Commercial Drivers: Certification Process for Drivers with	 
Serious Medical Conditions (24-JUL-08, GAO-08-1030T).		 
                                                                 
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. Because	 
the effectiveness of the medical certification process is not	 
known, this testimony, and the accompanying report (GAO-08-826)  
that GAO is releasing today focuses on (1) GAO's analyses of the 
magnitude of commercial drivers with serious medical conditions, 
and (2) examples of cases where careful medical examinations did 
not occur on commercial drivers with serious medical conditions. 
To examine the extent individuals holding CDLs have significant  
disabilities, GAO identified those who were in both DOT's CDL	 
database and selected disability databases of 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. GAO	 
obtained current CDL data from 12 selected states. To provide	 
case studies, GAO focused on 4 states--Florida, Maryland,	 
Minnesota, and Virginia. For 15 drivers identified from data	 
mining, GAO interviewed, as appropriate, the driver, the driver's
employer and the driver's physician.				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-1030T					        
    ACCNO:   A83048						        
  TITLE:     Commercial Drivers: Certification Process for Drivers    
with Serious Medical Conditions 				 
     DATE:   07/24/2008 
  SUBJECT:   Bus drivers					 
	     Commercial motor vehicle operators 		 
	     Disabilities					 
	     Disability benefits				 
	     Drivers' licenses					 
	     Eligibility determinations 			 
	     Federal regulations				 
	     Federal/state relations				 
	     Impaired motor vehicle operators			 
	     Licenses						 
	     Medical certification				 
	     Medical examinations				 
	     Medical records					 
	     Motor vehicle safety				 
	     Motor vehicle standards				 
	     Motor vehicles					 
	     Persons with disabilities				 
	     Program evaluation 				 
	     Risk management					 
	     Safety standards					 
	     Social security benefits				 
	     Standards evaluation				 
	     Transportation industry				 
	     Transportation safety				 
	     Transportation workers				 
	     Truck drivers					 

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GAO-08-1030T

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Testimony: 

Before the Committee on Transportation and Infrastructure, House of 
Representatives: 

United States Government Accountability Office: 
GAO: 

For Release on Delivery: 
Expected at 2:00 p.m. EDT:
Thursday, July 24, 2008: 

Commercial Drivers: 

Certification Process for Drivers with Serious Medical Conditions: 

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

GAO-08-1030T: 

GAO Highlights: 

Highlights of GAO-08-1030T, a testimony before the Committee on 
Transportation and Infrastructure, House of Representatives. 

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. 
Because the effectiveness of the medical certification process is not 
known, this testimony, and the accompanying report (GAO-08-826) that 
GAO is releasing today focuses on (1) GAOï¿½s analyses of the magnitude 
of commercial drivers with serious medical conditions, and (2) examples 
of cases where careful medical examinations did not occur on commercial 
drivers with serious medical conditions. 

To examine the extent individuals holding CDLs have significant 
disabilities, GAO identified those who were in both DOTï¿½s CDL database 
and selected disability databases of 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 
programï¿½s criteria. GAO obtained current CDL data from 12 selected 
states. To provide case studies, GAO focused on 4 statesï¿½Florida, 
Maryland, Minnesota, and Virginia. For 15 drivers identified from data 
mining, GAO interviewed, as appropriate, the driver, the driverï¿½s 
employer and the driverï¿½s physician. 

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. GAOï¿½s analysis provides a starting point for exploring the 
effectiveness of the current CDL medical certification process. 

GAOï¿½s 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 individuals had commercial driver licenses and 
were determined by the federal government to be eligible for full 
disability benefits. This represented about 4 percent of all commercial 
drivers in the DOT database. The 12 selected states we analyzed 
represent about 135,000 of these commercial drivers. For these 12 
selected states, our analysis indicates that about 85 percent of these 
commercial drivers still have active licenses. The majority of these 
drivers were issued a CDL after being approved for full federal 
disability benefits. 

GAOï¿½s 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 ï¿½occasionally blacks out and forgets things,ï¿½ 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 
ï¿½loopyï¿½ 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-08-1030T]. For more 
information, contact Greg Kutz at (202)512-6722 or [email protected]. 

[End of section] 

Mr. Chairman and Members of the Committee: 

Thank you for the opportunity to discuss commercial drivers with 
serious medical conditions. Millions of American drivers hold a 
commercial driver license (CDL) that allows 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. Not all serious medical conditions interfere with the safe 
operation of a commercial vehicle. In fact, some federal disability 
programs appropriately try to encourage individuals to work. However, 
some serious medical conditions can and should disqualify a driver from 
being medically certified according to Department of Transportation 
(DOT) regulations. 

Because the effectiveness of the current medical certification process 
is not known, our testimony, and the accompanying report that we are 
releasing today,[Footnote 1] provide a starting point for this 
discussion. Today's testimony focuses on (1) our analyses of the 
magnitude of commercial drivers with serious medical conditions, and 
(2) examples of cases where careful medical examinations did not occur 
on commercial drivers with serious medical conditions. 

To examine the extent to which individuals holding CDLs have serious 
medical conditions, we identified people who were in both DOT's CDL 
database and selected federal disability databases--Social Security 
Administration (SSA), Office of Personnel Management (OPM), the 
Department of Veterans Affairs (VA), and the Department of Labor (DOL)-
-and have been identified as 100 percent disabled according to the 
program's criteria. Because DOT's data also include inactive licenses, 
we obtained current CDL data from 12 selected states (based primarily 
on the size of CDL population) to identify active CDL license holders 
who are receiving full federal disability benefits. To provide case 
study examples we focused on 4 states--Florida, Maryland, Minnesota, 
and Virginia. For 15 drivers identified from data mining, we 
interviewed, as appropriate, the driver, driver's employer, and 
driver's physician. 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. 

Summary: 

Commercial drivers with serious medical conditions, even those 
determined to be 100 percent disabled, can still meet DOT medical 
fitness requirements to safely operate a commercial vehicle and thus 
hold CDLs. 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 fully 
disabled.[Footnote 2] This represented about 4 percent of all CDLs in 
the DOT database. Our analysis of persons with CDLs who are receiving 
full federal disability benefits from 12 selected states (135,000) 
indicates that most of these commercial drivers still have active 
licenses. Specifically, about 85 percent (114,000) had a current CDL. A 
majority of these drivers (85,000) were issued a CDL after being 
approved for full federal disability benefits. 

Our investigations detail 15 cases where careful medical evaluations 
did not occur on commercial drivers who were fully disabled. Some of 
the more egregious examples of our investigations include: 

* A bus driver in Maryland has been receiving Social Security 
disability benefits since March 2006 due to his heart condition. 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. 

* A bus driver in Florida has been receiving Social Security disability 
benefits since 1994 for breathing deficiencies. The bus driver 
currently uses three daily inhalers to control his breathing. The bus 
driver stated that he "occasionally blacks out and forgets things." 
However, the driver stated that he continues to be hired as a 
substitute bus driver even though he does not have the required medical 
certification. 

Serious Medical Conditions and Commercial Driver Licenses: 

Commercial drivers with disabilities, even those determined to be 100 
percent disabled, can still meet DOT medical fitness requirements for 
operating a commercial vehicle and thus hold CDLs. Although we fully 
support individuals with serious medical conditions receiving the 
training and certifications necessary to safely operate commercial 
vehicles, 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 data matching the extent to which disabled commercial drivers have 
a medical condition that precludes 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 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 3] This represented about 4 percent of 
all CDLs in the DOT database.[Footnote 4] 

As shown in figure 1, of the 563,000 CDL holders nationwide who are 
receiving full federal disability benefits, about 135,000 are from our 
12 selected states. About 114,000 of these 135,000 individuals, or 
about 85 percent, had an active CDL according to data provided by the 
12 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, were issued a CDL 
after the federal agency determined that they met the federal 
requirements for full disability benefits. 

Figure 1: CDL Drivers with Full Federal Disabilities 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 discussed 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 5] However, because these individuals are receiving 
full disability benefits, it is likely that these medical conditions 
are severe. Further analysis 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. 
[Footnote 6] 

Examples of Commercial Drivers with Serious Medical Impairments: 

Our investigations detail 15 cases where careful medical evaluations 
did not occur on commercial drivers who were receiving full medical 
disability benefits. In 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. We referred all 
15 cases to their respective state driver license agencies for further 
investigation. In table 1, we summarize 5 of the more egregious cases. 

Table 1: Summary Information on Five Commercial Drivers with Active 
Licenses despite Serious Medical Conditions: 

Case: 1; 
State: Maryland; 
Details: 
* Bus driver has received 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: 
Florida; 
Details: 
* Bus driver has received 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: 3; 
State: Minnesota; 
Details: 
* Bus driver has received 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: 4; 
State: Florida; 
Details: 
* Truck driver has received Veteran Affairs disability benefits since 
1990 for multiple sclerosis; 
* Driver stated that the medical condition causes fatigue; 
* Driver stated he received his last medical certificate 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. 

Case: 5; 
State: Maryland; 
Details: 
* Truck driver has received 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. 

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

[End of table] 

The above cases illustrate instances where careful medical examinations 
did not occur. Based on our investigations, we found: 

* 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 7] 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. 

* 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. 

* Certain medical examiners did not follow the federal requirements in 
the determination of medical fitness of commercial drivers. For 
example, one medical examiner told GAO that she did not know that a 
driver's deafness disqualifies the driver from receiving a medical 
certification. 

Mr. Chairman and Members of the Committee, this concludes my statement. 
I would be pleased to answer any questions that you or other members of 
the committee may have at this time. 

Contacts and Staff Acknowledgments: 

For further information about this testimony, please contact Gregory D. 
Kutz at (202) 512-6722 or [email protected]. Contact points for our Offices 
of Congressional Relations and Public Affairs may be found on the last 
page of this testimony. GAO staff who made major contributions to this 
report include Matthew Harris, Assistant Director; Andrew O'Connell, 
Assistant Director; Matthew Valenta, Assistant Director; Gary Bianchi; 
Sunny Chang; Paul DeSaulniers; Eric Eskew; Craig Fischer; John Kelly; 
Jeffrey McDermott; Andrew McIntosh; Philip Reiff; Ray Rodriguez; Daniel 
Silva; Nathaniel Taylor; and Lindsay Welter. 

[End of section] 

Footnotes: 

[1] GAO, Commercial Drivers: Certification Process for Drivers with 
Serious Medical Conditions, [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-08-826] (Washington, D.C.: June 30, 2008). 

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

[4] Because DOT's database includes drivers with suspended, revoked, or 
lapsed licenses, the actual number of active commercial drivers who 
receive full federal disability benefits cannot be determined. Also, 
our analysis does not include drivers with severe medical conditions 
who are not in the specific disability programs we selected. 

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

[6] 49 C.F.R. ï¿½391.41(b). 

[7] 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. 

[End of section] 

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