MERCHANT MARINER MEDICAL MANUAL, COMDTINST M16721.48

Merchant Mariner

Medical Manual

COMDTINST M16721.48

August 2019

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DISTRIBUTION – SDL No. 170

NON-STANDARD DISTRIBUTION:

Commandant

United States Coast Guard

U.S. Coast Guard Stop 7509

2703 Martin Luther King Jr Ave SE

Washington, DC 20593-7509

Office Symbol: CG-MMC-2

Phone: 202-372-2357

Fax: 202-372-4908

Email: [email protected]l

COMDTINST M16721.48

30 AUGUST 2019

COMMANDANT INSTRUCTION M16721.48

Subj: MERCHANT MARINER MEDICAL MANUAL

Ref: (a) Title 46 United States Code (U.S.C.), Subtitle II, Part E

(b) International Convention on Standards of Training, Certification and

Watchkeeping for Seafarers, 1978, as amended (STCW)

(d) Title 46 CFR Parts 401 and 402

(e) 80 Federal Register (FR) 8586, February 18, 2015

1. PURPOSE. This Manual provides guidance for evaluating the physical and medical

condition of applicants for merchant mariner medical certificates. The guidance in this

Manual should assist medical practitioners, the maritime industry, individual mariners, and

U.S. Coast Guard (hereinafter, Coast Guard) personnel in evaluating an applicant’s physical

and medical status to meet the requirements of References (a) through (d).

2. ACTION. All Coast Guard Directorates, Offices, and Headquarters Units under the

Assistant Commandant for Prevention Policy (CG-5P) should comply with the provisions of

this Manual. Mariners who are required to hold a valid medical certificate should use the

guidance in this Manual to demonstrate their medical and physical qualifications. Medical

providers who conduct mariner medical certification examinations should use the guidance in

this Manual to conduct complete and appropriate medical certification evaluations. Internet

release is authorized.

3. DIRECTIVES AFFECTED. This Manual replaces prior guidance on the medical evaluation

of Merchant Mariners. Medical and Physical Evaluation Guidelines for Merchant Mariner

Credentials, Navigation and Inspection Circular (NVIC) 04-08, Commandant Publication

(COMDTPUB) 16700.4, and Guidance on the Issuance of Medical Certificates, NVIC 01-14,

COMDTINST M16721.48

COMDTPUB 16721, are hereby cancelled. Part A of the Marine Safety Manual, Volume III,

Marine Industry Personnel, COMDTINST M16000.8 (series) [MSM] has not been updated

since 1999, and may contain some information that conflicts with the guidance in this

Manual. Until Part A of the MSM is updated, the guidance in this Manual supersedes the

MSM in any areas where they may conflict.

4. BACKGROUND.

a. Service on vessels may be arduous and impose unique physical and medical demands on

mariners. The public safety risks associated with the medical and physical conditions of

mariners on vessels are important considerations for the safe operation of vessels and the

safety and well-being of the crew. In the event of an emergency, immediate response

may be limited to the vessel’s crew, and outside help may be delayed.

b. References (a) and (c) require that covered mariners be medically and physically able to

perform their duties. Reference (b) requires each party to establish standards of medical

fitness for seafarers. This convention applies to mariners on seagoing vessels, defined as

vessels which operate beyond the Boundary Line, and does not apply to inland mariners.

Reference (d) contains special requirements for registration for Great Lakes Pilots,

including the requirement to “pass a physical examination given by a licensed medical

doctor.” With the exception of hearing, visual acuity, and color vision, none of these

references contains specific standards for determining whether mariners are physically

and medically qualified.

c. The Coast Guard provided additional detail on mariner medical and physical

requirements through guidance published in NVIC 04-08, NVIC 01-14, and Part A of

MSM Volume III, Chapter 4. NVIC 04-08 detailed mariner physical ability guidelines,

acceptable vision and hearing standards, medical conditions that are subject to further

review, and the recommended evaluation data for each condition. The additional

specificity provided by NVIC 04-08 helped to reduce the subjectivity of the physical and

medical evaluation process and promoted more consistent evaluations. NVIC 04-08 also

helped to reduce application processing time by reducing uncertainty regarding the

appropriate physical and medical information needed to evaluate applications.

d. In the years since publication of NVIC 04-08, information received from public

comment, medical appeals, and the recommendations of the Merchant Mariner Medical

Advisory Committee (MEDMAC) highlighted the need to provide additional specificity

and clarity on mariner medical and physical requirements. It also underscored the

potential for confusion caused by having medical evaluation guidance contained in

several different guidance documents. In response, the Coast Guard began a series of

revisions to the medical evaluation guidelines, published as Change 1 to NVIC 04-08, in

June 2013, and Change 2 to NVIC 04-08, in April 2016. Reference (e) proposed further

revision to NVIC 04-08, specifically requesting public comment on proposed policy

clarifications regarding the issuance of medical waivers for diabetes mellitus,

cardiomyopathy and sleep disorders.

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e. NVIC 04-08 also required additional policy clarification and reference updates following

publication of the final rule on the Implementation of the Amendments to the

International Convention on Standards for Training, Certification and Watchkeeping for

Seafarers, 1978, and Changes to National Endorsements (78 FR 77795, Dec. 24, 2013).

New guidance was required to address the medical certificate and related processes,

including procedures for application, issuance, and cancellation of the medical certificate.

Incorporating the additional guidance, the required reference updates, the policy

clarifications proposed in Reference (e), and the changes previously incorporated into

Change 1 and Change 2 to NVIC 04-08 triggered issuance of a new policy document, in

accordance with the Coast Guard Directives System, COMDTINST M5215.6 (series).

f. This Manual consolidates guidance on mariner medical evaluations, previously contained

in NVIC 04-08, NVIC 01-14, and Part A of MSM Volume III, Chapter 4, into one

document, and serves as a resource for mariner applicants, medical practitioners,

employers, and Coast Guard personnel. It also provides written documentation of

medical evaluation practices that were not previously contained in any guidance

document, making these practices transparent and consistent.

(1) The Manual provides information to mariner applicants on the Coast Guard’s

processes for evaluating physical and medical status to determine fitness for merchant

mariner medical certification.

(2) The Manual provides information for medical practitioners who perform merchant

mariner medical examinations. The information includes guidance on the conduct of

general medical examinations, provides detail on medical conditions that are subject

to further review, and incorporates flexibility in the recommended evaluation data for

those conditions.

(3) The Manual provides guidance to Coast Guard personnel who evaluate mariner

medical examinations, promoting consistency in the medical certification process.

g. Since this Manual clarifies and consolidates prior medical evaluation guidance, the Coast

Guard does not expect it to result in higher rates of medical disqualification or in

increased processing time for the medical certificate application. Instead, the Coast

Guard anticipates that use of this Manual will promote medical evaluations that are less

subjective and more efficient because the information needed will be clear at the outset of

the application process.

(1) The Manual represents the Coast Guard’s current thinking on mariner medical

evaluation and is issued for guidance purposes to outline methods of best practice for

compliance with the applicable law.

(2) Applicants for the medical certificate may use an alternative approach to demonstrate

compliance with the merchant mariner medical standards, if the approach satisfies the

requirements of the applicable statutes and regulations. While not required, those

who wish to discuss alternative approaches may contact the National Maritime Center

(NMC) Medical Evaluations Division, which is responsible for implementing this

COMDTINST M16721.48

guidance. Contact information for the NMC Medical Evaluations Division is listed in

Paragraph 11, below.

h. This Manual has been developed by the Coast Guard in consultation with experienced

maritime community medical practitioners and industry stakeholders serving on the

Merchant Mariner Medical Advisory Committee (MEDMAC), and the Merchant Marine

Personnel Advisory Committee (MERPAC).

(1) In addition, the public was afforded the opportunity to participate in the development

of medical policy by providing comment and serving on working groups at the public

meetings of MEDMAC. The public was also afforded opportunity to comment on

drafts of the policies contained in this Manual, and its predecessor, NVIC 04-08. See

80 FR 8586 (February 18, 2015) [Diabetes, cardiomyopathy and sleep disorders],

80 FR 4582 (January 28, 2015) [Medications], 78 FR 17917 (March 25, 2013)

[Seizures], and 77 FR 55174 (September 7, 2012) [Implantable Cardioverter

Defibrillators].

(2) The Coast Guard also considered the medical evaluation guidelines utilized by other

Federal transportation mode authorities.

i. The Coast Guard mariner medical evaluation and certification process seeks to determine

whether an applicant meets the medical and physical standards for merchant mariners

based upon the information available to the Coast Guard at the time of the certification

decision. The Coast Guard recognizes that some maritime work environments may

require additional medical and physical standards related to factors that include, but are

not limited to, specific duty requirements, austere work environments, lack of access to

definitive medical care, and operational tempo. Nothing in this Manual precludes marine

employers from establishing more rigorous medical or physical ability guidelines.

j. The guidance in this Manual may also be helpful to maritime academies when

determining whether entrants into a cadet program are physically and medically qualified.

A cadet with a condition that may lead to disqualification, as outlined in Chapters 8

through 25 of this Manual, should be advised as early as possible that he or she may not

be physically or medically eligible to receive a credential upon graduation.

5. DISCLAIMER. This guidance is not a substitute for applicable legal requirements, nor is it

itself a rule. It is intended to provide operational guidance for Coast Guard personnel and is

not intended to nor does it impose legally binding requirements on any party outside the

Coast Guard.

6. MAJOR CHANGES. This Manual consolidates, clarifies, and updates prior guidance on the

merchant mariner medical evaluation.

a. The material was reorganized into a manual format instead of a NVIC to improve utility

and ease of use for the regulated community and others who reference the document.

Additionally, the name and number of the Manual will not change with every future

issuance of the document, reducing the risk of confusion.

COMDTINST M16721.48

b. Provisions were added that clarify confusion between 46 CFR 15.401(c), which requires

a medical certificate in order to serve under the authority of the merchant mariner

credential (MMC), and Table 1 to 46 CFR 10.302(a), which provides no medical

requirements for certain entry-level mariners (In accordance with 46 CFR 10.107, entry-

level mariner means a mariner holding no rating other than ordinary seaman, wiper,

steward’s department, or steward’s department food handler (F.H.)). To resolve this

confusion, the Coast Guard will no longer require medical certificates for entry-level

mariners on vessels not subject to STCW who do not serve as food handlers.

c. Material was added that provides detailed processing guidance to the National Maritime

Center so that Coast Guard personnel will have a standardized process for dealing with a

number of situations that recur regularly.

d. Information was added to provide more detail on the relationship between medical

certificates for pilots and the requirement for annual pilot physicals.

e. Information was added to provide clarity and guidance on conduct of the merchant

mariner general medical examination, in accordance with 46 CFR 10.304(a).

f. The guidance now includes the process to be followed when the Coast Guard receives

information indicating that a medical certificate holder has developed a medical condition

that poses a significant risk of sudden incapacitation, or is taking medication that poses a

significant risk of impairment. The process includes procedures for cancelling medical

certificates for mariners who no longer meet medical certification criteria.

g. Finally, much of the guidance from NVIC 01-14 relating to implementation and

transition provisions for moving to issuance of separate medical certificates is no longer

relevant and, therefore, was not included in this Manual.

7. ENVIRONMENTAL ASPECT AND IMPACT CONSIDERATIONS.

a. The development of this Manual and the general policies contained within it have been

thoroughly reviewed by the originating office in conjunction with the Office of

Environmental Management, Commandant (CG-47). This Manual is categorically

excluded under current Department of Homeland Security (DHS) categorical exclusion

DHS (CATEX) A3 from further environmental analysis in accordance with the U.S.

Coast Guard Environmental Planning Policy, COMDTINST 5090.1 and the

Environmental Planning (EP) Implementing Procedures (IP).

b. This Manual will not have any of the following: significant cumulative impacts on the

human environment; substantial controversy or substantial change to existing

environmental conditions; or inconsistencies with any Federal, State, or local laws or

administrative determinations relating to the environment. All future specific actions

resulting from the general policy in this Manual must be individually evaluated for

compliance with the National Environmental Policy Act (NEPA) and Environmental

Effects Abroad of Major Federal Actions, Executive Order 12114, Department of

Homeland Security (DHS) NEPA policy, Coast Guard Environmental Planning policy,

and compliance with all other applicable environmental mandates.

COMDTINST M16721.48

8. DISTRIBUTION. No paper distribution will be made of this Manual. An electronic version

is located on the following Commandant (CG-612) websites. Internet:

http://www.dcms.uscg.mil/directives and CGPortal:

https://cg.portal.uscg.mil/library/directives/SitePages/Home.aspx. A link is also located on

the NMC site: https://www.dco.uscg.mil/Our-Organization/Assistant-Commandant-for-

Prevention-Policy-CG-5P/National-Maritime-Center/ .

9. RECORDS MANAGEMENT CONSIDERATIONS. This Manual has been evaluated for

potential records management impacts. The development of this Manual has been thoroughly

reviewed during the directives clearance process, and it has been determined there are no

further records scheduling requirements, in accordance with Federal Records Act, 44 U.S.C.

3101 et seq., National Archives and Records Administration (NARA) requirements, and

Information and Life Cycle Management Manual, COMDTINST M5212.12 (series). This

policy does not have any significant or substantial change to existing records management

requirements.

10. CHAPTER GUIDE. While all chapters of this Manual provide information useful to mariner

applicants, as well as the medical practitioners who treat and evaluate them, certain chapters

may be of particular interest to specific audiences. Table 1, Chapter Guide, summarizes the

contents of the Chapters in this Manual and likely primary audiences.

Table 1: Chapter Guide. The following abbreviations are used in the Table: Coast Guard evaluators (CG);

Company and Vessel Owners and Operators (OO); Mariner applicants (MA); Medical practitioners (MP).

hapter Number Chapter Name Brief Description of Contents Of primary interest to:

Medical Certification

Standards

Medical certification standards for

each credential.

CG, MA

2 The Medical Certificate

Contents of the certificate,

application procedures, and a

sample medical certificate.

CG, MA

Medical Certificate

Processing

Guidance on the medical review

process, as well as waivers and

limitations.

CG, MA, OO

The Merchant Mariner

Medical Examination

Guidance on the merchant mariner

medical examination.

MA, MP

Vision and Hearing

Standards

Guidance on evaluating vision and

hearing.

CG, MA, MP

Physical Ability

Guidelines

Guidance on evaluating whether

MAs are physically able to perform

the function of the credential.

CG, MA, MP

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Chapter Number Chapter Name Brief Description of Contents Of primary interest to:

Medications Subject to

Further Review

Guidance on evaluating MAs who

take certain medications.

CG, MA, MP

Medical Conditions

Subject to Further

Review

Guidance on medical conditions

subject to further review.

CG, MA, MP

9 - 25

Specific Medical

Conditions

Detailed guidance on listed

conditions and supplemental

information to be submitted for

review.

CG,MA, MP

11. QUESTIONS. All questions regarding implementation of this Manual should be directed to

the NMC Medical Evaluations Division at iasknmc@uscg.mil. The NMC can also be

contacted by telephone at: 1-888-I-ASK-NMC.

12. FORMS/REPORTS. The forms referenced in this Manual are available from USCG

Electronic Forms on the Standard Workstation, or on the Internet at

http://www.dco.uscg.mil/Our-Organization/Assistant-Commandant-for-Prevention-Policy-

CG-5P/National-Maritime-Center/ or https://www.dcms.uscg.mil/Our-

Organization/Assistant-Commandant-for-C4IT-CG-6/The-Office-of-Information-

Management-CG-61/Forms-Management/ ; on the Coast Guard Portal at

https://cg.portal.uscg.mil/library/forms/SitePages/Home.aspx; and available to the public at

https://www.dco.uscg.mil/Portals/9/NMC/pdfs/forms/CG_719K.pdf , and

https://www.dco.uscg.mil/Portals/9/NMC/pdfs/forms/CG_719KE.pdf .

13. REQUESTS FOR CHANGES. Changes will be issued as necessary. All requests for

changes should be directed to the Office of Merchant Mariner Credentialing (CG-MMC), at

(202) 372-2357, or MMCPolicy@uscg.mil.

R. V. TIMME /s/

Rear Admiral, U.S. Coast Guard

Assistant Commandant for Prevention Policy

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COMDTINST M16721.48

Table of Contents

Chapter 1: Medical Certification Standards ........................................................................... 1-1

A. Medical Certification ………………………………………………. ...................... 1-1

B. Table of Medical and Physical Requirements for Mariner Endorsements ................ 1-1

C. Requirements for Conduct of Medical Exams, Tests, and Demonstrations of

Physical Ability ....................................................................................................... 1-4

D. Medical Certification Requirements for Specific Endorsements ............................ 1-5

Chapter 2: The Medical Certificate ......................................................................................... 2-1

A. Medical Certificate Overview ................................................................................. 2-1

B. Background ............................................................................................................. 2-1

C. Medical Certificate Key Terms ............................................................................... 2-2

D. Medical Certificate Contents ................................................................................... 2-3

E. General Guidance on the Application for Medical Certificate ................................ 2-4

F. Medical Certificate Application Requirements for Specific Endorsements ............ 2-6

G. Submission Procedures ............................................................................................ 2-8

H. Sample Medical Certificate ..................................................................................... 2-9

Chapter 3: Medical Certificate Processing .............................................................................. 3-1

A. Introduction ............................................................................................................. 3-1

B. Medical Certificate Requirements ........................................................................... 3-1

C. The Medical Review Process .................................................................................. 3-2

D. NMC Medical Evaluation Procedures by Type of Application .............................. 3-3

E. Special NMC Medical Evaluation Procedures for Entry Level Mariners, Staff

Officers, and Individuals Endorsed as Tankerman PIC Restricted to Fuel Transfers

on Towing Vessels .................................................................................................. 3-4

F. NMC Medical Evaluation Procedures for the Issuance of Medical Waivers .......... 3-6

G. NMC Medical Evaluation Procedures for the Issuance of Operational Limitations 3-7

H. NMC Medical Evaluation Procedures for the Issuance of Restrictions .................... 3-8

I. NMC Medical Evaluation Procedures for Mariners with Existing Waivers .......... .3-9

J. NMC Medical Evaluation Procedures for Mariners with Short-Term

Conditions ................. ............................................................................ ............... 3-10

K. NMC Medical Evaluation Procedures for Mariners Who Do Not Meet the Medical

Qualification Standards ......................................................................................... 3-10

L. NMC Medical Evaluation Procedures for Cancellation of a Medical

ertificate ........ ………………………………………………………………….3-12

M. Automatic Stay of Decision to Cancel a Medical Certificate ................................ 3-13

N. Mariner Reconsiderations and Appeals ................................................................. 3-13

O. Authority to Work Pending Final Agency Action ................................................. 3-14

Chapter 4: The Merchant Mariner Medical Examination .................................................... 4-1

A. The Merchant Mariner General Medical Examination ............................................ 4-1

B. Benefits of Screening for Significant Medical Conditions ...................................... 4-2

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hapter 5: Vision and Hearing Standards .............................................................................. 5-1

A. Vision Requirements ............................................................................................... 5-1

B. Hearing Requirements ............................................................................................. 5-5

Chapter 6: Physical Ability Guidelines .................................................................................... 6-1

A. Introduction ............................................................................................................. 6-1

B. The Demonstration of Physical Ability ................................................................... 6-1

C. The Practical Evaluation of Physical Ability .......................................................... 6-5

D. Guidance on the Practical Evaluation of Physical Ability ...................................... 6-5

E. Components of the Practical Evaluation of Physical Ability, by Endorsement

Sought or Held ......................................................................................................... 6-6

Chapter 7: Medications Subject to Further Review ............................................................... 7-1

A. Definitions ............................................................................................................... 7-1

B. Prohibitions ............................................................................................................. 7-1

C. Important Safety Warnings ..................................................................................... 7-2

D. Disclosure of Prescription and Over-the-Counter (OTC) Medications ................... 7-3

E. Recommended Evaluation Data for Medications .................................................... 7-3

F. Medication Waivers—General Information ............................................................ 7-4

G. Medications Subject to Further Review due to Risk of Impaired Cognitive Ability,

udgment, or Reaction Time ................................................................................... 7-4

H. Medications Subject to Further Review due to Risk of Other Impairment and

Safety Concerns ....................................................................................................... 7-8

I. Medication Waivers Requiring Special Consideration ........................................... 7-8

J. Recommended Evaluation Data for Medication Waivers that Require Special

Consideration ......................................................................................................... 7-10

Chapter 8: Medical Conditions Subject to Further Review .................................................. 8-1

A. Medical Conditions Subject to Further Review ...................................................... 8-1

B. Medications, Vitamins and Dietary Supplements ................................................... 8-1

C. Reports of Medical and Physical Exams, Demonstrations, and Tests ....................... 8-2

D. Recommended Evaluation Data ................................................................................ 8-2

E. Medical Conditions Previously Reported to the Coast Guard ................................... 8-3

F. Waivers ...................................................................................................................... 8-3

G. T

erms ......................................................................................................................... 8-3

H. Index of Medical Conditions Discussed in the Merchant Mariner Medical

Manual... .................................................................................................................... 8-4

Chapter 9: Allergic Conditions ................................................................................................. 9-1

A. Conditions of Concern ............................................................................................. 9-1

B. Guidance to Mariner Applicants ............................................................................. 9-1

C. Guidance to Treating Providers ............................................................................... 9-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ..................................................................................... 9-3

E. Medical Certification Evaluation ............................................................................ 9-5

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iii

Chapter 10: Blood or Hematologic Conditions ..................................................................... 10-1

A. Conditions of Concern ........................................................................................... 10-1

B. Guidance to Mariner Applicants ........................................................................... 10-1

C. Guidance to Treating Providers ............................................................................. 10-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 10-3

E. Medical Certification Evaluation .......................................................................... 10-5

Chapter 11: Cancer or Malignant Conditions...................................................................... 11-1

A. Conditions of Concern ........................................................................................... 11-1

B. Guidance to Mariner Applicants ........................................................................... 11-1

C. Guidance to Treating Providers ............................................................................. 11-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 11-3

E. Medical Certification Evaluation .......................................................................... 11-5

Chapter 12: Cardiovascular Conditions ................................................................................ 12-1

A. Introduction ........................................................................................................... 12-1

B. Coronary Artery Disease and Cardiomyopathy .................................................... 12-5

C. Cardiac Arrhythmias ........................................................................................... 12-12

D. Valvular Disease .................................................................................................. 12-19

E. Vascular Disease ................................................................................................. 12-26

F. Cerebrovascular Disease ..................................................................................... 12-32

G. Waivers for Cardiovascular Conditions That Require Special Consideration ..... 12-38

Chapter 13: Ear, Nose, and Throat Conditions .................................................................... 13-1

A. Conditions of Concern ............................................................................................ 13-1

B. Guidance to Mariner Applicants ........................................................................... 13-1

C. Guidance to Treating Providers ............................................................................. 13-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 13-3

E. Medical Certification Evaluation .......................................................................... 13-5

Chapter 14: Endocrine Conditions ........................................................................................ 14-1

A. Conditions of Concern ........................................................................................... 14-1

B. G

uidance to Mariner Applicants ........................................................................... 14-1

C. Guidance to Treating Providers ............................................................................. 14-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ..................................................................................... 14-3

E. Medical Certification Evaluation .......................................................................... 14-5

F. Waivers for Endocrine Conditions that Require Special Consideration ............... 14-6

Chapter 15: Gastrointestinal Conditions ............................................................................... 15-1

A. Conditions of Concern ........................................................................................... 15-1

B. Guidance to Mariner Applicants ........................................................................... 15-1

C. Guidance to Treating Providers ............................................................................. 15-2

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D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ..................................................................................... 15-3

E. Medical Certification Evaluation .......................................................................... 15-5

Chapter 16: Genitourinary Conditions .................................................................................. 16-1

A. Conditions of Concern ........................................................................................... 16-1

B. Guidance to Mariner Applicants ........................................................................... 16-1

C. Guidance to Treating Providers ............................................................................. 16-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 16-3

E. Medical Certification Evaluation .......................................................................... 16-5

Chapter 17: Infectious Conditions.......................................................................................... 17-1

A. Conditions of Concern ........................................................................................... 17-1

B. Guidance to Mariner Applicants ........................................................................... 17-1

C. Guidance to Treating Providers ............................................................................. 17-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 17-3

E. Medical Certification Evaluation .......................................................................... 17-5

Chapter 18: Musculoskeletal Conditions ............................................................................... 18-1

A. Conditions of Concern ........................................................................................... 18-1

B. Guidance to Mariner Applicants ........................................................................... 18-1

C. Guidance to Treating Providers ............................................................................. 18-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ..................................................................................... 18-3

E. Medical Certification Evaluation .......................................................................... 18-5

Chapter 19: Neurologic Conditions ....................................................................................... 19-1

A. Introduction ........................................................................................................... 19-1

B. Chronic, Progressive Conditions ........................................................................... 19-5

C. Non-Progressive Conditions ................................................................................ 19-11

D. Intracranial Surgery, Brain Injury, Brain Tumors, and Central Nervous System

Infection .............................................................................................................. 19-17

E. Seizure or Convulsive Disorders ......................................................................... 19-23

F. Sleep Disorders .................................................................................................... 19-30

G. Waivers for Neurologic Conditions That Require Special Consideration ........... 19-37

Chapter 20: Ophthalmologic Conditions .............................................................................. 20-1

A. Conditions of Concern ........................................................................................... 20-1

B. Guidance to Mariner Applicants ........................................................................... 20-1

C. Guidance to Treating Providers ............................................................................. 20-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 20-3

E. Medical Certification Evaluation .......................................................................... 20-5

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Chapter 21: Organ Transplant ............................................................................................... 21-1

A. Conditions of Concern ........................................................................................... 21-1

B. Guidance to Mariner Applicants ........................................................................... 21-1

C. Guidance to Treating Providers ............................................................................. 21-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K .................................................................................... 21-3

E. Medical Certification Evaluation ........................................................................... 21-5

Chapter 22: Pregnancy ............................................................................................................ 22-1

A. Conditions of Concern ........................................................................................... 22-1

B. Guidance to Mariner Applicants ........................................................................... 22-1

C. Guidance to Treating Providers ............................................................................. 22-1

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 22-3

E. Medical Certification Evaluation .......................................................................... 22-4

Chapter 23: Psychiatric or Mental Health Conditions ........................................................ 23-1

A. Introduction ........................................................................................................... 23-1

B. Mood Conditions ................................................................................................... 23-5

C. Anxiety Conditions .............................................................................................. 23-11

D. Attention-Deficit/Hyperactivity Disorders (ADD/ADHD) ................................. 23-17

E. Alcohol/Substance Abuse or Dependence Conditions ........................................ 23-23

F. Schizophrenia/Psychotic Conditions ................................................................... 23-31

Chapter 24: Pulmonary Conditions ....................................................................................... 24-1

A. Conditions of Concern ........................................................................................... 24-1

B. Guidance to Mariner Applicants ........................................................................... 24-1

C. Guidance to Treating Providers ............................................................................. 24-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K ................................................................................... 24-3

E. Medical Certification Evaluation ......................................................................... 24-5

Chapter 25: Skin Conditions .................................................................................................. 25-1

A. Conditions of Concern ........................................................................................... 25-1

B. Guidance to Mariner Applicants ........................................................................... 25-1

C. Guidance to Treating Providers ............................................................................. 25-2

D. Guidance to the Medical Practitioner Completing the Application for Medical

Certificate, Form CG-719K .................................................................................... 25-3

E. Medical Certification Evaluation ........................................................................... 25-5

List of Tables and Figures

Table 1-1: Medical and Physical Requirements for Mariner Endorsements …………...1-2

Figure 2-1: Medical Certificate – Front ……………………………………...…………2-9

Figure 2-2: Medical Certificate – Back ………………………………………………..2-10

Table 6-1: Physical Ability Guidelines …………………………………………………6-2

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CHAPTER 1. MEDICAL CERTIFICATION STANDARDS

A. Medical Certification

The standards for merchant mariner medical certification are contained in 46 CFR,

Part 10, Subpart C. The standards include requirements for vision, hearing, general

medical examination and demonstration of physical ability.

1. Vision Requirements.

Title 46 CFR 10.305 provides the vision standards for medical certification.

Guidance on vision standards and waivers is contained in Chapter 5 of this

Manual, Vision and Hearing Standards.

2. Hearing Requirements.

Title 46 CFR 10.306 provides the hearing standards for medical certification.

Guidance on hearing standards and waivers is contained in Chapter 5 of this

Manual, Vision and Hearing Standards.

3. The General Medical Examination.

Title 46 CFR 10.304 requires that the general medical exam be documented and

of sufficient scope to ensure that the applicant for medical certificate has no

conditions that pose significant risk of sudden incapacitation or debilitating

complication. The regulation also requires documentation of any conditions

requiring medications that impair cognitive ability, judgment or reaction time.

Chapter 4 of this Manual provides guidance on the merchant mariner general

medical examination, and Chapter 7 provides guidance on medications that are

subject to further review.

4. Physical Abilities.

The duties and responsibilities that a mariner may perform can vary widely by

credential. Mariners should be physically capable of performing all potential

duties, both routine and emergency, associated with their credential(s). Chapter 6

of this Manual, Physical Ability Guidelines, provides guidance on typical

mariner duties.

B. Table of Medical and Physical Requirements for Mariner Endorsements. Table

1-1 lists the medical and physical requirements for mariner endorsements. It

expands the contents of Table 1 to 46 CFR 10.302(a) to provide further guidance to

applicants. If an applicant applies for more than one credential at the same time, the

most stringent of the requirements that applies to each credential will prevail.

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Credential

Vision Test

Hearing

Test

General Medical

Exam

Demonstration of

Physical Ability

(1) Deck officer, including pilots

Yes

§10.305(a)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(2) Engineering officer

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(3) Radio officer

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(4) Offshore installation manager, barge supervisor, or ballast control

operator

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(5) Able

seaman

Yes

§10.305(a)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(6) QMED

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(7) Able seafarer deck

Yes

§10.305(a)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(8) RFPNW

Yes

§10.305(a)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(9) Able seafarer engine

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(10) RFPEW

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(11) Electro

-technical rating

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(12) Tankerman

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(13) Lifeboatman and Proficiency in survival craft and rescue boats

other than fast rescue boats (PSC)

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(14) Lifeboatman-Limited and Proficiency in survival craft and rescue

boats other than fast rescue boats—limited (PSC—limited)

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(15) Fast Rescue Boat

Yes

§10.305(b)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(16) Food handler serving on vessels to which STCW does not apply

No No

(See Note 1)

(17) Food handler serving on vessels to which STCW applies

No No

(See Note 1)

Yes

§10.304(c)

(18) Ratings, including entry level, serving on vessels to which STCW

applies, other than those listed above. This includes endorsements as

Vessel personnel with designated security duties and security

awareness (VPDSD and SA).

No No No

Yes

§10.304(c)

(19) Ratings, including entry level, serving on vessels to which STCW

does not apply, other than those listed above. (

See Note 2).

(20) Vessel security officer

Yes

§10.305(a)

Yes

§10.306

Yes

§10.304(a)

Yes

§10.304(c)

(21) Staff Officers (46 CFR 10.301(c)). (See Note 3).

Table 1-1: Medical and Physical Requirements for Mariner Endorsements

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NOTE 1 to Table 1-1, Food Handlers: Applicants for food handler endorsement are not

required to submit to a general medical exam, but must obtain a statement from a licensed

physician, physician assistant, or nurse practitioner attesting that they are free of

communicable diseases that pose a direct threat to the health or safety of other individuals

in the workplace (See 46 CFR 10.304(b)). The statement may be documented in any

verifiable format, including as notes on the Application for Medical Certificate, Form

CG-719K, or the Application for Medical Certificate, Short Form, CG-719K/E, or on

letterhead from the practitioner.

a. Communicable disease is defined in 46 CFR 10.107(b) as “any disease capable of

being transmitted from one person to another directly, by contact with excreta or

other discharges from the body; or indirectly, via substances or inanimate objects

contaminated with excreta or other discharges from an infected person.”

b. The Department of Health and Human Services periodically publishes, in the

Federal Register, a list of infectious and communicable diseases transmissible

through the food supply, and that list provides examples of communicable

diseases for the purposes of 46 CFR 10.304.

c. The Medical Practitioner need not perform any additional testing unless it is

deemed clinically necessary. Applicants and currently employed food workers

should report information about their health as it relates to diseases that are

transmissible through food. Circumstances that the medical practitioner should

consider when certifying an applicant include, but are not limited to, the

following:

(1) Whether the applicant reports that they have been diagnosed with, or

exposed to an illness due to organisms including, but not limited to,

Salmonella Typhi, Shigella species, Shiga-toxin producing Escherichia

coli, or Hepatitis A virus within the past month;

(2) Whether the applicant reports that they have at least one symptom caused

by illness, infection, or other source that is associated with an acute

gastrointestinal illness such as diarrhea, fever, vomiting, jaundice, or sore

throat with fever; or

(3) Whether the applicant reports that they have a lesion containing pus, such

as a boil or infected wound, which is open or draining and is on the hands,

wrists, or exposed portions of the arms.

NOTE 2 to Table 1-1, Entry Level Ratings Serving on a Vessel to which STCW does not

apply:

a. Entry-level mariner means a mariner holding no rating other than ordinary

seaman, wiper, steward’s department, or steward’s department food handler

(F.H.) (See 46 CFR 10.107).

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b. MMC applicants holding only an entry-level national endorsement need not meet

the medical and physical requirements unless they are serving on a vessel subject

to STCW (See 46 CFR 10.301(a) and line 19 in Table 1 to 46 CFR 10.302(a)).

Therefore, MMC applicants holding or seeking only an entry-level national

endorsement, without food handler endorsement, are not required to apply for or

hold a valid medical certificate, except as indicated in Paragraph B.3 of Chapter 2

of this Manual.

NOTE 3 to Table 1-1, Staff Officers: Applicants holding only a staff officer endorsement

need not meet the medical and physical requirements (See 46 CFR 10.301(c)). Therefore,

MMC applicants holding or seeking only a staff officer endorsement are not required to

apply for or hold a valid medical certificate.

C. Requirements for Conduct of Medical Exams, Tests, and Demonstrations of

Physical Ability.

1. In accordance with 46 CFR 10.302(b), all exams, tests, and demonstrations must

be performed, witnessed, or reviewed by a licensed medical doctor, licensed

physician assistant, licensed nurse practitioner, or a designated medical examiner

(DME). All licensed medical practitioners must hold a valid license issued in the

United States (U.S.), a U.S. possession, or a U.S. territory. Examinations for

Great Lakes Registered Pilots must be conducted by a licensed medical doctor in

accordance with the physical exam requirements in 46 CFR 402.210 (See

Paragraph D.4. of this Chapter).

2. A DME means a licensed physician, licensed physician assistant, or licensed

nurse practitioner who has been trained and approved to conduct medical and

physical examinations of merchant mariners on behalf of the U.S. Coast Guard

and may be delegated limited authority to grant waivers and approve

physical/medical suitability for service (See 46 CFR 10.107).

3. The terms medical doctor and physician mean an individual who has been

educated, trained and licensed to practice medicine as a medical doctor (M.D.) or

doctor of osteopathy (D.O.).

4. Exams, tests and demonstrations performed, witnessed, or reviewed by holders of

foreign medical licenses, or by chiropractors or naturopathic doctors, are not

accepted under current regulations.

5. All applicants who require a general medical exam must be physically examined.

Examinations based solely on documentary review and/or patient history review

are unacceptable (See Table 1 to 46 CFR 10.302(a) and 46 CFR 10.304).

6. Individuals who submit false information to the Coast Guard may be subject to

criminal prosecution under 18 U.S.C. 1001.

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D. Medical Certification Requirements for Specific Endorsements.

1. Entry-level, Staff Officer, and Tankerman Person in Charge.

Although 46 CFR 15.401(c) requires a medical certificate in order to serve under

the authority of the MMC, Table 1 to 46 CFR 10.302(a) does not provide any

medical requirements for certain entry-level mariners. To resolve confusion

between these two regulations, the Coast Guard will not require a medical

certificate for those mariners who are not required to undergo a general medical

exam or a demonstration of physical ability under 46 CFR 10.302 (See Table 1-1

of this Chapter: Medical and Physical Requirements for Mariner Endorsements,

rows (19) and (21)).

a. Mariners with only an entry-level national endorsement or a staff officer

endorsement do not require a medical certificate.

b. Mariners with only an endorsement as Tankerman Person in Charge (PIC)

Restricted to Fuel Transfers on Towing Vessels do not require a medical

certificate (See CG-MMC Policy Letter 01-17 which can be found at

https://www.dco.uscg.mil/Portals/9/NMC/pdfs/announcements/2017/cg-

mmc_policy_letter_01-17_final_3_9_17-date.pdf ).

2. Food Handler Endorsement.

a. Applicants for endorsement as food handler are required to produce a

statement from a licensed physician, physician assistant, or nurse practitioner

certifying that the applicant is free from communicable diseases that pose a

direct threat to the health or safety of other individuals in the workplace, in

accordance with 46 CFR 10.304(b).

b. Communicable disease is defined in 46 CFR 10.107(b) as “any disease

capable of being transmitted from one person to another directly, by contact

with excreta or other discharges from the body; or indirectly, via substances or

inanimate objects contaminated with excreta or other discharges from an

infected person.” The Department of Health and Human Services periodically

publishes, in the Federal Register, a list of infectious and communicable

diseases transmissible through the food supply, and that list provides

examples of communicable diseases for the purposes of 46 CFR 10.304.

c. The medical practitioner’s communicable disease certification may be

documented in any verifiable format, including as notes on the Application for

Medical Certificate, Form CG-719K, or the Application for Medical

Certificate, Short Form, CG-719K/E, or on letterhead from the practitioner.

d. The medical practitioner need not perform any additional testing unless it is

deemed clinically necessary. Applicants and currently employed food

workers should report information about their health as it relates to diseases

that are transmissible through food. Circumstances that the medical

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practitioner should consider when certifying an applicant include, but are not

limited to, the following:

(1) Whether the applicant reports that they have been diagnosed with, or

exposed to an illness due to organisms including, but not limited to,

Salmonella Typhi, Shigella species, Shiga-toxin producing Escherichia

coli, or Hepatitis A virus within the past month;

(2) Whether the applicant reports that they have at least one symptom caused

by illness, infection, or other source that is associated with an acute

gastrointestinal illness such as diarrhea, fever, vomiting, jaundice, or sore

throat with fever; or

(3) Whether the applicant reports that they have a lesion containing pus, such

as a boil or infected wound, which is open or draining and is on the hands,

wrists, or exposed portions of the arms.

e. If the mariner applicant does not provide a statement regarding communicable

diseases, in accordance with 46 CFR 10.304(b), the medical certificate will

contain a limitation stating “No food handling.”

3. First Class Pilots and Those Individuals Serving As Pilots.

a. Title 46 CFR 11.709 requires that every credentialed first-class pilot serving

as a pilot on a vessel of 1600 Gross Register Tons (GRT) or more have a

thorough physical examination each year, that this physical examination meets

the same requirements for originally obtaining the medical certificate as

specified in 46 CFR, part 10, subpart C, and that it be recorded on an

Application for Medical Certificate, Form CG-719K.

b. Every other year, the results of the examination must be submitted to the

Coast Guard, no later than 30 calendar days after completion of the physical

examination, in accordance with 46 CFR 11.709(b).

c. An individual’s first-class pilot endorsement becomes invalid on the first day

of the month following the anniversary of the individual’s most recently

completed Coast Guard-required physical examination, in accordance with

46 CFR 11.709(d). The individual may not operate under the authority of that

endorsement until a physical examination has been satisfactorily completed.

d. For the purposes of 46 CFR 11.709(b) and (d), the Coast Guard considers the

date of “the individual’s most recently completed Coast Guard-required

physical examination” as follows:

(1) In the years that the mariner is required to submit the results of the annual

physical to the Coast Guard, the Coast Guard will consider the date of “the

individual’s most recently completed Coast Guard-required physical

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examination” to be the same as the date of examination listed on the

medical certificate (See Paragraph C.1. of Chapter 2 of this Manual).

(2) In the years that the mariner is not required to submit the annual physical

examination to the Coast Guard, the Coast Guard will consider the date of

“the individual’s most recently completed Coast Guard-required physical

examination” to be the same as the date that the medical practitioner signs

the Application for Merchant Mariner Medical Certificate, Form CG-

719K.

e. Title 46 CFR 15.812 (b)(3)(iii) and (c)(3) requires that other licensed

individuals who serve as pilots on certain types of vessels must have a current

physical examination, in accordance with the provisions of 46 CFR 11.709.

These individuals must meet the same requirements of Paragraphs D.3.a

through D.3.d of this Chapter. Individuals with endorsements as pilot, master,

or mate (and individuals applying for those credentials) who do not, in fact,

serve as first-class pilots or otherwise serve as pilots, in accordance with

46 CFR 15.812(b)(3) and (c), are not required to have an annual physical

examination.

f. The Coast Guard may initiate appropriate administrative action in the event

that any first-class pilot, or any other individual serving as a pilot (as

described above), does not meet the physical examination requirements

specified in 46 CFR 10.301 and 46 CFR 11.709, up to and including

suspension or revocation of the mariner’s credential, in accordance with

46 CFR part 5.

4. Great Lakes Registered Pilots.

a. A Great Lakes Registered Pilot must be “physically competent to perform the

duties of a U.S. Registered Pilot and meet the medical requirements

prescribed by the Commandant” (See 46 CFR 401.210(a)(4)). The annual

physical examination required by 46 CFR 402.210(a) must be reported “on the

form furnished by the Director” and must be given by a “licensed medical

doctor.” The Director, Office of Great Lakes Pilotage at Coast Guard

Headquarters (Director), has designated the Application for Medical

Certificate, Form CG-719K, as the required form for physical examinations,

replacing the previous requirement to use Page 3 of the Application for

Registration as United States Registered Pilot, Form CG-4509.

b. To satisfy all original, renewal and annual physical reporting requirements of

46 CFR 401.210 and 402.210, Great Lakes Registered Pilots are responsible

for annually submitting the Application for Medical Certificate, Form CG-

719K, to the Director, at: Commandant (CG-WWM-2), ATTN: Great Lakes

Pilotage, U.S. Coast Guard, Stop 7509, 2703 Martin Luther King Jr. Ave. SE,

Washington, DC 20593-7509. The Director will forward the application for

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medical certificate to the NMC for evaluation and determination of fitness for

medical certification.

c. The Director may suspend and/or revoke or refuse to register or renew a Great

Lakes Registered Pilot’s registration when that Pilot does not continuously

meet the standards of this Manual (See 46 CFR 401.210 and

46 CFR 401.240). Evidence obtained from any physical examination may be

used by the Coast Guard to cancel a mariner’s medical certificate.

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CHAPTER 2. THE MEDICAL CERTIFICATE

A. Medical Certificate Overview.

1. The medical certificate, issued by the Coast Guard under 46 CFR part 10, subpart C,

serves as proof that a mariner meets the medical and physical standards for merchant

mariners. The Coast Guard retains final authority for determining whether a mariner

applicant is medically and physically qualified for the medical certificate (See 46 CFR

10.302(a)).

2. All credentialed mariners who are required to meet the medical and physical standards

for merchant mariners are required to hold a valid medical certificate in order to operate

under the authority of their merchant mariner credential (MMC) (See 46 CFR 15.401(c)).

Mariners who are not required to undergo a general medical exam or a demonstration of

physical ability under 46 CFR 10.302 are not required to hold a medical certificate.

3. In order to avoid foreign port state control actions, and to comply with 46 CFR 15.401,

companies and vessel operators should:

a. Ensure that all seafarers employed by the company or operator carry a valid medical

certificate when operating under the authority of their MMC on vessels subject to the

STCW; or when engaged on a vessel calling on a port in a country ratifying the

Maritime Labour Convention (MLC).

b. Determine whether employed mariners have a valid medical certificate in accordance

with 46 CFR 15.401(c).

B. Background.

1. The STCW Convention requires signatory parties to establish standards of medical

fitness for seafarers and procedures for the issuance of a separate medical certificate.

a. In order to comply with the Convention, seafarers must hold a valid medical

certificate when serving at sea under the authority of their STCW credential.

b. While initially an STCW provision, the Coast Guard implemented the change to a

separate medical certificate for all credentialed mariners who are required to meet the

medical and physical standards for merchant mariners, including those holding only a

national endorsement.

2. In addition, the Maritime Labour Convention (MLC), which entered into force on August

20, 2013, requires all mariners (including entry-level, food handlers, and staff personnel)

serving on vessels to have a valid medical certificate.

a. Until such time that the United States ratifies the MLC, the Coast Guard cannot

mandate enforcement of its requirements for U.S. mariners. However, Article V,

Paragraph 7 of the MLC contains a “no more favorable treatment clause” that

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requires ratifying governments to impose Convention requirements on all vessels—

even those from a non-ratifying government—when calling on their ports. As a

result, U.S. vessels that cannot demonstrate compliance with the MLC may be at risk

of port state control actions, including detention, when operating in the port of a

ratifying nation.

b. The MLC does provide that medical certificates meeting STCW requirements also

satisfy the MLC requirement. Medical certificates issued under 46 CFR part 10 meet

the requirements of MLC Regulation 1.2.

3. In the event that a vessel is not subject to STCW but may be subject to the MLC as it is

calling on a port in a country that has ratified the MLC, the vessel operator should ensure

that all mariners serving on the vessel are in possession of a valid medical certificate.

C Medical Certificate Key Terms.

1. Date of Examination.

The date that the Coast Guard approves issuance of the medical certificate will serve as

the date of examination listed on the medical certificate. It will not necessarily coincide

with the date the medical practitioner signs the Application for Medical Certificate, Form

CG-719K, or the Application for Medical Certificate, Short Form, CG-719K/E; nor will

it necessarily coincide with the date that the medical certificate is actually issued to the

mariner.

a. An applicant seeking an original MMC may be approved for issuance of the medical

certificate on a particular date, while the MMC may not be issued for an

undetermined amount of time as the applicant completes professional requirements,

as appropriate.

b. An applicant may be issued a time-limited medical certificate with a medical waiver.

Time-limited certificates may be limited to 1 or 2 years, depending on the conditions

of the medical waiver. The date of examination listed on the medical certificate

establishes the anniversary date for the medical waiver. A mariner may have to apply

for a new medical certificate, in compliance with the expiration date and waiver

conditions, before the issuance date for his or her MMC.

EXAMPLE: On February 4, 2016, an applicant is approved for

issuance of a time-limited medical certificate with a 1-year expiration

and waiver conditions. The date of examination listed on the medical

certificate is February 4, 2016. The mariner meets all professional

qualifications and is approved to test for an endorsement approximately

2 weeks later. The mariner uses the full 1-year approved-to-test period

and passes all professional examinations. The medical certificate will

expire on February 3, 2017, even though the mariner’s MMC may not

have been issued.

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2. Date of Expiration.

Because of differing legal requirements, each medical certificate will have three

expiration dates and validity periods, as appropriate. One will be the expiration date for

STCW (See 46 CFR 10.301(b)(1)). A second expiration date will be for Pilots under

46 CFR 15.812 (See 46 CFR 10.301(b)(2)). The third will be for the national

endorsement (See 46 CFR 10.301(b)(3)). Mariners who have a medical certificate must

remain aware of the expiration dates on their medical certificate and the applicability of

the dates to their current employment.

a. STCW Endorsement expiration date: The validity period applicable to a mariner

holding an STCW endorsement that authorizes service onboard vessels to which

STCW applies will be for up to 2 years, unless the mariner is under the age of 18, in

which case the maximum period of validity will be 1 year (See 46 CFR 10.301(b)(1)).

b. Pilot expiration date: The validity period applicable to a mariner who serves under

an endorsement as a First Class Pilot (See 46 CFR 11.709) or who serves as pilot

under 46 CFR 15.812 will be a maximum period of 2 years (See

46 CFR 10.301(b)(2)). Although first-class pilots and those serving as pilots under

46 CFR 15.812 continue to be subject to the annual physical examination

requirements of 46 CFR 11.709(b), a new medical certificate will only need to be

issued every 2 years.

c. National Endorsements expiration date: The validity period applicable to all other

mariners (mariners sailing only under the authority of the national endorsement on

their MMC) will be for a maximum period of 5 years (See 46 CFR 10.301(b)(3)).

3. Time-Restricted Medical Certificates.

Mariners receiving a waiver of certain medical conditions may be issued a time-limited

certificate. Those certificates will expire in either 1 or 2 years, depending on the

condition. Applicants must comply with the terms of their waiver letters in order to be

issued a new medical certificate (See 46 CFR 10.303(c)).

D. Medical Certificate Contents.

The medical certificate will include the following information blocks:

1. Authorizing authority and the requirements under which the document is issued;

2. Name (Last, first, middle);

3. Date of birth (day/month/year);

4. Gender (Male/Female);

5. Date of examination (day/month/year);

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6. Hearing meets the standards in Section A-I/9 (Y/N);

7. Visual acuity meets standards in Section A-I/9 (Y/N);

8. Color vision meets standards in Section A-I/9 (Y/N);

9. Fit for look-out duties (Y/N);

10. Unaided Hearing Satisfactory (Y/N);

11. No limitations or restrictions on fitness (Y/N). If “N”, specify limitations or restrictions;

12. Is the mariner free from any medical condition likely to be aggravated by service at sea or

to render the seafarer unfit for such service or to endanger the health of other persons on

board? (Y/N);

13. Expiration dates of certificate;

14. Identification checked at examination (Y/N);

15. Official stamp (including name) of the issuing authority;

16. Signature of the authorized person; and

17. Mariner’s signature confirming that the mariner has been informed of the contents of the

certificate and of the right to appeal in accordance with 46 CFR 1.03-40. The medical

certificate is not valid until signed by the mariner.

E. General

Guidance on the Application for Medical Certificate.

1. To qualify for a medical certificate, mariner applicants must provide evidence of meeting

the medical and physical standards on the Application for Medical Certificate, Form

CG-719K or the Application for Medical Certificate, Short Form CG-719K/E, as

described below in Paragraphs E.1.a - b of this Chapter. The Coast Guard retains final

authority for determining whether a mariner applicant is medically and physically

qualified (See 46 CFR 10.302(a)).

a. Mariner applicants who are required to submit a general medical exam (See Table 1 to

46 CFR 10.302(a) and Table 1-1 in Chapter 1 of this Manual) must provide evidence

of meeting the medical and physical standards on the Application for Medical

Certificate, Form CG-719K.

b. Mariner applicants who are not required to submit a general medical exam (See Table

1 to 46CFR 10.302(a) and Table 1-1 of Chapter 1 of this Manual), may apply using

the Application for Medical Certificate, Short Form CG-719K/E.

2. In accordance with 46 CFR 10.302(b), all exams, tests, and demonstrations must be

performed, witnessed, or reviewed by a licensed medical doctor, licensed physician

assistant, licensed nurse practitioner, or a designated medical examiner (DME). All

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licensed medical practitioners must hold a valid license issued in the United States (U.S.),

a U.S. possession, or a U.S. territory. Examinations for Great Lakes Registered Pilots

must be conducted by a licensed medical doctor in accordance with the physical exam

requirements in 46 CFR 402.210 (See Paragraph D.4 of Chapter 1 of this Manual).

a. A DME means a licensed physician, licensed physician assistant, or licensed nurse

practitioner who has been trained and approved to conduct medical and physical

examinations of merchant mariners on behalf of the Coast Guard and may be

delegated limited authority to grant waivers and approve physical/medical suitability

for service (See 46 CFR 10.107).

b. The terms medical doctor and physician mean an individual who has been educated,

trained and licensed to practice medicine as a medical doctor (M.D.) or doctor of

osteopathy (D.O.).

c. Exams, tests and demonstrations performed, witnessed, or reviewed by chiropractors,

naturopathic doctors, or holders of foreign medical licenses are not accepted under

current regulations.

3. All applicants who require a general medical exam must be physically examined.

Examinations based solely on documentary review and/or patient history review are

unacceptable (See Table 1 to 46 CFR 10.302(a) and 46 CFR 10.304).

4. In accordance with 46 CFR 10.304(d), reports of medical and physical exams,

demonstrations, and tests must be submitted within 12 months from the date signed by the

licensed medical professional. When submitted as part of an MMC application, these

reports remain valid for 12 months from the date the Coast Guard accepts a complete

application.

5. Applicants and their medical providers should be aware that medical conditions may

require further review if there is concern that the condition might render the applicant

incapable of performing the duties of the credential. Chapters 8 through 25 of this

Manual provide guidance on medical conditions that may be subject to further review, in

accordance with Chapter 3 of this Manual. The list of conditions is not all-inclusive;

other conditions may be subject to further review if they are likely to pose risk of sudden

incapacitation or debilitating complication.

6. Medical practitioners who are evaluating mariner applicants for the medical certificate

should provide their professional assessment and recommendation with regard to the

applicant’s risk for sudden incapacitation and the applicant’s ability to safely perform the

duties of their credential without risk to themselves or others.

a. To that end, medical practitioners should familiarize themselves with the duties and

responsibilities of the mariner’s requested credential, to include emergency response.

b. Medical practitioners should also submit the evaluation data used to support their

overall assessment of the applicant’s risk. This may include medical test results,

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medical records review, consultation reports, or other evaluation data that the medical

practitioner has considered.

c. Additional information on recommended evaluation data is contained in Chapters 8

through 25 of this Manual.

7. In cases where the applicant does not meet the standards specified in references (a)

through (d), as supplemented by the guidance contained herein, the Coast Guard may

consider issuing a medical certificate with waivers, limitations, and/or restrictions if it

finds that there are extenuating circumstances that warrant special consideration.

a. In general, waivers may be considered when objective medical evidence indicates that

the medical condition is sufficiently controlled and the effects of medication pose no

significant risk to maritime and public safety. (See also 46 CFR 10.303 and

Paragraphs F, G, and H of Chapter 3 of this Manual).

b. The final determination regarding issuance of the medical certificate lies with the

Coast Guard.

8. Individuals who submit false information to the Coast Guard may be subject to criminal

prosecution under 18 U.S.C. 1001.

F. Medical Certificate Application Requirements for Specific Endorsements.

1. Entry-level national endorsement or a staff officer national endorsement only.

For mariners applying for an MMC with an entry-level national endorsement or a staff

officer national endorsement only (See 46 CFR part 11, subpart H):

a. No medical certificate or medical certificate application is required.

b. Applicants additionally seeking to serve as food handler are required to obtain a

medical certificate. These applicants must:

(1) Submit the Application for Medical Certificate, Form CG-719K, or the

Application for Medical Certificate, Short Form CG-719K/E ; and

(2) Provide a statement from a licensed physician, physician assistant, or nurse

practitioner attesting that they are free of communicable diseases that pose a

direct threat to the health or safety of other individuals in the workplace, in

accordance with 46 CFR 10.304(b). The statement may be documented in any

verifiable format, including as notes on the Application for Medical Certificate,

Form CG-719K, or the Application for Medical Certificate, Short Form CG-

719K/E, or on letterhead from the medical practitioner.

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2. Endorsement as Tankerman Person in Charge (PIC) Restricted to Fuel Transfers on

Towing Vessels.

For mariners applying for an MMC with only an endorsement as Tankerman PIC

Restricted to Fuel Transfers on Towing Vessels, no medical certificate application is

required (See CG-MMC Policy Letter 01-17 which can be found at

https://www.dco.uscg.mil/Portals/9/NMC/pdfs/announcements/2017/cg-

mmc_policy_letter_01-17_final_3_9_17-date.pdf ).

3. Entry-level or staff officer endorsement only, seeking an STCW or MLC-compliant

medical certificate.

Mariners applying for or holding an MMC with an entry-level or a staff officer

endorsement only, who seek a medical certificate that complies with STCW or MLC

requirements, and who will not stand navigational watches, should apply using an

Application for Medical Certificate, Short Form CG-719K/E.

a. Qualified mariners will be issued a medical certificate.

b. The blocks listed in Paragraph D.6 through 11 of this Chapter, will be marked “N” on

the certificate. No lookout duties will be authorized.

c. The medical certificate will be restricted to entry-level only or staff officer

endorsements, as appropriate.

d. Mariners seeking to serve as food handlers should provide a statement from a

licensed physician, physician assistant, or nurse practitioner attesting that they are

free of communicable diseases that pose a direct threat to the health or safety of other

individuals in the workplace, in accordance with 46 CFR 10.304(b). The statement

may be documented in any verifiable format, including as notes on the Application

for Medical Certificate, Form CG-719K, or the Application for Medical Certificate,

Short Form CG-719K/E, or on letterhead from the medical practitioner.

4. Entry-level only, serving on a vessel not subject to STCW, seeking an MLC-compliant

medical certificate with qualification for lookout duties.

Mariners applying for or holding an MMC with an entry-level endorsement only, serving

on a vessel not subject to STCW, who seek a medical certificate that satisfies the MLC

and who want to be qualified for lookout duties, should submit an Application for

Medical Certificate, Form CG-719K. Sections III (Medical Conditions), IV

(Medications) and V (Physical Exam) do not have to be completed.

a. Mariners will be evaluated on hearing and vision requirements and, if found qualified,

will be issued a medical certificate with the appropriate blocks marked “Y.” “Fit for

lookout duties” will be annotated on the medical certificate.

b. The medical certificate will be restricted to entry-level.

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c. Mariners seeking to serve as food handlers should provide a statement from a

licensed physician, physician assistant, or nurse practitioner attesting that they are

free of communicable diseases that pose a direct threat to the health or safety of other

individuals in the workplace, in accordance with 46 CFR 10.304(b). The statement

may be documented in any verifiable format, including as notes on the Application

for Medical Certificate, Form CG-719K, or the Application for Medical Certificate,

Short Form CG-719K/E, or on letterhead from the medical practitioner.

5. Officer Endorsement, Qualified Rating Endorsement or STCW Endorsement.

Mariners applying for an officer endorsement (other than a staff officer endorsement), a

qualified rating endorsement, or an STCW endorsement, should either hold a valid U.S.-

issued medical certificate or submit an Application for Medical Certificate, Form CG-

719K.

6. Additional Endorsements.

Mariner applicants holding an MMC and a valid medical certificate who seek a raise of

grade or new endorsement are not required to submit a new medical examination if their

existing medical certification meets all the requirements for the endorsement sought (See

46 CFR 10.301(b)(4)).

7. Food Handler Endorsement.

Most entry level mariners will be issued an MMC endorsed as Stewards Department

(F.H.).

a. In order to serve as food handler, a mariner must have the Stewards Department

(F.H.) endorsement on the MMC and a medical certificate that does not exclude food

handling.

b. All medical certificates will contain a limitation stating “No food handling,” unless a

statement is provided from a licensed physician, physician assistant, or nurse

practitioner attesting that the applicant is free of communicable diseases that pose a

direct threat to the health or safety of other individuals in the workplace, in

accordance with 46 CFR 10.304(b). The statement may be documented in any

verifiable format, including as notes on the Application for Medical Certificate, Form

CG-719K, or the Application for Medical Certificate, Short Form CG-719K/E, or on

letterhead from the medical practitioner.

G. Submission Procedures.

1. Mariners seeking a medical certificate as part of an original MMC should submit the

application through their local Regional Exam Center (REC). Mariners seeking a

medical certificate only, or as part of an MMC application other than original, may

submit the medical certificate application directly to the National Maritime Center

(NMC).

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2. Before submitting the application, mariner applicants should ensure that all supporting

documentation is included, and that all necessary signatures have been provided.

3. Applicants should be aware that submission of applications that are incomplete, or that

are missing signatures, may result in processing delays.

4. Applicants may consult the NMC website,

https://www.dco.uscg.mil/national_maritime_center/ for information on application

processing time. Additionally, mariners with medical conditions should submit their

applications early to allow adequate processing time.

5. Additional information on the application and submission process for medical certificates

and mariner credentials can be found on the NMC website,

https://www.dco.uscg.mil/national_maritime_center/.

H. Sample Medical Certificate.

Figures 2-1 and 2-2 provide a sample of the merchant mariner medical certificate.

Figure 2-1: Medical Certificate – Front

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Figure 2-2: Medical Certificate – Back

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CHAPTER 3. MEDICAL CERTIFICATE PROCESSING

A. Introduction.

1. This chapter provides guidance on the issuance of medical certificates under the

regulations in Title 46 CFR, part 10, subpart C—Medical Certification (Reference (c)),

and the International Convention on Standards of Training, Certification and

Watchkeeping for Seafarers, 1978, as amended (STCW) (Reference (b)). It describes the

medical review process, to include waivers, limitations and other conditions of issuance

that may be placed on the medical certificate or credential.

2. No fees will be charged for medical certificates.

3. The Coast Guard will issue a medical certificate to each qualified mariner when

processing an application for a medical certificate. Once issued, a valid medical

certificate must be carried by all mariners who are required to meet the medical or

physical standards for certification when serving under the authority of a merchant

mariner credential (MMC) (See 46 CFR 15.401(d)).

4. As discussed in Paragraph E of this Chapter and Paragraph D.1 of Chapter 1 of this

Manual, mariners who are not required to undergo a general medical exam or a

demonstration of physical ability under 46 CFR 10.302 are not required to hold a medical

certificate (See lines 19 and 21 of Table 1-1 of this Manual,).

5. Title 46 CFR part 10, subpart C contains the physical ability and medical examination

requirements for credentialed mariners. Specifically, Table 1 to 46 CFR 10.302(a) and

Table 1-1 of this Manual list various credentials and reference the vision, hearing, general

medical examination and demonstration of physical ability requirements that must be met

prior to receiving a medical certificate. Guidance on these standards can be found in the

following Chapters of this Manual: Chapter 4 (The Merchant Mariner Medical

Examination), Chapter 5 (Vision and Hearing Standards), and Chapter 6 (Physical Ability

Guidelines).

6. Waivers, restrictions and limitations will be applied in accordance with Paragraph F

(Medical Waivers), Paragraph G (Operational Limitations), and Paragraph H

(Restrictions) of this Chapter.

7. Mariners who have been determined medically disqualified will be processed in

accordance with Paragraph K of this Chapter.

8. Details concerning the format and contents of medical certificates are found in Chapter 2

of this Manual. Key terms related to medical certificates are also defined in Chapter 2.

B. Medical Certificate Requirements.

1. Under 46 CFR 15.401(c), all mariners who are required to meet the medical and physical

standards for merchant mariners are required to hold a valid medical certificate in order

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to serve on a vessel under the authority of their credential. Mariners operating under the

authority of an STCW endorsement are required to maintain a valid medical certificate,

regardless of when the STCW endorsement was issued.

2. In accordance with Paragraph D.1 of Chapter 1 of this Manual, and Paragraph E.1 of this

Chapter, mariners with only a national endorsement for staff officer or entry-level do not

require a medical certificate. Additionally, mariners with only an endorsement as

Tankerman Person in Charge (PIC) Restricted to Fuel Transfers on Towing Vessels do

not require a medical certificate (See CG-MMC Policy Letter 01-17 which can be found

at https://www.dco.uscg.mil/Portals/9/NMC/pdfs/announcements/2017/cg-

mmc_policy_letter_01-17_final_3_9_17-date.pdf ).

C. The Medical Review Process.

1. When individuals submit an application for a medical certificate, the Coast Guard will

review the application to determine whether the applicant meets the medical and physical

standards for merchant mariner medical certification (See 46 CFR 10.301(a)). The Coast

Guard will advise the applicant if there are any discrepancies or if any additional

information is needed.

2. The National Maritime Center (NMC) will review all information provided and will

make one of the determinations below, as indicated in 46 CFR 10.301(a):

a. The applicant is physically and medically qualified for the medical certificate without

any limitations, waivers and/or other conditions;

b. The applicant is physically and medically qualified for issuance of the medical

certificate with appropriate waivers, limitations and/or other conditions as specified

by the Coast Guard;

c. Additional information is necessary to determine if the applicant is physically and/or

medically qualified for the medical certificate; or

d. The applicant is not physically and/or medically qualified for the medical certificate.

3. The Coast Guard will inform the applicant of the results of the review, and:

a. If the mariner is found qualified, the Coast Guard will issue a medical certificate with

or without waivers, limitations, restrictions, and/or other conditions, as appropriate.

b. If additional information is necessary, the Coast Guard will request the information

from the applicant. The Coast Guard may hold the application and temporarily delay

final determination pending receipt of the requested information.

c. If the Coast Guard determines that the applicant is not physically and/or medically

qualified, the application for medical certificate will be denied. The applicant will be

informed in writing of the cause and be advised that:

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(1) Under 46 CFR 1.03-15 and 1.03-40, the applicant may seek reconsideration of the

denial of medical certification within 30 days of the date of the denial; and

(2) The applicant may subsequently appeal the reconsideration decision within 30

days of the date of the decision. The Coast Guard may extend the 30-day time

limit to file an appeal upon a showing of good cause. See Paragraph N of this

Chapter.

D. NMC Medical Evaluation Procedures by Type of Application.

1. Application for a Medical Certificate Only.

a. Requirements for medical certification are found in 46 CFR, part 10, subpart C

(Sections 10.301-10.306). Guidance on certification standards are found in Chapter 1

of this Manual.

(1) The complete application package includes, but is not limited to, the Application

for Medical Certificate, Form CG-719K, or the Application for Medical

Certificate, Short Form CG-719K/E.

(a) Mariner applicants who are required to submit a general medical exam (See

Table 1 to 46 CFR 10.302(a) and Table 1-1 of this Manual) must provide

evidence of meeting the medical and physical standards on the Application for

Medical Certificate, Form CG-719K.

(b) Mariner applicants who are not required to submit a general medical exam

(See Table 1 to 46CFR 10.302(a) and Table 1-1 of this Manual), may apply

using the Application for Medical Certificate, Short Form CG-719K/E.

(2) The Application for Merchant Mariner Credential, Form CG-719B, is not required.

(3) The application will be reviewed in accordance with the guidance in this Manual.

b. If the applicant is found to have a potentially disqualifying condition, the NMC will

conduct an individualized assessment and consider issuance of a waiver in accordance

with 46 CFR 10.303 and Paragraph F of this Chapter.

c. If the applicant is found not qualified, the NMC will process in accordance with

Paragraph K of this Chapter.

d. If the applicant is found qualified, the NMC will issue a medical certificate. Medical

certificates may be time-limited, in accordance with 46 CFR 10.303 and Paragraph

H.1 of this Chapter.

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2. Application for Removal of a Medical Restriction or Medical Operational Limitation.

a. The Application for Medical Certificate, Form CG-719K, or the Application for

Medical Certificate, Short Form CG-719K/E, plus supporting documentation as

described in Chapters 8 through 25 of this Manual, is required.

(1) Mariner applicants who are required to submit a general medical exam (See Table

1 to 46 CFR 10.302(a) and Table 1-1 of this Manual) must provide evidence of

meeting the medical and physical standards on the Application for Medical

Certificate, Form CG-719K.

(2) Mariner applicants who are not required to submit a general medical exam (See

Table 1 to 46CFR 10.302(a) and Table 1-1 of this Manual), may apply using the

Application for Medical Certificate, Short Form CG-719K/E.

b. The NMC will review all information provided and will make a determination in

accordance with 46 CFR 10.301(a) and Paragraphs C, F, G and H of this Chapter.

E. Special NMC Medical Evaluation Procedures for Entry Level Mariners, Staff Officers,

and Individuals Endorsed as Tankerman PIC Restricted to Fuel Transfers on Towing

Vessels.

1. Mariners with only a national endorsement for staff officer or entry level do not require a

medical certificate. Additionally, mariners with only an endorsement as Tankerman PIC

Restricted to Fuel Transfers on Towing Vessels do not require a medical certificate, as

indicated in CG-MMC Policy Letter 01-17, which can be found at

https://www.dco.uscg.mil/Portals/9/NMC/pdfs/announcements/2017/cg-

mmc_policy_letter_01-17_final_3_9_17-date.pdf.

2. Mariners applying for or holding an MMC with only an entry-level national endorsement

or a staff officer endorsement, who require a medical certificate that complies with

STCW or MLC requirements and will not stand navigational watches:

a. The appropriate application is the Application for Medical Certificate, Short Form

CG-719K/E.

b. Qualified mariners will be issued a medical certificate.

c. The information blocks on the medical certificate related to hearing, visual acuity,

color vision, unaided hearing and fitness for lookout duties (See Paragraph D of

Chapter 2 of this Manual) will be marked either “N/A” or “N”, as appropriate.

d. The medical certificate will be restricted to entry-level only and will not certify the

applicant as “fit for look-out duties.”

e. Unless a statement regarding communicable diseases is provided, in accordance with

46 CFR 10.304(b), the medical certificate will contain a limitation stating “No food

handling".

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(1) Mariners seeking to serve as food handlers must provide a statement from a

licensed physician, physician assistant, or nurse practitioner attesting that they are

free of communicable diseases that pose a direct threat to the health or safety of

other individuals in the workplace, in accordance with 46 CFR 10.304(b).

(2) The statement may be documented in any verifiable format, including as notes on

the Application for Medical Certificate, Form CG-719K, or the Application for

Medical Certificate, Short Form, CG-719K/E, or on letterhead from the medical

practitioner.

(3) The Medical Practitioner need not perform any additional testing unless it is

deemed clinically necessary. Applicants and currently employed food workers

should report information about their health as it relates to diseases that are

transmissible through food. Circumstances that the medical practitioner should

consider when certifying an applicant include, but are not limited to, the

following:

i. Whether the applicant reports that they have been diagnosed with, or exposed

to an illness due to organisms including, but not limited to, Salmonella Typhi,

Shigella species, Shiga-toxin producing Escherichia coli, or Hepatitis A virus

within the past month;

ii. Whether the applicant reports that they have at least one symptom caused by

illness, infection, or other source that is associated with an acute

gastrointestinal illness such as diarrhea, fever, vomiting, jaundice, or sore

throat with fever; or

iii. Whether the applicant reports that they have a lesion containing pus, such as a

boil or infected wound, which is open or draining and is on the hands, wrists,

or exposed portions of the arms.

3. Mariners applying for or holding an MMC with an entry-level national endorsement only,

seeking to be qualified for lookout duties:

a. The appropriate medical certificate application includes the Application for Medical

Certificate, Form CG-719K. Sections III (Medical Conditions), IV (Medications) and

V (Physical Examination) DO NOT have to be completed.

b. If the applicant is found qualified as to the hearing and vision requirements, then the

medical certificate will be issued with the information blocks for hearing, visual

acuity, color vision, and unaided hearing marked “Y.”

c. Medical certificates will be restricted to entry-level only and will certify the

applicant as “fit for lookout duties.”

d. Unless a statement regarding communicable diseases is provided, in accordance with

46 CFR 10.304(b), the medical certificate will contain a limitation stating “No food

handling.”

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(1) Mariners seeking to serve as food handlers must provide a statement from a

licensed physician, physician assistant, or nurse practitioner attesting that they are

free of communicable diseases that pose a direct threat to the health or safety of

other individuals in the workplace, in accordance with 46 CFR 10.304(b).

(2) The statement may be documented in any verifiable format, including as notes on

the Application for Medical Certificate, Form CG-719K, or the Application for

Medical Certificate, Short Form, CG-719K/E, or on letterhead from the medical

practitioner.

(3) The Medical Practitioner need not perform any additional testing unless it is

deemed clinically necessary. Applicants and currently employed food workers

should report information about their health as it relates to diseases that are

transmissible through food. Circumstances that the medical practitioner should

consider when certifying an applicant include, but are not limited to, the

following:

i. Whether the applicant reports that they have been diagnosed with, or exposed

to an illness due to organisms including, but not limited to, Salmonella

Typhi, Shigella species, Shiga-toxin producing Escherichia coli, or Hepatitis

A virus within the past month;

ii. Whether the applicant reports that they have at least one symptom caused by

illness, infection, or other source that is associated with an acute

gastrointestinal illness such as diarrhea, fever, vomiting, jaundice, or sore

throat with fever; or

iii. Whether the applicant reports that they have a lesion containing pus, such as

a boil or infected wound, which is open or draining and is on the hands,

wrists, or exposed portions of the arms.

F. NMC Medical Evaluation Procedures for the Issuance of Medical Waivers.

1. The Coast Guard may grant a waiver if an applicant does not possess the vision, hearing,

or general physical condition necessary and extenuating circumstances warrant special

consideration (See 46 CFR 10.303(a)). Chapters 8 through 25 of this Manual contain

guidance on specific medical conditions and factors to consider in determining whether a

waiver is warranted.

2. An applicant may submit additional correspondence, records, and reports to the Coast

Guard in support of a waiver. In this regard, recommendations made on behalf of their

employees from agencies of the Federal Government operating government vessels, as

well as owners and operators of private vessels will be given full consideration (See

46 CFR 10.303(a)).

3. In general, the Coast Guard will not approve medical waivers when an applicant does not

meet the applicable medical standards, unless objective medical evidence indicates that

the condition is sufficiently controlled and the effects of medication pose no significant

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risk to maritime and public safety. The Coast Guard retains final administrative authority

for the issuance of medical waivers (See 46 CFR 10.303(b)).

4. The Coast Guard may grant medical waivers with specific restrictions or limitations to

which the applicant must adhere. This may include constraints such as more frequent

monitoring of the mariner’s medical conditions, submission of medical exams and/or

tests at varying intervals to track the ongoing status of the medical condition, or

operational limitations (See 46 CFR 10.303(c), (d) and (e)). The restrictions and

limitations on the medical certificate may differ from those on the MMC. The mariner

must operate within the most restrictive of the limitations.

5. Failure to comply with the terms and conditions of a medical waiver, including any

follow-up reporting requirements, restrictions, or adherence to operational limitation(s),

may result in loss of medical certification. Additionally, appropriate administrative

action, up to and including suspension or revocation of the mariner’s credential(s), in

accordance with 46 CFR part 5, may result.

6. For medical certificate purposes, the Coast Guard considers the terms “restriction” and

“limitation” to be synonymous. Both terms are considered constraints on the authority

granted by a medical certificate. The granting of a medical waiver is conditioned upon

compliance with the limitation or restriction. Within 46 CFR subpart C, it is relatively

common practice to use the term “operational limitation” on a constraint that limits the

actual operating authority of a credential (e.g., daylight hours only) while “restriction” is

used to describe a more general constraint such as annual reporting requirements or

specialized testing.

G. NMC Medical Evaluation Procedures for the Issuance of Operational Limitations.

1. The Coast Guard may place an operational limitation on the mariner’s medical certificate

(See 46 CFR 10.303(d)).

2. An operational limitation is a specific constraint placed upon the medical certificate that

reduces the mariner’s ability to serve under the full authority of his or her credential.

Examples of common operational limitations include, but are not limited to:

a. Daylight operations only: May be applied to deck department mariners unable to

pass the color vision standards in 46 CFR 10.305(a).

b. Limitations requiring the use of corrective lenses: May be applied to mariners with

vision deficiencies (See 46 CFR 10.305(d)).

c. Restrictions regarding impaired hearing, requiring the use of hearing aids with spare

batteries kept onboard at all times: Will be applied in accordance with the hearing

standards outlined in Chapter 5 of this Manual (See 46 CFR 10.306(e)).

d. No Food Handling: May be applied to mariners who have not been certified as free

of communicable diseases that pose a direct threat to the health or safety of other

individuals in the workplace. (See 46 CFR 10.304(b)).

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3. The Coast Guard may impose other limitations, as appropriate, depending on the specific

medical condition and its impact on the mariner’s ability to perform routine and

emergency duties. Additional considerations include, but are not limited to, the

recommendations of the treating and/or examining medical practitioner.

H. NMC Medical Evaluation Procedures for the Issuance of Restrictions.

1. Time Restrictions.

a. Medical certificates may include time constraints that cause the certificate to expire

earlier than the full certification period. The full certification period is 2 years for

first class pilots, 2 years for STCW holders, and 5 years for national endorsements.

The full certification period for mariners who are under 18 years of age and seeking

an STCW endorsement is 1 year (See 46 CFR 10.301(b)(1)).

b. Time-restricted medical certificates will expire either 1 year or 2 years from the date

of examination, depending on the medical condition, condition status, and the need

for periodic medical evaluations. This 1- or 2-year expiration date will apply to all

medical certificate categories (i.e., STCW endorsements, national endorsements, and

First Class Pilots).

2. Geographical Restrictions.

a. Medical certificates may include geographical restrictions that reduce the waters upon

which a mariner may operate a vessel. These restrictions may include “Near Coastal

Waters only,” “Inland Waters only,” or other appropriate route restrictions depending

on the medical condition and condition status.

b. Other geographical restrictions, such as “25 nautical miles from Harbor of Safe

Refuge,” etc., may be applied as appropriate, depending on the medical condition and

the need for surveillance and/or availability to obtain medical assistance. Additional

considerations include, but are not limited to, the recommendations of the treating

and/or examining medical practitioner.

3. Medical Restrictions.

a. Medical restrictions may be applied, as appropriate, depending on the specific

medical condition and its impact on the mariner’s ability to perform routine and

emergency duties. Considerations include, but are not limited to, the

recommendations of the treating and/or examining medical practitioner.

b. For mariners with obstructive sleep apnea (OSA) requiring the use of positive airway

pressure devices or oral/nasal appliances, the following restriction will be applied:

“Special equipment required while sleeping.”

c. For mariners with conditions requiring medications to ensure safe functioning and

provide for any emergency needs, the following restriction will be applied: “Must

carry self-administered medications.”

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I. NMC Medical Evaluation Procedures for Mariners with Existing Waivers.

1. If a mariner has a waiver previously granted by the Coast Guard, the prior waiver should

be honored and the conditions retained in the new waiver unless one of the following

conditions exist:

a. Failure to comply with the terms of the prior waiver; including any requirements for

providing additional medical information;

b. Material change in the mariner’s condition (See Paragraph I.2 of this Chapter);

c. A bona fide change in duly promulgated policy or regulations; or

d. The prior waiver was issued in clear error, contrary to duly promulgated policy in

effect at the time of issuance (See Paragraph I.3 of this Chapter).

2. A ‘material change in the mariner’s condition’ is a change that is so significant that, if it

had been present at the time of prior review, it would have resulted in denial of the

medical certificate or placement of more restrictive conditions.

a. Examples include, but are not limited to:

(1) A mariner who was previously granted a waiver for heart disease, whose

condition subsequently changes because of a heart attack, need for heart surgery,

new test results, or because the treating physician’s assessment indicates an

increase in risk;

(2) A mariner who was previously granted a waiver for diabetes, who develops

complications from diabetes, and who has not been compliant with the treating

physician’s treatment plan, or whose laboratory work indicates poor diabetic

control; or

(3) A mariner who was previously granted a waiver for occasional use of an

impairing medication, whose records now indicate or suggest use of additional

impairing medication, chronic daily use of impairing medication, or use of

impairing medication while working under the authority of a credential.

b. While not possible to delineate every material change in condition that may occur, a

material change generally includes conditions or situations that increase the risk of

sudden incapacitation or debilitating complication, or that involve the use of

medication that can impair cognitive ability, judgment or reaction time. This does not

include minor medication adjustments, minor fluctuations in lab results, or the

development of conditions that are not associated with an increased risk of sudden

incapacitation, debilitating complication, or the use of medications that do not pose a

risk of impairment.

3. Clear error is not a difference of opinion between different reviews. It is when a waiver

is granted and the policy in effect at the time clearly prohibited the waiver that was

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granted. While mariners are entitled to rely on decisions made by the Coast Guard, the

government is not bound to honor a waiver that was issued in error, especially in a

situation where public safety is at issue.

4. These provisions do not prohibit the issuance of a time-restricted medical certificate, in

accordance with Paragraph H.1 of this Chapter, where the prior waiver had recurring

reporting requirements.

J. NMC Medical Evaluation Procedures for Mariners with Short-Term Conditions.

Short-term conditions may render a mariner not physically or medically competent at the

time of application, even though the condition is being appropriately treated and will be of

relatively short duration. An example of this might be a broken arm that impairs the

applicant’s ability to meet the physical ability guidelines, in accordance with 46 CFR

10.304(c). In some cases, if requested, the NMC may hold the medical certificate application

open for no more than 90 days to allow the short-term condition to resolve itself. If, after 90

days, the impairing condition still persists, the application will be denied, and the applicant

will be required to resubmit an application.

K. NMC Medical Evaluation Procedures for Mariners Who Do Not Meet the Medical

Qualification Standards.

For mariners who do not meet the medical qualification standards in 46 CFR part 10, subpart

C, the NMC will provide an individual assessment regarding eligibility for a waiver. If a

waiver is not granted, or the mariner is no longer compliant with an existing waiver, the

NMC will process the mariner in accordance with the following directions:

1. Mariners who are noncompliant with existing medical waivers, limitations, restrictions

and/or other conditions of issuance.

a. Advise the mariner of the deficiency and warn the mariner that failure to comply with

waiver requirements may result in loss of medical certification. The warning should

provide detailed guidance on what reports, testing, or examinations the mariner

should submit in accordance with the terms of the original waiver. Provide a deadline

by which time the mariner must comply with the terms of the waiver. Note: the

warning and opportunity to comply is not required in cases of willfulness or cases in

which there is an imminent threat to public safety.

b. If the mariner cures the deficiency, warn the mariner that further failure to comply

with waiver requirements may result in denial of future waivers or loss of medical

certification.

c. If the mariner does not cure the deficiency within the time allotted, the NMC will

cancel the medical certificate, as indicated in Paragraph L of this Chapter.

2. Medically Disqualified Mariners.

The guidance in this Section (Paragraphs K.2.a-c) assumes that the mariner was

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considered for a waiver under 46 CFR 10.303 and Chapters 8 through 25 of this Manual,

as applicable, but the waiver was not issued. In the case of medically disqualified

mariners who held a prior waiver, consider the specific instructions found in Paragraph I

of this Chapter.

a. If the mariner is applying for a medical certificate, then the NMC will:

(1) Deny the medical certificate and provide a written statement as required by

46 CFR 10.237(a). If the mariner holds a valid medical certificate, the NMC will

follow the cancellation process outlined in Paragraph L of this Chapter.

(2) If the mariner holds a valid MMC, the NMC will warn the mariner that operating

under the authority of a credential without a valid medical certificate is a violation

of 46 CFR 15.401 and may subject the mariner to suspension and revocation

action under 46 CFR part 5.

(3) The NMC will advise the mariner of the right to reconsideration and appeal under

46 CFR 1.03-15.

b. If the mariner is seeking continuation of a waiver or submitting information as

required by a waiver.

(1) The NMC will deny the waiver continuance.

(2) The NMC will advise the mariner of the right to reconsideration and appeal under

46 CFR 1.03-15.

(3) If the mariner holds a valid medical certificate, the NMC will follow the

cancellation process outlined in Paragraph L of this Chapter.

c. If the National Maritime Center (NMC) receives credible information that leads to the

conclusion that the mariner is unfit.

(1) The NMC will inform the mariner of the situation and provide the mariner an

opportunity to respond to the information provided. The NMC will provide

guidance on the type of information, reports, examinations or tests that would be

required to demonstrate continued medical competence.

(a) The NMC will establish a reasonable deadline, by which time mariner must

comply with the request for more information.

(b) If circumstances require additional investigation, the NMC may refer the case

to the local Officer in Charge, Marine Inspection, in accordance with 46 CFR

1.01-15(b).

(2) The NMC will review all information provided and make a determination in

accordance with 46 CFR 10.301(a).

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(3) If the mariner is then determined to be unfit:

(a) The NMC will conduct an individualized assessment of the mariner’s

condition and determine whether a waiver may be granted in accordance with

46 CFR 10.303 and Paragraph F of this Chapter.

(b) The NMC will advise the mariner of the right to reconsideration and appeal

under 46 CFR 1.03-15.

cancellation process outlined in Paragraph L of this Chapter.

L. NMC Medical Evaluation Procedures for Cancellation of a Medical Certificate.

This Section outlines the procedures to be followed if the NMC Medical Evaluation

Procedures for Medically Disqualified Mariners, as described in Paragraph K, above, lead to

a determination that the medical certificate should be cancelled.

1. A medical certificate may be cancelled by the NMC if:

a. A mariner develops a new medical condition or a change in a medical condition that

would be disqualifying under 46 CFR part 10, subpart C, as implemented by this

Manual;

b. A mariner is non-compliant with the conditions, limitations, and/or restrictions placed

on their medical certificate; or

c. A mariner has submitted a fraudulent medical application or false information; or has

withheld or otherwise failed to disclose medical information in support of a medical

certificate application.

2. If the NMC receives credible information indicating that one or more of the

circumstances described in Paragraph L.1. a. - c. above is present or has occurred, the

NMC will:

a. Inform the mariner of the situation and provide the mariner an opportunity to respond

to the information provided. The NMC will provide guidance on the type of

information, reports, examinations or tests that would be required to demonstrate

continued medical competence or compliance.

(1) The NMC will establish a reasonable deadline, but not less than thirty (30) days

from the time the mariner is informed of the situation, by which time the mariner

must comply with the request for more information.

(2) If circumstances require additional investigation, the NMC may refer the case to

the local Officer in Charge, Marine Inspection, in accordance with 46 CFR 1.01-

15(b).

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b. Review all information provided and make a determination in accordance with 46

CFR 10.301(a).

3. If, after following the procedures outlined in Paragraph L.2. above, the NMC determines

that the cancellation of a medical certificate is warranted, the NMC will:

c. Provide the mariner with written notification of the cancellation by mail. In addition

to written notification, the NMC will also attempt to inform the mariner of the

cancellation by telephone, by e-mail, and/or both, if relevant contact information has

been provided to the NMC;

d. Provide the mariner with information concerning the grounds for the cancellation;

and

e. Advise the mariner in writing that he or she may request reconsideration of any

decision that cancels a medical certificate, as allowed for in 46 CFR 1.03-15 and, if

necessary and after requesting reconsideration, appeal any decision that cancels a

medical certificate, as allowed for in 46 CFR 1.03-15 and 1.03-40.

M. Automatic Stay of Decision to Cancel a Medical Certificate.

1. The procedures in 46 CFR 1.03-15 are applicable except that, notwithstanding

46 CFR 1.03-15(f), the decision to cancel a medical certificate is automatically stayed

pending final agency action on the matter, unless the Commanding Officer, NMC, after

consulting with the Chief of the NMC Medical Evaluation Division and assigned legal

counsel, finds that:

a. There is evidence of a compelling and substantial risk of imminent harm if the

mariner is allowed to continue to operate under the authority of his or her credential;

and,

b. The continuation of the automatic stay presents a substantial risk to maritime safety.

2. In cases where the Commanding Officer, NMC, lifts the automatic stay, the processing of

the request for reconsideration and, if necessary, appeal will take priority, subject to the

mariner’s right to respond. These appeals will normally process within 21 business days,

once the mariner has submitted a complete appeal package, in accordance with

46 CFR 1.03-15(c).

3. Until final agency action cancels the medical certificate, or the automatic stay is lifted

under Paragraph M.1 above, the medical certificate is valid until expiration, and may be

used to operate under the authority of the MMC.

N. Mariner Reconsiderations and Appeals.

In accordance with 46 CFR 1.03-40, any person directly affected by a decision or action of

an officer or employee of the National Maritime Center (NMC) involving any of the marine

safety functions listed in 46 CFR 1.01-15(c) may, after requesting reconsideration of the

decision or action by the NMC, make a formal appeal of that decision or action to the

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Director of Commercial Regulations and Standards (CG-5PS), in accordance with the

procedures contained in 46 CFR 1.03-15.

1. Reconsiderations (See 46 CFR 1.03-15).

a. Should be received within 30 days of the action or decision by the NMC.

b. Have no requirement to be in writing.

c. Have no requirement that new information or specific errors be alleged.

d. Have no specific format requirements.

e. Although it is not required, it is recommended that applicants submit their

reconsideration requests in writing, and consult Chapters 8 through 25 of this Manual

to determine suggested testing and reports for the condition at issue.

f. The NMC’s determination becomes final agency action if no request for

reconsideration is received with 30 days of action or decision by the NMC.

2. Appeals (See 46 CFR 1.03-15 and 1.03-40).

a. Appeals on reconsideration must be received within 30 days of action or decision by

the NMC.

b. An extension may be requested in writing, and will be granted for good cause.

c. Appeals must be submitted in writing to the Commandant (CG-5PS) (See

46 CFR 1.03-15(c)).

O. Authority to Work Pending Final Agency Action.

1. Cancellation of a Medical Certificate.

a. Until final agency action cancels the medical certificate, or the automatic stay is lifted

under Paragraph M.1 above, the medical certificate is valid until expiration and may

be used to operate under the authority of an MMC.

b. The NMC’s initial determination becomes final agency action if no request for

reconsideration is received with 30 days of action or decision by the NMC (See

46 CFR 1.03-40).

c. The NMC’s decision on reconsideration becomes final agency action if no appeal is

submitted, in accordance with 46 CFR 1.03-15, within 30 days of the NMC decision

(See 46 CFR 1.03-15(i)).

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2. Medical Certificate Expiration.

a. Until the medical certificate expires, or is cancelled in accordance with Paragraph L

of this Chapter, the medical certificate is valid and may be used to operate under the

authority of an MMC during the reconsideration and appeal process.

b. A mariner whose pilot or STCW medical certificate expiration date has passed may

not serve under the authority of any STCW or pilot endorsement. The mariner may

serve under the authority of his or her national endorsement if the expiration date has

not passed.

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CHAPTER 4. THE MERCHANT MARINER MEDICAL EXAMINATION

A. The Merchant Mariner General Medical Examination.

This Chapter provides guidance on the conduct of the merchant mariner general medical

examination, in accordance with 46 CFR 10.304(a). The guidance was developed based on

recommendations from the Merchant Mariner Medical Advisory Committee (MEDMAC).

1. The public safety risks associated with the medical and physical condition of mariners is

an important consideration in the safe operation of vessels. An illness, condition, or

medication that has the potential to cause sudden incapacitation, altered sensorium, or loss

of awareness could render the mariner unable to perform his or her duties or respond

appropriately in an emergency situation. Such an occurrence places the vessel at risk of

an accident and poses a danger to the mariner, other crewmembers, the public, and

maritime safety. Additionally, in the event that a mariner experiences a medical

emergency, immediate medical

response may be limited to the vessel’s crew, and outside

help may be delayed.

2. Because of these safety concerns, 46 CFR part 10, subpart C requires that mariner

applicants undergo a general medical examination that is “documented and of such scope

to ensure that there are no conditions that pose significant risk of sudden incapacitation or

debilitating c

omplication” (See 46 CFR 10.304(a)). The regulation additionally requires

that the medical examination “document any condition requiring medication that impairs

cognitive ability, judgment or reaction time” (See 46 CFR 10.304(a)).

3. In accordance with 46 CFR 10.302(b), all exams, tests, and demonstrations must be

performed, witnessed, or reviewed by a licensed medical doctor, licensed physician

assistant, licensed nurse practitioner, or a designated medical examiner (DME). All

licensed m

edical practitioners must hold a valid license issued in the United States (U.S.),

a U.S. possession, or a U.S. territory.

Examinations for Great Lakes Registered Pilots

must be conducted by a licensed medical doctor in accordance with the physical exam

requirements in 46 CFR 402.210 (

See

Paragraph D.4 of Chapter 1 of this Manual).

a. A DME means a licensed physician, licensed physician assistant, or licensed nurse

practitioner who has been trained and approved to conduct medical and physical

examinations of merchant mariners on behalf of the Coast Guard and may be

delegated limited authority to grant waivers and approve physical/medical suitability

for service (

See 46 CFR 10.107).

b. The terms

medical doctor and physician mean an individual who has been educated,

trained and licensed to practice medicine as a medical doctor (M.D.) or doctor of

osteopathy (D.O.).

c. Exams, tests and demonstrations performed, witnessed, or reviewed by holders of

foreign medical licenses or by chiropractors or naturopathic doctors are not accepted

under current regulations.

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d. All applicants who require a general medical exam must be physically examined.

Examinations based solely on documentary review, and/or patient history review, are

unacceptable (See Table 1 to 46 CFR 10.302(a) and 46 CFR 10.304).

e. Individuals who submit false information to the Coast Guard may be subject to

criminal prosecution under 18 U.S.C. 1001.

4. Consistent with generally accepted medical practice, an examination of sufficient scope:

a. Includes an evaluation of the mariner applicant’s hearing, vision, and physical

abilities, in accordance with Chapters 5 and 6 of this Manual;

b. Includes an assessment of the mariner applicant’s medication use, to include over-

the-counter preparations and supplements, in accordance with Chapter 7 of this

Manual;

c. Includes a comprehensive medical exam that assesses for the presence or absence of

disease by considering the mariner applicant’s medical history, risk factors for

disease, review of systems, and physical examination findings;

d. May include basic screening for conditions that:

(1) Are common in the general population;

(2) Pose a significant risk of sudden incapacitation or debilitating complication when

not adequately treated; and

(3) Are not always apparent on limited physical examination. Such conditions may

include, but are not limited to, obstructive sleep apnea (OSA), diabetes mellitus,

and coronary artery disease;

e. May benefit from review of documentation from the applicant’s treating provider(s)

on active medical conditions, and on any prior screening for conditions that pose a

significant risk of sudden incapacitation or debilitating complication; and

f. Should document whether and to what extent the examining medical practitioner has

screened and assessed the applicant for conditions that pose a significant risk of

sudden incapacitation or debilitating complication.

B. Benefits of Screening for Significant Medical Conditions.

1. Provides mariners the opportunity for appropriate referral and treatment.

Mariner applicants who have significant medical conditions that are left undiagnosed,

untreated, or both, are at risk for developing disease complications that may threaten their

health and eventually lead to loss of medical certification. Accordingly, it is

recommended that the examining medical practitioner take appropriate steps to identify

and refer mariner applicants for further evaluation, as appropriate, if they are determined

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to be at high risk for conditions that pose a significant risk of sudden incapacitation or

debilitating complication.

2. Provides mariners the opportunity for timely health education.

The examining medical practitioner should provide education to applicants about their

health conditions and risk factors for disease, and discuss how those conditions and risk

factors might affect, or be affected by, work in the maritime environment.

3. Does not generally bar medical certification.

The guidance in this Chapter does not preclude the issuance of a medical certificate to

those applicants whose screening indicates that they may be at risk for a medical

condition, unless there is indication that the applicant may be at high risk for sudden

incapacitation or debilitating complication. Examples of screening outcomes that may

preclude certification include, but are not limited to:

a. The examiner/evaluator determines that the applicant is at significant risk for

obstructive sleep apnea that is severe, symptomatic, and inadequately treated; OR

b. The examiner/evaluator determines that the applicant is at significant risk for diabetes

mellitus that is associated with episodes of severe hypoglycemia, symptomatic

hyperglycemia, or metabolic derangement; OR

c. The examiner/evaluator determines that the applicant is at significant risk for

coronary artery disease that is symptomatic, uncontrolled, or unstable.

4. Basic screening may be accomplished with office-based screening tools.

The Coast Guard consulted with MEDMAC to provide recommendations on screening

for medical conditions that pose significant risk of sudden incapacitation, and are

common in the general population. MEDMAC’s recommendations focused on the

conditions of obstructive sleep apnea, diabetes mellitus and coronary artery disease

because these conditions affect many mariners, are not generally apparent on cursory

examination, and are amenable to office-based screening. Their recommendations for

basic screening follow below.

a. Recommendations on screening for obstructive sleep apnea (OSA).

(1) The examining medical practitioner should assess the mariner applicant’s risk

factors for OSA and then determine whether further evaluation is indicated. Risk

factors for OSA may include, but are not limited to:

(a) Medical history of hypertension, diabetes, elevated blood sugars, elevated

cholesterol, coronary artery disease, atrial fibrillation or stroke.

(b) Personal history of smoking.

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(male) or 16 inches (female).

(d) Personal history of sedentary lifestyle.

(e) Personal history of snoring, or observed apnea.

(f) Personal history of accident(s) related to falling asleep while working, driving

or operating a vessel.

(g) Symptoms of non-restful sleep, fatigue, or day-time sleepiness.

(2) Examples of screening tools for OSA may include validated office-based

screening tools such as the STOP-Bang questionnaire.

(3) If the examining medical practitioner determines that the mariner applicant is at

significant risk for OSA, the examiner should provide the applicant with

education on OSA and refer for appropriate evaluation and testing.

(a) Further evaluation may include referral to a primary care provider, internist,

or sleep specialist, as appropriate.

(b) When medically indicated, diagnostic testing may include a home sleep study

that measures a minimum of three channels to include air flow, respiratory

effort, and pulse oximetry; or attended polysomnogram.

(4) If the examining medical practitioner determines that the applicant needs further

evaluation for OSA, but assesses that the applicant is NOT at immediate risk of

sudden incapacitation, then the applicant may be considered for a time-limited

medical certificate to allow time to complete the evaluation.

b. Recommendations on screening for diabetes mellitus.

(1) The examining medical practitioner should assess the mariner applicant’s risk

factors for diabetes and then determine whether further evaluation is indicated.

Risk factors for diabetes mellitus include, but are not limited to:

(a) Medical history of hypertension, abnormal cholesterol, or elevated blood

sugar levels.

(b) Family history of diabetes.

(2) If the examining medical practitioner determines that the mariner applicant is at

significant risk for diabetes, the examiner should provide the applicant with

education on diabetes mellitus and refer for appropriate evaluation and testing.

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(a) Further evaluation may include referral to primary care provider, internist or

endocrinologist, as appropriate.

(b) When medically indicated, office testing may include fingerstick glucose or

urinalysis.

level, a glycated hemoglobin level (HbA1c), or a glucose tolerance test.

(3) If the examining medical practitioner determines that the applicant needs further

evaluation for diabetes mellitus, but assesses that the applicant is NOT at

significant risk for diabetes mellitus that is associated with episodes of severe

hypoglycemia, symptomatic hyperglycemia, or metabolic derangement, then the

applicant may be considered for a time-limited medical certificate to allow time to

complete the evaluation.

c. Recommendations on screening for coronary artery disease.

(1) The examining medical practitioner should consider the mariner applicant’s risk

factors for coronary artery disease and determine whether further evaluation is

indicated. Risk factors for coronary artery disease include, but are not limited to:

(a) Medical history of hypertension, abnormal blood sugar, diabetes, high

cholesterol, sleep apnea, stroke or other vascular disease.

(b) Family history of premature cardiovascular disease.

(2) If the examining medical practitioner determines that the mariner applicant is at

significant risk for coronary artery disease, the examiner should provide the

applicant with education on coronary artery disease and refer for appropriate

evaluation and testing.

(a) Further evaluation may include referral to a primary care provider, internist,

or cardiologist, as appropriate.

(b) When medically indicated, office testing may include resting

electrocardiogram.

stress testing, myocardial perfusion stress testing, and coronary angiography.

(3) If the examining medical practitioner determines that the applicant needs further

evaluation for coronary artery disease, but assesses that the applicant is NOT at

significant risk for coronary artery disease that is symptomatic, uncontrolled, or

unstable, then the applicant may be considered for a time-limited medical

certificate to allow time to complete the evaluation.

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CHAPTER 5. VISION AND HEARING STANDARDS

A. Vision Requirements.

The vision requirements for merchant mariner medical certification are contained in

46 CFR 10.305.

1. Credentialed Deck Personnel Vision Standards.

a. In accordance with 46 CFR 10.305(a)(1), applicants for any national endorsement or

qualified deck rating must have vision in at least one eye that is correctable to 20/40

or better. Uncorrected vision in the same eye must not be worse than 20/200.

b. The horizontal field of vision should not be less than 100 degrees in each eye.

c. Applicants for an STCW endorsement must have vision in both eyes that is

correctable to 20/40 or better in each eye. Uncorrected vision in each eye must not be

worse than 20/200. The following exceptions apply:

(1) A mariner who loses vision in one eye, after meeting the requirements and

receiving a merchant mariner credential (MMC), may be granted a medical

waiver, and/or may have operational limitations placed upon the medical

certificate, in accordance with Paragraph A.3 of this Chapter and

46 CFR 10.305(c), (d), and (e), as applicable.

(2) A mariner holding an MMC prior to January 1, 2017, need only meet the vision

requirements of 46 CFR 10.305(a)(1) in one eye (See Paragraph A.1 and

Paragraph A.1.d of this Chapter). The mariner may be granted a medical waiver,

and/or may have operational limitations placed upon the medical certificate, in

accordance with Paragraph A.3 of this Chapter and 46 CFR 10.305(c), (d), and

(e), as applicable.

d. Applicants must also demonstrate satisfactory color sense when tested by one of the

screening methods listed below (See 46 CFR 10.305(a)(1)), or by an alternative test

acceptable to the Coast Guard. This requirement must be met without the use of

lenses that enhance color perception.

(1) Color vision testing methods.

(a) Pseudoisochromatic Plates (Dvorine, 2nd Edition; AOC; revised edition or

AOC-HRR; Ishihara 14-, 24- , or 38-plate editions).

(b) Farnsworth Lantern.

(d) Optec 900.

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(e) Richmond Test, 2nd and 4th edition.

(2) Alternative Testing Methodologies. Applicants seeking to demonstrate

satisfactory color vision sense through the use of an alternative test should

consider the information that follows and contact the NMC for further guidance.

(a) The test submission should include a full description of the test in addition to

a discussion of test results.

(b) An acceptable alternative color vision test may include a formal color vision

evaluation conducted by an ophthalmologist or qualified optometrist. The

evaluation should include assessment and discussion of any functional

limitations. Further guidance on this can be obtained from the NMC.

alternative testing is sufficient for issuance of the medical certificate.

Normally, the Coast Guard's approval of an alternative test (such as a

Farnsworth D-15, or any other test not listed in Paragraph A.1.d(1) of this

Chapter) will be contingent on the test results being accompanied by a formal

color vision evaluation from an ophthalmologist or optometrist.

2. Credentialed Engineering Personnel, Qualified Engineering Rating, Tankermen, Offshore

Installation Managers, Barge Supervisors, Ballast Control Officers, and Radio Officers

Vision Standards.

a. In accordance with 46 CFR 10.305(b), applicants must have vision in at least one eye

that is correctable to 20/50 or better. Uncorrected vision in the same eye must not be

worse than 20/200.

b. The horizontal field of vision should not be less than 100 degrees in each eye.

c. Applicants must also demonstrate satisfactory color sense when tested by one of the

screening methods listed below (See 46 CFR 10.305(a)(1)), or by an alternative test

acceptable to the Coast Guard. Applicants need only the ability to distinguish the

colors red, green, blue, and yellow. This requirement must be met without the use of

lenses that enhance color perception.

(1) Color vision testing methods.

(a) Pseudoisochromatic Plates (Dvorine, 2nd Edition; AOC; revised edition or

AOC-HRR; Ishihara 14-, 24- , or 38-plate editions).

(b) Farnsworth Lantern.

(d) Optec 900.

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