Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders, 23054-23056 [2014-09447]

Download as PDF mstockstill on DSK4VPTVN1PROD with NOTICES 23054 Federal Register / Vol. 79, No. 80 / Friday, April 25, 2014 / Notices Transportation (WisDOT): Name, Wisconsin Department of Transportation, Northeast Region, 944 Vanderperren Way, Green Bay, Wisconsin 54304; telephone: (920) 920– 492–5698; email: Jill.Michaelson@ dot.wi.gov. The WisDOT Northeast Region’s normal office hours are 7:45 a.m. to 4:30 p.m. central time. SUPPLEMENTARY INFORMATION: Notice is hereby given that FHWA has taken final agency actions subject to 23 U.S.C. 139(l)(1) by issuing approvals for the following highway project: WIS 23 Corridor Expansion Project in Fond du Lac and Sheboygan Counties, Wisconsin. The purpose of the project is to provide additional highway capacity to serve existing and projected traffic volumes and improve operational efficiency and safety for local and through traffic while avoiding or minimizing environmental effects. The project will widen the existing WIS 23 two-lane roadway and construct a fourlane divided highway with a median approximately 19.1 miles from US 151 to County UU. Project specific actions include acquiring right-of-way, constructing two diamond interchanges and one jug-handle interchange, constructing a roundabout, constructing new travel lanes and frontage roads, modifying local roads, improving two local trails and extending another, installing new bridges and culverts, removing and placing fill, removing vegetation, providing stormwater management measures, and implementing mitigation measures. The actions by FHWA on this project, and the laws under which such actions were taken, are described in the combined Record of Decision (ROD) and Limited Scope Supplemental Final Environmental Impacts Statement (LS SFEIS) approved on March 17, 2014, and in other documents in the FHWA administrative record. The decisions approved in the combined ROD and LS SFEIS are consistent with the September 27, 2010 ROD. The combined ROD and LS SFEIS supersedes the 2010 ROD where it addresses issues identified as part of the Limited Scope Supplemental EIS pursuant to 23 CFR 771.130. The combined ROD and LS SFEIS was prepared pursuant to Moving Ahead for Progress in the 21st Century Act (MAP– 21), Public Law 112–141, § 1319, 126 Stat. 405 (2012). The combined ROD and LS SFEIS, and other documents in the Administrative Record are available by contacting FHWA or WisDOT at the addresses provided above. The combined ROD and LS SFEIS can be viewed and downloaded from the VerDate Mar<15>2010 16:57 Apr 24, 2014 Jkt 232001 project Web site at https:// www.dot.wisconsin.gov/projects/ neregion/23/index.htm or viewed at the Fond du Lac or Plymouth public libraries. This notice applies to all Federal agency decisions as of the issuance date of this notice and all laws under which such actions were taken, including but not limited to: 1. General: National Environmental Policy Act (NEPA) [42 U.S.C. 4321– 4351]; Federal-Aid Highway Act [23 U.S.C. 109, 23 U.S.C. 128, and U.S.C. 139]. 2. Air: Clean Air Act [42 U.S.C. 7401– 7671(q)]. 3. Land: Section 4(f) of the Department of Transportation Act of 1966 [23 U.S.C. 138 and 49 U.S.C. 303]. 5. Historic and Cultural Resources: Section 106 of the National Historic Preservation Act of 1966, as amended [16 U.S.C. 470(f) et seq.]. 6. Social and Economic: Uniform Relocation Assistance and Real Property Acquisition Act of 1970 [42 U.S.C. 4601 et seq. as amended by the Uniform Relocation Act Amendments of 1987 [Pub. L. 100–17]. 7. Wetlands and Water Resources: Clean Water Act (Section 404, Section 401, Section 319) [33 U.S.C. 1251– 1376]. (Catalog of Federal Domestic Assistance Program Number 20.205, Highway Planning and Construction. The regulations implementing Executive Order 12372 regarding intergovernmental consultation on Federal programs and activities apply to this program.) Authority: 23 U.S.C. 139(l)(1), as amended by Moving Ahead for Progress in the 21st Century Act (MAP–21), Pub. L. 112–141, § 1308, 126 Stat. 405(2012). Issued on: April 14, 2014. R. Kirk Fredrichs, Assistant Division Administrator, FHWA Wisconsin Division, Madison, Wisconsin. [FR Doc. 2014–09254 Filed 4–24–14; 8:45 am] BILLING CODE 4910–RY–P DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration [Docket No. FMCSA–2013–0109] Qualification of Drivers; Exemption Applications; Epilepsy and Seizure Disorders Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION: Notice of final disposition. AGENCY: FMCSA announces its decision to grant requests from four SUMMARY: PO 00000 Frm 00112 Fmt 4703 Sfmt 4703 individuals for exemptions from the regulatory requirement that interstate commercial motor vehicle (CMV) drivers have ‘‘no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a CMV.’’ The regulation and the associated advisory criteria published in the Code of Federal Regulations as the ‘‘Instructions for Performing and Recording Physical Examinations’’ have resulted in numerous drivers being prohibited from operating CMVs in interstate commerce based on the fact that they have had one or more seizures and are taking antiseizure medication, rather than an individual analysis of their circumstances by a qualified medical examiner. The Agency concluded that granting exemptions for these CMV drivers will provide a level of safety that is equivalent to or greater than the level of safety maintained without the exemptions. FMCSA grants exemptions that will allow these four individuals to operate CMVs in interstate commerce for a 2-year period. The exemptions preempt State laws and regulations and may be renewed. DATES: The exemptions are effective April 25, 2014. The exemptions expire on April 25, 2016. FOR FURTHER INFORMATION CONTACT: Elaine M. Papp, Division Chief, Physical Qualifications, Office of Medical Programs, (202) 366–4001, fmcsamedical@dot.gov, FMCSA, Department of Transportation, 1200 New Jersey Avenue SE., Room W64– 224, Washington, DC 20590–0001. Office hours are 8:30 a.m. to 5 p.m., e.t., Monday through Friday, except Federal holidays. SUPPLEMENTARY INFORMATION: A. Electronic Access You may see all the comments online through the Federal Document Management System (FDMS) at: https:// www.regulations.gov. Docket: For access to the docket to read background documents or comments, go to https:// www.regulations.gov and/or Room W12–140 on the ground level of the West Building, 1200 New Jersey Avenue SE., Washington, DC, between 9 a.m. and 5 p.m., e.t., Monday through Friday, except Federal holidays. Privacy Act: Anyone may search the electronic form of all comments received into any of DOT’s dockets by the name of the individual submitting the comment (or of the person signing the comment, if submitted on behalf of an association, business, labor union, or E:\FR\FM\25APN1.SGM 25APN1 Federal Register / Vol. 79, No. 80 / Friday, April 25, 2014 / Notices other entity). You may review DOT’s complete Privacy Act Statement in the Federal Register (73 FR 3316, January 17, 2008). This statement is also available at https://Docketinfo.dot.gov. mstockstill on DSK4VPTVN1PROD with NOTICES B. Background Under 49 U.S.C. 31136(e) and 31315(b), FMCSA may grant an exemption from the safety regulations for a 2-year period if it finds ‘‘such exemption would likely achieve a level of safety that is equivalent to or greater than the level that would be achieved absent such exemption.’’ The statute also allows the Agency to renew exemptions at the end of the 2-year period. FMCSA grants four individuals an exemption from the regulatory requirement in § 391.41(b)(8), to allow these individuals who take anti-seizure medication to operate CMVs in interstate commerce for a 2-year period. The Agency’s decision on these exemption applications is based on an individualized assessment of each applicant’s medical information, including the root cause of the respective seizure(s), the length of time elapsed since the individual’s last seizure, and each individual’s treatment regimen. In addition, the Agency reviewed each applicant’s driving record found in the Commercial Driver’s License Information System (CDLIS) 1 for commercial driver’s license (CDL) holders, and interstate and intrastate inspections recorded in Motor Carrier Management Information System (MCMIS).2 For non-CDL holders, the Agency reviewed the driving records from the State licensing agency. The Agency acknowledges the potential consequences of a driver experiencing a seizure while operating a CMV. However, the Agency believes the drivers covered by the exemptions granted here have demonstrated that they are unlikely to have a seizure and their medical condition does not pose a risk to public safety. In reaching the decision to grant these exemption requests, the Agency considered both current medical literature and information and the 2007 recommendations of the Agency’s 1 Commercial Driver License Information System (CDLIS) is an information system that allows the exchange of commercial driver licensing information among all the States. CDLIS includes the databases of fifty-one licensing jurisdictions and the CDLIS Central Site, all connected by a telecommunications network. 2 Motor Carrier Management Information System (MCMIS) is an information system that captures data from field offices through SAFETYNET, CAPRI, and other sources. It is a source for FMCSA inspection, crash, compliance review, safety audit, and registration data. VerDate Mar<15>2010 16:57 Apr 24, 2014 Jkt 232001 Medical Expert Panel (MEP). The Agency previously gathered evidence for potential changes to the regulation at 49 CFR 391.41(b)(8) by conducting a comprehensive review of scientific literature that was compiled into the ‘‘Evidence Report on Seizure Disorders and Commercial Vehicle Driving’’ (Evidence Report) [CD–ROM HD TL230.3 .E95 2007]. The Agency then convened a panel of medical experts in the field of neurology (the MEP) on May 14–15, 2007, to review 49 CFR 391.41(b)(8) and the advisory criteria regarding individuals who have experienced a seizure, and the 2007 Evidence Report. The Evidence Report and the MEP recommendations are published on-line at https:// www.fmcsa.dot.gov/rules-regulations/ topics/mep/mep-reports.htm, under Seizure Disorders, and are in the docket for this notice. MEP Criteria for Evaluation On October 15, 2007, the MEP issued the following recommended criteria for evaluating whether an individual with epilepsy or a seizure disorder should be allowed to operate a CMV.3 The MEP recommendations are included in previously published dockets. Epilepsy diagnosis. If there is an epilepsy diagnosis, the applicant should be seizure-free for 8 years, on or off medication. If the individual is taking anti-seizure medication(s), the plan for medication should be stable for 2 years. Stable means no changes in medication, dosage, or frequency of medication administration. Recertification for drivers with an epilepsy diagnosis should be performed every year. Single unprovoked seizure. If there is a single unprovoked seizure (i.e., there is no known trigger for the seizure), the individual should be seizure-free for 4 years, on or off medication. If the individual is taking anti-seizure medication(s), the plan for medication should be stable for 2 years. Stable means no changes in medication, dosage, or frequency of medication administration. Recertification for drivers with a single unprovoked seizure should be performed every 2 years. Single provoked seizure. If there is a single provoked seizure (i.e., there is a known reason for the seizure), the Agency should consider specific criteria that fall into the following two categories: low-risk factors for 3 Engel, J., Fisher, R.S., Krauss, G.L., Krumholz, A., and Quigg, M.S., ‘‘Expert Panel Recommendations: Seizure Disorders and Commercial Motor Vehicle Driver Safety,’’ FMCSA, October 15, 2007. PO 00000 Frm 00113 Fmt 4703 Sfmt 4703 23055 recurrence and moderate-to-high risk factors for recurrence. • Examples of low-risk factors for recurrence include seizures that were caused by a medication; by nonpenetrating head injury with loss of consciousness less than or equal to 30 minutes; by a brief loss of consciousness not likely to recur while driving; by metabolic derangement not likely to recur; and by alcohol or illicit drug withdrawal. • Examples of moderate-to-high-risk factors for recurrence include seizures caused by non-penetrating head injury with loss of consciousness or amnesia greater than 30 minutes, or penetrating head injury; intracerebral hemorrhage associated with a stroke or trauma; infections; intracranial hemorrhage; post-operative complications from brain surgery with significant brain hemorrhage; brain tumor; or stroke. The MEP report indicates individuals with moderate to high-risk conditions should not be certified. Drivers with a history of a single provoked seizure with low risk factors for recurrence should be recertified every year. Medical Review Board Recommendations and Agency Decision FMCSA presented the MEP’s findings and the Evidence Report to the Medical Review Board (MRB) for consideration. The MRB reviewed and considered the 2007 ‘‘Seizure Disorders and Commercial Driver Safety’’ evidence report and the 2007 MEP recommendations. The MRB recommended maintaining the current advisory criteria, which provide that ‘‘drivers with a history of epilepsy/ seizures off anti-seizure medication and seizure-free for 10 years may be qualified to drive a CMV in interstate commerce. Interstate drivers with a history of a single unprovoked seizure may be qualified to drive a CMV in interstate commerce if seizure-free and off anti-seizure medication for a 5 year period or more’’ [Advisory criteria to 49 CFR 391.43(f)]. The Agency acknowledges the MRB’s position on the issue but believes relevant current medical evidence supports a less conservative approach. The medical advisory criteria for epilepsy and other seizure or loss of consciousness episodes was based on the 1988 ‘‘Conference on Neurological Disorders and Commercial Drivers’’ (NITS Accession No. PB89–158950/AS). A copy of the report can be found in the docket referenced in this notice. The MRB’s recommendation treats all drivers who have experienced a seizure the same, regardless of individual medical conditions and circumstances. E:\FR\FM\25APN1.SGM 25APN1 23056 Federal Register / Vol. 79, No. 80 / Friday, April 25, 2014 / Notices mstockstill on DSK4VPTVN1PROD with NOTICES In addition, the recommendation to continue prohibiting drivers who are taking anti-seizure medication from operating a CMV in interstate commerce does not consider a driver’s actual seizure history and time since the last seizure. The Agency has decided to use the 2007 MEP recommendations as the basis for evaluating applications for an exemption from the seizure regulation on an individual, case-by-case basis. C. Exemptions Following individualized assessments of the exemption applications, including a review of detailed follow-up information requested from each applicant, FMCSA is granting exemptions from 49 CFR 391.41(b)(8) to four individuals. Under current FMCSA regulations, all of the four drivers receiving exemptions from 49 CFR 391.41(b)(8) would have been considered physically qualified to drive a CMV in interstate commerce except that they presently take or have recently stopped taking anti-seizure medication. For these four drivers, the primary obstacle to medical qualification was the FMCSA Advisory Criteria for Medical Examiners, based on the 1988 ‘‘Conference on Neurological Disorders and Commercial Drivers,’’ stating that a driver should be off anti-seizure medication in order to drive in interstate commerce. In fact, the Advisory Criteria have little if anything to do with the actual risk of a seizure and more to do with assumptions about individuals who are taking anti-seizure medication. In addition to evaluating the medical status of each applicant, FMCSA evaluated the crash and violation data for the four drivers, some of whom currently drive a CMV in intrastate commerce. The CDLIS and MCMIS were searched for crash and violation data on the four applicants. For non-CDL holders, the Agency reviewed the driving records from the State licensing agency. These exemptions are contingent on the driver maintaining a stable treatment regimen and remaining seizure-free during the 2-year exemption period. The exempted drivers must submit annual reports from their treating physicians attesting to the stability of treatment and that the driver has remained seizure-free. The driver must undergo an annual medical examination by a medical examiner, as defined by 49 CFR 390.5, following the FCMSA’s regulations for the physical qualifications for CMV drivers. FMCSA published a notice of receipt of application and requested public comment during a 30-day public VerDate Mar<15>2010 16:57 Apr 24, 2014 Jkt 232001 comment period in a Federal Register notice for each of the applicants. A short summary of the applicants’ qualifications and a discussion of the comments received follows this section. For applicants who were denied an exemption, a notice will be published at a later date. D. Comments Docket # FMCSA–2013–0109 On November 13, 2013, FMCSA published a notice of receipt of exemption applications and requested public comment on 11individuals (78 FR 68144). The comment period ended on December 13, 2013. No commenters responded to this Federal Register notice. FMCSA has determined that four of these applicants should be granted an exemption. Dean Bretey Mr. Bretey is a 63 year-old driver in Wisconsin. He has a history of seizures and has remained seizure free for at least 10 years. He takes anti-seizure medication with the dosage and frequency remaining the same for 10 years. If granted the exemption, he would like to drive a CMV. His physician states he is supportive of Mr. Bretey receiving an exemption. Dwight Crownover Mr. Crownover is 49 year-old driver in New York. He has a history of seizures and has remained seizure free for 29 years. He takes anti-seizure medication with the dosage and frequency remaining the same since that time. If granted the exemption, he would like to drive a delivery truck. His physician states he is supportive of Mr. Crownover receiving an exemption. John Johnson Mr. Johnson is a 35 year-old driver in Wisconsin. He has a history of epilepsy and has remained seizure free since 2005. He takes anti-seizure medication with the dosage and frequency remaining the same for over 8 years. If granted the exemption, he would like to drive a CMV. His physician states that he is supportive of Mr. Johnson receiving an exemption. Michael Schneider Mr. Schneider is a 27 year-old driver in Wisconsin. He has a history seizure and has remained seizure free since 2004. He does not take seizure medication and states that he has never taken seizure medication. If granted the exemption, he would like to drive a heavy equipment truck. His physician states that he is supportive of Mr. Schneider receiving an exemption. PO 00000 Frm 00114 Fmt 4703 Sfmt 9990 E. Basis for Exemption Under 49 U.S.C. 31136(e) and 31315(b), FMCSA may grant an exemption from the epilepsy/seizure standard in 49 CFR 391.41(b)(8) if the exemption is likely to achieve an equivalent or greater level of safety than would be achieved without the exemption. Without the exemption, applicants will continue to be restricted to intrastate driving. With the exemption, applicants can drive in interstate commerce. Thus, the Agency’s analysis focuses on whether an equal or greater level of safety is likely to be achieved by permitting each of these drivers to drive in interstate commerce as opposed to restricting the driver to driving in intrastate commerce. Conclusion The Agency is granting exemptions from the epilepsy standard, 49 CFR 391.41(b)(8), to four individuals based on a thorough evaluation of each driver’s qualifications, safety experience, and medical condition. Safety analysis of information relating to these four applicants meets the burden of showing that granting the exemptions would achieve a level of safety that is equivalent to or greater than the level that would be achieved without the exemption. In accordance with 49 U.S.C. 31315(b)(1), each exemption will be valid for 2 years, with annual recertification required unless revoked earlier by FMCSA. The exemption will be revoked if the following occurs: (1) The person fails to comply with the terms and conditions of the exemption; (2) the exemption has resulted in a lower level of safety than was maintained prior to being granted; or (3) continuation of the exemption would not be consistent with the goals and objectives of 49 U.S.C. 31136 and 31315. FMCSA exempts the following four drivers for a period of 2 years with annual medical certification required: Dean Bretey (WI); Dwight Crownover (NY); John Johnson (WI); and Michael Schneider (WI) from the prohibition of CMV operations by persons with a clinical diagnosis of epilepsy or seizures. If the exemption is still in effect at the end of the 2-year period, each of the drivers may apply to FMCSA for a renewal under procedures in effect at that time. Issued on: March 25, 2014. Anne S. Ferro, Administrator. [FR Doc. 2014–09447 Filed 4–24–14; 8:45 am] BILLING CODE 4910–EX–P E:\FR\FM\25APN1.SGM 25APN1

Agencies

[Federal Register Volume 79, Number 80 (Friday, April 25, 2014)]
[Notices]
[Pages 23054-23056]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-09447]


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DEPARTMENT OF TRANSPORTATION

Federal Motor Carrier Safety Administration

[Docket No. FMCSA-2013-0109]


Qualification of Drivers; Exemption Applications; Epilepsy and 
Seizure Disorders

AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.

ACTION: Notice of final disposition.

-----------------------------------------------------------------------

SUMMARY: FMCSA announces its decision to grant requests from four 
individuals for exemptions from the regulatory requirement that 
interstate commercial motor vehicle (CMV) drivers have ``no established 
medical history or clinical diagnosis of epilepsy or any other 
condition which is likely to cause loss of consciousness or any loss of 
ability to control a CMV.'' The regulation and the associated advisory 
criteria published in the Code of Federal Regulations as the 
``Instructions for Performing and Recording Physical Examinations'' 
have resulted in numerous drivers being prohibited from operating CMVs 
in interstate commerce based on the fact that they have had one or more 
seizures and are taking anti-seizure medication, rather than an 
individual analysis of their circumstances by a qualified medical 
examiner. The Agency concluded that granting exemptions for these CMV 
drivers will provide a level of safety that is equivalent to or greater 
than the level of safety maintained without the exemptions. FMCSA 
grants exemptions that will allow these four individuals to operate 
CMVs in interstate commerce for a 2-year period. The exemptions preempt 
State laws and regulations and may be renewed.

DATES: The exemptions are effective April 25, 2014. The exemptions 
expire on April 25, 2016.

FOR FURTHER INFORMATION CONTACT: Elaine M. Papp, Division Chief, 
Physical Qualifications, Office of Medical Programs, (202) 366-4001, 
fmcsamedical@dot.gov, FMCSA, Department of Transportation, 1200 New 
Jersey Avenue SE., Room W64-224, Washington, DC 20590-0001. Office 
hours are 8:30 a.m. to 5 p.m., e.t., Monday through Friday, except 
Federal holidays.

SUPPLEMENTARY INFORMATION:

A. Electronic Access

    You may see all the comments online through the Federal Document 
Management System (FDMS) at: https://www.regulations.gov.
    Docket: For access to the docket to read background documents or 
comments, go to https://www.regulations.gov and/or Room W12-140 on the 
ground level of the West Building, 1200 New Jersey Avenue SE., 
Washington, DC, between 9 a.m. and 5 p.m., e.t., Monday through Friday, 
except Federal holidays.
    Privacy Act: Anyone may search the electronic form of all comments 
received into any of DOT's dockets by the name of the individual 
submitting the comment (or of the person signing the comment, if 
submitted on behalf of an association, business, labor union, or

[[Page 23055]]

other entity). You may review DOT's complete Privacy Act Statement in 
the Federal Register (73 FR 3316, January 17, 2008). This statement is 
also available at https://Docketinfo.dot.gov.

B. Background

    Under 49 U.S.C. 31136(e) and 31315(b), FMCSA may grant an exemption 
from the safety regulations for a 2-year period if it finds ``such 
exemption would likely achieve a level of safety that is equivalent to 
or greater than the level that would be achieved absent such 
exemption.'' The statute also allows the Agency to renew exemptions at 
the end of the 2-year period.
    FMCSA grants four individuals an exemption from the regulatory 
requirement in Sec.  391.41(b)(8), to allow these individuals who take 
anti-seizure medication to operate CMVs in interstate commerce for a 2-
year period. The Agency's decision on these exemption applications is 
based on an individualized assessment of each applicant's medical 
information, including the root cause of the respective seizure(s), the 
length of time elapsed since the individual's last seizure, and each 
individual's treatment regimen. In addition, the Agency reviewed each 
applicant's driving record found in the Commercial Driver's License 
Information System (CDLIS) \1\ for commercial driver's license (CDL) 
holders, and interstate and intrastate inspections recorded in Motor 
Carrier Management Information System (MCMIS).\2\ For non-CDL holders, 
the Agency reviewed the driving records from the State licensing 
agency. The Agency acknowledges the potential consequences of a driver 
experiencing a seizure while operating a CMV. However, the Agency 
believes the drivers covered by the exemptions granted here have 
demonstrated that they are unlikely to have a seizure and their medical 
condition does not pose a risk to public safety.
---------------------------------------------------------------------------

    \1\ Commercial Driver License Information System (CDLIS) is an 
information system that allows the exchange of commercial driver 
licensing information among all the States. CDLIS includes the 
databases of fifty-one licensing jurisdictions and the CDLIS Central 
Site, all connected by a telecommunications network.
    \2\ Motor Carrier Management Information System (MCMIS) is an 
information system that captures data from field offices through 
SAFETYNET, CAPRI, and other sources. It is a source for FMCSA 
inspection, crash, compliance review, safety audit, and registration 
data.
---------------------------------------------------------------------------

    In reaching the decision to grant these exemption requests, the 
Agency considered both current medical literature and information and 
the 2007 recommendations of the Agency's Medical Expert Panel (MEP). 
The Agency previously gathered evidence for potential changes to the 
regulation at 49 CFR 391.41(b)(8) by conducting a comprehensive review 
of scientific literature that was compiled into the ``Evidence Report 
on Seizure Disorders and Commercial Vehicle Driving'' (Evidence Report) 
[CD-ROM HD TL230.3 .E95 2007]. The Agency then convened a panel of 
medical experts in the field of neurology (the MEP) on May 14-15, 2007, 
to review 49 CFR 391.41(b)(8) and the advisory criteria regarding 
individuals who have experienced a seizure, and the 2007 Evidence 
Report. The Evidence Report and the MEP recommendations are published 
on-line at https://www.fmcsa.dot.gov/rules-regulations/topics/mep/mep-reports.htm, under Seizure Disorders, and are in the docket for this 
notice.

MEP Criteria for Evaluation

    On October 15, 2007, the MEP issued the following recommended 
criteria for evaluating whether an individual with epilepsy or a 
seizure disorder should be allowed to operate a CMV.\3\ The MEP 
recommendations are included in previously published dockets.
---------------------------------------------------------------------------

    \3\ Engel, J., Fisher, R.S., Krauss, G.L., Krumholz, A., and 
Quigg, M.S., ``Expert Panel Recommendations: Seizure Disorders and 
Commercial Motor Vehicle Driver Safety,'' FMCSA, October 15, 2007.
---------------------------------------------------------------------------

    Epilepsy diagnosis. If there is an epilepsy diagnosis, the 
applicant should be seizure-free for 8 years, on or off medication. If 
the individual is taking anti-seizure medication(s), the plan for 
medication should be stable for 2 years. Stable means no changes in 
medication, dosage, or frequency of medication administration. 
Recertification for drivers with an epilepsy diagnosis should be 
performed every year.
    Single unprovoked seizure. If there is a single unprovoked seizure 
(i.e., there is no known trigger for the seizure), the individual 
should be seizure-free for 4 years, on or off medication. If the 
individual is taking anti-seizure medication(s), the plan for 
medication should be stable for 2 years. Stable means no changes in 
medication, dosage, or frequency of medication administration. 
Recertification for drivers with a single unprovoked seizure should be 
performed every 2 years.
    Single provoked seizure. If there is a single provoked seizure 
(i.e., there is a known reason for the seizure), the Agency should 
consider specific criteria that fall into the following two categories: 
low-risk factors for recurrence and moderate-to-high risk factors for 
recurrence.
     Examples of low-risk factors for recurrence include 
seizures that were caused by a medication; by non-penetrating head 
injury with loss of consciousness less than or equal to 30 minutes; by 
a brief loss of consciousness not likely to recur while driving; by 
metabolic derangement not likely to recur; and by alcohol or illicit 
drug withdrawal.
     Examples of moderate-to-high-risk factors for recurrence 
include seizures caused by non-penetrating head injury with loss of 
consciousness or amnesia greater than 30 minutes, or penetrating head 
injury; intracerebral hemorrhage associated with a stroke or trauma; 
infections; intracranial hemorrhage; post-operative complications from 
brain surgery with significant brain hemorrhage; brain tumor; or 
stroke.
    The MEP report indicates individuals with moderate to high-risk 
conditions should not be certified. Drivers with a history of a single 
provoked seizure with low risk factors for recurrence should be 
recertified every year.

Medical Review Board Recommendations and Agency Decision

    FMCSA presented the MEP's findings and the Evidence Report to the 
Medical Review Board (MRB) for consideration. The MRB reviewed and 
considered the 2007 ``Seizure Disorders and Commercial Driver Safety'' 
evidence report and the 2007 MEP recommendations. The MRB recommended 
maintaining the current advisory criteria, which provide that ``drivers 
with a history of epilepsy/seizures off anti-seizure medication and 
seizure-free for 10 years may be qualified to drive a CMV in interstate 
commerce. Interstate drivers with a history of a single unprovoked 
seizure may be qualified to drive a CMV in interstate commerce if 
seizure-free and off anti-seizure medication for a 5 year period or 
more'' [Advisory criteria to 49 CFR 391.43(f)].
    The Agency acknowledges the MRB's position on the issue but 
believes relevant current medical evidence supports a less conservative 
approach. The medical advisory criteria for epilepsy and other seizure 
or loss of consciousness episodes was based on the 1988 ``Conference on 
Neurological Disorders and Commercial Drivers'' (NITS Accession No. 
PB89-158950/AS). A copy of the report can be found in the docket 
referenced in this notice.
    The MRB's recommendation treats all drivers who have experienced a 
seizure the same, regardless of individual medical conditions and 
circumstances.

[[Page 23056]]

In addition, the recommendation to continue prohibiting drivers who are 
taking anti-seizure medication from operating a CMV in interstate 
commerce does not consider a driver's actual seizure history and time 
since the last seizure. The Agency has decided to use the 2007 MEP 
recommendations as the basis for evaluating applications for an 
exemption from the seizure regulation on an individual, case-by-case 
basis.

C. Exemptions

    Following individualized assessments of the exemption applications, 
including a review of detailed follow-up information requested from 
each applicant, FMCSA is granting exemptions from 49 CFR 391.41(b)(8) 
to four individuals. Under current FMCSA regulations, all of the four 
drivers receiving exemptions from 49 CFR 391.41(b)(8) would have been 
considered physically qualified to drive a CMV in interstate commerce 
except that they presently take or have recently stopped taking anti-
seizure medication. For these four drivers, the primary obstacle to 
medical qualification was the FMCSA Advisory Criteria for Medical 
Examiners, based on the 1988 ``Conference on Neurological Disorders and 
Commercial Drivers,'' stating that a driver should be off anti-seizure 
medication in order to drive in interstate commerce. In fact, the 
Advisory Criteria have little if anything to do with the actual risk of 
a seizure and more to do with assumptions about individuals who are 
taking anti-seizure medication.
    In addition to evaluating the medical status of each applicant, 
FMCSA evaluated the crash and violation data for the four drivers, some 
of whom currently drive a CMV in intrastate commerce. The CDLIS and 
MCMIS were searched for crash and violation data on the four 
applicants. For non-CDL holders, the Agency reviewed the driving 
records from the State licensing agency.
    These exemptions are contingent on the driver maintaining a stable 
treatment regimen and remaining seizure-free during the 2-year 
exemption period. The exempted drivers must submit annual reports from 
their treating physicians attesting to the stability of treatment and 
that the driver has remained seizure-free. The driver must undergo an 
annual medical examination by a medical examiner, as defined by 49 CFR 
390.5, following the FCMSA's regulations for the physical 
qualifications for CMV drivers.
    FMCSA published a notice of receipt of application and requested 
public comment during a 30-day public comment period in a Federal 
Register notice for each of the applicants. A short summary of the 
applicants' qualifications and a discussion of the comments received 
follows this section. For applicants who were denied an exemption, a 
notice will be published at a later date.

D. Comments

Docket  FMCSA-2013-0109

    On November 13, 2013, FMCSA published a notice of receipt of 
exemption applications and requested public comment on 11individuals 
(78 FR 68144). The comment period ended on December 13, 2013. No 
commenters responded to this Federal Register notice. FMCSA has 
determined that four of these applicants should be granted an 
exemption.
Dean Bretey
    Mr. Bretey is a 63 year-old driver in Wisconsin. He has a history 
of seizures and has remained seizure free for at least 10 years. He 
takes anti-seizure medication with the dosage and frequency remaining 
the same for 10 years. If granted the exemption, he would like to drive 
a CMV. His physician states he is supportive of Mr. Bretey receiving an 
exemption.
Dwight Crownover
    Mr. Crownover is 49 year-old driver in New York. He has a history 
of seizures and has remained seizure free for 29 years. He takes anti-
seizure medication with the dosage and frequency remaining the same 
since that time. If granted the exemption, he would like to drive a 
delivery truck. His physician states he is supportive of Mr. Crownover 
receiving an exemption.
John Johnson
    Mr. Johnson is a 35 year-old driver in Wisconsin. He has a history 
of epilepsy and has remained seizure free since 2005. He takes anti-
seizure medication with the dosage and frequency remaining the same for 
over 8 years. If granted the exemption, he would like to drive a CMV. 
His physician states that he is supportive of Mr. Johnson receiving an 
exemption.
Michael Schneider
    Mr. Schneider is a 27 year-old driver in Wisconsin. He has a 
history seizure and has remained seizure free since 2004. He does not 
take seizure medication and states that he has never taken seizure 
medication. If granted the exemption, he would like to drive a heavy 
equipment truck. His physician states that he is supportive of Mr. 
Schneider receiving an exemption.

E. Basis for Exemption

    Under 49 U.S.C. 31136(e) and 31315(b), FMCSA may grant an exemption 
from the epilepsy/seizure standard in 49 CFR 391.41(b)(8) if the 
exemption is likely to achieve an equivalent or greater level of safety 
than would be achieved without the exemption. Without the exemption, 
applicants will continue to be restricted to intrastate driving. With 
the exemption, applicants can drive in interstate commerce. Thus, the 
Agency's analysis focuses on whether an equal or greater level of 
safety is likely to be achieved by permitting each of these drivers to 
drive in interstate commerce as opposed to restricting the driver to 
driving in intrastate commerce.

Conclusion

    The Agency is granting exemptions from the epilepsy standard, 49 
CFR 391.41(b)(8), to four individuals based on a thorough evaluation of 
each driver's qualifications, safety experience, and medical condition. 
Safety analysis of information relating to these four applicants meets 
the burden of showing that granting the exemptions would achieve a 
level of safety that is equivalent to or greater than the level that 
would be achieved without the exemption. In accordance with 49 U.S.C. 
31315(b)(1), each exemption will be valid for 2 years, with annual 
recertification required unless revoked earlier by FMCSA. The exemption 
will be revoked if the following occurs: (1) The person fails to comply 
with the terms and conditions of the exemption; (2) the exemption has 
resulted in a lower level of safety than was maintained prior to being 
granted; or (3) continuation of the exemption would not be consistent 
with the goals and objectives of 49 U.S.C. 31136 and 31315.
    FMCSA exempts the following four drivers for a period of 2 years 
with annual medical certification required: Dean Bretey (WI); Dwight 
Crownover (NY); John Johnson (WI); and Michael Schneider (WI) from the 
prohibition of CMV operations by persons with a clinical diagnosis of 
epilepsy or seizures. If the exemption is still in effect at the end of 
the 2-year period, each of the drivers may apply to FMCSA for a renewal 
under procedures in effect at that time.

    Issued on: March 25, 2014.
Anne S. Ferro,
Administrator.
[FR Doc. 2014-09447 Filed 4-24-14; 8:45 am]
BILLING CODE 4910-EX-P