Mariner Credentialing Program Policy Division CG-5434 Mr. Luke Harden

Mariner Credentialing Program Issue credentials to qualified mariners Approximately 210,000 mariners in U.S. Credentials issued to: Officers Ratings Credentials endorsed based upon qualifications Officer endorsements Rating endorsements STCW endorsements (International requirements)

Mariner Credentialing Program Policy Division Division Chief GS-15 (Mr. Luke Harden) Medical Officer (Occupational Medicine) GS-14 Dr. Adrienne Buggs Marine Personnel Spec LCDR/O4 (LT Corydon Heard) Marine Transportation Spec GS-13 Vacant LT/O3 (LT Dylan McCall) GS-14 (Mr. James Cavo) Attorney Advisor (Mr. David Van Nevel) Office of Maritime and International Law CG-0941

Principle Functions of CG-5434 Develop program policy and standards Interpret mariner qualification standards Prepare final action on appeals STCW oversight Provide program performance oversight Public outreach Administer Merchant Mariner Medical Advisory Committee CG-01 memo 5400 dtd 20 APR 2007.

How a Mariner Goes Through Appeal Process The Appeal Process is fairly simple. Denial letter will explain reasons and next step in appeal process. Mariner writes directly to CG and states clearly why she/he thinks our decision was incorrect. Title 46, Code of Federal Regulations. Sections 1.03-04; and 1.03-15 Next

Denial of Application to Appeal Sequential Order Awaiting Information Letter Request for Reconsideration Denial of Request for Reconsideration Letter Appeal Appeal Package to CGHQ Applicant Final Agency Action AI Letter- Letter sent by the NMC to the applicant describing the error found in the application and the correct information required to continue the application. Request for Reconsideration- Applicant believes there is no error in the application. The application is forwarded to a specialist which issue gets re-evaluated. Denial of Request for Reconsideration Letter- Letter sent by the NMC to the applicant which describes more in-depth the error found in the initial application and any additional info submitted in the request for reconsideration. This letter from the NMC states that the applicant has a right to an appeal. Appeal- Mariner appeals the NMC decision and NMC forwards the appeal and application package to Coast Guard Headquarters in Washington D.C.. Final Agency Action- Director of Prevention Policy decision NMC

Types of Appeals Medical Safety & suitability (Criminal convictions) Professional Course/instructor approvals

Appeal Process CG-54 Final Agency Action CG-543 Clearance Medical/Marine Transportation Specialist Review/Drafting Subject Matter Expert Review CG-0941 Legal Review CG-5434 Division Chief Approval CG-543 Clearance CG-54 Final Agency Action AI Letter- Letter sent by the NMC to the applicant describing the error found in the application and the correct information required to continue the application. Request for Reconsideration- Applicant believes there is no error in the application. The application is forwarded to a specialist which issue gets re-evaluated. Denial of Request for Reconsideration Letter- Letter sent by the NMC to the applicant which describes more in-depth the error found in the initial application and any additional info submitted in the request for reconsideration. This letter from the NMC states that the applicant has a right to an appeal. Appeal- Mariner appeals the NMC decision and NMC forwards the appeal and application package to Coast Guard Headquarters in Washington D.C.. Final Agency Action- Director of Prevention Policy decision Notification/MMLD/Administrative Processing

2011 Month to Month & Yearly Amount Received On Hand- Beginning of Month Received Completed On Hand- End of Month Jan-11 37 9 10 36 Feb-11 4 6 34 Mar-11 19 21 Apr-11 8 5 24 May-11 17 33 Jun-11 35 59 Jul-11 29 3 85 Aug-11 66 134 Sep-11 28 156 Oct-11 22 30 148 Nov-11 14 139 Dec-11 1 143 Appeals Received at HQ 2008 29 2009 62 2010 138 2011 234 As you can see from the yearly statistics, the amount of appeals have grown exponentially year by year.

Pending Appeals Breakdown Branch Number of Open Appeals % by Issue Safety & Suitability 4 3% Medical 112 78% Professional 26 18% Other Issue 1 1% Total 143 *Average age of pending appeals -120 days old as of December 7

Outcome/Number of Appeals Completed Broken Down By Years ALL Appeals Granted Partially Granted Denied Other Outcome Total 2008 6 10 1 23 2009 24 7 28 60 2010 34 51 4 113 2011 59 11 57 128 TOTAL 123 48 146 324 Total % out of 324 38% 15% 45% 2% 95 This statistics shows a breakdown of how many medical appeals were granted, partially granted, or denied during that year. Granting or partially granting an appeal means the Director of Prevention Policy overturned the NMC’s decision to deny the mariner. - Many of the appeals granted in 2011 are because the mariner gathered the information previously requested by the NMC and it showed the mariner could be given a waiver or they were considered fully medically fit.

Since all appeals require almost the same amount of research time, we focus more on getting older appeals. Appeals that are older than 90 days normally are from additional information being requested. As a courtesy to the mariner, some appeals that have the potential of being granted are held onto much longer than our targeted complete date so the mariner can retrieve what is required/needed in order for the appeal to be granted. Otherwise, all denial decisions require a new application to be submitted if the issue would eventually be resolved. 19

The Merchant Mariner Medical Advisory Committee (MMMAC) The hopeful solution in developing better standards

The Merchant Mariner Medical Advisory Committee (MMMAC) Previously established in May 2009 as a discretionary committee Members were solicited over the summer 2009, received 41 applications The selection & appointment of the members to MMMAC were on hold while DHS was undergoing a review of all their currently established advisory committees A quick history and timeline about the establishment of the Merchant Mariner Medical Advisory Committee (MMMAC)

The Merchant Mariner Medical Advisory Committee (MMMAC) October 2010 CG Authorization Act of 2010 established MMMAC as a statutory committee Dec 2, 2010 MMMAC charter as a statutory committee was approved by DHS August 8, 2011 the Secretary selected and appointed the members to MMMAC September 19-21, 2011 the inaugural meeting was held at the Calhoon MEBA School in Easton, MD

Purpose of MMMAC MMMAC shall advise the Secretary/Coast Guard on matters related to: (A) medical certification determinations for issuance of licenses, certificates of registry, and merchant mariner documents; (B) medical standards and guidelines for the physical qualifications of operators of commercial vessels; (C) medical examiner education; and (D) medical research.

MMMAC Member Composition 14 members total 10 health-care professionals with particular expertise, knowledge, or experience regarding the medical examinations of merchant mariners or occupational medicine 4 professional mariners with knowledge and experience in mariners’ occupational requirements Members serve five year terms Except for three members (one professional mariner and two medical professionals) appointed for a term of two years.

Inaugural Meeting of MMMAC The Coast Guard presented 6 Task Statements for the Committee to work on: NVIC 04-08 REVISION TOP MEDICAL CONDITIONS REVIEW OF PART 10 SUBPART C SNPRM REVISING 719K MEDICAL EVALUATION FORM CREATING MEDICAL EXPERT PANELS DESIGNATED MEDICAL EXAMINER PROGRAM 1) NVIC 04-08 REVISION -Determine appropriate testing to assess the condition (if applicable) -Determine the minimum compliance for the condition that should allow the mariner to safely operate under a credential -Determine the parameters for which a waiver should be set (if the medical condition can be waived). This will allow limited credentialing for some mariners with conditions previously deemed disqualifying. 2) Top Medical Conditions Review and discuss the most common medical conditions leading to denial of merchant mariner medical credentialing. Prepare recommendation(s) for the full Committee to present to the Coast Guard a list of proposed changes to the current NVIC 04-08 to improve transparency in medical decision-making until full NVIC revisions can be made. 3) Review of Part 10 Subpart C SNPRM Review Part 10 Subpart C of the STCW SNPRM and provide comments/recommendations to the Coast Guard regarding the proposed regulations on medical certification of mariners by the conclusion of this inaugural meeting. 4) Revising 719K Medical Evaluation Form Evaluate and prepare recommendation(s) for the full Committee to present to the Coast Guard propose corrections and improvements to current 719K Medical Evaluation Report Form. 5) Creating Medical Expert Panels -Evaluate and prepare recommendation(s) for the most common medical conditions leading to denial of merchant mariner medical credentialing and develop a list of topics and/or conditions to be addressed by MEP’s. Prioritize list for order of completion. - Evaluate and prepare recommendation(s) for outline for creating MEP’s, reporting requirements, and MMMAC’s procedures for considering MEP results. 6) Designated Medical Examiner Program Evaluate and prepare recommendation(s) for the full Committee to present to the Coast Guard program outline with implementation ideas for DME Program. Outline to include suggestions for training, certification/recertification, and duration of certification.

Getting Information about MMMAC Detailed recommendations, member names and POC information, minutes of meetings can be found on Coast Guard’s HOMEPORT website: Missions => Ports and Waterways => Safety Advisory Committees => MMMAC Or contact Assistant Designated Federal Officer LT Dylan McCall dylan.k.mccall@uscg.mil Phone: 202-372-1128

NVIC Revisions

Questions If you have specific questions regarding mariner credentialing policy, please contact: Luke Harden Chief, Mariner Credentialing Program Policy Office of Vessel Activities (CG-5434) Luke.b.harden@uscg.mil Phone: (202) 372-1206 / Fax: (202) 372-1918 2100 2nd St, SW Stop 7581 Washington, DC 20593-7581