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AR 40-501 Standards of Medical Fitness (4 August 2011)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

Chapter 2
Physical Standards for Enlistment, Appointment, and Induction


Chapter 3
Medical Fitness Standards for Retention and Separation, Including Retirement

Comments: This is from the Table of Contents of this 139-page document. Chapter 3 describes the conditions that may qualify a Soldier for a discharge for Disability. To see the detailed description of each condition, click on the link to the regulation in the box above these comments.

Abdominal and gastrointestinal defects and diseases 3-5

Gastrointestinal and abdominal surgery 3-6

Blood and blood-forming tissue diseases 3-7

Dental diseases and abnormalities of the jaws 3-8

Ears 3-9

Hearing 3-10

Endocrine and metabolic disorders 3-11

Upper extremities 3-12

Lower extremities 3-13

Miscellaneous conditions of the extremities 3-14

Eyes 3-15

Vision 3-16

Genitourinary system 3-17

Genitourinary and gynecological surgery 3-18

Head 3-19

Neck 3-20

Heart 3-21

Vascular system 3-22

Miscellaneous cardiovascular conditions 3-23

Surgery and other invasive procedures involving the heart, pericardium, or vascular system 3-24

Trial of duty and profiling for cardiovascular conditions 3-25

Tuberculosis, pulmonary 3-26

Miscellaneous respiratory disorders 3-27

Surgery of the lungs 3-28

Mouth, esophagus, nose, pharynx, larynx, and trachea 3-29

Neurological disorders 3-30

Disorders with psychotic features 3-31

Mood disorders 3-32

Anxiety, somatoform, or dissociative disorders 3-33

Dementia and other cognitive disorders due to general medical condition 3-34

Personality, psychosexual conditions, transsexual, gender identity, exhibitionism, transvestism, voyeurism, other paraphilias, or factitious disorders; disorders of impulse control not elsewhere classified 3-35

Adjustment disorders 3-36

Eating disorders 3-37

Skin and cellular tissues 3-38

Spine, scapulae, ribs, and sacroiliac joints 3-39

Systemic diseases 3-40

General and miscellaneous conditions and defects 3-41

Malignant neoplasms 3-42

Benign neoplasms 3-43

Sexually transmitted diseases 3-44

Heat illness and injury 3-45

Cold injury 3-46
Chapter 5
Medical Fitness Standards for Miscellaneous Purposes
5-14. Medical fitness standards for deployment and certain geographical areas

Comments: Chapter 5, Section 5-14 describes conditions that may disqualify a soldier for deployment. To see the detailed description of each condition, click on the link to the regulation in the box above these comments.

f. ... The following medical conditions must be reviewed carefully by the clinician before making a recommendation as to whether the Soldier can deploy to duty in a combat zone (or austere isolated area where medical treatment may not be readily available).

(1) Diabetes requiring insulin. ...

(2) Diabetes requiring oral medication for control. ...

(3) Cardiovascular conditions...the Soldier should not be deployed with any of the following conditions-

(a) Hypertension not controlled with medication.

(b) Recent episodes necessitating emergency room visits or closely monitored follow-up care.

(c) Permanent pacemakers, implanted antitachycardia and automatic implantable cardiac defibrillator (AICD) devices, ...

(d) Conditions requiring anticoagulants.

(e) Bare metal coronary stents. ...

(f) Drug eluting coronary stents. ...

(g) Closure device for patent foramen ovale or atrial septal defect. ...

(h) Cardiac arrhythmias. ...

(i) Smallpox vaccine associated myocarditis. ...

(4) Neurological conditions. Review paragraph 3-30 for profile guidance and MEB/PEB processing criteria.

(a) Seizure disorders. ...

(b) Demyelinating conditions...

(5) Asthma...

(6) Sleep apnea...

(7) Musculoskeletal...

(8) Psychiatric...

(a) A psychiatric condition controlled by medication should not automatically lead to nondeployment. Soldiers with a psychiatric disorder in remission or whose residual symptoms do not impair duty performance may be  considered for deployment  duties.  The  commander  makes  the  ultimate  decision  to  deploy  after  consulting  with  the  treating  physician
or  other  privileged  provider.  The  availability,  accessibility,  and  practicality  of  a  course  of  treatment  or  continuation  of treatment  in  theater  or  austere  environment  should  be  consistent  with  clinical practice  standards.  If  there  are  any questions  on  the  safety  of  psychiatric  medication,  a  psychiatrist  must  be  consulted.

(b) Psychotic  and  bipolar  disorders  are  considered  disqualifying  for  deployment.

(c) Psychiatric  disorders  that  meet  medical  retention  standards  must  demonstrate  a  pattern  of  stability  without significant  symptoms  for  at  least  3  months  prior  to  deployment.

(d) Soldiers must demonstrate behavioral stability and minimal potential for deterioration or recurrence of symptoms in  a  deployed,  austere  environment,  to  the  extent  this  can  be  predicted.  The  potential  for  deterioration  must  be evaluated  considering  potential  environmental  demands  and  individual  vulnerabilities.

(e) Medication  disqualifying  for  deployment  include—
1. Antipsychotics used to control psychotic, bipolar, and chronic insomnia symptoms; lithium and anticonvulsants to control  bipolar  symptoms;
2. Medications  that  require  special  storage  considerations,  for  example,  refrigeration;
3. Medications  that  require  laboratory  monitoring  or  special  assessments,  including  lithium,  anticonvulsants,  and antipsychotics;
4. Medication  prescribed  within  3  months  prior  to  deployment  that  has  yet  to  demonstrate  efficacy  or  be  free  of significant  impairing  side  effects.

(f) Psychotropics clinically and operationally problematic during deployments include short half-life benzodiazepines and  stimulants.  Decisions  to  deploy  personnel  on  such  medications  should  be  balanced  with  necessity  for  such medication  in  order  to  effectively  function  in  a  deployed  setting,  susceptibility  to  withdrawal  symptoms,  ability  to
secure  and  procure  controlled  medications,  and  potential  for  medication  abuse.

(9) History of exertional heat injuries...

(10) Pregnancy. Pregnant Soldiers will not deploy.

(11) History of cancer. ...

(12) Chronic infectious diseases (HIV, Hepatitis B or C) ...

(13) Abnormal Cervical Cytology. ...

(14) Malignant hyperthermia. ...

(15) Contact lenses. ...

(16) Miscellaneous conditions. ...

(17) Medications. Soldiers taking medications should not automatically be disqualified for any duty assignment. Medications used for serious and/or complex medical conditions are not usually suitable for extended deployments. The medications on the list below are most likely to be used for serious and/or complex medical conditions that could likely
result  in  adverse  health  consequences...

(18) Dental. ...
Chapter 7
Physical Profiling

7-4. Temporary vs. permanent profiles
b.  Permanent   profiles. 

A  profile  is  considered  permanent  unless  a  modifier  of  “T” (temporary)  is  added.  A permanent  profile  may  only  be  awarded  or  changed  by  the  authority  designated  in  paragraph  7–6,  below.  All
permanent  “3”  and  “4”  profiles,  for  Soldiers  on  active  duty,  will  be  reviewed  by  an  MEB  physician  or  physician approval  authority.  An  MEB  physician  is  an  MTF  dedicated  subject  matter  expert  trained  to  perform  disability evaluations  per  guidelines  established  in  DODI  1332.38  (see  AR  40–400  for  MEB  process).  The  MEB  physician  will
assist  the  MTF  commander  in  educating  profiling  officers  on  current  physical  profiling  regulation  and  policy  guidance.

(1)   If  the  profile  is  permanent,  the  profiling  officer  must  assess  if  the  Soldier  meets  the  medical  retention  standards of  chapter  3.  Those  Soldiers  on  active  duty  who  do  not  meet  the  medical  retention  standards  must  be  referred  to  an MEB  as  per  chapter  3.  (See  paras  9–10  and  10–25,  respectively,  for  disposition  of  USAR  and  ARNG  Soldiers  not  on active  duty  who  do  not  meet  medical  retention  standards.)

(2)  Soldiers who have one or more condition(s) that do not meet medical retention standards are referred to a MEB /PEB  after  attaining  the  Medical  Retention  Determination  Point  (MRDP).  The  MRDP  is  when  the  Soldier’s  progress appears  to  have  medically  stabilized;  the  course  of  further  recovery  is  relatively  predictable;  and  where  it  can  be reasonably  determined  that  the  Soldier  is  most  likely  not  capable  of  performing  the  duties  required  of  his  MOS,  grade, or  rank.  This  MRDP  and  referral  to  a  MEB/PEB  will  be  made  within  1  year  of  being  diagnosed  with  a  medical condition(s)  that  does  not  appear  to  meet  medical  retention  standards,  but  the  referral  may  be  earlier  if  the  medical provider  determines  that  the  Soldier  will  not  be  capable  of  returning  to  duty  within  1  year.  The  MEB  physician  or physician  approval  authority  will  review  all  MEB  referrals  to  insure  that  MRDP  has  been  achieved  prior  to  initiating  a
medical  evaluation  board;  coordinate  inappropriate  MEB  referrals  back  through  the  profiling  officer  for  appropriate disposition;  and  assist  physician  approving  authorities  in  reconciling  profiling  officer’s  questions  and  concerns  about MRDP  timing  and  MMRB  versus  MEB  referrals.  The  MEB  physician  or  physician  approval  authority  will  review  all profiles  to  confirm  that  the  MRDP  has  been  reached  before  obtaining  the  approving  authority  signature.

(3)  Those Soldiers (active duty and USAR/ARNG) who meet retention standards but have at least a 3 or 4 PULHES serial  will  be  referred  to  a  Medical  MOS  Retention  Board  (MMRB)  in  accordance  with  AR  600–60,  unless  waived  by the  MMRB  convening  authority.

(4)  Permanent profiles may be amended (following the correct procedure) at any time if clinically indicated and will automatically  be  reviewed  and  verified  by  the  privileged  provider  at  the  time  of  a  Soldier’s  periodic  health  assessment or  other  medical  examination.

(5)  The  Soldier’s  commander  may  also  request  a  review  of  a  permanent  profile,  in  accordance  with  paragraph 7–12b.

c.  Temporary  profiles. 

Soldiers  receiving  medical  or  surgical  care  or  recovering  from  illness,  injury,  or  surgery,  will be  managed  with  temporary  physical  profiles  until  they  reach  the  point  in  their  evaluation,  recovery,  or  rehabilitation where  the  profiling  officer  determines  that  MRDP  has  been  achieved  but  no  longer  than  12  months.  A  temporary
profile  is  given  if  the  condition  is  considered  temporary,  the  correction  or  treatment  of  the  condition  is  medically advisable,  and  correction  usually  will  result  in  a  higher  physical  capacity.  Soldiers  on  active  duty  and  RC  Soldiers  not on  active  duty  with  a  temporary  profile  will  be  medically  evaluated  at  least  once  every  3  months  at  which  time  the profile  may  be  extended  for  a  maximum  of  6  months  from  the  initial  profile  start  date  by  the  profiling  officer.

(1)   Temporary  profiles  exceeding  6  months  duration,  for  the  same  medical  condition,  will  be  referred  to  a  specialist (for  that  medical  condition)  for  management  and  consideration  for  one  of  the  following  actions:

(a) Continuation  of  a  temporary  profile  for  a  maximum  of  12  months  from  the  initial  profile  start  date;
(b) Change  the  temporary  profile  to  a  permanent  profile;
(c) Determination of whether the Soldier meets the medical retention standards of chapter 3 and, if not, referral to an

(2)   The  profiling  officer  must  review  previous  profiles  before  making  a  decision  to  extend  a  temporary  profile  and refer  the  Soldier  to  a  medical  specialist  for  management  if  the  temporary  profile  has  been  in  effect  for  6  months.  Any extension  of  a  temporary  profile  must  be  recorded  on  DA  Form  3349,  and  if  renewed,  item  8  on  the  DA  Form  3349 will  contain  the  following  statement:  "This  temporary  profile  is  an  extension  of  a  temporary  profile  first  issued  on (date)."

(3)  Temporary profiles will specify an expiration date. If no date is specified, the profile will automatically expire at the  end  of  30  days  from  issuance  of  the  profile.  In  no  case  will  Soldiers  carry  a  temporary  profile  that  has  been extended  for  more  than  12  months.  If  a  profile  is  needed  beyond  the  12  months,  the  temporary  profile  will  be  changed to  a  permanent  profile.  Exceptions  to  the  12-month  temporary  physical  profile  restriction  must  be  approved  by  the
medical  treatment  facility  (MTF)  commander  or  their  designated  senior  physician  approval  authority  (often  the  deputy commander  for  clinical  services).

Chapter 10
Army National Guard

10-15. Duty restrictions

a. Any recommendation for restricted activity that has been made by a private physician will be reported in writing, before performing any duty.

b. It is the individual Soldier's responsibility to report any medical problems immediately to the chain of command and to comply with medical restrictions. Commanders will honor the private physician's recommendations until the Soldier is evaluated by a military provider, and a recommended course of action is determined by a profiling officer (see para 7-6).

c. Soldiers and commanders will abide by the medical restrictions and limitations documented on any profile (DA Form 3349) issued.