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

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

15-66 Diving Duty

Department of the Navy
Bureau of Medicine and Surgery

(1) Purpose. All personnel, except patients, exposed to the hyperbaric environment, including but not limited to those engaged in hyperbaric chamber duty (clinical, research, and recompression), hyperbaric coffers or caissons, sonar dome work (when a hyperbaric environment), hull containment testing (compartment workers), diving, combat swimming (SEALs), USMC combat swimmers, and all candidates for such duty, must conform to the appropriate physical standards in this article.

Note: Compartment workers who are submariners and have a current medical examination filed in their Health Record will be considered qualified for hull containment testing. When possible the diving medical examination (DME) should be performed by a medical officer, preferable a privileged undersea medical officer (UMO). DMEs which are not personally performed by a qualified UMO, DMO, or HMO must be reviewed and approved by: (1) a UMO, DMO, or HMO; (2) a FS, AMO, or graduate of the various hyperbaric medical officer courses taught at the Naval Diving and Salvage

Training Center to wham BUMED 21 has granted written authority to review and approve DMEs; a (3) BUMED 21.

(2) Additional Standards. Some of the items listed in section III may be duplicated here for emphasis. In addition to the standards listed in section III, the following will be cause to rejection or disqualification:

(a) General. Any disease a condition that causes chronic or recurrent disability, increases the hazards of isolation, or has the potential of being exacerbated by the hyperbaric environment.

(b) Ear, Nose, and Throat

(1 ) Any history of inner ear pathology.

(2) Any history of inner or middle ear surgery.

(3) Inability to equalize pressure as required by Navy diving profiles.

(4) Hearing

(a) As for initial acceptance for candidates.

(b) Qualified divers must demonstrate ability to communicate and perform duty.

(c) Divers who use underwater devices that exceed the noise level standards established in OPNAVINST 5100.23 series will receive an audiogram quarterly.

(1 ) Night vision impairment.

(2) Vision that does not correct to 20t20.

(3) For Navy combat swimmers (SEALs) the uncorrected visual acuity will not be worse than 20t40 in the better eye and 20/70 in the worse eye. For other Navy divers the uncorrected visual acuity will not be worse than 20t100 in the better eye and 20/200 in the worse eye. Sonar dome workers, research saturation divers not qualified as Navy divers, naval architects, compartment workers, hyperbaric cotters and caisson workers, undersea medical officers, and civil engineering caps personnel may have any degree correctable to 20t20 and may have night vision impairment. Other military services may establish their own vision standard to the purpose of complying with U.S. Navy requirements for diving training.

(4) Waivers are not required for the use of optically corrected masks or underwater glasses. Waivers, however, are required for the use of contact lenses.

(5) Detective color vision for Navy combat swimmers (tested by the Farnsworth Lantern) or explosive ordnance disposal personnel.

(6) Radial keratotomy, laser, or other forms of corneal surgery.

(d) Pulmonary

(1) Congenital and acquired detects which may restrict pulmonary function, cause air trapping, or affect the ventilation perfusion balance.

(2) Chronic a restrictive pulmonary disease of any

type.

(3) Pneumothorax. Waiver may be granted for traumatic pneumothorax. Spontaneous pneumothorax is absolutely disqualifying.

(4) Reactive airway disease or asthma, after age 12 (waiver request is not appropriate).

(5) Chronic obstructive pulmonary disease.

(e) Skin and Cellular Tissues. Acute or chronic diseases that are exacerbated by the hyperbaric environment.

(f) Dental

(1) All divers should normally be class I or 11 before assuming diving duty. Divers who are class III for acute conditions should be temporarily disqualified tram diving duty until the acute condition is corrected. Divers who are class III because of a chronic condition (e.g., periodontal disease) must be receiving ongoing dental care for the condition a they are to be considered qualified to diving duty.

(2) Acute infectious diseases of the soft tissues of the oral cavity, until treatment is completed.

(3) Any defect of the oral cavity or associated structures which interfere with effective use of self contained underwater breathing apparatus (SCUBA).

(g) Blood and Blood Forming Tissues. Any significant anemia or hemolytic disease.

(h) Neurologic

(1) Organic brain disease seizure disorders of any

sort.

(2) Head injury with sequelae.

(3) Unexplained a recurrent syncope.

(4) Decompression sickness a air embolism with persistent neurological deficit.

(i) Psychiatric

(1) Personality disorders, neurosis, immaturity, instability, asocial traits, or psychosis.

(2) Stammering a stuttering.

(3) Alcoholism except those who have successfully completed a recognized rehabilitation and after care program. Any relapse is cause for disqualification.

(j) Musculoskeletal

(1) Intervertebral disc disease with neurological deficit

(2) Chronic arthritis.

(3) Dysbaric osteonecrosis.

(k) Height, Weight, and Body Build. Greater than 22 percent body fat for males and 30 percent for females as determined by anthropometric measurement per OPNAVINST 6110 series.

(l) Age. All military divers 45 years of age a older require a waiver to continue diving. Usually such waivers will be limited to senior supervisory capacity. BUMED defines senior supervisory diving capacity as monitoring of work performed by other divers. Navy civilian divers may continue active diving beyond age 45 provided their medical examination is conducted by a UMO a DMO and meets all other requirements of this article. There is no age requirement for compartment workers.

(3) Additional Standards for Candidates. In addition to ~e previous standards for diving g duty, initial applicants must meet the following standards:

(a) Pressure Testing and Ascent Training

(1) All candidates will be subjected, in a recompression chamber, to a pressure of 27 PSIG (60 FSW) to determine their ability to withstand the effects of pressure. This test must not be performed in the presence of a respiratory infection that may temporarily impair the ability to equalize or ventilate.

(2) In all cases of ascent testing, training, evaluation, or examination, a UMO or DMO must be present at the test site (this does not apply to ascent training or lockin/lockout training where all participating personnel are fully qualified for the procedures). Compartment workers and sonar dome workers are not required to undergo pressure testing. Sonar dome workers must pass pressure test.

(b) Age. Navy applicants who have attained their 35th birthday (28th birthday in the case of Navy combat swimmers) will not be considered for initial diving training without a waiver. Waiver request will require a statement from the using community. Other military services may establish their own age standard for the purpose of complying with U.S. Navy requirements for diving training. There is no age requirement for sonar dome workers, compartment workers, and caisson workers.

(4) Additional Standards for Saturation Diving Duty

(a) General

(1) Saturation diving involves prolonged exposure to the hyperbaric environment, isolated from direct medical care. Therefore, conditions which would be exacerbated or be untreatable during a saturation dive are disqualifying.

(2) A saturation diving physical must be completed within 6 months of commencement of training.

Note: Block 5 of the SF 88 should state Saturation Diving.

(3) Saturation diving examinations must be completed by a DMO.

(b) Standards. Saturation diving physicals must comply with all standards for entry and continuation in diving duty, as well as the following disqualifying items.

(1) General. Any disease or condition which predictably will occur and be difficult to treat or exacerbated by a continuous hyperbaric environment of 30 days or more.

(2) Ears. Any history of permanent hearing tees secondary to decompression sickness or arterial gas embolism. Any permanent tees, secondary to those causes, even it hearing threshold does not exceed standards specified for duty or diving duty, must be considered disqualifying.

(3) Urinary System. History of urinary tract calculus

(4) Skin and Cellular Tissues. Any condition which may be exacerbated by the hyperbaric environment, including acne vulgaris, moderate or severe; psoriasis; eczema; or atopic dermatitis, moderate or severe.

(5) Gastrointestinal. Peptic ulcer disease within the last 2 years or requiring medication for control. Inflammatory bowel disease.

(6) Systemic Diseases. Allergic or atopic manifestations which require allergy immunotherapy or would likely be exacerbated by a hyperbaric environment.

(5) Additional Standards for Hyperbaric Exposure-Nondiving

(a) General. Individuals who will be exposed to a dry hyperbaric environment in a nondiving capacity (sonar dome, hull pressurization, recompression chamber) will have an examination, identified as Hyperbaric Exposure, conducted to the scope of the diving medical examination.

(b) Standards. The standards for diving duty apply with the exceptions that there is no age limit or vision requirement other than that described in section lilt

(6) Special Studies. in addition to the special studies required in article 15-9 of this chapter the below listed studies will be completed.

(a) Chest x ray on initial diving medical examination, within the previous 6 months, and then when clinically indicated by the examiner.

(b) Saturation divers will have long bone x rays surveys with diving medical examinations on entry and termination from the saturation diving program and when clinically indicated, as determined by a UMO or DMO.

(7) Periodicity

(a) All active divers will have a diving medical examination every 5 years. If assigned remote from a DMO or UMO the examination will be conducted every 3 years.

(b) After age 45 the examination will be conducted every 2 years. The formal radiology report must be placed in the record. For candidates, the films must be hand carried by the member to saturation diving school. Films, with a copy of the formal radiologist interpretation, must be forwarded to Commander, Submarine Development Group ONE, 139 Sylvester Road, San Diego, CA 92106 3597, attn: Senior Medical Officer.