Medical Advisory Board Guide For Determining Driver Limitation

Texas Medical Advisory BoardOffice of EMS and Trauma SystemsConsumer Protection DivisionTexas Department of State Health ServicesGuide for DeterminingDriver Limitation

Reviewed 08/31/2020Revised 03/2014

PREFACEThe Texas Medical Advisory Board (MAB) for Driver Licensing was established in 1970 to advisethe Texas Department of Public Safety (DPS) in the licensing of drivers having medical limitations,which might adversely affect driving. See Chapter 12 of the Texas Health and Safety Code, Sections12.092–12.098.Realizing a need for criteria with which to judge the cases consistently and fairly, the MAB membersassembled a set of guidelines. The original set of guidelines was composed of some informationborrowed from the American Medical Association's Physician's Guide for Determining DriverLimitation with input from MAB members. However, further revisions in 2013 were made, utilizingthe expertise of MAB members and other physicians along with a guide, entitled: “Driver FitnessMedical Guidelines” produced in 2009 by the National Highway Traffic Safety Association (NHTSA)and The American Association of Motor Vehicle Administrators (AAMVA) to assist licensingagencies in making decisions about an individual’s fitness for driving. MAB’s current revisedguidelines are entitled: “Guide for Determining Driver Limitations for the Medical Advisory Board”.The ultimate goal is to allow all who can drive safely to do so, and to continue to reduce the numberand severity of motor vehicle accidents in Texas. The Texas Transportation Code, Chapter 521charges DPS with the responsibility of determining if applicants or licensees should or should not belicensed when a medical condition exists that could possibly affect their ability to drive. There areseveral types of examinations that can legally be required as part of the medical review and licensingprocess to help make the determination - one of which is a complete medical examination.The Medical Advisory Board operates solely in an advisory capacity and DPS relies heavily on theirprofessional advice, and has the final responsibility for licensure.No individual is permitted to appear personally before the Medical Advisory Board. The MABreviews medical facts provided by the licensee’s attending physician and sometimes other relevantevidence. MAB member physicians utilize their expertise and accumulated years of experience alongwith its MAB guidelines in reaching an opinion. MAB meets every other week to review cases. Aftercompletion of its reviews, the MAB makes a written recommendation for each case reviewed which isforwarded to the DPS Driver License Division. After receiving MAB’s opinion, DPS notifies theindividual by mail of its decision concerning licensure. This takes approximately two (2) weeks fromthe time it receives the MAB recommendation.As the driver licensing agency for Texas, DPS is solely responsible for all actions taken or initiated.Neither the Medical Advisory Board nor the attending physicians are legally liable for the decisions oractions taken by DPS in the suspension, revocation or denial of driver licenses. The DPS decisionmay be appealed to the courts for final determination.Reviewed 08/31/2020Revised 03/2014

Reviewed 08/31/2020Revised 03/2014

Special Thanks and Acknowledgement to All The Physicians That Helped Create ThisGuideSara Austin, M.D.Steven Tynes, M.D.Neurology, Neuromuscular diseaseA Special Thanks for coordinating the revisions2013Physical Med. & Rehabilitation, Sports Medicine Rehab MedBoard MemberRobert Fayle, M.D.Neurology, Sleep MedicineRevision CommitteeJacqueline Phillips-Sabol, PhD, ABCNNeuropsychology, DementiaRevision CommitteeJonathan Larson, M.D.Emergency MedicineBoard MemberRyan Butler, O.D.OptometristBoard MemberAlexander Ely, M.D.Emergency MedicineBoard MemberJim Kelaher, M.D.Occupational Medicine, Internal MedicineBoard MemberJames V. Kemper, MDENT, OtologyRevision CommitteeRonald DeVere, M.D.Neurology, DementiaRevision CommitteeJohn McCormick, O.D.OptometristBoard MemberCardiovascular Diseases, CardiacElectrophysiologyThomas Coopwood, M.D.General Surgery, Critical CareBoard MemberBernard Patten, M.D.NeurologyBoard MemberLee Arnold, M.D.Family PracticeBoard MemberNeil Grieshop, M.D.General SurgeryBoard MemberLawrence Buxton, M.D.NeurologyBoard MemberJohn Anil Lincoln, MD, PhDNeurology, Multiple SclerosisRevision CommitteeMatthew Phillips MDCardiologyRevision CommitteeJeremy D. Slater, MDReviewed 08/31/2020Revised 03/2014David Tschopp, M.D.Revision CommitteeNeurology, EpilepsyRevision Committee

Paul E. Schulz M.DNeurology, DementiaRevision CommitteeAlison Leston M.D.NeurologyBoard MemberSteven Croft M.D.NeurologyBoard MemberMalvin Driver M.D.OpthamologyBoard MemberShobana Murugan M.DAnesthesiologyBoard MemberRobert Van Boven M.D.Glen Journeay, M.D. editingFamily PracticeBoard MemberMaria E Arizmendez M.D.Physical MedicineBoard MemberLeanne Burnett M.D.NeurologyBoard MemberDr. Nicolo Geralde M.D.NeonatologyBoard MemberWilliam LaValley M.D.Internal MedicineBoard MemberWilliam Pollan D.OOccupational MedicineBoard MemberCognitive NeurologyBoard MemberJudson Smith M.D.OphthalmologyBoard MemberDavid Tasker M.D.OphthalmologyBoard MemberReviewed 08/31/2020Revised 03/2014Michael Stones M.D.Family MedicineBoard Member

Reviewed 08/31/2020Revised 03/2014

TABLE OF CONTENTSFUNCTIONAL ABILITY PROFILES . 1DRIVER CLASSIFICATION . 2GENERAL DEBILITY . 3AGING .3PULMONARY DISEASES .3Pulmonary Conditions – Table 1 .3MALIGNANCIES .4CARDIOVASCULAR DISEASE . 5FUNCTIONAL CAPACITIES .5THERAPEUTIC CAPACITIES .5ANGINA PECTORIS .5HEART FAILURE .5ATHEROSCLEROTIC CARDIOVASCULAR DISEASE .6MYOCARDIAL INFARCTION (MI) .6CORONARY ARTERY BYPASS GRAFTING (CABG) .6PERCUTANEOUS CORONARY INTERVENTION .6NEW YORK HEART ASSOCIATION CLASS (NYAH)I-II .6NEW YORK HEART ASSOCIATION CLASS III OR IV .6MALIGNANT HYPERTENSION .7SYNCOPE .7UNEXPLAINED SYNCOPE .7NEUROCARDIOGENIC SYNCOPE (VASOVAGAL SYNCOPE) .7RECURRENT UNCONTROLLED SYNCOPE DUE TO ANYTHING OTHER THAN VASOVAGALATTACKS.7SYNCOPE DUE TO BRADYARRHYTHMIA .7SYNCOPE DUE TO TACHYARRHYTHMIAS .7CARDIAC DYSRHYTHMIAS .7PREMATURE ATRIAL CONTRACTIONS AND PREMATURE VENTRICULAR CONTRACTIONS .7ATRIAL FIBRILLATION OR ATRIAL FLUTTER .7ATRIAL VENTRICULAR NODAL RE-ENTRY TACHYCARDIA .7VENTRICULAR TACHYCARDIA .8HEART BLOCK .8CARDIAC PACEMAKERS.8AUTOMATIC IMPLANTABLE CARDIO-DEFIBRILLATOR (AICD) .8VENOUS THROMBOEMBOLIC DISEASE .8ACUTE DEEP VEIN THROMBOSIS (DVT) .8CHRONIC DEEP VEIN THROMBOSIS .9Blackout Guidelines .9NEUROLOGICAL DISORDERS . 10RECURRENT TRANSIENT CEREBRAL ISCHEMIC ATTACKS .10CEREBROVASCULAR ACCIDENT .10CONVULSIVE DISORDERS .11Seizure - Table 2 .11DEMENTIA .12Dementia - Table 3 .13Reviewed 08/31/2020Revised 03/2014

THE CLINICAL DEMENTIA RATING SCALE (see below for instructions on how to score this test).14HEAD INJURY .15Head Injury - Table 4 .15MOVEMENT DISORDERS .16Parkinson’s - Table 5 .17MULTIPLE SCLEROSIS.17EXCESSIVE DROWSINESS (ED) .18Excessive Sleeping - Table 6 .18NARCOLEPSY .19PERIPHERAL NEUROPATHY .19VERTIGO AND DIZZINESS .19Vertigo - Table 7 .20PSYCHIATRIC DISORDERS . 21PERSONALITY DISORDERS .21PSYCHOTIC DISORDERS .21PSYCHOTROPIC DRUGS .21POST-TRAUMATIC STRESS DISORDER .21HOMICIDAL AND SUICIDAL MANIFESTATIONS .22INTELLECTUAL DISABILITIES .22Psychiatric Disorders - Table 8 .22EXCESSIVE ALCOHOL USE AND/OR ABUSE . 24Alcohol Use and/or abuse - Table 9 .24DRUG USE AND/OR ABUSE . 26Drug Use and/or abuse - Table 10 .26METABOLIC DISEASES. 28CHRONIC RENAL FAILURE.28DIABETES MELLITUS .28Metabolic - Table 11a and 11b .29MUSCULOSKELETAL DEFECTS . 32ARTHRITIS .32BACK PAIN .32CEREBRAL PALSY .32CERVICAL SPINE DISORDERS .32HEMIPLEGIA.32MUSCLE DYSTROPHIES .32Musculoskeletal - Table 12 .33EYE DEFECTS . 34VISUAL STANDARDS FOR DRIVER LICENSING .35DOUBLE VISION – Table 13 .35PERIPHERAL VISION – Table 14.36VISUAL ACUITY – Table 15.36VISUAL ACUITY FOOTNOTES: .36GLOSSARY . 39ACRONYMS . 43Reviewed 08/31/2020Revised 03/2014

FUNCTIONAL ABILITY PROFILESFunctional ability to operate a vehicle safely may be affected by a wide range of physical,mental or emotional impairments. To simplify reporting and to make possible acomparison of relative risks and limitations, the Medical Advisory Board has developedFunctional Ability Profiles for ten categories and seven subcategories, with multiplelevels under each profile. These categories and subcategories are listed in Tables 1-15.Each profile follows the same format:1. No diagnosed condition. This section is used for a patient who has indicatedto the Department of Public Safety a problem for which no evidence is found,or for which no ongoing condition can be identified. For example, thiscategory might apply to a person with a heart murmur as a young child whoindicates heart trouble, or to a teenager who fainted in gym class once on a hotday who indicates blackouts.2. Condition. Fully recovered/compensated. This category indicates a history ofa condition which has been resolved or which does not warrant review.Guidance for the use of this section is given in each profile3. Active impairmenta. Minimal. This section may call for a periodic review because of anongoing condition which could deteriorate.b. Mild. This section deals with conditions which may impair driving butwhich are controlled so that a person can still operate a motor vehiclesafely. Reviews are more frequent than in (a).c. Moderate. This section identifies impairment which often precludesdriving, but for which there is the potential for recovery to the point ofallowing safe operation of a motor vehicle.d. Severe. This section identifies permanen

Board Member Glen Journeay, M.D. editing Family Practice Board Member Maria E Arizmendez M.D. Physical Medicine Board Member Leanne Burnett M.D. Neurology Board Member Dr. Nicolo Geralde M.D. Neonatology Board Member William LaValley M.D. Internal Medicine Board Member William Pollan D.O Occupational Medicine Board Member Judson Smith M.D.