NSCC Medical Manual

1. INTRODUCTION AND BACKGROUND.

Program Goals. NLCC and NSCC Program goals are as stated in Naval Sea Cadet Corps Annual Report to Congress. They include:
- Develop an interest and skill in seamanship and seagoing subjects.
- Develop and appreciation for our Navy’s history, customs, traditions, and its significant role in national defense.
- Develop positive qualities of patriotism, courage, self reliance, confidence, pride in our nation and other attributes which contribute to development of strong moral character, good citizenship traits, and a drug-free, gang-free lifestyle.
- Present the advantages and prestige of a military career.
The NLCC was established “…to give young people mental, moral, and physical training through the medium of naval and other instruction, with objective of developing principles of patriotism and good citizenship, instilling in them a sense of duty, discipline, self-respect, self-confidence, and a respect for others”.
Achieving Program Goals. To accomplish these goals, the NLCC and NSCC model the Navy and use Navy resources. Other state and federal service components are modeled and used as well. This includes medical qualification and physical fitness. To do the things and participate in the training evolutions that are based on active and reserve component programs, the NSCC and NLCC necessarily must also adhere to active component medical qualification criteria. While many other youth organizations also rely upon and use active and reserve component resources, few are authorized training that models and generally is the same as that received by the service members themselves. These include rappelling towers; confidence and obstacle courses; damage control and fire fighting trainers; ship simulators; military shipboard training; SCUBA and diving training; as well as actual participation in ship and aircrew training; SEAL; EOD; and SWCC training among others. NLCC and NSCC cadets are authorized these opportunities to a large extent because medical qualification for the NLCC and NSCC models active component medical qualification criteria.
Cadet safety, well being and Unit CO and COTC authority. Cadet safety and well being is always first and the first consideration in decision making. The NLCC and NSCC will not place cadets in harms way by allowing cadets who are not medically qualified to participate in program training events. To support this standard cadets must meet the NLCC and NSCC program’s medical qualification criteria and once enrolled must continue to meet established medical qualification standards. The only exceptions are as detailed in para 2. e below. Unit Commanding Officers are not permitted to enroll any cadet not medically qualified, and are charged to dis-enroll cadets who become medically disqualified while in the program. Cadet advancement is one of the foundations of the NLCC/NSCC program. To advance, cadets are expected to complete summer and/or other program training evolutions. Prior to any Recruit, Orientation, or Advanced Training, Unit CO’s are responsible for ensuring cadets are medically screened before being released to go to that training. Procedures for screening are as detailed below in para 4.a (2). Unit CO’s are not authorized to release any cadet to go to any training unless medically qualified. COTC’s who have cadets arrive for training who are not medically qualified are charged to send those cadets home immediately. AGAIN: The NLCC and NSCC will not place cadets in harms way by allowing cadets who are not medically qualified to participate in program training events.
Medications as a 21st century fact of life. For both adults and cadets, medications are increasingly more available, and use is increasing all the time. As medications continue to change, the NSCC will continue to use the military services medical qualification entrance requirements as the standard, and will conform to any medical qualification changes that they might incorporate. NLCC/NSCC policy and procedures as outlined below recognize that use of medicines for short term, suddenly occurring illnesses has also increased. Most of these medical conditions are of a short term nature and have no impact on unit training where cadets either self medicate or are medicated by parents at home. However, as summer training approaches and cadets find themselves taking prescription or non prescription medications for a prescribed duration that impinges upon their scheduled training, COTC’s have the option of accepting, or not accepting, that cadet dependant upon the medical resources available at their training and dependant upon the parent/medical provider properly completing the enclosed NSCC release forms as directed below. COTC’s are authorized, without question, not to accept cadets taking medications if these cadets can not be accommodated. These policies and procedures are also intended to accommodate those few cadets who enroll in the program without any medical condition, but sometime during their tenure as Sea Cadets require medication for a non-disqualifying condition. Cadets who find themselves in this circumstance must understand their continuation and participation in the NSCC with their particular condition is a privilege and not a right, and some training will not be available to them until the condition has cleared.

2. POLICY

General Medical Fitness Policies:

Cadet Medical Qualification Policy for NLCC/NSCC Cadet Program Participation. The general policy for medical qualification of cadets to participate in the NLCC and NSCC is that if the medical condition is disqualifying for entry into the Armed Services of the United States, then it is also disqualifying for enrollment and participation in the NLCC and NSCC. The exception to this policy is that if the condition is a mild, non-limiting and not clearly disqualifying medical condition, that is clearly understood and easily managed, and that the child’s medical provider confirms is a condition that the child will “outgrow” so that he or she will be medically qualified for entry into the Armed Services upon becoming of age, then that child may enroll and participate in the NLCC and NSCC. However, any of these conditions subject to being “outgrown” must still not restrict program participation in any way. Medical fitness standards are as established by Military Entrance Processing Stations (MEPS). Questions should be directed up the chain of command. The NLCC and NSCC is a volunteer program, subject to resource limitations as well as limitations with regard to medical services that can be provided across the wide variety of opportunity in the training arena. Accordingly, cadets enrolling with any medical exception, may not be able to participate in all NLCC/NSCC training offered due to limitations for that particular training. Commanding Officers of Training Contingents (COTC’s) determine whether the cadet having the medical exception can participate or not. Upon enrollment, cadets must maintain their medical qualification to remain in the program.

Adult Medical Fitness Policy for NLCC/NSCC Adult Program Participation. Adult applicants must be in good health commensurate with their age group and be free from any ailment or condition that would prevent them from satisfactorily performing their primary duty of supervising youth.

NOTE: Adults not physically qualified to perform all duties may still participate with a waiver from NHQ considering the parameters of their expected contribution to the NSCC program.

Responsibility

All Hands. All hands bear the responsibility for knowing their own medical qualification and for ensuring their medical qualification is never hidden or misrepresented. All hands also share the responsibility to always be looking out for their shipmates and taking whatever action necessary for ensuring their continued health, well being and medical qualification as well.
Parents and Cadets. Parent responsibility includes appropriately notifying Unit Commanding Officers, COTC’s and other personnel as necessary regarding any changes in their cadets medical qualification or of any medical circumstances that might affect their cadets ability to fully participate in any of the programs’ events. Full disclosure of cadet medical condition is required at time of program entry and in completion of annual screening prior to any away from home training.
Unit CO’s. Unit CO responsibility rests with properly discharging their duties as Unit Commanding Officer as detailed in NLCC/NSCC Instructions, Manuals, Regulations, and other guidance as provided. With specific regard to Medical qualification of cadets, Unit CO’s must not enroll children not medically qualified for enrollment. For cadets already enrolled, annual screening prior to any training must receive special attention so that cadets are never put in jeopardy by being allowed to go to a training when they are sick, injured or in any other manner not qualified. Unit CO’s must emphasize with parents that full disclosure is required with regard to both program entry and in all pre-training screening. Cadets who develop a disqualifying medical condition after enrollment are to be dis-enrolled from the NLCC/NSCC program. Unpleasant as this may be, it is required so that they are never placed in jeopardy due to their newly acquired medical condition. Questions should be directed up the chain of command.
COTC’s. COTC’s have the unique responsibility for the continued health, well being and medical fitness of cadets after arriving at their particular training site. If a cadet is not qualified for the particular training, COTC’s are specifically charged to not to accept the cadet for training. COTC’s have the option of addressing unique medical circumstances that cadets may have but the final decision is theirs. COTC’s know best the physical and personnel medical resources, limitations and capabilities at their training site and NHQ will support their decisions.

NSCC Medical Qualification Requirements. These are the medical acceptance criteria for acceptance of applicants for participation in the Naval Sea Cadet Corps.

Generally, acceptance is based upon the ability to participate in strenuous physical activity and the absence of contagious disease, illness, or history that will or is likely to require medical care or restriction of participation during training exercises, particularly during “away from home” one, two week or longer training evolutions. A sports type physical is required to make this determination.
Routine immunizations are required. Cadets are to be current on their immunization for measles, mumps, and rubella (MMR), have proof of a tetanus booster (Td or Tdap) within the past 10 years, and have received one vaccine to immunize against meningitis (Menactra). In addition, all cadets should have proof of a negative tuberculosis skin test (or other proof of negative tuberculosis disease such as a chest x-ray or medical provider note) upon entering the program. Menactra is required because the program includes and requires away from home overnight trainings, frequently in close quarters. Currently enrolled cadets with out this immunization are strongly encouraged to get it. Newly enrolling cadets are required to get it.

Special attention should be given to the absence of orthopedic and cardiovascular conditions/complaints and /or any other conditions that would preclude full participation.

There is no specific limit for vision. However, applicants who wear glasses or contacts lenses but cannot participate in activities that require the removal of glasses (or contacts) should be reviewed on a case by case basis. Additionally, there must be vision in both eyes.

Where a marginal medical condition exists, examining medical care providers may submit appropriate statements for consideration of acceptance when the provider is of the opinion that the applicant will not encounter any restriction of participation in the program and the that condition in question does not present and unacceptable risk for aggravation or worsening as a result of participation in the activities of the program. Statements are subject to review via the chain of command with the NSCC Executive Director having final decision authority.

Adult applicants must be in good health commensurate with their age group and be free from any ailment or condition that would prevent them form satisfactorily performing their primary duty of supervising youth.

Program Medical Disqualifiers. DO NOT ENROLL, RE-ENROLL OR CONTINUE IN THE NSCC PROGRAM CADETS WITH THESE MEDICAL CONCERNS.
1. Cadets with history of seizure or convulsion disorder requiring medication.
2. Cadets currently having asthma in any form (vs an allergy).
3. Cadets with symptomatic or recurrent orthopedic injuries or conditions.
4. Type I and Type II diabetic patients.
5. Hypersensitivity to foods, i.e. if eaten, you will need immediate medical attention.
6. Insect bites or stings beyond “average person sensitivity” requiring immediate on scene medical attention.
7. Head injuries having resulted in residual impairment
8. History of recurrent loss of consciousness.
9. History of debilitating motion sickness
10. Sleepwalking
11. Bed wetting if not controlled.
12. Where a medical condition exists and a question arises if it is a disqualifying condition, the MEPS standards for entering the Armed Forces shall be referred to via the local Navy Recruiter. If the condition is disqualifying for entry into the armed services, it is disqualifying for participation in the NLCC and NSCC except as might be provided for in this manual immediately below under exceptions or special conditions.
EXCEPTIONS OR SPECIAL CONSIDERATIONS. Cadets entering the program with any exceptions as noted below must understand that participation is a privilege and that they may be restricted in the trainings they can attend due to medical resource and personnel limitations as determined by the COTC of the training event. Additionally, participation may also depend on a parent being present as an escort for the training event. If present, medications will still be in the custody of and administered by the training event medical staff. The same applies to cadets who might develop these conditions after enrolling.

Child will outgrow the medical condition. If the medical condition is not clearly disqualifying, easily understood and easily managed, and considered by the medical care provider to be a condition that the child will outgrow so that upon reaching the age of 17 or 18, the condition no longer exists and the young adult at that age would meet qualification for military service, then enrollment may be considered, understanding the cadet may not be eligible to participate in all training opportunities. However, any of these conditions subject to being “outgrown” must still not restrict general program participation in any way, except for certain trainings with special restrictions as established by COTC’s for their training. Questionable conditions should be referred up the chain of command.
Common allergy medications to include non-sedating antihistamines (Claritin, Allegra, Zyrtec, etc) and nasal steroid sprays (Flonase, Rhinocort, etc).
Oral contraceptives (birth control pills)
Acne medication
Medication for bed wetting (if controlled).
Antibiotics and anti-fungals if not contagious
Asthma. May have a history of asthma as long as not currently requiring any asthma inhaled medications or taking oral tablet medications for control of active asthma conditions, and not having taken any inhaled steroid medication for the last 2 years, with physician statement stating the expectation that further medication for asthma will not be needed.
Inhalers for occasional respiratory infection (not steroid inhaler for asthma) or occasional relief from allergies as long as not a daily dependency.
ADHD medication. Cadet must be well controlled and dependency cannot be severe.
History of mild childhood depression, but only with medical care provider certification of expectation that cadet can now fully perform in the NSCC without any restriction or any further expectation of depression episodes.

Pre-existing Medical Conditions. Should hospital or other medical services be required, the cadets family medical insurance plan is the first resource. NSCC medical insurance is secondary and becomes primary only in the absence of cadet personal insurance. NSCC medical insurance will not cover pre-existing medical conditions. So if the cadet had the condition prior to embarking upon his or her training and aggravation occurred during training such that medical attention was required, NSCC insurance will not cover pre-existing.
NSCC Medical Insurance. See current year NSCC Information Letter. Cadets are covered under NSCC’s Accident ($25,000 max.) or Illness ($5,000. max.) policy with Nationwide Insurance Company. This plan is an “excess insurance plan” meaning that each family’s primary medical insurance policy will be in effect and used before the NSCC policy becomes effective. For personnel without any medical insurance coverage, the NSCC coverage becomes the primary policy to cover NSCC members who became ill or injured but only when participating in NSCC authorized activities. If a cadet is hurt, Unit CO’s, COTC’s must first submit to NHQ an Accident Report. This is most important because it confirms the injury with NHQ Headquarters and prompts NHQ to send to the parent or guardian the necessary paperwork to file a claim. A claim form will be sent to be filled out by the parent/guardian/individual making an insurance claim under NSCC’s policy. This form has to be completely filled out and mailed/faxed within 90 days from date of accident/illness to Nationwide Insurance Co., Special Risks Health Claims Dept., P.O. Box 2399, Columbus, OH 43216-2399 under policy #502-95-21736. All original itemized bills associated with the illness or accident have to be included. In 1996 the Congress of the U.S., passed Public Law 104-191 – Health Insurance Portability And Accountability Act of 1996. (HIPAA) This law governs who has access to individual’s medical information. Because of this law, claims can only be handled by the parent/guardian/individual directly with the insurance company.

3. PROCEDURES

Enrolling in the NSCC. The NSCC Administrative Manual refers. For the medical requirement:

Cadets. A medical examination similar to a high school sports examination is required. The examination must be completed by one of the following licensed medical providers: physician (MD or DO only), nurse practitioner (NP, FNP, PNP, or physician’s assistant (PA, PA-C).

As part of the enrollment procedure, cadets and their parent or guardian must first complete the current NSCADM 020 form, see encl (1). Fill out this form to the best of your knowledge and attach a copy of your immunization record.
Consult with your prospective Unit Commanding Officer for determination of any immediately identifiable medical disqualifiers. If a disqualifying condition exists the enrollment process stops here and there is no need to go further. If there appears to be no medical disqualifiers, then go to the next step.
Take the completed NSCADM 020 along with a copy of the NSCADM 021 to your medical provider. Your medical provider will conduct a medical examination and complete the NSCADM021, see encl (2). Your medical provider will review the NSCADM020 you completed as part of the examination and then make a determination as to medical fitness for participation in the NLCC/NSCC. IAW NSCC Regulations Manual, the medical providers office form may be used to record the examination results, if the NSCC Medical Examination Form is used as a guideline for the examination, when the medical providers office is going to charge an additional fee to record the results on the NSCC form.
The completed NSCADM 020 and NSCADM 021 are then returned to the prospective Commanding Officer and he will complete of the rest of the enrollment process.
If questions cannot be resolved and a determination of medical qualification cannot be made, the issue should be referred to NSCC National Headquarters via the chain of command for resolution. The NSCC Executive Director is the final decision authority.

Adults. NSCC Regulations, the Administrative Manual and the Advancement and Training Manual refer. Adults are not required to get a physical to join the program. NSCC Regulations will be changed to delete this requirement with its next change. However all adults are expected to be physically qualified to perform the duties required of the NSCC adult. Upon joining, adults are required to complete and place in their records a completed NSCADM 020 with annotations and comments that accurately reflect their current medical condition. A current list of medications the adult is taking (names and doses) is to be included on the NSCADM 020. Adults can get sick and/or injured just like cadets, and possibly require emergency room visits or hospitalization just like cadets. COTC’s and Unit CO’s need to have on file a record of medical problems or special circumstances that their adults might have, again, just like cadets. Completing an accurate NSCADM 020 for inclusion in their records upon enrolling is required and maintaining that NSCADM 020 is as further discussed in paragraph 4 below.

4. CONTINUATION AND TRAINING IN THE NLCC AND NSCC. To continue as a member of the NSCC all cadets must maintain their medical qualification to do so. If a cadet encounters a medical problem that may extend beyond a couple of drills, a leave of absence may be requested until the medical problem is resolved.

For all NLCC and NSCC cadets:

Unit training. Following enrollment, cadets and parents are required to keep Unit Commanding Officers fully informed of any changes in cadet medical qualification and fitness.
Orientation, Recruit, and all NLCC and NSCC Advanced Training. In preparation for Orientation, Recruit and any Advanced Training, typically away from the home drill site and generally of an extended nature lasting from several days up to three weeks or more, Unit CO’s are responsible for ensuring a medical screening is completed. To do this:

Use NSCADM 020. This is the same form used when affiliating with the NSCC and when the entrance physical was completed. It is to be again completed within 30 days of departing for training and signed off by the parent and retained in the cadet’s record. Again, parents are responsible for full disclosure of any medical changes. Some COTC’s may require this form to be submitted with the request for training orders. In the time between screening and actual departure, the Unit CO must still be advised of any change in cadet medical qualification. Only medically qualified cadets are allowed to be released for these trainings. Cadets with broken bones, wearing soft or hard casts, still recovering from surgeries or any other condition that inhibits full participation are not to be released to training.
After screening, if there is no change in medical qualification, the Unit CO may then release the cadet to attend training, complete the NSCTNG 001 and further forward to the COTC.
If during screening it is determined that there is a change in medical qualification, or should a change be reported in the time frame between screening and departure, the Unit CO must make a determination as to the cadets qualification to attend training. If the cadet is taking a OTC or prescription medication that extends into his training period (i.e. supposed to take an antibiotic for 10 days and training starts on day 6, or if a long term acne medication is prescribed, or cadet is taking an ADHD medication, or an inhaler is prescribed for occasional use for an allergy), then the Unit CO must contact the COTC for determination if the cadet can still attend training and bring the medication with him or her. NSCTNG025, see encl (3), has been developed to assist depending upon the nature of the new medical condition.

If any of these conditions exist, or if there is any other question regarding if the cadet should be released to go to training, the COTC must be contacted before releasing the cadet to go to training. If the COTC agrees that the condition will not interfere with training, or that his medical staff and host resources can accommodate the cadet, he will so advise and the cadet may be released for training. IF THE COTC IS UNCERTAIN, HE MAY DIRECT SUBMISSION OF THE TRAINING REQUEST ALONG WITH NSCADM 020 AND NSCTNG 025, SUBJECT TO REVIEW BY HIS MEDICAL STAFF BEFORE ACCEPTING THE CADET FOR TRAINING .
If the COTC can not take the cadet, the cadet cannot be released to go to this training.
All this has to be completed in advance of the training and before any cadet can be released for training. DO NOT COMPLETE THE NSCTNG025 AND SEND WITH THE CADET TO TRAINING WITHOUT FULL APPROVAL OF THE COTC FIRST.

If the new condition is clearly disqualifying for program participation, then the cadet must be dis-enrolled.

COTC Action.

COTC’s are not required to accept for training any cadet not fully medically qualified. Many however, do accept cadets with minor, temporary conditions but only because they have the qualified personnel staff and medical resources available to handle minor cadet medical issues. COTC’s whose resources allow this are encouraged to post on their websites, details describing what medical conditions can be accepted and what can’t, as well as any further medical guidance they wish to post in support of cadet training.
COTC’s having medical personnel and resources that allow acceptance of cadets with minor medical qualification restrictions or cadets participating under any of the exceptions listed under paragraph 2e. are responsible for incorporating into their Standard Operating Procedures (SOP) a written plan that defines, addresses, and identifies:

Medical Dept Head and credentials/qualifications
The medical staff compliment. Note: the revised NSCADM 020 release form acknowledges the staff might be just “as assigned”. Many youth summer camps operate same way. If so, post to the training website.
Hours and staffing shifts for operation of the department.
Quality assurance procedures, such as 2 person rule for giving cadets their medications.
Disaster plan in case access to cadet medications becomes unavailable as with summer storms, or evacuation to safer buildings.
Adverse reaction plan for cadets who might have an adverse reaction to their medications, addressing closest hospitals, who will take the cadets there, how will transportation be provided, time to get there, etc.
Physical medical storage facility, to include refrigeration if needed, and security.
Local State Division of EMS and local EMS organizations available in case of emergency.
Plan must be written and promulgated, so no question as to who’s doing what and how things are going to be handled.

Advanced training having special medical qualification requirements. Some NSCC training such as SEAL, EOD, SWCC, SCUBA and others may have more stringent medical qualification requirements. Where these requirements exist, they will be as promulgated by the COTC.

Appointed Officers, WO’s, Instructors and any Other Adult Escorts. All adults are required to ensure their NSCADM 020 is kept up to date after first enrolling. The NSCADM 020 is to be reviewed and updated at least annually and when ever any changes occur. Further, any adults performing escort duty are required to update their NSCADM 020 within 30 days of departing for escort duty, and annotate or comment on any medical conditions that they have or changes that might have occurred since last review. COTC’s may request a copy of the NSCADM 020.