military fitness standard

8/13/2019 Military Fitness Standard

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AR 40-501Chapter 3Medical Fitness Standards for Retention andSeparation, Including Retireent

3!1" #eneralThis chapter gives the various medical conditions and physical defects which mayrender a Soldier unfit for further military service and which fall below the standardsrequired for the individuals in paragraph 32 below.3!$" Application

These standards apply to the following individuals (see chaps 4 and for otherstandards that apply to specific specialties!"a. #ll commissioned and warrant officers of the #ctive #rmy$ #%&'#%&')S$ and)S#%.b. #ll enlisted Soldiers of the #ctive #rmy$ #%&'#%&')S$ and )S#%.c. Students already enrolled in the *+S+ and )S)*S programs.d. ,nlisted Soldiers of the #%&'#%&')S or )S#% who apply for enlistment in the#ctive #rmy.e. -ommissioned and warrant officers of the #%&'#%&')S or )S#% who apply forappointment in the #ctive #rmy.f. Soldiers of the #%&'#%&')S or )S#% who reenter active duty under the /splittraining option.0 (*owever$ the weight standards of tables 21 and 22 apply to splitoption trainees.!g. %etired Soldiers recalled to active duty.3!3" %ispositionSoldiers with conditions listed in this chapter who do not meet the required medicalstandards will be evaluated by an , as defined in #% 44 and will be referredto a +, as defined in #% 534 with the following caveats"a. )S#% or #%&'#%&')S Soldiers not on active duty$ whose medical condition was

not incurred or aggravated during an active duty period$ will be processed inaccordance with chapter 6 and chapter 1 of this regulation.b. Soldiers pending separation in accordance with provisions of #% 532 or #%5724 authori8ing separation under other than honorable conditions who do notmeet medical retention standards will be referred to an ,. 9n the case of enlistedSoldiers$ the physical disability processing and the administrative separationprocessing will be conducted in accordance with the provisions of #% 532 and #%534. 9n the case of commissioned or warrant officers$ the physical disabilityprocessing and the administrative separation processing will be conducted inaccordance with the provisions of #% 5724 and #% 534.c. # Soldier will not be referred to an , or a +, because of impairments that were:nown to e;ist at the time of acceptance in the #rmy and that have remainedessentially the same in degree of severity and have not interfered with successful

performance of duty.d. +hysicians who identify Soldiers with medical conditions listed in this chaptershould initiate an , at the time of identification. +hysicians should not deferinitiating the , until the Soldier is being processed for nondisability retirement.any of the conditions listed in this chapter (for e;ample$ arthritis in para 314b! fallbelow retention standards only if the condition has precluded or prevented successfulperformance of duty. 9n those cases when it is clear the condition is long standingand has not prevented the Soldier from reaching retirement$ then the Soldier meetsthe standard and an , is not required.e. Soldiers who have previously been found unfit for duty by a +,$ but were


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continued on active duty (-s =isease9leitis$ regional$ e;cept when responding well to treatment.i. +ancreatitis$ chronic$ with frequent abdominal pain of a severe nature@ steatorrheaor disturbance of glucose metabolism requiring hypoglycemic agents.

j. +eritoneal adhesions with recurring episodes of intestinal obstruction characteri8edby abdominal colic:y pain$ vomiting$ and intractable constipation requiring frequentadmissions to the hospital.k. +roctitis$ chronic$ with moderate to severe symptoms of bleeding$ painfuldefecation$ tenesmus$ and diarrhea$ and repeated admissions to the hospital.l. )lcer$ duodenal$ or gastric with repeated hospitali8ation$ or /sic: in quarters0because of frequent recurrence ofsymptoms (pain$ vomiting$ or bleeding! in spite ofgood medical management and supported by endoscopic evidence of activity.m. )lcerative colitis$ e;cept when responding well to treatment.n. %ectum$ stricture of with severe symptoms of obstruction characteri8ed byintractable constipation$ pain on defecation$ or difficult bowel movements$ requiringthe regular use of la;atives or enemas$ or requiring repeated hospitali8ation.


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3!(" #astrointestinal and a'doinal surger&The causes for referral to an , are as follows"a. -olectomy$ partial$ when more than mild symptoms of diarrhea remain or ifcomplicated by colostomy.b. -olostomy$ when permanent.c. ,nterostomy$ when permanent.d. 'astrectomy$ total.

e. 'astrectomy$ subtotal$ with or without vagotomy$ or gastro?e?unostomy$ with orwithout vagotomy$ when$ in spiteof good medical management$ the individual develops /dumping syndrome0 whichpersists for 5 months postoperatively@ or develops frequent episodes of epigastricdistress with characteristic circulatory symptoms or diarrhea persisting 5 monthspostoperatively@ or continues to demonstrate appreciable weight loss 5 monthspostoperatively.f. 'astrostomy$ when permanent.g. 9leostomy$ when permanent.h. +ancreatectomy. i. +ancreaticoduodenostomy$ pancreaticogastrostomy$ or pancreatico?e?unostomy$followed by more than mild symptoms of digestive disturbance$ or requiring insulin.

j. +roctectomy.k. +roctope;y$ proctoplasty$ proctorrhaphy$ or proctotomy$ if fecal incontinenceremains after an appropriate treatment period.3!)" *lood and 'lood-foring tissue diseases

The causes for referral to an , are as follows"a. #nemia$ hereditary$ acquired$ aplastic$ or unspecified$ when response to therapy isunsatisfactory$ or when therapy is such as to require prolonged$ intensive medicalsupervision.b. *emolytic crisis$ chronic and symptomatic.c. Aeu:openia$ chronic$ when response to therapy is unsatisfactory$ or when therapyis such as to require prolonged$ intensive medical supervision.d. *ypogammaglobulinemia with ob?ective evidence of function deficiency andsevere symptoms not controlled with treatment.e. +urpura and other bleeding diseases$ when response to therapy is unsatisfactory$or when therapy is such as to require prolonged$ intensive medical supervision.f.Thromboembolic disease when response to therapy is unsatisfactory$ or whentherapy is such as to requireprolonged$ intensive medical supervision.g. Splenomegaly$ chronic.h. *9B confirmed antibody positivity$ with the presence of progressive clinical illnessor immunological deficiency. Cor #ctive #rmy Soldiers and %- Soldiers on active dutyfor more than 3 days (e;cept for training under 1 )S- 1147!$ an , must beaccomplished and$ if appropriate$ the Soldier must be referred to a +, under #%534. Cor %- Soldiers not on active duty for more than 3 days or on #=T under 1)S- 1147$ referral to a +, will be determined under #% 534. %ecords of officialdiagnoses provided by private physicians (that is$ civilian doctors providingevaluations under contract with =epartment of the #rmy (=#! or =


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The causes for referral to an , are diseases of the ?aws$ periodontium$ orassociated tissues when$ following restorative surgery$ there are residuals that areincapacitating or interfere with the individual>s satisfactory performanceof military duty.3!." /ars

The causes for referral to an , are as follows"a. 9nfections of the e;ternal auditory canal when chronic and severe$ resulting inthic:ening and e;coriation of the canal or chronic secondary infection requiringfrequent and prolonged medical treatment and hospitali8ationb. alfunction of theacoustic nerve. (,valuate functional impairment of hearing under para 31.!c. astoiditis$ chronic$ with constant drainage from the mastoid cavity$ requiringfrequent and prolonged medical care.d. astoiditis$ chronic$ following mastoidectomy$ with constant drainage from themastoid cavity$ requiring frequent and prolonged medical care or hospitali8ation.e. EniFre>s syndrome or any peripheral imbalance$ syndrome or labyrinthinedisorder with recurrent attac:s of sufficient frequency and severity as to interferewith the satisfactory performance of duty or requiring frequent or prolonged medical

care or hospitali8ation.f.


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m. +ituitary macroadenomas when resulting in hypothalamicpituitary dysfunction orsymptoms of mass effect.n. +heochromocytoma.o.Thyroid carcinoma$ any type$ if persistent despite usual therapy (surgery$radioactive iodine and treatment with suppressive doses of levothyro;ine!.3!1$" pper e2treities

The causes for referral to an , are as follows (see also para 314!"a. #mputation.(1! Cor purposes of this regulation$ upper e;tremity amputation is defined as the lossof part or parts of an upper e;tremity equal to or greater than(a) # thumb pro;imalto the interphalangeal ?oint.(b)Two fingers of one hand$ other than the little finger$ at the pro;imalinterphalangeal ?oints.(c)


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symptoms@ or severe with arthritic changes.(2! +es planus$ when symptomatic$ more than moderate$ with pronation on weightbearing which prevents the wearing of military footwear$ or when associated withvascular changes.(3! +es cavus when moderately severe$ with moderate discomfort on prolongedstanding and wal:ing$ metatarsalgia$ and which prevents the wearing of military

footwear.(4! &euroma that is refractory to medical treatment$ refractory to surgical treatment$and interferes with thesatisfactory performance of military duties.(! +lantar fascitis or heel spur syndrome that is refractory to medical or surgicaltreatment$ interferes with the satisfactory performance of military duties$ or preventsthe wearing of military footwear.(5! *ammertoes$ severe$ that precludes the wearing of appropriate military footwear$refractory to surgery$ or interferes with satisfactory performance of duty.(D! *allu; limitus$ hallu; rigidus.c. Internal derangement of the knee.(1! %esidual instability following remedial measures$ if more than moderate indegree.(2! 9f complicated by arthritis$ see paragraph 314a.d. Joint ranges of motion (ROM). %


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(4! -allus$ e;cessive$ following fracture$ when functional impairment precludessatisfactory performance of duty andthe callus does not respond to adequate treatment.g.Ioints.(1! #rthroplasty with severe pain$ limitation of motion$ and of function.(2! ony or fibrous an:ylosis$ with severe pain involving ma?or ?oints or spinalsegments in an unfavorable position$ and with mar:ed loss of function.

(3! -ontracture of ?oint$ with mar:ed loss of function and the condition is notremediable by surgery.(4! Aoose bodies within a ?oint$ with mar:ed functional impairment and complicatedby arthritis to such a degree as to preclude favorable results of treatment or notremediable by surgery.(! +rosthetic replacement of ma?or ?oints if there is resultant loss of function or painthat precludes satisfactory performance of duty.h. uscles.(1! Claccid paralysis of one or more muscles with loss of function that precludessatisfactory performance of duty following surgical correction or if not remediable bysurgery.(2! Spastic paralysis of one or more muscles with loss of function that precludes thesatisfactory performance of military duty.i. yotonia congenita.

j. s disease! with involvement of single or multiple boneswith resultant deformities or symptoms severely interfering with function.k.


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of the condition of the better eye.i. ilateral detachment of retina$ regardless of etiology or results of correctivesurgery.3!1(" ision

The causes for referral to an , are as follows"a. #nisei:onia$ with sub?ective eye discomfort$ neurologic symptoms$ sensations of

motion sic:ness and other gastrointestinal disturbances$ functional disturbances anddifficulties in form sense$ and not corrected by isei:onica lenses.b. inocular diplopia$ not correctable by surgery$ that is severe$ constant$ and in a8one less than 2 degrees from the primary position.c. *emianopsia$ of any type if bilateral$ permanent$ and based on an organic defect.

Those due to a functional neurosis and those due to transitory conditions$ such asperiodic migraine$ are not considered to fall below required standards.d. &ight blindness$ of such a degree that the Soldier requires assistance in any travelat night.e. Bisual acuity.(1! Bision that cannot be corrected with ordinary spectacle lenses (contact lenses orother special corrective devices (telescopic lenses$ and so forth! are unacceptable! toat least" 24 in one eye and 21 in the other eye$ or 23 in one eye and22 in the other eye$ or 22 in one eye and 27 in the other eye$ or (2! #neye has been enucleated.f. Bisual field with bilateral concentric constriction to less than 2 degrees.3!1)" #enitourinar& s&ste

The causes for referral to an , are as follows"a. -ystitis$ when complications or residuals of treatment themselves precludesatisfactory performance of duty.b. =ysmenorrhea$ when symptomatic$ irregular cycle$ not amenable to treatment$and of such severity as tonecessitate recurrent absences of more than 1 day.c. ,ndometriosis$ symptomatic and incapacitating to a degree that necessitates

recurrent absences of more than 1 day.

d. *ypospadias$ when accompanied by evidence of chronic infection of thegenitourinary tract or instances where the urine is voided in such a manner as to soilclothes or surroundings and the condition is not amenable to treatment.e. 9ncontinence of urine$ due to disease or defect not amenable to treatment and ofsuch severity as to necessitate recurrent absence from duty.f. Lidney.(1! -alculus in :idney$ when bilateral$ resulting in frequent or recurring infections$ orwhen there is evidence of obstructive uropathy not responding to medical or surgicaltreatment.(2! -ongenital anomaly$ when bilateral$ resulting in frequent or recurring infections$or when there is evidence of obstructive uropathy not responding to medical orsurgical treatment.(3! -ystic :idney (polycystic :idney!$ when symptomatic and renal function isimpaired or is the focus of frequent infection.(4! 'lomerulonephritis$ when chronic.(! *ydronephrosis$ when more than mild$ bilateral$ and causing continuous orfrequent symptoms.(5! *ypoplasia of the :idney$ when symptomatic and associated with elevated bloodpressure or frequent infections and not controlled by surgery.(D! &ephritis$ when chronic.(7! &ephrosis.(6! +erirenal abscess$ with residuals of a degree that precludes the satisfactory


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performance of duty.(1! +yelonephritis or pyelitis$ when chronic$ that has not responded to medical orsurgical treatment$ with evidence of hypertension$ eyeground changes$ cardiacabnormalities.(11! +yonephrosis$ when not responding to treatment.g. enopausal syndrome$ physiologic or artificial$ when symptoms are not amenable

to treatment and preclude successful performance of duty.

h. -hronic pelvic pain with or without demonstrative pathology that has notresponded to medical or surgical treatment and of such severity to necessitaterecurrent absence from duty.i. Strictures of the urethra or ureter$ when severe and not amenable to treatment.

j. )rethritis$ chronic$ when not responsive to treatment and necessitating frequentabsences from duty.3!1+" #enitourinar& and g&necological surger&

The causes for referral to an , are as follows"a. -ystectomy.b. -ystoplasty$ if reconstruction is unsatisfactory or if residual urine persists in e;cess

of cubic centimeters or if refractory symptomatic infection persists.c. *ysterectomy$ when residual symptoms or complications preclude the satisfactoryperformance of duty.d. &ephrectomy$ when after treatment$ there is infection or pathology in theremaining :idney.e. &ephrostomy$ if drainage persists.f.


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The causes for referral to an , are torticollis (wry nec:!@ severe fi;ed deformitywith cervical scoliosis$ flattening of the head and face$ and loss of cervical mobility.(See also paras 311 and 336h.!3!$1" eart

The causes for referral to an , are as follows (see table 31 for functionalclassifications and for metabolic equivalents (,TS! ratings to be included in the

,!"

a. -oronary heart disease associated withJ(1! yocardial infarction$ angina pectoris$ or congestive heart failure due to fi;edobstructive coronary arterydisease or coronary artery spasm. The policies for trial of duty$ profiling$ and referralto an , and a +, (as outlined in para 32! apply. The trial of duty will be for 12days.(2! yocardial infarction with normal coronary artery anatomy. The policies for trialof duty$ profiling$ and referral to an , and a +, (as outlined in para 32! apply.

The trial of duty will be for 12 days.(3! #ngina pectoris in association with ob?ective evidence of myocardial ischemia inthe presence of normalcoronary artery anatomy.(4! Ci;ed obstructive coronary artery disease$ asymptomatic but with ob?ectiveevidence of myocardial ischemia. The policies for trial of duty$ profiling$ and referralto an , and a +, (as outlined in para 32! apply. The trial of duty will be for 12days.b. Supraventricular tachyarrhythmias$ when life threatening or symptomatic enoughto interfere with performance of duty and when not adequately controlled. Thisincludes atrial fibrillation$ atrial flutter$ paro;ysmal supraventricular tachycardia$ andothers.c. ,ndocarditis with any residual abnormality or if associated with valvular$congenital$ or hypertrophic myocardialdisease.d. *eart bloc: (second degree or third degree #B bloc:! and symptomaticbradyarrhythmias$ even in the absence oforganic heart disease or syncope. Kenc:ebach second degree heart bloc: occurringin healthy asymptomatic individuals without evidence of organic heart disease is nota cause for referral to a +,. &one of these conditions is cause for ,+, whenassociated with recogni8able temporary precipitating conditions" for e;ample$perioperative period$ hypo;ia$ electrolyte disturbance$ drug to;icity$ acute illness.e. yocardial disease$ &ew Mor: *eart #ssociation or -anadian -ardiovascularSociety Cunctional -lass 99 or worse. (See table 31.!f. Bentricular flutter and fibrillation$ ventricular tachycardia when potentially lifethreatening (for e;ample$ when associated with forms of heart disease that arerecogni8ed to predispose to increased ris: of death and when there is no definitivetherapy available to reduce this ris:! or when symptomatic enough to interfere withthe performance of duty. &one of these ventricular arrhythmias are a cause formedical board referral toa +, when associated with recogni8able temporaryprecipitating conditions" for e;ample$ perioperative period$ hypo;ia$ electrolytedisturbance$

drug to;icity$ or acute illness.g. Sudden cardiac death$ when an individual survives sudden cardiac death that isnot associated with a temporary or treatable cause$ and when there is no definitivetherapy available to reduce the ris: of recurrent sudden cardiac death.h. *ypertrophic cardiomyopathy when it restricts activity.i. +ericarditis as follows"(1! -hronic constrictive pericarditis unless successful remedial surgery has beenperformed.(2! -hronic serous pericarditis.


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j. Balvular heart disease with cardiac insufficiency at functional capacity of -lass 99 orworse as defined by the &ew Mor: *eart #ssociation. (See table 31.!k. Bentricular premature contractions with frequent or continuous attac:s$ whether ornot associated with organic heart disease$ accompanied by discomfort or fear of sucha degree as to interfere with the satisfactory performance of duty.l. %ecurrent syncope or near syncope of cardiovascular etiology that is not controlled

or when it interferes with the performance of duty$ even if the etiology is un:nown.

m. #ny cardiovascular disorder requiring chronic drug therapy in order to prevent theoccurrence of potentially fatal or severely symptomatic events that would interferewith duty performance.n. -ongenital heart disease that has long term ris:s$ complications$ or impact on dutyperformance. The e;ception would be those congenital heart disease conditions thatcan be repaired with resolution of long term ris:s$ complications$ and impact on dutyperformance.3!$$" ascular s&ste

The causes for referral to an , are as follows"a. #rteriosclerosis obliterans when any of the following pertain"

(1! 9ntermittent claudication of sufficient severity to produce discomfort and inabilityto complete a wal: of 2 yards or less on level ground at 112 steps per minutewithout a rest.(2! sinability to perform satisfactory duty. The policies for trial of duty$ profiling$ andreferral to an , and a +, (as outlined in para 32! apply.d. +eriarteritis nodosa with definite evidence of functional impairment.e. -hronic venous insufficiency (postphlebitic syndrome! when more than mild andsymptomatic despite elastic support.f. %aynaud>s phenomenon manifested by trophic changes of the involved partscharacteri8ed by scarring of the s:in or ulceration.g.Thromboangiitis obliterans with intermittent claudication of sufficient severity toproduce discomfort and inability to complete a wal: of 2 yards or less on levelground at 112 steps per minute without rest$ or other complications.h.Thrombophlebitis when repeated attac:s requiring treatment are of suchfrequency as to interfere with thesatisfactory performance of duty.i. Baricose veins that are severe and symptomatic despite therapy.

j. -old in?ury. (See paragraph 345!.3!$3" Miscellaneous cardio7ascular conditions

The causes for referral to an , are as follows"a. *ypertensive cardiovascular disease and hypertensive vascular disease. =iastolicpressure consistently more than 11 mm*g following an adequate period of therapyin an ambulatory status.


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b. %heumatic fever$ active$ with heart damage. %ecurrent attac:s. 3!$4" Surger& and other in7asi7e procedures in7ol7ing the heart,pericardiu, or 7ascular s&ste

These procedures include newly developed techniques or prostheses not otherwisecovered in this paragraph. The causes for referral to an , are as follows" a.+ermanent prosthetic valve implantation.

b. 9mplantation of permanent pacema:ers$ antitachycardia and defibrillator devices$and similar newly developed devices.c. %econstructive cardiovascular surgery employing e;ogenous grafting material.d. Bascular reconstruction$ after a period of 6 days trial of duty when medicallyadvisable$ that results in individual>s inability to perform satisfactory duty. Thepolicies for trial of duty$ profiling$ and referral to an , and a +, (as outlined inpara 32! apply.e. -oronary artery revasculari8ation$ with the option of a 12day trial of duty basedupon physician recommendation when the individual is asymptomatic$ withoutob?ective evidence of myocardial ischemia$ and when other functional assessment(such as e;ercise testing and newly developed techniques! indicates that it ismedically advisable. #ny individual undergoing median sternotomy for surgery will berestricted from lifting 2 pounds or more$ performing pullups and pushups$ or asotherwise prescribed by a physician for a period of 6 days from the date of surgeryon =# Corm 3346 (+hysical +rofile!. The policies for trial of duty$ profiling$ and referralto an , and a +, (as outlined in para 32! apply.f. *eart or heartlung transplantation.g. -oronary or valvular angioplasty procedures$ with the option of a 17day trial ofduty based upon physician recommendation when the individual is asymptomatic$without ob?ective evidence of myocardial ischemia$ and when other functionalassessment (such as cardiac catheteri8ation$ e;ercise testing$ and newly developedtechniques! indicates that it is medically advisable. The policies for trial of duty$profiling$ and referral to an , and a +, (as outlined in para 32! apply.h. -ardiac arrhythmia ablation procedures$ with the option of a 17day trial of dutybased upon physicianrecommendation when asymptomatic$ and no evidence of any unfitting arrhythmiaas noted in paragraph 321. The policies for trial of duty$ ,$ and physical profile(as outlined in para 32! apply.i. -ongenital heart disease with surgical orpercutaneous repair procedures$ with the option of a 17day trial of dutybased upon physician recommendations when the individual is asymptomatic andwhen other functional assessment procedures indicate it is advisable. The policies fortrial of duty and referral to an , are outlined in paragraph 32.3!$5" 8rial of dut& and profiling for cardio7ascular conditionsa.Trial of duty will be based upon physician recommendation when the individual isasymptomatic withoutob?ective evidence of myocardial ischemia$ and when other functional assessment(such as coronary angiography$ e;ercise testing$ and newly developed techniques!indicates it is medically advisable.b. +rior to commencing the trial of duty period$ an , will be accomplished in allcases (including evaluation by a cardiologist or internist! and a physical activityprescription on =# Corm 3346 will be provided by a physician. )pon completion ofthe trial of duty period$ the results will be incorporated into the ,. The results ofthe trial of duty will include the individual>s interim history$ present condition$prognosis$ and the final recommendations. # detailed report from the commander orsupervisor clearly describing the individual>s ability to accomplish assigned dutiesand to perform physical activity will be incorporated into the , record. The resultsof the , and an updated =# Corm 3346 will then be forwarded to a +, in all cases


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e;cept for the following" 9f the Soldier successfully completes thetrial of duty$ is considered a &ew Mor: *eart #ssociation Cunctional -lass 9$ #&= thereare no physical orassignments restrictions$ the Soldier may be returned to duty without referral to a+,. 9f the Soldier>s condition becomes worse at a later date$ a new , will beaccomplished and the Soldier will be referred to a +,. Cor %-

Soldiers not on active duty$ the trial of duty may consider performance in theSoldier>s civilian position$ as well as any military duty that may have been performedin the interim.c.The following profile guidelines supplement chapter D. 9ndividuals returning to atrial of duty will be given a temporary +3 profile with specific written limitations andinstructions for physical and cardiovascular rehabilitation on =# Corm 3346. Thecompleted , will include a permanent numerical designator in the /+0 factor of thephysical profile that is based on functional assessment as follows"(1! &umerical designator /1.0 9ndividuals who are asymptomatic$ without ob?ectiveevidence of myocardial ischemia or other cardiovascular functional abnormality (&ew

Mor: *eart #ssociation Cunctional -lass 9!.(2! &umerical designator /2.0 9ndividuals with minor physical activity limitations orwho require frequent medical followup.(3! &umerical =esignator /3.0 9ndividuals who are asymptomatic but with ob?ectiveevidence of myocardial ischemia or other cardiovascular functional abnormality.

Those requiring assignment limitations.(4! &umerical designator /4.0 9ndividuals who are symptomatic (&ew Mor: *eart#ssociation Cunctional -lass 99 or worse!.3!$(" 8u'erculosis, pulonar&

The causes for referral to an , for pulmonary tuberculosis"a. 9f an e;piration of service will occur before completion of the period ofhospitali8ation. (-areer Soldiers who e;press a desire to reenlist after treatment maye;tend their enlistment to cover the period of hospitali8ation.!b. Khen a member of the )S#% or #%&'#%&')S not on active duty has activedisease that will probably require treatment for more than 12 to 1 months includingan appropriate period of convalescence before he or she can perform fulltimemilitary duty. 9ndividuals who are retained in the )S#% or #%&'#%&')S whileundergoingtreatment may not be called or ordered to active duty (includingmobili8ation!$ #=T$ or inactive duty training (9=T! during the period of treatment andconvalescence.3!$)" Miscellaneous respirator& disorders

The causes for referral to an , are as follows"a. Asthma. This includes reactive airway disease$ e;erciseinduced bronchospasm$asthmatic bronchospasm$ or asthmatic bronchitis within the criteria outlined inparagraphs (1! through (4! below.(1! =efinitionsdiagnostic criteria are as follows.(a) #sthma is a clinical syndrome characteri8ed by cough$ whee8e$ or dyspnea andphysiologic evidence ofreversible airflow obstruction or airway hyperactivity that persists over a prolongedperiod of time (generally more than 5 to 12 months!.(b) %eversible airflow obstruction is defined as more than 1 percent increase inforced e;piratory volume in 1 second (C,B9! following the administration of aninhaled bronchodilator or prolonged corticosteroid therapy.(c) 9ncreased bronchial responsiveness is the presence of an e;aggerated decrease inairflow induced by a standard bronchoprovocation challenge such as methacholineinhalation (+=2 C,B1 less than or equal to 4mgml!. =emonstration of e;ercise


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induced bronchospasm (1 percent decline in C,B1! is also diagnostic of increasedbronchial responsiveness@ however$ failure to induce bronchospasm with e;ercisedoes not rule out the diagnosis of asthma. ronchoprovacation or e;ercise testingshould be performed by a credentialed provider privileged to perform the procedures.(d) Soldiers who are diagnosed as having asthma may be placed on a temporaryprofile under the /+0 factor of the physical profile for up to 12 months trial of duty$

when medically advisable. 9f at the end of that period$ the Soldier is unable toperform all military training and duty as cited below$ the Soldier will be referred to,+,.(e) #cute$ self limited$ reversible airflow obstruction and airway hyperactivity can becaused by upper respiratory infections and inhalation of irritant gases or pollutants.

This should not be permanently diagnosed as asthma unless significant symptoms orairflow abnormalities persist for more than 12 months.(2! -hronic asthma is cause for a permanent +3 or +4 profile and ,+, referralif itJ(a) %esults in repetitive hospitali8ations$ repetitive emergency room visits ore;cessive time lost from duty.(b) %equires repetitive use of oral corticosteroids to enable the Soldier to perform allmilitary training and duties.(c) %esults in inability to run outdoors at a pace that meets the standards for thetimed 2mile run despitemedications. (The +3 for the inability to perform the run refers to the inability due toasthma and should not be confused with giving an A2 or A3 based on an underlyingorthopedic condition that requires an alternate #rmy +hysicalCitness Test (#+CT!.!(d) +revents the Soldier from wearing a protective mas:.(3! #ll Soldiers meeting an , for asthma should receive a consultation from aninternist$ pulmonologist$ or allergist.(4! -hronic asthma meets retention standards$ but is a cause for a permanent +2profile if itJ(a) %equires regular medications including low dose inhaled corticosteroids andororal or inhaled bronchodilators@ but(b) =oes not prevent the Soldier from otherwise performing all military training andduties including the 2 mile run within time standards.(! Soldiers with a diagnosis of asthma who require no medications or activitylimitations require no profiling action.b. Atelectasis or massi!e collapse of the lung. oderately symptomatic withparo;ysmal cough at frequent intervals t h r o u g h o u t t h e d a y o r w i t h m od e r a t e e m p h y s e m a o r w i t h r e s i d u a l s o r c o m p l i c a t i o n s t ha t r e q u i r e r e p e a t e d hospitali8ation.c. "ronchiectasis or bronchiolectasis. -ylindrical or saccular type that is moderatelysymptomatic$ with paro;ysmal cough at frequent intervals throughout the day orwith moderate emphysema with a moderate amount of bronchiectatic sputum or withrecurrent pneumonia or with residuals or complications that require repeatedhospitali8ation.d. "ronchitis. -hronic$ severe$ persistent cough$ with considerable e;pectoration or

with dyspnea at rest or on slight e;ertion or with residuals or complications thatrequire repeated hospitali8ation.e. #$stic disease of the lung congenital disease in!ol!ing more than one lobe of alung.f. %iaphragm congenital defect. Symptomatic.g. &emopneumothora' hemothora' or p$opneumothora'. ore than moderatepleuritic residuals with persistent underweight or mar:ed restriction of respiratorye;cursions and chest deformity or mar:ed wea:ness and fatigue on slight e;ertion.h. &istoplasmosis. -hronic and not responding to treatment.


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i. +leurisy$ chronic$ or pleural adhesions. Severe dyspnea or pain on mild e;ertionassociated with definite evidence of pleural adhesions and demonstrable moderatereduction of pulmonary function.

j. neumothora' spontaneous. %ecurrent episodes of pneumothora; not correctedby surgery or pleural sclerosis.k. neumoconiosis. Severe$ with dyspnea on mild e;ertion.l. ulmonar$ calcification. ultiple calcifications associated with significantrespiratory embarrassment or active disease not responsive to treatment.m. ulmonar$ emph$sema. ar:ed emphysema with dyspnea on mild e;ertion anddemonstrable moderate reduc tion in pulmonary function.n. ulmonar$ fibrosis. Ainear fibrosis or fibrocalcific residuals of such a degree as tocause dyspnea on milde;ertion and demonstrable moderate reduction in pulmonary function.o. ulmonar$ sarcoidosis. 9f not responding to therapy and complicated bydemonstrable moderate reduction in pulmonary function.

p. tenosis bronchus. Severe stenosis associated with repeated attac:s ofbronchopulmonary infections requiring hospitali8ation of such frequency as tointerfere with the satisfactory performance of duty.3!$+" Surger& of the lungs

The cause for referral to an , is a complete lobectomy$ if pulmonary function(ventilatory tests! is impaired to a moderate degree or more.3!$." Mouth, esophagus, nose, phar&n2, lar&n2, and trachea

The causes for referral to an , are as follows"a. *sophagus.(1! #chalasia$ unless controlled by medical therapy.(2! ,sophagitis$ persistent and severe.(3! =iverticulum of the esophagus of such a degree as to cause frequentregurgitation$ obstruction$ and weight loss that does not respond to treatment.(4! Stricture of the esophagus of such a degree as to almost restrict diet to liquids$

require frequent dilatation and hospitali8ation$ and cause difficulty in maintainingweight and nutrition.b. +ar$n'.(1! +aralysis of the laryn; characteri8ed by bilateral vocal cord paralysis seriouslyinterfering with speech and adequate airway.(2! Stenosis of the laryn; of a degree causing respiratory embarrassment upon morethan minimal e;ertion.c. Obstructi!e edema of glottis. 9f chronic$ not amenable to treatment$ and requires atracheotomy.d. Rhinitis. #trophic rhinitis characteri8ed by bilateral atrophy of nasal mucousmembrane with severe crusting$ concomitant severe headaches$ and foul$ fetid odor.e. inusitis. Severe$ chronic sinusitis that is suppurative$ complicated by chronic orrecurrent polyps$ and that does not respond to treatment.f. ,rachea. Stenosis of trachea.3!30" eurological disorders

The causes for referral to an , are as follows"a. #myotrophic lateral sclerosis and all other forms of progressive neurogenicmuscular atrophy.b. #ll primary muscle disorders including facioscapulohumeral dystrophy$ limb girdleatrophy$ and myotonia dystrophy characteri8ed by progressive wea:ness andatrophy.c. yasthenia gravis unless clinically restricted to the e;traocular muscles.


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d. +rogressive degenerative disorders of the basal ganglia and cerebellum including+ar:inson>s disease$ *untington>s chorea$ hepatolenticular degeneration$ andvariants of Criedreich>s ata;ia.e. ultiple sclerosis$ optic neuritis$ transverse myelitis$ and similar demyelinatingdisorders.f. Stro:e$ including both the effects of ischemia and hemorrhage$ when residuals

affect performance.

g. igraine$ tension$ or cluster headaches$ when manifested by frequentincapacitating attac:s. #ll such Soldiers will be referred to a neurologist$ who willascertain the cause of the headaches. 9f the neurologist feels a trial of prophylacticmedicine is warranted$ a 3month trial of therapy can be initiated. 9f the headachesare not adequately controlled at the end of the 3 months$ the Soldier will undergo an, for referral to a +,. 9f the neurologist feels the Soldier is unli:ely to respond totherapy$ the Soldier can be referred directly to ,+,.h. &arcolepsy$ sleep apnea syndrome$ or similar disorders. (See para 341.! Theevaluation and treatment of these diagnoses by a neurologist or other sleepspecialist should be routinely sufficient.i. Sei8ure disorders and epilepsy. Sei8ures by themselves are not disqualifying unlessthey are manifestations of epilepsy. *owever$ they may be considered along withother disabilities in ?udging fitness. 9n general$ epilepsy is disqualifying unless theSoldier can be maintained free of clinical sei8ures of all types by nonto;ic doses ofmedications. The following guidance applies when determining whether a Soldier willbe referred to an ,+,.(1! #ll active duty Soldiers with suspected epilepsy must be evaluated by aneurologist who will determine whether epilepsy e;ists and whether the Soldiershould be given a trial of therapy on active duty or referred directly to an ,forreferral to a +,. 9n ma:ing the determination$ the neurologist may consider theunderlying cause$ ,,' findings$ type of sei8ure$ duration of epilepsy$ family history$Soldier>s li:elihood of compliance with therapeutic program$ absence of substanceabuse$ or any other clinical factor influencing the probability of control or theSoldier>s ability to perform duty during the trial of treatment.(2! 9f a trial of duty on treatment is elected by the neurologist$ the Soldier will begiven a temporary +3 profile with as few restrictions as possible.(3!


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3!31" %isorders ith ps&chotic featuresThe causes for referral to an , are mental disorders not secondary to into;ication$infectious$ to;ic$ or other organic causes$ with gross impairment in reality testing$resulting in interference with duty or social ad?ustment.3!3$" Mood disorders

The causes for referral to an , are as follows"

a. +ersistence or recurrence of symptoms sufficient to require e;tended or recurrenthospitali8ation@ orb. +ersistence or recurrence of symptoms necessitating limitations of duty or duty inprotected environment@ orc. +ersistence or recurrence of symptoms resulting in interference with effectivemilitary performance.3!33" An2iet&, soatofor, or dissociati7e disorders

The causes for referral to an , are as follows"a. +ersistence or recurrence of symptoms sufficient to require e;tended or recurrenthospitali8ation@ orb. +ersistence or recurrence of symptoms necessitating limitations of duty or duty inprotected environment@ orc. +ersistence or recurrence of symptoms resulting in interference with effectivemilitary performance.3!34" %eentia and other cogniti7e disorders due to general edicalcondition

The causes for referral to an , include persistence of symptoms or associatedpersonality change sufficient to interfere with the performance of duty or socialad?ustment.3!35" 9ersonalit&, ps&chose2ual conditions, transse2ual, gender identit&,e2hi'itionis,trans7estis, 7o&euris, other paraphilias, or factitious disorders:disorders of ipulse control not elsehere classifieda. # history of$ or current manifestations of$ personality disorders$ disorders ofimpulse control not elsewhere classified$ transvestism$ voyeurism$ other paraphilias$or factitious disorders$ psychose;ual conditions$ transse;ual$ gender identity disorderto include ma?or abnormalities or defects of the genitalia such as change of se; oracurrent attempt to change se;$ hermaphroditism$ pseudohermaphroditism$ or puregonadal dysgenesis or dysfunctional residuals from surgical correction of theseconditions render an individual administratively unfit.b.These conditions render an individual administratively unfit rather than unfitbecause of physical illness or medical disability. These conditions will be dealt withthrough administrative channels$ including #% 131D$ #% 131D7$ #% 532$ or#% 5724.3!3(" Adustent disordersSituational malad?ustments due to acute or chronic situational stress do not renderan individual unfit because of physical disability$ but may be the basis for

administrative separation if recurrent and causing interference with military duty.3!3)" /ating disorders

The causes for referral to an , are eating disorders that are unresponsive totreatment or that interfere with the satisfactory performance of duty.3!3+" S6in and cellular tissues

The causes for referral to an , are as follows"a. Acne. Severe$ unresponsive to treatment$ and interfering with the satisfactory


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performance of duty or wearing of the uniform or other military equipment.b. Atopic dermatitis. ore than moderate$ unresponsive to treatment$ and whichinterferes with the Soldier>s performance of duty.c. Am$loidosis. 'enerali8ed.d. #$sts and tumors. (See paras 342 and 343.!e. %ermatitis herpetiformis. &ot responsive to therapy.f. %ermatom$ositis.g. %ermographism. 9nterfering with the performance of duty.h. *cema chronic. %egardless of type$ when there is more than minimalinvolvement and the condition isunresponsive to treatment and interferes with the satisfactory performance of duty.i. *lephantiasis or chronic l$mphedema. &ot responsive to treatment.

j. *pidermol$sis bullosa.k. *r$thema multiforme. ore than moderate and recurrent or chronic.l. *'foliati!e dermatitis. -hronic.m. Fungus infections superficial or s$stemic t$pes. 9f not responsive to therapy andinterfering with the satisfactory performance of duty.n. &idradenitis suppurati!e and/or folliculitis decal!ans (dissecting cellulitis of thescalp).o. &$perhidrosis.


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involvement.c. pond$lol$sis or spond$lolisthesis. ore than mild symptoms resulting in repeatedoutpatient visits$ or repeated hospitali8ation or limitations effecting performance ofduty.d. #o'a !ara. ore than moderate with pain$ deformity$ and arthritic changes.e. &erniation of nucleus pulposus. ore than mild symptoms following appropriatetreatment or remedial measures$ with sufficient ob?ective findings to demonstrate

interference with the satisfactory performance of duty.

f. 5$phosis. ore than moderate$ interfering with military duties.g. coliosis. Severe deformity with over 2 inches deviation of tips of spinous processfrom the midline$ or of lesser degree if recurrently symptomatic and interfering withmilitary duties.h. -onradicular pain in!ol!ing the cer!ical thoracic lumbosacral or cocc$geal spine2hether idiopathic or secondar$ to degenerati!e disc or joint disease that fails torespond to ade1uate conser!ati!e treatment and necessitates significant limitationof ph$sical acti!it$. %ange of motion (%


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l. pond$loarthropathies. -hronic or recurring episodes of arthritis causing functionalimpairment interfering with successful performance of duty supported by ob?ective$sub?ective$ and radiographic findings$ or requires medication for control that requiresfrequent monitoring by a physician due to debilitating or serious side effects.(1! #n:ylosingpondylitis.(2! %eiter>s syndrome.

(3! +soriatic arthritis.(4! #rthritis associated with inflammatory bowel disease.(! Khipple>s disease.m. $stemic lupus er$thematosus.That interferes with successful performance ofduty or requires geographicassignment limitations or requires medication for control that requires frequentmonitoring by a physician due to debilitating or serious side effects.n. jogren6s s$ndrome. Khen chronic$ more than mildly symptomatic and resistant totreatment after a reasonable period of time.o. rogressi!e s$stemic sclerosis. =iffuse and limited disease that interferes withsuccessful performance of duty or requires geographic assignment limitations orrequires medication for control that requires frequent monitoring by a physician dueto debilitating or serious side effects.

p. M$opath$.To include inflammatory$ metabolic or inherited$ that interferes withsuccessful performance of duty or requires geographic assignment limitations orrequires medication for control that requires frequent monitoring by a physician dueto debilitating or serious side effects.1. $stemic !asculitis. 9nvolving ma?or organ systems$ chronic$ that interferes withsuccessful performance of duty or requires geographic assignment limitations orrequires medication for control that requires frequent monitoring by a physician dueto debilitating or serious side effects.r. &$persensiti!it$ angiitis. Khen chronic or having recurring episodes that are morethan mildly symptomatic or show definite evidence of functional impairment which isresistant to treatment after a reasonable period of time.s. "ehcet6s s$ndrome.That interferes with successful performance of duty or requiresgeographic assignmentlimitations or requires medication for control that requires frequent monitoring by aphysician due to debilitating or serious side effects.t. Adult onset till6s disease.That interferes with successful performance of duty orrequires geographic assignment limitations or requires medication for control thatrequires frequent monitoring by a physician due to debilitating or serious side effects.u. Mi'ed connecti!e tissue disease and other o!erlap s$ndromes.That interfere withsuccessful performance of duty or require geographic assignment limitations orrequire medication for control that requires frequent monitoring by a physician dueto debilitating or serious side effects.!. An$ chronic or recurrent s$stemic inflammator$ disease or arthritis not listedabo!e.That interferes with successful performance of duty or requires geographicassignment limitations$ or requires medication for control that requires frequentmonitoring by a physician due to debilitating or serious side effects.3!41" #eneral and iscellaneous conditions and defects

The causes for referral to an , are as follows"a. Allergic manifestations.(1! #llergic rhinitis$ chronic$ severe$ and not responsive to treatment. (See also paras326d and 326e.!(2! #sthma. (See para 32Da.!(3! #llergic dermatoses. (See para 337.!b. #old injur$/heat injur$. (See paras 34 and 345.!c. leep apnea.


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daytime hypersomnolence or snoring that interferes with the sleep of others and thatcannot be corrected with medical therapy$ surgery$ or oral prosthesis. The diagnosismust be based upon a nocturnal polysomnogram and the evaluation of apulmonologist$ neurologist$ or a provider with e;pertise in sleep medicine. # 12month trial of therapy with nasal continuous positive air pressure may be attemptedto assist in weight reduction or other interventions$ during which time the individual

will be profiled as T3. Aongterm therapy with nasal continuous positive air pressurerequires referral to an ,.d. Fibrom$algia. Khen severe enough to prevent successful performance of duty.=iagnosis will include evaluation by a rheumatologist.e. Miscellaneous conditions and defects. -onditions and defects not mentionedelsewhere in this chapter are causes for referral to an ,$ ifJ(1! The conditions (individually or in combination! result in interference withsatisfactory performance of duty as substantiated by the individual>s commander orsupervisor.(2! The individual>s health or wellbeing would be compromised if he or she were toremain in the military service.(3! 9n view of the Soldier>s condition$ his or her retention in the military service wouldpre?udice the best interests of the 'overnment (for e;ample$ a carrier ofcommunicable disease who poses a health threat to others!. Nuestionable cases$including those involving latent impairment$ will be referred to +,s.3!4$" Malignant neoplass

The causes for referral to an , are as follows"a. alignant neoplasms that are unresponsive to therapy$ or when the residuals oftreatment are in themselves unfitting under other provisions of this chapter.b. &eoplastic conditions of the lymphoid and bloodforming tissues that areunresponsive to therapy$ or when the residuals of treatment are in themselvesunfitting under other provisions of this chapter.c. alignant neoplasms$ when on evaluation for administrative separation orretirement$ the observation period subsequent to treatment is deemed inadequate in

accordance with accepted medical principles.d.The above definitions of malignancyor malignant disease e;clude basal cell carcinoma of the s:in.

3!43" *enign neoplassThe causes for referral to an , are as follows"a. enign tumors if their condition precludes the satisfactory performance of militaryduty.b. 'anglioneuroma. c. eningeal fibroblastoma$ when the brain is involved.d. +igmented villonodular synovitis when severe enough to prevent successfulperformance of duty.3!44" Se2uall& transitted diseasesThe causes for referral to an , are as follows"a. Symptomatic neurosyphilis in any form.b. -omplications or residuals of a se;ually transmitted disease of such chronicity ordegree that the individual is incapable of performing useful duty.3!45" eat illness and inur&

The causes for referral to an , are as follows"


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a. &eat e'haustion.(1! *eat e;haustion is defined as collapse$ including syncope$ occurring during orimmediately following e;erciseheat stress without evidence of organ damage orsystemic inflammatory activation.(2! 9ndividual episodes of heat e;haustion are not cause for , referral. *owever$

Soldiers suffering fromrecurrent episodes of heat e;haustion (three or more in less than 24 months! shouldbe referred for complete medical evaluation for contributing factors.(3! 9f no remediable factor causing recurrent heat e;haustion is identified$ then theSoldier will be referred to an ,.b. &eat stroke.(1! The definitions of heat stro:e are as follows"(a) *eat stro:e" # syndrome of hyperpyre;ia$ collapse$ and encephalopathy withevidence of organ damage andor systemic inflammatory activation occurring in thesetting of environmental heat stress.(b) ,;ertional rhabdomyolysis" %habdomyolysis with myoglobinuria occurring withe;erciseheat stress but without the encephalopathy of heat stro:e.(2! Soldiers will be referred to an , after an episode of heat stro:e or e;ertional

rhabdomyolysis. 9f the Soldier has had full clinical recovery$ and particularly if acircumstantial contributing factor to the episode can be identified$ the , mayrecommend a trial of duty with a +3 (T! profile. The profile will restrict the Soldierfrom performing vigorous physical e;ercise for periods longer than 1 minutes.a;imal efforts$ such as the #+CT 2mile run are not permitted. 9f$ after 3 months$the Soldier has not manifested any heat intolerance$ the profile may be modified to+2(T! and normal unrestricted wor: permitted. a;imal e;ertion and significant heate;posure (such as wearing ission


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persistent cold sensitivity despite the +2 profile$ vascular or neuropathic symptoms$or disability due to tissue lost from cold in?ury.b. ,rench foot (nonfreeing cold injur$).(1! The definition of trench foot is the consequence of prolonged cold immersion ofan e;tremity. 9t is manifested by maceration of tissue and neurovascular in?ury.(2! Soldiers with residual symptoms or significant tissue loss after healing will be

referred to an ,.

c. Accidental h$pothermia.(1! The definition of accidental hypothermia is clinically significant depression of bodytemperature due to environmental cold e;posure.(2! Soldiers with significant symptoms of cold intolerance or a recurrence ofhypothermia after an episode ofaccidental hypothermia will be referred to an ,.;8a'le 3-1 I appears on pages 3(-3)

military fitness standard

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