This is the accessible text file for GAO report number GAO-08-826 
entitled 'Commercial Drivers: Certification Process for Drivers with 
Serious Medical Conditions' which was released on July 21, 2008.

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Report to Congressional Requesters: 

United States Government Accountability Office: 
GAO: 

June 2008: 

Commercial Drivers: 

Certification Process for Drivers with Serious Medical Conditions: 

GAO-08-826: 

GAO Highlights: 

Highlights of GAO-08-826, a report to congressional requesters. 

Why GAO Did This Study: 

Millions of drivers hold commercial driver licenses (CDL), allowing 
them to operate commercial vehicles. The Department of Transportation 
(DOT) established regulations requiring medical examiners to certify 
that these drivers are medically fit to operate their vehicles and 
provides oversight of their implementation. Little is known on the 
extent to which individuals with serious medical conditions hold CDLs. 
GAO was asked to (1) examine the extent to which individuals holding a 
current CDL have serious medical conditions and (2) provide examples of 
commercial drivers with medical conditions that should disqualify them 
from receiving a CDL. 

To examine the extent to which individuals holding CDLs have serious 
medical conditions, GAO identified those who were in both DOT’s CDL 
database and selected federal disability databases of the Social 
Security Administration, Office of Personnel Management, and 
Departments of Veterans Affairs and Labor and have been identified as 
100 percent disabled according to the program’s criteria. Because DOT’s 
data also include inactive licenses, GAO obtained current CDL data from 
12 selected states based primarily on the size of CDL population. To 
provide case study examples, GAO focused on four states—Florida, 
Maryland, Minnesota, and Virginia. For 15 drivers identified from data 
mining, GAO interviewed, as appropriate, the driver, driver’s employer, 
and driver’s physician. GAO is not making any recommendations. 

What GAO Found: 

Commercial drivers with serious medical conditions can still meet DOT 
medical fitness requirements to safely operate a commercial vehicle and 
thus hold CDLs. However, there is general agreement that careful 
medical evaluations are necessary to ensure that serious medical 
conditions do not preclude the safe operation of a commercial vehicle. 
Because medical determinations rely in large part on subjective factors 
that are not captured in databases, it is impossible to determine from 
data matching and mining alone the extent to which commercial drivers 
have medical conditions that preclude them from safely driving a 
commercial vehicle and therefore if the certification process is 
effective. GAO’s analysis provides a starting point for exploring the 
effectiveness of the current CDL medical certification process. 

Our analysis of commercial license data from DOT and medical disability 
data from the Social Security Administration, Office of Personnel 
Management, and Departments of Veterans Affairs and Labor found that 
about 563,000 of such individuals had commercial driver licenses and 
were determined by the federal government to be eligible for full 
disability benefits. This represented over 4 percent of all commercial 
driver licenses in the DOT database. Our analysis of 12 selected states 
indicates that most of these commercial drivers still have active 
licenses. Specifically, for these 12 selected states, about 85 percent 
had a current CDL even though they had a medical condition from which 
they received full federal disability benefits. The majority of these 
drivers were issued a CDL after the driver was approved for full 
federal disability benefit. 

Our investigations detail examples of 15 cases where careful medical 
evaluations did not occur on commercial drivers who were receiving full 
disability benefits for serious medical conditions. The following table 
details some of the more egregious examples from our investigation. 

Table: Examples of Commercial Drivers with Serious Medical Conditions: 

Type of driver: Bus; 
State: Florida; 
Medical condition: Driver receives disability benefits due to breathing 
insufficiency, for which he uses three daily inhalers. He stated that 
he “occasionally blacks out and forgets things,” but continues to hold 
a CDL and be hired as a substitute bus driver, despite not having the 
required medical certificate. 

Type of driver: Bus; 
State: Minnesota; 
Medical condition: Driver receives disability benefits due to epilepsy. 
He also suffers from headaches, sleep apnea, asthma, and high blood 
pressure. Driver and medical examiner agreed that if the driver felt 
“loopy” he would not drive a commercial vehicle. 

Type of driver: Truck; 
State: Florida; 
Medical condition: Driver receives disability benefits for multiple 
sclerosis, which causes fatigue. Driver hauls circus equipment to 
various shows, despite not having the required medical certificate. 

Type of driver: Truck; 
State: Maryland; 
Medical condition: Driver receives disability benefits for complete 
deafness. Medical examiner acknowledged error in certifying medical 
fitness of driver. 

Source: GAO. 

[End of table] 

To view the full product, including the scope and methodology, click on 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-826]. For more 
information, contact Greg Kutz at (202) 512-6722 or kutzg@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

Serious Medical Conditions and Commercial Driver Licenses: 

Examples of Commercial Drivers with Serious Medical Conditions: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology: 

Appendix II: Medical Certificate Requirements: 

Appendix III: Information on Commercial Drivers for the 12 Selected 
States: 

Appendix IV: Methods Used by States to Verify Commercial Driver Medical 
Certification: 

Appendix V: Commercial Drivers with Serious Medical Conditions: 

Appendix VI: Staff Acknowledgments: 

Tables: 

Table 1: NTSB's Recommendations to FMCSA for Preventing Unqualified 
Drivers from Operating Commercial Vehicles: 

Table 2: Summary Information on Five Commercial Drivers with Active 
Licenses despite Serious Medical Conditions: 

Table 3: Detail Information on Commercial Drivers for 12 Selected 
States: 

Table 4: Summary Information on Remaining 10 Commercial Drivers with 
Serious Medical Conditions: 

Figures: 

Figure 1: CDL Drivers Receiving Full Federal Disability Benefits for 12 
Selected States: 

Figure 2: State Methods to Verify Medical Certification: 

Abbreviations: 

CDL: Commercial Driver License: 

CDLIS: Commercial Driver License Information System: 

COPD: Chronic Obstructive Pulmonary Disorder: 

DOL: Department of Labor: 

DOT: Department of Transportation: 

FMCSA: Federal Motor Carrier Safety Administration: 

NTSB: National Transportation Safety Board: 

OPM: Office of Personnel Management: 

SPE: Skills Performance Evaluation: 

SSA: Social Security Administration: 

VA: Department of Veterans Affairs: 

[End of section] 

United States Government Accountability Office:
Washington, DC 20548: 

June 30, 2008: 

The Honorable James L. Oberstar: 
Chairman: 
Committee on Transportation and Infrastructure: 
House of Representatives: 

The Honorable Peter A. DeFazio: 
Chairman: 
Subcommittee on Highways and Transit: 
Committee on Transportation and Infrastructure: 
House of Representatives: 

Millions of American drivers hold commercial driver licenses (CDL), 
allowing them to operate a variety of commercial vehicles such as 
school buses, cargo vans, and tractor trailers. To help prevent 
accidents resulting from commercial drivers with medical conditions, 
federal law requires medical examiners to certify that commercial 
drivers are medically fit to operate their vehicles. Specifically, the 
Department of Transportation (DOT) requires commercial drivers to 
undergo a medical physical examination at least every 2 years. As part 
of this medical physical, DOT regulations establish standards that the 
medical examiner must follow to determine a driver's fitness including 
reviewing the driver's medical history, performing key medical tests 
(such as vision and hearing tests), and conducting a physical 
examination of the commercial driver. Notwithstanding these written 
regulations, medical examiners must still exercise judgment in 
determining whether individuals are medically fit to drive commercial 
vehicles, such as people whose serious medical conditions make them 
eligible for federal disability benefits. 

Not all serious medical conditions interfere with the safe operation of 
a commercial vehicle. However, some serious medical conditions can and 
should disqualify a driver from being medically certified according to 
DOT regulations. 

It is unknown to what extent individuals with serious medical 
conditions hold CDLs and whether there are situations of medically 
unfit individuals who hold a CDL. In this context, you asked us to (1) 
determine to the extent possible the number of individuals holding a 
current CDL who have serious medical conditions, and (2) provide case- 
study examples of commercial drivers who hold an active CDL despite 
having a medical condition that should disqualify them from obtaining a 
CDL. 

To explore the overlap between CDL holders and people with serious 
medical conditions, we identified individuals who were in both DOT's 
Commercial Driver License Information System (CDLIS) database and 
selected federal disability databases. We presumed that individuals 
receiving full federal disability benefits were eligible for these 
benefits because of the seriousness of their medical conditions. DOT's 
CDLIS database contains an archive of all CDLs reported to DOT by the 
states. We obtained this database and compared the CDL holders from 
CDLIS with the disability recipients of selected federal programs 
administered by the Social Security Administration (SSA), Department of 
Veterans Affairs (VA), Office of Personnel Management (OPM), and 
Department of Labor (DOL). Specifically, we identified CDL holders that 
are both currently receiving disability benefits and have been 
identified as 100 percent disabled according to the program's criteria. 
We further analyzed the recipient files to extract those medical 
conditions that would likely disqualify a driver from a CDL, such as 
deafness and epilepsy. Because CDLIS contains inactive CDLs in its 
population, we obtained data of active CDLs from a nonrepresentative 
selection of 12 states to identify those CDL holders in CDLIS that have 
an active CDL.[Footnote 1] Further, because commercial drivers may 
contract a serious medical condition after the issuance of the CDL, we 
determined the number of individuals that received their CDL subsequent 
to the federal agencies determination that the individual is eligible 
for full benefits due to their medical condition. In addition, our 
estimate does not include drivers with severe medical conditions that 
are not in the selected federal programs we analyzed. 

To provide case-study examples of commercial drivers who hold active 
CDLs and also receive full federal benefits due to a CDL disqualifying 
medical condition, we focused on four states as agreed to with your 
staff--Florida, Maryland, Minnesota, and Virginia. From these four 
states, we selected, for detailed investigation, 15 commercial drivers 
that we identified based on our data analysis and mining. For each 
case, we interviewed, as appropriate, the commercial driver, the 
driver's employer, and the driver's physician to determine whether, 
under current DOT regulations and guidelines, the medical condition 
should have precluded the driver from holding a valid CDL. For these 15 
cases, we also reviewed relevant state department of motor vehicle 
reports, police reports, and other public records. 

We performed our investigative work from May 2007 to June 2008 in 
accordance with standards prescribed by the President's Council on 
Integrity and Efficiency. A detailed discussion of our scope and 
methodology is presented in appendix I. 

Results in Brief: 

Commercial drivers with serious medical conditions, even those whose 
conditions qualify them for full federal disability benefits, can still 
meet DOT medical fitness requirements to safely operate a commercial 
vehicle and thus hold CDLs. However, there is general agreement that 
careful medical evaluations are necessary to ensure that serious 
medical conditions do not preclude the safe operation of a commercial 
vehicle. Because medical determinations rely in large part on 
subjective factors that are not captured in databases, it is impossible 
to determine from data mining and matching the extent to which 
commercial drivers have medical conditions that preclude them from 
safely driving a commercial vehicle and therefore if the certification 
process is effective. As such our analysis provides a starting point 
for exploring the effectiveness of the current CDL medical 
certification process. 

Our analysis of commercial license data from DOT and medical disability 
data from SSA, VA, OPM, and DOL found that about 563,000 individuals 
had CDLs and were determined by the federal government to be eligible 
for full federal benefits due to their medical condition.[Footnote 2] 
This represented over 4 percent of all CDLs in the DOT database. 
Further, our analysis also showed that over 1,000 of these drivers were 
diagnosed with vision, hearing, or seizure disorders, which are medical 
conditions that would generally deny the granting of a CDL. 

While some of the 563,000 commercial drivers may have inactive 
licenses, our analysis of 12 selected states indicates that most of 
these commercial drivers still have active licenses. Specifically, of 
the 563,000 CDL holders receiving full disability benefits, about 
135,000 were from our 12 selected states. Of these 135,000 commercial 
drivers, about 114,000, or approximately 85 percent, had a current CDL 
while also receiving full federal disability benefits. Further, 
approximately 85,000, or about 63 percent of the active commercial 
drivers from the 12 selected states, were issued a CDL after the driver 
was approved for full federal benefits. 

Our investigations detail examples of 15 cases where careful medical 
evaluations did not occur on commercial drivers with serious medical 
conditions. Some of the more egregious examples of our investigations 
include the following: 

* A bus driver in Maryland has been receiving Social Security 
disability benefits since March 2006 due to his heart conditions. In 
June 2006, approximately 3 months after Social Security determined the 
driver was fully disabled, the Maryland driver license agency renewed 
his CDL. The bus driver provided our investigator a forged medical 
certificate. Specifically, we found that (1) the medical certificate 
did not have the required medical license number; (2) the physician did 
not have any record that the bus driver underwent a medical examination 
for a CDL; and (3) the physician denied conducting a CDL medical exam 
or signing the medical certificate. 

* A truck driver has received SSA disability benefits for over 10 years 
for several medical conditions, including complications due to an 
amputation. The truck driver stated he has a prosthetic right leg due 
to a farm accident in 1985. Drivers with amputations are disqualified 
unless they obtain a Skills Performance Evaluation (SPE) from DOT. To 
test his prosthetic leg, the truck driver stated that he was required 
to push the doctor across the room in a rolling chair. The doctor 
signed the medical certificate without indicating that an SPE must be 
obtained from DOT. 

We provided a draft of our report to DOT for review and comment. In 
response to our draft, DOT commented that our first objective 
incorrectly implied that individuals who are fully disabled with severe 
medical conditions cannot safely drive commercial vehicles. In 
addition, DOT stated that our report did not accurately characterize 
the 15 cases where careful medical evaluations did not occur because 9 
drivers were not evaluated by a medical examiner. We believe our report 
clearly acknowledges that it is impossible to determine the extent to 
which these commercial drivers have a medical condition that would 
preclude them from safely driving a commercial vehicle and that our 
analysis simply provides a starting point for exploring the 
effectiveness of the current CDL medical certification process. We also 
believe that we fairly characterize that all 15 cases did not have a 
careful medical evaluation because for all 15 cases the medical 
evaluation was inadequate or did not occur. DOT also provided us a 
technical comment which we incorporated in the report. See the "Agency 
Comments and Our Evaluation" section of this report for a more detailed 
discussion of agency comments from DOT. 

Background: 

The loss of lives and property resulting from commercial motor vehicle 
accidents has been a focus of public concern for several years. In 
2006, about 5,300 people died as a result of crashes involving large 
commercial trucks or buses, and about 126,000 more were injured. 
[Footnote 3] A recent study performed by DOT showed that a significant 
number of commercial driver crashes were due to a physical impairment 
of the driver. Specifically, DOT found that about 12 percent of the 
crashes where the crash cause could be identified were due to drivers 
falling asleep, being disabled by a heart attack or seizure, or other 
physical impairments.[Footnote 4] 

The Federal Motor Carrier Safety Administration (FMCSA) within DOT 
shoulders the primary federal responsibility for reducing crashes, 
injuries, and fatalities involving large trucks and buses. FMCSA's 
primary means of preventing these crashes is to develop and enforce 
regulations to help ensure that drivers and motor carriers are 
operating in a safe manner. FMCSA's regulations, among other things, 
require that drivers of commercial motor vehicles are 21 years old, can 
read and speak the English language, have a current and valid 
commercial motor vehicle operator's license, have successfully 
completed a driver's road test, and are physically qualified to drive. 
[Footnote 5] As part of these regulations, FMCSA established standards 
for the physical qualifications of commercial drivers, including the 
requirement of a medical certification from a medical examiner stating 
that the commercial driver is physically qualified to operate a 
commercial motor vehicle.[Footnote 6] See appendix II for a description 
of the federal medical requirements.[Footnote 7] 

The National Transportation Safety Board (NTSB),[Footnote 8] an 
independent federal agency that investigates transportation accidents, 
considers the medical fitness of commercial drivers a major concern. 
Over the past several years, NTSB has reported on serious flaws in the 
medical certification process of commercial drivers. NTSB stated that 
these flaws can lead to increased highway fatalities and injuries for 
commercial vehicle drivers, their passengers, and the motoring public. 

In 2001 NTSB recommended eight safety actions to improve the oversight 
of the medical certification process, in response to a bus crash that 
killed 22 people in Louisiana. According to NTSB, currently all eight 
of the recommendations remain open. In response to FMCSA's failure to 
adequately address NTSB's recommendations, NTSB placed the oversight of 
medical fitness on its "Most Wanted" list in 2003. Table 1 details each 
of NTSB's recommendations. 

Table 1: NTSB's Recommendations to FMCSA for Preventing Unqualified 
Drivers from Operating Commercial Vehicles: 

Description of NTSB recommendations: 

1. Individuals performing medical examinations for drivers are 
qualified to do so and are educated about occupational issues for 
drivers. 

2. Every prior application by an individual for medical certification 
is recorded and reviewed. 

3. Medical certification regulations are updated periodically to permit 
trained examiners to clearly determine whether drivers with common 
medical conditions should be issued a medical certificate. 

4. Individuals performing examinations have specific guidance and a 
readily identifiable source of information for questions on such 
examinations. 

5. The review process prevents, or identifies and corrects, the 
inappropriate issuance of medical certification. 

6. Enforcement authorities can identify invalid medical certification 
during safety inspections and routine stops. 

7. Enforcement authorities can prevent an uncertified driver from 
driving until an appropriate medical examination takes place. 

8. Mechanisms for reporting medical conditions to the medical 
certification and reviewing authority and for evaluating these 
conditions between medical certification exams are in place, and that 
individuals, health care providers, and employers are aware of these 
mechanisms. 

Source: NTSB. 

[End of table] 

Several fatality crashes highlight the need for and the importance of 
having an effective medical certificate process. For example, 

* In July 2000, a truck collided with a Tennessee Highway Patrol 
vehicle protecting a highway work zone. The patrol car exploded at 
impact, killing the state trooper. The driver of the truck had 
previously been diagnosed with sleep apnea and hypothyroidism, and had 
a similar crash in 1997, when he struck the rear of a patrol car in 
Utah. NTSB stated that it believes that if a comprehensive medical 
oversight program been in place at the time of the accident, this 
driver, with known and potentially incapacitating medical conditions, 
would have been less likely to have been operating a commercial 
vehicle. This accident, the NTSB said, "demonstrates how easily unfit 
drivers are able to take advantage of the inadequacies of the current 
medical system, resulting in potentially fatal consequences." 

* In May 2005, a truck collided with a sports utility vehicle in Kansas 
killing a mother and her 10-month-old baby. Prior to the accident, a 
physician diagnosed the truck driver with a severe form of sleep apnea. 
The truck driver subsequently went to another physician who issued the 
medical certificate because the driver did not disclose this illness. 
The truck driver was found guilty of two counts of vehicular 
manslaughter. 

* In August 2005 in New York, a truck collided with a motor vehicle, 
killing the occupants. The truck driver admitted to forging a medical 
certificate required to get his CDL license because he had been 
diagnosed with a seizure disorder. The truck driver recently pled 
guilty of two counts of manslaughter. 

Serious Medical Conditions and Commercial Driver Licenses: 

Commercial drivers with serious medical conditions can still meet DOT 
medical fitness requirements to safely operate a commercial vehicle and 
thus hold CDLs. However, there is general agreement that careful 
medical evaluations are necessary to ensure that serious medical 
conditions do not preclude the safe operation of a commercial vehicle. 
It is impossible to determine from data analysis which commercial 
drivers receiving disability benefits have a medical condition that 
precludes them from safely driving a commercial vehicle because medical 
determinations are largely based on subjective factors that are not 
captured in databases. As such our analysis provides a starting point 
for exploring the effectiveness of the current CDL medical 
certification process. 

Our analysis of DOT data and disability data from the four selected 
federal agencies, SSA, VA, OPM, and DOL, found that about 563,000 
individuals had been issued CDLs and were receiving full medical 
disability benefits.[Footnote 9] This represented over 4 percent of all 
CDLs in the DOT database. However, because DOT's database does include 
drivers that had suspended, revoked, or lapsed licenses,[Footnote 10] 
the actual number of active commercial drivers that receive full 
federal disability benefits cannot be determined. Also, our analysis 
does not include drivers with severe medical conditions that are not in 
the specific disability programs we selected. 

The majority of the individuals with serious medical conditions from 
our 12 selected states had an active CDL. Specifically, as shown in 
figure 1, of the 563,000 CDL holders receiving full disability 
benefits, about 135,000 of those individuals were from our 12 selected 
states. About 114,000 of these 135,000 individuals, or about 85 
percent, had an active CDL according to CDL data provided by the 12 
selected states. 

Further, our analysis of the state CDL data indicates that most of the 
licenses were issued after the commercial driver was found to be 
eligible for full disability benefits. Specifically, about 85,000 of 
the 135,000 individuals, or about 63 percent, had their CDL issued 
after the federal agency determined that the individual met the federal 
requirements for full disability benefits according to data from our 
four selected federal agencies. See appendix III for details for each 
selected state for the number of (1) commercial drivers with active 
CDLs, (2) commercial drivers with an active CDL even though they had a 
medical condition from which they received full federal disability 
benefits, and (3) commercial drivers that were issued a CDL after the 
driver was approved for full federal disability benefit payments. 

Figure 1: CDL Drivers Receiving Full Federal Disability Benefits for 12 
Selected States: 

[See PDF for image] 

This figure is an illustration of CDL drivers receiving full federal 
disability benefits for 12 selected states, as follows: 

Data match: 
DOT CDL data are matched against data from four federal agencies 
administering disability programs. 

50-state population: 
Total 50-state population of CDL holders receiving medical disability
is 563,000. 

12-state analysis (135,000): 
12 states are selected for analysis: CA, FL, IL, KY, MD, MI, MN, MT, 
TN, TX, VA, WI. 

85% of licenses are active: 
114,000 licenses (85%) are still active despite conditions including 
vision, hearing, and seizure disorders. 

63% are active and issued after disability: 
85,000 licenses (63%) have an issue date after disability benefit start 
date. 

Source: GAO (data), Art Explosion (graphics). 

[End of figure] 

Because much of the determination of the medical fitness of commercial 
drivers relies on subjective factors, and because there are ways to 
circumvent the process (as shown below), it is impossible to determine 
the extent to which these commercial drivers have a medical condition 
that would preclude them from safely driving a commercial 
vehicle.[Footnote 11] As such our analysis provides a starting point 
for exploring the effectiveness of the current CDL medical 
certification process. However, because these individuals are receiving 
full disability benefits, it is likely that these medical conditions 
are severe. Further, our analysis also showed that over 1,000 of these 
drivers are diagnosed with vision, hearing, or seizure disorders, which 
are medical conditions that would routinely deny the granting of a CDL. 

Examples of Commercial Drivers with Serious Medical Conditions: 

Our investigations detail examples of 15 cases where careful medical 
evaluations did not occur on commercial drivers who were receiving full 
medical disability benefits. The case studies were selected from 
approximately 30,000 individuals from Florida, Maryland, Minnesota, and 
Virginia that had their CDL issued after the federal agency determined 
that the individual met the federal requirements for full medical 
disability benefits. For all 15 cases, we found that the states renewed 
the drivers' CDLs after the drivers were found by the federal 
government to be eligible for full disability benefits. For more 
detailed information on criteria for selection of the 15 cases, see 
appendix I. 

On the basis of our investigation of these 15 cases, we identified 
instances where careful medical examinations did not occur. Most states 
do not require commercial drivers to provide medical certifications to 
be issued a CDL. Instead, many states only require individuals to self- 
certify that a medical examiner granted them a medical certification 
allowing them to operate commercial vehicles, thus meeting the minimum 
federal requirements.[Footnote 12] As a result, we found several 
commercial drivers who made false assertions on their self- 
certification that they received a medical certification when in fact 
no certification was made. For more information on state requirements 
for medical certifications, see appendix IV. 

In addition, our investigations found that commercial drivers produced 
fraudulent documentation regarding their medical certification. 
Specifically, we found instances where commercial drivers forged a 
medical examiner's signature on a medical certification form. In 
addition, we also found a driver who failed to disclose to the medical 
examiner that another doctor had prescribed him morphine for his back 
pain. 

Finally, our investigations found certain medical examiners did not 
follow the federal requirements in the determination of medical fitness 
of commercial drivers. For example, one medical examiner represented to 
GAO that she did not know that a driver's deafness would disqualify the 
individual from receiving a medical certification. 

Table 2 highlights 5 of the 15 drivers we investigated. For all cases 
we investigated, the CDL was issued after the driver's disability 
benefits started. Appendix V provides details on the other 10 cases we 
examined. We are referring all 15 cases to the respective state driver 
license agency for further investigation. 

Table 2: Summary Information on Five Commercial Drivers with Active 
Licenses despite Serious Medical Conditions: 

Case: 1; 
State: Maryland; 
Details: 
* Bus driver receives Social Security disability benefits since March 
2006 due to an aneurysm of the aorta and valvular heart disease; 
* Three months after disability determination, the state renewed bus 
driver's CDL for 5 years; 
* The bus driver provided our investigator a forged medical 
certificate, without the required medical license number. Medical 
examiner denied conducting CDL medical exam or signing the medical 
certificate. 

Case: 2; 
State: Virginia; 
Details: 
* Truck driver receives Social Security disability benefits since 1995 
for leg amputation, among other medical conditions; 
* Medical examiner did not require truck driver to obtain the mandatory 
Skills Performance Evaluation (SPE); 
* In 2007, the state driver license agency renewed driver's CDL for 5 
years with a "Tanker" endorsement. 

Case: 3; 
State: Florida; 
Details: 
* Bus driver receives Social Security disability benefits since 1994 
for chronic obstructive pulmonary disorder (COPD)[A]; 
* Bus driver currently uses three daily inhalers to control breathing, 
and stated that he "occasionally blacks out and forgets things;" 
* Driver continues to be hired as a substitute bus driver, despite not 
having a medical certificate; 
* Bus driver's CDL expires in 2010. 

Case: 4; 
State: Minnesota; 
Details: 
* Bus driver receives Social Security disability benefits since 2004 
for epilepsy, among other medical conditions; 
* Medical examiner certified the driver in 2007 despite previously 
prescribing him daily antiseizure medication. DOT guidance states that 
this disqualifies the driver; 
* The driver and medical examiner agreed that if the driver felt 
"loopy" he would not drive a commercial vehicle; 
* Driver stated that he also suffers from headaches, sleep apnea, 
asthma, and high blood pressure; 
* The state driver license agency renewed the CDL for 4 years in 2007. 

Case: 5; 
State: Florida; 
Details: 
* Truck driver receives Veteran Affairs disability benefits since 1990 
for multiple sclerosis; 
* Driver stated that the medical condition causes fatigue; 
* Driver stated that the last medical certificate received was in the 
late 1990s; 
* The driver's relative occasionally employs the driver to haul circus 
equipment to various shows, despite not having a current medical 
certificate; 
* The state driver license agency renewed the CDL for about 4 years in 
2007. 

Source: GAO. 

[A] Chronic obstructive pulmonary disease (COPD) is a term referring to 
two lung diseases, chronic bronchitis and emphysema. 

[End of table] 

The following provides illustrative detailed information on three of 
the cases we examined. 

Case 1: A bus driver in Maryland has been receiving Social Security 
disability benefits since March 2006 due to his heart conditions. 
Specifically, the driver had open heart surgery in 2003 to repair a 
ruptured aorta, had a stroke in 2005, and shortly thereafter had 
another surgery to replace a heart valve. In June 2006, approximately 3 
months after Social Security determined the driver was fully disabled; 
the Maryland driver license agency renewed his CDL for 5 years with a 
"Passenger" endorsement. The bus driver provided our investigator a 
forged medical certificate. Specifically, we found that: 

* the medical certificate did not have the required medical license 
number; 

* the physician did not have any record that the bus driver underwent a 
medical examination for a CDL, and: 

* the physician denied conducting a CDL medical exam or signing the 
medical certificate. 

Surprisingly, the medical practice also had a copy of the forged 
medical certificate in its files. The medical practice's staff stated, 
however, that it is not uncommon for a patient to bring documents to 
the office and ask that they be stored in their medical records. The 
driver's CDL does not expire until 2011. 

Case 2: A Virginia truck driver has received SSA disability benefits 
for over 10 years. The driver's disability records indicate that that 
driver had multiple medical conditions, including complications due to 
an amputation, and that the driver is "also essentially illiterate." 
[Footnote 13] The truck driver has a prosthetic right leg resulting 
from a farm accident. Although the driver possesses a current medical 
certificate, the medical examiner did not specify on the medical 
certificate that it is only valid when accompanied with a Skills 
Performance Evaluation (SPE) certificate.[Footnote 14] To test his 
prosthetic leg, the truck driver stated that he was asked to push the 
medical examiner across the room in a rolling chair with the prosthetic 
leg. In our investigation, we attempted to contact the medical examiner 
but discovered that he is no longer employed by that clinic. The state 
revoked his medical license due to illegally distributing controlled 
substances. 

In 2006, the truck driver was involved in a single vehicle accident 
when the load in his truck shifted when making a turn and the truck 
overturned. Prior to October 2007, the truck driver had a CDL with both 
"Tanker" and "Hazmat" endorsements. In October 2007, the state driver 
license agency renewed his CDL with a "Tanker" endorsement, which will 
not expire until 2012. 

Case 3: A bus driver has been receiving Social Security disability 
benefits since 1994 for chronic obstructive pulmonary disorder (COPD). 
The bus driver currently uses three daily inhalers to control his 
breathing and has a breathing test conducted every 6 months. The bus 
driver stated that he "gets winded" when he walks to his mailbox and he 
"occasionally blacks out and forgets things." However, the driver 
stated that he has no problem driving a bus, however, he cannot handle 
luggage or perform any other strenuous duties. 

Despite not possessing a valid medical certificate, companies continue 
to hire him as a bus driver on an ad hoc basis. For example, the driver 
drove a passenger bus as recently as 1 month prior to the time of our 
interview. The driver stated that the companies have not asked to see 
his medical certificate. He further stated that because most companies 
are "hurting for drivers," they "don't ask a lot of questions" and pay 
many of their drivers in cash. The driver's CDL expires in 2010. 

Agency Comments and Our Evaluation: 

We provided a draft of our report to DOT for review and comment. We 
received e-mail comments on the draft on June 16, 2008, from FMCSA's 
Office of Medical Programs. In FMCSA's response, FMCSA stated that our 
first objective implies that individuals who are fully disabled have 
severe medical conditions that may also prevent safe driving. FMCSA 
stated the following: 

* Disability, even full disability associated with a diagnosis, does 
not necessarily mean that an individual is medically unfit to operate a 
commercial vehicle. 

* Disability is not related necessarily to when a medical condition 
occurred or recurs. The onset of a disease or disabling medical 
condition is more relevant to medical fitness than when the disability 
benefits and payments began. As an example, a fully disabled individual 
may have accommodated to the disability and may improve with treatment 
while receiving lifelong disability payments. 

* In general, a medical diagnosis alone is not adequate to determine 
medical fitness to operate a commercial vehicle safely. As an example, 
multiple sclerosis, while disabling, has several progressive phases, 
and is not necessarily disqualifying. 

In addition, FMCSA did not believe that we accurately characterized the 
15 cases where careful medical evaluations did not occur. FMCSA stated 
that this implies these drivers were evaluated by someone for medical 
fitness for duty, but in 9 cases, the driver was not certified or not 
evaluated by a medical examiner. 

We believe our report clearly acknowledges that it is impossible to 
determine the extent to which these commercial drivers have medical 
conditions that would preclude them from safely driving a commercial 
vehicle. In the report, we state that commercial drivers with serious 
medical conditions can still meet DOT medical fitness requirements to 
safely operate a commercial vehicle and thus hold CDLs. Further, our 
report acknowledged that because medical determinations rely in large 
part on subjective factors that are not captured in databases, it is 
impossible to determine from data mining and matching the extent to 
which commercial drivers have a medical condition that precludes them 
from safely driving a commercial vehicle and therefore if the 
certification process is effective. Thus, our analysis provides a 
starting point for exploring the effectiveness of the current CDL 
medical certification process. 

We also believe that we fairly characterize that all 15 cases did not 
have a careful medical evaluation. For all 15 cases that we reviewed, 
we found that the medical evaluation was not adequate or did not occur. 
Thus, we conclude that a careful medical evaluation did not occur for 
all 15 drivers in our case studies. 

FMCSA also provided us a technical comment which we incorporated in the 
report. 

As agreed with your offices, unless you publicly release its contents 
earlier we plan no further distribution of this report until 30 days 
from its date. At that time, we will send copies of this report to the 
Secretary of Transportation. We will make copies available to others 
upon request. In addition, the report will be available at no charge on 
the GAO Web site at [hyperlink, http://www.gao.gov]. 

Please contact me at (202) 512-6722 or kutzg@gao.gov if you have any 
questions concerning this report. Contact points for our Offices of 
Congressional Relations and Public Affairs may be found on the last 
page of this report. GAO staff who made key contributions to this 
report are listed in appendix VI. 

Signed by: 

Gregory D. Kutz: 
Managing Director: 
Forensic Audits and Special Investigations: 

[End of section] 

Appendix I: Scope and Methodology: 

To determine to the extent possible the number of individuals holding a 
current commercial driver license (CDL) who have serious medical 
conditions, we presumed that individuals receiving full federal 
disability benefits were eligible for these benefits because of the 
seriousness of their medical conditions. As such, we obtained and 
analyzed the Department of Transportation's (DOT) Commercial Driver 
License Information System (CDLIS) database as of May 2007. For the 
Social Security Administration (SSA) and the Department of Veterans 
Affairs (VA) we provided the CDLIS commercial driver information to 
those agencies. SSA and VA then matched the commercial drivers to the 
individuals receiving benefits for their disability programs and 
provided us those results. We also obtained and analyzed the recipient 
files for four additional federal disability programs. These include 
the Office of Personnel Management's (OPM) civil service retirement 
program and the three programs administered by the Department of Labor: 
Black Lung, Federal Employee Compensation Act, and the Energy Employees 
Occupational Illness Compensation Program. We matched the CDL holders 
from CDLIS to the four federal disability recipient files based on 
social security number, name, and date of birth. We further analyzed 
the CDL and disability data to ensure that the commercial drivers met 
the following criteria: 

* the individual must be currently receiving disability benefits, and: 

* the individual must be identified as 100 percent disabled[Footnote 
15] according to the program's criteria. 

Because CDLIS is an archival database, the CDLIS data contain 
information on expired CDLs. To identify the active drivers within 
CDLIS, we obtained CDL data from a nonrepresentative selection of 12 
states. The 12 selected states, representing about 42 percent of all 
CDLs contained in CDLIS, are: California, Florida, Illinois, Kentucky, 
Maryland, Michigan, Minnesota, Montana, Tennessee, Texas, Virginia, and 
Wisconsin. The 12 states were selected primarily based on the size of 
the CDL population. Because commercial drivers may contract a serious 
medical condition after the issuance of the CDL, we also determined the 
number of individuals that received their CDL subsequent to when the 
federal agencies determined the individual to be eligible for full 
disability benefits. Our estimate does not include drivers with severe 
medical conditions that are not in the selected programs we analyzed. 

We matched the 12 state CDL files to the six CDLIS-disability match 
files based on driver license number, and identified those CDLs that 
were current based on license status. 

To provide case-study examples of commercial drivers who hold active 
CDLs while also receiving federal disability payments for a 
disqualifying medical condition, we focused on four states--Florida, 
Maryland, Minnesota, and Virginia. From these four states, we selected, 
in a nonrepresentative fashion, 15 commercial drivers for detailed 
investigation. We identified these driver cases based on our data 
analysis and mining. For each case, we interviewed, as appropriate, the 
commercial driver, the driver's employer, and the driver's physician to 
determine whether the medical condition should have precluded the 
driver from holding a valid CDL. For these 15 cases, we also reviewed 
state department of motor vehicle reports, police reports, and other 
public records. 

Data Reliability: 

To determine the reliability of DOT's CDLIS data, we used SSA's 
Enumeration and Verification System to verify key data elements in the 
database that were used to perform our work. 

For the federal disability databases, we assessed the reliability of 
the data from SSA and VA, which comprise 99 percent of the CDLIS- 
disability matches. To verify its reliability, we reviewed program 
logic used by the agencies to match the CDLIS data with their federal 
disability recipients. We also reviewed the current Performance and 
Accountability Reports for the agencies to verify that their systems 
had successfully undergone the required stewardship reviews. 

For the 12 selected states' CDL databases, we performed electronic 
testing of the specific data elements in the database that were used to 
perform our work. In addition, for 5 of the 12 states we verified the 
query logic used to create the CDL extract files. For the other 7 
states we were unable to obtain the query logic. 

We performed our investigative work from May 2007 to June 2008 in 
accordance with standards prescribed by the President's Council on 
Integrity and Efficiency. 

[End of section] 

Appendix II: Medical Certificate Requirements: 

Federal regulations require that commercial drivers be examined and 
certified by a licensed medical examiner, such as licensed physician, 
physician's assistant, and nurse practitioner, to ensure they meet 
minimum physical qualifications prior to driving. It is the 
responsibility of both drivers and motor carriers employing drivers to 
ensure that drivers' medical certificates are current. According to 
federal regulations, the medical examiner must be knowledgeable about 
the regulatory physical qualifications and guidelines as well as the 
driver's responsibilities and work environment. In general, the medical 
certification procedures include the following steps: 

* The driver completes and certifies a medical certification form that 
includes information about the driver's health history. The form is 
provided to the medical examiner as part of the examination. 

* The medical examiner discusses the driver's health history and the 
side effects of prescribed medication and common over-the-counter 
medications. 

* The medical examiner tests the driver's vision, hearing, blood 
pressure, pulse rate, and urine specimen (for testing sugar and protein 
levels). 

* The medical examiner conducts a physical examination and makes a 
determination on driver fitness. 

* If the medical examiner determines the driver is fit to drive, he/she 
signs the medical certificate, which the driver must carry with his/her 
license. The certificate must be dated. The medical examiner keeps a 
copy in his/her records, and provides a copy to the driver's employer. 

* When the medical examiner finds medical conditions that prevent 
certification of the physical condition of the driver and this finding 
is in conflict with the findings of another medical examiner or the 
driver's personal physician, the driver can apply to the Federal Motor 
Carrier Safety Administration (FMCSA) for a determination. 

Federal regulations and the accompanying medical guidance provide 
criteria to the medical examiners for determining the physical 
condition of commercial drivers. Although the medical examiner makes 
the determination as to whether the driver is medically fit to operate 
a commercial vehicle, the following provides a general overview of the 
nature of the physical qualifications: 

* no loss of physical limbs, including a foot, a leg, a hand, or an 
arm; 

* no impairment of limbs that would interfere with grasping or their 
ability to perform normal tasks;[Footnote 16] 

* no established medical history or clinical diagnosis of diabetes 
currently requiring insulin for control, respiratory dysfunction, or 
high blood pressure that would affect their ability to control or drive 
a commercial motor vehicle; 

* no current diagnosis of a variety of coronary conditions and 
cardiovascular disease including congestive heart failure; 

* no mental disease or psychiatric disorder that would interfere with 
their ability to drive a commercial vehicle safely; 

* has distant visual acuity and hearing ability that meets stated 
standards; 

* does not use a controlled substance or habit-forming drug; and: 

* has no current clinical diagnosis of alcoholism. 

When operating a commercial motor vehicle, drivers must have a copy of 
the medical examiner's certificate in their possession.[Footnote 17] 
Motor carriers, in turn, are required to maintain a copy of the 
certificate in their files. When drivers are stopped for a roadside 
inspection, state inspectors can review the medical examiner's 
certificate. During compliance reviews of motor carriers, FMCSA 
investigators may also verify the validity of medical certifications on 
file with the motor carrier. 

[End of section] 

Appendix III: Information on Commercial Drivers for the 12 Selected 
States: 

In the main portion of the report, we state that from the 12 selected 
states 114,000 commercial drivers had a current commercial driver 
license (CDL) even though they had a medical condition from which they 
received full federal disability benefits. Further, approximately 
85,000, or about 63 percent of the active commercial drivers, were 
issued a CDL after the driver was approved for full federal disability 
benefit payments. Table 3 below provides details by each selected state 
on the number of (1) commercial drivers with active CDLs, (2) 
commercial drivers with an active CDL even though they had a medical 
condition from which they received full federal disability benefits, 
and (3) commercial drivers that were issued a CDL after the driver was 
approved for full federal disability benefit payments. 

Table 3: Detail Information on Commercial Drivers for 12 Selected 
States: 

State: California; 
Drivers with active CDLs: 683,300; 
Drivers with active CDLs receiving full federal disability payments: 
11,600; 
Drivers where CDL issued after full federal disability was approved: 
6,600. 

State: Florida; 
Drivers with active CDLs: 603,700; 
Drivers with active CDLs receiving full federal disability payments: 
22,500; 
Drivers where CDL issued after full federal disability was approved: 
19,000. 

State: Illinois; 
Drivers with active CDLs: 377,800; 
Drivers with active CDLs receiving full federal disability payments: 
7,800; 
Drivers where CDL issued after full federal disability was approved: 
6,500. 

State: Kentucky; 
Drivers with active CDLs: 142,100; 
Drivers with active CDLs receiving full federal disability payments: 
4,800; 
Drivers where CDL issued after full federal disability was approved: 
3,500. 

State: Maryland; 
Drivers with active CDLs: 129,300; 
Drivers with active CDLs receiving full federal disability payments: 
2,400; 
Drivers where CDL issued after full federal disability was approved: 
1,600. 

State: Michigan; 
Drivers with active CDLs: 377,300; 
Drivers with active CDLs receiving full federal disability payments: 
14,900; 
Drivers where CDL issued after full federal disability was approved: 
12,500. 

State: Minnesota; 
Drivers with active CDLs: 240,100; 
Drivers with active CDLs receiving full federal disability payments: 
5,500; 
Drivers where CDL issued after full federal disability was approved: 
4,400. 

State: Montana; 
Drivers with active CDLs: 51,100; 
Drivers with active CDLs receiving full federal disability payments: 
1,000; 
Drivers where CDL issued after full federal disability was approved: 
600. 

State: Tennessee; 
Drivers with active CDLs: 206,600; 
Drivers with active CDLs receiving full federal disability payments: 
6,200; 
Drivers where CDL issued after full federal disability was approved: 
4,100. 

State: Texas; 
Drivers with active CDLs: 819,300; 
Drivers with active CDLs receiving full federal disability payments: 
22,600; 
Drivers where CDL issued after full federal disability was approved: 
16,100. 

State: Virginia; 
Drivers with active CDLs: 215,500; 
Drivers with active CDLs receiving full federal disability payments: 
7,800; 
Drivers where CDL issued after full federal disability was approved: 
5,200. 

State: Wisconsin; 
Drivers with active CDLs: 297,900; 
Drivers with active CDLs receiving full federal disability payments: 
8,200; 
Drivers where CDL issued after full federal disability was approved: 
5,900. 

Source: GAO. 

Note: Numbers are rounded to the nearest hundred. 

[End of table] 

[End of section] 

Appendix IV: Methods Used by States to Verify Commercial Driver Medical 
Certification: 

The states have adopted different levels of control to verify that 
commercial driver license applicants meet the Department of 
Transportation (DOT) medical certification requirements. As shown in 
figure 2, 25 states, or 50 percent, allow drivers to self-certify that 
they meet the requirements. The self-certification is often simply a 
check-box on the application. Eighteen states, or 36 percent, require 
that the commercial driver show the DOT medical certificate to the 
driver licensing agency at the time of application. Further, 6 states, 
or 12 percent, not only require that the driver show the DOT medical 
certificate at the time of application but also maintain a copy of the 
certificate in the driving records of the applicant. Finally, 1 state 
did not respond to the inquiries. 

Figure 2: State Methods to Verify Medical Certification: 

[See PDF for image] 

This figure contains a map of the United States with shading indicating 
methods used by state to verify medical certification, as well as the 
following number of states per category: 

Allow driver to self-certify: 25 (50%); 
Driver shows certificate: 18 (36%); 
Driver's license agency retains copy of certificate: 6 (12%); 
No answer: 1 (2%). 

States in each category: 

Allow driver to self-certify: 
Alaska; 
Arkansas; 
Delaware; 
Idaho; 
Illinois; 
Iowa; 
Kansas; 
Maine; 
Michigan; 
Minnesota; 
Missouri; 
Nebraska; 
New Hampshire; 
New Jersey; 
New York; 
North Dakota; 
Ohio; 
Oklahoma; 
Oregon; 
Pennsylvania; 
Rhode Island; 
South Dakota; 
Texas; 
Virginia; 
Washington. 

Driver shows certificate: 
Colorado; 
Connecticut; 
Florida; 
Georgia; 
Hawaii; 
Kentucky; 
Nevada; 
Massachusetts; 
Mississippi; 
Montana; 
North Carolina; 
South Carolina; 
Tennessee; 
Utah; 
Vermont; 
West Virginia; 
Wisconsin; 
Wyoming; 

Driver's license agency retains copy of certificate: 
Arizona; 
California; 
Indiana; 
Louisiana; 
Maryland; 
New Mexico. 

No answer: 
Alabama. 

[End of figure] 

[End of section] 

Appendix V: Commercial Drivers with Serious Medical Conditions: 

Table 2 in the main portion of the report provides information on five 
detailed case studies. Table 4 shows the remaining case studies that we 
investigated. As with the five cases discussed in the body of this 
testimony, we found drivers with a valid commercial driver license 
(CDL) who also had serious medical conditions. 

Table 4: Summary Information on Remaining 10 Commercial Drivers with 
Serious Medical Conditions: 

Case: 6; 
State: Maryland; 
Details: 
* Truck driver receiving Federal Employee's Compensation Act benefits 
since 2000 due to back injury; 
* Truck driver prescribed morphine for pain since at least 2004. 
Medical examiner stated that he was not aware of the prescription and 
would not have certified the driver under that condition; 
* Truck driver is currently bedridden and on bottled oxygen for lung 
disease; 
* The state driver license agency last renewed the CDL in 2002. 

Case: 7; 
State: Maryland; 
Details: 
* Truck driver receiving Social Security disability benefits since 2001 
due to asbestosis; 
* The driver provided Maryland a medical certificate in 2007; 
* Medical examiner denied signing the medical certificate form and has 
not performed any medical examination of truck driver for over 5 years. 
Medical examiner stated that the examiner's phone number and 
certificate number on the medical certificate were erroneous; 
* Medical examiner stated that the driver was not medically fit to 
drive because of the medical conditions; 
* The state driver license agency last renewed the CDL in 2007. 

Case: 8; State: 
Virginia; Details: 
* Bus driver receiving Social Security disability benefits since 1998 
for multiple sclerosis; 
* Bus driver never had CDL medical examination performed. Bus driver 
stated employer did not require medical certification; 
* Bus driver drove school bus for several years in early 2000s while 
receiving Social Security disability benefits; 
* Police officer cited bus driver as responsible for three-vehicle 
accident in 2006. The accident caused injuries to 16 people; 
* The state driver license agency last renewed the CDL in 2006. 

Case: 9; 
State: Virginia; Details: 
* Truck driver receiving Veterans Affairs (VA) disability benefits 
since 1998 for multiple conditions including emphysema, spinal 
arthritis, and limited arm motion; 
* Truck driver drove dump truck and snow plow; 
* Truck driver did not obtain a medical certificate. Truck driver 
stated that at times he had difficulty breathing and likely would not 
pass the medical examination for a CDL; 
* The state driver license agency last renewed the CDL in 2005. 

Case: 10; 
State: Florida; 
Details: 
* Truck driver receiving Social Security disability benefits since 2002 
due to an amputation; 
* Driver stated that he also has had two surgeries on his back and 
cannot sit or stand for extended periods of time; 
* Driver does not have current medical certificate, and stated that he 
"does not think he would pass" the medical examination; 
* Driver denied driving a commercial vehicle in the past year. When 
told that DOT records indicate he had a roadside inspection in 2007 he 
became evasive and terminated the interview; 
* The state driver license agency last renewed the CDL in 2003. 

Case: 11; 
State: Minnesota; 
Details: 
* Truck driver receiving Social Security disability benefits since 2001 
for multiple medical conditions, including leg amputation; 
* Medical examiner did not indicate on medical certificate that a 
Skills Performance Evaluation (SPE) is required. The truck driver 
stated that he did not have an SPE or a waiver; 
* The state driver license agency last renewed the CDL in 2005. 

Case: 12; 
State: Minnesota; Details: 
* Bus driver receiving VA disability since 2001 for multiple sclerosis; 
* The driver could not provide a copy of the CDL medical certificate. 
Driver stated that he did not know when he last took a medical 
certification examination; 
* The state driver license agency last renewed the CDL in 2004. 

Case: 13; 
State: Minnesota; 
Details: 
* Commercial driver receiving VA disability since 2004 for epilepsy, 
schizophrenia, posttraumatic stress disorder, and depression; 
* The driver could not provide a copy of the CDL medical certificate. 
Driver stated he had not taken a medical certification examination 
since early 2000s; 
* Driver stated that he is taking several medications to control his 
mental illnesses; 
* The state driver license agency last renewed the CDL in 2004. 

Case: 14; 
State: Virginia; 
Details: 
* Truck driver receiving Social Security disability benefits since 2001 
for chronic obstructive pulmonary disorder (COPD) and heart failure; 
* Truck driver never had medical certification examination performed. 
Driver stated that he would probably not pass the CDL medical 
examination; 
* Truck driver stated he occasionally drove a dump truck; 
* The state driver license agency last renewed the CDL in 2007. 

Case: 15; 
State: Maryland; 
Details: 
* Truck driver receiving Social Security disability benefits since 2001 
due to complete deafness; 
* Truck driver operates a dump truck as part of an excavating business; 
* Medical examiner admitted error in certifying medical fitness of 
driver; 
* The state driver license agency last renewed the CDL in 2006. 

Source: GAO. 

[End of table] 

[End of section] 

Appendix VI: Staff Acknowledgments: 

GAO staff who made major contributions to this report include Matthew 
Valenta, Assistant Director; Sunny Chang; Paul DeSaulniers; Craig 
Fischer; John V. Kelly; Jeffrey McDermott; Andrew McIntosh; Andrew 
O'Connell; Philip Reiff; Nathaniel Taylor; and Lindsay Welter. 

[End of section] 

Footnotes: 

[1] The 12 selected states were California, Florida, Illinois, 
Kentucky, Maryland, Michigan, Minnesota, Montana, Tennessee, Texas, 
Virginia, and Wisconsin. The 12 states were selected primarily based on 
the size of the CDL population. These 12 selected states represented 
about 42 percent of all CDLs contained in CDLIS. 

[2] A certain number of commercial drivers may also not be legally 
entitled to federal disability payments because they do not have a 
qualifying disability. For example, our review did not make a 
determination as to whether commercial drivers committed fraud in their 
application for disability benefits. 

[3] These figures are from 2006, the most recent year for which data 
are available. 

[4] DOT, Federal Motor Carrier Safety Administration, Large Truck Crash 
Causation Study, Publication No.: FMCSA-RRA-07-017 (July 2007). 

[5] The FMCSA develops requirements for operating commercial vehicles, 
while states issue CDLs. Along with verifying identity, residency, and 
driving skills, states must also verify that the commercial driver 
applicant is medically qualified for the license prior to issuance of 
the CDL. 

[6] Federal regulations require that commercial drivers provide 
evidence of their medical certifications to employers (e.g., motor 
carrier companies). In addition, commercial drivers are required to 
carry their medical certifications when operating a commercial vehicle, 
and as such, may be required to show such certifications to inspectors 
(e.g., roadside check) or law enforcement, if requested. 

[7] Although federal regulations apply specifically to interstate 
drivers, at least 47 of the 50 states have adopted the federal medical 
requirements for their intrastate commercial drivers. 

[8] NTSB is an independent U.S. federal agency that investigates every 
civil aviation accident in the United States and significant accidents 
in the other modes of transportation. 

[9] SSA and VA accounted for 99 percent of the identified drivers. 

[10] CDLIS is used to ensure that drivers do not obtain CDLs from 
multiple states. As such, it is an archival system and includes 
licenses that are expired or suspended. CDLIS does not contain an 
identifier to indicate whether the license is currently active. 

[11] Federal disability programs such as the SSA's "Ticket to Work" do 
allow certain fully disabled recipients to work and still receive their 
disability benefits. 

[12] DOT is finalizing a proposed rule to merge information from the 
medical examiner's certificate into the commercial driver license 
process as required by the Motor Carrier Safety Improvement Act of 
1999. The new rule would require drivers to provide a copy of their 
current medical examiner's certificate to their state driver license 
agency. This new rule would make the state driver license agencies 
responsible for ensuring that holders of commercial driver licenses 
have current medical certificates. 

[13] To be qualified for a CDL, DOT regulations require that a driver 
"can read and speak the English language sufficiently to converse with 
the general public, to understand highway traffic signs and signals in 
the English language, to respond to official inquiries, and to make 
entries on reports and records." 49 C.F.R. §391.11(b)(2). 

[14] Drivers with amputations are disqualified from receiving a medical 
certificate unless they obtain an SPE from DOT. 

[15] OPM's disability criteria do not allow for precise identification 
of 100 percent disabled. Its definition of disabled is becoming 
"disabled because of a medical condition, resulting in a deficiency in 
performance, conduct, or attendance, or if there is no such deficiency, 
the disabling medical condition must be incompatible with either useful 
and efficient service or retention in the position." 5 C.F.R §844.103. 
Of the 563,000 CDLIS-disability matches, about 1,500 (0.26 percent) 
came from OPM. 

[16] If one of these first two conditions exists, the commercial driver 
is required to obtain a Skills Performance Evaluation (SPE) 
certificate. 

[17] The Department of Transportation is finalizing a proposed rule to 
merge information from the medical examiner's certificate into the 
commercial driver license process as required by the Motor Carrier 
Safety Improvement Act of 1999. The new rule would require drivers to 
provide a copy of their current medical examiner's certificate to their 
state driver license agency. This new rule would make the state driver 
license agencies responsible for ensuring that holders of commercial 
driver licenses have current medical certificates. 

[End of section] 

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