DOT physical medical examiner performing a neurological exam on a driver in Charlotte, NC

DOT Physical Neurological Requirements

Medically Authored & Reviewed By:
Dr. Lemuel P. Byrd, Jr., FMCSA Certified Medical Examiner.

Updated: November 2025 | Verifiable Credentials: View Profile
Quick Answer: Neurological conditions are the most complex for DOT certification. The minimum waiting period for a Single Unprovoked Seizure is 5 years (seizure-free and off medication). Epilepsy (two or more seizures) is disqualifying unless an FMCSA exemption is obtained (8 years seizure-free). A Stroke or TIA requires a minimum 1-year waiting period. All cases require mandatory neurologist clearance.
In This Guide:

FMCSA Mandatory Waiting Periods for Seizures and Epilepsy

The rules governing seizures are the most strict in FMCSA regulations because of the high risk of sudden incapacitation. The classification of the event dictates the required waiting period.

Epilepsy (2 or More Unprovoked Seizures)

Automatic Disqualification Rule:A clinical diagnosis of Epilepsy (two or more unprovoked seizures) is an automatic DOT disqualification under 49 CFR 391.41(b)(8).

Certification is only possible through a rare, complex FMCSA Exemption application, which typically requires the driver to be seizure-free for 8 years (on or off medication), along with extensive medical documentation.

Single Unprovoked Seizure

This is defined as a one-time seizure with no identifiable cause. While not technically “epilepsy,” it carries a high recurrence risk.

  • Minimum Waiting Period: 5 Years.
  • Mandatory Requirement: The driver must be seizure-free and off all anti-seizure medication for the entire 5-year period.
  • Certification: Limited to 1 Year, and requires mandatory annual follow-up with a neurologist.

Stroke and TIA (Mini-Stroke) Certification Rules

The time you must wait after a stroke or TIA (Transient Ischemic Attack) depends heavily on the type of event and whether it occurred in a region of the brain that increases the risk of future seizures (cortical involvement).

Neurological Event Minimum Waiting Period Key Certification Requirements
Transient Ischemic Attack (TIA) 1 Year (12 months) Must be asymptomatic, have a normal neurological exam, and provide neurologist clearance. High recurrence risk during the first year is the reason for the mandatory wait.
Stroke (Non-Cortical / Brainstem) 1 Year (12 months) Applies to strokes in regions with low seizure risk (e.g., cerebellum). Must have no physical or cognitive residuals that interfere with CMV operation.
Stroke (Cortical / High Seizure Risk) 5 Years (60 months) Applies to strokes involving the medial or anterior cerebral artery, or any event deemed by a specialist to have a high risk of subsequent seizures. Must be seizure-free and off medication.

Mandatory Neurologist Documentation Checklist

DOT physical medical examiner performing a neurological exam on a driver in Charlotte, NC and explaining the neurological requirements for the FMCSA.

To avoid a Determination Pending status, every driver with a history of seizures, stroke, or TIA must bring the following documentation to the exam. Failure to provide these items will result in an automatic deferral.

  1. A Clearance Letter from your Neurologist (must explicitly state that the doctor understands the functions of commercial driving and confirms you are medically safe to operate a CMV).
  2. A detailed report of the neurological event (seizure, stroke, or TIA) and the exact date it occurred.
  3. A report from a recent CT or MRI Scan (within the last 12 months) of the brain.
  4. A complete, legible list of all current medications and dosages, including the date any anti-seizure medication was discontinued.
Q: Can I get certified if my neurologist clears me, but I haven’t completed the FMCSA waiting period?
A: No. The Medical Examiner is federally required to follow the FMCSA’s mandatory minimum waiting periods (1, 5, or 8 years). A clearance letter from a specialist alone is not sufficient if the statutory time has not elapsed.

Have Complex Neurological Documentation? Get Certified by an FMCSA Expert.

Don’t risk disqualification due to missing paperwork or confusion over waiting periods. Our FMCSA-Certified Medical Examiner is an expert in complex neurological clearance requirements.

Examiner: Dr. Lemuel P. Byrd, Jr., D.C.

Call Now: 704-544-3494

Hours: Monday-Friday 9am-5pm | Saturday 9am-12pm
Location: 8415 Pineville-Matthews Road, Suite 102, Charlotte, NC 28226
Cost: $70 | No Wait Policy | Walk-ins & Appointments Welcome