a certified examiner can do that. Bring your situation to one.

Requirements verified July 20, 2026 against FMCSA (49 CFR 391.41)

How to read this page

The physical qualification standards live in 49 CFR 391.41(b)(1) through (13). Below are the ones drivers ask about most, described as the regulatory standard and the process — not as a pass/fail checklist you can score at home. The certified examiner applies these standards to your exam, and for several conditions there are legitimate exemption or alternative paths, covered at the end.

Vision — 391.41(b)(10)

The vision standard has three parts, in each eye:

• Acuity: at least 20/40, with or without corrective lenses.
• Field of vision: at least 70 degrees in the horizontal meridian.
• Color recognition: able to recognize the colors of traffic signals — red, green, and amber.

Glasses and contacts are allowed; if you need them to meet the standard, the certificate carries a “corrective lenses” restriction. If one eye can’t meet the standard, see the alternative vision standardbelow.

Hearing — 391.41(b)(11)

You meet the hearing standard if, in your better ear, you can either:

• Perceive a forced whispered voice at 5 feet or more, or
• Have an average hearing loss of 40 decibels or less at 500, 1000, and 2000 Hz (audiometry).

Hearing aids are permitted to meet the standard.

Blood pressure / hypertension — 391.41(b)(6)

The rule states a driver must not have a current diagnosis of high blood pressure likely to interfere with safe driving. Notably, the regulation itself sets no single numeric cutoff. FMCSA examiner guidance ties higher stages of blood pressure to shorter certification periods and follow-up exams. In practice, that means someone with controlled or borderline blood pressure may be certified for a shorter window rather than turned away. The examiner decides based on your readings and history.

Diabetes and insulin — 391.41(b)(3) and 391.46

Diabetes is no longer an automatic barrier. The insulin-treated diabetes mellitus (ITDM) standard in 49 CFR 391.46 replaced the old exemption program. The process:

• Your treating clinician completes Form MCSA-5870, documenting that your condition is stable and well controlled.
• The certified examiner reviews that form as part of the exam.
• If qualified, the examiner may certify you for up to 12 months (a shorter maximum than the usual 24).

Non-insulin diabetes is evaluated under the general standard by the examiner.

Epilepsy / seizures — 391.41(b)(8)

The standard is that a driver must have no established medical history or clinical diagnosis of epilepsy or any condition likely to cause loss of consciousness or loss of the ability to control a commercial vehicle. Seizure history is evaluated carefully, and FMCSA runs a case-by-case exemption program for some situations. This is one to discuss directly with a certified examiner and, where relevant, through the FMCSA exemption process.

Sleep apnea — no specific regulation

This is widely misunderstood, so to be precise: there is no specific FMCSA regulation that requires sleep apnea screening or testing. A 2016 advance notice of proposed rulemaking on obstructive sleep apnea waswithdrawn in 2017. Sleep apnea is instead handled under the examiner’s general medical judgment and the respiratory standard (391.41(b)(5)). Because there is no fixed rule, examiner and employer practices vary. If sleep apnea applies to you, talk it through with your certified examiner.

Exemptions, alternative standards, and waivers

If a standard is hard for you to meet, the answer is a legitimate, documented path — not skipping the exam. The main ones:

Alternative vision standard — 391.44

Effective March 22, 2022, the alternative vision standard (49 CFR 391.44) replaced the older vision exemption program. If your better eye meets 20/40 and the 70-degree field, you can recognize traffic-signal colors, and your vision is stable, an ophthalmologist or optometrist completes Form MCSA-5871, and the certified examiner then makes a determination. This lets some drivers who can’t meet the standard in one eye still qualify.

Insulin-treated diabetes standard — 391.46

As above, this is a standard (not a waiver): Form MCSA-5870 from your treating clinician, examiner review, and certification up to 12 months.

Skill Performance Evaluation (SPE) certificate — 391.49

For a fixed limb impairment or loss (391.41(b)(1)–(2)), the SPE certificate under 49 CFR 391.49 is the route. You apply to an FMCSA Service Center, and the process includes a road test to show you can operate the vehicle safely. Confirm the exact certificate term and renewal details in the regulation, as they can change.

For other conditions such as hearing or seizures, FMCSA runs case-by-case exemption programs. The DOT physical disqualifications page walks through these paths in more detail.

Related pages

Back to the DOT physical hub. See theCDL medical card for what happens after you pass, and DOT physical disqualifications for conditions and the legitimate paths around them. New to this? Read how to get a CDL. Driving offenses are covered separately underCDL disqualifications. State medical rules differ — for example, Florida.

DOT physical requirements FAQ