Reflection: National Diabetes Month and B. Emerging Issues and Challenges of Oral Anti-Diabetes Medications 12th: Diabetes and Cardiovascular Disease …

MEDICAL CONDITIONS

This enclosure contains three parts The first section provides
information about medical conditions that may be disqualifying for any
applicant Part two provides additional specific information that applies
only to deck officers, able seamen, and ratings forming part of a
navigational watch Part three provides additional information that
pertains to engineering officers, engineering ratings qualified members of
the engine department, tankermen, and ratings forming part of a
navigational watch

PART 1
POTENTIALLY DISQUALIFYING MEDICAL CONDITIONS
APPLICABLE TO ALL MARINERS

1 ALLERGY: Any severe allergy that would cause sudden incapacitation or
be life-threatening

2 CARDIAC: The following conditions require review:

a Myocardial infarction: Functional class II, III, or IV INYHA-New
York Heart Association A recommendation for a waiver must include a
narrative from the doctor giving a history of the condition and
prognosis The report should include a list of all medications and
their side effects, if any, experienced by
the applicant A recent
exercise stress test to determine the condition and reaction of the
heart and vascular system under emergency conditions may be requested

b Any cardiac surgery, such as implantation of a pacemaker or
bypass;
c Heart irregularity sufficient to compromise cardiac function; or
d Hypertension: Uncontrolled hypertension or hypertension
controlled by medication requiring close monitoring
1 For an original credential, the blood pressure should not
exceed 150/90
2 For a renewal or raise in grade, the blood pressure should
not exceed 160/100 if under age 50 or exceed 175/100 if age 50 or
older

3 ENDOCRINE/METABOLIC DIABETES MELLITUS:

a Addisons disease;
b Cushings syndrome-Adrenal dysfunction hyperaldosteronismd;
c Diabetes, either insulin controlled or poorly controlled non-
insulin dependent diabetes To be considered for a waiver, the
following amplifying information is required:
1 Brief history of the disease including when first diagnosed;
2 The extent of the applicants education about the nature and
control of the disease; See
Comdinst Instruction Manual M160008B,
Marine Safety Manual Volume III for educational information;
3 Description of any hospitalization within the past 12 months;
4 Description of applicants control of the diabetes;
5 If insulin dependent, the applicants ability to monitor blood
glucose and adjust the insulin dosage;
6 A list of medications, dosage, and required dosage frequency;
7 Length of time on the present dosage;
8 Copies of medical record entries for past 18 months;
9 The effects of the diabetes on the applicants eyesight;
10 A recent HgbA1c test is required, the results of which must not
exceed 90 for consideration of a waiver
d Obesity sufficient to impair ordinary activity or likely to
prevent rapid response to an emergency

4 GASTROINTESTINAL:

a Chronic or recurrent pancreatitis; or
b Esophageal varices - one episode of gastrointestinal bleeding in
the past six months or two episodes within the past two years

5 GENITOURINARY: Chronic renal failure

6
HEMATOLOGIC/ONCOLOGIC:

a Hemophilia;
b Leukemia; or
c Malignancies: Untreatable, recurrent, or presently undergoing
treatment

7 HIV-AIDS: Requires review for medications and their side effects, the
applicants present condition, and the stage of the disease

8 INFECTIOUS DISEASES: Any disease in its communicable or chronic
carrier state which would present a health hazard to other crewmembers or
passengers as a result of casual contact These include hepatitis,
meningitis, encephalitis, and poliomyelitis

9 MEDICATIONS: Narcotic medications are not acceptable for use by
mariners and waivers will not be granted If a mariner requires narcotic
medications for pain, the license should not be renewed with full
operating authority until he or she provides information from a medical
practitioner that the use of narcotic medications are no longer
prescribed The following medications require review by the Medical
Review Board

a Anticoagulents such as warfarin or coumadin;
b Systemic corticosteroids;
c Psychotropic medications; or
d Any prescription, over-the-counter, or herbal medication that
causes side
effects that affect the ability of the applicant to perform
his or her duties See item 10 below

10 MISCELLANEOUS: Any disease, constitutional defect, side effects of
medication, sleep disorders, or therapy which would result in:

a Gradual deterioration in the applicants ability to perform his
or her duties;
b Sudden incapacitation;
c Compromise shipboard safety; or
d Prevent the applicant from responding in an emergency

11 NEUROLOGIC:

a Any convulsive disorder that results in an altered state of
consciousness regardless of control by medication;
b Any condition which seriously limits balance or coordination
eg, Parkinsons disease, chorea, or Menieres disease;
c Chronic organic/traumatic brain syndrome;
d Narcolepsy;
e Neurosyphilis;
f Senility;
g Somnambulism; or
h Residual neurological defects from a disease such as poliomyelitis
that interfere with an applicants ability to perform his or her duties

12 ORTHOPEDIC: Amputation, deformity, or arthritis resulting in
impairment of motion or use of limbs or back

13 PULMONARY:

a Lung disease including
chronic or active asthma that incapacitates
and requires corticosteroids medication; or
b Tuberculosis or other active pulmonary disease

14 PSYCHIATRIC: The conditions listed below require review by the
Medical Review Board An applicant with a history of mental disease
must provide documentation from his doctor stating the adequacy of
control of the disease; medications and any side effects experienced
by the applicant; the length of time the applicant has been taking the
medications; and the date of the last change in therapy A

a Any condition requiring use of psychotropic medications;
b Current or chronic alcohol abuse, alcohol dependence, or
alcoholism;
c Diagnosis of primary psychosis;
d Drug addiction;
e Mental retardation; or
f Suicidal behavior

PART 2
MEDICAL CONDITIONS APPLICABLE TO DECK OFFICERS, PILOTS, ABLE SEAMEN, AND
RATINGS FORMING PART OF A NAVIGATIONAL WATCH

1 VISION:

a An applicant must have vision correctable to at lest 20/40 in each
eye and uncorrected vision of at least 20/200 in each eye uncorrected
The OCMI may grant a local waiver for uncorrected vision up to 20/800
in each eye

b The applicant must have at least 90o horizontal field of vision in

each eye and a combined total of 180o combined An applicant with
diabetes must provide documentation that the diabetes in not affecting
his or her eyesight

c Waivers are not generally granted for monocular vision of an
applicant for an original license An applicant for a very limited
license, such as limited master, may be considered if the applicant
meets the standards in paragraph d below

d An applicant for renewal or upgrade of his credentials who has lost the
sight of one eye may have his or her application processed by the REC
without a medical waiver provided the applicant is qualified in all
other respects and that the visual acuity in the one remaining eye
meets the requirements of paragraph 1a Applicants must provide at
least three letters of commendation from supervisors and co-workers
attesting to their ability to perform the duties required for the
credentials sought and a report from an ophthalmologist The report
must substantiate that the
applicant has compensated for the loss of
depth perception and peripheral vision

2 COLOR VISION:

a The mariners to whom this part applies must have the ability to
recognize colored lights that are used in aids to navigation and as
navigation lights on vessels In addition, the applicant must have
the
ability to recognize basic colors to interpret color-coded
indicator lights, diagrams, piping systems, valves, and wiring 46
CFR 10205d specifies the tests that are acceptable as proof of
adequate color vision and states that color-sensing lens are not
permitted An applicant who passes the standards for any of the
following tests will be deemed to have adequate color vision:

a Pseudoisochromatic plates Dvorine 2nd edition; AOC revised
edition;
AOC-HRR; Ishihara 16-, 24-, or 38 plate editions;
b Eldridge green color perception lantern;
c Farnsworth lantern;
d Keystone orthoscope;
e Keystone telebinocular;
f School of Aviation Medicine color threshold tester;
g Titmus optical vision tester; or
h Williams lantern

In addition, it has been determined that the Stereo Optical Co
Farnsworth Lantern color perception test provides results equivalent
to those above and it will also be accepted

b An applicant
for a restricted inland license who cannot pass one of
the above tests, may have his or her license endorsed as restricted to
daylight operation only

3 HEARING:

a Hearing thresholds should be checked at 500 Hertz, 1,000 Hertz, 2,000
Hertz, and 3,000 Hertz The frequency responses for each ear are
averaged

1 For an original credential, an average, unaided hearing threshold
of 70 decibels db in each ear is required and a functional speech
discrimination of at least 90

2 For renewal or raise in grade, an average hearing threshold of 70
db or less for each ear and a functional speech discrimination of
at least 80 at 55 db for each ear is acceptable

b For original credentials, hearing aids are not permitted The OCMI
may recommend to the NMC that a waiver be granted

c For renewals and raises in grade, a hearing aid may be used to meet
the auditory requirements If a hearing aid is worn, there are no
other complications, and the applicant meets the standards below, a
local waiver may be granted by the REC

1 The aided threshold is 40 db or less, and functional speech
discrimination is at least 90 at 55 db in both ears

2 The unaided threshold is 70 db or
less in each ear, and functional
speech discrimination is at least 80 at 55 db in each ear

PART 3
MEDICAL CONDITIONS APPLICABLE TO ENGINEER OFFICERS, OFFICERS FOR MOBILE
OFFSHORE DRILLING UNITS, ENGINEERING RATINGS, TANKERMEN, AND RATINGS
FORMING PART OF AN ENGINEERING WATCH

1 VISION:

a An applicant must have vision correctable to at lest 20/50 in each

eye and uncorrected vision of at least 20/200 in each eye uncorrected
The OCMI may grant a local waiver for uncorrected vision up to 20/800
in each eye

b The applicant must have at least 90o horizontal field of vision in
each eye and a total of 180o combined An applicant with diabetes must
provide documentation that the diabetes in not affecting his or her
eyesight

c Waivers are not generally granted for monocular vision of an
applicant for an original license An applicant for a very limited
license, such as designated duty engineer limited to a specific vessel
or class of vessel, may be considered if the applicant meets the
standards in paragraph d below

d An applicant for renewal or upgrade of his credentials who has lost
the sight of one eye may have his or her application processed by the
REC without a medical waiver provided the applicant is qualified in all
other respects and that the visual acuity in the one remaining eye
meets the requirements of paragraph 1a Applicants must provide at
least three letters of commendation from supervisors and co-workers
attesting to their
ability to perform the duties required for the
credentials sought and a report from an ophthalmologist The report
must substantiate that the applicant has compensated for the loss of
depth perception and peripheral vision

2 COLOR VISION: The mariners to whom part 3 applies must have the
ability to recognize and interpret color-coded indicator lights,
diagrams, piping systems, valves, and wiring 46 CFR 10205d specifies
that an applicant for one of these licenses must have the ability to
distinguish the colors red, green, blue and yellow Color sensing lenses
may be worn by applicants to whom this section applies The tests listed
below are acceptable as proof of adequate color vision

a Pseudoisochromatic plates Dvorine 2nd edition; AOC revised edition;
AOC-HRR; Ishihara 16-, 24-, or 38 plate editions;
b Stereo Optical Company Farnsworth Lantern color perception test;
c Farnsworth lantern;
d Keystone orthoscope;
e Keystone telebinocular;
f School of Aviation Medicine color threshold tester;
g Titmus optical vision tester;
h Williams lantern; or
i Any other test certified by an ophthalmologist that the
test
adequately demonstrates the applicants ability to recognize the colors
red, green, yellow, and blue

3 HEARING:

a Hearing thresholds should be checked at 500 Hertz, 1,000 Hertz, 2,000
Hertz, and 3,000 Hertz The frequency responses for each ear are
averaged

1 For an original credential, an average, unaided hearing threshold
of 70 decibels db in each ear is required and a functional speech

discrimination of at least 90

2 For renewal or raise in grade, an average hearing threshold of 70
db or less for each ear and a functional speech discrimination of
at least 80 at 55 db for each ear is acceptable

b A hearing aid may not be used to assist the applicant to meet the
auditory requirements However, in the engine room or other working
environment with high noise levels, impaired hearing may be no more of
an obstacle to a mariner performing his or her duties, than the
wearing of hearing-protective equipment These personnel must be able
to hear telephone bells, buzzers, alarms, and sirens without aid when
working in a noisy environment A local waiver may be granted if the
applicant provides satisfactory proof of attesting to his or her
ability to respond to these signals

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