Stay on Course: Understanding Medical Disqualifiers for Your Captain’s License

I’ve had a lot of conversations with aspiring captains over the years, and one frequent concern I hear is this:

“Will this medical issue prevent me from getting my license?”

It’s a fair question — and a fear that holds many people back from even trying. But the Coast Guard’s guidelines around captain’s license medical disqualifiers aren’t meant to filter out all but 20-year-old athletes. They simply ensure that any licensed captain is capable of safely operating their vessel and protecting the lives of the people on board. 

So before you talk yourself out of your dream, let’s walk through what the Coast Guard really looks for when it comes to medical fitness, what might lead to captain’s license disqualification, and how you can prepare.

Captain’s License Medical Disqualifiers: Roadblocks vs. Speed Bumps

After working with thousands of students, I’ve learned that nearly everyone has something in their health history that worries them. But not every medical concern is a roadblock to getting your license; some are just speed bumps, and others are no problem at all. 

If you’re interested in pursuing a captain’s license but are concerned that health issues could present a problem, I recommend taking the required physical ahead of time, before you invest in a course. While some medical issues are true disqualifiers, many simply require additional assessment and proof of management to meet Coast Guard requirements.

By getting your physical first, you find out whether you have an actual medical disqualifier before committing to the full licensing process. Plus, you may discover ways to improve your condition to the point that you can move forward with licensing in the future.

The cost of a physical is relatively small in comparison to the total cost of a captain’s license, so this approach is usually worthwhile even if you have to repeat the exam closer to application time.

When to Worry: Common Medical Conditions

Let’s look at a few of the most frequently asked-about health concerns and how they play into the Coast Guard’s decision-making process.

Heart Conditions

Cardiovascular issues are among the most serious potential captain’s license medical disqualifiers, and understandably so. The Coast Guard’s primary concern is preventing a heart attack or cardiac emergency while you’re responsible for the lives of passengers.

That said, cardiovascular issues aren’t automatic captain’s license disqualifiers. If you’ve had a procedure like bypass surgery or stent placement, however, the Coast Guard typically wants to see you go 18 months without needing further procedures. They may also require a stress test and a letter from your cardiologist clearing you for maritime duties.

The key with cardiovascular issues is demonstrating that your condition is stable, well-managed, and unlikely to cause sudden incapacitation on the water.

Type 1 and 2 Diabetes

Both type 1 and type 2 diabetes fall into the category of conditions that require careful evaluation rather than automatic disqualification. The Coast Guard’s main concern here is insulin shock — a dangerous situation when you’re responsible for others’ lives.

They’ll want to see A1C levels below 8 and documentation that you’re managing your condition under proper medical supervision. The goal is proving you can maintain stable blood sugar levels during the physical and mental demands of captaining a vessel.

Prescription Medications

Medication is where things get more complex, and it’s one of the most common areas of confusion regarding captain’s license medical disqualifiers.

The Coast Guard evaluates medications based on whether they could impair your ability to safely operate a vessel. Anything that affects thought processes, reaction time, or alertness is problematic.

Opioids like OxyContin, fentanyl, and Percocet are significant concerns because they slow reaction time and impair judgment. Even if these medications are legally prescribed and perfectly legitimate, they’re typically considered at least temporary disqualifiers. 

In my own case, I developed back issues after earning my captain’s license that required serious, but temporary, pain medication. Fortunately, the Coast Guard recognizes situations like this arise and provides an option to put your license into continuity, meaning you keep your license but can’t use it. 

That’s what I did, and when the back issues resolved, I was able to take my license out of continuity and resume working. 

Many other common medications, like statins, thyroid hormones, and blood pressure medicine, generally aren’t issues because they don’t impact cognitive function or reaction time.

The Marijuana Question

Marijuana gets special attention since it catches many people off guard. 

Even if marijuana is legal in your state and prescribed by a doctor, it remains illegal at a federal level. Since captain’s licenses are issued federally, any marijuana use is considered a captain’s license disqualification.

I’ve seen students fail their drug tests after taking “just one gummy,” thinking their medical marijuana card would protect them. It doesn’t. They then had to wait a full year before reapplying, so keep this in mind.

Vision Impairment and Color Blindness

Vision is, of course, crucial for navigating your vessel and spotting important signals or safety hazards. Consequently, many people worry that nearsightedness or color blindness are automatic captain’s license medical disqualifiers. 

They aren’t — necessarily. 

The Coast Guard’s general vision requirements are:

• Uncorrected vision of at least 20/200 in one eye
• Corrected vision of at least 20/40 in that same eye

Wearing glasses or contacts is perfectly fine. Just make sure your correction brings you into range, and always carry a backup pair on board.

As far as color vision, the Coast Guard evaluates each applicant on a case-by-case basis. If your color blindness is severe, you may receive restrictions — for example, not operating at night — but still get your license.

Hearing Impairment

Hearing is just as important as vision when you’re responsible for lives on the water. Like vision impairment, however, hearing impairment isn’t an automatic captain’s license disqualification. 

Here’s what the Coast Guard expects:

• Unaided hearing threshold: 30 decibels or less in each ear
• Speech discrimination: At least 90% for a new license, and 80% for renewals

Hearing aids are acceptable as long as they bring you within those ranges, and you’ll be expected to wear them while working.

Captain’s License Disqualification and the Role of Waivers

As mentioned, the Coast Guard does grant waivers on a case-by-case basis for some conditions that would otherwise be disqualifying. If you can show that your condition is stable, well-managed, and doesn’t compromise safety, you may still qualify for your captain’s license.

To get a waiver, you’ll usually need:

• A detailed medical history
• A doctor’s statement clearing you for duty
• A record of consistent management and monitoring

But there’s a responsibility that comes with a waiver: You must immediately report any changes in your condition. Failure to do so can put your license at risk — and worse, it could endanger lives.

Temporary vs. Permanent: Understanding the Distinction

When considering waivers, the Coast Guard makes important distinctions between temporary and permanent medical conditions. They consider three main factors in their evaluation:

• Persistence is a key factor in determining whether an issue rates as a captain’s license medical disqualifier. Will the condition likely recur or worsen over time? Conditions with high recurrence rates are viewed more seriously.
• Potential for complications also matters. If a condition could lead to sudden incapacitation or an emergency situation, it’s more likely to be considered a permanent medical disqualifier.
• Treatability is the third major factor. If a condition can be effectively treated without interfering with safety and job performance, it may be addressed through waivers or conditional approvals.

Sleep apnea, for example, is a persistent condition that can cause significant drowsiness and affect safe boating operation. However, sleep apnea is usually quite treatable, so applicants who demonstrate good management of their condition are often approved for their captain’s licenses.

Anxiety and depression are a little trickier. These conditions may be temporary and treatable with medication, leading to a waiver, but a significant history of mental health issues or a worsening illness may lead to disqualification.

Captain’s License Medical Disqualifiers: Your Path Forward

Don’t let medical worries prevent you from moving toward your maritime dreams. The Coast Guard’s captain’s license medical disqualifiers exist to ensure safety, not to exclude people unnecessarily. The key is approaching the process with complete honesty and realistic expectations.

So, take that physical and get the facts. It’s better to get concrete information now rather than let fear hold you back indefinitely. 

If you have questions about a specific condition, contact the National Maritime Center directly. The Coast Guard itself is the ultimate authority in determining whether an ailment is an issue, so they’ll be able to provide you with the most accurate information and guidance.

You might discover that your condition isn’t as problematic as you thought. But even if it does create challenges, you’ll know exactly what you’re dealing with and can explore your options.