NRII Implementation Deadline

The Federal Motor Carrier Safety Administration (FMCSA) has set June 23, 2025, as the official compliance date for the National Registry Integration Initiative (NRII). However, states may implement NRII earlier if they are prepared. Once a state integrates NRII, medical certification information for Commercial Learner's Permit (CLP) applicants and Commercial Driver’s License (CDL) holders will be electronically transmitted from the National Registry to the State Driver Licensing Agency (SDLA). In such states, the paper Medical Examiner’s Certificate (MCSA-5876) may no longer serve as valid proof of medical certification.

Key Changes Effective June 23, 2025

Several important modifications will take place:

• FMCSA will electronically transmit medical examination results (qualified, unqualified, and voided) for CLP applicants and CDL holders to the SDLAs.
• FMCSA will transmit medical variance information (medical exemptions and Skill Performance Evaluation (SPE) certificates) electronically to the SDLAs.
• SDLAs will update CDL Information System (CDLIS) driver Motor Vehicle Records (MVR) with examination results and restrictions.
• Medical examiners will no longer issue paper certificates (MCSA-5876) to CLP applicants or CDL holders.
• CLP applicants and CDL holders will no longer need to submit paper certificates to their SDLAs.
• Motor carriers must verify medical certification electronically through the CDLIS driver MVR instead of using paper Medical Examiner’s Certificates.

Medical Variances

If a medical examiner determines that a driver requires a medical variance, such as an SPE Certificate or medical exemption, the driver’s examination results will not be transmitted to the SDLA until FMCSA issues the variance. Once obtained, the National Registry system will link the variance with the original examination results and transmit them to the SDLA. Despite electronic transmission, drivers must still carry proof of medical variances while operating.

Ensuring Your Medical Certification is Posted to Your Record

Since drivers do not have direct access to the National Registry or SDLA systems, errors in transmission may occur. If a driver receives a CDL downgrade letter despite having completed a physical qualification exam, their medical certification was not received by the SDLA. Follow these steps to resolve the issue:

1. Contact the medical examiner who conducted your exam and ask them to verify if an error message was received regarding your certification.
2. Contact your SDLA to confirm whether the corrected medical certification was posted.
3. If the issue persists, reach out to FMCSA’s National Registry Technical Support Helpdesk at This email address is being protected from spambots. You need JavaScript enabled to view it. or (617) 494-3003.
If stopped by law enforcement and informed that you are not medically certified, follow the same steps immediately to correct the issue.

Non-CDL Holders

If you do not hold a CDL, NRII does not apply to you. Medical examiners will continue to issue the paper Medical Examiner’s Certificate (MCSA-5876) as proof of medical certification, and you must carry it while operating a commercial motor vehicle. However, if you later obtain a CDL, the SDLA can retrieve your existing certification information from the National Registry and post it to your CDLIS driver MVR.

On November 18, 2024, FMCSA published the attached technical amendment final rule that amends 49 CFR 391.49(d)(3)(i)(B) and (d)(3)(ii)(C) to clarify the meaning and effect of the current requirement that individuals with upper limb loss or impairment must be capable of demonstrating precision prehension and power grasp prehension to be eligible for a skill performance evaluation (SPE) certificate issued by FMCSA. The amendments clarify that a functioning hand is necessary to demonstrate precision prehension and power grasp prehension and that a prosthesis is required if the applicant does not have a hand. The amendments also clarify when an applicant has upper limb impairment that a prosthesis or orthotic device is required if the applicant is not capable of demonstrating precision prehension and power grasp prehension with each hand separately without a prosthesis or orthotic device.

Specifically, paragraphs (B) (for limb loss) and (C) (for limb impairment) relating to the statements made by the physiatrists and orthopedic surgeons in the medical evaluation summary have been amended to read as follows:

(B) A statement by the examiner that the applicant is capable of demonstrating precision prehension (e.g., grasping and manipulating knobs and switches using the fingers/thumb) and power grasp prehension (e.g., grasping, holding, and maneuvering the steering wheel using a hand) with each hand separately. Prior to applying for an SPE certificate, an applicant with loss of a hand or arm must be fitted and proficient with a proper prosthesis that enables the applicant to demonstrate precision prehension and power grasp prehension with each hand separately. This requirement does not apply to an individual who was granted a waiver, absent a prosthetic device, prior to January 6, 1986, the effective date of the requirement.

(C) A statement by the examiner that the applicant is capable of demonstrating precision prehension (e.g., grasping and manipulating knobs and switches using the fingers/thumb) and power grasp prehension (e.g., grasping, holding, and maneuvering the steering wheel using a hand) with each hand separately. Prior to applying for an SPE certificate, an applicant with upper limb impairment must be fitted and proficient with a proper prosthesis or orthotic device, if the applicant is not capable of demonstrating precision prehension and power grasp prehension with each hand separately without a prosthesis or orthotic device. This requirement does not apply to an individual who was granted a waiver, absent an orthotic device, prior to January 6, 1986, the effective date of the requirement.

In addition to the attached technical amendment final rule, FMCSA has also attached information outlining prevalent issues present when MEs are documenting evaluation outcomes of limb loss and impairment under 49 CFR 391.41(b)(1) and (2) during the physical qualification examination. These errors require FMCSA to void the examinations and require the drivers to obtain a new examination. FMCSA requests that all MEs review this information closely to ensure that examinations are recorded in accordance with the Federal Motor Carrier Safety Regulations.

Alternative Physical Qualification Standards for the Loss or Impairment of Limbs

Skill Performance Evaluation (SPE) Certificate Issues

Any medical professional seeking to become certified to conduct examinations on potential commercial vehicle drivers should be familiar with the role of a Medical Expert Panel (MEP).

Freddy Starr, M.D. reviews the Large Truck Crash Causation Study and discusses the role of the Certified Medical Examiner in determining psychological fitness for duty.

CASE

A 55 y.o. Male presents to the medical examiner for his Commercial Motor Vehicle (CMV) driver certification exam. His normal job description includes long haul driving across the country and occasional heavy lifting.

During the history portion of the exam he reports occasionally feeling some palpitations, especially after a poor night of sleep. He denies any chest pain or shortness of breath. In fact, he is feeling some palpitations at present, but denies any other symptoms or concerns. He takes no medications and has no history of any prior cardiac problems or stroke.