Medical standards for passenger (Class D) and motorcycle (Class M) driver's licenses

Learn about the Registry of Motor Vehicles' current medical policies relating to passenger vehicle and motorcycle driver's licenses.

Medical Affairs is primarily responsible for setting agency policies and procedures regarding physical qualifications for operator licensing. Medical Affairs sets its policies in accordance with recommendations made by the RMV's Medical Advisory Board. The Medical Advisory Board is appointed to the RMV by statute, Massachusetts General Laws Chapter 90 Section 8C, and consists of a panel of approximately 15 physicians of varying specialties. Currently, Medical Affairs has set minimum standards for vision qualifications, loss of consciousness and seizure conditions, and cardiovascular and respiratory conditions. When the RMV has cause to believe that a person may be unable to operate a motor vehicle due to any other condition not specifically addressed by the RMV's minimum standards, Medical Affairs shall conduct an individualized assessment of that person's qualifications to operate a motor vehicle safely.

Vision

You're eligible for a Class D or Class M permit/license if you, at minimum:

  • Have at least 20/40 distant visual acuity in either eye, with or without corrective lenses
  • Have not less than 120 degrees combined horizontal peripheral field of vision 
  • Are able to distinguish the colors red, green and amber 
  • Do not have unresolvable diplopia

If you have mono-vision, or the ability to see at distance out of one eye, a vision screening certificate, completed by an optometrist or ophthalmologist and indicating that you are visually qualified to safely operate a motor vehicle, can be accepted in place of the computerized vision screening.

If you are 75 years of age or older you have to follow certain guidelines when renewing your Class D or M driver's license:

  • Appear in-person at an RMV service center or AAA office, and pass a vision test administered by the RMV or AAA personnel
  • Present a completed vision screening certificate that meets the RMV's vision standards

 

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Seizure/loss of consciousness

If you've experienced a seizure, syncope, or any other episode of altered consciousness which will affect the safe operation of a motor vehicle, you cannot obtain a learner's permit or driver's license. If you already have a learner's permit or driver's license, you must voluntarily surrender it or be subject to suspension or revocation until you have remained episode free for a period of at least 6 months.

At the end of the 6 month period, you may receive a Class D, Class M, or Class D/M permit/license when you provide the Medical Affairs with a completed loss of consciousness evaluation form or a written statement completed by your health care provider confirming that the you have been free from episodes for a minimum of 6 months and which states all of the following:

  • The date of the most recent episode
  • The cause of the episode (type of disorder suffered)
  • The means by which the condition is controlled (including any medications and dosages)
  • The degree of impairment or disability suffered during an episode (extent of episode)
  • The probability of recurrence of the episode (including frequency of occurrence, degree of assurance that the event will not reoccur, and basis for estimate of probability)
  • A certification that, to a reasonable degree of medical certainty, the customer's medical condition and medications will not interfere with the safe operation of a motor vehicle

The Registrar may waive or shorten the 6 month episode-free requirement upon receipt of a written statement from a health care provider requesting that the policy be waived because the health care provider has determined that the customer's medical condition and medications will not interfere with the safe operation of a motor vehicle. The written statement must include a specific request from the health care provider to waive the 6-month episode-free period, and it must also include all of the information listed above.

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Cardiovascular condition

Eligibility by heart disease classification

You can get a Class D, Class M, or Class D/M learner's permit or driver's license if you're classified by the American Heart Association as a functional Class I, II, or III heart patient. You're not eligible for a permit/license if you are medically determined to be a functional Class IV heart patient, according to the American Heart Association functional guidelines for classifying heart disease.

If you were formerly determined to be an American Heart Association functional Class IV heart patient and have since been reevaluated and determined to be an American Heart Association functional Class I, II, or III heart patient you must submit all of the following documentation from the health care provider to the Medical Affairs in order to be eligible for a Class D, Class M, or Class D/M permit/license:

  • Medical documentation of the status of your heart condition, including American Heart Association functional class and accompanying symptomatology (if any)
  • A written statement from the health care provider certifying that, to a reasonable degree of medical certainty, you are medically qualified to operate a motor vehicle safely

The RMV may restrict, suspend, or revoke driving privileges if it has reason to believe that an American Heart Association functional Class I, II, or III heart patient is unsafe to operate a motor vehicle.

Eligibility for customers with automated implantable cardiac defibrillators

You're not eligible for a Class D, Class M, or Class D/M learner's permit or driver's license if you have an automated implantable cardiac defibrillator placed for a “sudden death event” until you've experienced a 6 month period during which there is documentation proving there were no episodes of the device firing.

If, at any time after implantation, the Automated Implantable Cardiac Defibrillator has triggered, whether during the initial 6 month period or later, you are required to voluntarily surrender your license or be subject to suspension or revocation until you can provide the reinstatement information.

If you have an automated implantable cardiac defibrillator you are eligible to regain your Class D, Class M, or Class D/M permit/license provided you submit all of the following information from your health care provider to the Medical Affairs:

  • A description of your current heart condition, including the American Heart Association functional class and accompanying symptomatology (if any)
  • The status of the automated implantable cardiac defibrillator including whether the device has triggered and the date of the last trigger
  • A certification that, to a reasonable degree of certainty, you are asymptomatic, and that the device has not triggered for at least 6 months, and that you are medically qualified to operate a motor vehicle safely with specific reasons provided for that determination

If you have an automated implantable cardiac defibrillator for prophylactic (preventative) reasons, you will not be subject to a 6 month waiting period and are eligible for a Class D, Class M, or Class D/M permit/license provided you submit all of the information listed above from your physician to the Medical Affairs.

Pulmonary/respiratory condition

Minimum O2 saturation levels

If your oxygen (O2) saturation level is greater than 88% at rest or with minimal exertion, with or without supplemental oxygen, you will be presumed safe to operate a motor vehicle and will continue to be eligible to get a permit/license until such time as the RMV has cause to believe that you are unsafe to operate a motor vehicle.

If your oxygen saturation level is 88% or less at rest or with minimal exertion, even with supplemental oxygen, you are not eligible to get a learner's permit or driver's license and, if you already have a permit/license, you are required to voluntarily surrender it, or be subject to suspension or revocation.

If you were previously not eligible for a permit/license you will be eligible to get a Class D, Class M, or Class D/M permit/license, if you can provide all of the following information from your physician to the Medical Affairs:

  • Medical documentation that your O2 saturation level is greater than 88% at rest or with minimal exertion
  • A certification that, to a reasonable degree of medical certainty, you are medically qualified to operate a motor vehicle safely

Minimum respiratory function

If your forced expiratory (respiratory) volume in one second (FEV 1) level is 1.2 liters or less will be required to submit an O2 saturation test result in order to be eligible for a permit/license. Upon receipt of the O2 saturation test, the RMV will use the above O2 saturation level criteria in evaluating the customer's ability to operate a motor vehicle safely.

Musculo-skeletal impairment

The Medical Affairs has determined that a customer who suffers from a musculo-skeletal condition as severe as to prevent them from performing self-care may be functionally unable to operate a motor vehicle safely. Therefore, they require an individual assessment of their operating ability in the form of a medical certification from a health care provider.

If you are medically determined to have a musculo-skeletal condition which renders you unable to perform self-care, you are eligible for a Class D, Class M, or Class D/M learner's permit or driver's license if your health care provider provides a written statement with all of the following to the Medical Affairs:

  • Your name and date of birth
  • The status of the your musculo-skeletal condition
  • Accompanying symptomatology
  • A list of medications and dosages
  • A certification that, to a reasonable degree of medical certainty, you are medically qualified to operate a motor vehicle safely and your medications and dosages will not interfere with the safe operation of a motor vehicle

A health care provider may use the RMV's medical evaluation form to deliver this evaluation.

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Cognitive impairment

A cognitive impairment is any condition that impairs any of the mental faculties of attention, perception, comprehension, judgment, memory, reasoning, or physical action or response used by a person to understand and interact with the environment. Some cognitive impairments can affect driving ability. A severe driving-related cognitive impairment is a significant deficit or impairment of any cause, in any of the above faculties, limiting your ability to exercise appropriate judgment or maintain sustained attention necessary to the safe operation of a motor vehicle such that operating a motor vehicle is likely to produce an unacceptable risk to public safety.

If you're medically determined to have a severe driving-related cognitive impairment you're not eligible for a permit/license to operate a motor vehicle and must voluntarily surrender your driver's license or the RMV will suspend or revoke that license.

You may regain driving privileges after submitting an evaluation completed by your health care provider confirming that the customer no longer has a severe driving-related cognitive impairment. A health care provider may use the medical evaluation form to deliver this evaluation.

The evaluation to regain driving privileges (to be completed by the health care provider) should contain an assessment of cognitive function, including a statement verifying that:

  • There is a reasonable degree of medical certainty that you have the cognitive capacity to safely operate a motor vehicle
  • Any currently prescribed medications or dosages related to cognitive function are not likely to interfere with the safe operation of a motor vehicle

A health care provider who believes that a patient's cognitive impairment is not severe enough to recommend surrender of the driver's license, but that the patient's driving ability should be tested before re-licensing, may request a competency road test administered by the RMV be completed.

The RMV will then determine if you are eligible for licensure or to be issued a learner's permit.

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