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MEDICAL EXAMINATIONS AND STANDARDS

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Chapter 4
APPOINTMENT, ENLISTMENT, AND INDUCTION

Section 4A--Medical Standards for Appointment, Enlistment, and Induction.

4.1. References. DoDI 6130.4. establishes basic medical standards for enlistment, appointment, and induction into the Armed Forces of the United States according to the authority contained in Title 10, United States Code, Section 113. DoDI 6130.4 implements DoD Directive 6130.3, DoDI 6130.4 sets forth the medical conditions and physical defects that are causes for rejection for military service. These standards are not all inclusive and other diseases or defects can be cause for rejection based upon the medical judgment of the examining healthcare provider.
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Chapter 5
CONTINUED MILITARY SERVICE (RETENTION STANDARDS)

Section 5B--Medical Standards for Continued Military Service (Retention Standards)

5.3. Standards. While this is not an all-inclusive list of unfitting/disqualifying conditions, Airmen with conditions listed in this section require evaluation for continued military service. These standards and other diseases or defects not specifically listed can be cause for rejection based upon the medical judgment of the examining physician or reviewing authority. The retention standard also requires the member to be fit for mobility status IAW Chapter 13.... While elective surgery by itself is not necessarily disqualifying , intentional effects and unintended complications from elective surgery may render an individual unfit for worldwide duty. For elective surgery information, refer to AFI 44-102.

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5.3.1. Head.

5.3.2. Mouth, Nose, Pharynx, Larynx, and Trachea.

5.3.2.1. Larynx.

5.3.2.2. Nose, Pharynx, and Trachea.

5.3.3. Ears and Hearing.

5.3.3.1. Ears.

5.3.3.2. Hearing.

5.3.4. Dental.

5.3.5. Eyes and Vision.

5.3.6. Lungs and Chest Wall.

5.3.7. Heart and Vascular System.

5.3.7.1. Heart disease.

5.3.7.2. Vascular Disease.

5.3.8. Blood, Blood-Forming Tissue, and Immune System Diseases.

5.3.8.1. Anemia, symptomatic.

5.3.8.2. Leucopenia, chronic.

5.3.8.3. Hemolytic disease, chronic.

5.3.8.4. Polycythemia, symptomatic.

5.3.8.5. Purpura and other bleeding disorders.

5.3.8.6. Thromboembolic disease, except for acute, non-recurrent conditions..

5.3.8.7. Coagulopathies...

5.3.8.8. Thrombocytopenia or thrombocytosis.

5.3.8.9. Platelet dysfunctions.

5.3.8.10. Leukopenia (granulocytopenia).

5.3.8.11. All leukemias and other myeloproliferative disorders.

5.3.8.12. All lymphomas, including mycosis fungoides and Sezary syndrome.

5.3.8.13. Plasma cell dyscrasias.

5.3.8.14. Splenomegaly, chronic, inoperable.

5.3.8.15. Other such diseases when response to therapy is unsatisfactory or when therapy is prolonged or requires intense medical supervision such as use of anticoagulants or antiplatelet agents other than aspirin or persantine.

5.3.8.16. Immunodeficiency.

5.3.8.17. Sickle cell disease and heterozygous sickling disorders other than sickle cell trait are disqualifying.

5.3.8.18. Miscellaneous conditions such as porpyria, hemochromatosis, and amyloidosis.

5.3.9. Abdomen and Gastrointestinal System.

5.3.9.1. Esophageal.

5.3.9.2. Gastritis.

5.3.9.3. Hernia.

5.3.9.4. Ulcer.

5.3.9.5. Cirrhosis of the liver.

5.3.9.6. Hepatitis.

5.3.9.7. Amebic abscess residuals.

5.3.9.8. Pancreatitis, chronic.

5.3.9.9. Peritoneal adhesions.

5.3.9.10. Granulomatous enteritis or enterocolitis or Crohn's disease.

5.3.9.11. Ulcerative colitis.

5.3.9.12. Stricture of rectum.

5.3.9.13. Proctitis, chronic.

5.3.9.14. Anus.

5.3.9.15. Familial polyposis.

5.3.9.16. Gastrointestinal bypass or stomach stapling, or any other procedure to alter gastric volume for control of obesity.

5.3.10. Genitourinary System.

5.3.10.1. Genitourinary conditions.

5.3.10.2. Genitourinary and Gynecological Surgery.

5.3.11. Neurologic Disorders.

5.3.11.1. Amyotrophic lateral sclerosis.

5.3.11.2. Myelopathic muscular atrophy, including residuals of poliomyelitis.

5.3.11.3. Progressive muscular atrophy.

5.3.11.4. Chorea. Chronic and progressive.

5.3.11.5. Friedreich's ataxia.

5.3.11.6. Hepatolenticular degeneration.

5.3.11.7. Seizure disorder.

5.3.11.8. Migraine.

5.3.11.9. Multiple sclerosis.

5.3.11.10. Myasthenia gravis.

5.3.11.11. Transverse myelopathy.

5.3.11.12. Narcolepsy.

5.3.11.13. Paralysis agitans.

5.3.11.14. Peripheral nerve conditions...

5.3.11.15. Syringomyelia.

5.3.11.16. Other neurological conditions.

5.3.12. Axis I Diagnosis, and Other Mental Conditions... Certain Axis I conditions make an airman unfit for duty and subject to MEB... Axis II conditions can make a person unsuitable for further military service and subject to administrative separation...

5.3.12.1. Any psychotic episode other than those with a brief duration, good prognosis and clearly identifiable and reversible cause must meet MEB.

5.3.12.2. Mental conditions requiring MEB...

5.3.12.3. Certain psychiatric disorders render an individual unsuited for duty, rather than unfit, and are subject to administrative separation (IAW AFI 36-3208, para 5.11).

5.3.13. Extremities.

5.3.13.1. Upper extremities.

5.3.13.2. Lower Extremities.

5.3.14. Spine, Scapulae, Ribs, and Sacroiliac Joints.

5.3.14.1. Congenital anomalies presenting functional impairment of a degree to preclude the satisfactory performance of duty.

5.3.14.2. Spina bifida, with demonstrable signs and moderate symptoms of root or cord involvement.

5.3.14.3. Coxa vara, more than moderate with pain, deformity and arthritic changes.

5.3.14.4. Herniation of nucleus pulposus, when symptoms and associated objective findings are of such a degree as to require repeated hospitalization or frequent absences from duty.

5.3.14.5. Spondylolysis or spondylolisthesis, when symptoms and associated objective findings are of such a degree as to require repeated hospitalization or frequent absences from duty.

5.3.14.6. Deviation or curvature of spine...

5.3.15. Skin and Cellular Tissues.

5.3.15.1. Acne, severe, unresponsive to treatment, and interfering with the satisfactory performance of duty or wear of the uniform or use of military equipment.

5.3.15.2. Atopic dermatitis, severe or requiring frequent hospitalization.

5.3.15.3. Cysts and tumors.

5.3.15.4. Dermatitis herpetiformis, which fails to respond to therapy.

5.3.15.5. Eczema, chronic, regardless of type, when there is moderate involvement or when there are repeated exacerbations in spite of continuing treatment.

5.3.15.6. Elephantiasis or chronic lymphedema, not responsive to treatment.

5.3.15.7. Epidermolysis bullosa.

5.3.15.8. Erythema multiforme, severe, and chronic or recurrent.

5.3.15.9. Exfoliative dermatitis, chronic.

5.3.15.10. Fungus infections, superficial, if not responsive to therapy and resulting in frequent absences from duty.

5.3.15.11. Hidradenitis, suppurative, and folliculitis decalvans.

5.3.15.12. Hyperhidrosis of the hands or feet when severe or complicated by a dermatitis or infection, either fungal or bacterial, and not amenable to treatment.

5.3.15.13. Leukemia cutis and mycosis fungoides.

5.3.15.14. Lichen planus, generalized and not responsive to treatment.

5.3.15.15. Lupus erythematosus, chronic discoid variety with extensive involvement or when the condition does not respond to treatment.

5.3.15.16. Neurofibromatosis, if disfigurement is extensive or when associated with manifestation of other organ system involvement.

5.3.15.17. Pemphigus, not responsive to treatment and with moderate constitutional or systemic symptoms.

5.3.15.18. Psoriasis or parapsoriasis, extensive and not controlled by treatment or controllable only with potent cytotoxic agents.

5.3.15.19. Radiodermatitis, if resulting in malignant degeneration at a site not amenable to treatment.

5.3.15.20. Scars and keloids, so extensive they seriously interfere with the function of the body area or they interfere with proper fit and wear of military equipment.

5.3.15.21. Tuberculosis of the skin, if not responsive to therapy.

5.3.15.22. Ulcers of the skin, not responsive to treatment after an appropriate period of time or if they result in frequent absences from duty.

5.3.15.23. Urticaria, chronic, severe, and not amenable to treatment.

5.3.15.24. Other skin diseases, if chronic or of a nature that requires frequent medical care or interferes with the satisfactory performance of military duty.

5.3.16. Endocrine and Metabolic Conditions.

5.3.16.1. Acromegaly.

5.3.16.2. Adrenal hyperfunction, not responding to therapy.

5.3.16.3. Adrenal hypofunction.

5.3.16.4. Diabetes insipidus, requiring antidiuretic hormone replacement therapy.

5.3.16.5. Diabetes mellitus, diagnosed, including diet controlled and those requiring insulin or oral hypoglycemic drugs.

5.3.16.6. Gout, with frequent acute exacerbations in spite of therapy, or with severe bone, joint, or kidney damage.

5.3.16.7. Hyperinsulinism, when caused by a malignant tumor, or when the condition is not readily controlled.

5.3.16.8. Hyperparathyroidism, when residuals or complications such as renal or bony defects preclude satisfactory performance of military duty.

5.3.16.9. Hyperthyroidism, with severe symptoms that do not respond to treatment.

5.3.16.10. Hypoparathyroidism, with objective evidence and severe symptoms not controlled by maintenance therapy.

5.3.16.11. Osteomalacia, when residuals after therapy are of such degree or nature as to limit physical activity to a significant degree.

5.3.17. Systemic Disease.

5.3.17.1. HIV seropositivity, confirmed.

5.3.17.2. Amyloidosis, generalized.

5.3.17.3. Dermatomyositis polymyositis complex.

5.3.17.4. Leprosy, any type.

5.3.17.5. Lupus erythematosus, disseminated, chronic.

5.3.17.6. Myasthenia gravis.

5.3.17.7. Mycoses, active, not responsive to therapy, or requiring prolonged treatment, or when complicated by disqualifying residuals.

5.3.17.8. Panniculitis, relapsing, febrile, nodular.

5.3.17.9. Porphyria.

5.3.17.10. Sarcoidosis, progressive, with severe or multiple organ involvement and not responsive to therapy.

5.3.17.11. Scleroderma, generalized or of the linear type which seriously interferes with the function of an extremity or body area involved or progressive systemic sclerosis including CREST Syndrome...

5.3.17.12. Tuberculosis, generalized.

5.3.17.13. Other autoimmune diseases requiring immunomodulating medications.

5.3.18. Tumors and Malignant Diseases.

5.3.18.1. Malignant neoplasms (including carcinomas in-situ). Malignancies that respond to treatment may require follow-up care that impacts deployability. Malignant neoplasms that are unresponsive to therapy, or have residuals of treatment, are in themselves unfitting under other provisions of this chapter. All malignancies except those listed in 5.3.18.4. require MEB (ALC Fast Track package, at minimum).

5.3.18.2. Neoplastic conditions of lymphoid and blood-forming tissues that are unresponsive to therapy or when the residuals of treatment are in themselves unfitting under other provisions of this chapter.

5.3.18.3. Ganglion neuroma or meningeal fibroblastoma when the brain is involved.

5.3.18.4. Benign neoplasms, when the condition prevents the satisfactory performance of duty and the condition is not remediable or a remedial operation is refused.

5.3.19. Sexually Transmitted Diseases.

5.3.19.1. Symptomatic neurosyphilis, in any form.

5.3.19.2. Complications or residual of sexually transmitted disease, of such chronicity or degree of severity the individual is incapable of performing duty.

5.3.20. General and Miscellaneous Conditions and Defects.

5.3.20.1. The individual is precluded from a reasonable fulfillment of the purpose of his or her employment in the military service.

5.3.20.2. The individual's health or well-being would be compromised if he or she were to remain in the military service.

5.3.20.2. The individual's health or well-being would be compromised if he or she were to remain in the military service. This includes, but is not limited to: dependence on medications or other treatments requiring frequent clinical monitoring, special handling or severe dietary restrictions.

5.3.20.4. The individual has an EPTS defect or condition which may affect their retainability for continued military service and for which corrective surgery is contemplated.

5.3.20.5. The individual requires an exemption from any component of the fitness test exceeding one year.

5.3.20.6. The individual's travel by military air transportation is precluded for medical reasons.

5.3.20.7. The individual has an assignment canceled due to a medical condition.

5.3.20.8. The individual continues to have a mobility limiting condition 1 year after the defect became limiting and has not yet met an MEB or Assignment Limitation Code Fast Track (ALC-FT).

5.3.20.9. The individual has been hospitalized 90 calendar days and return to duty within 3 more months is not expected.

5.3.20.10. The individual refuses required medical, surgical, or dental treatment or diagnostic procedures and the condition renders them not qualified for retention.

5.3.20.11. The individual requires determination of his or her competency for pay purposes.

5.3.20.12. The individual has had a sanity determination required by the Manual for Courts-Martial and the psychiatric findings indicate the member's fitness for continued military service is questionable.

5.3.20.13. The individual has coexisting medical defects that are thought to be the primary cause of unacceptable behavior or unsatisfactory performance.

5.3.21. General Conditions That Interfere With Military Service (See AFI 36-3208, para 5.11 and AFI 36-3212).

5.3.21.1. Certain conditions render an individual unsuited for duty, rather than unfit, and are subject to administrative separation (IAW AFI 36-3208, para 5.11). Discharge may be considered when the physical or mental condition interferes with assignment or duty performance (as judged by the commander).

5.3.21.2. Common diagnoses, from AFI 36-3208 are summarized below for ease of standards application. The referenced AFI is the source instruction and must be consulted for details and specific cases.

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Chapter 1

GENERAL PROVISIONS
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1.3. Eligibility for Disability Evaluation. HQ AFPC/DPPD determines eligibility for disability processing. The mere presence of a physical defect or condition does not qualify a member for disability retirement or discharge. The physical defect or conditions must render the member unfit for duty. Disability evaluation begins only when examination, treatment, hospitalization, or substandard performance result in referral to a Medical Evaluation Board (MEB). ...

Comentario: "HQ AFPC/DPPD" significa "USAF Physical Disability Division" (la división de discapacidad física de la Air Force estadounidense).

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2.2. Role of the Medical Officers in the MEB Process.

2.2.1. The attending physician at the medical treatment facility (MTF) will:

2.2.1.1. Conduct the examination.

2.2.1.2. Prepare the documents required to identify medical defects or conditions that may disqualify the member for continued active duty (AD).

2.2.1.3. Refer the case to a MEB.

2.2.2. Medical officers on the MEB will:

2.2.2.1. Evaluate the documentation. Recommend the disposition of the MEB case and refer it to the approving authority as outlined in AFI 48-123.

2.3. Role of the Physical Evaluation Board Liaison Officer (PEBLO). The PEBLO will:

2.3.1. Ensure disability cases referred to the PEB are complete, accurate, and fully documented.

2.3.2. Counsel evaluees concerning their rights in the disability process (see Attachment 2).

2.3.3. Maintain coordination with the member, medical facility, MPF, and HQ AFPC/DPPD.

2.4. Role of Commander and Supervisor. Except in situations of critical illness or injury in which return to duty is not expected, a written statement from the member's immediate commanding officer or supervisor describing the impact of the members medical condition on normal military duties and ability to deploy or mobilize, as applicable, will be submitted with the documentation required by AFI 48-123.
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Chapter 3
THE PHYSICAL EVALUATION BOARD (PEB)

3.1. Purpose of PEBs. A PEB is a fact-finding body that investigates the nature, origin, degree of impairment, and probable permanence of the physical or mental defect or condition of any member whose case it evaluates. The disability system provides for two PEBs: an Informal PEB and a Formal PEB. If either board finds a member unfit, it recommends appropriate disposition based on the degree of impairment caused by the disabling condition, the date incurred, and the member's line of duty status. A PEB is not a statutory board, and there is no statute of limitations in considering evidence.
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Chapter 8
EVALUATION OF AIR RESERVE COMPONENT (ARC) MEMBERS

Section 8A- General Guidelines

8.1. Purpose. This chapter provides the guidelines for processing through the disability system certain ARC members who meet eligibility requirements in paragraph 8.2. Paragraph 8.3. gives an ineligibility guideline.
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8.2. Eligibility for Disability Processing. The following ARC members who have impairments which were incurred or aggravated in the line of duty are eligible for disability processing:

8.2.1. On active duty for 31 days or more while the member was entitled to basic pay.

8.2.2. After 23 Sep 96, on active duty for 31 days or more but not entitled to basic pay under 37 U.S.C. 502(B) due to authorized absence to participate in an educational program, or for an emergency purpose, as determined by the SAF or designated representative.

Comentario: "SAF" significa "Secretary of the Air Force" (el ministro de la Air Force).

8.2.3. On active duty for 30 days or less or on call to Inactive Duty Training (IDT).

Comentario: Inactive Duty Training significa una instrucción (drill).

8.2.3.1. While traveling directly to or from the place at which such duty is performed; and/or

8.2.3.2. After September 23, l996, any injury, illness, or disease incurred or aggravated while remaining overnight, between successive periods of IDT, at or in the vicinity of the site of the inactive duty training, if the site is outside reasonable commuting distance of the member's residence.

8.2.3.3. Additionally, members of the Ready Reserve with nonduty-related impairments pending separation for failure to meet physical standards. (See eligibility criteria in Section 8E).

8.3. Ineligibility for Disability Processing. ARC members are ineligible for disability processing if the member is pending an approved, unsuspended, punitive discharge or dismissal.