Document ID: USCG-2006-25080-0093
Agency: uscg
Document Type: Rule
Title: Medical and Physical Evaluation Guidelines for Merchant Mariner Credentials
Posted Date: 2008-09-29T04:00Z

[Federal Register: September 29, 2008 (Volume 73, Number 189)]
[Notices]               
[Page 56600-56604]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29se08-91]                         

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DEPARTMENT OF HOMELAND SECURITY

Coast Guard

[USCG 2006-25080]

 
Medical and Physical Evaluation Guidelines for Merchant Mariner 
Credentials

ACTION: Notice of availability.

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SUMMARY: The purpose of this notice is to announce the availability of 
the final version of a Navigation and Vessel Inspection Circular. This 
NVIC contains revised guidelines for evaluating the physical and 
medical conditions of applicants for merchant mariner's documents, 
licenses, certificates of registry and STCW endorsements, collectively 
referred to as ``credential(s).''
    The new NVIC is numbered 04-08, and it is entitled ``Medical and 
Physical Evaluation Guidelines for Merchant Mariner Credentials.'' It 
replaces NVIC 2-98, which is cancelled as of the effective date of NVIC 
04-08.

DATES: NVIC 04-08 is effective on October 29, 2008.

ADDRESSES: NVIC 04-08 is available on the internet at http://
www.regulations.gov, under this docket number [USCG 2006-25080]. It is 
also permanently available on the HOMEPORT internet Web site at: http:/
/homeport.uscg.mil/mycg/portal/ep/browse.do?channelId=-25023.
    The Department of Transportation Docket Management Facility 
maintains the public docket for this notice. All materials related to 
this NVIC are part of this docket and are available for inspection or 
copying at the Docket Management Facility (M-30), U.S. Department of 
Transportation, West Building Ground Floor, Room W12-140, 1200 New 
Jersey Avenue, SE., Washington, DC 20590, between 9 a.m. and 5 p.m., 
Monday through Friday, except Federal holidays. Copies of the docket 
may also be viewed on the Internet at: http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: For questions on this notice or on 
NVIC 04-08, e-mail or call Captain Matthew D. Hall, MD, USPHS at the 
National

[[Page 56601]]

Maritime Center, 304-433-3551, e-mail: matthew.d.hall@uscg.mil.
    For questions on viewing the docket, contact Renee V. Wright, 
Program Manager, Docket Operations, Office of Information Services, 
Office of the Assistant Secretary for Administration, Office of the 
Secretary, at M-30, West Building Ground Floor, Room W12-140, 1200 New 
Jersey Avenue, SE., Washington, DC 20590; telephone: 202-366-9826; e-
mail: renee.wright@dot.gov.

SUPPLEMENTARY INFORMATION: On September 26, 2006, the Coast Guard 
published a notice announcing the availability of, and seeking public 
comment on, a draft Navigation and Vessel Inspection Circular (NVIC) to 
replace the existing NVIC 2-98, ``Physical Evaluation Guidelines for 
Merchant Mariner's Documents and Licenses.'' See 71 FR 56998. The 
contents of the draft NVIC (September 2006 draft NVIC) were developed 
from recommendations and input provided by the Merchant Marine 
Personnel Advisory Committee (MERPAC), the Towing Safety Advisory 
Committee (TSAC), and experienced maritime community medical 
practitioners. The public comment period ended on November 27, 2006.
    The Coast Guard received comments from 46 mariners, 15 shipping 
companies, 6 pilots and pilot organizations, 2 government agencies, 8 
advocacy groups, and 4 maritime unions.
    The Coast Guard has made numerous changes to the draft NVIC based 
upon the public comments received, and further input provided by MERPAC 
and TSAC after the Notice of Availability for the draft NVIC published 
in the Federal Register. These changes have been incorporated into NVIC 
04-08, entitled ``Medical and Physical Evaluation Guidelines for 
Merchant Mariner Credentials,'' so as to create a guidance document 
that is more viable and responsive to the needs of the impacted 
community.

Discussion of the Changes From the Draft NVIC

    We have revised the format of the NVIC to make it easier to 
understand and use, and we have added a direct link to the National 
Maritime Center (NMC) Medical Evaluations Web site on HOMEPORT. This 
Web site contains additional useful medical related information for 
credential applicants, such as recent articles and links to other 
relevant information.
    There are now six enclosures instead of five to reflect a stand-
alone enclosure for medications, and we have added a separate index and 
table of abbreviations for the medical conditions in enclosure (3) for 
ease of reference. We have also clarified, in the main body of the NVIC 
as opposed to only discussing it in the enclosures, that the guidance 
contained in the NVIC applies to applicants for original, renewal and 
raise in grade credentials.

Enclosure (1)--Medical Certification Standards

    Minor changes were made to enclosure (1) to clarify a few concerns 
expressed in some comments. It was clarified that mariners with short-
term conditions, such as a broken arm, have numerous flexible options 
at their disposal. They can request the credential be issued if they 
want to immediately deposit it with the Coast Guard until such time as 
they are healed. They may also choose not to apply for the credential 
until their condition has improved, or they may renew the credential 
for continuity purposes only until such time as their condition 
improves. We also added a warning in paragraph 10 of enclosure (1) 
advising that, under 18 U.S.C. 1001, criminal prosecution may result if 
false information is submitted to the Coast Guard with respect to the 
credential application process, by either the applicant or the medical 
practitioner responsible for the exams, tests, and/or physical 
demonstrations.
    Finally, the information contained in the paragraphs of enclosure 
(1) was reorganized, at the recommendation of MERPAC, to make the 
enclosure flow more logically. Now, the first paragraph discusses 
original credentials, the second paragraph discusses renewals, the 
third paragraph discusses raises in grade, and the fourth and fifth 
paragraphs discuss STCW endorsements and certificates of registry, 
respectively.

Enclosure (2)--Physical Ability Guidelines

    There were numerous changes made to this enclosure, starting with 
its title being changed from ``physical ability standards'' to 
``physical ability guidelines'' at the request of TSAC and MERPAC. The 
physical ability guidelines listed in the table of enclosure (2) were 
significantly revised, based largely on input provided by TSAC. There 
were also three important changes made to the introductory text of the 
enclosure.
    First, in response to multiple comments from vessel owner/operators 
expressing safety concerns related to obesity, we stated that if the 
examining medical practitioner doubts the applicant's ability to meet 
the guidelines contained within this table, and for all applicants with 
a Body Mass Index (BMI) of 40.0 or higher, the practitioner should 
require that the applicant demonstrate the ability to meet the 
guidelines. This does not mean, for example, that the applicant must 
actually don an exposure suit, pull an uncharged 1.5 inch diameter 50' 
fire hose with nozzle to full extension, or lift a charged 1.5 inch 
diameter fire hose to fire fighting position. Rather, the medical 
practitioner may utilize alternative measures to satisfy himself or 
herself that the applicant possesses the ability to meet the guidelines 
in the third column. If an individual is unable to satisfactorily 
demonstrate the ability to meet these guidelines, a credential with 
appropriate limitations may be issued by the Coast Guard.
    Second, in response to comments from the towing, offshore, and 
small passenger vessel industries expressing concern that the table 
(which is largely based upon Regulation I/9 and Table B-I/9-2 of the 
International Convention on Standards of Training, Certification & 
Watchkeeping for Seafarers, 1978 as (amended)) does not accurately 
reflect operating conditions on many ``smaller'' vessels, we clarified 
that applicants who cannot meet all of the physical ability standards 
contained in the table may propose suitable alternate standards that 
are reflective of their particular operating conditions. Such proposals 
will be given consideration by the Coast Guard on an individual case-
by-case basis.
    No consideration is being given to excluding broad classes of 
credential applicants from the guidance contained in the table, because 
for the most part, credentials issued by the Coast Guard are not vessel 
specific. They provide authority to work on different types and sizes 
of vessels, with each vessel having its own equipment and operating 
conditions.
    Third, language was added to reflect the Coast Guard's 
understanding that all medical practitioners may not have the equipment 
necessary to test all of the tasks as listed in the third column of the 
table. In such cases, equivalent alternate testing methodologies may be 
used.
    Various changes were made to the table itself to make compliance 
less burdensome for applicants. For example, the criterion listed in 
the third column of the table for ``participate in firefighting 
activities'' now states that the applicant should be able to pull an 
uncharged 1.5'' diameter, 50' fire hose with nozzle to full extension, 
and to lift a charged 1.5'' diameter fire hose to fire fighting 
position. This criterion previously asked the applicant to

[[Page 56602]]

handle a 2.5'' diameter fire hose for a distance of 400'.

Enclosure (3)--Medical Conditions Subject to Further Review

    First, at the request of MERPAC and TSAC, the title of enclosure 
(3) was changed and now more clearly reflects the Coast Guard's 
intended use of the information provided in enclosure (3). It is now 
called ``Medical Conditions Subject to Further Review'' instead of 
``Potentially Disqualifying Medical Conditions.'' We also added the 
word ``recommended'' in front of ``evaluation data'' in the header of 
the table, so that it now reads ``recommended evaluation data.'' This 
change reflects the voluntary nature of this guidance document.
    Moreover, this enclosure, which is the central component of the 
NVIC because it lists the medical conditions subject to further review, 
underwent substantial revision. Technical comments were received on 
specific medical conditions and were presented to MERPAC for review and 
recommendations. Many of the comments were implemented into this 
revision of the NVIC. Some of the significant changes to enclosure (3) 
are described below.
    In the preface to enclosure (3), we clarified that the term 
``history'' means a single previous diagnosis or treatment of a medical 
condition, even once in the applicant's life, unless otherwise 
specified in the table listing the medical conditions. For example, 
condition number 131 in the enclosure (3) table states ``history of 
invertebral disc surgery within the last 5 years.'' This means that 
invertebral disc surgery six years ago is not considered a medical 
condition which needs to be reported for review for purposes of this 
NVIC.
    We also revised the discussion of evaluation data in the preface to 
enclosure (3). We clarified that all time frames specified in the table 
are measured from the date that the application is received by the 
Coast Guard. For example, if the table requires a medical test that is 
no more than 90 days old, the test should have been completed within 
the 90 days prior to the date that the application for the credential 
is received by the Coast Guard.
    We also noted that for most conditions, the table does not contain 
a specific time frame as to how old a status report, evaluation report, 
or consultation (of whatever type) may be. For all active conditions, 
we added that the status report, evaluation report or consultation 
should have been completed no more than 1 year prior to the date the 
application is received by the Coast Guard. For conditions which are 
not active but for which the table indicates that a ``history of'' the 
condition should be reported, we added that the appropriate time frame 
depends on what is medically relevant given the individual 
circumstances of the applicant's condition. Medical providers may 
contact NMC, listed under FOR FURTHER INFORMATION CONTACT, if they have 
any question about how recent a status report, evaluation report, or 
consultation should be.
    For example, an applicant with an acquired right bundle branch 
block (listed as condition number 54 under ``Heart'' in the enclosure 
(3) table) should submit a cardiology consultation that is no more than 
a year old at the time of application. An applicant with a prior 
history of gastrointestinal bleeding who is not currently suffering 
from, or under current treatment or observation for, the condition 
(listed as condition number 96 under ``Abdomen, Viscera and Anus 
Conditions'' in the enclosure (3) table), may be able to submit an 
internal medicine or gastroenterology consultation that is more than a 
year old if the report confirms that the applicant is free of symptoms 
and that the bleeding source has healed. In such a case, there would be 
no need for the applicant to undergo another consultation just for 
purposes of applying for a credential.
    We also revised the respective evaluation data associated with the 
medical conditions to remove the word ``current'' that formerly 
preceded many of status reports, evaluation reports or consultations in 
the table. We discovered that in some places, the word ``current'' 
preceded the evaluation data, while in others it did not. As pointed 
out by MERPAC, this caused confusion as to how old the evaluation data 
may be because there is no definition of the term ``current'' in the 
NVIC.
    We also clarified that medical providers may contact the NMC to 
discuss submitting acceptable alternate evaluation data to demonstrate 
that the applicant's medical status is appropriate for his/her duties 
and the limited scope of the credential being sought.
    Finally, we added a paragraph explaining that the NMC may issue a 
letter specifying the extent of the evaluation data, if any, that 
should be submitted to the Coast Guard for any medical conditions that 
have been previously reported to, and evaluated by, the NMC. This means 
that an individual who has properly reported a medical condition, and 
provided the requisite evaluation data regarding it, may be excused 
from having to resubmit evaluation data for that condition in the 
future, but only if authorized by the NMC.
    With respect to the table of medical conditions in enclosure (3), a 
number of changes were made to reduce unnecessary evaluations and 
clarify ambiguous criteria. The former condition number 111, 
pylonephrosis, was consolidated with condition number 110 and number 
111 was deleted from the table. The former condition number 150, 
allergic encephalomyelitis, was also deleted from the table after it 
was determined, at the recommendation of MERPAC, that this condition 
was unnecessary.
    A history of asthma symptoms was modified to episodes requiring 
emergency treatment in the past 2 years. A history of head trauma was 
revised to include only conditions within the last 10 years, and 
history of seizure disorder was changed to exclude febrile seizures 
prior to age 5. The criteria for asthma was changed to include only 
clinically significant moderate to severe asthma.
    The supplemental evaluation information needed for cardiac 
conditions was clarified to include an exercise stress test versus a 
pharmacologic stress test. Mariners need to demonstrate adequate 
cardiopulmonary capacity to perform safety duties such as fire fighting 
and passenger evacuation. Pharmacologic stress tests evaluate coronary 
artery disease but do not provide information on cardiopulmonary 
capacity.
    The recommended evaluation data for sarcoidosis, at the urging of 
certain maritime labor unions, was restated to be less extensive. The 
table now simply asks for pertinent medical records, pulmonology 
consultations, and names and dosages of medications.
    In recognition of the distinction between substance or alcohol 
abuse and substance or alcohol dependence, conditions number 186 & 
186a, respectively, in the enclosure (3) table were revised. Consistent 
with the medical diagnoses of these conditions, condition number 186 
now covers history of substance or alcohol abuse, as defined in the 
current Diagnostic and Statistical Manual (DSM), within the last 5 
years. Condition number 186a now covers history of substance or alcohol 
dependence, as defined in the current DSM, within the last 10 years. 
Reference to the Coast Guard standard of ``cure,'' which applies when 
credentials are subject to suspension and revocation but not 
necessarily when credentials are issued, has been deleted.
    The evaluation data for these conditions has been accordingly 
changed to request only a current

[[Page 56603]]

evaluation report, including a determination that the individual is 
safe to return to work, from a DOT-qualified substance abuse 
professional (SAP), physician certified by the American Society of 
Addiction Medicine, or any other addiction specialist accepted by the 
Coast Guard, and reports from the rehabilitation clinic/center (if 
any). Documentation of at least 90 days of objectively measured and 
sustained total abstinence is also recommended evaluation data for 
dependence.
    It was further modified that, for applicants with a history of 
substance abuse, if they are renewal and/or raise in grade applicants 
who have been subject to the dangerous drug testing requirements in 46 
CFR Part 16 for at least 3 years, and if they have no verified non-
negative drug test results for the entire time that they have held the 
credential being renewed and/or raised in grade, they need not submit 
any evaluation data for substance abuse.
    Likewise, for applicants with a history of substance dependence, if 
they are renewal and/or raise in grade applicants who have been subject 
to the dangerous drug testing requirements in 46 CFR part 16 for at 
least 5 years, and if they have no verified non-negative drug test 
results for the entire time that they have held the credential being 
renewed and/or raised in grade, they need not submit any evaluation 
data for substance dependence.
    This exception does not apply to alcohol abuse or dependence 
because there are no random, pre-employment, or periodic testing 
requirements for alcohol in 46 CFR Part 16 or 33 CFR part 95.

Enclosure (4)--Medications

    The newly renumbered enclosure (4) contains information about 
illegal substances and intoxicants, and a non-exhaustive list of 
potentially disqualifying medications that may be subject to further 
medical review in accordance with enclosure (6). This information was a 
subset of the larger enclosure (3) in the September 2006 draft NVIC, 
but the Coast Guard agrees with the public comments and MERPAC input 
that there should be a separate enclosure dedicated to medications.
    The information was also reorganized to make it a more useful 
reference. A definitions section has been added to the enclosure, and a 
new prohibitions section dealing with illegal substances and 
intoxicants has been included.
    It was clarified that applicants, who complete a general medical 
exam, should report all prescription medications prescribed, filled or 
refilled and/or taken, and all non-prescription (over-the-counter) 
medications, including dietary supplements and vitamins, within 30 days 
prior to the date that they sign the CG-719K or approved equivalent 
form. The September 2006 draft NVIC stated that applicants should 
report all prescription and over-the-counter medications ``at the time 
of application,'' but the new language is much more precise in 
specifying what should be reported.
    The non-exhaustive list of prescription and over-the-counter 
medications that may be subject to further medical review was also 
revised, primarily to eliminate redundancies in the medications listed 
and to adjust the allowable time frames for usage of some of the 
medications.
    The use of motion sickness medications was also addressed to allow 
their use in accordance with directions. The use of anti-depressants 
for use in smoking cessation and other off-label indications was also 
allowed.
    The Coast Guard understands the complexities associated with over-
the-counter (OTC) medications and has revised the NVIC to strike a 
balance between the medical needs of mariners and public safety in 
response to comments. The Coast Guard intends to publish a guide for 
mariners on the use of OTC medications.

Enclosure (5)--Vision & Hearing Standards

    The newly renumbered enclosure (5), which was previously enclosure 
(4) in the September 2006 draft NVIC, contains the same, unrevised 
vision standards from NVIC 2-98, but notes that the Coast Guard has 
proposed revising its vision standards in an ongoing rulemaking. The 
proposed vision standards would require applicants to meet vision 
acuity standards in one eye only rather than both eyes under the 
current rule. See 72 FR 3605, 3656 (Jan. 2007) (proposed 46 CFR 
10.215(b)). The proposed vision standards would become the new visions 
standards for NVIC 04-08 if the proposed rule becomes an effective, 
final rule.
    Color vision testing standards have also been clarified, with 
reference to the specific acceptable tests: 14 plate (which replaces 
the obsolete 16 plate), 24 plate, or 38 plate Ishihara plates tests, 
Farnsworth Lantern, or an alternative test approved by the NMC. We have 
also added an express reference to the 46 CFR 10.205(d)(2) prohibition 
on using color sensing lenses to assist applicants with passing the 
color vision test.
    Finally, audiometer test hearing standards were adjusted from 20 
decibels or less in each ear (unaided) to 30 decibels or less in the 
best ear (unaided). This allows for monaural hearing, provided the 
applicant has an unaided threshold of 30 decibels (unaided) in the ear. 
Applicants who are unable to meet the standards of the audiometer test, 
but who can pass the functional speech discrimination test, may be 
eligible for a waiver.

Enclosure (6)--Medical Review Process

    Important changes were made to the newly renumbered enclosure (6), 
which was previously enclosure (5) in the September 2006 draft NVIC, in 
response to various public comments and MERPAC and TSAC input. 
Paragraph 2 of this enclosure was revised to clarify that a waiver may 
be granted in all cases, not necessarily limited to situations ``for a 
mariner with a borderline condition.'' Language was added at the end of 
paragraph 5.f. to expressly state that recommendations from private 
employers (and government agencies) made on behalf of applicants will 
be given full consideration by the NMC when considering a waiver.
    Paragraph 7 was revised to clearly state that the NMC will review 
all information provided and make an appropriate determination as to 
one of the following outcomes: (a) Applicant is physically and 
medically qualified without any limitations, waivers and/or other 
conditions for issuance of the credential, (b) applicant is physically 
and medically qualified with limitations and/or other conditions for 
issuance of the credential, (c) applicant is not physically or 
medically qualified, but a credential may be issued with appropriate 
limitations, waivers and/or other conditions for issuance, (d) 
additional information is necessary to determine if applicant is 
physically and/or medically qualified, or (e) applicant is not 
physically and/or medically qualified.
    Paragraph 8 was revised to clarify that the NMC will inform the 
applicant of the results of their waiver review. The appellate rights 
of applicants, who are affected by a waiver determination, are now 
fully explained in this paragraph as well. Likewise, in paragraph 9, 
the appellate rights of applicants who disagree with any conditions 
placed on their waivers are fully explained.
    A new paragraph 10 was added to this enclosure to state that the 
NMC will, on a case-by-case basis, consider individual proposals from 
applicants (and their employers) for credentials to be issued with 
appropriate limitations, waivers, and/or other conditions in order to 
address concerns associated with

[[Page 56604]]

medical conditions (enclosure (3)) or the inability to meet the 
physical ability standards (enclosure (2)). This was added to 
articulate the Coast Guard's flexibility and willingness to consider 
the unique needs and work environments of individual mariners who are 
otherwise unable to meet the medical and/or physical standards 
specified in the NVIC.
    Finally, at the request of both MERPAC and TSAC, a new paragraph 11 
was added to this enclosure authorizing--but not requiring--the Coast 
Guard to designate certain medical practitioners as ``trusted agents'' 
to perform physical examinations on mariners. Physical examinations 
conducted by these designated trusted agents and/or their 
recommendations may be given more weight by the Coast Guard. The Coast 
Guard would specify the criteria for designation as a trusted agent if/
when the Coast Guard initiates this program.
    It is not anticipated that the NVIC will result in significantly 
higher rates of disqualification for mariners, nor in increased 
processing time for credential applications with physical and/or 
medical issues. To the contrary, the Coast Guard expects the process to 
be more consistent and less subjective, and that the application 
processing time will be reduced because all parties will know precisely 
what information is needed at the outset of the application process.
    The Coast Guard did receive some comments that the NVIC may 
increase costs. Based on consultation with medical practitioners and 
MERPAC, we determined exams and documentation addressed by the NVIC are 
commonly required by current medical practice and will not represent a 
significant additional cost to the individual. The NVIC guidelines 
apply if the applicant has an underlying medical condition. The 
majority of medical evaluations and tests specified in the NVIC will be 
provided by the mariner's primary care provider or specialist as part 
of standard care.
    Potential benefits associated with adoption of this NVIC include 
decreased credential application processing time and clearer medical 
and physical guidelines for merchant mariners. We also anticipate that 
public safety will improve as result of this NVIC, since mariners and 
the medical community would be aware of complete policy guidance that 
is consistent with current industry health care practice when 
evaluating medical conditions.

    Dated: September 17, 2008.
J.G. Lantz,
Director of Commercial Regulations & Standards.
[FR Doc. E8-22724 Filed 9-26-08; 8:45 am]

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