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For what it's worth, in Tx. you must have a written doctor's excuse to apply with the tax collectors office for the permit, and then renew it every 5 years (for perminate conditions such as PD, the original doctor's excuse will still work). I don't know if it would cause a review of your license because I had already had to take a driving test to show I could safely (boy did I fool them) drive with hand-controls since my pd effects my rt. leg most.