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  • ACOEM Comments on Proposal to Include Qualified VA Physicians on National Registry

    January 3, 2017

    Docket Management Facility
    U.S. Department of Transportation
    1200 New Jersey Avenue SE
    West Building, Room W12–140
    Washington, DC 20590–0001

    Re: Docket No. FMCSA–2016–0333

    To Whom It May Concern:

    The American College of Occupational and Environmental Medicine (ACOEM) appreciates the opportunity to provide comments on the proposed amendments to the Federal Motor Carrier Safety Regulations (FMCSRs) to establish an alternate process for qualified physicians employed in the Department of Veterans Affairs (VA) to be listed on the Agency’s National Registry of Certified Medical Examiners (NRCME).

    The Fixing America’s Surface Transportation Act (FAST Act) allows for a qualified VA physician, subject to certain requirements, to perform a medical examination and provide a medical certificate and include such physicians on the national registry of medical examiners established under section 31149(d) of title 49, United States Code. While ACOEM supports this provision to encourage veterans to enter the trucking industry, we do not see a need for a totally separate system to certify VA physicians.

    One of the concerns of the FAST Act was a lack of access by veterans to qualified medical examiners. This was based on an assumption that time and travel costs prevent VA physicians from being trained under the NRCME requirements. We disagree with the estimated savings associated with an alternate process, as noted in the NPRM. Since many training programs are offered partially or entirely online, travel costs (or time away from work) are virtually eliminated. For example, ACOEM’s training program is currently available entirely online, requiring no travel and offered in one hour segments. As required by NRCME, ACOEM grants continuing medical education credits to those who complete the course, providing an additional benefit that would be realized if a distance-learning training program is completed through the previously designed NRCME training system.

    The core content of any training should be include at least the minimum specified in the Core Curriculum announced in the Federal Register in April 2012. The training should also make certain potential examiners are aware of other sources of information, such as information developed by the Medical Review Board and the Motor Carrier Safety Advisory Committee, as well as medical literature which could be consulted when no official guidance is available from FMCSA. Of course, as with any training program, it should be explicitly stated that such information is not officially endorsed by FMCSA.

    It would be a disservice to both the military veterans and the motoring public if the VA examiners are less aware of the regulations, guidelines and current literature, as well as the roles, responsibilities and risks of operating commercial motor vehicles than examiners for the general population of drivers. The purpose of at least a minimally consistent training content is to protect the public. Eliminating much of this information undermines the purpose of the NRCME.

    The relative cost of subsidizing the VA examiner to complete a distance learning training program compared to the FMCSA developing and maintaining a training program (including periodic updates as new guidance, regulations or other information becomes available) would most likely be comparable.

    ACOEM applauds the intent to offer remote testing. We also request, however, that FMCSA consider allowing online testing for all applicants and not just qualified VA physicians. This would be a cost savings for all who seek to be a CDME and also assist those who wish to become examiners, especially in remote locations.

    While veterans will have many of the same medical conditions as the general population, they may also be dealing with musculoskeletal or mental health issues that are different from those who have not served our country. For this reason, we do feel it is important to limit examiners to those that by virtue of their training and/or licensure are able to diagnose and treat those conditions they are being asked to evaluate. The examiner must be capable of evaluating whether the condition or the treatment may place the military veteran driver at risk of sudden or gradual impairment or incapacitation.

    Thank you for your consideration of our comments. Please do not hesitate to contact either one of us or Patrick O’Connor, ACOEM’s Director of Government Affairs, at 703/351-6222, should you have any questions.

    Sincerely,

    James A. Tacci, MD, JD, MPH, FACOEM, FACPM
    President

    Natalie P. Hartenbaum, MD, MPH, FACOEM
    Chair, Transportation Section