[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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