A "failed" DOT physical is often really a deferral — the examiner needs more information before certifying you. Understanding what triggers a disqualification helps you show up prepared. Here are the most common issues and what you can do about each.
Key point: Many "disqualifying" conditions are certifiable once they're documented and controlled. Bringing the right paperwork is often the difference between a card and a deferral. When you're ready, order your DOT physical online.
High blood pressure
The single most common reason for a shortened or deferred card. A reading of 180/110 or higher is disqualifying until it's reduced and controlled. Take your medication as prescribed and avoid salt, caffeine, and nicotine before the exam.
Vision that doesn't meet the standard
You need at least 20/40 in each eye (with correction) and a 70° field of vision. If you don't meet this in one eye, the FMCSA Vision Exemption Program may still allow certification with an eye specialist's evaluation.
Uncontrolled diabetes
Diabetes itself is not disqualifying. Insulin-treated drivers can be certified through the FMCSA insulin-treated diabetes standard, which requires a treating clinician's assessment (form MCSA-5870) showing stable control and no severe hypoglycemia. Bring recent A1c results and your provider's evaluation.
Sleep apnea
Untreated moderate-to-severe obstructive sleep apnea can lead to a deferral. Drivers who are diagnosed and compliant with CPAP therapy are routinely certified — bring your CPAP compliance report showing consistent usage.
Heart disease
Recent heart attack, bypass surgery, stent placement, pacemaker, or an implanted defibrillator require a waiting period and a cardiologist's clearance. With documentation of stable cardiac function and appropriate stress testing, many drivers are certified for a shorter interval.
Seizures and neurological conditions
A seizure disorder or epilepsy requiring medication is generally disqualifying for interstate driving, though the FMCSA has a seizure exemption program for some drivers who have been seizure-free and off medication for a defined period.
Certain medications
Some prescriptions — particularly Schedule II drugs, certain sedatives, and methadone — can be disqualifying. A letter from your prescriber confirming the medication is safe for commercial driving can support certification. Never stop a prescribed medication without talking to your doctor.
Substance use
Current use of a controlled substance without a valid prescription, or a diagnosis of alcohol use disorder, is disqualifying. Drivers with a prior violation may need to complete the return-to-duty process before being certified.
What to do if you're deferred
- Ask the examiner exactly what documentation is needed.
- Get the specialist evaluation or lab work requested.
- Return with the paperwork — you usually don't have to restart the whole exam.
A deferral is not the end of the road. With the right records, most drivers get certified.
Frequently Asked Questions
Can you pass a DOT physical with high blood pressure?
Yes, if it’s controlled. Below 140/90 earns a 2-year card. Readings up to 179/109 can still be certified for shorter intervals. 180/110 or higher is disqualifying until reduced.
Does diabetes disqualify you from a DOT physical?
No. Diabetes — including insulin-treated diabetes — can be certified when it is well controlled and documented by your treating clinician using the FMCSA diabetes assessment form.
Will sleep apnea fail my DOT physical?
Not if it’s treated. Drivers who are compliant with CPAP therapy and bring their compliance report are routinely certified.
What medications disqualify a DOT physical?
Certain Schedule II drugs, some sedatives, and methadone can be disqualifying. A letter from your prescriber confirming the medication is safe for driving often supports certification. Never stop a prescribed medication without medical advice.
Reviewed by Chantal Gabriel, MD
Medical Director, Doctors Place Inc. · FMCSA-Certified Medical Examiner. This guide is reviewed by a certified medical examiner for accuracy.