Subject 375-3-5 DRIVER'S LICENSE ADVISORY BOARD

Episodic alteration of consciousness, severe enough to cause the person to lose his postural attitude or to be unable to continue whatever action he was involved in, whether or not caused by disorders primary to the central nervous system, would cause that individual to be reviewed under this section. Isolated incidents of lapses of consciousness without likelihood of recurrence need not be considered here.

All individuals who have had one episode of altered consciousness should be grouped as follows:

(a)	Group A-Individuals who have had an episode of altered consciousness but not within the last year.

Group B-Individuals who have had an episode of altered consciousness in the preceding year.

	Class C	Class M	Class B	Class A
Group A	Yes	Yes	Yes	Yes
Group B	No	No	No	No
	Periodic Evaluation		Limited License
Group A	Yes		No
Group B	Yes		Yes*

* Nocturnal epilepsy and stress hypoglycemia.

(c)	Notwithstanding the foregoing, an individual who had an episode of altered consciousness due to epilepsy may be issued a Class C license, if otherwise qualified, if the episode did not occur within the last six months.

Rule 375-3-5-.03 Cardiovascular Function

Certain cases of heart disease, hypertensive vascular disease, peripheral vascular disease, and aneurysms will cause the suffering individual to be reviewed under this section.

Heart disease--Organic heart disease is divided into three groups. A fourth group deals with certain arrhythmias.

Group A--A driver is in Group A when:

(i)	he has asymptomatic heart disease; and

(ii)	the single or double masters' two step test does not produce symptoms, or alterations of the ECG; and

prolonged exertion, emotional stress, hurrying, hill climbing, recreation, or daily activities do not produce pathological symptoms, and

(iv)	signs of congestive heart failure are not present.

Group B--A driver is in Group B when he has organic heart disease and one or more of the following:

(i)	walking one or two level blocks, climbing one flight of stairs, or the performance of usual activities produces symptoms, or

(ii)	master's Two Step Test produces symptoms and ECG changes indicative of anoxia, or

emotional stress, hurrying, hill climbing, recreation, or similar activities produce pathologic symptoms, or

(iv)	signs of congestive failure, if present, or relieved by therapy.

Group C--A driver is in Group C when he has organic heart disease with symptoms at rest, and one or both of the following:

(i)	The performance of any of the activities of daily living beyond the personal toilet or its equivalent produces increased discomfort, or

(ii)	Signs of congestive failure, if any present, are resistant to therapy.

4.

Group D--This group includes individuals with cardia arryhthmias. While some of these ailments, such as chronic asymptomatic atrial fibrillation usually do not present notable impairments, other such as paroxysmal atrial flutter do present a high risk of catastrophe. Hence, consideration must be based on their risk factor, which can be arrived at only by evaluating each disease entity.

	Class C	Class M	Class B
A	Yes	Yes	Individual
			Consideration
B	Yes	No	No
C	Unsafe-No	No	No
D	Individual	Individual	Individual
	Consideration	Consideration	Consideration
	Class A	Periodic	Limited
		Reevaluation	License
A	Individual	Yes	No
	Consideration
B	No	Yes	Yes
C	No	Yes	Yes
D	Individual	Yes	Yes
	Consideration

(b)	Cardiac Pacemakers--Individuals with implanted pacemakers to control heart rate should not be recommended for Class M, A or B licenses. They may reasonably be given a medical review at yearly intervals by a physician familiar with cardiac pacemakers.

Hypertensive Vascular Disease--A repeatedly elevated diastolic pressure over 90 mm Hg. in an untreated individual is, for purposes of these guidelines assumed, to be diagnostic of hypertension. Transient headaches from this disease must be judged on an individual basis to determine their severity, frequency, and subsequent interference with the individual's driving ability.

Group A--Diastolic pressure repeatedly over 90 mm. Hg. and none of the following:

(i)	abnormalities of urinalysis or urinary function tests;

(ii)	history of hypertensive cerebrovascular damage;

evidence of left ventricular hypertrophy; or

(iv)	hypertensive abnormalities of the optic fundus.

Group B--A repeatedly elevated diastolic pressure over 90 mm. Hg. and any one of the following:

(i)	proteinuria and abnormalities is the urinary sediment but no impairment to the renal function;

(ii)	evidence of left ventricular hypertrophy, or

definite hypertensive changes in the retinal arterioles without hemorrhages.

Group C--A repeatedly elevated diastolic pressure over 90 mm. Hg. and any two of the following:

(i)	diastolic pressure usually in excess of 120 mm. Hg.;

(ii)	proteinuria and abnormalities in the urinary sediment, with evidence of impaired renal function;

hypertensive cerebrovascular damage with permanent neurological residuals;

(iv)	left ventricular hypertrophy;

(v)	retinopathy of arterioles, with hemorrhages and exudates. (Keith-Wagner Retinopathy, Stage III)

4.

Group D--Repeatedly elevated diastolic pressure over 120 mm. Hg. and any two of the following:

(i)	diastolic pressure usually in the range of 140mm. Hg. or more;

(ii)	proteinuria and abnormalities of the urinary sediment with evidence of nitrogen retention;

hypertensive cerebrovascular damage with permanent neurological impairment;

(iv)	left ventricular hypertrophy;

(v)

retinopathy of arterioles with papilledema (Keith-Wagner Retinopathy, Stage IV)

	Class C	Class M	Class B
A	Yes	Yes	Yes
B	Yes	No	No
C	Individual	No	No
	Consideration
D	Individual	No	No
	Consideration
	Class A	Periodic	Limited
		Reevaluation	License
A	Yes	Yes	No
B	No	Yes	Yes
C	No	Yes	Individual
			Consideration
D	No	NO	NO

(d)

Vascular Disease Affecting the Extremities. The importance of this category to the ability to drive safely depends on the impairment of the functional use of the affected extremity or extremities. This category is divided into three groups. Presence of vascular disease is presumed to have been diagnosed by existing conventional methods. Loss of pulses or arterial calcification is not considered an impairment to driving.

Group A--A driver is in Group A when he has vascular disease and:

(i)	experiences either intermittent claudication or pain at rest, or

(ii)	experiences only transient edema.

Group B--A driver is in Group B when he has vascular disease with any one of the following:

(i)	intermittent claudication occurring on walking more than 50 yards;

(ii)	vascular damage evidenced by healed amputation of any number of digits of one extremity or amputations at or above the wrist or ankle of one extremity with evidence of persistent vascular disease;

healed or persistent superficial ulceration, and

(iv)	moderate to marked edema which is only partially controlled by elastic supports.

Group C--A driver is in Group C when he has vascular disease with one of the following:

(i)	intermittent claudication of walking less than 50 yards, or severe and constant pain at rest;

(ii)	vascular damage evidenced by amputations of 3 or more digits of each of two extremities, with persistent vascular disease;

persistent, widespread, or deep ulceration involving any number of extremities.

	Class C	Class M	Class B
A	Yes	Yes	Yes
B	No	No	No
C	Individual	No	No
	Consideration
	Class A	Periodic	Limited
		Reevaluation	License
A	Yes	Yes	No
B	No	Yes	Yes
C	No	No	Yes

(e)

Aneurysms. Each case should be given individual consideration. The following recommendations are intended to be very general.

1.	Femoral and Popliteal Aneurysms. Persons with such conditions should be advised that long periods of sitting are dangerous. After such advice, however, they should be able to drive private automobiles safely. They should not be recommended for Classes M, A, or B licenses.

2.	Aortic and Central Nervous Systems Aneurysms. In general, such individuals usually should not be recommended for a Class C or M license. None should be recommended for Class A or B licenses.

Rule 375-3-5-.04 Repealed

Rule 375-3-5-.05 Mental Condition

(1)	Emotional disturbance on the part of a motor vehicle operator as it affects his ability to drive should be individually considered.

Factors to be considered in determining mental fitness to drive include, but are not limited to the following:

(a)	The ability to maintain a reasonably stable and realistic personality;

(b)	Manifestation of an emotionally erratic pattern, showing periods of irresponsibility, outward or inward aggressiveness, distorted perceptual thought impulsiveness, suicidal tendencies or paranoid thoughts.

(3)	A person with 2 or more convictions for crimes of violence against others may have severe emotional disturbances and should have careful evaluation of his mental function before being recommended for any class of license.

(4)	These personality characteristics often become apparent in police records, work records, job disability records, and in the histories of martial difficulty, and these records should be considered.

Rule 375-3-5-.06 Musculoskeletal Performance

While in many cases the best evaluation of driving performance still remains the practical road test, in order to insure adequate manual control in driving an automobile the following guidelines for musculoskeletal performance should be used.

Motor Power Requirements.

The strength of muscles required to perform the task of driving should be determined. This determination is based on two factors: the force of gravity and the resistance applied by the examining physician to the muscle group being tested. A determination should be made based on the physicians interpretation as to whether the strength is:

(i)	Normal--Complete range of motion against gravity with full resistance.

(ii)	Good--Complete range of motion against gravity with some resistance.

Fair--Complete range of motion against gravity without resistance.

(iv)	Poor--Complete range of motion with gravity eliminated.

(v)	Trace--Evidence of slight contractility, no joint motion.

(vi)	Zero--No evidence of contractility.

Impairment to driving caused by motor power deficiency may be group as follows:

(i)

Group A.

(I)

A normal muscle power as tested at all of the following joints:

I.	Right ankle dorsi and plantor flexion.

II.	Right Knee extension.

III.	Hip flexion and extension.

IV.	Grip--both hands.

V.	Both wrists--extension and flexion.

VI.	Both elbows--extension and flexion.

(II)	At least good muscle power in flexion of the right knee.

(ii)

Group B.

(I)

Muscle power classified as good or better at any one or more of the following joints:

I.	Right ankle dorsi and plantor flexion.

II.	Right knee extension.

III.	Hip flexion and extension.

IV.	Grip--both hands.

V.	Both wrists--extension and flexion.

VI.	Both elbows--extension and flexion.

(II)	At least fair muscle power in flexion of right knee.

Group C.

(I)	Fair muscle power at any one or more of the following joints as listed in Group Aa and Group Bb.

(II)	Poor or trace muscle power in flexion of the right knee.

Table Motor Power and Acceptable Level of Function for Driver Licensure.

	Class C	Class M	Class B
A	Yes	Yes	Yes
B	Yes	Yes	Individual
			Consideration
C	Individual	No	No
	Consideration
	Class A	Periodic	Limited
		Reevaluation	License
A	Yes	No	No
B	Individual	Yes	Yes
	Consideration
C	No	Yes	Yes

Active Range of Motion of Joints. A driver must have adequate mobility of the joints that are important to the safe operation of a motor vehicle. The range of motion necessary will vary as to the specific vehicle and as to the size of the individual evaluation of this category of driver impairment must be based on individual consideration by the examining physician and on the performance of the road test.

(c)	Amputations. Whether or not an amputation will impair the ability to drive an automobile safely should be decided if brought to the medical board, on an individual basis.

Rule 375-3-5-.07 Respiratory Function

Respiratory impairment leads to a decreased ability to adequately provide sufficient oxygenation of the blood to meet the demands, required of drivers.

Tests of Ventilatory Function.

1.	Since tests require maximal voluntary effort on the part of the patient they are not infallible, and should be repeated if significant impairment is noted.

2.	A bronchodilator should be administered if the cause of the respiratory deficiency is suspected to be bronchial obstruction. If there is a 15 percent improvement in subsequent tests after this treatment, these values must be considered to be the true state of the individuals respiratory capacity.

The tests most likely to give a survey of the driver's ventiliatory capacity are:

1.	The 1 second forced expiratory volume (F.E.V.);

2.	The forced vital capacity (F.V.C.);

3.	The determination of the maximal voluntary ventilation (M.V.V.).

Test requirements.

1.	Results of the above tests should be expressed in terms of liters or liters per minute and also as a percentage of the predicted normal.

2.	The FEVT.O and the FVC should be administered three times, with the best test result determined as the most representative of the patients capacity.

3.	The MVV is a fatiguing test, requiring considerable muscular effort, thus the better of two attempts should be accepted.

(d)

Groupings of impairment to driving caused by ventilatory deficiency:

Group A--Chest X-Ray are usually normal, but may show healed or inactive disease of the chest. Dyspnea, if it occurs is consistent with the type and degree of physical exertion. Values obtained from at least two of the ventilatory function tests are no less than 85 percent of predicted normal values for patient's age, sex and height. Blood gases are usually within the normal range.

Group B--Chest X-Rays are normal or abnormal. Dyspnea does not occur at rest and usually does not occur during the performance of usual daily activities. The subject can keep a normal pace with persons of the same age and body build on level ground without breathlessness, but not on hills and stairs. Values obtained from at least two of the ventilatory function tests are in the range of 70 to 85 percent of the predicted normal values. Blood gases usually are normal but the oxygen partial pressure present on a random sample of arterial blood may be diminished to 75 mm. Hg. (Numerical values may differ among laboratories and it should be noted that the following values are based on a lower limit of 85 mm. Hg.)

Group C--Chest X-Rays may be normal but usually are not. Dyspnea does not occur at rest but is present during performance of usual daily activities. The individual can walk one mile at his own pace without dyspnea but is unable to keep up with his peers. Value of at least two ventilatory function tests are in the range of 55 to 70 percent of the predicted normal values. The blood gases are usually normal with partial pressure of arterial oxygen no less than 70 mm. Hg.

4.

Group D -- Chest X-Rays are usually abnormal. Dyspnea occurs climbing one flight of stairs, walking 100 yards on the level, or even at rest. Values obtained from at least two ventilatory function tests are below 55 percent of the predicted normal value. The partial pressure of arterial oxygen is less than 65 mm. Hg.

(i)

Table acceptable levels of respiratory function for Drivers Licensure.

	Class C	Class M	Class B
A	Yes	Yes	Yes
B	Yes	Yes	Individual
			Consideration
C	Yes	Yes	Individual
			Consideration
D	Individual	No	No
	Consideration
	Class A	Periodic	Limited
		Reevaluation	License
A	Yes	No	No
B	Individual	Yes	Yes
	Consideration
C	Individual	Yes	Yes
	Consideration
D	No	Yes	Yes

Rule 375-3-5-.08 Vision

Certain cases of poor function in visual acuity, visual fields, ocular mobility, dark adaptation, and color blindness will cause the individual to be reviewed under this section.

(a)	Visual acuity should be recorded using the Snellen notation.

Individuals with visual acuity of at least 20/60 corrected or uncorrected, in at least one eye or better and a horizontal field of vision with both eyes open of at least 140 degrees or, in the event that one eye only has usable vision, horizontal field of vision must be at least 70 degrees temporally and 50 degrees nasally.

Individuals with visual acuity less than 20/60 but better than 20/200 using spectacles, contact lenses, or the carrier portion of the bioptic spectacles shall be considered eligible for a driver's license if not otherwise disqualified from having a driver's license under the following provisions:

1.	The person can attain a visual acuity of at least 20/60 through utilizing bioptic telescopes;

2.	The telescopes are prescribed by a licensed optometrist or ophthalmologist;

3.	The person presents documentation of having satisfactorily completed training in the use of the bioptic telescope as certified by the prescribing doctor;

4.	The person completes a standard driver's education course while using the bioptic telescopes prior to the on-the-road evaluation;

5.

The person present documentation from the prescribing doctor; proof of completing a standard driver's education course to the Department of Driver Services certified driver's license examiner at the time of the on-the-road evaluation; satisfactorily completes any recommended training in driving while using bioptic telescopes from the Department of Driver Services examiner; and, passes a written and driver's test examination at the exam station.

(d)	Any person who is licensed to drive using bioptic telescopes shall be subject to restrictions placed on his or her license as determined or recommended by the prescribing optometrist or ophthalmologist or the Department of Driver Services driver's license examiner.

(e)	Any recommended restrictions shall be reported to the Department in writing and presented to the examiner at the time the person appears for a driver's license examination.

(f)

Restrictions may include the following:

1.	Daylight driving only;

2.	Outside rear-view mirrors;

3.	Certain area;

4.	Time restrictions;

5.	No interstate driving;

6.	Yearly reevaluations by an optometrist or ophthalmologist; and

7.	Other such restrictions deemed appropriate.

(g)

Any restrictions imposed shall be subject to review and reconsideration after one year by completing all of the steps described in subparagraphs 1. through 5. of paragraph (c), which may include completing any additional testing under special conditions, as determined by the optometrist or ophthalmologist.

(h)	The user of a bioptic telescope shall be required every two years to renew his or her driver's license, be reevaluated by an optometrist or ophthalmologist and pass the driver's road test examination administered by the Department of Driver Services.

(i)	The user of a bioptic telescope, in addition to paragraph (h), is required to present to the Department of Driver Services, at time of renewal, a certification by the optometrist or ophthalmologist, that the user's visual acuity, visual field, and eye health remain stable.

(j)	In the event changes in vision are determined, the person's driver's license shall expire and the person must successfully repeat all of the steps described in paragraphs (b) through (e).

Any person applying for a license to operate a commercial motor vehicle as defined in O.C.G.A. § 40-5-142, who is not required to obtain a commercial driver's license to operate such vehicle, and who has lost some or all of the vision in one (1) eye may be exempted from the vision standard set forth in paragraph (1)(b) of this regulation by providing the Department with medical evidence satisfactory to the Department that said applicant's visual acuity in the other eye is at least 20/40 corrected or uncorrected. Said medical evidence shall include the following a signed statement on letterhead from an ophthalmologist or optometrist who has examined the applicant within three (3) months of the date of the application which:

1.	Identifies and defines the nature and duration of the vision deficiency;

2.	States the date of examination;

3.	Certifies that the visual deficiency is stable;

4.	Identifies the visual acuity of each eye, corrected and uncorrected;

5.	Identifies the field of vision of each eye, including central and peripheral fields, testing to at least 120° in the horizontal. (Formal perimetry is required. The doctor must submit the formal perimetry for each eye and interpret the results in degrees of field of vision.);

6.	Identifies if the applicant has the ability to recognize the colors of traffic control signals and devices showing red, green, and amber; and

7.	Certifies that in his/her medical opinion, the applicant has sufficient vision to perform the driving tasks required to operate a commercial vehicle.

(b)	An exemption may be issued for a maximum of 2 years, but may be renewed at the discretion of the Department.

Rule 375-3-5-.09 Medical Review Procedures for Persons Believed to be Incompetent or Unqualified

No license shall be issued to or retained by any person who is unable to safely operate a motor vehicle due to:

(a)	a disorder characterized by lapses of consciousness;

(b)	a mental or physical disability affecting the ability to drive safely; or

(c)	an addiction to alcohol or drugs to the extent that such person is incompetent to operate a motor vehicle.

Upon receipt of a report that a person with a disability or disorder defined in paragraph (1) (a) through (c) may be unqualified to be licensed, the Department may obtain the advice of the Driver License Advisory Board. Such review by the Driver License Advisory Board may also be requested by the licensee. The Board may base its advice on records and reports provided by the department, an examination and report made by a Board member or other qualified person designated by the Board, or a written report provided by a licensed physician chosen by licensee. The submission of such reports shall be without expense to the State or the Department.

(3)

Whenever the Department has good cause to believe a licensee is incompetent or unqualified to safely operate a motor vehicle, the licensee shall be required to submit to an examination at the nearest driver's license facility within ten (10) days of receipt of written notice from the Department. Based upon the results of the examination, the Department may revoke the license or issue a license with the appropriate restrictions. If the licensee does not comply with the Department's request to submit to an examination, then the driver's license shall be revoked.

Whenever the Department receives a Request for Driver Review (form DDS-270), the Department shall conduct an investigation to determine whether the licensee is qualified to be licensed.

(i)	After the completion of said investigation, the Department shall determine whether there is evidence to support the allegation that the licensee is unqualified to be licensed. If the investigation does not substantiate the allegations, no further action shall be taken by the Department.

If the Department shall determine that there is evidence to support the allegation that the licensee is unqualified to be licensed, the Department shall send the licensee a notice containing the following information:

(i)	That a licensee unable to drive safely due to a disability and/or disorder as provided in paragraph (1)(a) through (c) may not retain a driver's license under Georgia Law;

(ii)	That a question has arisen as to the licensee's capacity to drive;

That enclosed medical report forms must be completed by a licensed physician of the licensee's choice and returned by the physician directly to the Department within thirty (30) days of receipt;

(iv)	That, after review of the medical reports, the Department will make a determination of whether to allow such licensee to retain their driver's license, add restrictions to their driver's license, or impose a revocation of the license;

(v)	That the letter may be considered that licensee's authority to drive pending subsequent notification from the Department of Driver Services that their driver's license has been retained, retained with restrictions, or revoked;

(vi)	That, should the licensee fail to submit completed medical reports to the Department within thirty (30) days, their driver's license shall be revoked and they shall be deemed to have waived their right to appeal the revocation of the driver's license.

(4)	If the Department has not received completed medical reports from the licensee within thirty (30) days, their driver's license shall be revoked and they shall be deemed to have waived their right to appeal or otherwise contest the revocation.

(5)	The Department may, upon good cause shown, extend the time periods established above. The Department's decisions in this regard shall be final and not subject to review.

(6)

After receipt of the recommendation of the Driver License Advisory Board, where applicable, and any other pertinent information, the Department shall notify the licensee, by mail, of the retention, retention with restrictions, or revocation of his driver's license. As the Department is authorized by statute to impose any restrictions which it may determine are appropriate to assure the safe operation of any motor vehicle by the licensee, no appeal shall be granted regarding the Department's decision to impose restrictions on a person's driver's license. If the driver's license is revoked, the licensee may appeal that revocation as provided hereinafter.

(7)

The licensee may, within fifteen (15) days of receipt of notice of revocation, request a hearing by a designated hearing officer of the Department. Such request must be made in accordance with the appeal requirements in Ga. Comp. R. & Regs. R. and received by the Department within the 15-day period specified. If no request for hearing is received within the 15-day time period, the licensee shall be considered to have waived their right to a hearing and to appeal the revocation of their driver's license. The notice of revocation shall advise the driver of this requirement.

(8)	The hearing and appeal procedures shall be as specified in Ga. Comp. R. & Regs. R. .

(9)

The department is authorized to revoke the license of a licensee without a preliminary examination or hearing upon a recommendation by a court or prosecutor, or upon a showing by the records of the department, that the licensee is unable to drive safely due to a disability and/or disorder as provided in paragraph (1)(a) through (c).

(10)

Once a licensee is found to be physically and/or mentally qualified, the Department shall require such person to present an application for a new license and complete the applicable knowledge and/or skills tests for issuance of a driver's license. Any person who fails an applicable skills or knowledge test may make another attempt at such test in the time intervals established in Ga. Comp. R. & Regs. R. . Notwithstanding the foregoing, if a person successfully completes the knowledge test(s) but does not take or fails the applicable skills test(s), they may be issued an instructional permit in the applicable license class.

Rule 375-3-5-.10 Applicants-Physical and Mental Conditions

Whenever the Department has reason to believe that an applicant is physically or mentally incompetent to operate a motor vehicle, the applicant shall be given a medical report form which must be completed by a licensed physician of the applicant's choice and returned by the licensed physician directly to the Department before the application will be taken under consideration by the Department. The submission of such reports is to be without expense to the State.