What actually disqualifies you from a DOT physical

Named in the rule text itself (49 CFR 391.41)

• Loss of a foot, leg, hand, or arm — unless certified through the Skill Performance Evaluation (§391.49). (b)(1)–(2)
• Impairment of a hand, finger, arm, foot, or leg that interferes with grasping or prehension — SPE path again. (b)(2)
• Diabetes requiring insulin — NOT a disqualification since 2018; it is the §391.46 form-and-records pathway. Any list still calling insulin an automatic disqualifier is pre-2018 material.
• A current clinical diagnosis of alcoholism. (b)(13)
• Use of a Schedule I substance (marijuana included, whatever your state says), amphetamines, narcotics, or other habit-forming drugs — outside the prescription exception in (b)(12)(ii). (b)(12)
• A mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with safe operation. (b)(9) — functional language; no diagnosis list exists.

Named in Appendix A to Part 391 (FMCSA's advisory criteria)

• An implanted cardiac defibrillator (ICD) — "disqualifying" (§D.2).
• Proliferative diabetic retinopathy.
• Hypertrophic cardiomyopathy — certification not recommended.
• Active psychotic disorders — certification not recommended.
• Untreated narcolepsy and conditions causing loss of consciousness inside their published waiting periods.

NOT disqualifications, whatever the internet says

• Any weight or BMI number. No federal weight limit exists in 391.41.
• Any cholesterol number. No federal cholesterol standard exists.
• Any A1C number. No federal A1C cutoff is published; examiners use A1C as context.
• Methadone, by name. The rule text does not name it; it sits in the prescription-exception class (examiner practice is another matter — see its matrix page).
• Any drug described as "FMCSA approved." FMCSA approves no drug by name; that phrase marks a page that did not read the rule.

Every condition in the second and third lists has a full page in this section's matrix, with its citation and its date stamp. Where the honest answer is "the examiner decides," the page says exactly that — EXAMINER'S CALL — instead of dressing practice up as law.

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