Manual of the Medical Department (NAVMED P-117): Chapter 15: Medical Examinations: Special Duty

15-69 Submarine Duty

Department of the Navy
Bureau of Medicine and Surgery

(a) Entrance. Submarine candidates must meet the physical standards for submarine duty. Medical examinations should be performed by a medical officer, preferably a UMO. The member's unit medical officer, i.e., the squadron or group medical officer, should perform the examinations of personnel attached to their unit and subordinate units. Only those individuals not physically qualified for submarine duty, but for whom waivers to the standards appears justified, need BUMED review per section V.

(b) Continuation of Submarine Duty. The standards for continuation of submarine duty will be the same as for first acceptance for submarine duty. Waivers may be applied for per section V.

(1) Submarine personnel reporting for duty following absence of greater than 90 days due to serious illness or injury; hospitalized hr any reason; reported on by a medical board (see article 18-27(3); or when returning to submarine duty after other duty of more than 2 years, will, at the earliest practicable date, have a Health Record review and such medical examination as may be required by an UMO to determine their physical qualification to resume submarine duty. This examination will be completed prior to the transfer of the member (see article 15 30). It a UMO is not available at the parent command, the nearest available UMO should perform this examination to ensure personnel arrive at their permanent duty station physically qualified for submarine duty.

(2) Submarine personnel who have developed or are found to have disqualifying defects which preclude their ability to reasonably perform the duties of their grade or rate in submarines, or whose duty in submarines would be detrimental to their health, other members of the crew, or to the mission of the submarine, should be processed for submarine disqualification. The proximate UMO will make a recommendation on the SF 88 or SF 600 for all persons being processed for submarine physical disqualification.

(2) Additional Standards. Some items from section III may be duplicated here for emphasis. In addition to the standards listed in section III, the following are causes for rejection:

(a) Ears

(1) History of chronic inability to equalize pressure manifested by repeated aural barotrauma or persistent ear pain secondary to minor pressure variations (e.g., in aircraft, air lock, or elevator). In instances where a clinical determination cannot be made, the candidate must be subjected to a 27 PSIG (60 FSW) pressure test in a recompression chamber, per article 15~6(3)(a).

(2) Inability to satisfactorily pass the pressure test noted above.

(3) Hearing. As for initial acceptance except:

(a) Qualified personnel must demonstrate ability to communicate and perform their duty.

(b) All personnel (applicants or qualified) must have bilateral hearing and be able to understand the spoken word with either ear.

(b) Eyes

(1) The minimum visual acuity for unrestricted line officers (URL), quartermasters (OM), quartermaster strikers, and contact coordinators is any level of uncorrected visual acuity as long as it meets general entrance standards (see section III) and at least one eye is correctable to 20/20. Additionally, if more than 3 diopters of sphere or 1 diopter of cylinder is present in the refraction, the individual must wear contact lenses and demonstrate, with the lenses in place, an ability to achieve 20/25 vision in at least one eye or be able to achieve 20/25 with a spherical correction of 3 diopters or less.

(2) Defective color vision except for supply corps officer, medical corps officer, storekeeper (SK), yeoman (YN), messmanagement specialist (MS), hospital corpsman (HM), and personnelman (PN) ratings. Testing will be conducted with the Farnsworth Lantern (FALANT). Waiver will be considered for submarine qualified personnel who can demonstrate a functional ability to discern color associated with their work environment; such requests must include the results of the FALANT test and a statement from the individual's supervisor attending to his or her ability to meet the color vision requirements of the position.

(c) Lungs and Chest Wall

(1) History of bronchial asthma (reactive airway disease) after age 12 (waivers will not be considered).

(2) Chronic obstructive pulmonary disease.

(3) History of spontaneous pneumothorax.

(d) Abdominal Organs and Gastrointestinal System. History of disease such as severe colitis or irritable bowel syndrome, peptic ulcer disease, duodenal ulcer disease, recurrent or chronic pancreatitis, or chronic diarrhea, gastrointestinal tract perforation. or hemorrhage. Waivers will not be considered unless they have been asymptomatic on an unrestricted diet without medication during the past 2 years and currently have no radiographic or endoscopic evidence of active disease or of severe scarring or deformity. Waivers will be considered for ulcerative proctitis.

(e) Urinary System. History of urinary tract calculus.

(f) Extremities

(1) Conditions which result in decreased strength or range of motion or presents with symptoms of inhibiting pain of such nature to interfere with ready movement about a submarine or performance of duties.

(2) Conditions causing a person to be excessively prone to injury.

(g) Spine, Scapula, Ribs, and Sacroiliac Joints. Any conditions which preclude ready movement in confined spaces, inability to stand or sit for prolonged periods.

(h) Skin and Cellular Tissues

(1) Any condition which may be aggravated by the submarine environment.

(2) Acne vulgaris, moderate or severe.

(3) History of psoriasis or eczema.

(4) Unexplained or recurrent rashes.

(5) Atopic dermatitis.

(i) Psychiatric. Because of the nature of the duties and responsibilities of each person in a submarine, the psychological fitness of applicants for submarine training must be carefully appraised. The objective is to elicit evidence of tendencies which might prevent satisfactory adjustment to submarine life. Among these are below average intelligence, claustrophobic tendencies, lack of motivation, unhealthy motivation, history of personal ineffectiveness, difficulties in interpersonal relations, lack of adaptability, or personality disorders.

(1) Any examinee diagnosed by a psychiatrist, clinical psychologist, or UMO as suffering from depression, psychosis, manic depression, paranoia, severe neurosis, severe borderline personality, or schizophrenia will be recommended for submarine disqualification at the time of initial diagnosis. Waiver request may be submitted per section V.

(2) Those personnel with diagnosed suicidal ideation will have their cases reviewed, as a minimum, by the type commander (TYCOM) medical officer, if a UMO, for fleet personnel, or MED 21 it at a shore establishment, to determine the necessity for disqualification or return to duty. Personnel with suicidal gestures or attempts will be recommended for submarine disqualification. Waivers will be considered on in individual basis per section V.

(3) Those personnel with minor psychiatric disorders such as acute situational stress reactions will be evaluated by the local group or squadron UMO in conjunction with a formal psychiatric evaluation when necessary. Those cases which resolve completely, quickly, and without significant psychotherapy can be found tit for submarine duty by the responsible local UMO, it deemed appropriate. Those cases in which confusion exists must be reviewed by the TYCOM medical officer, if a UMO, for fleet personnel, or MED 21 for shore based personnel. It must be stressed that any consideration for return to duty in these cases must address the issue of whether the service member, in the written opinions of the UMO and the member's commanding officer, can successfully return to the specific stresses and environment of submarine duty.

(j) Dental. All dental treatment should be completed prior to transfer of the member for training or sea duty (see article 1 5 30).

(1) Indications of, or currently under treatment for, any acute infection disease of the soft tissues of the oral cavity.

(2) Candidates for basic submarine school must be classified by a dental officer as Class I or 11 (see article 6 101) prior to executing such orders.

(3) Medically indicated conditions requiring extensive or prolonged follow-up which could not be completed due to the training w operational requirements of member's assignment, e.g., orthodontics.

(k) Systemic Diseases and Miscellaneous Conditions

(1) Allergic or atopic manifestations which require allergy immunotherapy.

(2) A member, on submarine duty, who develops allergies which require immunotherapy will be considered for waiver if:

(a) Therapy is not for stinging venomous in sects.

(b) AIT injections may be discontinued while the ship is underway.

(c) The member's AIT kit is Kept at the squadron or group medical department and used under the supervision of a medical officer in a facility where emergency care can be provided for anaphylaxis.

(3) History of migraine headaches that are recurrent, incapacitating, or require the chronic use of medications for control.

(3) Special Studies. In addition to the special studies required in article 15-9, also perform a standard chest x ray within preceding 6 months, on initial application and when clinically indicated.

(4) Periodicity. Medical examinations will be conducted per article 15-11.