Until this summer, a commercial driver who never crossed South Dakota’s borders could skip the medical exam entirely. That exemption is gone. The state has adopted federal regulation 49 CFR 391.11, which means most drivers now need a valid South Dakota CDL medical certificate to keep operating commercially, even if their routes never leave the state. For the physicians who perform those exams, the phones have been busy.

Dr. Chad Storch, an occupational medicine physician with Monument Health in Rapid City, spent more than two decades in the Navy keeping pilots and sailors fit for duty. These days he applies that same eye to the drivers hauling freight, fuel, and passengers across western South Dakota, and he has watched the rule change land on people who never saw it coming.

“It all comes from a place of safety,” Storch said. “We don’t want them to have a disease process that may cause a sudden incapacitation. We expect the same thing of our pilots. When you take that flight to Denver or Dallas, you want that pilot up there to be as healthy as can be.”

The exam itself, commonly called a DOT physical, gets performed by a certified medical examiner who has completed specific training through the Federal Motor Carrier Safety Administration. Drivers can find one through the FMCSA’s national registry online.

Who the New Rule Affects

Previously, drivers who held a CDL with a K restriction and stayed within state lines faced no medical qualification at all. If they could drive, they drove. Now those same drivers must pass a DOT physical and carry a medical certificate, and the state expects to notify roughly 28,000 CDL holders about the change.

The original compliance deadline was July 1. According to Storch, the state has since extended that window to August 29, giving drivers additional time to get certified.

A handful of carve-outs exist. “If you’re a beekeeper transporting bees, then you don’t need that DOT medical certificate,” Storch said. Certain government vehicles, emergency vehicles, and farm operations also qualify for exceptions, and the full list is available through the state.

Over-the-road truckers already lived under these requirements, so nothing changes for them. As for why the exemption existed in the first place, Storch offered a shrug. “I didn’t make the rules, but those are the rules that existed here when I got here, and now those rules have changed.”

What the Exam Actually Checks

Medications trip up more drivers than anything else, according to Storch. Some prescriptions raise safety questions for commercial driving, and examiners often need a letter from the prescribing physician confirming the driver tolerates the medication without side effects.

Blood pressure comes next. The standard sits at 140 over 90 or less, and medication to reach that number is allowed. Vision must measure 20/40 or better, and drivers with sight in only one eye can qualify through a separate form completed by an optometrist. Insulin-dependent diabetics need their treating provider to fill out an MCSA form attesting to recent lab work.

Then there’s sleep apnea. “We don’t want anybody falling asleep at the wheel,” Storch said. Drivers diagnosed with the condition and treated with a CPAP machine must document thirty days of compliance through printouts from the device. Anyone who loses weight and believes the condition has resolved needs a new sleep study before the requirement drops. “That’s all well and good,” Storch said, “but prove it.”

A Lapsed Card Has a Path Back

For many drivers, the medical card represents the whole paycheck, which makes a failed exam a heavy conversation. Storch understands the frustration. “I don’t write the law. I didn’t write 49 CFR. The government plays the music, the drivers and I dance to it.”

The state system builds in some cushion, and Storch makes a point of telling drivers about it. In South Dakota, a CDL whose medical certificate expires simply becomes a regular driver’s license. Once a new certificate reaches the state licensing office in Pierre, the license converts back to a CDL with no retesting required. “I’m trying to keep drivers driving,” he said.

When Storch can’t certify someone, he sends them out the door with the exact forms and referrals needed to try again. “Look, I can’t certify you today, but this is what you need. This is the path forward.”

His best advice costs nothing. “Take ownership of your medical conditions,” he said. “If it’s your livelihood, then take an active role in setting yourself up for success. Study for the exam.”

That studying can start in the parking lot. “If that’s not having that cup of coffee, three energy drinks, and two cigarettes before you come in with your high blood pressure, maybe you don’t do that. It’s all waiting for you in the car when you get out there.”