In which case is a medical fitness for sea pilots excluded?

Someone is unfit for service as sea pilot if he or she, among other things,

has very poor eyesight and insufficient contrast vision during twilight,
has red-green colour blindness (deck department and technical department),
has a language or speech impairment, in particular an impairment to give clear and coherent instructions on board,
displays unsatisfactory performance of the cardiovascular system,
takes medication or has a health condition that significantly limits him or her physically or mentally,
has a body mass index of over 40 kg/m².