Licence Appeal Tribunal File Number: 18399/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:

Shawn Rock

Appellant

and

Minister of Transportation

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Shawn Rock, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: April 22, 2026

OVERVIEW

1Shawn Rock (the “appellant”) appeals from the decision of the Minister of Transportation (“Minister”) to downgrade his commercial 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.

2Section 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.

3Section 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.

4The Minister takes the position that the appellant has a medical condition, namely an implantable cardioverter defibrillator (ICD) due to a heart condition, 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.

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

6Pursuant 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.

7The Open Court Principle was explained at the outset of the hearing.

ISSUES

1The 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 safely.

2To resolve that issue, I will address the following questions:

i. Does the appellant have an ICD due to a heart condition?

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

3The Minister bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

4Having 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 an ICD due to a heart condition?

5The evidence presented at the hearing establishes that the appellant has a medical condition, namely an ICD due to a heart condition.

6The Minister’s position is supported by:

i. a Medical Report Form, dated January 16, 2023, completed by family physician Dr. B;

ii. a Cardiovascular Assessment Form, dated January 31, 2023, also completed by Dr. B;

iii. a second Cardiovascular Assessment Form, dated December 15, 2025, completed by cardiologist Dr. D;

iv. a Consultation Report from Cardiologist Dr. D dated July 28, 2025, and

v. a letter from Cardiologist Dr. Y dated April 16, 2026.

7As a commercial driver, the appellant is required to submit cyclical medical documentation based on age as a mandatory requirement for holding a controlled class of licence.

8A Medical Report Form was completed by family physician Dr. B on January 16, 2023, and documented the appellant had suffered a myocardial infarction and had cardiology follow up. In response to receiving this report, the Minister requested completion of a Cardiovascular Assessment Form.

9On January 31, 2023, family physician Dr. B documented on the requested Cardiovascular Assessment Form that the appellant had been diagnosed with coronary artery disease, moderate heart valve disease in the form of mitral regurgitation and dilated or ischemic cardiomyopathy. In response to receiving this report, the Minister confirmed the appellant’s eligibility for a D class licence and requested further cyclical monitoring of his heart conditions.

10On December 15, 2025, cardiologist Dr. D completed a second Cardiovascular Assessment Form as part of the required cyclical monitoring. She documented that the appellant had been diagnosed with coronary artery disease, moderate or severe mitral regurgitation, hypertension, dilated or ischemic cardiomyopathy, and an ICD had been inserted for primary prophylaxis.

11Following receipt of this form, the Minister communicated to the appellant that he no longer met the national medical standards for a commercial licence due to his ICD, and his class of licence was changed to a Class G licence.

12In response to his licence being downgraded, the appellant submitted a consultation from Dr. D dated July 28, 2025, and letter from Dr. Y dated April 14, 2026. Both reports document the presence of an ICD, and Dr. D’s consultation documents the appellant has cardiac diagnoses that includes coronary artery disease with an inferolateral ST elevation MI complicated by cardiogenic shock that was treated with PCI with a drug-eluding stent and required inotropic therapy initially for a few days in the ICU, ischemic cardiomyopathy, severe functional mitral regurgitation, hypertension, and a primary prevention ICD placed in 2023 by Dr. Y.

13The appellant agrees that he has an ICD due to a heart condition and asserts that the ICD was implanted as a preventative measure only. He confirmed he had the ICD implanted in 2023. He testified that he had asked Dr. D at his latest appointment about his valvular heart disease and was told he does not need surgical or medical treatment to fix it.

14Under cross-examination, the appellant testified that he suffered a heart attack in 2020. He testified he was admitted to hospital for an extended period of time following this event, approximately 40 days. While he described his heart condition as resolving sufficiently that he could be discharged home after 6 days, his course in hospital was complicated by another medical condition.

15I 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 an ICD due to underlying a heart condition.

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

16I 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.

17The Minister argued that the appellant’s medical condition is likely to interfere with his ability to drive a commercial vehicle safely.

18The Minister highlighted that on the Cardiovascular Assessment Form completed by Dr. D in 2025 she checked “unknown” to the question of whether the appellant’s risk of sudden incapacitation was 1% or less. The Minister also highlighted comments from Dr. Y’s letter which stated that the Canadian Cardiovascular Fitness to Drive Guidelines are clear in that all patients with ICDs are disqualified from commercial driving.

19The Minister relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [2025] (the “CCMTA Standards”), Chapter 3. He stated that these Standards are written by physicians and experts across the country and used as guidelines to assess medical fitness as it pertains to driving. Standard 3.6.24 applies to commercial drivers who have declined an ICD or have an ICD implanted, and states that these drivers are not eligible for a commercial licence. The Minister highlights that this Standard acknowledges that individual cases may be made to continue driving commercially provided the risk of sudden incapacitation is 1% or less. However, cardiologist Dr. D documented that the appellant’s risk of sudden incapacitation did not meet this threshold.

20The Minister submits that they do not take the downgrade lightly but have a duty to protect all road users in Ontario and the CCMTA Standards are clear that the appellant is not eligible for a commercial licence. The Minister submits that if there was a medical event while driving a commercial vehicle, the results could be catastrophic, and the medical standards reflect this inherent risk. The Minister submits their decision is reasonable, prudent and supported by law and the national medical standards.

21Section 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 is not bound by them.

22During cross-examination of the Minister the appellant said that the Minister had stated the evidence shows he doesn’t fall within the rationale of 1% or less, but the latest letter from Dr. Y states that the overall appropriate shock rate is 0.5 – 1%, and 0.3 – 0.7%. The Minister responded that they were not a medical doctor and that this letter was under review by the medical review department and he could not speak to this statement.

23The appellant testified that his cardiologist and the hospital monitor his ICD on a regular basis, and from their letters, what he understands is there is no reason why he should lose his commercial licence. He testified that the downgrade should be removed based on what Dr. D has said with his NYHA and EF and that his risk is modest and in his favor because he is monitored remotely and closely followed. The appellant further testified that Dr. Y stating he’s lower than the percentage of the rationale, and these are the tests of his device and his health, not just statistics, which is what the MTO operates on.

24The appellant further testified that Dr. Y also put in his letter that his ICD was only implanted for precautionary reasons because he qualified for it, not because he needed it. He testified he goes to his cardiologist twice per year, and to another hospital to have his ICD monitored. He has a monitoring system in his home that they take readings from, and he is a lot lower risk than what the guidelines are allowing.

25The appellant further testified that he works for a municipality, and he has submitted logs which show over a four-day period he drove 814 km. He testified that on top of that he does not drive on the 400 series highways. He testified in the winter he drives a pick up truck, but his job still requires him to have a DZ licence. He testified he is at the tail end of his career, and he does not wish to be a long haul trucker. He testified he drives a dump truck only 23% of the time for the year and worse case scenario he is driving 800 km per week.

26Under cross-examination the Minister asked what led to the ICD implant, and the appellant described having a heart attack in 2020, and being advised to lose weight and quite smoking, which he is working on. The Minister asked if it had been explained to the appellant what would happen if his ICD discharged, and he responded he had been told by his doctors it would be like being kicked in the chest by a horse. The Minister then questioned him on what might happen if he was driving when this happened. The appellant responded that he would gather himself and pull over on the side of the road.

27The appellant was asked as to why his ICD was inserted and the appellant stated that the ICD had been implanted to prevent another heart attack. The appellant was asked if Dr. Y had discussed with him the impact inserting an ICD would have on his eligibility for a commercial licence, and the appellant responded that he was told it might or might not impact his commercial licence. I note that this contrasts with what Dr. Y has documented in the submitted letter. Dr. Y has clearly stated in his letter his understanding of the Canadian Cardiovascular Society’s Guidelines on the fitness to drive with respect to commercial driving and ICDs, “…the CCS [Canadian Cardiovascular Society] position statement is clear that all patients with ICDs are disqualified…”.

28I acknowledge that the Canadian Cardiovascular Society Guidelines that are referenced by Dr. Y are produced by cardiovascular researchers and clinicians and updated periodically in response to advances in investigation and management of cardiovascular diseases. These Guidelines are 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, and take into consideration estimates of risk in patients on contemporary therapy for cardiovascular diseases. I further note that these Guidelines highlight that cardiovascular conditions are among the most frequent causes of impairment to drive.

29In Dr. D’s consultation report from July 28, 2025, she has documented the appellant drives a snow plow in the winter. In the appellant’s Notice of Appeal (NOA) he documented that he drives a pick up truck on night patrol in the winter months. This inconsistency was questioned, and the appellant responded he had driven a pick up truck for two winters. It is not clear why Dr. D documented he drove a snow plow.

30I acknowledge the appellant’s position that his ICD due to a heart condition will not interfere with his ability to safely drive a commercial vehicle, however this is weighed against the risk of suffering a cardiac event that may result in sudden incapacitation. The CCMTA Standards document that the Canadian Cardiovascular Society has recommended that in low-risk patients, individual cases may be made for allowing a commercial driver to continue driving with an ICD, provided the annual risk of sudden incapacitation is felt to be 1% or less. In all medical documentation submitted to the Tribunal, the appellant’s risk of sudden incapacitation is estimated to be higher or unknown, and there is no submitted medical opinion or testimony provided that documents his risk is 1% or less.

31While I have heard the appellant testify that Dr. Y has documented the risk of an ICD shock is 0.5-1.0% and 0.3 – 0.7%, I disagree with the appellant’s interpretation of Dr. Y’s letter. When Dr. Y documented appropriate ICD shock rates of 0.5 – 1% and 0.3 – 0.7%, he is referencing patients with an ejection fraction of over 35%, which Dr. Y explicitly states, does not apply to the appellant. Dr. Y documents, “there is prospective data and subgroup analyses from RCTs [randomized controlled trials] for patients with heart failure and improve EF (to above 35%). This patient does not quite meet this category…”. I further note that Dr. Y documents the appellant has an EF close to 35%, but not above, and that the risk of ICD shock is ~1-2% at this range, “RCTs suggest an overall risk of appropriate shock of ~1-2% per year in primary prevention patients with an EF <35%”. Furthermore, Dr. D’s documentation of the appellant’s risk of sudden incapacitation is documented on the Cardiovascular Assessment Form when she was asked if the risk was 1% or less, and she has checked the box “unknown”. I find that the evidence before the Tribunal is clear that the appellant’s risk has not been established to be 1% or less.

32I have considered the appellant’s testimony that his ICD has been implanted for primary prophylaxis, and that the ICD was recommended, but not needed. While the medical documentation consistently states that the ICD was implanted for primary prophylaxis, there is no medical evidence before the Tribunal indicating that the device was unnecessary or optional from a clinical perspective. I find it illogical to conclude that a medical professional would expose a patient to the risks associated with the surgical implantation of a foreign medical device if the device was not medically indicated.

33While I accept that the appellant’s understanding of why his ICD had been implanted was to prevent another heart attack, I do not find that explanation captures the seriousness of the risk the ICD is intended to address. The purpose of ICDs is not to prevent heart attacks, and I find the explanation of why ICDs are inserted that is provided in the CCMTA Standards is clear, logical and captures the seriousness of the cardiac conditions that ICDs are implanted for, “when implanted as a primary prophylaxis, the ICD is implanted to prevent sudden cardiac death in individuals considered to be at high risk but who have not had an episode of ventricular arrhythmia”. I also find the appellant’s evidence that he would “gather himself” and pull to the side of the road if the ICD discharged demonstrates a lack of appreciation for the potential consequences associated with such an event. An ICD discharge may be accompanied by loss of consciousness, impaired awareness, distraction, and/or an abrupt loss of control of the vehicle. The appellant’s suggestion that he could simply pull over safely reflects a misunderstanding of the potential consequences of device discharge while operating a commercial vehicle.

34While the CCMTA Standards are considered, as with any guideline, they should not act as a substitute for clinical judgement and assessment of risk with appropriate regard to the individual circumstances of each driver. As mentioned, Dr. D and Dr. Y have not documented a risk of sudden incapacitation of 1% or less, and importantly, they have also not provided a written statement that they support the reinstatement of the appellant’s commercial licence.

35I have heard the appellant’s position that his ICD due to a heart condition will not interfere with his ability to safely drive a commercial vehicle, and he has testified that the type of commercial driving does not carry the same risk as a long-haul truck driver. I understand the CCMTA Standards for commercial drivers require a higher level of fitness than those that operate G class vehicles. I acknowledge that the differences in these standards are significant to the appellant, but I appreciate this standard for driving a commercial vehicle is higher for the reasons that these drivers spend more hours driving, often drive under far more adverse conditions, are often unable to select their hours of work, cannot readily abandon their cargo should they become unwell on duty, and lastly, because should the commercial driver suffer a collision, the consequences are much more likely to be serious. The appellant testified that many of these conditions are present in the work he does as a commercial driver. Furthermore, I find there is inconsistency in the evidence as to the appellant’s commercial driving. The appellant testified that he drives a pick up truck in the winter and has for the past two years, but Dr. D has documented eight months ago that he drives a snow plow in the winter.

36I appreciate the burden that the lack of a commercial driver’s licence is having on the appellant. However, given the clear risk of sudden incapacitation while driving a dump truck, no risk estimate of sudden incapacitation being 1% or less, and no explicit support for reinstatement of the commercial licence from a treating physician, I find this insufficient to reinstate the appellant’s commercial licence.

Conclusion

37I find that the Minister has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely an ICD due to a heart condition, and that medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

ORDER

38For 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: May 21, 2026

__________________________

Dr. Isla McPherson, Member

Adjudicator