Guide to medical fitness standards for applicants




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GUIDE TO MEDICAL FITNESS STANDARDS FOR APPLICANTS

Applicants must be screened to identify medical conditions, which might limit their ability to complete their training or might result in excessive costs for medical care for a preexisting condition.


This guide provides medical fitness standards of sufficient detail to ensure uniformity in the medical evaluation of applicants for training programs. Although the guide attempts to generally include all disease conditions, it is not possible to cover every disease or physical finding. It is the responsibility of the medical examiner to use sound medical judgment to determine fitness of those personnel whom have medical findings not covered precisely by the guide.
If a disqualifying defect listed in this guide is identified but not considered disqualifying for this particular applicant, the examining physician should state the reasons why the finding is not likely to limit performance or cause undue risk during training. In addition, those conditions indicated as causes for rejection, which can be corrected by treatment or by spontaneous cure will be reconsidered following resolution and/or therapy when substantiating studies have been completed and received.
The medical assessment should be based on the established classifications given in the following Guide to Medical Fitness.
MEDICAL CONDITIONS LISTED UNDER EACH HEADING IN SECTION ONE THROUGH SIXTEEN ARE REASONS FOR DISQUALIFICATION UNLESS OTHERWISE STATED.



CONTENTS



SECTION

1

ABDOMEN AND GASTROINTESTINAL SYSTEM

SECTION

2

BLOOD AND BLOOD-FORMING DISEASES

SECTION

3

EARS AND HEARING

SECTION

4

ENDOCRINE AND METABOLIC DISORDERS

SECTION

5

MUSCULO-SKELETAL SYSTEM

SECTION

6

EYES AND VISION

SECTION

7

GENITO-URINARY SYSTEM

SECTION

8

HEAD AND NECK

SECTION

9

HEART AND VASCULAR SYSTEM

SECTION

10

HEIGHT, WEIGHT AND BODY BUILD

SECTION

11

LUNG AND CHEST WALL

SECTION

12

MOUTH NOSE, PHARYNX, TRACHEA, ESOPHAGUS AND LARYNX

SECTION

13

NEUROLOGICAL DISORDERS

SECTION

14

PSYCHOSES, PHYCHONEUROSES, PERSONALITY DISORDERS, ALCOHOLISH, DRUG DEPENDENCE, ETC.

SECTION

15

SKIN AND CELLULAR TISSUES

SECTION

16

SYSTEMIC DISEASES AND MISCELLANEOUS CONDITIONS AND DEFECTS



MEDICAL CONDITIONS LISTED UNDER EACH HEADING ABOVE ARE REASONS FOR DISQUALIFICATION UNLESS OTHERWISE STATED.

Section 1



ABDOMEN AND GASTROINTESTINAL SYSTEM




Cholecystitis (gall bladder disease) chronic with symptoms so severe as to interfere with normal activities.
Cholelithiasis (gall stones), symptomatic or asymptomatic.
Cirrhosis demonstrated by abnormal liver function tests with or without jaundice, or with acites or varices of the esophagus.
Hepatitis, active or chronic demonstrated by liver function tests.
Hernia, symptomatic inguinal, umbilical, hiatal.
Intestinal tract, megacolon, diverticulitis, ulcerative colitis, Chron’s disease.
Rectum and anus, stricture, fissure, prolapse, hemorrhoids.
Pancreas, acute or chronic disease.
Spleen, diseases involving, spleenectomy within the last two years.
Tumors, benign or malignant. (see section 15)
Ulcer, stomach or duodenal confirmed by history or X-Ray.
OTHER CONGENITAL OR ACQUIRED ABNORMALITIES AND DEFECTS WHICH REQUIRE SPECIAL MEDICAL CARE.
Section 2

BLOOD AND BLOOD-FORMING TISSUE DISEASES




Anemias, blood loss anemia, abnormal destruction of RBCs (hemolytic anemia) faulty RBC production including: hereditary hemolytic anemia, thalassemia, sickle cell and other clinically significant hemoglobinopathies.
Hemorrhagic states, caused b coagulation defect or vascular instability.
Leukopenia, chronic or recurrent.
Myeloproliferative disease, polycythemia, leukemia, etc.

Hypogammaglobulinemia




Acquired Immune Deficiency Syndrome & ARC\



Malignancies, those conditions associated with the blood forming elements.
Section 3

EARS AND HEARING




Auditory canal, tumors or obstruction of the ear canal.
Mastoids, chronic mastoiditis.
Tympanic membrane (ear drum), perforation or severe scarring associated with a hearing level below standards and requiring hearing apparatus.
OTHER DEFECTS AND DISEASES OF THE EAR REQUIRING FREQUENT AND PROLONGED TREATMENT.
Hearing defect, significant hearing loss determined by audiometer. Use of a hearing aid to bring auditory acuity up to acceptable standards is permitted.
Section 4

ENDOCRINE AND METABOLIC DISORDERS




Adrenal gland, abnormal function of any degree.
Diabetes mellitus, requiring insulin and not controlled by diet, history of acidosis.
Thyroid, goiter, thyroid nodule (benign or malignant), hypo or hyperthyroidism.
Gout, moderate to severe with renal complications, any gouty condition not controlled by diet or medication.
Hyperlipidemia, familial.
OTHER ENDOCRINE OR METABOLIC DISORDERS WHICH REQUIRE FREQUENT MONITORING AND TREATMENT.
Section 5

MUSCULO-SKELETAL SYSTEM




Extremities, congenital or acquired abnormality which requires frequent observation, evaluation and/or treatment including prosthetic appliances.
Arthritis, chronic osteoarthritis or traumatic arthritis, rheumatoid arthritis documented by laboratory studies or by history.
Osteomyelitis, any infection involving bone, including tuberculosis, which is active or recurrent, unless successfully treated two or more years previously.
Spine, diseases, abnormalities, or injuries which require continual treatment or evaluation of the spine and prevent physically active participation in training. Intervertebral disc herniation or history of surgical intervention unless two or more years have passed and no symptoms exist.
Fractures, any fracture of a bone which has not healed completely and therefore requires continual treatment.

Section 6



EYES AND VISION



EYES



Lids, ptosis, growth or tumor, which interferes with vision.
Conjunctiva, conjunctivitis, including trachoma interfering with normal vision.
Cornea, opacification of the cornea from any cause, including corneal ulcer, herpetic ulcer.
Retina, degeneration, detachment of the retina, or congenital condition that impairs vision.
Lens, opacities or dislocation of the lens which interferes with vision.
Glaucoma, primary or secondary that is not easily controlled by medication or where vision is significantly affected.
ALL OTHER DEFECTS AND DISEASES WHICH IMPAIR VISION OR REQUIRE CONTINUED EVALUATION AND TREATMENT.


VISION



Distant vision, visual acuity which does not correct to at least one of the following:
20/30 in one eye and;

20/100 in the other eye.


20/20 in one eye and;

20/400 in the other eye.


Section 7

GENITO-URINARY SYSTEM




Kidney, absence of one kidney unless the remaining kidney has normal function, cystic or polycystic kidney, chronic infection of the urinary tract such as pyelonephritis, glomerulonephritis, or tuberculosis. Any tumor or persistent calculi (stone) which is identified and symptomatic.
Ureter, bladder, urethra, any infection which does not respond to treatment or reoccurs with such frequency so as to interfere with normal function. Stones located in any portion of the urinary tract.
Testicles, undescended testicle unless surgically corrected, epiditimitis, or tumors and cysts involving this organ.
Prostate, enlargement to such a degree so as to cause obstruction to urine flow, chronic infection.
Uterus, enlargement due to fibroids.
Pregnancy, until satisfactory delivery and no residual complication.
Ovaries, cysts or tumors or chronic infections involving the tubes (salpingitis).
Genitalia, male or female, any abnormality, acquired or congenital, that will require treatment; this includes cystocele, rectocele, vaginal cysts, hydrocele, etc.
Tumor, any tumor, benign or malignant, of the genito-urinary system.
ALL OTHER CONDITIONS INVOLVING THE G-U SYSTEM THAT WILL INTERFERE WITH NORMAL FUNCTION OR

REQUIRE EXTENSIVE MEDICAL CARE.
Section 8

HEAD AND NECK




Abnormalities, any injury or congenital changes which affect normal function.
Skull, any deformity if associated with evidence of compromise of brain, spinal cord, or peripheral nerve function.
Neck, congenital bronchial cleft cyst, spastic contraction of neck muscles (torticolis), cervical lymph node enlargement.
ALL OTHER CONDITIONS INVOLVING THE HEAD AND NECK THAT PROHIBIT NORMAL FUNCTION OR WHICH MAY REQUIRE EXTENSIVE MEDICAL CARE.
Section 9

HEART AND VASCULAR SYSTEM



Congenital abnormalities, heart and major vessels unless such abnormalities have been satisfactorily corrected without prosthesis and there are no residual or complications of treatment.
Valvular disease, this includes mitral valve prolapse which has persistent hemodynamic significance.
Ischemic myocardial disease, occlusive coronary artery disease as manifested by any of the following:

  • History of myocardial damage

  • Symptoms of acute or chronic ischemia

  • Electrocardiographic evidence of myocardial ischemia.


Pericarditis, including constrictive pericarditis unless surgically corrected.
Endocarditis, valve deformity with or without myocarditis.
Hypertrophy (enlargement) of the heart, dilitation for any reason, including congestive failure, parasitic infection (Chaga’s disease), etc.
Abnormal electrocardiogram, evidence of myocardial infarctions arrythmias, conduction disorder or defect including second or third degree heart block, persistent tachycardia or bradycardia.
Hypertension, manifested by consistent systolic pressure readings of 160 mm Mg. or more in a 35 year old person, 140 mm Hg. or more in a person under 35 years old, or in a person whose diastolic pressure remains above 95 mm Mg. at any age. Pre-existing hypertension well controlled by drug therapy and no evidence of involvement of any organs may be exempted if verified.
Acquired diseases of the circulatory system, aneurysms of major vessels, varicosities, thrombophlebitis, occlusive disease of vessels, arterio-spastic diseases, etc.
Rheumatic fever, evidence of Rheumatic Fever present now or within the past two years.
Coronary revescularization, any person who is a candidate for coronary bypass surgery or who has had such surgery in the past year.
ANY CARDIOVASCULAR CONDITION THAT INTERFERES WITH NORMAL FUNCTION OR REQUIRES MEDICAL CARE AND MONITORING.
Section 10

HEIGHT AND WEIGHT

Proportion of height to weight which would limit physical activity or normal function and place the subject at increased medical risk is reason for rejection.


The examining physician should include an evaluation of the subject’s physical condition and review those whose weight exceeds that from the height/weight table by more than 30 percent. If no additional conditions are present that would impede training a waiver may be provided.

Height and Weight Tables*




MEN




WOMEN










Height

Small

Medium

Large

Height

Small

Medium

Large

Feet

Inches

Frame

Frame

Frame

Feet

Inches

Frame

Frame

Frame

5

2

128-134

131-141

138-150

4

10

102-111

109-121



118-131

5

3

130-136

133-143

140-153

4

11

103-113

111-123

120-134

5

4

132-138

135-145

142-156

5

0

104-115

113-126

122-137

5

5

134-140

137-148

144-160

5

1

106-113

115-129

125-140

5

6

136-142

139-151

146-164

5

2

108-121

118-132

125-143

5

7

138-145

142-154

149-168

5

3

111-124

121-135

131-147

5

8

140-143

145-157

152-172

5

4

114-127

124-138

134-151

5

9

142-151

148-160

155-176

5

5

117-130

127-141

137-155

5

10

144-154

151-163

158-180

5

6

120-133

130-144

140-159

5

11

146-157

154-166

161-184

5

7

123-136

133-147

143-163

6

0

149-160

157-170

164-188

5

8

126-139

136-150

146-167

6

1

152-164

160-174

168-192

5

9

129-142

139-153

149-170

6

2

155-168

164-178

172-197

5

10

132-145

142-156

152-173

6

3

158-172

167-182

176-202

5

11

135-143

145-159

155-176

6

4

162-176

171-187

181-207

6

0

138-151

148-162

158-179

*In shoes with one-inch heels and under clothing weighing five pounds for men and three pounds for women.


Section 11

LUNGS AND CHEST WALL


Tuberculous lesions, active tuberculosis or evidence of tuberculosis within the past two years. Treated and healed tuberculosis which is demonstrated as inactive by X-ray and laboratory studies is not disqualifying. The subject should not currently require anti-tuberculosis treatment.


Lung, lobectomy for any reason, pneumothorax which has reoccurred within the past two years regardless of cause, abscess of the lung bullous emphysema, or bronchopleural fistula.
Infectious disease, any non-tubercular chronic infection involving the lungs such as sarcoidosis, histoplasmosis, coccidiomycosis mycotic infections, chronic lung abscesses.
Respiratory diseases, asthma requiring frequent medication and/or requiring hospitalization in the past five years, bronchiectasis, chronic emphysema, and extensive pulmonary fibrosis.
Tumor, any tumor or growth, malignant or benign.
Chest wall, any deformity causing pulmonary insufficiency.
ALL OTHER CONDITIONS OF THE CHEST AND LUNGS THAT RESULT IN DIFFICULTY IN RESPIRATION AND

THUS LIMIT ACTIVITY OR REQUIRE EXTENSIVE MEDICAL CARE ARE REASONS FOR REJECTION.
Section 12

MOUTH, NOSE, THROAT, ESOPHAGUS, LARYNX



Nose, allergies not controlled by medication, nasal polyps, perforated nasal septum associated with interference of function.
Sinuses, chronic sinusitis requiring frequent medical attention.
Pharynx/Larynx, disease condition which results in ulceration or obstruction, tumor or polyps, laryngeal paralysis which interferes with swallowing or speech.
Esophagus, obstruction due to scarring or tumor, varicose veins associated with portal hypertension.
Tongue, paralysis affecting speech, tumors.
ALL OTHER CONDITIONS THAT INTERFERE WITH FUNCTION OR REQUIRE CONTINUED MEDICAL CARE.
Section 13

NEUROLOGICAL DISORDERS




Degenerative disorders, cerebral arterial sclerosis, ataxias, multiple sclerosis, Parkinson’s disease, etc.
Convulsive disorders, all forms of psychomotor or temporal lobe epilepsy except by history more then five years previous and not requiring medication for control.
Migraine headaches, those headaches which respond poorly to treatment and result in incapacitation.
Paralysis, incapacitation, congenital or acquired, if subject is unable to care for himself or where therapy or appliances are required.
Peripheral nerve disorder, neuralgia which is chronic and of an intensity that is incapacitating, polyneuritis, neurofibromatosis.
NEUROLOGICAL CONDTIONS THAT LIMIT FNCTION AND THE ABILITY TO COMPLY WITH TRAINING PROGRAMS OR REQUIRE EXTENSIVE MEDICAL CARE.
Section 14
PSYCHOSES, PSYCHONEUROSES, PERSONALITY DISORDERS, DRUG DEPENDENCE, ETC.

Psychoses, current behavior suggestive of a psychosis or by history unless of a brief duration and at least three years have elapsed since recovery.
Psychoneuroses, neurotic symptoms or behavior which impairs occupation or interpersonal effectiveness, depressive state which is or was sufficiently severe to require hospitalization or therapy.
Personality disorders, personality inadequacy which will seriously interfere with adjustment.
Drug dependencies, this includes all illegal drugs and the state o alcoholism which is characterized b repeated and excessive abuse of alcohol which interfere with normal functions. Recovering alcoholics who have a period of sobriety for more than three years may be considered for training if continued participation in a form of treatment can be assured.
OTHER PSYCHIATRIC CONDITIONS WHICH INTERFERE WITH EXPECTED ACTIVITIES OR THOSE WHICH MAY

INVOLVE OR AFFECT OTHERS ARE REASONS FOR DISQUALIFICATION.
Section 15

SKIN DISORDERS




Lupus erythematosis, discoid or systemic which is not controlled or is aggravated by sunlight.
Psoriasis, if extensive and requiring frequent medical attention.
Pemphigus, familial and vulgaris, especially when in bullious form and requiring extensive medical care.
Fungal any of the fungal infections which are chronic and unresponsive to treatment.
Eczema, atopic dermatitis, if symptomatic and unresponsive to treatment.
Malignancies, basal cell, squamous cell, or malignant melanoma cancers which have not been adequately treated, leukemia cutis.
OTHER CHRONIC DISORDERS OF THE SKIN OF A DEGREE OR NATURE WHICH REQUIRE FREQUENT

OUTPATIENT TREATMENT OR INTERFERE WITH NORMAL FUNCTION.
Section 16

SYSTEMIC DISEASES AND OTHER CONDITIONS




Tuberculosis, active tuberculosis in any form or location except treated or spontaneously healed lesions for more than one year under supervised treatment.
Sarcoidosis, unless the manifestations of the disease are limited to hilaradenopathy and the condition has been stable for more than two years.
Allergies, all forms of skin, respiratory, rhinitis allergies that require constant medical evaluation, treatment or desensitization.
Parasitic infections, this includes schistosomiasis, filariasis, trypanisomiasis, amebiasis, hookworm, and other similar parasitic infections until successfully treated.
Tumors, for this purpose, tumor includes all malignancies and benign lesions which interfere with normal function, require extensive medical treatment or surveillance and have the potential for increased morbidity or mortality.
Malignancies, this includes lymphomas, leukemia, Hodgkins disease, etc.
Venereal, any acute or chronic venereal disease such as Syphilis, Gonorrhea, Lymphogranuloma Benereum, Acquired Immune Deficiency Syndrome (AIDS), etc. The finding of a positive blood test for syphilis following the adequate WHO treatment is not in itself considered evidence of chronic venereal disease.


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