Licence Appeal Tribunal File Number: 17488/MED

An appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Minister of Transportation to downgrade a licence pursuant to Section 32(5)(b)(i) of the Act.

Between:

Thomas Breton

Appellant

and

Minister of Transportation

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Thomas Breton, Appellant Jami Sanftleben, Paralegal

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: October 6, 2025

OVERVIEW

[ 1 ] Thomas Breton (the “appellant”) appeals from the decision of the Minister of Transportation (“Minister”) to downgrade his commercial AC licence to a G class licence under s. 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Minister received a medical report from a physician indicating that the appellant suffers from a medical condition that may affect his ability to drive a vehicle of the applicable class safely.

[ 2 ] Section 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”) states that a holder of a driver’s licence must not suffer from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with their ability to safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Minister may require a driver to provide satisfactory evidence that they are able to drive safely.

[ 3 ] Section 32(5)(b)(i) of the Act states that the Minister may impose the conditions authorized by the regulations, remove any conditions or endorsements or change the class or classes of driver’s licence held by the person, in accordance with the results of the examinations and other prescribed requirements.

[ 4 ] The Minister takes the position that the appellant has a medical condition, namely heart condition/implantable cardioverter defibrillator (ICD) implant, that is likely to significantly interfere with his ability to drive a commercial vehicle safely and that this provides sufficient reason to downgrade his licence under s. 32(5)(b)(i) of the Act.

[ 5 ] The appellant appeals the downgrade under s. 50(1) of the Act. He agrees that he has a heart condition/ICD implant but denies that he suffers from a medical condition which interferes with his ability to drive a commercial vehicle safely.

[ 6 ] Pursuant to section 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Minister.

[ 7 ] The Open Court Principle was explained at the outset of the hearing as it had not been discussed during the Case Conference.

ISSUES

[ 8 ] The issue in this appeal is whether the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a commercial vehicle of the applicable class safely.

[ 9 ] To resolve that issue, I will address the following questions:

i. Does the appellant have a heart condition/ICD implant?

ii. If so, is this likely to significantly interfere with his ability to drive a commercial vehicle safely?

[ 10 ] The Minister bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

[ 11 ] Having considered all the evidence and submissions and for the reasons that follow, I find that the Minister has satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a commercial vehicle safely and I confirm the Minister’s decision to downgrade the appellant’s driver’s licence.

ANALYSIS

Does the appellant have a heart condition/ICD implant?

[ 12 ] The evidence presented at the hearing establishes that the appellant has a heart condition/ICD implant.

[ 13 ] The Minister’s position is supported by multiple medical documents as the appellant is a commercial driver who has been required to submit cyclical documentation to maintain his commercial licence. The appellant first came to the attention of the Minister when an unsolicited medical condition report (MCR) dated February 3, 2022, completed by cardiologist Dr. M was submitted. Dr. M documented that the appellant had a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence and described that the patient had heart disease with known history of ventricular tachycardia and had presented with 5 shocks from his ICD.

[ 14 ] Since receipt of this MCR, the Minister has requested the appellant to submit cyclical documentation regarding his cardiac status from his treating healthcare practitioners. All of the submitted cardiac documents confirm the presence of an ICD, and earlier documents report that the ICD was implanted on November 4, 2020.

[ 15 ] The appellant agreed that he has a heart condition/ICD implant.

[ 16 ] I find the medical evidence in this case clear and the medical condition not under dispute. Based on the information available, I find that the Minister has established on a balance of probabilities that the appellant has a heart condition/ICD implant.

Is the appellant’s medical condition likely to significantly interfere with his ability to drive a commercial motor vehicle safely?

[ 17 ] I find that the Minister has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

[ 18 ] The Minister stated that following receipt of the MCR dated February 3, 2022, by Dr. M the appellant’s G and AC licences were suspended, and a completed Cardiovascular Assessment Form was requested. The Minister argued that sudden incapacitation due to ICD shocks can and will interfere with the safe operation of a commercial vehicle and the Minister did take the appropriate action.

[ 19 ] A Cardiovascular Assessment Form completed by cardiologist Dr. PH and dated February 18, 2022, reported a diagnosis of ventricular tachycardia, the presence of an ICD for secondary prophylaxis with a shock or device intervention that impaired level of consciousness less than 6 months prior, and a risk of sudden incapacitation reported as unknown.

[ 20 ] In response to receiving this Form, the Minister continued the suspension, requesting further medical information as well as confirmation that three months had elapsed since the last episode of sustained symptomatic ventricular tachycardia (VT) or syncope judged to be likely due to VT or cardiac arrest.

[ 21 ] An updated Cardiovascular Assessment Form dated April 20, 2022, and narrative letter from Dr. PH dated April 27, 2022, was submitted to the Minister. The Minister issued a letter to the appellant dated April 28, 2022, indicating that his G class licence was reinstated. The appellant’s commercial licence was not reinstated.

[ 22 ] The appellant appealed the Minister’s decision to downgrade his commercial licence at a hearing before the Tribunal on June 2, 2022, and was successful. The Minister subsequently issued a letter indicating his AC licence was reinstated dated June 27, 2022.

[ 23 ] The Minister explained that as part of the cyclical requirements for commercial drivers, a Cardiovascular Assessment Form was requested and submitted dated March 25, 2024, and completed by Dr. PH. After receipt of this Form, the appellant’s commercial licence was downgraded in February 2024. Another Cardiovascular Assessment Form was completed by Dr. PH dated April 25, 2024, reiterating that the appellant had an ICD for secondary prophylaxis, but his annual risk of sudden incapacitation was changed from unknown to 1% or less. The Minister stated this downgrade was the Minister’s error in light of the successful appeal in June 2022, as the cardiac condition had not changed since the hearing, and the commercial licence was subsequently reinstated on April 23, 2024.

[ 24 ] The Minister requested further information again as part of the cyclical monitoring requirements for commercial drivers and received a Cardiovascular Assessment Form completed by Dr. PH dated April 3, 2025. The document reported the appellant had had recent cardiac surgery with defibrillator lead repositioning 1-3 months prior, had VT and hemodynamically unstable VT, had an ICD for secondary prophylaxis and had an annual risk of sudden incapacitation that was unknown. Dr. PH added the comments, “Has ICD, now upgraded to CRTD, taking amiodarone”. After review of this Form, the Minister downgraded the appellant’s licence to a Class G licence in a letter dated April 9, 2025.

[ 25 ] The Minister referenced two subsequent submissions from the appellant. The first was a letter from nurse practitioner CF dated April 15, 2025, which reported that the appellant had an ICD for secondary prevention, had a diagnosis of ischemic cardiomyopathy, had a preserved ejection fraction, had no ventricular arrhythmia events during follow up and no therapies (ATP or shocks) delivered during follow up. The risk of syncope was estimated to be <0.5% annually and based on this information there was no medical reason to downgrade the appellant’s commercial licence.

[ 26 ] The second submission was a consultation letter from Dr. B on behalf of Dr. H also dated April 15, 2025 which documented the presence of the ICD with the CRTD upgrade for exercise intolerance on August 8, 2024, repositioning of both RA and LV leads on December 11, 2024, ischemic cardiomyopathy with preserved ejection fraction and the annual risk of syncope to be less than 0.5% with support for the appellant to hold a commercial licence.

[ 27 ] Following receipt of this information, the Minister referred the appellant’s file to the Medical Advisory Committee (MAC) Physician, cardiologist Dr. S, for review. Dr. S summarized the case documenting the appellant has coronary artery disease, underwent ICD implant in 2020 following an episode of ventricular tachycardia. The appellant subsequently had ICD shocks for ventricular tachycardia after the device was implanted that prompted the initiation of amiodarone. He further documents the appellant underwent an upgrade to a CRT-D in August 2024 followed by another procedure to reposition both the atrial and left ventricular leads and that most recently, the left ventricular lead was not found to be capturing again with conservative treatment being pursued unless symptoms worsen, and that there had been mention of exertional dyspnea which implies a different NYHA class then was documented. He further acknowledges the appellant’s cardiologist believes his risk of sudden cardiac incapacitation is less than 0.5%.

[ 28 ] Dr. S summarizes the MAC recommendation as follows: “The LV function is near-normal, but not normal. The patient has an ischemic cardiomyopathy and a prior history of sustained, hemodynamically unstable VT with a non-reversible cause. It is for this reason that he received a secondary prevention ICD. Although he has been upgraded to CRT, the LV lead is not functional. He has had appropriate shocks for VT since the ICD was implanted. It is the view of MAC that this driver cannot reasonably be assigned an annual risk of sudden incapacitation of <1% as is asserted by his cardiologist. The ‘1% rule’ in the CCS guidelines was intended to be a rarely-invoked exception to the general rule that ICD patients should not drive commercially, to exempt people at very low risk who had ICDs implanted for patient preference reasons…This exception was never intended to apply to secondary prophylaxis ICD patients, and there is no literature to support the contention that secondary prevention patients with ischemic CM and ICD would be at a risk of <1%. MAC therefore recommends that this driver remains eligible for a G licence but is not eligible for a commercial licence”.

[ 29 ] In addition to the recommendation of Dr. S, the Minister relies on 3 different Canadian Council of Motor Transport Administrators Medical Standards for Drivers [2025 Update] (the “CCMTA Standards”). The Minister noted that these standards are written by physicians and experts across the country and used in Ontario and other jurisdictions to assess driver fitness in the setting of certain medical conditions.

[ 30 ] Section 14(2)(a) of the Regulation allows the Minister to consider the CCMTA Standards when determining whether the requirements of s. 14(1) are met. The Tribunal may take the CCMTA Standards into consideration but are not bound by them.

[ 31 ] The Minister argued that the appellant’s medical condition is likely to interfere with his ability to drive a commercial vehicle safely and relied on Chapter 3 of the CCMTA Standards which indicates that drivers with cardiovascular disease have a higher risk of adverse driving outcomes than those without cardiovascular disease. The Minister highlighted that the CCMTA Standards were updated in 2025 to reflect the latest Guidelines from the Canadian Cardiovascular Society (CCS). The Minister noted that the appellant was ineligible for a commercial licence based on three independent standards:

i. Standard 3.6.24 applies to commercial drivers who have declined an implantable cardioverter defibrillator (ICD) or have an ICD implanted. This Standard states that drivers with an ICD implanted are not eligible for a commercial licence.

ii. Standard 3.6.27 applies to commercial drivers where an ICD therapy (shock or ATP) has been delivered. This Standard states that drivers who have had ICD therapy delivered are not eligible for a commercial licence.

iii. Standards 3.6.13 applies to commercial drivers who have hemodynamically unstable VT or VT with impaired level of consciousness. This Standard states that drivers with hemodynamically unstable VT are not eligible for a commercial licence.

[ 32 ] The Minister further submits that commercial drivers spend more time on the road, carry a much heavier load and if they are to have a cardiac or ICD event behind the wheel of a commercial vehicle the results could be catastrophic. The Minister submits that the (CCS) Guidelines reflect this higher standard for commercial drivers and that their decision is reasonable and supported by law and the national medical standards.

[ 33 ] Under cross-examination the Minister was asked why the appellant’s licence was downgraded when the appellant had submitted Cardiovascular Assessment Forms in 2023 and 2024 as requested, and these forms indicate the medical condition had not changed and the annual risk of sudden incapacitation decreased from 1% to <0.5%. The Minister responded that in addition to the risk of sudden incapacitation changing, they were also notified that the appellant’s ICD had been upgraded, and that the appellant’s cardiac condition had changed to include diagnoses of ischemic cardiomyopathy and hemodynamically unstable VT. Furthermore, the hemodynamically unstable VT would be a diagnosis that would disqualify a driver from holding a commercial licence independent of having an ICD, and these important changes warranted a review by their cardiac specialist.

[ 34 ] The Minister was further asked if any of the CCMTA Standards had changed since the Tribunal’s 2022 decision, and the Minister responded that several of the cardiac sections were updated, but the standard for an ICD implanted for secondary prophylaxis was very similar to the 2022 Standard applied which was that drivers with an ICD for secondary prophylaxis are ineligible for a commercial licence.

[ 35 ] The Minister was questioned as to whether they were aware that the appellant was compliant with his medical care and that his ICD was monitored remotely by his cardiologists, and the Minister responded affirmatively.

[ 36 ] The Minister was questioned whether the appellant’s ICD had administered any shocks since 2022, and the Minister responded that they had not received any reports indicating the appellant’s ICD had delivered a shock since 2022.

[ 37 ] The appellant’s representative questioned the Minister as to whether there were concerns about the appellant’s adherence to medical recommendations or whether his medical condition had declined since 2022. The Minister responded that their position is that the medical evidence demonstrates the appellant was not eligible for a commercial licence as he had not met three different CCMTA Standards. It was clarified that Standard 3.6.13 had not been applied in 2022.

[ 38 ] The appellant called his witness, cardiologist Dr. H. Dr. H testified as to his qualifications including that he was a board certified cardiologist, electrophysiologist, cardiology director at a university and had a master’s degree in health research. He testified he had worked with the Minister’s cardiologist Dr. S on the risk of harm formula and as a member of the advisory committee and cardiac care network when that concept was conceived.

[ 39 ] He testified he had been the appellant’s cardiologist since 2020 and more recently as his electrophysiologist. Dr. H reviewed that the appellant has type II diabetes, ischemic heart disease with mild LV dysfunction and ischemic cardiomyopathy with VT and syncope in August 2020, when an ICD was implanted, and he was started on amiodarone. Due to side effects of the amiodarone including slowing of the sinus node and not feeling energetic, his amiodarone was stopped by his other cardiologist Dr. PH in 2021. Six months later the appellant suffered a recurrent episode of VT with four ICD shocks administered. Amiodarone was then restarted, and the appellant has been free of recurrent shocks and has an ejection fraction (EF) of 40-45% which has been up and down. The appellant was 117 kg which may affect the acoustic window in measurement of his EF. Dr. H testified that it would make sense to him that the VT even in February 2022 could be due to the amiodarone being discontinued as it has a long half life. Dr. H further testified the appellant has had no further sustained arrhythmias; he takes a variety of medications for his diabetes as well as standard cardiac medications and has remote monitoring which streams to cardiology clinic on a daily basis.

[ 40 ] When Dr. H was asked by the appellant’s representative as to whether he supported reinstating the appellant’s commercial driver’s licence, he described how he felt the risk of harm formula may be inaccurate. He testified that part of the risk of harm formula includes the time spent driving with the assumption that commercial drivers are behind the wheel for several hours at a time and that a risk of sudden incapacitation that is acceptable is set at 1% for commercial drivers and 22% for non-commercial drivers, and that the big determinants of sudden risk of incapacitation are the heart’s rhythm and ejection fraction. He testified that the appellant’s risk of sudden incapacitation being 1% or less was a fair assessment, and he cited a study published in 2022 looking at ICDs being implanted for secondary prevention. Dr. H further testified that the appellant does not spend very long driving a commercial vehicle, stating he drives only a few times a month in a pickup truck.

[ 41 ] Dr. H was asked whether the remote monitoring of the appellant’s ICD reduces his risk for driving a commercial vehicle and he responded that there is no trial data to support that, but they would intervene if they saw an escalating arrhythmia, and again qualified this statement testifying that there are no reports directly assessing this.

[ 42 ] Under cross-examination from the Minister, Dr. H was asked if he thought the CCTMA standards are too strict for commercial drivers or if it doesn’t fit the appellant’s case. Dr. H responded the latter, that he felt that if the time the appellant spent driving a commercial vehicle was put into the risk of harm equation it may overestimate his risk. He stated that there is uncertainty when making an exact prediction of what the annual risk of sudden incapacitation is, whether “it is 0.6% or 1.1%”, and physicians give their best estimate, but it is not possible for anyone to say “0.9%”; the risk cannot be defined with this degree of precision.

[ 43 ] The appellant testified that he has a business that requires him to drive an F350 pickup truck to cart supplies and equipment with a trailer, but the weight exceeds 10 000 lbs, so a commercial vehicle licence is required. He has several businesses and owns eight vehicles and drives several hours per day in a G class vehicle, but only operates his commercial vehicle four to five times per month.

[ 44 ] The appellant testified that his ICD has not delivered any therapies since 2022, and he has felt well. He testified that he is responsible and if he wasn’t well, he would not drive a vehicle. He testified he does not take driving for granted.

[ 45 ] The appellant testified as to his ICD being monitored remotely by his cardiologist and he has not been made aware of any concerns with the monitoring.

[ 46 ] The Minister asked if the appellant’s doctors had explained to him what it would feel like if his ICD administered a shock. The appellant responded that he has felt the shocks from his ICD previously while he was standing beside a forklift and it felt like he was getting a shock from the forklift. He reported an ambulance was called where he heard one paramedic tell the other to drive as fast as they could with lights and sirens, and he was told by the paramedic treating him that he could not believe the appellant was conscious given his heart rhythm was VT.

[ 47 ] The Minister further questioned if the ICD did deliver a shock while driving, would that not be a risk behind the wheel given the appellant was told the paramedic could not believe he was conscious. The appellant responded that he would pull over as quickly and safely as possible and turn on the 4-way lights on his vehicle.

[ 48 ] The Minister submitted that the CCMTA guidance is very clear that the appellant is disqualified for commercial driving based on three different Standards and reiterated that Dr. S has indicated there is no literature to support a risk assessment in this case as estimating the risk of sudden incapacitation was never intended to apply to drivers with an ICD for secondary prophylaxis. The Minister submitted their decision is not mean to be in defiance, but is a reasonable decision based on the current medical condition and the potential road safety risk. They submitted that they don’t take the decision to downgrade a licence lightly and that this decision was reasonable and in line with the Standards.

[ 49 ] The appellant’s representative submitted that the Minister has provided no evidence of a substantial change to risk since the LAT decision of 2022 and that finding remains applicable today as the appellant has not experienced any other cardiac events. He stated the appellant has followed the treatment plan, attended all follow ups and is remotely monitored by the clinic. He stated Dr. H has quoted many studies that define the 1% rule. He further stated the appellant is only an occasional commercial driver, his driving conduct is predictable, and he has never driven when unsafe.

[ 50 ] I have considered the appellant’s position that he has had no shocks from his ICD since 2022, won an appeal through the Licence Appeal Tribunal following these shocks in 2022, and that there has not been a substantial change to his cardiac condition since his successful appeal. I agree that the evidence demonstrates that he has not received ICD therapy since 2022. However, the evidence also demonstrates that he has a serious cardiac condition as he has suffered an acute and dangerous arrhythmia twice in the past 5 years, and his cardiac condition is not static. I disagree with the appellant’s position that there has not been substantial change to his cardiac condition since his 2022 appeal. The evidence demonstrates the appellant has required two interventions to his ICD in the past two years, including an upgrade to CRTD due to exercise intolerance, then a second intervention to address lead repositioning, with the LV lead found to not be capturing again, and the appellant’s symptoms will be followed to determine whether he requires the insertion of an epicardial LV lead. Furthermore, since the 2022 decision the medical evidence documents new cardiac diagnoses of hemodynamically unstable VT and ischemic cardiomyopathy.

[ 51 ] I accept that the appellant has remained compliant with medical care and now has remote monitoring of his device. However, the evidence presented does not establish that the risk associated with his cardiac condition can be eliminated through monitoring alone. Dr. H testified that there is no trial data that reports remote ICD monitoring reduces the risk of sudden incapacitation while driving. I find that the appellant’s compliance and monitoring do not negate the potential for an unpredictable, incapacitating event.

[ 52 ] I recognize that Dr. H is very qualified to provide an opinion on the appellant’s medical condition and through his testimony was able to share his qualifications. However, I also recognize that Dr. PH is a cardiologist who has treated the appellant for many years and the evidence demonstrates he is very familiar with the appellant’s medical condition. In the medical evidence provided, Dr. PH has submitted five Cardiovascular Assessment Forms over the past three years (Dr. H has not submitted any). I further recognize Dr. S has specific experience in assessing driver risk with cardiovascular conditions as he is one of the co-chairs of the Canadian Cardiovascular Society 2023 Guidelines on Fitness to Drive. I recognize the diverse qualifications and experience of each physician are all relevant to this case and for this reason, give them all weight.

[ 53 ] I understand that while guidelines are important to consider, they should not act as a substitute for clinical judgement and assessment of risk with appropriate regard to the individual circumstances of each driver. However, the medical evidence provided by the physicians in this case pose interpretive challenges as there are many inconsistencies, including in the assessment of the appellant’s annual risk of sudden incapacitation:

i. Dr. PH has documented on the Cardiovascular Assessment Form on March 25, 2024, that the risk was unknown, then on the same form dated April 24, 2024, that the risk was <1%, then on the latest version of the same form April 3, 2025, changed his response back to unknown.

ii. Dr. B and nurse CF working under Dr. H on April 15, 2025, have written in that the appellant’s risk is < 0.5%.

iii. Dr. H has testified that a risk of 1% or less is a fair assessment although determining an exact risk is not possible to define with the precision being asked, but the appellant’s risk may be overestimated if using the risk of harm formula in the calculation due to his limited time spent driving.

iv. Dr. S has written that the application of a risk of sudden incapacitation of 1% or less in the CCS Guidelines was never intended to apply to drivers with an ICD for secondary prophylaxis and that there is no literature to support the contention that secondary prevention patients with ischemic cardiomyopathy and an ICD would be at a risk of <1%.

[ 54 ] The wide range of medical opinions concerning the appellant’s annual risk of sudden incapacitation demonstrates uncertainty in attempting to quantify that risk. This variability lends weight to Dr. S’s statement that there is no literature to support the contention that secondary prevention patients with ischemic cardiomyopathy and an ICD would be at a risk of <1%.

[ 55 ] I also find that the attempts to determine the appellant’s annual risk of sudden incapacitation are important because the appellant’s cardiac condition can cause episodic impairment through partial or complete loss of consciousness that incapacitates the driver and for which a driver cannot compensate. Thus, experiencing an arrhythmia that required ICD therapy would significantly interfere with a driver’s ability to drive safely and present a safety risk to the driver themselves, and other road users.

[ 56 ] There is further conflicting medical evidence with respect to the recommendation for reinstating the appellant’s commercial licence.

i. Dr. PH gives no recommendation in his Cardiovascular Assessment Forms dated March 25, 2024, April 24, 2024, or April 3, 2025.

ii. Dr. B and nurse CF working under Dr. H on April 15, 2025, broadly support the appellant’s commercial licence.

iii. Dr. H has testified he supports reinstating the appellant’s commercial licence but qualifies this recommendation that this is because of the limited time spent driving and because of the type of vehicle driven.

iv. Dr. S takes the position that the appellant is not eligible for a commercial licence.

[ 57 ] Dr. H testified that his support for reinstatement was based in part on the premise that the appellant infrequently uses his commercial vehicle, which is only a pickup truck, an assertion that I find minimizes the nature of the vehicle and associated risks. The appellant testified that he operates a F350 with a trailer exceeding 10 000 lbs. I accept that this vehicle is different from a large transport truck, but also appreciate that he has met the regulatory definition of a commercial vehicle, a fact none of the parties’ disputes. I also acknowledge that the appellant has testified to driving that is less frequent than that of many commercial drivers, but I also appreciate that the frequency of driving does not mitigate the potential severity of harm in the event of sudden incapacitation causing a collision.

[ 58 ] I further acknowledge the strength of the medical evidence that the CCMTA Standards are based upon. The CCMTA Standards are contemporarily written having been updated in 2025 to reflect the CCS 2023 Fitness to Drive Guidelines which are produced by cardiovascular researchers and clinicians and updated periodically in response to advances in investigation and management of cardiovascular diseases. These 2023 Guidelines were formulated on the best evidence available to guide risk assessment, reporting, and fill a gap in knowledge synthesis pertaining to the risk of sudden incapacitation across cardiovascular conditions. Lastly, the updated 2023 Guidelines have taken into consideration estimates of risk in patients on contemporary therapy for cardiovascular diseases.

[ 59 ] While the appellant has argued that his heart condition/ICD implant will not interfere with his ability to drive a commercial vehicle safely, and his condition has not significantly changed since the Tribunal’s 2022 decision, I find the following points relevant and persuasive:

i. The medical evidence reflects that the medical condition has evolved since the 2022 Tribunal decision.

ii. The appellant has a complex and serious medical condition as demonstrated by the medical evidence and further by his ineligibility for a commercial licence under three independent CCMTA Standards.

iii. The appellant’s medical condition may impair his ability to drive through sudden incapacitation in a way in which a driver cannot compensate.

iv. There is no consensus on the degree of risk of sudden incapacitation and whether the appellant’s commercial licence should be reinstated among three credible cardiologists who have reviewed the individual characteristics of this case.

v. The outcome of a collision with an incapacitated driver pulling a load weighing 10 000 lbs could be catastrophic.

[ 60 ] For these reasons, I am persuaded to apply the CCMTA Standards, and there are three relevant CCMTA Standards that apply to the appellant’s situation, each of which disqualify him from having a commercial vehicle licence.

[ 61 ] I find that the Minister has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely a heart condition/ICD implant, and that medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

ORDER

[ 62 ] For the reasons set out above, pursuant to subsection 50(2) of the Act, I confirm the Minister’s decision to downgrade the appellant’s driver’s licence.

Released: November 5, 2025

__________________________

Dr. Isla McPherson, Adjudicator